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73 PIERPONT ST - BUILDING INSPECTION Tr,�)- IIA - 1 -12 y� 0%o clot %19 The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date�xi!ied: 4"'. �. _ Building Official(Print Name) Signature Date (� SECTION 1: SITE INFORMATION Ql� 1.1 Proe���eyy Address: 1.2 Assessors Map& Parcel Numbers ! ! L la Is this an accepted street? yes y no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: so rn Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) t„► — ;v' 1.5 Building Setbacks(ft) Z�rt Front Yard Side Yards Rear Yaq r rn Required Provided Required Provided Required Provi 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage D'sposal S em: N /' O Zone: _ Outside Flood Zone? M// Public$l Private❑ Check if yes❑ Municipal On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' J.s(j?wner'of$eF�d. Name(Pr'p� City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Worltz: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $G BOO. ❑ Paid in Full ❑ Outstanding Balance Due: u /0 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No. and Street Type Description U Unrestricted(Buildings up to 35,000 cu. ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner or Authorized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 10/3d/2014 Unofficial Property Record Card Unofficial Property Record Card - Salem, MA General Property Data Parcel ID 10-0077.0 Account Number Prior Parcel ID 41 — Property Owner GARD GLEN P Property Location 73 PIERPONT STREET GARD CHERYL ANN Property Use One Family Mailing Address 73 PIERPONT STREET Most Recent Sale Date 4/28/1995 Legal Reference 13001-39 City SALEM Grantor SWINIUCH MARGARETTE A Mailing State MA Zip 01970 Sale Price 135,500 ParcelZoning R1 Land Area 0.125 acres Current Property Assessment Card 1 Value Building Value 167,100 Xtra Features 5,000 Land Value 97,100 Total Value 269,200 Value Building Description Building Style Old Style Foundation Type Brick/Stone Flooring Type Hardwood #of Living Units 1 Frame Type Wood Basement Floor Concrete Year Built 1905 Roof Structure Gable Heating Type Forced H/W Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Gas Building Condition Good Siding Vinyl Air Conditioning 0% Finished Area(SF)1702 Interior Walls Plaster #of Bsmt Garages 0 Number Rooms 6 #of Bedrooms 3 #of Full Baths 1 #of 314 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 0.125 acres of land mainly classified as One Family with a(n)Old Style style building,bulk about 1905,having Vinyl exterior and Asphalt Shgl roof cover,with 1 unit ),6 room ),3 beciroom(s),1 bath(s),0 half bath(s). Property Images Frt F 17 i , 3 � v Disclaimer:This information is believed to be correct but is subject to change and is not warranteed. hfp://salem.patriotproperties.mm/RecordCard.asp 1/1 ' QTY OF SALEM MASSAC:HUSETTS BUILDING DEPARTMENT 120 WASFUNGTON STREET 31D FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KINIBERLEY DRISCOLL MAYOR Tf io&As ST.PIE RRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: / Date /e -,-76 -1-7` Job LocationOI�G/eZ� Q� Home Owner Address ✓ C� ✓ Present Mailing Address a� I� The current exemption of"Homeowners" was extended to include owner-occupied dwellings of two Units or less and to allow such homeowners to engage an individual for hire that does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one- or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she be responsible for all such work performed under the Building Permit. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeowner" certifies that he/she understand the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with such procedures and requirements. HOMEOWNER'S SIGNATU APPROVAL OF BUILDING INSPECTOR "