28 PRESCOTT ST - BUILDING INSPECTION t
The Commonwealth of Massachusetts
►a Board of Building Regulations and Standards
t V Massachusetts State Building Code, 780 CMR, T°edition
Building Permit Application To Construe Repa'r, Renovate Or Demolish]a :*:W0:ftWWft
One-or rtv a nilp Due! g Amos
Th ection For O cial 'e Only
Building Permit Nu ber: APP ed:
Signature:
Budding Comm ssioner/I for of Bu Date
SECTION I: ITE INFORMATION
1.1 Proitert Address: 1.2 Assessors Map& Parcel Numbers
1.Is Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
fly- I i'IbSrJr(AZ-t9/.t&i- 12-7'5-
Zoning District Proposed Use [i ,Lot Area(sq R) Frontage(n)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood one? Municipal IOn site disposal system ❑
Pubiicx_ Private❑ Check if e
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: S, /Ll{�—
Ira m 1 Ia�r.1Q(&gYl o GQ �$ �YI —
(Print) OAA1.AAn, L1 Address for Service:
q70 �bzS gIGZ,
ignatur Telephone
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied Repairs(s) &,I Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units I Other ❑ Specify:
Brief Description of Proposed Work': KIEE!� Yfl'e-VL -greo-P A9.A Z�� fir' f�11
A—r 1, 1a S fi LAB r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
NE�sttmated Official Use Only
Item 1. Building 1. Building Permit Fee: S Indicate how fee is determined:O Standard City/Town Application Fee
2. Electrical ❑Total Project Cost'(Item 6)x multiplier x
J. Plumbing 2. OtherFees: S
List:4. Mechanical (HVAC) v I
5. Mechanical (Fire S Total All Fees: S
Su ression
Check No. _Check Amount: Cash Amount:
6. Total Project Cost: S 0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
r
5.1 Licensed Construction Supervisor(CSL) '
a - License Number Expiration Date
N.groc of"CSL- Helder List CSL Type(see below)
Address
T Description
U I Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 Family Dwellm
Signature ,M Masonry Only
RC Residential Roofing Covering
Telephone WS Rrsidtnnal Window and Siding
SF Residential Solid Fuel Butming Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature 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.
4ps
i nature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
Cf. �.-2_ , as Owner or Authorized Agent hereby declare
statements and info ti n t the f goi g application are true and accurate, to the best of my knowledge and
ehalf.
t Nam
ature of Owner or Authorized Agent Date
(Signed under the pains and penalties of fir
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 W have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and I 10.11S, respectively.
2. When substantial work is planned, provide the information below
Total floors 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
7. "Total Project Square Footage" may be substituted for 'Total Project Cost"
CITY OF SAL EIM
14D PUBLIC PROPERTY
DEPARTMENT
K1 L
.MAW* 1301 aMT4CWW STIEn•SALM NASSAAlLSKM 019'0
TEL V..e-73S•9S"• F.ut 978-740.964
HOMEOWNER LICENSE EXE.MMON
Plow met
Date l&
Job Location 7;�e B22�- Mrs
Home Ownw Address <7-0 �( �(—
Home Owner Telephone 4/t 1?10,51
Preseat Mailing Address_ rW
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 who,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 "homeownee'certifies that he/she understands the City of Salem
Building Department minimum inspection procedures an requirem is and that he/she
will comply with said procedures and requiremen .
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
PLAN
SCALE: 1 "= 1 '-0"
SHEET 1A OF 3
3'
- - - - - - 11 „
8"D FOOTING
TTII = � � � _
4"X1 "
- - - e. DESCKING,
TYP
- - - - - - � I I I I I I I JOIST, TYP 32'-7 >
x I II II I II
II II II II 1 '-9"
- - - - - 7c.-
�J L - L j h_- LEDGER
Xl
rr
PLAN
2"X4" SCALE: 1 "= 1 '-0"
RAILING, TYP SHEET 1 .OF 3
1 „X9„ 3'-8" 4»
4"X4" POST,
611 91, TREAD, TYP 3' TYP
4"
9„
- � -- - - - -- - --� � ---- �-- 11 '�-I---- 8"D FOOTING
4"X1 "
DECKING,
t TYP
JOIST, TYP „
2'-7
i t E I I_I I
I I I I 1 '-9"
- i - - - - - - LEDGER
� - -- - -- - -- - - - - - - - - -IL- - -
2.. SECTION A-A1-
SCALE: 1 "= 1 '-0"
SHEET 2 OF 3
2"X4" RAILING, TOP AND
4» BOTTOM, TYP
3 1 "X1 " RAILING PANEL,
TYP
2"X6 LEDGER
2"X6" JOIST WITH METAL
HANGERS, TYP
6„ I 6"
BEAM: TWO 2"X6"S
2 1 '- 11 " I 111
I I FOR LATTICE PANELS,
SEE BELOW
I
L J
a1 a
.T CONCRETE SONATUBE
FOOTING
.a
4' °
.o
C
Qa LATTICE PANELS A & B
a
* 8" *