10 PURCHASE ST - BUILDING INSPECTION (3) t
The Commonwealth of Massachusetts
► Board of Building Regulations and Standards NIVNICIP
Massachusetts State Building Code, 780 C'MR. 7 edition ( tit
Building Permit Application To Construct. Repair, Renovate Or Demolish a Rci me!Jamearr
Our. or Tit Dwelling
This Section For Official Use Only
Building Permit No er Date Applied: t
Signature: -
Building Cununissioner/Inspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Proper Address: 1.2:assessors Map & Parcel Numbers
/ = ST
1.la Is this an accepted street?yes t� no Map Number Parcel Number
1.3 Zoning Information: L4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tt) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Sopply: (M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
/ Zone: _ Outside Flood Zone'?
Public Ca"",
� Private❑ Check if yes❑ Municipal Q-10o site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP[
2. wne t LRe � �
lD
am t tt Address for Service:
�'i7iY 7cf(/2�1D _
Sign, ure - Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairsls) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. O Number of Units_ Other peciry:
Brief Description of Proposed Work': / OAr'rw
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 3 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
3. Electrical $ ❑Total Project Cost'(Item 6) x multiplier x
3. Plumbing3
2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Total All Fees:
Suppression)
Check No. Check Amount: Cash Amount:__
b. Total Project Cost: $ _ ❑Paid in Full ❑Outstanding Balance Due:
o �
Y r SECTION5: CONSTRUCTION SERVICES
5.1 L' ensed Construction Supervisor (CSL)
1 L�ILI nA l- [/vtNf� License Numher IS.vpuawm Uatt
Namcul'CS Ilul er
List CSL Type Isce below)
T• Dcsoi (ion
\ld
C Unrestncicd lu In ii,(N)U Cu. 1'l.i
- - Restricted l&2 Family D%%dline
Sign ure �I Masonry Only -
�tn D RC Residential Ruutin•Co%crm¢
Telephone WS Residential \Vmdoa and Sulur_• _—
SF Residential Sobd Fucl Buminc :y >>h:mie Inst.dlaunn
D - Revdenlial Demolition
5.2 RV tt red home I uv}ement Contractor(HIC) � ��&ro 1 --
HIC 1 t mpan auto or HIC RegjstranIN a AAA
. 0f4"1 e7 Registration Number
r g7�7`{y28JO pirat n Date
Sig 'cure 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 lu provide
this affidavit will result in the denial of the Issuance of ilding 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. ,i
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1, Kn , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
-
behN f.
Print e
Signature o gent Datgf
(Signed under the i2ains and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(nut 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 and
Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations 110.116 and 110.115. respectively.
When substantial work is planned, provide the information below:
Total flours area(Sq. FL) (including garage, finished basement/attics, decks or porcht
Gross living area fSq. Ft.) Habitable room count _
Number of fireplaces - Number of bedrooms _
Number of bathrooms Number of half/baths
Type of heating sysrem Number of decks/porches
Type of cooling system Enclosed Open _ _—_-
3. "Total Project Square Footage' may be substituted for "Total Project Cost'
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
aa�taaatavnuaoou. --
110 WAaatw'tWSTsta'r a satOb MM&jU7atWM0lW0
Tess 9DW4ti*U a PAx NW404 at
Workers Compensation Inswaiue A!![dav* BuGderWCo
AnoBeaud ietsrasatloo Pfesaw Mwr i
Name
Address: '
City/$teta/Z1p now
An yea u dmpleyer!Cheer the appropriate has
1.❑ I sm a employer with 4, [31 am a groom cons actor and I Type of �
ampiayeu on bow hired the suh•ooatmicams 6' ❑New canstroedon
2-❑ I an a sob prop law at proms► listed as the aoaahed shoat,t 7. ❑Rmodaliep
ship and have no amployeaa TLess wb•aomsero,e haw !L a Damolitlaat
Walking he me is soy capacity. wotlrom'camp iaatwann y, ❑g addbtos
(No amp imoss ee 3. ❑We am a ompomdm and in
m ) neurons have exmeisod their 10.13>3leeaieal tepa;m or addbiass
3. am a homeowos& tg an wroth risk of a numpt(ee par MOL I I.(Q PhtmbbS or addidooa
workers,hammop a �comp 1mp Ib workers' w
'
000Abuttsaoa 13.
•AM spedons dot 0wha tat tt ant atr ar at dt aatlstaipealedq iieakwP
tta.ra.ats w wants tW amdtea °0��1011 twlay baatilo.
lca.e.aa.dr sort W hens am aa.eea�ad�OYd.Mr aha�it er rant�d sr♦aiwaawitr aaavtetwa nottinb•es noise ta/ery.m�
slwy tag aaer air aaa dtatt anent'aaq,perry isi nrtloa
few aw rwylaya aYd bOrorldat worRaa'eowpowrwdow tw+wnwcdJ�nqr rwP/oYt4 Bo�tr 6 rJbyolYgr salJai sty
lalfeaswckws,
Insurance Company Namr
Policy N a Sei6ita Lis N: Fxpirallon Date
Job Site Address Ch'S
Attach a copy of the workers'compensation policy doclanden pap(showing the Policy amber and expiration daft)6
Failure to seam coveap as rgWb d under Section 23A of MOL a. 132 cas lad 0 the imposition of aiminal pansltia of a
firer up to S 1,300.00 and/or one impriwommR as well as civil penalties in the form of s STOP WORK ORDER and a Age
of up to 3250.00 a day against the violuw. ised that a copy of this statement may be forwarded to the Of @ of
Investigations of a 0 fo ap v 'Ratios
It do hers oral lOrr/wq'rArthelafffmatlsw Provided oboes a"and eorreet
Phone IN Cj' yC' 7Z7
F
e on#)& De Mat wdh fw thk area,to be campk t/by dip a M"oQleAd
wsthorlty(circle oas):
f Health L Building Department 3.Cltyfrowo Clerk t Electrical Inspector I Plumbing Inspector
Contact Person: phone w
CITY OF SALEM
si PUBLIC PROPRERTY
DEPARTMENT
F.Atltrhl.hy PKIA:0I 1.
\l.tsctt 120 WAMUNGCONSIREET •SALFM, 'V1.%ii.\(:HLSLr1S5 197t
Tr•.t:978-74i 9395 ♦F,--X:978-74C9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined byMGL c
111, S 150A.
The debris will be transported by:
_0-VL _
Itne reot'Itaultr)
Th bris will be disposed of in
c51
(name of f ac it ity
/ . ,r • ntit a r' ant —
MORTGAGE INSPECTION
BAY STATE SURVEYING ASSOCIATES INC. JOB#
100 CUMMINGS CENTER, SUITE#316J,BEVERLY,MA., 01915
SALEM /t'!A• NOTES:
LOCATION :.......... .........a......,......}..............• t)This Is a mortgage Inspection survey and not an
,r Instrument survey,therefore this plot plan is for
SCALE : 1" _ DATE :.......:.................5..... mortgage inspection purposes only.It is NOT to
be used to establish boundaries or for the
REFERENCE . :.. 3foS� �� ��?9••• construction of any type of improvements.
2)This survey is based on survey marks of others.
E5 .�..... .. p!• �%....... 3)Bushes,shrubs,fences and tree Tines do not
................................................ necessarily indicate property lines.
4)Whenever an offset is 1'+.or less;an instrument
TC: .: (2 5 ,GAGE ,viv�TG�4� Gem survey is recommended to determine property
............................._ ..................
The location of the buildings)as shown,either lines;and arty possible encroachments.
complied with the local zoning setbacks at the time of 5)ORasts shown are approximate,and are to be
construction or is exempt from violation enforcement used only for the determination of zoning,Not to
action under Mass.G.L Title VIl Chapter 40A Section 7 be used to establish property lines.
tl)In my professional opinion the building(s)are not
located in the special flood hazard zone,as
deflned.bv H.U.D.MAP#
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SN IP THE SUKVEYORs SEAL I5 NOT
EMBOSSED.THE A ,T10uRcHAs
THE CERrIMCATION CONTAINED ON
THIS DOCUMENT SHALL NOT APPLY
TOCOPIES
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FLOORPLAN
Borrower:CUNHA . File No.: 5FTM51214
Property Address:10 PURCHASE STREET Case No.:
City:SALEM - State:MA Zip:01970
Lender:FIRST CALL MORTGAGE COMPANY
54.0'
c
emmom C Betlmom L vft
0 0
C 0inkp area
ic¢nen 1lY
27.0' 22.0'
Sketeb by Apex V WindmsTM
AREA CALCULATIONS SUMMARY It LIVING AREA BREAKDOWN y
Co. p .Hptlon M.. Toteb Breakdown Sbbtbt6la
Glhl FSist Fleei 1772.00 2772.00 FSiat Floe.
31.0 54.0 1674.00
2.0 . 27.0 54.00
2.0 x 22.0 44.00 {
y
g
A
4
t
TOTAL LIVABLE (rounded) 1772 1n 3 Areas Total(rounded) 1772 '!