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2 ROSEDALE AVE - BUILDING INSPECTION (2) \�1 i The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF �7f Massachusetts State Building Code, 730 CMR RevisedSALEtvl 1p/l Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Divelling This Sect'ionF' • fticial tiOnl . Building Permit Number: . Date A AA L rs- Building Otfic l(Print Name) Date SECTIOt I:SI A 7t RAlATION 1.1 Prop rty Addres : Assessors bfap&Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions. Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.4 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ' 1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1 1.3 Sewage Disposal System: Public❑ Private❑' Zone: _ Outside Flood Zone?Cheek if ye3G Municipal❑ On site disposal system ❑ S9CTION2;' PROPERTV'OWNERSftH+ 1: 2.1 Ownert of Rec d: AV®rmz>x� �� S,p © O Name(Print) City,State,ZIP Ave, J7g729/33B 1SRogERtS/a�Nseedv No,and Street Telephone Emat ddress SECTION 3: DESCRIPTION OF. PROPOSED WORW'(check ail that apply) New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) DiAddition01 Demolition ❑ Accessory Bldg. Cl NumberofUnits--L_ I Other ❑ Specify: Brief Description of Proposed Norka: �/'Y/1♦'Aw ./➢r /D .d JNn n y 0 A ell- SECTION 4: ESTINIATED CONSTRUCTION COSTS- itemrE,ti,,nts: OfRcial Usti Only: iols 1. BuildingL Building PermitFee:S` Indicate how fee is determined: 2. Electrical ❑Standard.CiVrown•Application Fee .` J. Plumbing ❑'rotat Project Cost'(Ilem.6)x multiplier x �. Other Pees: S 1. •M.Chanird (IList: (F 'utal All Fees:SCheck�lo. _CheCk r\uwunt•. __Gush f ❑ I'Ad ill Fall Cl t)utstandinq II_dance I)na; SECTION 5: CoNS'rRUCt'ION SERVICES , 5.1 Construction Supervisor License(CSI.) Lieense Number Expiration Data Name of CSL I folder List CSL Type(sce below) rype Description No. and Street U Unrestricted(Buildings 211 to 435,000 cu. ft.) R Restricted I&2 Faintly Dwelliu City/rown, State,ZIP �l Mason ry RC Roofing Cuverin WS I,Vindow and Sidin 4 SF Solid Fuel Burning Appliances ( Insulation D Demolition l'cle hung Email uddrcs9 5.2 Registered Home Improvement Contractor(IIIC) HIC Registration Number Expiration Date I I IC Company Name or I IIC Registrant Name Email address No.and Street City/Town, State 'LIP rele one SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. g 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 ..........0 ,No ❑' SECTION 7a: OWNER AUTHORIZATION TO DE 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. Date Print Uwtter's Nmne(Electronic Signature) SECTION 7b: OWNEW 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 i t this�ayptplication i and �acc�uratcAo'the best of my knowledge and understanding. _ Print Uwner';or Authurired:\gent's Nano(Electronic Signature) Date NOTES: I. :1n Owner who ubnins a building permit to do hisiher own work,or an owner who hires an unregistered contractor (nut registered in the Hume [in rovement Contractor(HIC) Program), will 1 have access to the arbitration program or guaranty fund under M.U.L. c. 142A. Other important information on the HIC Program can be found at w t�t� max:.cuv%oca lit formation on the Construction Supervisor 1.icense can be found at ww\Y\v ass., ILt 2. 1Vhen sub.;tantinl work is planned,provide the information below: Total flour area(sq. It.) ___ _(inducting garage, finished hasemenVattics,decks or porch) Gros; liviov,:tea 0+ it.) _-- Number o room count — Number of tireplaecs._.---------- Numbentf be ---------__.____-- Number of bathroouh .----_---_--_-- Numberafhaltbaths _-_--.—_--- f.peofh.'.uiu ;y,teut _-. _-- Nuuther'it,Ixk..Jpor.hex _-- --_---- y.teul Euclosetl i Ipcli 1'tpcotcanliti� ; ___ ---. he 4111,titlllJd L,I' ..I.q.d i'10ieLt .M r CITY OF S.1LZNII ,bL155:\CHL'SETTS 1 Ql tLO�fG DEPAATS(E,VT \�y��+ l!0 CV.13H6VCTOV STREfiT, 3"FLOOZ TEL (979) 141.9595 x1moRQLSY OCUSCOLL F%A(973) 7•w-9344 AMA TEt0161iST.F1EAtig ❑CiECTOR OF PI:Ot:1C PROPEa7y/g��pLyG GOSL�tf55lO.V ER Construction Debris D13P033i AftIduvit (required for all dcmalitiun and renuvation work) In accordance with tha sixdt edition ofthe Stara Building Coda, I L3 Debris, :uid thepravisions at tMGL c 40, S 94; 790 Ct1fR section l ©wilding Permit M this is issued with the condition that the debris resulting from I 1, s l5o,�.1 wu shall be dispuscd of in a properly licensed wasta disposal racility as detincd by,tifGL a The debris will be tr w3partcd by: (name ut'hauler), The debri s will be dispo,ed Orin �v� (name of t�cdilY) I� tti � ( rahl�) iprantte,�(parmit applia.mt CITY OF SM-EN PUBLIC PROPERTY DEPARTMENT u.urYfr O.a'lYL VA°Oe t b v�.r.r.,ssr stsaar•!n►++a M�e�ow r:rn Ot•'0 rti rs.r+sss•s.r..a,r.ar+e.ew HOMEOWNER LICLNSB EXE.MFTIOV Pfease Mat Date 7-JS-J3 n job L.acadas z P2ose-r�,�-P . 4v e, Home Owner Address HomsOwnsrTelephone 975�-72R-/.�3 &' Present Mailing Address dI v G he current exemption of"Homeowners"was extended to include owner-occupied dweULngs of two Units or few and to allow such homeowners to engsgs an individual for hire who does not posse a Ueense`provided that the owner acts err supervisor. DEFINMON OF HOM80WNElt Person(s) who owns a parcel of Land on which he/she resides or Intends to resider on which there is, or is intended to bur a one or two rawly dwelling, attached or detached structured accessory to,such use and/or farm structurea A person who comtructs more thaw ant home in a two year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building OQleial,on a form acceptable to the Building Official, that he/shd be responsible for all such worst performed under the Building Permit. The undersigned "homeowner"asnuaes responsibility for compliance with the State Building Code and other applicable bylaws and regulations The undenigned "homeowner'certifies that hdshe understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she .vill comply with said procedures and. equirements HOMEOWNERS SIG; ATUBE APPROVAL OF SU/LONG NSPECTOR See other lids for state code NORTHSHORE `•_� i EDidCA3ION Norman Rober. CONS SORTIIIM Director of,Facilites &T,anspor ation 112 3ohier Road/' X , �' �� Be- Y MA 01�15..- `�� tel 978.232.9755 x1257 fax 978.232.9449 / nroberts@nsedu.org website nsedu.org '' DuPont Refrigerants .0 NPAMCE PAC Zbpe/®ssd r ' moeAilcoii OONN SP RL _ SON m.m;bn:.olxh.n }�, L rms ec eh I `�Se®fsstt�e2 CONTR REFRIGERATION SUPPLY CORP. 1110 xma rn.r .,.,.xmu • �"bDINE ArtELECTRICNI QUOTATION TO: DATE ,BOB ATTN. of: QTY: WE ARE PLEASED TO QUOTE ON THE FOLLOW11NG i ' 6[ 1 p �`q f •� L y tjlk ! s l �4J�gisc, I I F6 g� 44 S I a I � r f hilt� s' -,--.— i f0aT i s-- .�,+,-. 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