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34 SABLE RD - BUILDING INSPECTION (2) VQI- Building The Commonwealth ofMassachusetts CITY Board ofBuilding Regulations and Standards OF SALEM Massachusetts State Building Code, 780 CMR, T°cdi[ionRe ised dwmurs Permit Application fo Construct, Repair, Renovate Or Demolish a 1. =uux Une-or Tu•o-Ffnnily Dwelling his Section For Olficial Use Onl :13uiI,d:ingPe;rmitpmbcr. ale Applied:g ss o /1 •tor of Buildings Date SECTION 1:SITE INFORMATION I.I Property Address: 1.2 Assessors Map& Parcel Numbers 3y sA-3�>s Ma Number Parcel Number I.la Is this an accepte d street?yes no_ M P 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Imposed Use Lot Area(sy It) Frontage(tt) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided ReyuircJ Provided Required Provided 1.6 Water Supply:(M.G.I.c.40.§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipgl�kOn site disposal system ❑ Publy'e� Private❑ Check if ZesO SECTlON2: PROPERTY OWNERSHIP 2. O) Ef Record:J ��Zv L O -3(f 5A-GL 1_ Z2- 5,,Vz---t 1 Nume(Print) Address for Service: 752/S:G / 7a� Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied I,( Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': ger;i� 5;O'"/� c'Lp L?JO e= SECTION J: ESTIMATED CONSTRUCTION COSTS Estimated Costs: OMcial Use Only Item Labor and Materials 1. Building S 3©n B 1. Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S f 4. Mechanical (IIVAC) S List: —w( ) 5. Mechanical (Fire 5 Total All Fees:S Su ression Check No. Check Amount: Cash Amount: 6. Total Project Cost: S 13 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) I.icense Nurnber Fxpiratiun Date Name W CSI.-I loldcr I.ist CSL'I')pe(see below) Address fs pe I Description U I Unrestricted(tip to 35.000 Cu.Ft. Signature It I Restricted 1&2 Family Dwelling M I Masonry Only RC' Residential Routing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation 1) 1 Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) I IIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 2SC(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 OW�N/y�ER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. " ' �� wG as Owner of the subject property hereby authorize to act on my behalf, in all matters relativ w out ed by this building permit-application. Date /2� I SECTION 7b: OWNER(OR AUTHORIZED AGENT DECLARATION 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 behalf. Print Name Signature of Owneror AuthorWil Agent Date (Signed under the pains and penalties of nu 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 no have access to the arbitration program or guaranty fund under M.G.L. c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and 110.115, respectively. 2 When substantial work is planned,provide the information below: Total Il mrs area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. FL) Ilabitable room count .� Number of fireplaces 0 Number of bedrooms 3 Numberol'bathrooms / Number ofhalf/baths o Type of heating system Number of decks/porches / Type of cooling system p (inclosed Open K 3. "Total Project Square Footage"may he substituted for"Total Project Cost" CITY OF SALE.*vi PUBLIC PROPERTY DEPARTMENT Mnrae 17a WASMAMM shftler•&MAft MANA90ftSKM 0197e ra.9"V&S.95"•F..a.978•746994 HOMEOWNER LICE.AISS EXENMION Pkase "I Dam 6 _ Job Location Home Ownstr Address 3,V Home Owner Telephone 7,91 , a2 a Present Mailing Addraas 3,!4 02, 5777-117-1 The current exemption of"Homeowners"was extended to include owner-occupied dwellings ottwo Units or leas and to allow sucb homeowners to engage an individual for hire who.does not possess a licenser provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Perwn(s)who owns a parcel of land on which hatsbe resides or intends to resider on which there is, or is intended to bs;a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A pews who constructs more than one hone in a two year period shall not be considered a homeowner. Such a tomeowner'shall submit to the Building Official,on a form acceptable to the Building Official, that he/she be responsible for all such wort 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 understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ir HOMEOWNERS SIGNATURE APPROVAL OF BUILDING NSPECTOR See other side for state code CITY OF S�U &M, lL-kSSACHUSETrS 01 Bl;UMNG DEPAR7'.%MNT 120 W."HLNGTON STRM. 31D FLOOR TEL (978)74S-959S FAX(978) 740-9846 KI.,%IBERL.EY DRISCOLL MAYOR THO.sUs ST.PtERRB DIRECTOR OF PI;BUC PROPERTY/BCII.DLNG CO\LMRSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris,-and-the provisions ofMGL c 40,954•,-— --- - 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 by MGL c 111, S 150A. The debris will be transported by: 7— (name of hauler) The debris will be disposed of in (name of facility) (address of facility) signature of permit applicant date I.bna [N.R