65 SALEM ST - BUILDING INSPECTION —_ --.----_ --- -- -- the Conwrnn)ealth of \las,a(hux•us
(� e li)auil ))t I3utlJing RCgttlailUlb ,old .Standards I r rlt
t \1as,achusens Sta(C 1uildiii l •.ale. 'Sll ('\IR. 7 ' cLli o11
Htlildim_ Permit :\pplic.rti)vt focmisiimt. Repair. Reno,.ttc Or i)Ciiimi,IIIAN (�
ON (hn-. nr T)ut-lluuNclhlrllinB -- — I ----° \- `A
- This Secnun For Official (',e Only
I�ing Petrim .Number IJ.tte :\pphcJ
_ t, tI
..._ ..nure- �Gt el -- - - . .. _�
� Build �� ('ununi,•unir� Li• -, nail of 19u' Ong, ;).uf __ . ._ __ _ . . ._ _
.SFC'1'ION L .SF11•: INFOR\IA IION'
1.1 P ) t r v d ss 12 Vsessms lap & Ptrecl Numbers
LIaA . .s ..n NI.I, Nu .her i'��� %,w
1.3 Zuning Inrornialion: I i "7cper:y 7roc•nsio
rZoning DUlrlet Pn nyneJ I'sr -_ I t.Id Atea ny h) Fiunmge Ili,
1.5 Building Setbacks (fl)
——
Fun 1'arJ "de Tanis RC]I 7:ud
Reyun�d 1 Pon lded Rey:;m,d Pnlr lded Reyuued Poi.id..d
1.6 Water Supply: i.\t G L c 40, §9L 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public ❑ Pnvure❑ "Lune. _ Outside FIrwJ Zone .Mumapal ❑ (fin .iie J s1x)sal ,.,iem ❑ i
_— ('heck It ye,❑ — ---__...—._. 1
-- SECTION ?: PROPERTY OWNE`3SPIPt
2.1 wnert of Record: G
N.uw I Prim) Address for Sea iee. �
' tiler:m)
SECTION 3: DESCRIPTION OF PROPOSED \VORK=(check all that appiv)
Neu Cl�nstruetiun ❑ Existing. Building :> Our -( u.:upied ❑ Repairs(s) Al�u I f7
Jemuhtiun ❑ Aeee„ )�? 14t:ig ❑ �;Yur'lhe• of Units— Other ❑ Spicily
B� riet Deschh uor ut Propuv_d %'�)rk
IX'HON 4: ESTIMATED CG%NTRU.:TION COSI'S
Eenmated Costs:
HeinOfPcial Use Only
+I.ahur and Matenalsl
-- I. Building Permit Pee: 'S Indicate hn„ Ice I,- -
I 13mldin_e 7 Sd C)0,O0 — JCIrl innteJ:
- —)-- ❑ Standard C iW-h,%kn Application Fee
❑ Total Pnrl rct Coat (item 61 s multiplier N
J Plumbing 5 ?. Other Fees: 'S
i
1 \nechamcul M ACI )
i }1ec h,tmr.J ifite S F"(,II \II Fee, S --
,r-�. .� < heck .No ('heck .\nn,urtt l'.I,h \momit
o FuWI Project Coll ) J 00O, t9P ❑ P.ud In Full ❑ Out.LutJing 13.)hIn e Ihlr
-
,
SECTION 5: CONSTRUC HORN SF:R\ ICES + �
Sl Licroscd l'u list ruction Sit prnisor ICSL1
I'.,pii.tln"u U.tl:/
� LtH I�SI. T,lie 'Cl:ihi low
,i
- --
\,1JIr.• 1\ ,r Ui,cis ni,m _.___
lic,Lihled pup lu ".IN111( a I't
J I&_' f.ulul,
hilk
i - K:,IJ:mul It„aline ( ,n.'uu` _
halo ph,me \\;—rK:aJ:nU.J \\,u J,.,, .,I:J
�il`_— iJ:mial ;,didI ,ii I:ni .t, ,
�._ a ist•red tome m rucen ni Cur r 'tor I II 1
IC( m, n NJIIIC or� Rccisir t �\' tilt. Reguirautn .\ Oct) Lin�,
F.vpuallon Uatr
Signature relephone
SECTION 6: WORKERS' CONIPENSATION INSURANCE AFFIDAVIT (M.G.L. e. 152. 9 25061)
Workers Compensation Insurance affidavit must be completed :md submitted with this apphcauun. Fat l Lire to pn,v lde
this affidavit will result in the denial of the.lssuance 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, � -��y_Q_�wf� y, Z as Owner of the subject prrlpeity hereby
authorize n z7� e�'�a��1 'P'�'�-��rEC to act on my behalf. In all nLltten
i
relative to %v.0 k authorized by this building permit application.
I
Si nalull l61ner — Date
(— SECTION
�7)b::.OWN/ER' OR�AUTHORIIIZ�ED AGENT DECLARATION —�
1, I^�t (��r� �(�.t��J Y'N CJ� �r7YP��as Owner or :\uthorized r\gent hereby Jeclarr
that the statements and iinformation on the'Jforeeg_oing application are true and accurate, to the best of my knowledge and I -
behalf. F--To ^ llP,-
Print Name
Signature nl Owner or Authorized :\gem Date
ISiened under the afro and penalties of perjury i �..
NOTES:
1. An Owner who obtains a budding permit it,do his/her own work. or ;)n owner who hires an unre�i,icicd :,ultra, I'll I,
(not registered in the Home Improvement Contractor (HICI Program), will not have acccs, to ine .ohitiation
program or guaranty fund under VI.G.L. c. I42A. Other important information on the MC Progrun and i -
Consirucnon Supervisor Licensing (('SI_)can he found in 730('SIR Regulations I I0.R6 and 1 IU R5. rc,pccnsclv_.1 .
' When ,uhstantial work is planned. provide the inki maton below: - -
Total floors area iSy. R,i oncluding garage. finished ha,emen Uatncs. decks or p„r.h, . . _
(;ro,s Irvine area iSq. Ft.l Habitable room count
Number of —
rueplaces Numhet Lit hedroom, _-
Nnitt(ler ,Jt halhtooms - NIImhCl ,if li.,10,ath,
I\pe ,it he.ning ,y,tem -- Numher ,d Jr.ks; p-i,hc,
Ivpe of .o„lo,g
i ).. 'Total Project Squire Foof.ige" mAN he ,uh,tiriited for Toll Prtycct ('o,t" Y