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18 SAUNDERS ST - BPA 15-653 1'he C'ummunwcuhh oFMassachuseus i; '� Board of Building Regulations and Standards CITY OF st y, Massachusetts State Building Code. 730 C'NIR ti,\LGAI Building Permit Application To Construct, Repair. Renovate Or Den a One-or rnv-Fantill Dn el/iuq This Section For 011iciul Use Onl Building Permit Number ate Applied: I UudJing 011icial(Print N,unc) Signalu Dale SECTION I: SITE INFORNIATIO I I.1 Property Address: 1.2 Assessors Map S Parcel Numbers 0,_SAU4\/DeR-S Si �1tr7Vl Ma 1.In Is this an acce led street?yes s/ no blap Number Parcel Numhcr I.,1 Zoning information: 1.4 Property Dimensions: Zoning District Proposed Uw: Lot Area IN 11) Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.1.c.qo•§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if es❑ Municipal❑ On site disposal spstcm ❑ SECTION2: PROPERTYOWNER., 2.1 Owner'of Record: SvMATn / A=j Hykvk l S�2EM , MA ©/g 70 N;une(Print) C ny.Jtale.l.IP /9 _0- q78 sg�-Onoo s el� /v�lrl, co NU.and Street Telephone F:mail Address SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repoirs(s) ❑ Alterstion(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ specily: Brief Description of Proposed Work': SECTION a: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only I. Building S I. Building Permit Fee: S Indicate how fee is determined: 2. Plecirical S ❑Standard CityrTown Application Fee Cl Total Project Cost'l ltern 6)x multiplier _ _ x i ?. I'lumhi°g S 2. Other Fees: S 1. mech,mic,d ill\'.\(') S List:._ . <. \lMlaoical iFire tiu+uvssion) S Totl All Fees: S m. Total Project Cost: S tf*� Cheek No. _Check Amount: — lash \mount: ❑Paid in Full ❑Outstanding Bal:mce Doc: 9� 9)9� � + SECTION 5: CONS rRInCnON SERVI(TS 5.1 (•onstruction Supen isor License(C'SI.1 I ieense Number I'�piruion Date Nano o(C.11. I luldcr I isl CS I. I\Pe(see below 1 1)PC Description U I htrewricicd Illuildilto ti ( 15,000 cu. Il.) _ R Re.mricted LY;'_Tamil l D+wllin AI 1 asuu RC Rooting Covering \\'S R'indow and Siding SF Solid fuel Burning Appliances I Insulation I'ele hone Ifnwil address D Demolition 5.2 Registered Home Improvement Contractor(HIC) I IIC Registration Numher Ecpirutiun Dula I IIC Compan) Name or IIIC Itegistrant Name No.and Street Email address City/Town,State,ZIP rcle hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.J 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 I,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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below. I hereby attest under the pains and penalties of perjury that all of the information ntai d in t is a licat Is rue and accurate to the best of my knowledge and understanding. Pro I Osmer's :\ulho ' ,\genVi Name(11ectrunic Signature) Data NOTES: I. An Osvner who obtains a building permit to do his her own work,or an owner who hires an unregistered contractor l nut registered in the Hurtle Improvement C ontractur(HIC) Program),will nrr have access to the arbitration program or guaranty I•und under\I.G.L.c. 1 4_'A. Other important information on the HIC Program can be found at wss+s l Information on the Construction Supervisor License can be found at i+�+++ ]. \Tlien sobst:mlial+wrk is planned,pros ide the infonnalion below: rota) Boor area(sq. tl.) . _.._I including garnge. finished basenlentattics,decks or porch) Gross lisingareal sq. 11.) __. Habitable room count \tuubar oI'll replaces Number ber of bedrooms Vum her tit hathroums _ Number oflialfhalhs I I)pa of heating s)steal Number ofdccks, porches i 111+e+d c++++hllg i%Stei❑ 17n6ised Opoll 1, "1*otal I'rojeo Square foolayc"n)u) he;uhNnitacd Ihr"1'olul Projeel Coss" 4 . CITY OF SM-EN PUBLIC PROPERTY DEPART1dENT V Arse I b WA2dPWn 1 star a lm^VASAo%sarss On 9V ru.9-1,U611"•V.%&b'0.716,764 HOMEOWNER LICENSE EXEMMON Pkw Mat Date t t �W/2 Job I oeadom /9 SALX� Q-/ SAL/'k)1 A e9/-7 W7 Home Owner Address / C4ZI ,1 �yi477 Home Owner Telephone '92 -"4 00ay Present Mailing Address M rr t ®,te --a_ A4A The current exemption of"Homeowners"was extended to include owneroccupied dwellings of two Units or leas and to allow such homeowners to=gags an individual for him who.does not posses a lieanso provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persoo(s) who owns a portal of land on which he/she redden or intends to reside.on which then its or is intended to be4 a one or two tinily dwelling attached or detached structures accessory to such use and/or farm structures. A person who conatrncts more than one home in a two year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Ofllcial,on a form acceptable to the Building Oft1cia4 that he/she be responsible for all such wort parformad under the Building Permit The undasigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undenigned "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 requir rn HOMEOWNERS SIGNATURE 4 - APPROVAL OF BUILDING ClSPECTOR See other side for state code CITY OF S,V-ENf, NWs.ICHL'SETI'S 9LILOLNG DEP.imtE\T I_'O W-ts"'GTON STU=, Y°FLOOR Ili. (978) M-9595 KIJ®EM, Y OUXOLL F.Vc(978) 740-9846 ,MAYOR ILIO.VAI ST.RFRJts DIRECTOR OP PL Suc PROPERTY/BVIIJONG GO\LIIISSION Elt Construction Debris Disposal }I (required for all demolition and renovation work) Vit In accordance with the sixth edition of the State Building Code, 78o CMR section I I I.S Debris, and the provision of MOL a 40, S 34; Building permit q is issued with the condition that the debris resulting from S 13OA. this shell be disposed of in a properly licensed waste disposal facility as defined by MOL c 111, The debris will be transported by: (n.+ma orhaular) The debris will be disposed of in : (name o— f racild.) f�ddre�a of rj-Ci6ty) - �iyn,rNre ofpermrt ipphunt