2 CHERRY HILL AVENUE - BUILDING JACKET The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repo-If
Or Demolish a
r One or Two Family Dwelling
This Section For Official Only .1
71 r .a
Building Permit Number ' Da ' plie
B Idmg Official(Pant Name) -,, , g Date
SECTIONI SITE I- TON:,
1 Property Address: 1.2 Assessors Map& Parcel Numbers
csrE/rRy fricc ,4v0
M Number Parcel Number
1.1a Is this an accepted street?yes_ no a_ P
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
-I'
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system El
Public PI Private ❑ Check if yes[]
.. _
PROPERT OW.N.ERSHIP ,
$ECTION. 2. Y
2.1 OwnertofRecord:
ame(Print) City,State,ZIP
a Cl/, .Aey 97877/� `/o t4 �va��,9aC . Cow
No. and Street Telephone Email Address
SECTION 3i,DESCRIPTION OF PROPOSED WORKZ,(check all that-apply) -
New Construction Existing Build ng❑ Owner-OcEUnits
d ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of _ Other ❑ Specify: `
Brief Description of Proposed Work: SyE - Ta/Ii9 FoR �P ni Y >
9� SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Onty
Item Labor and Nlaterials
1. Building 'S a, OOU. ° 1 But ldmg Permit.Fee $ Indteate how fee is determined:
❑ Slar Bard:CttylTown Application Fee
2. Electrical $ �Y,4 ❑ OthTotal eject Cost%(Item 6)x mu1tiplielr x
3. Plumbing $ N q 2. er 6es: $
4. Mechanical (FIVAC) $ h//� List:
S. Mechanical (Fire $ N� Total All Fees,: $
Su ression
oa Check No. CheckAmotmt Cash Amount:
6. Total Project Cost: $ �, Ooa 0 Paid in Full . ❑.Outstanding Balance One:
J
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Folder
List CSL Type(see below)
No. and Street Type, Description-:
U Unrestricted(Buildings up to 35,000 cu. ft.
R Restricted ISr.2 FamilyDwellin
Crty/town, Slate,Z[P bt Nlasonr
RC Rootin Coverin
WS Window and Sicfin
SF Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date_
No. and Street Email address
City/Town, State, ZIP 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 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: 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 in this application i true and accurateto the best of my knowledge and understanding.
Print�or Authorized Agent's Name(Electronic Signature) Date
NOTES:
=obtainsbtains a building permit to do his/her own work, or an owner who hiresan unregistered contractor
the Home Improvement Contractor(HIC) Program), will nothave access to the arbitration
anty Iutd under tbIG.L. c. 142A. Other important information on the IIIC Program can be found at
ua Information on the Construction Supervisor License can be found at www.ntass.eov.dr)s
2. hen substantial work is planned, provide the information below:
Total Floor area(sq. ft.) (including garage, finished basement/attics, clecks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling .system _ Enclosed ---Open_
3_ "Fotal Project Square Footage" may be substituted for"rota) Project Cost"
CITY OF S.U.Em
PUBLIC PROPERTY
DEPART1LENT
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Vwrae 130vASWAG MSrun•SAtay Vwfuorasar�s01•'0
ru F.Ai 9?174&964
HOMEOWNER LICENSE EXEMMON
Pleaw M.t
Date ////.T ao/
JobLoeado a ch`�/r/�y />'/cc
n
HomeOwne<Addrea/ 02 <--77gwy 71lee A(iE SALEM. MA
Home Owner Telephone G 7 P 7 7/ a e1.0
Present Mailing Addrese Avx5 .S,9,-x!r iA
TTse current exemption of"Homeowners"was extended to inchrde owner-occupied
dwellings of two Units err less and to allow such homeowners to engage an individual for
hire who does not possess a license provided that the owner acts as supervisor.
DE INMON OF HOMEOWNER
Pasan(s) who owns a paeel of land on which Wdtt resides or intends to reside, on
which then is, or is intended to be6 a one or two family dwelling, attached or detached
structures accessary to such use and/or farm structures. A person who construct$more
than one home in a two year period shall not be considered a homeowner. Such
"homeowner'shall submit to the Building Omcial,on a form acceptable to the Building
Oalcial, that he/she be responsible for all such work perforated under the Building
Permit
The undersigned "homeownd''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 requirements.
HOMEOWNERS SIGNATURE
.APPROVAL OF BUILDING NSPECTOR
See other side for state code
2 CHERRY HILL -AVE.
(situ of §�ttlem, Massar4usetts
Public Prnpertg Department
Nuilbing Department
(9ne Salem (6reen
500-745-9595 Fal. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer 02/03/94
Dear Property Owner:
The following notice is in regard to your property located at:
2 Cherry Hill Avenue, Salem, Dass.
It is your responsibility to have snow and ice removed from your sidewalk
within six (6) hours after the snow ceases to fall. Failure to do so will
result in a fine being posed on your property.
Please contact this office upon receipt of this letter as to your course
of action.
Leo F. Tremblay
Director of Public Pro ' ty