25 SAVOY RD - BUILDING INSPECTION s The Commonwealth of Massachusetts
14 i" Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fomily Dwelling
"this Section For Official Use Only --
Building Permit Number: Date Applied: s N
'O
Building Official(Print Name) ignature D; _
SECTION 1:SITE INFORMATION C0 r.<
1 ro ert Ad�drress:� / /� 1.2 Assessors Map& Parcel Numbers D M
b �� /'''V 0 "1 R
1.1 a Is this an accepted street?yes no Map Number Parcel Number Cl)
1.3 "toning Information: IA Property Dimensions: .D N
%Doing District Proposed Use Lot Arca(sq 11) Frontage(tl)
1.5 Building Setbacks(It)
Front Yard Side Yards Rear Yard
Kequircd Provided Required Provided Required Provided
1.6 Water Supply:Q&G.L c.4n,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑
2. '(cy.�� �,,t��,� SEEC��T--IION 2: PROPERTY OWNERSHIP'M ll
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ I Accessory Bldg. ❑ Number,of Units I Other ❑ Specity:
Brief Description of Proposed Work'':
v SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials -
I. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
�. Electrical $ ❑Standard Cityffown Application Fee
❑Total Project Cost'(Item 6)s multiplier x
3. Plumbing $ 2. Other Fees: $ —
4. Mechanical (I IVAC) S List:
5. Mechanical (Fire _
Su>>ression) $ Total All Fees:$ _
Check No.__Check Amount--Cash Amount:
6. Total Project Cost $ 96n r b 0 ❑ Paid in Full ❑Outstanding Balance Due:
61
' r
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL'fype(see below)
No.and Street Ty PC Description
U Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted 1&2 Famil Dwelling
'City/'I'Swu,State,ZIP M Masonry
t
X4 RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
d I Insulation
c Teie hone Email address D Demolition
5.2 Registered home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or 1-IIC Registrant Name
No.mid Street
Pannil address
City/Town,State,ZIP Tele hone
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 CONIPLETED 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 is true and accurate to the best of my knowledge and understanding.
4Pnnt( ,--�er's or Authorized Agent's N:�ire(Eleclrcmic Signature) Date
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 nol have access to the arbitration
program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
www.nntss.eov/oca Information on the Construction Supervisor License can be found at www.ntass.4ov/dns
2. When substantial work is planned, provide the information below:
Total floor area(sq. ft.)_ (including garage, finished basement/attics,decks or porch)
Gross living area(sq. R.) _ Habitable room count_
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of flecks/porches_
'type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
J
QTY OF SALEM, MASSACHUSETTS
BUILDING DEPARTb[ENT
120 NVASHINGTONSTREET,3M FLOOR
TEL. (978) 745-9595
FAx(978) 740-9846
KINIBERLEY DRISCOLL
MAYOR THOMAS STTIERRE
DIRE CTOR OF PUBLIC PROPERTY/BUILD[NG CObIlVIISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date c�
Job Location1C/ /Q�
Home Owner Address �� JTT uo�
Present Mailing Address
The current exemption of"Homeowners" was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable
to the Building Official, that he/she be responsible for all such work 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 understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Commonwealth of Massachusetts
eP a a
Citv of Salem
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy up
.
Permit No. B-14-1251 �®
FEE PAID: $25.00 PERMIT
BUILD
DATE ISSUED: 7/29/2014
This certifies that DEVEREUX BARBARA D MALONEY JOHN K
has permission to erect, alter, or demolish a building ffi25 SAVOY ROAD Map/Lot: 320340-0
as follows: Pools REPLACE HOT TUB
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Contractor Name:
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DBA: IF h �fi
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Contractor License No:
`µ P " 7/29/2014
Building Official Ott` Date
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This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request. "W tlr+i . ., -
ia.. .,,� I',sa. 'v,
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
in-t 11' tv tMl .
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspec3tion for the entire duration of the
work until the completion of the same. ;g
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
HIC #: Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
-�re,, �iliiqla,
Restrictions: P, b
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Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.