32 SHORE AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR Rev SALE 42011
Building Permit Application To Construct,Repair,Renovate Or
One-or Two-Family Dwelling
This Section For Official Use ly
Building Permit Number: ate Appli :
Building Official(Print Name) S;gnaturo Date
SECTION 1:SITE INFORMATION
1.1 Pro a duress: 1.2 Assessors Map&Parcel Numbers
_ 32 :91�3-6b66_p
L la Is this an accepted street?yes no Map Number Parcel Number
1.3 � ring Information: 1.4 4 10$ ��s Dimensions:
K C
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:
Zone: _ Outside Flood Zone?
Public Private[3Check if es❑ Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
Name(Prin City,State,ZIP
32 Wk Ave, '�76921-66�1
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED ORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition EY Accessory Bldg. ❑ Number of Units 2 Other ❑ Specify:
Brief Descnp on o.Pro Work z:
V
SECTION IkE&TINUTED CONS UCT1ON COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
/ ❑Total Project CoNe(Item 6)x multiplier x
3.Plumbing
� ) $ 5 2. Other Fees' $
4.Mechanical ( AC $ List:
5.Mechanical (Fire $
Su ression Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: 1 $(van 0 Paid in Full 11 Outstanding Balance Due:
CITY OF S.UY. NI
PUBLIC PROPERTY
DEPARTMENT
clfalltaY rn�•y• .
.Nwvoe I.30 WASUNGWO trvsr•4A,1- VAaAa4L W n 0l9V
119L f'67454S"0 F.%L 979.746964
H0ME0WNER LICLNSE EXEM"102V
Pfeaw Print
Dar. g 9
job Loeatios 32- S 6( Ave.
HomeOWMAddreata M- 5ho2E MA.
HomeOemtr?elepbone 7q-421.6bt7
Present Mailing Address 32 56 nr Ave
The current exemption of"Homeowner"was extended to include ownw-occupied
dwellings of two Units or teas and to allow such homeowner to engage an individual for
hire who.don not powers a lieeaser provided that the owner sets as superviaor.
DEFINMON OF HOMEOWNER
Person(s)who owns a paced of land on which he/she resident or intends to resider on
which there is, or is intended to bar a one or two family dwellin& attached or detached
structures accessory to such use and/or farm structurea, .A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official,on a form acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit
The undasigned"homeowner"assume$ responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undmigned "homeowner'certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
vill comply with said procedures and r firem10-�
HOMEOWNERS SIGNATLRE
APPROVAL OF BUILDING IN PECTO ./lc 0— �
t
See other side for state code
CITY OF S.U-&Nf, ,tiL-kSSACHL'SETTS
BI;IIDOIG ❑EPARTILNT
110 W.UHLNGTON STREET, 3iO FY-001
TEL (978) 745-9595
FAX(978) 740.9&M
KIJ®E11tLEY DRISCOLL
MAYOR THOma ST.PiF.RRti
DIRECTOR OF PLBLIc PROPERTY/BLILDLYG CONLNISSIONER
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 l 11.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit p is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as dcfincd by MGL c
111, S 150A.
The debris will be transported by:
,1 _I ^
OACUCO
6�0 Dvwt 0 ruoL
(name of hauler) 1
The debris will be disposed of in
-LoosoU Ca21i n�G
(name fac/lily)
w�9 Y11ir I
VVldreae offacifity)
MA
sign q to ofpermit applicant
Zob)
�afC
ih/1 ylr.�R'
SECTION 5: CONSTRUCTION SERVICES
5.1 Constriction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
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 BUH DING 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:OWNE W 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.
S � 1P�(Q7 ISf Il
Print er's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building pemit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not 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.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dam
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.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. "Total Project Square Footage"maybe substituted for"Total Project Cost'
f
Office of Consumer Affairs and > usiness R'® ulation
�± 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Ctintractor Registration
Registration: 11014Y
Type: Partnership
Expiration, 101012012 Tr# 203859
MONACO JOHNSON GROUP
CHRISTOPHER MONACO
3 ELM'PL
MARBLEHEAD, MA 01946 ---
?;;;; Updato Address and return pard, Mark reason for change.
...... [] Address ❑ Renewal [],Employment Lost Cord
QN-CA1 A e0M•04104.0011001010
;:� Ofllco oPiConoGm" r$1a�`�s`rd�"llltilh'o66` � 4Ntd License or registration valid for lndivldul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date, if found return tot
M1, Roplotretlon: .,.�1014i Type: Office of Consumer Affairs and Business Regulation
h Expiraion <104f 012 Partnership
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Boston,MA 02116
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