Loading...
11 SOUTH ST - BUILDING INSPECTION (2) f the Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF� SALEM � Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct, Repair enovate Or Demolish a One-or vo-Fmnrly Dive ing Th' S tion For Offi al Use Only Building Permit Number: D Applied: B it ing is a riot Name Signature Date SECTI 1: SITE INFORMATION Property Address: 1.2 Assessors Map& Parcel Numbers ii Scvil c`51 lew�{NIA 0 )9,.70 I.In Is this an accepted street?yes no Map Number Parcel Nltmber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(It) 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❑ Checkif ycs❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIPt Owner of Record: .a-lt Ake Sa Li,*-- 114,r i a791 0 N a(Pool) City,State,ZIP A,,� 9.4.4.. No.and Street telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Own ccupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ umber of Units_ Other ❑ Specify: Brief Description of Proposed Work: � /Ou tgS! — NHMaAunlin=t D. f' C- e-n A SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Labor and Materials) Official Use Only I. Building S I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. Mechanical (FIVAC) S List: i. ,\lechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6. Total Project Cost $ '�j©Q ^� ❑ Paid in Full ❑Outstanding Balance Due: � la SECTION5: CONs'fRUCTIONSERVICES 5.1 Construction Supervisor License(CSL) f.iccnse Number Ezpiralion Date Name ul'CSL, lioldcr List CSL Type(see below) Nu.and Street Type Description U Unrestricted(Buildings up to 35,000 cu. it.) R Restricted l&2 Fmnil Dwelfi— Cuy/town. Sluts.%IP M Masonr RC Rootin Coverin WS Window and Siding SF Solid Fuel Burning Appliances I Insulation 'Tcle hone -]--mail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Rcgistm F tion Number Tpiratiun Date I IIC.Company Nome or I IIC Registrant Name Nu. and Slrcet Email address Ci /Town, State,ZIP Telc 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 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. Pnnt Owner's N;une(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 III contained in is ap true an ecurate to the best of my knowledge and understanding. Pr�t Owner s or�thorizcd Ages amc(Electronic Signature) Dale NOTES: 1, 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 trot have access to the arbitration program or guaranty fund under NI.G.L.c. 142A.Other important information on the HIC Program can be found at _is_.gus_oca Information on the Construction Supervisor License can be found at�r�tiw_mass.o-oyjylL 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"may be substituted for"TTotal Project Cost" CITY OF S.UY.Nl, I&L-kSSACHUSETTS BLIMMG DEPARTMENT 120 WA.iHLNGTON STRasT, Y'FLOOR ex TEL (978) 745-959S PAX(978) 740-9846 KiJtBERIEY DRISCOLL MAYOR THO.�Us ST.Pmm DIRECTOR OF PLBLIC PROPERTY/8t:mnLYG COMMISSIONER 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 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit N is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by IVIGL c 111, S 150A. The debris will be transportcd by: NZ-4c S, L (name of hauler) The debris will be disposed of in (name of facility) (address of facility) signature p rmit applicant / 5116 /i/ date Jbnud6a CITY OF SM-EM PUBLIC PROPERTY DEPART-mENT u.aurs+r o�rrntL wrae t ro WMMv@GTM Roar•sK.+a HweAaa earn m r.e rtL rain-sssy•r..n r.e.7+oow HOMEOWNER LICLNSE EXE.Xff10M Please rose Date Job Laicadom 5�. Sw(wri AA Home Owner Address // S 1 . la ,, M Home Chow Telephoee Presort Mauling Address W9 ,a 5-r 4/ .lk-. �q a f 9 6 f no current e;emptloo of-Homeowners"was extended to include owner-0ccupied dwellings of two Units or lase and to allow such homeorvetms to engage set individual for him who.does not possess a licso `peovided that the owner acts as supervisor. DP.FII MON OF HOMEOWNER Person(i)who owns a pwd of l nd on which he/she resides or iatende to red" on which there is, or is intended to bs,a one or two &mily dweWnS attached or detached structures accessory to such use and/or firm structures. A person who constructs more than one home is a two year period shall not be considered a homeowner. Such e lraneowner'shall submit to the Building Otlkial,on a form acceptable to the Building Of!lcial, 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"certif cs 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 SIGYATLIM .APPROVAL OF BUILDING NSPECTOR See other side for state code WGx ST PRINTING SERVICES(603)]C26013 Ral.Na:G ONW1249 CONTRACT TO PURCHASE NORTH SHORE ASSOCIATION OF REACTORS®,INC. 6GOLLxGG661G ovvoRTuxlTr ZO DATE: I" / s � -AULFrom the office of: I�F�L� (� Presented to: 7TAPI- FF4 CT�:j .1�,� A"JO 2 S Listing Of -Listing Agent TO: t L SELLER(S)Property Address SO S Town/City - ' `� r -StateJ'It1n11 /" " Approximate Lot Size 2 MA Ae t Book� Page 33 7_ Registry of Deeds l 1. WE HEREBY OFFER TO PAY FOR THE ABOVE-NOTED PROPERTY: Sow (a) $ 0 DD ,of which (b) $ f„!_o is,paid herewith as a deposit to bind this Offer t/ (c) $ is to be paid as an additional deposit on or before M/�-- bk� �t17 , 20 (d) $ XqSi J is to be paid at a time of delivery of the deed, by cash,certified or bank check. (e) $ D,5 5 y O 1—) Total Purchase Price Ate,./ , ` All deposits made hereunder shall be held in escrow by At% IW'1 •y S- g6A/ �— , an Escrow Agent, subject to the terms of this Agreement and shall be duly accounted for Mhe time for performance. In the eveM of any disagreement between the parties, the Escrow Agent is authorized, by the SELLER(s) and BUYER(s) to retain the deposit(s) paid under this Agreement pending written instructions mutually given by the SELLER(s)and BUYER(s), or until a court has rendered a decision as to who is entitled to the deposit(s). The Escrow Agent is hereby authorized to file an interpleader action in a court of competent jurisdiction in which case the Agent shall be entitled to an award of attorney's fees and costs. If the Escrow Agent is made a party to any lawsuit filed by the SELLER(s) or Buyer(s), the Agent shall be entitled to recover reasonable attorney's fees and costs from the party asserting the claim against the Escrow Agent SELLER(s) and BUYER(s) hereby agree to hold the Escrow Agent harmless and to indemnify the Agent from any and all liability with respect to his/her duties, and decisions made in good faith with respect to the release of the escrow funds shall be final and binding on the parties. _ 2. ACCEPTANCE TERMS: /� This Offer shall remain open until :oo A.M.esignifying I" APC_t� ,20�nd maybe accepted only by the SELLER(s)' igning this document prior thereto where acceptance of this Offer. Upon acceptance by SELLER(s) this shall become the contract between the parties; otherwise, this Offer shall be considered rejected, and any deposit paid in accordance herewith returned to BUYER(s). 3. AGENCY DISCLOSURE ACKNOWLEDGEMENT: The BUYER(s) and SELLER(s) acknowledge receipt of the notice required by Regulation 254 of the Code of Massachusetts Regulations, Section 2.05(15),regarding the relationship of the Broker(s) with the BUYER(s) and SELLER(s)of the property. 4. LEAD LAW ACKNOWLEDGEMENT: BUYER(s) acknowledge receipt of the 'Massachusetts Department of Public Health Property Transfer Notification' regarding the Lead Law. 5. INSPECTION; BUYER(S)' ELECTION TO TERMINATE: This Contract is subject to the right of the BUYER(s)to obtain, at the BUYER(s)' sole cost, a home inspection, including a lead paint inspection of the premises by consultant(s) of the BUYER(s) own choosing within ten (10) day after the SELLER(s)' execution of this Contract or no later than tAd- Fd 74 . If the BUYER(s) is not satisfied with the results of such inspection, this Contract may be terminated by the BUYER(s) at the BUYER(s) election, without legal or equitable recourse to any party, the parties thereby releasing each other from all liability under this Contract, and all deposits shall be returned to the BUYER(s). However, in order to elect to terminate, BUYER(s) must notify the SELLER(s) and Listing Broker(s) in writing, on or before the expiration of the ten (10) day inspection period, of BUYER(s)' intentions to so terminate; failure to so notify will bar the BUYER(s) from termination under this paragraph. In the event the BUYER(s) do not elect to have such inspection or to so terminate within ten (10) days, the Seller(s) and the Broker(s) are hereby released from liability relating to defects in the premises which the BUY�ER(s)or B YER(s)' consultant(s)could reasonably discover. BUYERS' lit BU— SELLERS' Initials SELLERS'Initials Page I of 2 Coldwell Banker Residential Brokerage Lead Pain(( Disclosure Contract Contingency Sel ler(s): C OyF r ai lcz^� Buyer(s): m4 " �� Properly Address: i,, , --,A Seller's Obligation under Federal and State Law to provide Lead Paint Disclosures Seller understands that Seller is obligated by law to provide certain lead paint disclosures to prospective purchasers whenever the property to be sold was constructed prior to 1978. Seller further understands that Seller must provide these disclosures before a prospective purchaser becomes bound under any contract to purchase such seller's property. if the Buyer has not received the applicable lead paint disclosures at or prior to the Buyer's submission of an offer to purchase Seller's property then this Lead Paint Disclosure Contract Contingency shall apply. Buyer's Offer Subject to Receipt of Lead Paint Disclosures and Affirmation of Contract Buyer's offer is expressly contingent upon the terms and conditions staled herein and can not be accepted by the Seller unless Seller agrees to (he terms and conditions stated herein. Notwithstanding the fact that the Buyer has signed an offer to purchase Seller's property, Buyer and Seller agree that Buyer shall not become bound under the terms of such agreement unless and until the following has occurred: I. On or befaret\AAPfF �1i�D�he Buyer has received the applicable lead paint disclosure documents (including the Lead Paint Transfer Notification form signed by the Seller; AND 2. On or before , the Buyer and Seller have signed the Affirmation Sestion below affirming the terns of the agreement. uy Seller j" Buye Seller Buyerand eller-Affirmation: Buyer hereby acknowledges the receipt of Lead Paint disclosure information with respect to the above referenced property. Seller and Buyer hereby affirm all of the provisions of the agreement between the Buyer and the Seller dated Buyer Seller Buyer Seller J J . 6. FINANCING: This Cgrypptr c 'st �Lto the BUYER(s) obtaining a Conventional, VA, or FHA first mortgage commitment off $ oC�n- � .h�'7 at prevailing interest rates, points and terms. [f the BUYER(s) is unable to obtain [he above-noted financ g, after using diligent effflrts to do so, which 'diligent efforts' shall mean at least one application to an institutional lender ''matte on or before (�1J� , 2 ;tl n BUYER(s) may r�ttinate this Contract by notifying the SELLER(s) and Listing Brokei(s) in writing, on or before Q 1 20 , upon which notification all deposits shall be returned to the BUYER(s). Failure to so notify wit bar the BUYER(s)from termination under this paragraph. 7. CLOSING: A good qd sufficient Deed, convey' a cod ear record ago marketable title shall be delivered, by the SELLER(s), on or before :� A.M./P.M. (mi d l '20— at the appropriate Registry of Deeds, unless some other time and place are mutually agreed upon i writing. Time is of the essence of this Contract. 8. SPECIAL VISIONS: 6-4/ v U/`)t I.5 2 1n? D 4AT_ r nl'SC rn� 7" ;< (l-L)\) 9. WARRANTIES & REPRESENTATIONS: The BUYER(s) acknowledges that he / she has not relied upon any warranties or representations not incorporated in this contract, except for the additional warranties and representations, if any, made by either the SELLER(s) or the Broker(s). If none,state"NONE". N "� NOTICE: THIS IS A LEGAL DOCUMENT THAT CREATES BINDING OBLIGATIONS. F NOT UNDERSTOOD, CONSULT AN ATTORNEY. BUYER: BUYER:' ��� //� Signature 7 S nat BUYER:�P t7e�tS- I BUYER:A t��ilr Print Name Pry This Offer is hereby accepted at A.M. /P.M. on 20 . SELLER: SELLER: Address: Address: This Offer is hereby acknowledged but rejected at ._ A.M./P.M. on , 20 . SELLER: SELLER: Signature Signature SELLER: SELLER: Print Name Print Name All rights reserved. The use,distribution or reproduction of this form,in whole or in part,is permitted only by express written consent of the North Shore Association of REALTORS®, Inc. ©N.S.A.R. 4/91, 10/96, 8/08 asni a 30 year commitment worth a second opinion'? cat NE Moves Modpa9e for a tree pmapproval(978)865.1151 Page 2 of 1 MASSACHUSETTS MANDATORY LICENSEE-CONSUMER RELATIONSHIP DISCLOSURE This disolosure is provided to you, the consumer, by the real estate agent listed on this form. Make sure you read both sides of this form. The reverse,side contains a more detailed description of the different types of relationships available to you. This is not a contract. THE TIME WHEN THE LICENSEE MUST PROVIDE THIS NOTICE TO THE CONSUMER: All real estate licensees must present this form to you at the first personal meeting with you to discuss a specific property. The licensee can represent you as the seller(Seller's Agent)or represent you as the buyer(Buyer's Agent)and also can assist you as a facilitator. CONSUMER INFORMATION AND RESPONSIBILITY: Whether you are the buyer;or seller you can choose to have the advice, assistance and representation of your own agent who works for you. Do not assume that a real estate agent works solely for you unless you have an agreement for that relationship. With your consent, licensees from the same firm may represent a buyer and seller in the same transaction. These agents are referred to as dual agents. Also a buyer and seller may be represented by agents in the same real estate firm as designated agents. The "designated seller or buyer agent"is your sole representative. However where both the seller and buyer provide written consent to have a designated agent represent them then the agent making such designation becomes a "dual agent"for the buyer and seller. All real estate agents must, by law, present properties honestly and accurately. They must also disclose known material defects in the real estate. The duties of a real estate agent do not relieve the consumers of the responsibility to protect their own interests. If you need advice for legal, tax,insurance or land survey matters it is your responsibility to consult a professional in those areas. Real Estate agents do not have a duty to perform home, lead paint or insect inspections nor do they perform septic system, wetlands or environmental evaluations. RELATIONSHIP OF Al ESTATE LICENSEE WITH THE CONSUMER (check one) _Seller's agent _Buyers agent _Facilitator IF A SELLER'S OR BUYER'S AGENT IS CHECKED ABOVE COMPLETE THE SECTION BELOW: Relationship with others affiliated with.COLDWELL BANKER RESIDENTIAL BROKERAGE- _ LICENSE#8064 )er) (Check one) The real estate agent listed below,the real estate firm or business listed above and all other affiliated agents have the same relationship with the consumer named herein(seller or buyer agency,not designated agency). Only the real estate agent listed below represents the consumer named in this form (designated seller or buyer agency). In this situation any firm or business listed above and other agents This paragraph is not affiliated with the firm or business do not represent you and may represent another party in your real,pplicable if"Facilitator"is estate transaction. :hecked above." B I, th I state licensee,ackn wled at this disclosure has been provided timely to the consumer named herein. i rw( 4NOWC)4s R4.4 Zo t ignatu a of rea es ate agent) (Printed n e of real estate agent) (License Number/Type) (Today's Date) g ' g b i i, the consum nowledge that I have received and read the information in this disclosure. Sign of onsumer) (Printed name f consumer) (Today's ate) ,4b1 4 ,� (Signature of consumer) (Printed name of consumer). (Today's Date) _Check here if the consumer declines to sign this notice. ® HLwnS WssFoRms- 'ma1i��c�� 1�� Q ASSOCIATION S.,e.Me Si.ueeal Rut F�we ia.m. REALTOR* "l�EA O—W Fomn No'705