32 SUMMIT ST - BUILDING INSPECTION (2) r
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7t°edition OF SALEM
Revised January
Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008
1 One-or Two-Family Dwelling
This Section For Official Use Only
�(1 Building Permit Nu eer- - Date Applied: \
Signature:
Building Commissio r/Inspector of Buildings Date
SECTION 1: SITE INFORMATION
I.1ropeAd(ld�rf: S fi 1.2 Assessors Map&Parcel Numbers
157— ocr? O
Lla Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
�DCl�9llkl S' 970 � � ; Bo
Zonmg istrict 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:
Public Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal�ElOn site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP`
4.1 O Wert Record: C�L�ylY>` !
V�la t
Name in) Address f9r Service:
Signature- Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Er Owner-Occupied Ef Repairs(s) ❑ Alteration(s) V1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': r qp M
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ co?,0 O 0 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ c ❑ Standard City/Town Application Fee
0 U O ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ S't 0 OO 2. Other Fees: $
4.Mechanical (HVAC) $ List:_ t
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 1 �, O 0 0 0 Paid in Full 0 Outstanding Balance Due:
i' SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of CSL-Holder
List CSL Type(see below)
Address Type Description
U Unrestricted(up to 35,000 Cu.Ft.
Signature R Restricted 1&2 Family Dwelling
M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home 1170provement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature 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 deNal 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
1, 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.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
i7t)o� as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print
Signature w er o Aut or' d A t Date
(Sign
i ed er the pains and enaltie a 'u
NOTES:
L 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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(Sq.Ft.) Habitable room count
Number of fireplaces 7 Number of bedrooms
Number of bathrooms r Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system t2 Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
.1`.
1 ,
CITY OF S.U-E!M
PUBLIC PROPERTY
DEPARTMENT
w,arauar
wrw 136 w kMGMM srwar•
3ULt Nwaaotissrn 019'0
TzL r5-7+5-9S"•F.UL 976.746964
HOMEOWNER LICENSE EXEMPTION
Please Foust
Date a S
Job Locatim .
Home owner Address
Home Owner Telephone I -
Present Mailing Address c i 93.10
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 who.does not possess a license,provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons) who owns a parcel of land on which be/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 "homeownee 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/rrequirements.
HOMEOWNERS SIGNAT[.'RE�//,l 4
,APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
J%W: Pit.) I'Pty �'1I
0 S-\I f\t,MAii.\I I II it I i�a'i
fri:478.743 9i95 * I'.\x:418.7449Y46
Construction Debris Disposal At'lidavit
(required fur all demolition vtd renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section I 11.5
Debris, and the provisions of MGL c 40, S 54,
Building Permit y 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 MGL c
111, S 150A.
The debris will be transported by:
(„ nA o p b
tname of hauler)
The debris will be disposed of in
�n fl.c D � Q�. _ •
—�tn ana ui racihir)
(address of t'a duy)
gnalure of pg nut ap j cant
due
n Alt
t Sn Cl
C. 3 1♦ � '' 7L^T 5
� 1
41,
+"11
rswp II. I{ t
y.� Y {�t�e�ygey�Ik
Of ,xllbri
x a nWWI-
&h
1 i 6f. I
r;
1 �
+
d1i 1
'fi'^`£IiA' Ptpi1 Wrij/a �
��
,� �
\ �
t,
_-�
��.
_____ ____._____________: __�_���__ ��__ _ ______ .�_w__
t
F
5
t
t
�E
i
[�
,l
�a � I 35 -
Page I of 1
1 SA- IF I o oc
--------------
14 4
8
EF F �35
20 GAR 200
�,n
(M)
'. 25 �I Zt�
F
1 B
15)- �IZ
35
6
http://salem.patriotproperties.com/sketch/8000/13001 jpg 1/22/2010
Page I of 1
14 4
8
EF y1 vN
20 OAR�) 20(80 FiyOk
25 L
8� FFL
22(
e
http://salem.patriotproperties.com/sketch/8000113001 jpg 1/22/2010
Wednesday, January 27, 2010 8:42 AM Brookside Contracting 9787771075 p.01
GOP
.I
51
J Z.
� s Cx o
G*
o a •to
A