12 SURREY RD - BUILDING INSPECTION (2) t
1
a The l Commonwealth u Massachusetts
Board of Building Regulations and Standards CITY
y ) Massachusetts State Building Code. 790 CMR. 7a'edition OF SALEM
i� Revised Junu.or
Building Permit Application To Construct. Repair. Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For OfTcial Use Only
Building Permit Numbe Date Applied:
Signature: t 21 0
Nuilding ummissionerf Inspector of Buildings Dale -
I: SITE INFORMATION
J 1.1 1Property A'5U�7 �M- 1.1 Assessors Map& Parcel Numbers
1.12 is this an accepted street? es no Map Number Panel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yarda Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public 0 Private O Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if es0
SECTION2: PROPERTY OWNERSHIP'
LI wn t of Record•
�.
Nam ( nnt) Address for Service:
<97�P-. 7y/-yg 2�
i Telephone
SECTION l: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Existing Building 0 Owner-Occupied 0 Repairs(s) O 1 Alleration(s) 0 Addition 0
Demolition 0 Accessory Bldg 0 Number of Units_ Other (3 Specify:
Brief Descn tion of Pro sc4 Work:
xt
FOOL,
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofllelal Use Only
Labor and Materials
I. Building Is — I. Building Permit Fee: S Indicate how fee is determined:
O Standard City/Town Application Fee
?. Electrical S 0 Total Project Cost'(Item 6)x multiplier x
1. Plumbing S 2. Other Fees: S
4. Mechanical (fIVACI I S List:
S. Mechanical (Fire S " W
Suppression) Total All Fees:f
6. Total Project Cot: S Check No. Check Amount: Cash Amount:
X 0 Paid in Full 0 Outstanding Balance Due:
=141ldct
ECTION !: CONSTRUCTION SERVICES
sor(CSL)
L iccnse Number E%pinlliun Male
1.ist CSL fype(see below)
f Description
U I Unrestricted(uo to)3.000 Co.FI.
R I Restricted IR2 Family Owellin
Signature M I Masonry Only
RC Residential Roolin Coverin
I"elephant W S Residential Window and SiJin
SF Residenlial Solid Fuel Ruming Applianec Installatiun
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC Company Name or HIC Registrant Name Regisinuioo Number
Address Expiration Date
signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a ISL I M(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? Yea ..........O No........... O
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 Dote
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
1 ,as Owner or Authorized Agent hereby declare
I the statements and lnfarmation on the foregoing application are We and accurate,to the best of my knowledge and
behalf.
Print Name
gnalure ofshvne o Data
r the sins and naltio of
NOTES:
1. An Owner who obtains a building permit to Jo his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will=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 I IO.R6 and 1 IO.R3,respectively.
When substantial work is planned,provide the information below:
Total 1,1h arcs(Sq. Ft.) (including garage, finished basemen✓attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
LN;mbc"r of bathrooms Number ofhalf/baths
of heating system Number of decks/porches
ofcoolingsystem Encloxd Open
"Total Project Square Footage-may be substituted for'Towl Project Coil"
ASSESSORS MAP
Borrower Anthony Carnevale lr File No.: 21754
Property Address'12 Surrey Rd Case No.:Loan#0073118085
Ciy Salem State: KA Zip: 01970
Lender:MetLife Home Loans
City of Salem,MA 3/23/2010
Parcel Map
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MAP FOR REFERENCE ONLY iW wero,amios
NOT A LEGAL DOCUMENT t-i PBMgm
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United Appraisal Assmiates /www.united-appraisalxom
PROPERTY DEED
Borrower'Anthony Carnevale Jr File No.: 21754
Property Address:12 Surrey Rd Case No.:Loan#0073118085
City Salem State: MA Zip: 01970
Lender:MetLife Home Loans
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[ 28020412N988 Bk;18585 Pg;a
DEED __04/fal30aa f6,40,aa OMD_P, I,
I . .. .._
Lance Belostock,Executor of the Estate of Natalie Benstock Essex County Probate No. DI
pursuant to a License to Sell issued by Essex Probate Court for consideration paid,and in fu11
consideration of Three Hundred Twenty Thousand and 001100($320,000.00)Dollars grants.to
Anthony Carnevale,Jr.of 12 Surrey Road,Salem,Massachusetts
The land in Salem,Essex County,Massachusetts,with the buildings thereon,being Lot No.9 on
"Plan of Land owned.by Loring Realty Trust,Salem,Mass.,Scale 1.in.=40',Aug. 1954,
Osborne Palmer,C.E."recorded with Essex South District Deeds,Plan Book 85,Plan 25 and
bounded and described as follows:
SOUTHWESTERLY by Surrey Road,seventy-five(75)feet;
NORTHWESTERLY by Lot No.8 on said plan,one hundred(t 00)feet;
NORTHEASTERLY by Lot No.7 on said plan,seventy-five(75)feet;
SOUTHEASTERLY by Lot No. 10 on said plan,one hundred(100)feet.
Containing 7,500 sq.fr.,according to said.plan
For title see deed from Lucille I.Allen and F.Gordon Allen,dated July 9, 1999 and recorded
i
with said Deeds in Book 15799,Page 48 and Essex County Probate Number
Property Address: 12 Surrey Road Salem,Massachusetts
WITNESS my hand and seal this b2! day of 2002.,
La ....
Lance Belostock,Executor
COMMONWEALTI-I OF MASSAC11USETTS
, 2002 - l'
Then personally appeared the above-named Lance Helostoc Executor of the Estate of Natalie
Belostock and acknowledged the foregoing instrument t be is free act and deed as id
Executor,before me.
i Public
Goa
My Commission Expires:...._.._....._ ...
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United Appraisal Associates /www.united-appraisal.com
V
CITY OF S.ULE.%vI
PUBLIC PROPERTY
DEPARTMENT
w1O• i 3o vwuHc.Tow sera•sar�t Vwa�oascm 01970
t11 rs-735-9S" • FAX 978-746994
HOMEOWNER LICENSE EXEMPTION
please "I
Date 7a/
Job Locatias
Horne Owner Address \I
Home Owner Telephone - —
Present Mailing Address \1
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowner to engage an individual for
hire who.does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HONMOWNMt
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-taws 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 LNISPECTOR
See other side for state code
CITY OF SALEM
'r�' PUBLIC PROPRERTY
�,.., ti S lli as
DEPARTMENT
'.I 121u'.\,III\,.:,I`'*M81:fr • 1.\II-\1,
Construction Debris Disposal Affidavit
(rerluired for all dcnrolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CIv1R section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit it is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris will be transported by:
_- (name of hauler)
The debris will be disposed of in
(name ul facility)
(address of I'acilityl
_ rc u prrnu[app Ivan
�71';z //////7
date --