The URL can be used to link to this page

15 SUTTON AVE - BUILDING INSPECTION (3) T3- The ComReOu Plogiodel' sacusetts ' Board ofjt�tndards CITY OF �\ Massach , 0CMR SALEM dMar m 1 Revised Mar 20!l Building Permit Applicatio�n}} o qq�st��ppc[, a f&%Rrhovate Or Demolish a One<u�� T Fa7n(lyy4l elkng This Section For Official Use Only Building Permit Number: Date Ap ied: Building Official(Print Name) igna ate SECTION 1:SITE INFORMATION 1.1 II rgnertv Ad dregs: 1.2 Assessors Map& Parcel Numbers 1.[a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq III Frontage(II) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.QL,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' Record• f q J10 ✓�1 10LV)inSJ' _ �e� {r �/f 0117C) Name(Print) �� City,Slate,ZIP f� (� 15 S t,. 1/✓l �V�- 7 61 q1 Q �1�5 0 ��l t N'a�wr�'bf 4o�Yic. .C Ovcl No.mid Street 'telephone Email Adaress SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': JVt {Cv i o� t•�r�c%, dt r y�<', _ cGt �....e� SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 16 ,66 G 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/town Application Fee GGU ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (BVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ I GDU ❑Paid in Full ❑Outstanding Balance Due: M A-, , I 0 1 V U S -e SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1,47 r ' •License Number Expiration Date Name of CSL Holder •� ,Lis,CSL Type(see below) _y 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 Siding 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 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. 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. Print Owner's or Aut orized Agent's Na e(Electronic 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 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.niass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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"Total Project Cost" nor' CITY OF S:,LzNf) A-kS&kCHUSETTS ©L'[LOLNG DEP.IR- E.NT 120 Ct/.ISHLNGTON STREET, 3W FIAOR.dt.�, •1,'•` T EL (978) 745-9595 K!J®EIiLcY DRISCOLL F.VX(978) 7.104945 itiL1Y0.`l T�{056iS ST.P[ERRS DIRECTOR OF PUBLIC PROPERTY/BLM.DLNG CONNISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Debris, Building Coda, 730 Ci!�1R section l l I.5 m[d the provisions of tNIGL c 40, S 54; Building Permit a is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal racility as defined by t�IGL c 111, S I50A. l'hc debris will be transported by: (name at tauter) The debris will be disposed of in .(name of taellity) — —_---(address of(aeillty) fislta I el'mlt.1 PP by CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHNGTON STREET,3RD FLOOR T'EL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL. MAYOR TY-IOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date y� Job Location / 5� r A v.- Home Owner Address is gtr.� Av-cAve— The . Present Mailing Address j S S,�, 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 pe, 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 INSP