15 SUTTON AVE - BUILDING INSPECTION ' The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEiv(
Massachusetts State Building Code, 730 CMR Revised Mar 2011
1 Building Permit Application To Construct, Repair, Renovate Or Dem ' h a
One-or Two-Family Divelling
Chis SectionForOfficial UseOnl
Building Permit Numb6r:,'. Date Ap ted ;
Building Official(Print Name) ignature
S ECTION I c SITE 7NFOIL�GITION
Ll ProFerty Address: 1.2 Assessors Map& Parcel Numbers
S i cvt Avy-
L la [; 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 ft) Frontage(it)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required- Provided
1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private O Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if ycsC3
SECTIONZ:: PROP.ERTY'OWNERSH7Pt '.
2.1 .. t of Record:
J e � 06 76
\/ Name(Print)G Lr. City,State,ZIP( 5 SG+aro%t 1 ��IN�t1 �vSp iP)1Ntalr 4.G ,Sa �N6�n+t, r v�
No.and Street Telephone j Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKr'(check all that apply}
New Construction❑ Existing Building❑ Owner-Occupied ❑. Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Dzmolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Workt: ,{-a t
SECTION 4: ESTIMATED CONSTRUCTION COSTS-
Estimated Casts:
Item 0Mini Use Only
Labor and�.laterials
L Building $ 0 iM 1..Building Permit Fee:'S' Cndicdte now fee is determined:
2. Electrical g ❑Standard.,Cityf town Application Fear
❑'Cotal Project Cast(Item.6)x multiplier x
3. Plumbin; 2- Other Fees: S
1. Mechanical (IIVAQ 5 — List.
i" Mechanical (Fire 5
"total All Fees!5_
5 Cluck No. _Check Auwunt: ---Cash Aowuac
Fatal Project Cost. _
X, 00o f O I wl in Full ClClOnUt:mding IkiLtncc Lue: ---
sr,crION 5: CO:Ns•i-RUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Namc ofCSL Ifolder
List CSL Type(sea baluw)
Nu. and Street type I I Description
U Unrestricted Buildin s up to 35,000 cu. 11.
R Restricted U2 FamilyDwelling
City/Town,State,LIP 'I \4asonr
RC Rooting Coverin
VS Window and Siding
SF Solid Fuel Burning Appliances
( I Insulation
'rele hone Email address E=D Demolition
5.2 Registered Home Improvement Contractor(111C)
MC Registration Number Expiration Date
I IIC Company Name or II IC 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 PEI IIT
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
rBymy name below, I hereby attest under the pains and penalties of perjury that all of the information
this application is true and accurate to the best of my knowledge and understanding.
or Autlwrired:\gent's Name(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 ;
(nut registered in the Monte Improvement Contractor(HIC) Program), will not have access to the;arbitration
program or guaranty Lund under M.G.L.c. 142A. Other important information on the IIIC Program can be found at
vww m:us.eoe%oCa Information on the Construction Supervisor License can be found at avww.uras .,n+�'dL
2. When substantial work is planned,provide the information below:
Total floor area(mi. 11.) _(including garage, tinished hasemendattics,decks or purch)
tiros; living:uea(sy. III _ Ilabimbleroom COMA
_
Nwnbcr of tirrplaCes ---- Number of bedrooms
Number othathr„ ni Numberofhalbbatlis ---__----
I'cpe of heating iystcnt ---_,-- Number of decks; ,arches
1)pe of Cooling iy:tein Enclosed -- !1pcn
`I',,r,il I'n q,,a iyu.ire F„nt.i,r" w.ry he illb;tinit:J f;,r"I' t.il Project Co'C'
CITY OF S.0 ENf
PUBLIC PROPERTY
DEPARTN, LENT
u o..►sr o�auxa,
w.oe
�]a a'�a+w.�oe tnasr� l�taa+.�sysra rsrn Ot f'0
ttL rtirsfvff!•v.a f't.t�e.�W
HOMEOWNER LICENSE EXE34PT10►N
Plesw lriat
Dats
Job Local" 15'
Home Owner Address
Hams Owoo Telaphrsns n x t y za g t
Ptmeot Mailks Address
The current a xanpdon of"homeowners"was extended to inchrde owner-occupied
dwellings of two Units or leas and to allow such homeowners to engage an individual for
hire who don not poxes a licenser provided that the owner acts as AgWWswt:
DEFINMON O/HOM80WN=
Parton($) who owns a paeal otlaad on which WAS resides or laterdo to reydde, on .
which there 1; or is intended to be, a one or two timily dwellhsg, attsahod or detached
structtum accessory to such use and/or rarm atructurm A person who constructs mars
hall
than one home in a two year period s not be considered a homeowner. Sueb
"homeowner"shall submit to the Building Offidal,an a forth aceeptable to the Building
Ofllci4 that hdshe be responsible for all such waft performed Permit under the Building
The undersigned "homeowner"umnes responsibility for compliAmst with the State
Building Code and other applicable by4awh and relstladon&
The undersigned "homeowner"cerdAa that hedshe understands the City of Salem
Building Department minimum inspection procesdtua and requirements and that hdshe
Nill comply with said procedures mad r ui ens
HOMEOWNERS S1GNA TLRE
APPROVAL OF 9UILD6YG 4YSPECTGR
See other side far suto code
CITY OF S.I -&Nf, LbL155.lCHUSETTS
U E11'ILD4YC DEP.14t3tE`iT
120 WA3J4WGT0,4 STirE&T, 3e F20OS
`'�•u rEL. (978) 145-9593
xl.%f0 U-EY DRISCOLL FU't(973) 7.10-9344
'%LkYo Z -I11a 1N$sr.PIEam
OfaECTOR OF PULIC PROPERTY/gt;MDLVG CCNOUSSION EA
Construction Debris Disposal AftIdavit
(required for all demolition and renovation work)
fn accordance with the sixth edition of t(te State Building Cade, 730 CjWR section l 11.5
Ocbris, naid the provisions of b(GL a 40, S 54;
Building permit a is issued with the condition that the debris resulting from
this work shall bo disposed of in a properly licensed waste disposal
111, S 150A. facility as defined by iL[GL e
Thu debris will be transported by;
(name a 'hauler)
The debris will be disposed of in :
----(idJres.v of ra:ilit/)
;i•;came• 'permit applie. —