6 TAFT RD - BUILDING INSPECTION (3) f l
The Commonwealth of Massachusetts CITY
Board of Building Regulations and Standards OF SALEM
Massachusetts State Building Code, 730 CMR, 7'h edition Kevised Januar'v
Building Permit Application"fu Construct, Repair, Renovate Or Demolish a 1. 2008
One-u un- tmilvDfwellin
his Sectio For OtUse Onl
Building Permit Number: ate Applied: `
' 3t25 • ll
Signature:
Building Cu ivionerl inspect rut' ilJings Date
S TION 1: SITE INFORMATION
1.1 Property Address: f7 1.2 Assessors Map As Parcel Numbers
m— Ma Number Parcel Number
I.la Is this an accepted street?yes_ no_ p
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided =RequiredProvide)1.6 Water Supply:(M.G.L c.qo,§5J) 1.7 Flood Zone Information: em:Zone: _ Outside Flood Zone? l system ❑Public O Private❑ Check il' es❑SECTION 2: PROPERTY OWNERSH
2.1 Owner'of Record:
IeO�-�5
Name(Print) Address 1•or Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': GCG d/'L �1 d
/�� It
SECTION J: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. Building S I. Building Permit Fee: S Indicate how tie is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
q. Mechanical (IIVAC) S List:
5. Mechanical (Fire Suppressionj S Total All Fees:S
Check No. Check Amount: Cash Amount:_
6.Total Project Cost: S �DOO 0 Paid in Full ❑Outstanding Balance Due:
r ,
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) '1� �iZO/Z
License Number/ 6 Expiration Date
Nam}•..If(.'St.-I folder
SS -ST/`1SC��r GGI�i// List CSL I)pe(see below)
:\JJres ft PC I Description
I I 1!nrestricrcJ(up w35.000 Cu.FtJ
R I Restricted 1&2 Family Dwelling
Signature M Masonry Only
RC Residentiat Routing C'oeerin
elcphone WS Residemiat Window and Siding
SF I Residential Solid Fuel Burning Appliance Installation
1) 1 Residential Demolition
5.2 �teT��m�l verJe-t o c r(H�Q� /5-�? �T5C,9
I IIC Company Nam r I IIC Registrant Name Registration N tuber
�1, �vs7sc
AJdrc
Crpi ,lion Date
Signature IleTelephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 AUTHORIZATIrON 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.
Si atu of Owner Date
SECTION 71b:OWNEW OR AUTHORIZED AGENT DECLARATION
1• ,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 Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of r'u
NOTES:
I. 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 trot have access to the arbitration
program or guaranty fund under M.G.L. c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.145,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basemem/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 -g
Enclosed Open
J. "Total Project Square Footage"may be substltuled ror"Total Project Cost"