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15 THORNDIKE ST - BUILDING INSPECTION
� " � � � -� ° `�dC c-(,� � �"�Ssa- -- -_ - - _ _ --- • _ _ �, I'hr C'i�miiioii�c�alih uf Mus�;irhu�clts Iluurd ul'13uilding Rcgul;�ti�ms ;uiJ Stmdards C'I'I'1' Uf r� '�� ti,\LGAI � �p ,, ��1;issarhtuctts Siatc DuilJing CuJc, 730 CbIR 'L,,„1 Nd risa�d.I Lu�_'ll// 1 13uilJing Pennit Applicatiun To Construct. Rcp�ir. Rcnuvatm Or Demulish a 1 lhir• ur T�rn-Funiilr U�rrlli�i,�, I, � -- Thi�Sictiun F�r(>17iciul U+x Onl — _ BuilJiny Permit Numbcr: Date:1 plieJ: - G � �/7 IuilJiny 011icial(Prial N;unc) S' urc p��� SECTION I:SITE INFOR�I TIO � I.I Property AJJresf: 1.2.leeawn��1 p.f� Punel Numben � —i S i v�ct�rt�l_�rso, S�-• 3 3'�-OD2.+.}-0 I.la Is ihis an acce tad slreet? -a no ����P N���»h« I'urc.l Numlxr I.,1 2anln� Infonnutlon: I.� Property Dlmenelon�: �. 145 Arrrc /.oning Dielricl PnipoKJ Uvc Lal Arcu(sy It) Pronlagu(Ill I.3 BuIIdInQ Setbaclu(R) Fru�u Ywd SiJc Y�nlf µ��Y;v� Rayuirod I'ruviJed Reyuircd Ikovided Nnyuind 1>ruviJeJ � � I 1.6 �Vw-ter/Supply;�M.G.I.c.JU,§Sa) 1.7 Flood Zone Informatlon: 1.8 Sew�ee/Dbpo�N System: Ih�blic fy/ Pri��atc O Zoni: _ Uubide Flood[una? Muniei el�On sila die au1 s vtcm O CM1CI'IIIY 'C9O P P�' )� SECTION2: PROPERTYOWNERSHIP� 2. Owner'of Reco � �'ir-k-� ��S �r�,\ ew� tii�F � e1q'� N;una 1 Prinl �/ C iqt Slatc.l.IP �hUr✓l�l l:�P.� �H'� (}� Nu.;ud S�m¢t f m rphune Fmuil AJdmas SECTION]: DESCRIPTION OF PROPOSED WORK�(tAcck rll thrt apply) Naw Construction Eristing Building O Owner-Occupied ❑ Repairs(s) � Alteratfon��) O Addition O Demulition ❑ Acassory 81dg.❑ Nwnberof Unite 7. Other ❑ Spuciiy: � �riafDescriptionofProposed Work=: �,� X,,�Gj 1 Siv2u .2 C[,�1 C2�Qpp i � SECTIO�V �; kST1�1.�TE0 CONSTRUCTION COSTS ������ Estinto�ed Costs: 1 Lahor and.\I�trrialsl Of1lclql Use Only I. DuilJing S oJ I. Building Pcrtnit Fee: f Indicate how f'ee is JetrrmineJ: i '. l:l.eiri.al 5 O Siandard Ciry�Tu�m Applicaiion Fee � ❑Tunl Projeet Cust�1 hem 61 x muitiplier _.__x � 1. I lunihing S '. Olher Fees: S - - - � J. \I�cli.iniial ill\' 1t'1 i �' Lisl: ' � \Iedt.miral iFin -- '---- ---'----- -.-."-- . . - . � � Cu�uesiiunl S futal ,U� Fres� S_.._ - _ —__ .-- -- ___...._ . . � ('hrcA Va. (�hecA:lmuunt: l',uh �\ni�nuu: ' �� Tuinl Prnject CmC i ❑Paid in Full ❑OuISLwJing Ifal;uice Dur: CC �. , St:("I'ION S: t'I)NS7'RI�C'fIO`1 tiENVI('F.S SJ Cunstructiun Supen'isur License lCtiL) _ _._ _._ ---- — I ictns¢ Nwnhar I��piraliou ITdle . .... .. __..__. .....---- - Nama�il'CSLILdJcr ... .. _._' ___ " li�tl'SI. I'��wl�echelu��l.'__ _— _ . .._—_ _'-_._."'—__ �I'�� I)cstripliun U��. ,md Slnel '�"—'--�'�"'-��'� �I 1�nn.viacJ iDuiWin�y�i l0 15,U110 cu. II.1 ` p __ .._"—_----.. . . R Re,IricleJ I�31�.imil D��ellin X �I 11awn Ciqifu��n.Rlal¢.LIP R�Mdin Curcria RC' N'ti N'ind��w•mJ tiiJin � tip tiuliJ I'uul Iluming i��1PI1JI1lC1 � Insululiun 1'.I. hunc — h:m:iil:idJrc.a D Dumolilion t,2 RrYletcreJ Ilume Impruvrmrnt Cuntnulor IFIIC) I IIC Rceisl—��� If cpirntiun I)Wv I IIC Contp�n) N,una nr I IIC Ragislrwil Namu J� �:ITJI�J��RY! ``/ Nu. mid Sw¢t /\ Ci /Town, Slnte,ZIP felc hone SECTION 6:WORKERS'COM1IPENSATION INSURANCE AFFIDAVIT(M.G.I..c. IS2.� ISC(6)) Worken Compensaeian Insurance uffidavit musl be completed and submitted with thif application. Failure to proviJe this aflidavit will result in the deniel of Ihe Iseuance of the building permit. Signed Aflidavit Attached? Ya .......... � No......... O SECTION 7�:OWNER aUTHORIZATION TO BE C0111PLETED WHEN OWNER'S AGEIVT OR CONTRACTOR APPLIES FOR BUILDINC PERMIT ub'ect ro e ,hereby authorize I, as Owner of the s � p P rtY to act on my behnlf,in all mntten relotive to wark euthorized by this 6uilding permit applicaUon. D�te Prinl O�mci�Nwne lElccuunic Signuluro) SECTION 7b:OWNER� OR AUTf101tIZED aGENT DECL�RATION By entering iny nnme b:low. I hereby attest under the poinf und penaltie�of pery'ury that ell uYthe infurma�iun contain d in this�ppli na ' true and accurate w�he beet of my knowledge and understanding. � �"� '� IhiN lhuier'���r:\uih�rci •d,\gam'e N;unu Ilikclrunic AignaWro) DuW vo�rEs: I. .�n O��nar��ho obiains a building parmit to do his har uwn �rork,ur nn owner��ho hirc�an unrcgisicrod cumr�ctur �nut registared in iha Hume Improvemant Contracror IHICI Progroml,��ill no have acces� to�ha zrbitntiun program ur gu�r;mty 1'und undar\I.G.L.c. I J'_.�. Uthcr impun�nt inl'urmmion on the HIC Progrun ran ba li�w�d ai ������ il�.�.. ��,� ,�..i Infom�ation un the Construction Supen•isor Lianse can be found at����" I��.I•: �_'� ,I�" ? �1'hen subs�:vilial�wrk is pl;mncd, pru�iJt ihe inful�'Io1luJinglcaraga. linished b�s.m.nt anics.Jccks or purclu I'atal flour arc�1 sy. IT.1 _ ------ Fl;�bi�able ruum cuunt _. .... . . ._ . liruis li�inq drea liy. Il.l _... - _.. . - — -- __ �umhcr oi b.Jruunu � \wnb.rol�lircpliccs ... ... _. . . \umbe�uf'hall'haihs .. _ . . . . i \uniher af ha�hrowns . . � . . �wnb�r oj d..ks, p��rclns I � ���ld�lI�1G11101� i1 il¢Itl . . - I..11`� �,i� ..O�iv0 i �1��U P� iOU�IIIL i�ildl❑ � 1. "��il,l� ��f���CCI \��II;V� �'OOId�C�� Ifl:l\ be �uhsiiiwcJ ti�r'f��i,d Pr��jca('�ut.. � � � �..� . .: ,J.,� __ _ _ __ T -- - - �...,..- - . " � *���•f � ` . - " CIT'Y OE S.�I.E,.tit PUBLIC PROPERTY DEp�x��.tvr �,,,.....0�'aYL � . . w.�a� i�e sw,w�al+.an•s.ua�ws�owmn an'o . � �Tri.f-f7�i9sf! � Y.ut f'i7+O9W � HO�N�OW�IEA LICE.rSL EX�.1�iPTI0�1 Pfe.s. rrt,e DW -4 a-' 2- !ab Loeado� ( c5 Ti�..��.r�,�k-0 �-, � ` Hom�OMna�Ad�ear . Hom�O�votTelephoo� q�-fl- �.10-s7"7 Ptr�oat Mailia�Addiear Th�current ezempdos o!"Iiomaownms"w�extmded oo includ�ow�mr-0ecupied daeUlnas otnvo Unib a fw�od w allaw�ucb homao�vnart w m�a�m individual for hitt w6o.dod not poa�aY�Iteeist�providad that th�ow�c�act�a�aupatvisor. DEFIIYITION Op HOMEOWNEA Pasoo(a) w6o o�vn� �pared otlaod os whleh Ed�catda or tntand�to ratd�. on whkh then i� or ii inteaded w b�, a an�or twro fl�mily dweWnf, attaehad or daached etructura �ceeswry to nuh u��nd/or farm equctura. A penoo who comauat�more �haa on�hom� in a two year period�haU not b�conadaed a homeowner 9ucA ..homeov►ma"�hall �ubmit w c!u 9uitdin�OQleial, on s fortn �eeeptabl�w th�8uildino Of!leial, �hat hd�h� b�raponiibl� fot all aueh wo�ls peafortnod uador cho 8uildinQ Pamit Th�undmi�ed "hameownd'ununa«opanaibiliry far complianc�wicb th�Stat� 8uildin�Cod�and orha ipplieabl�bp�lawa u�d n�uladoru The undmi�ed "homaownd'certifla thai hd�!►t undmtandi th� City of Salem 8wldin� Oryartrnrnt rninim�un i ation prac ura snd «quirrmrnu and chat hd�he .vill camply with �aid proeed�ua requitem u� HOLIEOWYEFL9 S(GYATL .�PPROVA(. OF 9UILDI�IG 4�'SPECTOR � ' O See o�ha siJe far sate cai� , � ' 1 , .:, CITY O� S.ILE,�(, �tiL1SS.lCH(.'SETTS f3l.�LOLVG DEi.1RT1�E.\T I 'O 1�.liHNGTON ST1lFgT� )'�FZaa1� ` �`. R+1,. �97� �;l�9S9S !U\�EALBY DIl1SCOLL F.�x(9�� 7a4984d 1�UYo1l Mo.w Sr.Pr�ua Dr�a�oP a:sccC vRave�ry/ecu_o4vC CosnnucovE� Con9tructtoa Debr1� Df�posal Afftdavlt (required for�ll demolitlon and renavation work) �n �cccrdance wi�h tha �ixth editlon otthe Stata Buildinq Cade. 190 CMR section I l 1.J Oebria, and the pcovi�iona cf kCL o 40, 914; Buiidiny pertnit p i� isaued with the condltton that the dcbria re�ulting from ihi� wurk�hall be di�posn!of in �properly licecued wmts di�poarl fsciliry y� daftncd by��IGL c 1 I I, S 1 JOA. The debria will be tran�pertcd by: (n,+ma u1'haulu) The debri� wi II ha dispo�ed of in : _ F!l i I�er � (nam� of pciluy) (�Jdreflaf'f�.�l��y)� . � i�� �rut �(„umif ipplicinf —_—,—__— :�ia , , .ii , . __.._-_.__ � ._-____...__._ _.. .______. ._._._.._..__._....._._.,_,._.....___.._..._.__...:_._,_..__'_._'_._________.__ i, . � I I I I �. I `"^---.,.".-..._ �.._ ' - � ' _.....__„_`-�...__ ��l�r�� ��I l7 .Zn n --� � i —�- -.,. I � "^.,-"'"`��-e..._.� � �� } �15.D�`-.._.,�--�� � � � - _ ._ __ � �.��� ... _ � _, ; i2,� � - --- .i___� �— � --,._.. --._.-- j I Io.D - - - i `'� ' � � � � � � i -- - - - - - - -.- -- ---,--- i � _ �fv�o�� z2x22 I , Ii { ��S�cn�y 2. ��� l ' �� � � C,.arn.�L i ;' i, � l � � � � J � i I l ! � I ; i � � � . i . � � '� i � � � � � j , ,�- �- � n o -- -- �, -�- J-- - --- j ' I� J� �� . 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