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83 TREMONT ST - BUILDING INSPECTION (3) -2013 b-72S The Commouweaith of Massachusetts Board of Building Regulations and Standards CI'rYOF n , Massachusetts State Building Code, 780 CMR' SALENI I Revised Mar 201! Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling 'f his Section For Official Use el . Building Permit Number Dot pYedi", Building Official(Print Name) -Si re Date e SECTION L Sl �. FORINIATION 1.1 Property Address: 1.2 Assessors tVtap& Parcel Numbers 1.la Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: '71 Via Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks (ft) Q Front Yard Side Yards Rear Yard f" t Required Provided Required Provided Required Provided � � N 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System: t Zone: Outside Flood Zone? Public Private❑ — Municipal On site disposal system ❑ Check if esid SECTION 2, PROPERTY'OWNERSHIPL 2.1 Ownert of gecor� T coGlGj !✓', Acuia Name A(Printnty City,State,ZIP 1 O'/ v K— 0 �7`r (�J a—8 j f)—4di n o(Jjj)J he-bo,S 0,I) f D je tT 1117 f No.and Street Telephone mail Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction ❑ Existing Building Owner-Occupied Repairs(s) Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of f roposed \Vork3: C E / Sr 0::�'44EMfZ Go v IGf �oUIvD -• ! S J - NO SECTION 4: EST ILNUTED CONSTRUCTION COSTS 950P,4N51 tb N Item APR 2 3 2013 Estimated Costs: Official Use Only, Labor and Materials I. Building $ I. Building Permit Fee:S Indicate how fee is determined: Q Standard..Cityf ruwn Application Fee 3. F"I«trn,tl $ ❑Total Project Costr(Item 6)x multiplier x 3. Plumbing i 2. Other Fees: S t. •M chanical (Il%'AQ S List: _ i. ,Medmoical (Kira $ -- Sn rres,ionIbtal :\Il Pces:.$_ Check No. __Cheek Amount: hush Amount I ---- ---n I'ntal 1'rnjcct Cost i / ` ❑ Paid in Pall ❑ Outstanding ISal.utcc Una: ma's� �cflata�� �o ly oN ueA�u �G� �— 51sC'I'ION 5. C(Y.NSTRUCT ION SERVICES 3 IQ 5. Construction Super r License (CSh) � i2 20 . // gr. j5g IC )OVM License Number Gspiruiva Date tame of CSL II lolder lvC, List CSL rype(see below) y p Descri awn T G � � -- rvC No. and Street Ii nrestncmd Duildin's u to)i,000 cu. lt. v �'�'�}�j R Restricted I°e3 Fumil Dwellin City/Town,State,ZIP iI tviasonr �� _ RC ©[ Ruotin Cuvarin fNNN\... �l,rVr/b WS WindowundSidin' Tr SF Solid Fucl Pluming r\pplianas rotation W 7 I li T � ass� d Co D Demolition `L l'cle huno Email address 5.2 Registered Hone Improvement Contractor(t1IC) HIC Registration Number Expiration Date I IIC Company Name or MC Registrant Name No.and Street Email address City/To n, 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 .......... (3 No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COhIPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of st 'act property,hereby authorize - L G VZO MF' to act o my a all in all matters relative to work authorized by this building permit application. Print Ow u. ' n Electronic Signature) ate t SECTION 7h: OWNERt OR AUTHORIZED AGENT DECLARATION WO�e, 13 anterin m na ne below, [ here attest under the pains and penalties of perjury that all of the information Y g Y the best of m knowledge eontatne this a plican s true and ccurate to h Y a and understanding.g _ 4 2� I Data Printwncr s ut writal \,cat'sN. �(Etccrunic Si nature) NOTES: I. ;\it owner who obtains a building permit to do hisiher own work, or an owner who hires an unregistered contractor (tot registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration progrun or guaranty Ilutd under M.G.L. c. 142A. Other important information on the HIC Program can be round at www.ma;;. uv oc;t lnfonn:uion on the Construction Supervisor License can be found at wwww.m;ui t�tt_wljt_: 2 Wit substantial work is planned,provide the information below: Total floor area(;y. lt.) --___ _(including garage, tinished busamenVattics,decks or porch) Kibitablo room count _— Nuntbcr of tirrplecci Number or bedrooms - -- . ----- — Nuuahcrnfh.dr'baths ---_------_.__--- Numbar — rcpeorhe.uin�; ;y,;lcitt NnmbcroFdack;;por.he; I?uclo;cd ttpQn l�,�,'t. ,,r" ut.tyhc ;nl?:lilut:,If. r 'I' t.ill'n3'1,xll_od'--- - . - - Y I e( CITY OF S.ULE-Nf, INLSSACHUSETTS BI;ILONGDEP.IRTIENT 120 WASHNGTON STRE� �. ET, "O 3 FLOOR �' TEL (978) 745-9595 :CIJf3ERLEY DUSCOLL FAx(978) 7-10-9345 �.UYOR TX10.%EU ST.PIEM DIRECTOR OFPULIC PROPERTY/8CILDLVG CONNISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance will' the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of tb1GL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by NIGL c l 11, S 150A. The debris will be tr..utsportcd by; 1zt5A( sue{ , `t(IG . (name of hauler) '('he debris will be disposed of in _X-111C� c� 4��. (name of fa it �IvD PEA_ vV, MA of quo (�ddnss of twilit/) signamrc ofpermit applicant APR 2 3 2013 lift: . %II..Ili I.'♦ I CITY OF slu- .el 1/ PUBLIC PROPERTY DEPARTMENT w.o...st o.unYL %"was 1]07UowMM1111010 WAK VAMAO&sernetf-e ru.Y►7,Lfs"•VA&f'L71Q.fW HOMEOWNER LICLNS6 EXE.r "10M Pfew "I Date APR 2 3 2013 NN AA Job Laeadon � Home Owner Address Home Owner Telepboae - ! Psount Mailing AddraM >� A-C -G The currant exemption of"Homeowners"was extended to include owner-occupied dwellings of two Units or fees and to allow such homeowners to engage an individual for hire who does not possess a license provided that the owner acts as supervisor. DEFINITION OF HOIZOWNER Persons) who owns a parcel of land on which he/she resides or intends to res1de6 on which there is, or is intended to bo, a one or two ramify dwelling attached or detached structures accessory to such use willor 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"assume responsibility for compliance with the State Building Code and other applicable by-laws and regulations, The undersigned "homeownd'certifies that he/she understands the City of Salem Building Department minimum inspection pro d ts and requirements and that he/she Will comply with said procedur uir �n HOMEOWNERS SIGN RE APPROVAL OF BUILD . NSPE OR See other side for state code