39 TURNER ST - BUILDING INSPECTION (2) t
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State BuildingCode, 780 CMR, 7"' edition OF SALEM
Reviseddanaaty
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 2008
One-or Two-Family Dwelling
his Section For Official Use Only
Building Permit Number: Date Applied: 20,
Signariu'e:
Building Comm domed h - ctor of Buildings Date
SECTION 1:SITE INFORMATION
LI Property Address: 1.2 Assessors Map& Parcel Numbers
39 Ti,trner Spree-+
I.I a Is this an accepted street?yes,*,. no Map Number I'mcel Number
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 Required Provided
1.6 Water Supply:(M.G l-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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.11 Owner'of Record:
-3 9 Tu,l?r�E2 SA-
le(P)inn Address for Service:
7/ o7
Si ahue 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 ❑ Specity:
v Brief Description of Proposed Work':
-hl X r otf-n G C•o d-r- OVe( Q.ttiQ o17 toh t eh t-AhCc wa
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
�. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
/� /vrn Check No. Check Amount: Cash Amount:
v 6. Total Project Cost: S tP v 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Dale
NameofCSl.-Holder - List CSL"fype(see below)
Address I ype Description
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 Family Dwelling
Signature M Masonry Only
RC Residential Rooling Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signauuer- - - 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 CO TRACTOR APPLIES FOR BUILDING PERMIT
S :"on 6 L0,l.�feOCC�
I, O " , as Owner of the subject property hereby
rA autl a e.-q c r e Se mpe, F1 gq ?I—S to act on my behalf, in all matters
relative to work autl prize7by,,is b ilding pe mit application.
S i lure of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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.
I'rint Name
Signature of Owner or Authorized Agent Date
(Signed under the pairs and penalties of erju )
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"
CITY OF SALE.NI
PUBLIC PROPERTY
DEPARTMENT
curaxL
Vwvw 130 WA206C ON STUW•SutK%L%&A 3&3ff 17 0191
HOMEOWNER LICENSE EXE.MMON
Please Friel
Diu QV-dam
MbLocados 39 TtArrier �ee�
Home Owner Addreae 3 R Tu r h-e r
Home Owner Telephone 7 fr-7 t/(/-7/!J 7
Presaot Mailing Address 3 y' Tu rK4. S-4 7t,
The 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
him who does not possess a license,provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons) who owns a parcel of land on which he/she resides or intends to reside, on
which them 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 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"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and reguladons.
The undersigned "homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATL
APPROVAL OF BUILDNG NSPECTOR
See other side for state code
,A CITY OF SALEM
6mr PUBLIC PROPRERTY
DEPARTMENT
\I J„M I�Q�.tdll.\b:�lV)1'Mkli �S•1tI M.M.\"M II1J 1.,.1'1 .
frl:v7t•TJS9;93 1°.\t:'J71.7lS'1MJ(1
Construction Debris Disposal AMdavit
(required lur all demolition mid renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building I'ertnit q is issued with the condition that the debris resulting froth
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
I11. S 150A.
The debris will be transported by:
SerV, peg FI Z� (1�1v. vS
t name of hauler)
The debris will be disposed of in
Nort �. sia -e,,
(mane ul'laullty)
(address ul'facility)
gnature of Ixinut applicant
o �- aO -, -ol a
date