14 UNION ST - BUILDING INSPECTION (I The Commonwealth of Massachusetts
I I ' Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM dMar
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only /
Building Permit Number: Date pplied:
')) 1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMAT N
1.1 Property Address: 1.2 Assessors rcel Numbers
14 Union St, Salem MA 35 279
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R-2 R-2 .057acres 39ft
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(it)
Front Yard Side Yards Rear Yazd
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 M Private❑ Zone: _ Outside Flood Zone? Municipal® On site disposal system ❑
Check if yes®
SECTION 2: PROPERTY OWNERSHIP"
2.1 Owneri of Record:
Michael Paul Navarro Salem, MA 01970
Name(Print) City,State,ZIP
14 Union St 978-660-3017 mnavarro@thelagassegroup.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ® I Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work!: Renovation of existing Kitchen & Bath. Selective
relocation of interior non-load bearing walls.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
1.Building $ 5, 000 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 2, 000 ❑Standard City/Town Application Fee
❑Total Project Cosy'(Item 6)x multiplier x
3.Plumbing $ 2, 000 2. Other Fees: $
4.Mechanical (HVAC) $ 500 List:
5.Mechanical (Fire $ 0
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 9, 500 ❑Paid in Full ❑ Outstanding Balance Due:
0,157
0,00 HAS 70= Ili a
Nl� 01g70
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
103960 5/25/2013
Michael Navarro License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
14 Union St
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
Salem, MA 01970 R Restricted1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Bunting Appliances
978-660.-3017 mnavarro@thelagassegroup.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
165971 4/12/2019
Michael Navarro HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
3 Pleasant Hill Rd mnavarro@thelagassegroup.com
No.and Street Email address
Hopkinton, MA 01748 978-660-3017
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 PERMIT
I,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
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in on is true and accurate to the best of my knowledge and understanding.
6 u �
er's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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 can be found at
www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
2. When substantial work is planned,provide the information below:
Total floor 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"maybe substituted for"Total Project Cost"
Demo all Flooring, Plaster Surfaces, Partitions, & Fixtures
In Shaded Area
0
Wall & Chimney to Remain
p _ Navarro Residence Renovations Date:
/16/2012
b
14 Union St, Salem MA
Scale:
Proposed Demo Plan 1 /4" = 1 '0"
Q
Rd. Wi0
own
a
A _ Navarro Residence Renovations Date:
/16/2012
6
14 Union St, Salem MA
Scale:
Proposed Floor Plan 1 /4" = 1 1011
CITY OF S.UMN4 UNSSACHUSETTS
BUMDLNG DEP,kRTJt&N-r
120 W ASHNGTON STREET,Yo FLOOR
TEL (978) 745-9595
FAx(978) 740-9846
KI\tBERLF-Y DRISCOL
MAYOR 'I1-toat.►s ST.P[ERRH
DIRECTOR OF PLBLIC PROPERTY/11CULDING COMMSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and rcnovation 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 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 MGL c
111, S 150A.
The debris will be transported by:
"My- WAW S�S7EMSI T14
(name of hauler)
The debris will be disposed of in :
_ &SfLiA
(name of facility)
Z Sr . PEA/ MA
of facility) /
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a e of permit applicant
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CITY OF S.u.E%f
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXE.W4PTION
Pleaw t
Dam6 zI miz
Job Lacadon ()
Homy Owner Address
Hoom Owner Telephoas $
Preeed Mailing Address I R fk
T-de current exemption oC'Homeowners"was extetded to include owner-occupied
dwellings of two Units or leas and to allow stach homeowners s to engage an irsdividual for
hire who dos not possm a litenso provided that the owner acts as supervfaa'
DEFiNMON OF HOMEOWNER
Person(s) who owns a parcel Of WW on which hdshe resides or intends to reside. on
which thane Is, or is intended to bs,a one or two &tnily dwelling, attached or detached
structures accessory to such use and/or farm structures. A parson who constructs more
than one home in a two year period shad not be considered a homeowner. Such
"homeowner"shall submit to the Building 0a7ciai,on a form acceptable to the Building
Official, that he/she be responsible for all such work perforated under the Building
Permit
The undersigned "homeownd'assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulation&
ne undersigned "homeowner"certifies that helshe understands the City of Salem
8uulding Department minimum inspection proced es and requirements and that hdshe
.vill comply with said procedures and requir
HOti1E0WYER$ SIGYATLRE // [�
.APPROVAL OF SUILDNG WPE OR 14A�
See other side far state code