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81 VALLEY ST - BUILDING INSPECTION (2) t Q The Commonwealth of Massachusetts Town of 1 t—, Board of Building Regulations and Standards 'Massachusetts State Building Code, 780 CMR. 7"edition Building Dept �I► ` Building Permit Application To Construct, Repair. Renovate Or Demolish a 1 One- or Trio-Fmrtilt,Duelling This Section For Official Use Onl Building Permit Num er: Date Applied: Signature: Building C ssioner/Ins t o Buildings Date SECTION 1: SITE INFORMATION LI Psrroperty Af Press: - 1.2 As�son Map& Parcel Numbers =" S Ma Parcel Number 1.Is Is this an accepted street'!yes_ no ✓ D Number 1.3 Zoning Information: 1.4�PProperty Dimensions: .,Y C cc Zoning District Proposed-Um Lot Area(sq it) Frontage III) 1.5 Building Setbacks((t) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40.154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIPt 2.1 Owner of Record:� Name(Print) Address for Service: 419 . .a�� Signature Z Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition Cl Demolition 01 Accessory Bldg. O Number of Units_ Other ❑ Specify: Brief Description of Proposed Work-: I.� E '� `» Q C SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials I. Building,. f 5+�� I. Building Permit coFe f Indicate how fee is determined: ❑Standard City/Town Application Fee 2 Electrical f C G 4 r ❑Total Project Cost'(Item 6)x multiplier x J. Plumbing f 2. Other Fees: f 4. Mechanical (HVAC) f List: S .Mechanical IFire f Total All Fees. f Su ression Check No. _Check Amount: Cash Amoune h. Total Project Cost. f �S �, 0 r ❑ Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date N.;Ime of CSL- Helder a Ltst CSL Type(see below) Address Type Description U I Unrestricted(up to 35,000 Cu. Ft.) Signature R Restricted 1&2 Family Dwelling M Masonry Only RC Rcstdcmial Roofin Covering Telephone WS Residential Windowand Sidm SF Residential Solid Fuel Burning Appliance Installation D I Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signarure Telephone i I SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6)) Workers Compensation Insurance affidavit must be completed and submined with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... O No........... O SECTION 7a:OWNER AUTHORIZATION 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. St rum of Owner Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare r that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. P t Name Signature of Owner or4Curhonzed Agent Date (Signed under the pains and penalties of perru 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 W 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 I IO.R6 and I IO.R3, respectively. 2. When submanlial 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 halfbaths Type of heating system Number of decks/ porches Type of cooling system Enclosed - Open 1. "Total Project Square Footage"may he substituted for"Total Project Cost" CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT Im 0 *&,IsLir.. 'f1tt:v7N+i�1i9! �E.�x:97L7�t:vW Construction Debris Disposai Affidsvit (required for all demolition and renovation work) in accordance w ith the sixth edition of the State Building Code,780 CAIR section 111.5 Debris,and the provisions of%4GL a 40.S A Blinding Permit N . _ is issued with the condition that the debris rcmddnS Atom this work shall be disposed of in a properly licensed waste disposal facility as defined by MIGL c I I L.31.90A. The debris will be transported by: tune of hauler) me debris will be disposed of in (awne of iauAty) CITY OF S.u.E.Avf PUBLIC PROPERTY DEPARTIMENT uarninr^•�•,� TEL 9-L143-99s •FAX 978.7+&9" HOMEOWNER LICENSE EXE.MMON Pleass "I Date $ o Job Locatives Home Owner Address SV-2 .c b. Home Owner Telephone Present Mailing Address g i ✓C The current exemption of"Homeowners"was extended to include ownw-accupied dwellings of two Units or less and to allow such homeowners to engage an individual for hire who does not posses a license,provided that the owner sets as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwellin& 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 Off vial,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"asaunes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. 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 SIGNATURE _ APPROVAL OF BUILDING INSPECTOR See other side for state code 27 ft pool 00 shed N � Deck 4 ft deck garage house n MWI�M E INSPECA'ON PLAN NO. ' 81 VALLEY STREET IN SALEM, MASS. MIDDI4$S X, "SURVEY INC.- LAND SURVEYORS 131 PARK STREET ` NORTH READING, MA 01864 SCALE 1"= 50' DATE.• MAY 1, 1998 CER77F1ED TO. UNION TRUST MORT. CORP. i f EASEMENT i LOT 135 N SPLIT W/F NO. 81� 87.00 VALLEY STREET P�j" F44 " 2�� c 3QQ Lp D. _ f ALL N: r NOTES: ' ff 1. OFFSETS ARE NOT-TOiBE'US'E jq ESTABLISH PROPERTY LINES. �cl 2 LOT UNES.ARE�OOMPILEO*INFORMATION. SAL LAW REGISTRY OF DE€DS (3ESSEX ) CM,T 38503 1 HEREBY'CERTIFY.BASED-�ONIMWKNOWLEDGE INFORMATION AND BELIEF THAT THE STRUCTURES'�ON.THIS' P&N `ARE,IOCAaTED 4 ON THE GROUND APPROXIMATELY AS SHOWN AND.CONFORMS;WIT#i THE�Cff- OF SALEM ZONING SETBACK REQUIREMENTS AT THE TIME'OF C©kST iCTiON AND THE PARCEL IS NOT IN A FLOOD HAZARD AREA AS SHOWN ON FEWM°A MAP. " COMMUNITY NO. 2501�0"E: C EFFECTIVE DATE: 8/5/85 P9814 �� hJ �' / •" '�4 r�{} ��'V(i h'Cr pal ,''!I t � � W I I I FI I M 10 ry O / 6 m 111 a�\g IN Al j 1 60 v F D'a ` e l 0 � '1 j aF ao 0yg 44) �9A6` °1. sy cY ° W h Ab O / e a\ti\ \0.. fat, e'ye aI7�°p �° ^0 1��h lbs< o�ee O \61 ,e � h� ah Prye . O a Hti M p0 ° b of 1 a1h p 1 ��, o tot ��pg <V os 10 � O q. 16 � y�o N a yo yy a9 . r< hM a. \ N p,M�p p� m° Vol lb Dry V �p� it p ee m Y cotik alb Ap gh p0. O v��ONO[Tq�O\ l?I? CITY OF SALEM, MASS City of Salem-City Electrican ELECTRICAL PERMIT APPLICATION FOR WIRING PERMIT 44 Lafayette Street Salem MA 01970 Tel:978-745-6300 Fax 978-745.4638 NO: 932 FEE: 60.00 'El New Work Date:5/10/2006Old Work erviceThis Permit is granted to o. of MetersCLIFFORD ELECTRIC INC License # A14435 lectric Sign siding Address 4 PICKMAN ROAD SALEM MA 01970 978-745-1314Tel# asPump For the Electrical Installation at wiming Pools/Tubs 81 VALLEY STREET Cell# __ ❑ Voice Data outlets Owner GARY TRAN ❑ Range Occupied by SAME _ ❑ water Heater Address SAME Tel# ❑ Dryer Gas-oProposed Work NEW 200 AMP SERVICE/POOL _._ ❑ No.Of Burner No.Of Circuits ❑ No.Of light Fixtures Received By 10-10-06 _._ ❑ No.Of Recpt i Outlets Electrical Official _._ ❑ No.Of Motors g p# JOHN J GIARDI ❑ Space/Heating/Kw Utility AUTH NONE ❑ Fire Alarm system M.E.N Date Industrial 0 Commercial El Condos Used For Dwelling g a ❑ Burglar Alarm Signature of Applicant ❑ Smoke Detectors __ ❑ HVAC Units __ ❑05/12/06 SERVICE O. K. JJG Other (specify) 05/12/06 POOL O. K. JJG FOR OFFICE USE ONLY 06/05/06 NO AUTHORIZATION # ON RECORD AT NATIONAL GRID ANGELA JJG Rough Inspection The fee for new work new construction or repairs ) shall be three dollars 3 Final Inspection $1,000.00) of the valuation as shown on the building ) Per one thousand dollars $15.00 minimum 9 permit. Fee scheduless available upon request Each permit