32 WALTER ST - BUILDING INSPECTION r
1 Z The Commonwealth or Massachusetts
Board u1'Building Regulations and Standards CITY
Massachusens State Building Code, Igo C•MR, Tu edition OF SALEM
RrrirrJ Junrnrrr
Building Permit Application To Construct. Repair, Renovate or Demolish a
One-or rlvo,.Aumoly Dwelling
This S tion For Official Use Only
Building Permi Num r: Date Applied: 417 O
Signature:
Huil ' g Cumm spore or of Buildinip Data
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Ma J Parcel Numbers
3L Wa flee g Sg leer, i M.A P
I.la Is this an accepted street?yes no Map Number Parcel Number
IJ Zoning lnformatkrn: 1.4 Property Dimension:
Zoning{District Proposed Use Lot Amo(sq 11) Frontage(11)
1.5 Building Setbacks fit)
Front Yard Side Yards Rear Ysrd
Required Provided Required Provided Required Provided
1.6 Water Supply:04.G.1.c.ao•§St) 1.1 Flood Zone Information: 1.8 Sawnge Disposal System:
Public Private❑ Zone:._ Outside Flood Zone? Munki
Check if es❑ pV On site disposal system O
SECTION 2: PROPERTY OWNERSHIP'
2 1 Ownert of Record: 3Z
SlN�lr•, Mom, l: a.�P�
Nume— (P..') �q �9 Address for Service:
Sie�urq/ 7elephoro
SECTION 3: DESCRIPTION OF PROPOSED WORKS(cbeck aB that apply)
New Constnrction❑ Existing Building❑ 1 Owner-Occupied ❑ 1 Repairgs) Alteration(s) ❑ Addition (3
Demolition ❑ Accessory Bldg.Cl Number of Units_ Other ❑ Specify:
Brief De npdon of Prop0ose,d,1�W, ork': -
` `L9 a'C' q•d �- /LPL.) 4 L-be-
L j5E e / o
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: ORlclal Use Only
Labor and Materials y
I. Building S ) I. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S IIIStandard City?own Application Fee
❑Total Project Cost'(Item 6)x multiplier x
). Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
S. Mechanical (Fire a
suppression)) S Total All Fees:S 3
Check No. _Check Amount: Cash Amount:
6. Total Project Cost: ist�1J ❑Paid in Full 0 Outstanding Balance Out:
r �
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Espirslion IAtle
Name art s.'SI.• I lulder Lisl C5L Type(see below)
f at Description
.%JJmss U llnre>lricleJ Jupto IS,OW Cu.Ft.
R Restricted IA2 Forth U%tllin
Signature M M Oni
RC Residential Raclin Coverin
I'dephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Imlallation
D Residential Demolilion
5.2 Registered Home Improvement Contractor(HIC)
I IIC Cwnpany Nam ur HIC Registrant Name
Registrslion Number
Address Expiration Dam
Signature 'felephune
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. ISL{ 2SC(6))
r
ompensation Insurance affidavit must be completed and submitted with this application. Failure to provide
it will result in the denial of the Issuance of the building permit.
idavit Attached? Yes ..........a No...........O
7a:OWNER AUTHORIZATION TO 8E COMPLETED WHEN
S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property hereby
to act on my behalf,in all matters
work authorized by this building permit application. -
Si um of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1 as Owner or Authorized Agent hereby declare
that the/statbe nts and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
F L
P ' IN -.-¢� - / 0 12) /-0
Signature Ow' or Authorized Agent Date i
Si untkr the pains and Penalties of 'u
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 d(have access to the arbitration
program or guaranty fund under M.G.L.c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations 1 IO.R6 and 1 IO.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 healing system Number of decks/porches
T)pe of cooling system Enclosed ()pen
). "Total Project Square Footage"may be substituted for"Total Pmjecl Cost"
CITY OF S.X1X-Nf
PUBLIC PROPERTY
DEPARTAtE.NT
wa�atar n••••••�
Vwroe 1 b WAaMINf.UN anaaT•&ALM NwsAAlttai'IS 0t1'0
raL V&7+5-9s"•F.%x 978.74&994
HOMEOWNER LICENSE EXEMPTION
Pkaw "t
Date %r, 2 10
Job Locatiaa vh
Home Owner Addrm 3 Z Wcl I er S1-
Home Owner Telephone - -6V 8- 7s s- 9-3 3 0
Pressnt Mailing Addrew -;L (;Jg I i S
The current exemption of"Homeowners"was extended to include owner-0ccupied
dwellings of two Units or leas and to allow such homeowners to engage an individual for
him who.does not possess a Bearer provided that this owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons) who owns a parcel of land on which he/she residas or intends to resider on
which there 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 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 uiremrnts
HOMEOWNERS SIGYATLI E jc f-�
,APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF S.U.&N1, AxSSACHUSET s
• BU:ILLWNG DEPARTMENT
120 W.xiHLNGTON STREET, Yo FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KINIBERLEY DRiSCOLL
MAYOR TrtOAtAS ST.PIERRH
DIRECTOR OF PUBLIC PROPERW/BUUMLNG COM!%l1SSIONFR
Construction Debris Disposal Affidavit
(required for all demolition and 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 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 wi II be transported by:
Sk✓e Me; ll'o le I
(name of hauler)
The debris will be disposed of in :
(name of facility') q
(address of facility)
/ si nature of permit applicant
date
arndu�r.a.k