3 WEST TER - BUILDING INSPECTION (2) ; >;
v '�, -- I'he Cummum�ralth ul Massadwscits — _
, s�. i� y 13uurJ uf 13uilding Rcgul:uions anJ Standards CI'I'1'OF
�!`�V, � ��lassachusctts Statc [luilding CuJe. 730 CbIR `,\LG��I �
�ti.,., x,-��.,,-d.ii�„ �ni�
13uilJing I'ermit i\pplication 'Po Cunstruct. Repaie Renuvate Or Demolish u
I _ Onr-ur Tuu-Fuwih'Dmt!(in,p I
�1� Phis Srction F� OlFicial Use Onl
J UuilJing Pemiit�umbcr. __ D�tr:�pplied: ---- I
�
�4 � � I
UuJding OI}icial(Prinl N;unc) Siµ�mW Duta
SECTION I:SITE IIVFOR�I,ITION
.I Pro erty Addrese: 11 Assevon biap& Pnrcel Numben
� ir�t-�sr fi�Rz�°a�
I.la Is Ihis an acce tad street?yes no ��1��P Number I'urccl Numhcr
I.J Zoning InformuNon: I.� Praperty Dimenalana: I
Zuning Dislrict Prnposcd Ux Lut Arca I+y Itl fronlagc�tl)
I.S Buflding Setbaclu(it)
Frunl Yard SiJc Yuds Hcor Yurd
Reyuircd Pruvided Reyuircd Pruvided Reyuind PNVIlIC1I
1.6 Water Supply:(M.G.I.c.aU,§Sa) 1.7 Flood 2one Information: 1.8 Sewxge Obpoaal System:
Public 0 Pnr�t�❑ Znnn: _ Outsida�load'Lune? ,y�unici al O Qn sitn Jis aul s ��ain ❑
Checkif ss0 P P�'' >� '
SECTION I: PROPERTY OWNERSHIP'
2.1 �1��) '�e9YrL�k'IG
�x Lrx���� ��y'I , /�°i.A-� D(q7o
N;unc 1 Pnnq C ily.Slatc.l.IP �
� UIY� T�K�� �lS-37pq _ �LIdQ!?�Ar�iil2l�i%O�d'Kl�t � !?'1
Nu.and Strcel . Telephune F.m� I Addmss
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that npply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repuirs�s) O Alteration�s) O Addition ❑
Demulition ❑ Accessory Bldg.❑ Numberof Units Other ❑ Spccil'y:
�riaf'DescriptionofProposed Work=: '
I
SECTIO�V J: ESTI��IATED CONSTRUCTIO�V COSTS
���i�� Esiimated Costs:
i Labur and.\latarialsl Ofllcial Use Only
I. �uilJing 5 I. Building Pertnit Fee: S Indic�te how f'ee is detennineJ:
'. [Icctric�l S ❑Standud CityiTuwn Application Fee
❑Tui�l Project Cust�I l�em 6)x multiptier _.. r
� �, Plumhing S ?, Uthcr Feas: S
� J. \Icch;utieal ill\�.\('1 S List: � � ��,/-,/�
— ---- v�
' S. \Icchaiural ifirc
� tiu+ttaisiunl � ToCil .\II FCes: $ -- .—'.—..—'_'- ----..._.. .
G Chak Vu Chcck:linuunt: (',uh liuounl:
' �,, Tut�l Prnjccl Cush i .J�� ❑P:iid in Full ❑Owstandiny Oal;mcc Duc: I
� �
�� �'D � l d�aU� .
t..:, r
serrioN s: c onsrRnrnon sr�kvu rs
S.1 (bnstructim�Supeniwr License�CSI.)
I.icense Nwnhcr Pcpiralion I)ule
._.----------- .._._- -'. ...__.._.—..._— '-
' �\':un¢��I'C.til. IlulJer
I is!Ctil. I)�n I���halu��l---'-
__.-__'—.._______'._—_ ._.__._..__._-- 'I��� I)c5cripliun
��i. anJ tilryct
U l�nrc.uicicdlDuilJin�sii tniS.U110.u. 11.1
----------.... - R HeslricteJ I�?fumil � D��cllin
Cii�ifu�w.S�;rtc.LIP M1I �I;uun
RC R�xrlin Cuvcrin
..._. W'ti N'indow:mdtiidin
tif tiolid Puul Ilurning Appliancca
I Insulution
'fcic hunc Fm:iil;iJJrc,. D Dcmoliliun
� t1 Rrgletered Ilume Impruvement Contr:ictor(t11C)
I IIC Itagi�uatiun Numlxr f cpirnliun UW�
I IIC Cumpan� NIIIt1C Uf I IIC R¢�ISIf0111 N�1110
Nu.mid Sv�et L'mail aJJresy
Ci /Town,Starc,ZIP f el. hunt
SECTION 6:WORKERS'COMPEIVSATION INSURAIVCE AFFIDAVIT(M.C.L.e. 153.9 ZSC(6))
Workers Compensa�ion Insurance affidevit must be completed and submitted with this applicetion. Failure to proviJe
this atTidavit will result in the deniel of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........O No........... O
SECTION 70:OWIVER AUTHOIi1ZAT10N TO BE C0111PLETED�VHEN
OWNER'S ACENT OR COIVTRACTOR APPLIES FOR BUILDINC PERM1IIT
I, ae Owner of the subject property,hereby authorize
to a•t on my behnif,in all matten relative to work authorized by this building permit application.
����� `
�. Pri O��ncr's N�une(Elcctmnic Signuwrc) D'JlC
� SECTION 7b:OWNER� OR AUTFIORIZED AGEIVT DECLAR.ITION
By entering iny name below, I hereby auest under the pains and penalties of perjury that all uf the in(ormotiun
contained in ihis application is true ond accurete ro ihe best of my knowledge and undersmnding.
I'ri111 ONItCf i IR:\u111Uri7C�r\6CIIl'X VIIIOC(1'.ICclfUOil'.tii�O;UUfL') n�l�
�O'f ES:
I. :�n Owner �rhu ob�ains a building permit m do his.har uwn wurk,ur an owner who hires an unngistered cuntrncwr
�nut registered in ihe Hunu Improvemem CunuacWr�HICI Programl,�vill nu h�ve access to�ha arbiu�tiun
prognm ur yuar:mty FunJ under\I.G.L.a i�_'A.Other imponant inf'urmation on ihe HIC Prognm��n be limnd at
��u�� n�,r.. �.�,�� ����i Informaiiun un ihe�unstruction Supervisor License can be found at��)���.��i.���g;�� ���»
�. \1'hen subsiamiai��urk is plannrJ,pru�iJe tha inl'urm�tiun bclow:
Tuml Iluor arc�I+y. ft.l- ----..-1 including garegt. tinisBed bascmcnt attics.dccks ur purch l
�I , C;ruiili�ing,�realsy. it.l -_- -___--__- _ Hobit:iblaroum.ount .
� \unibcrol'lircplaccs.__ ..-- - _ . _ ..._ Vwnherol'bcdruunu
-- -- -
_.._- - �- -. . .
i \innhrr of haUvumiu , _ Vumber ul'half'haihs
' I\pu at hca�ing s�;tem . .. . _ \'umher ol d.eks, purchcs . � .. _ I
, i
i �\4�C��I CJU�III� i�ilClll �:Ili��fiC� _ ..�1���11 �
I
i1. "I�UI;1� 1'fUjCCttil�ll;lfl`I'UUI;ISC��Itlll\ I�C>11h>Ii1ltlC� liV••�I�U1;111'f��fl'CIC���11,•
.
.� 1:t
,� ClTY OF S.1L.E.�t, �tiL�SS.ICHL'SETTS
9CILDLVC DEP.1RTtFNT
I?0 W,t�HLVGTON$1AEg't� )'O�,000.
T�L (97� 1�S-9S9S
KJJ[HEAL6Y DR13C0[1, F.�X(97� 7#98.{S
.tilAYOA Ilio.►W ST.Prp.us
DIItEGTOR OP Pl.'8LlC PROPEp7y�Hl'p,��G CO\L�1155fONE�
,,,,
Constructtoa Debrls Dlsposal. Attldavtt '
(required for all demolition and renavation work)
In accardance with the sixth edittan of the State Building Code, 780 CMR section 1 l 1.S
Debria, �nd the proviaioy of MGL c 40, 9 54;
8uilding Permit M ia isaued with tha condition that the dcbria resulting f�m
�hia work�ha11 be disposcd of in a properly licenaed wayte dispoeal facility aa dcfincd by MCL c
I 11, S I SOA.
The debria will be Unnsportcd by;
�•�l�!-�.
(n;une uChauler)
The Jebri� will ba disposed of in :
(name o��jy) "—"—�—
�
(�Jdraf oY fa.ililYl
��
fiyn�mre ofpermit�pplicanf .
`� � l
�ld�e ��
I�nri.�if 6�
.> �
;' CITY OF S.�I.E.tiI
PUBLIC PROPERTY
� DEP�#RT.1.fENT
[�.Q..�Y 0�W�V 1
w.a� i�v�w�r.�dlnas►o sK++a V,�,�oassm aH�o
M f'1•7ii7sf9�Y.ut f'L7r69W
HOHEOW�IEA LICE.rSB EXF.riPTI0�1
P1ew h1�t
Dat� iJ /
Job caado�a 3 W�3T ?�k'�AG�
HomrO�vn�Adm^ea�_a t�C�� TY�-°��,S,q'i,�'1M,/l�+ �/�I7o
Homi O�ar Telaphoa� . s ' '
P�eaaot M�ilia�Addrar � i� , " � O '
Th�current acempdoo ot"Homeowneas"war actmdad eo ineh�d�ow�n�-0eeupiad
daellin�o[nvo Unib or le�and w alla�v meh homaow�oen w enQa�m ind�vidua! tor
hire who.doa mt pou�a liem�prAvided that th�owmar actr ar aupa�viaor.
DP.FIIVRION OF HOMEOWNEA I
Penon(�)w6o ow�u�p�ee)o[taod oe whfch hd,+hr redda or iatandr w raid�,on
whicb then i� or i�inteadad to b�,�ac,�or nw famity deveWn�.attaehad or detaehed
�wctura uceawry to auch u�and/or f�rm eqveturp. A penoo who con�wcti mors
thao one hom� in� nvo year paiod�hal!not b�eoaddaed s homeownar. 3ueh
'.famaowmar'ahall wbmit w thr Buildin`OQlcial,on s form accrytabl�w tfu Buildin�
Otl'fcial, that hd�lf�b�resporoibt�for�II�uc6 work perfocmed uadar tlu Buildins
Permit
The undmi�ed "homeownd'an+ma re:ponaibiGty tor compliane�witA tht Sht�
Buildin�Cod�and othar opplicabb by�lawh utd rc�ulatioru.
7ha undeni�ed "homeownd'cerdRa thal hd�ht undmtandi the Ciry of Salem
Bwidin` Departrnrnt minimum irupaction procedurp and requircmrnu and thu hdshe
�vill eamply wi�h �aid procaduta utd requiremmu.
H01�1EOWYERS S[GNA7L'RE ��/,�/`iLf�c,�
.>PPROVAL OF eUfLD .NG L�iSPECTOR
Ses o�ha side for snte cod�
.�.. �. �
_
: r.,
Susan Lockyer
_ � �
q � ar�chifecf
IN FICL W�4ll es.5
REmOVE EXIST.D40R ��p�,-5, 5��N � NEW TOILET
5AVE FOR REUSE � NE4V VANIIY�SISJKS
REmOVE EX�ST. REmOVE E%I5T. REIOGaTE EXIST. 3 west terrace
PORTIONOF PLUm61NGFIXTURES ClOSETDOOR � NEWTUB/SHOWER sale�r , �ea04970
NOh4lC�aD BE�4RING +a55NOWN TOREPL4CE EXIST.
WqlL,a55HOWN (995) 37Q9059
_ . � NEW
� CLOS. .
' Q —
_ o
_ f
y
,
. A Lockyer-Groccia
_ ���i�!@n��
EXISTINGIDEMO BATHROOM FLOOR PLAN RemO��I
� NEUU BATHROOM FLOOR PLAN
. . SCA�E�1f4=1'-0r . .. . . . 2 ��SCA�E�7f4=1-0' . . . .
3 ►ties�t terrace I�
� sale�v . �ra 04870
NEV!VANIfY LIGMT NEN+ RKESSED
i�cMr
ISSUED FOR :
REmQVE EXlST. REmOVE EXIST.WAII
CEIIING IIGMT , ���r P9�MIT 1 ir28r11
FI �
NEVI SHOWER LIGNT
TO R EP IACE EXIST.
SCALE : ,AS S NCY,1�N
DRAV4N BV : S�
REUSE ERI5TING
IIGHTSWITCNES �10B NAME: ��K7ER-GRQCCtcS F;ES.
- JOB NUM�R:
��EW BATHRQOM ELECTRICALPLAN
�
� `� SG4�E�ifC=T-0� .. .