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3 WILLOW AVE - BUILDING INSPECTION G 4117 g� The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code 7SSggPPgg CI R.CEp�1'E� ReviseALEM2011 Building Permit Application To Construct,Repair,Renovate Or Demolish�a E One-or Two-Family Dwell, This Section For Official U n Building Permit Number: - :Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1 1.1 Property Address• 1.2 Assessors Map&Parcel Numbers aUr�� 3 w,GGoty �rc., .v�, 33 oarµ g 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZgrS.s 40' Zoning District Proposed Use Lot Area(sq It) Frontage(ft) 1.5 Building Setbacks(It) 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)l Private❑ Zone: _ Outside Flood Zone? Municipal On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' - 2.1 wnerr of Reco C rd• / / 0 �� /p•/�!� a r r n r! d r /J7a r b e a Name'(Print) City,State,ZIP ' 273 PCeg.gg- 5 ' 31J.5 No.and Street - Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ Existing Building Owner-Occupied� Re pairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Z Other ❑ Specify: Brief D c tion of Proposed World• 7`c! �� S ¢l� k z ��esd' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials - 1.Building $61061D--- 1. Building Permit Fee:.$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $5-000•— ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $s tj o oD 2. Other Fees; $ ,r`�✓� 4.Mechanical (HVAC) $ List:. !/1/ 5.Mechanical (Fire $ Suppression) Total All Fees:$ X 6.Total Project Cost: $ Check No.in Check Amount: Cash Amount: J 6�� ❑Paid Full ❑Outstanding Balance Due: s~�l� G 1 i✓� di SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date + Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address 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 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my time below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner'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 n3ny mass. Quin loci Information on the Construction Supervisor License can be found at ww�i•.mass. ov� /dns 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"may be substituted for"Total Project Cost" QTYOF SALEM, MASSACHUSEM , ! BUILDING DEPARTMENT 120 WASHNGTON STREET,3AO FLOOR TEL. (978)745-9595 FAX(978)740-9846 KINMERLEY DRISCOLL MAYOR TI-IOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date Tu,g MN-ow ,"/� Z O is Job Location 3 MN-o w d✓ekuie� Home Owner Address Present Mailing Address 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 hire that does not possess a license, provided that the owner acts 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 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 understand the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with such procedures and requirements. / HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING INSPECTOR aCITY OF SALEM, MASSAC RUSETTS BUILDNG DEPARTMENT 120WASHNGTON STREET,3' FLOOR TnL(978)745-9595 FAX AX(978)740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLICPROPERTY/BUILDING COM USSIONER 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 c40, 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 deposit facility as defined by MGL c 111, S 156A. The debris will be transported by: (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) 7 - nature of applicant Z Zt Su w z o l 5— Date Unofficial Property Record Card Page 1 of 1 Unofficial Property Record Card - Salem, MA a General Property Data Parcel ID 33-0448-0 Account Number Prior Parcel ID 51 -- Property Owner CLARKE STEPHEN J Property Location 3 WILLOW AVENUE Property Use Two Family Mailing Address 3 WILLOW AVE Most Recent Sale Date 7/31/1996 Legal Reference 13686-347 City SALEM Grantor DACY ANDREW W Mailing State MA Zip 01970 Sale Price 162,000 ParcelZoning R1 Land Area 0.067 acres Current Property Assessment Card 1 Value Building 198 000 Xtra Features Value Value 0 Land Value 96,700 Total Value 294,700 Building Description Building Style Multi-Conver Foundation Type BricklStone Flooring Type Hardwood #of Living Units 2 Frame Type Wood Basement Floor Concrete Year Built 1880 Roof Structure Mansard Heating Type Forced H/Air Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil Building Condition Average Siding Aluminum Air Conditioning 0 Finished Area(SF)2229 Interior Walls Plaster #of Bsmt Garages 0 Number Rooms 10 #of Bedrooms 4 #of Full Baths 2 #of 3/4 Baths 0 #of 112 Baths 0 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 0.067 acres of land mainly classified as Two Family with a(n)Multi-Conver style building,built about 1880,having Aluminum exterior and Asphalt Shgl roof cover,with 2 unit(s),10 room(s),4 bedroom(s),2 bath(s),0 half bath(s). Property Images a � It vo Disclaimer:This information is believed to be correct but is subject to change and is not warranteed. http://salem.patriotproperties.com/RecordCard.asp 6/24/2015