32 WILLSON ST - BUILDING INSPECTION The Commonwealth of Massachusetts
/� Board of Building Regulations and Standards CITY
14 Massachusetts State Building Code, 780 CMR, 7"eJition OF SALEM
!y/ Revised Jommry
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 2008
\�(J One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: to Applied:
XSignature: 0Building Commissioner/Inspeetor of Buildin' Date J
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�( ?Q wi//SoN SL
I.1 a Is this an accepted street?yes P-11_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(ft)
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: 1.9 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if es❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
sP,efi)r � 2dsT 32 vl////can/ �1✓ S/I/ 1
Name(Print) Address for Service:
f� �rr�/ �aevi,2y✓ g7S- 479 /376i
Signature ' Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: 011tclal Use Onl
Labor and Materials y
I. Building S 1. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S ❑Standard City/'Town Application Fee
❑Total Project Cost(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire S
Suppression) Total All Fees: S
Xheck No. Check Amount: Cash Amount:
6. Total Project Cost: S
d Crd (7 ❑Paid in Full ❑Outstanding Balance Due:
` 33 vlt�2 cists��
F
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name ol'CSL- I lolder List CSL Type(see below)
.f Description
Address U Unrestricted(up to 35,OD0 Cu.Ft.
R Restricted I&2 Family Dwelling
Signature M Masonry Only
RC Residential Rooting Coverin
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address Expiration Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152. 1 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...........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.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
xAW K S)Q NC- -6 R
Printr,?-,,� D
Signature of Owner or Auth rized Agent Date
(Signed under the pains and penalties of perjury)
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 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 I O.R6 and 110.115, 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 heating system Number of decks/porches
Type of cooling system Enclosed Open
3. 'Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF SALEM
PUBLIC PROPRERTY
#I DEPARTMENT
I'.W MIt 1 '4" .'•I1
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art •,:r.�a}'„vs .t�1r:vn•;�a's+a
Construction Debris Disposal Atlldavit
(required Our 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 he disposed of in a properly, licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris will be transported by.
h„ rs �l: F
Inann of toupee)
1'he debris will be disposed or in
(11WMof NO sty)
/
S/ 0 Z Gib�1i"�
Iaddrnsuf racduy/
signature or 1wrnut applicant
dart
CITY OF S.U.E.NI
PUBLIC PROPERTY
DEPAR NIENT
K o.
4wro. 130W.AdFacTtW9,.rsr•Smxj4%Azw34Ls„sou9ro
tta.97.misss99 r•..x.978-746994
HOMEOWNER LICENSE EXE.r MON
Please Prlat
Date 5- -2 - 90)V
Job Locatim 3 2 W IIISoN S7
Home Owner Address 3,2. W//Vee 1v
Home Owosr Telephone 97C- 9,2 9 t 3 7
Present Mailing Address !/ !yr /btl x e, A zl& ,V k 6 A AIT- M h
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 who,does not possess a license.provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons)who owns a parcel of land on which he/she resides or intaxle to reside. on
which there is, or is intended to be, a one or two family dwelling, attached or detached
stnrcnres accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shaU 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 requirements.
HOMEOWNERS SIGNATUM
,APPROVAL OF BUILDING NSPECTOR
See other side for state code
The Commonwealth of Massachusetts CITY
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 71°edition ALEM
ReOF S January
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1, 2008
One-or Two Family Dwelling
"�Thi"s,$'echon`For,Xriicn'I Ue Only ,
Buildipg.PetmitNumber• `IJate Applied: 00
Signature rt 5 ! -Z `6
Building onuaissioner/Inspector of Buildings -
< ' SECTION 1 SITEsINFORMATION.'r `
1.1 P�r�op�erty�A�ddress: 1.2 Assessors Map&Parcel Numbers
oil
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Is l Zoning District, Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑ .
SECTION 2 PROPERTY OWNERSHIP)'
2.1 Owner'of cord:/ /
Name(Print) Address for Service:
>,k 2 `/ i/ `/ rYO
Signature Telephone
SE N-,3:DESCRIPTION OF PROEOSED'WORKZ(check allthat apply)
New Construction ❑ Existing Building❑ O caner-Occupied� Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units 1 Other ❑ Specify:
Brief Description of Proposed Work 2:
a
ACTION 4: ESTIMATED_CONSTRUCTTON COSTS'
Estimated Costs:
Item Labor and Materials v ="� OfScial Use Only.
1.Building $ 1 Building PennitFeI $ Indicate how'fee-is determined:
2.Electrical $ ❑Standard:City/Tdwn AppliedtiotFee'
❑Total Protect Cost'(Item 6),x multiplier x
3.Plumbing $ 2.,Othe Fccs
4.Mechanical (HVAC) $
5.Mechanical (Fire $ '
Su ression) ll Fees $1
Cheek No Check Amount: _ Cash Amount:
6.Total Project Cost: $ �� 0(:- ❑Paid in Full , O Outstanding Ralance Due:-
IA
SECTION 5 COIVSTItUCTION,SERUICES
5.1 Licensed <Construction Supervisor(CSL)
Mi , lf L `' 1�2°�� License Number Expiration Date
Name of CSL-Holder List CSL Type(see below) V
� P l/I r Lc_J-GIG' �- I)`�(`S `, T ;,s a ••4-Description
Ad(ress��m�'� °
F y� j��� U Unrestricted(up to 35,000 Cu.Ft.
A.�C _ R Restricted 1&2 FamilyDwellin
SignCa�ture A / M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Re ister_e H e I provement Contragt��IC) I�
HIC Cot�pan Name or^ C Rjg � L-. Registration Number
AddresG� w" 7k,7 � .�'� Expiation Date
Signature / Telephone
C.
SECTION 6:WORKERS'COMPENSATION INSURANCSIAFFIDAVIT, 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...........❑
ST CTION,7a:OWNER AUTHOItIZATIONTO BE,COMPLETE;D UEN'
OWNER'S-AG ENT:IIR.CONTRACTbR AEPLIES`FOR BUILDING PERMIT
I as Owner of the subject property hereby
authorize G� c+ w� to act on my behalf,in all matters
relative to work authorized by this building permit application.
Jo
Signature of Owner Date
SECTION 7b .OWNER','OR QUTI30RIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and informatio on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
� l
Print Name ' �=
Signature of Owner or Authorized Agent' Date
Si ned under the sins and Densities of r'u
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.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 heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cosy'