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FIELD COPY
CITY OF SALEM BUILDING
i SALEM, MASSACHUSETTS 01970 PERMIT
Ta
�Dp9NE
DATE 4/5/88 P 138-88
AnnelieAe Seitz-,Mond ADDRESS 13"L King St. Groveland Ma. 01834 owner
APPLICANT (CONTN'S LICENSE)
(N0.1 ISTR EE
Inspection of Wood Stove NUMBER OF
PERMIT TO Imo) STORY DWELLING UNITS 1
IlrPf Op IMPROVEMCNTI C. IPp DPD5E0 USE)
lvgish St. Ward 1 DISTRICT R-2.
AT (LCCAT ION) )STREET)
IND.1
AND
BETWEEN ICpDSa STA EE TI (CROSS STREET)
LOT
SUBDIVISION LOT SLOCH SIZE
BUILDING IS TO BE FT. WIDE H, FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP < BASEMENT WALLS OR FOUNDATION
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REMARKS: Ins ion of Wood Stove
PERM 1 T
AREA OR
Pied a)� Armrrrved .tJV �, Cha_-P EST)MAT EO COST -- FEE S TIE: nn
VOLUME
aC UBIL 50UARE PEETI
OWNER Anneliese SeitZ-MM-d / DoncilaS E. :rund
ADDRESS
132 Sing St. Grovel.are7 Ma, 07.834 gs J. "
Inspector of Buildings J.S.
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS :NiPECTOR
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct;Repair,Renovate Or Demolish a
One-or Two-Famfly Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied: _
Z 2S 1
Building Official(Print Name) Sigaatme I I U0 Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Na bers
14 ENGLISH ST 41 -0114-0
1.1 a Is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
R2 SINGLE FAMILY
Zoning Disfitct Proposed Use Lot Area(sq R) Fmntage(ft)
1.5 Building Setbacks(fl)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) L7 Flood Zone Lrformatiou: 1.8 Sewage Disposal System:
Public O Private O Zoae. _ Outside Flood Zone?
Check IfycM Municipal O On she disposal system CI
SECTION 2: PROPERTY OWNERSEHA
2.1 Owner'of Record:
ADAM BREAZEALE SALEM, MA 01970
Name(Print) City,State,ZIP
14 ENGLISH ST 865-696-0823
No.and Street Telephone Email Address
;SECTION 3:DESCRIPTION OF PROPOSED WORKS(deck an that apply)-
New Construction O Existing Building 6 Owner-Occupied 6 Repairs(s) 0 1 Alteraticn(s) O I Addition ❑
Demolition O Accessory Bldg'.O Number of Units Other M specify;
Brief Description of Proposed Work:
REPLACE 19 WINDOWS-NO STRUCTURAL CHANGE
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item aAbor and Materials OYHdalUse Only
1.Building $ 31,193.00 1,,Building Permit Foes$ Indicate how fee is determined:
2.Electrical $ O Standard City/Town Application Fee . 1
[7 Total Project Costs(Item 6)x multiplier x
3.Plumbing $ 2. Odier Fees: $
4.Mechanical (HVAC) $ List'
5.Mechanical (Fire $Sion) Total All Foes;$
31,193.00 Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 13 Outstanding Balance Due.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-06-14
JAIME MORIN License Number Expiration Date
Name of CSL Holder
List CSL Type(am below)
86GARDINERST
No.and Street Iype Description
LYNN, MA 01905 Ll Unrestricted(BuiWings up to 35,000 an.ti
R Restricted 1&2 Family Dwelling
City/fown,State,ZIP M Masonry
RC Rooft Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2200 X 55285 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-15
RENEWAL BY ANDERSEN HIC Registration Number Expiration Date
HIC Company
Name or TUC Registrant Name
No.and Street Email address
NORTHBORO, MA 01532 508-351-2200 X 55285
City/Town,State,ZIP Tel one
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(11LG.I-c.152.¢ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failtma to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........® No...........Cl
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUIIAING PERNTiT
I,as Owner of the subject property,hereby authorize JAIMEMORIN
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 • WNERr OR AUTHORIZED AGENT DECLARATION
By entering my name b ow,I hereby under the pains and penalties of perjury that all of the information
contained in this app on is true accurate to the best of my knowledge and understands .
�r l
print Owner's or A is Name(Electronic Signature) Dau
NOTES: „
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an umWstered cordractor
(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
www.rass.aov/oce information on the Constuction Supervisor License can be found at w nL-m-q s.gn*1
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or powh)
Gross living area(sq.fL) Habitable room count
Number of fueplacwv 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"maybe substituted for"Total Project Cost"$31,193.00