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6 FLYNN ST - BUILDING INSPECTION r F - The Commonwealth of Massachusetts I— Board of Building Regulations and Standards Town of Massachusetts State Building Code, 780 CMR, 7""edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Fawih'Duelling This Section !Ficial Use•OnI Building Permit N mber: atf 4ppli4 Signature: h /v23to Building Commissio erl lnspectoe dings SECTION 1: SITE INFORMATION 1.1 Propert Address: ,y.... / /,, 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street'?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(R) 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? Check if yesO Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wrrg of Ricard: / YSrchtz�a Intl �.1�arlec1 ��ttutpylf f'l( Narne(Print) Address for Service: S' na re Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) O Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number ofUnits Other R specify: Brief Description of Proposed Work': i/1,5f 7F SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials L Building S 1. Building Permit I": S Indicate how fee is determined: 2. Electrical 5 ❑Standard City/Town Application Fee ❑Total Project Cost°(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees: S . Check No. _Check Amount: Cash Amount: Total Project Cost: S 0100i 00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) ' License Number Expiration Date Name of CSL-Helder List CSL Type(see below) Address T Descn tion U Unrestricted u to 35,000 Cu. Ft.) Signature R Restricted 1&2 Family Dwelling M Mason Only RC Residential RoofingCovering 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 I ECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.; 25C(6)) kers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide ffidavit will result in the denial of the Issuance of the building permit. d Affidavit Attached? Yes .......... 0 No........... 0 TION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN ER'S AG NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ar .✓` as Owner of the subject property hereby rize _ to act on my behalf,in all matters e to wor t 'zed by this b,Ming perryit�appli ation. o caner DaSECTION 7b: OWNERtOR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare e statements and information on the foregoing application are true and accurate,to the best of my knowledge and .ame Signature of Owner or Authorized Agent- Date (Signed under the pains and penalties of perjury NOTES: I. 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 I I0.116 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 haWbaths 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 Cosi' MORTGAGE INSPECTION JOB # BAY STATE SURVEYING ASSOCIATES INC. 100 CUMMINGS CENTER,SUITE#316J, SEVERLY,MA., 01915 NOTES: •' 1)This is a mortgage inspection survey and not an r Instrument survey,therefore this plot plan Is for SCALE : 11'= zd DATE:.. :.g.: Q.....».......... mortgage inspection purposes only. 21 This survey Is based on survey met**of others. REFERENCE: » �.. ©�»t {F:..�`gra............. 2I Buses stuubs ferrees and tree Ilnas do not ES EX 50tT D l 5 rR IG7- necessarily indicate property fines. " » •" »• » »• ». • »» 4)Whenever an offset Is 11+-or Jess,an instrument 5...... ......» survey Is recommended to determine property TO:«_.I�:L��E/Z....,...8 6)Offsets shown are approxbnate,and are to be gnes,and my possible encroachments. The location of the butidhmJtsl as shown,ether used only for the determination of zoning.Not to compiled with the focal zoning setbacks at the time of be used to establish property Imes. construction or is exempt tram violation enforcement action 61 in my professional opinion the butdinglsl are not under Mass.CIL Title VII Chapter 40A Section 7 located In the special flood hazard zone,as donned by IWOL MAPl1 .Z SO 107 407 GOT 5 7=iAa't Lor -1A A = 6,135* Q tot `d Lot 6A sif�>r °a a+m rn�s i- wD, # � S`t ' S} L�� TO r" 73,00' HOME SI, FLYNN ST CITY OF SMY. NI PUBLIC PROPERTY DEPARTMENT ivaairumr^-"..v 130 WADUM rrM SnEW•SAUK MAZACHLSEM 019'0 TEL r11-745-9S" # FAL 976-740.9&M HOMEOWNER LICENSE EXEMPTION Plow Prist Date 1 Job Location Home OwnerAddress L Home Owner Telephone S- ! Present Mailing Address SCr-rn-c 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 which in to resi on f land on htc6 he/she resides or tends Person(s) who owns a parcel o d0. 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 "homeownee'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 requir ents. — 7 HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code