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9 LIBERTY HILL AVE - BUILDING INSPECTION
The Commonwealth of Massachusetts Board of Building Regulations and Standards Town of Massachusetts State Building Code, 780 CMR, 7i°edition 1110 nig 110" Build1 ept Building Permit Application To Construct�, Repai� vate Or Demolish a One- or Tina-Fun�lc,well ng This Secti i( or Ofticiase my Building Permit Numb r: a A is Signature: 1 5 <L Building Commissioner/l6pectoref Bu(dings ate SECT( N 1:SIT FORMATION LI Property Address: 1.2 Assessors Map& Parcel Numbers ? Z4,6 1-4 >/'( c f� 1.1a Is this an accepted street?yes no Map Number Parcel Number _x__ Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(it) 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.40,5 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? PublicGU, Privatt❑ Check if es❑ Municipal40 On site disposal system 13 SECTION 2: PROPERTY OWNERSHIP" 2.1Owner'of Record• t4<Napn IeM �EcfCK� 9 1—/11j&TY 441tliAJIC Name(Print) Address for Service: 1198- "5,7v- Signatur Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction 0 Existing BuildingAl Owner-Occupied IW Repairs(s) ❑ 1 Alteration(s)Ai Addition ❑ Demolition d$. 1 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work":£XJT7/IVd- BCet,?D &E sQCHdW, rvbsy lh�et 7- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Oltlelal Use Only Labor and Materials Building S �� 1. Building Permit Fee:5 Indicate how fee is determined: L 2. BuildElectring $ 0 Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 5. Plumbing S 2, Other Fees: 5 4. Mechanical (HVAC) b List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No. _Check Amount: Cash Amount: 6. Total Project Cost: S 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date N})me of CSL- Hp Wer List CSL Type(see below) s Address Type Description U Unrestricted(up to 35,000 Cu. Ft.) Signature R Restricted 1&2 FamilyDwelling M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Sidin 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 Dale Signature Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE,AFFIDAVIT(M.G.L.C. 152.4 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 I. as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized thi building permit application. S1121OF Si na o O ner Date/ SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 1, ,as Owner or Authorized Agent hereby declajmdd that the statements and information on the foregoing application are true and accurate,to the best of my knowledge behalf. Print Na Signature ner or Authorized Agt pati Si ne and the 2ains and penalties of to - 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 I O.R6 and I I O.RS, 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 he substituted for"Total Project Cost' CITY OF SM.EM PUBLIC PROPERTY DEPARTMENT Kfa�fJLrr V�roa i 30 WAauew-roN s4zF+T•SALRK MASAC0.S619S 01970 7419'.8.74S•9S" •F,uL 97{:740.984 HOMEOWNER LICENSE EXEMPTION Plea" Priet Date o? 14,4Y ae0 9 Job Location 9- L/d-,CRT Y HILL 914,E �� SALEM, Home Owner Address SAME Home Owner Telephone 978— v 5'4l - /6 0X Present Mailing Address f4MF 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. 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 understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE ,APPROVAL OF BUILDING INSPECTOR /�?ro See other side for state code LieERTr 44/LL- AVE. !6"oc dun lo" f PT S7'R�nrGC � �� soistr u��r��Rs you QLI✓ Z"x to " J 1-606-66?- 7 EOb-627 T(zI PLe Z`'X Q v r� �Rnn fir' �osr 5 F004 = 2"x&'"fl c i A©a�i �- oeA1L)AjO-S Rei/G JV( OR7� X {P' X,X17'PeVP" hVUJF--,P S1 SICP OO&W TD c2 `` � I24,-� � xG POSES ® L x 4 [ Al L. POSrs Pr 2 x g RptM� FIF ® ax to TP,IKrrfE KS Pf ® � x R-&Il. SOffoR i5 PT ® a x a �9A LuLSTM RS 6r,d 3 o �} S ria �o�+v )2oM a IOvSE to Ucc� m lDOALE 2 x ID rl fore L-00,12 m 3EAMS - i x9 `((2-►PI6 CfT) o �Fo0°f INb-s to " SOQA3 roQ;FaS ® ml P O(�sF� -- 6, Q I m to RISE l2" "CRER D ® FLAS41kJ� To B£ )48-fXLLE9 4 (QVI vQ _ 1 CITY OF SALEM r i PUBLIC PROPRERTY - � DEPAR"I•titENT .. .• IU ,,i II`d... .1:i I I r • \111 M. %I�•,� I • .I' III '1'8.'l i. 14-,: • I N\ •i'S '4 L, Construction Debris Disposal Affidavit (rcyuired lbr all demolition and renovation work) In accordance \%ith the sixth edition of the State Building Code, 780 CNIR section 1 1 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit tt 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 It 1. S 150A. The debris will be transported by: sFLF 4� I°o� TO Dual 1 name uIhauler) I he debris will be disposed of in : 7R►4acr_ FU_ _S''TAIIO J. (namr ul IScdny) _ SALEM laddres. of gcihtvl namro d p.•rnut atylhca u MA aoa q MORTGAGE INSPECTION PIAN A9k BOSTON 1-f SURVEY, INC. 08-02938 110. Box 290220 Charicsitywn, MA 02129 (617) 212-1313 MAIN (617) 242-1616 FAX APPLICANT: SELECKY DEED/CERT: 6646-432 LOCATION: 9 LIBERTY HILL AVENUE PLAN REF.- SCALE: EF:SCALE: finch = 20 feet CITY, STATE: SALEM, MA PREPARED: 03-27-2008 CERTIFIED TO: SALEM FIVE MORTGAGE CO. L.L.0 SEE PLAN 776-65 i 71 I s d � c #9 2 STORY �1 PORCH I �I 28.25 LIBERTY HILL AVENUE I V94,,.)pos(on SurvaY SoMware I 11C p nu m vl .truilun m apps uvmafaly luencd un the yt OF'M4 Auurdulg lu I cd oral h.niuguny bLmuLun ul Agan'} 3i,mml I 1w,n.'Ih c oilmcvnWna Jto dxwthak - naps,the mut uupru%cmcnie on till,pr Ip riy f ifl iu.m ayuuuu nls ul the lues)i ning orJwccs unin chttl at the Inlic of uus_in uc nun or we eauupf Insn violation fr. ea dcsignatcd at Zan.. cidlrtcewrnl amus under,%Lli.I..Tido VII,('hapler 40A. WWNS y t'mununfty Panel No. 2. 0/0 Z f. iredun 7_ani aim d,crc nm nu viminichmvnls w major 'Cl No.417 �/ HiiccUec I7atc: �'.,., 9 S unpnit emen,either aaay .Tera>,properly'liucs eccepf as le9� NY� . Jun+n and nolcd heteuu. 9 SSsa yQ NOTE:Zone C is areas of minimal flooding(no sharing). Tj This designation is not based on an elevation certificate. NUI L.Tn,s a nut's noundaty or title Insurance survey.This an as preps Cordande to procedural and technical standards lot M009a9e Lodi)Inspections as adopted oq Tnu Masmn:hu4vI1,60.ud ul f9cuuuanon of prolessio engineers and land surveyors,250 CMR 605,and use for any usher purpose m prompted This plan is not to be .rnni!rn r�rnldln9tn'pslmq drnar Uo5cnpUr,p�.oI r0 iljclion.