50 LOVETT ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 CMR,7b edition Revised ed an ALEary
Building Permit Application To Construct,Repair,Renovate Or Demolish a 1,2008
One-or Two-Family Dwelling
This Section For OfficialiUse Only
Building Permit u/mabeer_: I Date plied:
F,1Signature: CAIl°Z�/d/ID
Building Commissi er/Ifispectorof I i Date
SE ON 1:SITE INFORMATION
1.1 Property Lovett Address: 1.2 Assessors Map&Parcel Numbers
5e Srre�r
L la Is this an accepted street?yes 1" no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
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 11 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2:.PROPERTY OWNERSHIP'
2.1 Owoerr.of Itecord:. .. . . .. . . ..
(�osc�m
R. MYbz 5o LaUe,�H ,51ree Slllem
Name(Print) - - Address for Service: -'
7*5 0/64
Si a Telephone
SECTION 3:DESCRIPTION OF PROPOSED WOR10(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Ef Repairs(s) ❑ 1 Alteration(s) ❑ Addition 0'
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of ProposedWork2: r 6;' f
YOUSe-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 3000 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard Citytl'own Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
. .... - . .. - Total All Fees:
Su ression '
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 3 000 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of CSL-Holder
List CSL Type(see below)
Address Type Description
U Unrestricted(up to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwelling
Signature M Maso Only
RC Residential Roofing Covering
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.§ 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, t�nS 2.tMdtiM 1, M r0 as Owner of the subject property hereby
authorize ten o loth to act on my behalf,in all matters
relative to work authorized by this building permit application.
/&—
Sign
D—
Si at a (Owner a 0 Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1, 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.
Print Name
Signature of r r Authorized- gent Date
(Signed under the pains and nal tes of )
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.85,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.FL) (including garage,finished basementlattics,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 I
Type of cooling system Enclosed Open r/
3. "Total Project Square Footage-'maybe substituted for"Total Project Cost"
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Essex County and Commonwealth of Massachusetts, as a Householder, and having a
family and being entitled to an Estate ofHomestead in the land and buildings hereinafter described do
hereby declare that I own and am possesed and occupy said premises as a residence and Homestead
under rieneral Laws,Chapter 188,Section I as amended to w0:
The land in. Salemt with the buildings thereon, being bots
Moos. 61,62 and 63 on a "Plan of House Lots belonging to Lovett
and Cole, Salem, Mass." recorded with Essex South Registry of Deeds,
Book 1990, Page 600 and
bounded and described as followst
Easterly by Bradford Street about. one hundred thirty (130) feet;
Southwesterly by land formerly of Poor, now or late of Ellis and
others, about two hundred ten (210) feet- Northerly by land now or
[\W' late of Lovett and Cole one. hundred (1601 feet.
Being the samepremisescon veyedtomeby .Tames P. Fay et al, by deed
datedSePtember 29, 1955 ,rec:ordedwith Essex South District Registry of
Deeds,Book No. 4209 Page 321
Witness my hand and seal this /U� dayofA4-
COMMONWEALTH OF MASSACHUSETTS
Then personally appeared theabove named Zt/azy"7;7. and acknowledged
0
the foregoing instrument to be his free act and deed,before ma.
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ESSEX SS.RECORDED 19 M.PAST M.INST#