40 SUMMIT AVE - BUILDING INSPECTION azo
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The Commonwealth of Massachusetts ' s
Board of Building Regulations and StandardsT4 ;
Massachusetts State Building Code,780 CMR DU
���c Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or DdSlibAK I A 11: 20
r One-or Two-Family Dwelling
This Seef3ea For f) :IIse ,
(�
Bvddmg Pormit,Number Date plied.
O (PrfNaeie) Sigoabne
SECTION It sl��c VWO�lf:4.T ON
lr! 1.1 P rty,Address: 1.2 Assessors Map&Parcel Numbers
GtMM/1 / IIF
1.In Is this an accepted street?yeses_ no_ Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoumg District Proposed Use Lot Area(sq ft) Frontage(fl)
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 es❑
SECTION 2: PROP%RTY OWNERSIf W
2.1 O err of Record: 1114 12d U
State,ZIP
(prior)
Ci te,
Y10 s(�No ff 9 a �q 6�,�� �e �
Te� Em Address
No.and Street eP
SECTION 3i DESCRIPTION OF PROPOSED WORIfr(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ plteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work=: j Al E6 IR 12& O
SECTION 4:ES TB) ATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
—labor and Materials
1.Building $ I. Building Permit Fee:$ Indicate how fee is determined
D Standard City/Town Application Fee
2.Electrical $ O Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2: Other Fees: $
4.Mechanical (HVAC) $ '
5.Mechanical (Fire $ Total All Foes:$
S Sion
Check No. Check Amount: Cash Amount'.•
6.Total roject Cost: $ �Qb, 0 Paidin Full E3 Quistanding Balance Due:
SECTIONS- CON$TRUt M SEIBVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name ofCSLHolder
List CSL Type(see below)
No.and Street Tip -.
Description
U Unrestricted 'din to 35 000 co.ft
R Restricted M2 Family Dwellin
City/Town,State,ZIP M Masonry
RC Roofin Coverm
WS Window and Si
SF Solid Fuel Burning Appliances
I Insulation
Tel hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration jEmail
ExpiratioJDate
HIC Company Name or HIC Registrant Name
No.and Street ress
Ci /town State ZIP Tel one
SECn0N tq tVOittl{ER3°COMPF•1�SaAMN AFFMAVIT(AI-"c.152.3 ;Scm
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...........17
S�Ci'IUlY'/a?OWI�R RUTH RiZA Tb BE COAliI'LETEA Wf�N
tiltlER'S GR. .V0—R# 1M 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.
OngFK &ems
Print Owner's Name(Electronic Signature) ate
SECTION 7b:OWN1W OR AUTHOAMD AGENT MCLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
rprao-- 7? -rc�2
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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 can be found at
Mvw.ntass.eov!oca Information on the Construction Supervisor License can be found at wwwmass.sov/dos
2. When substantial work is planned,provide the information below:
Total floor 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 beating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
This post is 5.5' off of corner
Mr-
Existing Deck(pe"it on file) WDK PC-j(IQ Yr--2005
•All existing framing is 2x8
• Joists are 16 on center
•All footings are 4' deep 1 tQ
•Joists have joist hangers
•Joists are hanging on doubles
UAT
Proposed Work SFL
We are proposing the following FFl
work to be done: OMT
• Place 1 double 2x10 or 12 PT 10
beam crossing underneath joist
at the center point of spa
• Carrying beam to be supported
by a post at each end sifting on FFL
a 4' footing aw
17 31
Spa Information
84' x 84'
Dry weight: 750lbs.
Filled weight: 3,880lbs.
7
19 EFP $ 4
40 Summit Ave, Proposed Deck Reinforcement Project
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CY7 YOFSALW MASSAaRSEM
BuamDBrArrn m
120 YOROOR
IkL(47)7 9595.
FAx71498t6
SII�ERLEYDRISOLL
MAYOR 7�raar�ssSTP
D=cTcotcFpLmjcmamm/Bumnmccmamcgm
Construction Debris Disposa/Affidavit
(required forall demolition and-renovation work)
in accordance with the sixth edition of the State Building Cole, 780 CMR,Section 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit NAs issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111,S JSCA
The debris will be transported by:
VO OFC39/S
(name of hauler)
The debris will be disposed of in:
(name of fadlity)
(address of facility)
Sign ure of a4p (cant
D to
QTY OF SALEM, MASSACHUSE TTS
!( I BUILDING DEPARTMENT
120 WASHINGTON STREET,3AD FLOOR
TEL. (978)745-9595
KIA BERLEYDRISCOLL FAX(978)740-9846
MAYOR TrIOMAS ST.RERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONWSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT.
Date Q
Job location
Home Owner Address_ SAME
Present Mailing Address !Sam 6
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 that 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 understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR