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_BUILDING JACKET Cn 0 0 P 0 9 =BuildinigPermit he Commonwealth of Massachusetts of Building Regulations and Standards CITY OF ( chusetts State Building Code,780 CMR REC IVEDSALEM INSPECT ION '\fev „' J11 lication To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: S Zt s� Budding Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers _S-� (3Mc,Pc+-d sa. ` I.In Is this an accepted street?yes_ no Map Number Parcel Number ^'^1 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 Requred 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 yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owne of Record: .0 (in. I rd t+ Rer<I�y/ �n PF 7� S Ic le S+ Mewb,ryP�t> /�a �sl Name(Print) City,State,ZIP 9�F�-778-45� No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units I Other Specify: Brief Description of Proposed WorV: r� pn rl- t. A . Pa>r, 1i�n a ;r clo a :�� h 34 r.S Kk S cke A:(a SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials Official Use Only ly 1.Building $ 1. Building Permit Fee-$ Indicate how fee is determined: 2.Electrical $ Ll Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: /� U 5.Mechanical (Fire �t Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 3a SO Q ❑Paid in Full ❑Outstanding Balance Due: s»7 z-I ► S SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C�„ 09 S( /� /ao 1�v� c Q n^t I"e License Number Expiration Date Name of CSL Holder � G a I Gwr P,CF S� . p - List CSL Type(see below) V No.and Street Type Description 0V970 U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2�R+egistered Home Improvement Contractor(HIC) J s D t:AG 7 a 006 J 1L G4^t'r-kt C6 yx�rc C+ HIC Registration Number Expiration Date HIC Con{Pany Name or HIC Registrant Name _ Ga. IQU�fFvvCC S • - .C�,1(-, MA CACl7G .� SC GPv.P(r+� �cw\�✓Sf l �nq� altOo No.and Street Email address -�� G7�(SSO cf f 7� City/Town,State,ZIP 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 I,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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 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. 3okv, Cg� � t5��.—� mey all a�L Print Owner's or Authorized Agent's Nam ctionic Signature) Date 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 can be found at v ww.mass.gov(oca Information on the Construction Supervisor License can be found at wwtiv.massgov/dns 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 heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ' r pL.*"Sj"T Kf4f I.M9 APPROVED BY T44E JdSPJ:DM PWOR TDA.PEAMIT AEING GRANTED CITY OF_SALEM No. IC171-42� is LOcam h Loeacion of �. �v«n rnd fed S fia FUaloriC l]IWla9 Yw No_ �� B Is Prapww LOCOW in Na Ca"natfon Ma? Ym No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, I sta�Sydinp, Construct Dk, Shed, Pool, RepaidReplace(Other // Ing C �I b✓;rl�(o VS PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: / Owner's Name ��l h/A✓ yes Address & Phone l 9r,4 1;j ,S (9qt3 430 oW Architect's Name Address & Phone t \ f Mechanics Name �,'�� oj �•1 d1'� d OF Gr -o.,A v go S4 o n Address A Phone 344 gaskOn fks 9b&\& E, Yr'VV&f'ovgl'�A soy) y60 6 u qs WfW Is Ia pwpo c1 buA ft? IZes I Jett �,a I Maw"of bi fidng? I a dWWQ'for how marry to R*"? WN bukW*WdarM to law? Aabaotos? Erier"Ooat 0 Q CIy ikon"a N A Stay a `♦ 3 Signature of Applicant Cs�e G SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE «-e.yv.� 0 Eli ;n� �6Ul�le, �� vnc, LJ+»ciac �S y,J; r o MAIL PERMIT TO: ' »�, Fd,�.� irav,� fti�m . YyJ►� ©�5�0_ 1 No. APPUCATION FOR PERMIT TO LOCATION S- -7 . Pcoyl 4- PERMIT GRANTED 20 P. IN OR OF BU ING8 The Commonwealth of Massachusetts l E' x Board of Building Regulations and Standards FO R )R y� Massachusetts State Building Code. 780 CMR, 7'" edition Building Permit Application To Construct. Repair, Renovate Or Demolish a LuuuOne- or Tito-Furnifv DuellingrHiY This Section For 1 Use Only Budding Permit Nu {fib/e/r: Dat lied: U Signature: Budding Cotmmssioned'Inspertur of But ldhw—s:y Date SECTION 1: SITE INFORMATION if Ll Pro [ address: 1.2 Assessors M1lup & Par cel Numbers off_ L27 IC) -00 as 1.la Is this an accepted street?yes_ no Map Number Parcel Numher 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage (it) 1.5 Building Setbacks (h) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.6—L c. 40• §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public E3PriVale❑ - Check if yes❑ - Municipal ❑ On site disposal system ❑ ' SECTION 2: PROPERTY OWNERSHIP' a4r " 2.1�pr1�/�ert of pi9l/ R Name(Print) Address for Service: Signatur Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ N mber of Unilsz Oth r ❑ Specify: Brief scr ion oNPropoed ork y aoi ti SECTION 4: ESTIMATED CONSTRUCTION COSTS 05. ,Mechanical Estimated Costs: Ofllclal Use Only La rr and Materials) ng S / 1. Building Permit Fee: E Indicate how fee is determined: ❑ Standard City/Town Application Fee cal b ,QQ Q� ❑Total Project Cost(Item 6) x multiplier x ing b Q 2. Other Fees: S nical (HVAC) s Lor nical (Fire sionlTotal All Fees: S Check No. Check Amount: Cash Amount: Project Cost: s L � 171 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction �Supervisor(CSL) Iy � v✓J� �{` License Number Kpiration Dat. Nance of CSL- List r��Ov�"� y��/• List CSL Type t see below) J Q/ /� T Desai non Add rc (/ ��/ L Unrestnctediu to t5,WOCu. Ft.) R Restricted 1812 Famil l Dwelho 'MMason Onl V RC Residrnual R,x,tin Currnn Tclephune R'S Residenual Wwdu', and Sidni ✓��/,jy SF Rr.idcmwl Soho Fuel F3lu.i.illalwn /YAC/ D Residcuual fh muhnun 5.2 Registered Horne Improvement Contractor(HIC) 3 HImRegtstrat unnNun her GC� ��?�or i�'�i�//�N�� e% .Add / /` �yyll(/ 45� �2Z/vExpiration Date Signatu /reG" '✓G Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c. 152. S 2506)). Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to pnwide 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 by this building permit application. Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I , 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. Pont.`lame Signature of Owner or Authorized Agent Date (Signed under the 2ains and penalties of jury) 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 IO.R6 and 110.115. respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished base mentlattics, decks ur porch) Gross living area iSq. Ft.) Habitable nxwm count i Number of fireplaces Number of bedrooms Number of hathrooms Number of half/baths Type of heating system Number of decks/ porches Type of cooling system Endused Open j J. "Total Project Square Footage- may be substituted for Total Project Cost- pL. MS1i WT qE f%*046 q APPROVED BY T44E JdSPFCIQH PWQR TD A.PEB UT MING GRANTED CITY OF_SALEM °"is Property Locam 14cation the midoric Dleldd?„ Yes No✓ Building Is Property Laceimci in ft Cawrvelion Am? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Carole whichever apply) Roof, Reroof, Install Siding, tract Deck Shed, Pool, Repau/Replace. Other: PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS. The undersigned hereby applies for a permit to build according to the following sly: Owner's Name � S S y1 P�2 1''s Address & Phone a�JW Ml Architect's Name ti,, S Sv rI &!�dl/ Address & Phone ! Mechanics Name Address & Phone r ii I t Whet a go pwpoee a tturdYq? he c JF - le i'Wr GC.�L/' mewad of bAWQ7 1 rnl�_K a&* Mq,for how menY to nW67 Ww b,r,d[tq mdann to taw? l e5 Aebaeroe? F.wommi eon 0 0a CaY Ucerne r ►� ` state r uma laproveaeat Z Lie. IF /1 Signature of cant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE / 1 e- t< .� �c inn S ,,Lee r� ke7 Vec.aj -Ajo ` ilk- 64.5 y y, ,1,T- 13 Ilwy /ia `311 D A 7,10 -- c MAIL PERMIT TO: ' Ere,d�J 5•1, S, If-0 , 94� Q L s' No. APPLICATION FOR PERMIT TO LOCATION �- 7_�� PERMIT GRANTED S-Jl-7 /a gf,zo AP 7 INSPECT OF BUILDINGS .l .