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3 BEACH AVENUE - BUILDING JACKET Esse/to 74520 400/ P4 J A Federal Emergency Management Agency wm3067'o/oExp/oaS��� 30. nj� NFIP REPETITIVE LOSS CORRECTION WORKSHEET (AW-501) NOTE: SEE REVERSE SIDE FOR PAPERWORK BURDEN STATEMENT DATE oFymi0pREPETITIVE LOSSES HxCOMMUNITY FOR CLAIMS 0N0nBEFORE DATE COMMUNITY NAME COMM PRI OR PURWFu ti SE CURRENT PROPERTY AOORESS DATES OF LOSS TOTAL NUMBER OF LOSSES FOR PROPERTY: 780207 ��������~T���MJ�� ���U|C���� ���x| wx�-�� � ���| *�� | x�~v����xx�~�x _ CHECK ALL BOXES BELOW THAT APPLY Internal use only A 0 NA E] FRR F71 INFORMATION PROVIDED NOT SUFFICIENT TO IDENTIFY PROPERTY THOROUGHLY RESEARCH[ [lCOSMETIC CHANGES REQUIRED TOTHE ADDRESS: (o.' et name has changed or is spelled vvrong' wrong numberasaignedLobui|Uing> ' 1-1PROPERTYNOT IN OUR COMMUNITY OR JURISDICTION: (Property will be removed from list A SIGN TO COMMUNITY mxmE Np|p COMMUNITY NUMBER: Fv/ UNABLE TO IDENTIFY CAUSE OF FLOODING / THOROUGHLY RESEARCHED 7FLOOD PROTECTION PROVIDED / DOCUMENTATION ATTACHED. NO BUILDING ONPROPERTY / DOCUMENTATION ATTACHED. F� ALL LOSSES DUE TO EVENTS GREATER THAN THE 100 YR FLOOD (DOCUMENTATION ATTACH[ �] DUPLICATE LISTING WITH PAGE NUMBER: COMBINE AS ONE LISTING Fl OTHER ADDITIONAL COMMENTS: /I HAVE RECEIVED AND READ A COPY OF THE INSTRUCTIONS: ) CHANGES AUTHORIZED BY: (FORM MUST 8ESIGNED BYCOMMUNITY OFFICIAL) Plans must be filed and approved by the Inspector prior to a permit being granted CITY OF SALEM No. /Q� Ward � �7 _ /�' CONDIT,�Q's wU l 30 `� HISTORIC DISTRICT? Y N � � Date �. IF FOR SIDING, HAS ELECTRIC ° Home Phone PERMIT BEEN OBTAINED? Y N � Bus. Phone- APPLICATION hone 5��-753 / APPLICATION 9T/ FOR PERMIT TO REV^oDcc., K-iTcNEIA TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owners name and address �ou(�AS W ox-'EtD Architect's name STEVE QuEAt -( Builder's name STEU(E- qut?a Aeu-160) Location of building, No. 3 &-AC4 i}UE What is the purpose of building? P-cDGNCE If dwelling, # of units? I Material of bldng? Will building conform to law? Asbestos? o Estimated Cost 5 000 oa City Lic.# State Lic.# Home Improvement License # Signature of Applicant SIGNED UNDER THE PEMALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE Mail Permit to: No./ Ward / APPLICATION FOR PERMIT TO ROOF REROOF OR INSTALL SIDING LoceGon � kza� Q ( ,CIV PERMIT GRANTED ( � 19 �7 roved Building Inspector acc�..eJn rtice uepaiwneru. F-vee Pnevenx. on Bureau APPOINTMENT FOR FINAL 48 La4ayette Street APPOINTMENT FOR FINAL INSPECTION MUST BE Salem, Ma 01 970 INSPECTION MUST BE MADE AT LEAST ONE WEEK (508) 745-7777 MADE AT LEAST ONE WEEK AHEAD------------------------------ AHEAD.----------------•----._--- FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PEP.MIT In accordance wZth the pn.0v46d on6 04 the Ma."achu.6ett,6 State Bu.r.2d,Lng Coda and the Satem F•i-ce Code, appp4catton 4.6 hereby made 4ot appn.ovat 04 ptar" and the .wauance 04 a cent,L4.icate o4 app4ovo.E 40n a bu,i.Cdus9 pe,,y by the Satem FZte DepaArtment. (Re4. Secttton 113. 3, Maoa. State SFdg. Code) Job Locat-(.on: Owner./Occupant: (-P- Elect LZcae Contnacton.: F.,Le Suppt"-6.i.on Cont,acton: SZ_gna;Uv o4 ApptZLant: �Y'OAOYA Phone #: -7H I ` cos,5 Addne,6e o4 a v v gygOF OTt F� C icy on Appttcant: �CV�£l� ���,�TlFv4iG'o Town: APpnovaC daze: 6 /3 Ce4t.L44eate o4 appnova.0 .w heaeby granted, on appuoved p.Can6 on .6ubm•(-tat 04 project d¢tatt4, by .the Satem Fivice Department. AZZ ptan,6 aae appn.oved eo.eeQy 4o'L Ldent.C-6•i-ca Zon o4 type and Eocat.Lon o4 44-ta p-Lotect Lon devtr-ea and equ.Lpment. Att p?an-6 aLe .6ubjert to appaova8 04 any other authority hay.Lng jw:.r,6d.Lct,Lon. Upon eomptet.4on, the appttcant ojL Zn-6ta t"(e) .6hatt 2equ a at an 4"peetl on and/o-% te.6t o4 the 4Z&e p totectl on devd ce6 and equtpment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) New eonatzuction. Pnopenty toea Zon ha.6 no eompti.ance wd th the p-%ov4,6.Lon.6 o4 Chaptea 148, Sectzorz 16 C/E, M. G. L. , aeQat,Lve to the 4,n6taeat-Lon o4 approved 4ULe a.Caam devdce4. The owners o4 th.i-6 p-Lopenty 4,6 ,Lequ4ked to obtain eompt axee as a mond, ti.gn o4 obta.Lnuig a Suttd.Lng Pe,umft. -Pn.openty Potation 46 .Ln compt lance with the p-Lovt-6- ona o4 Chapten 148, Sect on 26 C/E, M.G. L. Exp.f,catl.on date: 6 3b H A/�� Al� A Cts S.Lgnatwce o4 F-vee 0441cLaZ Fee due: undue 7 , 500 Sq. Ft. - cc, . 7 . 500 So . Ft. on. 2a,z9en. - $25. 00 Foam $81 (Ray. ' 0/100 ) FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT i In compliance with the provision of Section 113.5 of the Massachusetts State Building Code, and under. guidelines agreed upon by the Salem Bldg. Inspector and the Salem Fire Chief, the applicant for a building permit shall obtain the Certificate of Approval (see reverse side) and stamped plan approval from the Salem Fire Prevention Bureau. Said application and approval is required before a building permit may be issued. The Massachusetts State Building Code requires compliance approval of the Salem Fire Department, with.reference to provisions of Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts General Laws, and 527 Code of Massachusetts. Regulations. The applicant shall submit this application with three (3) sets of plans, drawn in sufficient clarity, to obtain stamped approval of the Salem Fire Department. This applies for all new construction, substantial alterations, change of use and/or occupancy, and any other approvals required by the Massachusetts General Laws, and the Salem Fire Code. Exception: Plans will not be required for structural work when the proposed work to be performed under the building permit will nqj;, in the opinion of the Building Inspector, require a Y plan to show the nature and character of the work to be ¢ w ; performed. z w � mw � Fpz Notice: Plans are normally required for fire suppression systems, fire alarm systems, tank installations, and Fire Code requirements. w z w .L0 J Under the provisions of Article 22 of the Massachusetts State Building z b o Code, certain proposed projects may not require submission of plans or complete compliance with new construction requirements. In these ° 5 cases, provisions of Article 22 Appendix T, and Tables applicable shall apply. This section shall not, however, supersede the provisions outlined in the Salem Fire Prevention Regulations, Chapter 148, MGL, or 527 Code of Massachusetts Regulations. All permits for ' fire code use and/or occupancy shall apply for the entire structure; fire alarm and/or smoke detector installation shall apply to the entire structure based upon current requirements as per Laws and/or Codes, but the existing structure may comply with regulations applicable for existing structures. Notice: Sub-contractors may alBo be required to file individual applications for a Fire Department Certificate of. Approval for the area of their work. Such sub-contractors shall file an Application to Install with the Fire prevention Bureau prior to commencing any work for those areas applicable. Form 81R (10/90) A-)P ,1TMENT FOR FINAL ` CTION MUST BE A'f LEAST ONE WEEK AH- -:. O ,OEN OEc,f W � f/+ •2ao � I I . i I I �. IVIIJ9 0 _._ a StA,a �O 2No F/Do2. { y2 ),AND INA C1,-0 No. 99 APP'D. ppp Ty o� CEO OF ICC-T , . .—in oow 1coo ow 1 r�-�� lO TTT ! i Ir .1 O ELAILDIlJGS H«N i I DECK LJ /Jr�1 -� 3/ 9Y �3'P:at al by any et .0 �T,Tavin jurisdicti �: , TriA.cB. Etttr�QF�4VED1'1'!ON B0131' .0 PBLAXB ARE APPROVED SOLELY FOR IDENTIFIC IONOF TYPE AND LOCATION OF FIRE PROTECTION DEVICM A TO PROTECTIO<rnm PLET CPLI DEVICES ARE ONCE`'Ml I HE FIRE CODE CITY OF SALEM BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please Print DATE M 9— 30 19Gy JOB LOCATION__ 3 TEAQf A-VE W(LLOWS Number Street address Section of Town "HOMEOWNER 'DW&LAS W, R.tbFiELb gL1I-005_5 C,( I -96( -2962 Name Home phone Work phone PRESENT MAILING ADDRESS S 3E H AVG SI-.Ewe 4At o qzo City/Town State Zip Code The current exemption of "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1 .1 DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 shall be res oosible for all such work performed under the buildingpermit. Section 109. 1 .1 The undersigned "homeowner" assumes responsibility for compliance with the State Building code and other applicable codes, by-laws, rules 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. HOMEOWNER'S SIGNATURE L&-LAWW E" 4Lt APPROVAL OF BUILDING OFFICIAL NOTE: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control . HOME OWNER'S EXEMPTION The Code states that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1 .1 - Licensing of Construction Supervisors) ; provided that is a Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor." Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2.15) . This lack of aware- ness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with licensed Supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. OPEN OcGk W � f�+ �200 � e\ l ivitil9 u N u StAhe fo 2NQ F�oo2. )-ANC 0 C1,oSet• a� � n Ki�then/ NNN AAA PNS N� coo woo x D� TTT T T T �I WNw o PEN DECK w /-/A /Z The Commonwealth of Massachusetts W Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ate I Building Official(Print Name) Si9framr, Date SECTION 1: SITE INFORRATION 1.1 Prperf �H Address: 1..2 Assessors Map&Parcel Numbers S AVt l.l 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 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❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: �T ,YA Name(Print) City,State,Z1P �laps�as No.and Sn t Telephephoneone Email Ad 'ss SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work : rAt-C,'"ALL M-e- O VCZ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ S�cOc7 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ Ov ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: PA 5.Mechanical (Fire $ �w Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $3-qro ❑Paid in Full ❑Outstanding Balance Due: (� Jb C civ7'r-c-dam 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) f:�L' eGR-mK 1AA-t—L License Number E piration Date Name of CSL Holder lG List CSL Type(see below) _ L�clf �vE No.and Street Type Description 5.4 t1W K4 6 /R'70 U Unrestricted(Buildings up to 35,000 cu.ft. City/Town,Stale, P' R Restricted 1&2 FamilyDwelling M asonry RC Roofing Covering WS Window and Sidin VrovementContractor SF Solid Fuel Burning Appliances t-/w7e,,K ; I Insulation Tele hone D Demolition 5.2 Registered HomeHIC) /Z-A 3 4 G 8 , HIC Registration Number Expir tion Date _HIC Company Name or HiC egistrant_Name No.and Street /�G L ®9 @ eamcAS y: N Email address City/Town,State,ZIP Telephone SECTION 6:WORYERS' 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 144 L to act on rut behalf,in all matters relative to work authorized by this building permit application. riot ner'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. Print Owner's or Authorized Agent's Name(Electronic Signature) f Date 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 can be found at www.mass.gov/oc Information on the Construction Supervisor License can be found at www.mass.gov/dpss 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 balf/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"