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14 BEACON STREET - BUILDING JACKET� �y �Je�r�n -5�..-1- � 116s�ef- Un��3 ►o � �aU/m MA , o -76 ��► ch�c� � . - �Jswn Yeer�n wig ass-u�n� G'es�imsi 611 d ►t Claim # 033546996 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall Salem, MA 01970 Salem, MA 01970 Re: Insured: Walter Keenan - Property address: •14 Beacon St. Salem, MA 01970 Policy #: 88979400001 Loss of: 2015/02/11 File or Claim No. AD 1694 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass._Gen._Laws,_Chapter_143, Section_6 to be applicable. If any notice under Gen-Laws,-Ch.-139-Sec.-3BMass_ is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. 02-23-15 Signature and date Claim # 033546996 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B / To: Building Commissioner or Board of Health o,f Inspector of Buildings Board of Selectmen Town Hall Town Hall Salem, MA 01970 Salem, MA 01970 Re.: Insured: - _ Walter Keenan - Property address: 14 Beacon St. Salem, MA 01970 Policy #: 88979400001 Loss of: 2015/02/11 File or Claim No. AD 1694 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000.00 or cause Mass._Gen._Laws,_Chapter_143, Section_6 to be applicable. If any notice under Gen-Laws,-Ch-7-139-Sec.-3BMass_ is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. 02-23-15 Signature and ,date I I $�SO� cK I1�S The Commonwealth of Massachusetts RECEINE� q� Board of Building Regulations and Standards SER41 ES CITY OF R j��NQL YYI Massachusetts State Building Code, 78M6Ff SALEMRevised Mar 2011 Building Permit Application To Construct,Repair,Renovate 3r„Daglplis�a �JL► One-or Two-FamilyDwelling UUII GG�� I - - This.Section For Official Only Building Permit Number: 1,Date A lied: : 215011 Building Official(Print Name) Signature - _ Date ' SECTION 1:SITE INFORMATION 1.1 Prop dress: 1.2 Assessors Map&Parcel Numbers L la 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 Regdued Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage gisposal System: -/ Zone: Outside Flood Zone? Public lam Private❑ Check if yes❑ Municipal eOn site disposal system ❑ SECTION 2: :PROPERTY OWNERSHIP'. 2.1 Owner'of Record: 1 ar.9�/ 1 ��/1/rg/✓ r�G E/�l Name(Print) City,State,ZIP e3� j7sr�o��4'y No.and Street Telephone Email Address SECTION 3,DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied IW Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work2:_AQ��QLf�l,�s /c')Y'(sj� 'd✓_T � C-LU SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only - Labor and Materials 1.Building $ 1. Building Permit I:ee:$ Indicate bow fee is deterinined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project.Cost"(Iterrr 6)x multiplier x. 3.Plumbing $ 2.. Other Fees: .$. 4.Mechanical (HVAC) $ List: : 5.Mechanical (Fire $ Su ression Total All Fees:$ Check No. - Check Amount: - Cash Amount:. 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: G1 lit I✓—T� I L (D tJEe— wlL_A_ ��U SECTION 5: CONSTRUCTION SERVICES 9 5.1 Construction Supervisor License(CSL) �(�/���� J�f�c/�,��' License Number NSL Holder �/ f� List CSL Type(see below) tJ Nf/o.and ZdW Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering < W S Window and Siding SF Solid Fuel Burning Appliances I Insulation ele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /1Oj,Ow IJ vy//r/JC�6✓ /7 9 7 e HIC Registration Number xp' anon Date HIC Company Name or HIC Registrant Name No.and Street Email address 4%i_�/l�//L'/ j7sr Sly' S y3 Ci /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:OWNER' 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. ,�l /lr�'Lr�/�01 / Print Owner's or Authorized A is Name(Electronic 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 wNvw.niass.-ov'oca Information on the Construction Supervisor License can be found at www.nrass.rod v/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.It.) (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 halfibaths 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" CC nn L N c_� _ Ma.N • T� Cpcv-�A �4 fi NC> PdZR tJ tam art Office of Consumer Ahairs&Business Regulation - EIMPROVEMENT CONTRACTOR. � UPPI VEMEN7 Type ation 9li1l20'L6 LLC BOSTON WINDOW LLC- M „ - :.. - 'MICHAEL MEYER ` 71 BAY ST - �'� -1 BEVERLY,MA 01915 )Undersecretary~ 1 U Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License CS-036479 c:rlc „ MICHAEL S MEY.AR . #' 3 71 BAY ST ug _ - - 1. BEVERLY MA 6191 . r �y .)1101d Expiration _ 04f1612016 Commissioner a y 14_ Ea_C_O_N.. ST. 1C� .QFOoF'_T- r 0bT1-k_'9�GKS_ _ ,a, _, 00 r I 9 1 _t t i- a 'U t CONFIRM AS . +/-14!V.IF. 10-6 MIN. FROM LOT ONE HALF WALL W 3 B WNDOWS ABOVE ON N3 SOB �•,,(�n { (Jh ENCLOSED PORCV N ,r,y Q � AOCN PORCH WALL W/INSTINC WALL 1. 0' A tSTEP ON •� O6 O WING GAAREA KITCHEN L I pIN I � z) wse ® t� i0 DRY WELL SEAT WALL BROOM/RECYCXE v:,•^v BEE. BEAM E0. --- 6'-T --- E0. POSTS IN BASEMEIT� \ / C.C.iD VERIFY ' \ / (+ ROCR EIfPOBEO i6" LIVING DRAIN j �\ PORCH / \ m1 Foundation/Patio MP AN STAIR 10 SMO BATH RELOCATED BASEMENT / ® BATHROOM OE WINDOW 1 2466 1 B' BEDROOM WALL KEY IE109T1NG ffl P ED 6 5067066 NDIE3: ———_ 1.ALL DIMENSIONS ARE CLEAR.FTNISH CLOSET DIMENSIONS. CLOSET �stFloor Plan Plan SCALE: I/4'= i'-T KEENAN RENOVATION /4 EeWWY Bveec Ste,AIA DECK roY N El £ E0. ED. v OA OA STEP DN AO DER 0 AIJGN W/MiN00W5 Raow CLOSE ai --- uDND r 2868 ..L NEW WNDDWS IN CiLOSE I• EXDiANG OPENINGS W� o—--I .' BATH 2468 CwTD 61-0' SKYLIGHT IMUERED I ON O STAIR OPENING — g) I I L_— N CLOSET I I I I I I I WALL KEY BEDROOM 002 I EXED010i PROPOSED I I NOTPs. I I 1. ALL DIMENSIONS ARE CLEAR.FINISH DIMENSIONS. Second Floor Plan ALE 1/4•=1'-0- KEENAN RENOVATION 14 sweet s.IeLem,AEA RENOW EMSRNG smucnRE ------ -- — ---�r--ITT—�1 I I / ~�I� J I PORCH ! /� I 1 . I ® T--� I RWOVE AND SAYE I — T I I WMDOW FOR REUSE II WNDOW OPENINGI �roYE 1MN00W5. \ / ean� ROKIVE ® cm FOmIRES < O CABINETS k I, O \ I I I i AnwEA. a uWixs I I L—J X OWNER IF ITEMS _ AIE TO BE SAVED LiT \I FM REUSE REMOVE mINNEY, IAUNODAr\ I � UVIING PORCH r REMOVE Dom,TYP. T— RST TREAD WALL ro {HOVE mIMNEY, I \\ RRST 1YP. UP �RFHOYE WALL,FP � I I I I II I I I 15T FLOOR FRAMING M BE RLIAOVID.CHECK OPENING Fm NEW BASEMENT ACCESS STAIR BEDROOM WALL KEY — OENO PARIrtI01lS First Floor Demolition Plan SCALE I/4'= 1' 0' REENAN RENOVATION ��� as.7wT n,mu sate,rvom 14 afa , Strees Salem.MA r_______________________, I I REMOW E]OSTNC I �— SflOCNRE I -------- I I I I I MNDOW WaINO,� `RUDW MN[IM, I 1 II Y I I CLOSE NEMOW CHIMNEY, ITP. ----------- —----- ----_____� I I I I i I I r Raa Daow rIN%aWT IN BA RoaE K x L_ - fl flENONE All FlNISHES I I �Fl%IUflES,1HIS I r-- HERON:CHIMNEY, L _ M N CLpSET CODD I I I I I I I I I I I I I BEDROOM j I ® I I I I I I I I I EwWALLp OKEY A lo]NlS Second Floor Demolition Plan scams ,/a•_ ,•-o• REENAN RENOVATION D-Zn,�i �s 14 Beacon Sam Salem,MA DECK EO. f EO. EQ. E0. OA OA STEP ON 6068 SLIP O AEICN W/'MNDOWS BELOW O CLOS ADNDIly 2668 � NEW tWNDOWS IN CLOSEIi E SDNG OPENINGS O I BATH 2*8 6tv SKRIGHT CENTERED I O ON STAIR OPENING — l.. L- CLOSET I I I I I I i I WALL KEY BEDROOM I WWWW� PROPOSED I I NOTES I I 1. ALL DIMENSIONS AAE CLEAR,FlNISH DIMENSIONS second Floor Plan SCALE 1/4•= f-O' KEENAN RENOVATION to a.,,s� sue,mA r I I I ----------------------- REMOVE ETIISINO SROCTURE I I -� I I I ENDOW OPENNG� `REMOTE WNDOW$ 1YP. � lYp. 1 \.III 1 II y I I CaREMOVE MIVNEY. TP. ______________I ________ _______L_J I I I I I I r ROOF BELOW CREATE OPENING Li FOR SNriICHT IN c X L RODE roT fl REMOVE ALL FINISHES I MDFI%NRES,THIS I I r- REMOVE CHIMNEY, x CLOSET I I I I I I I I I I I I I I BEDROOM I I I I I I I I WALL KEY - — oesro vaamlora �cond Floor Demolition Plan SCALE. 1/4-= 1'-0* RRRNAN RENOVATION QZ ax lw�z�,ans 14 Beacon Street s,.,ta.rbm Sao m,MA —REMOVE E%ISRNG --- SIRBCTUFE� ---- ,ffT i i PORCH I , I REMOVE SAVE I r T� I I I -- WINDOW FOR FOR REUSE I S}T—{ �J REAIOOE WNDOWS. II 1 WNDOW OPENNG YP., i TV. I RATM REMOW NI ® PWMBVlG nmRES _ CABRETS R `I WCHECWT)N O 1 1 AA aEgc WniNs I L_J% F 11 1 OWNER IF ITEMS REMOVE CHIY //{--- ARE TO BE SAVED V FOR REUSE REMNEY, / /LAUNDRY\ I I I/ J � WING PORRCH . REMOVE DOOR, M. FSIlT WALLADTD COVE CHIMNEY, HR UP �REMOVE WALL,T1P I I I II 1ST FLOOR FRAMING TO BE REMOVED.CHECK OPENING FOR NEW BASERTNT ACCESS STAR BEDROOM mT WALL KEY — DENO PARfIF10N5 first Floor Demolition Plan KEENAN RENOVATION Ia Rw eF Sak MA m,MA CONFIRM AS r +/-14 V.I.F. �• 10-6 MIN. FROM LOT LINE S-6• HALF WALL W/CAIOINC WINDOWS ABOVE ON 3 SIDES ENCLOSED PORCH ® - I + AUM PORCH WALL W/EIOSTNG WALL •i 1.-0. A STY ON 606 I Q EAnNGAREA KITCHEN L cm) ® e B E I I 2) 066 REF- TO r SAT WALL BROOM/ftECYC1E — ---EQ. 6•-0'* EQ. POSTS IN BASEMEN•G.0 TO bEPoFYED 18- LN�ING DRAIN / \ / \ PORCHNJ / \ aFou,?!lon/Patio UP ANGLED v SH STAR TO BATH R�TD BASEMENT / ® BATHROOM O MNDOW DI z+sa r-B- f BEDROOM WALL KEY mT msnNc � rBOPosEo 3U®6 NOTES: _ _ 1.ALL DIMENSIONS ARE CLEAR, FlMSH ———— DIMENSIONS CLOEET LL09:T ' First Floor Plan CALL: I/4•= 1'-0• %6L'NAN RENOVATION A-1 0 ld u.mis s�.s.Nms 14 weet sue,.k.,K Wrn Lono/ 07" � � Gcr-ni-dN.cgNoncr//Le6/onc Bencon.�i`: So%inil/lc�,sr i�L+�ZYPoENE ��� 6'�Gcor7 Jf 3s' 'v' *is sic �dss� b 79 ESSEX REGISTRY OF DEEDS,SO. 015f.SALEM,KASS Rece�red .1.fE._.194i-� with Rn5619 pxcst� �`�` 7�• S�tlY�.Q/ ReCCow of DefAi 1 � The Commonwealth of Massachusetts { Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR. 70 edition OF SALEMmvs•r Revised Jon Building Permit Application To Construct, Repair, Renovate Or Demolish a /. ?ortiY One-or Two-Family Dwelling \� This Section For Official Use Only Building Permit Nu ber: Date Applied:Signature: J e�z/[1T� Building CommissionerkWpector of Buildings Date SECTION I:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map dt Parcel Numbers /�/ 4?a;a00A) 9J l.l as l accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Toning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 Building Setbacks(R) 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: Zone: Outside Flood Zone? Public❑ Private❑ — Check if es❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 nert of Record: a (PhM) Address for Service: 97 g. - Signatum Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Pro sed Work': hr'/Ne I r c%� K Rfr�/�C e SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Ofllclal Use Only Labor and Materials I. Building s 1. Building Permit Fee:S Indicate how lee is determined: 2. Electrical S ❑Standard Cityfrown Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees: S Check No. Check Amount: Cash Amount: 6. Total Project Cost: s &40 1 ❑Paid in Full O Outstanding Balance Due: �68 �; $ oo CCS h / rl SECTION 5: CONSTRUCTION SERVICES 5.1(�Licensed Construction Superrlsor(CSLJRC / rZt'd f Number L'xpiraliun Date Name of C'SI.-I IulJer Type(sec below) Uescri ion Unrestricted u to 35.000 Cu.Ft.Restricted 1&2 Famil DwellinM OnlResidential Roulin CoverinTelephone Rnidcntial Window and SidinResidential Solid Fuel Bumin A liancc Installation Residential Demolition 5.2 RegJ reds ome lrat rovemeot Contractor(HIC) I IIC Cooe mp Name or HIC Registrant a Reg'istmY Num r !� / 0;)- AJJre ExpinitioK Date Signal re Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 2SC(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 ..........O No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING 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. Siginature of Owner Dale 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. Print Name Signature of(honer or Authorized Agent Date ISituned under the pains and penalties of 'u 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_qd have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 IO.R6 and I IO.RS, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/anics,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" �b The Comnionwealth of\4assachusetts Board of Building Regulations and Standards CCFY OF h Massachusetts State Building Code, 780 CIMR SALEb( 1 t Revised Mar 2011 iau i . f� '.7!V l Building Permit Application To Construct, Repair, Reno.vate.Or Demolish a One- or Two-Family Lhve14n19, , This Section For Official Use Only Building Permit Number: Date Applied>; doe W Building Official(Print Name):., �Signatur- - - Date - SECTION L•SITE INF 11NIATION . 1.1 Property.r dd s: 1.2 Assessors rNfa & Parcel Numbers �\ �2o Co n S r P I.1a Is this an a7accepted street?yes_ no Nlap Number .,Parcel Number 1.3 Zoning Information: 1.4 PropertyDimensionk"IJ V tt Zoning District Proposed Use Lot Area(sq R)^ Frontage(11) 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; PRO PERCY'OWNERSHIPL 2.1 Ownert,ofRecord: W / o-U� {�Ce.�I a d) S �l r r� �/f 6y` C) r 1 D Name(Print) City,State,ZIP /� S q)S- )Vyyy') 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 ❑ �Deolition ❑ Accessory Bldg. ❑ Number of Units ( Other ❑ Specify: B—LiTeIED-escription of P/roposed Work': �,- Se, � /�{r� � lie(/r,n n7 fow', CeatCa(a� sA Ifilter- SECTION 4: ESTENIATED CONSTRUCTION COSTS Estimated Costs: Item Labor and Official Use Only. ivlaterials 1 Building ; 1. Building Permit Fee.S Indicate how fee is determined: Elxtrical $ ❑:Standard..City/T e 2. own Application Fe ❑'rota!Project Cost(Item 6)s multiplier x 3. Plumbing S 2. Other Fees: 3 x 1. Mechanical (IIVAC) S List: �„/9 (� i. Meeh:urical (Fire $ -c -- Sm p rossimn) _ I'otal All Fees: .S Check No. Check Amount: __Cash Amount total Prnject ('ut: S 0D Oa - 1 Pnll Cl❑ Outstanding 13ulance I)ma t �r 0014�Cc , k-� SECTION 5: Co:wrRUCrION SERVICES 5.1 Construction Supervisor Liccuse(CSL) _" (1 r 3 License Number Gspiration Date ,Name ot'CSL (folder **:��' slut sit List CSL Type(see below) — TYpe Descriptg No. and Street Unrestricted Buildin s R Restricted 1&2 Famil DCity/Town,Slate,LIP b1 blasonr RC Ruotin Covering 1VS Window and Sidin, _q /� SF Solid Fuel Burning Appl yy r i'G f'7 Ot to Cf JL7 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(IIIC) //y At!=±.0 Vleet erLmfioB,LLC IIICliegistration Number Expiration Date IIIC Company Name or IIIC 6dgPttMjWlga1 7;c=e CC . tie- No.and Street ` _7yy� .�� Email address 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 Issuanc f 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 c-- `t �- " l to act on my behalf, in all matters relative to work authorized by this building permit application. Cyr~ ( A/� //is"�u � ' Date Print Owner's Name(Electronic Signature) SECTION 7b: OWNER( 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. �3 AVilts N,m7J Electronic Signature) Date l4 T'S Jf AUIhUrlied ' ( Print L) 11� NOTES: I. :1n owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Hones Improvement Contractor(HIC) Program), will rut have access to the arbitration program or guaranty fiord under DLG.L. c. 142A. Other important information on the HIC Program can be found at www mass.auvioca Information on the Construction Supervisor License can be found at %%ww.nslss.' VrdL 2. When substantial work is planned,provide the information below: Total floor:rca(sq. (t.) _—___ _(including garage, finished basement/attics, decks or porch) 'vi t g area sx . ft.) habitable room count tiro;, h 16 ( 1 -- o 'tira lace, Number of bedrooms -----""-____-- NunlLer t _---_ p - -- I o rdtibaths Number of bathroom; -- \nmbs ufdeck;,'porchas ----- �, 1",II II hoj'Ct 1y1111v Irnnl Ike" 111y hQ illhititllt I tar I.,I II Plojtd Co;t'• `) ) I'he Commonwealth of Massachusctls Board of Building Regulations and Standards CI"I'Y OF s ' Massachusetts State Building Cude. 7SO CMR SALEXI Building Permit \Poication 'fo C'onsrruct. Repair. Renovate Or Demolish a Uue-or Tuv-kannls Du elliusr I rhis Section For Official Usc Only Building Permit Number Oa Applied: Building Official tlrrint Nmnci Signature S1e( SECTION I: SITE INFORAIATION 1.1 Plr erty Address: 1.2 Assessurs blap& Parcel Numbers 1.la Is this an accepted street?yes. no Map Number Purcel Numhvr I.! Zoning Informatlon: 1.4 Property Dimensions: Zoning District 11n,powd Use Lot Area(sy 11) Fnsmage(fl) 1.5 Building Setbacks(R) Front Yurd Side Yams Rear Yard Reyuircd Provided Reyuircd Provided Reyuircd Provided 1.6 Water Supply.(M.G.I.c.40.§54) 1.7 Flood Zone Informatlon: 1.8 Sewage Disposal System: Public O Private O Zone: _ Outside Flood Zona? Municipal O On site disposal I -stain ❑ Check if yes0 > SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'o(�Record: a1�v R8EI.),n) Salem YYIq N;u'n1e tp nttl 1� City,State.ZIP Nu.m d 4el telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied O Repairs(s) ❑ 1 Alteration(s) ❑ I Addition O Demolition ❑ Accessory Bldg.O 1 Number of Units_ I Other ❑ Spcciiy, Brief Description of Proposed Work : -5 A D 5 f ' SECTION J: ESTLMATED CONSTRICTION COSTS Neill Estimated Costs: 0111c1u1 Use Only I Labor and Materials) y 1. Building SQO 1. Building Permit Fee: f Indicate how fee is determined: 2. Electrical S ❑Standard CityrTosvn Application Fee ❑Total Project Cost'I lts 6)n x multiplier —..— AI Plumbing ?. Other Fees: S - -\- J. .\Ieah.miral ill\.\('1 S List:-- ----- \lerhunieal I Firy Cu „ressiont S Tot:d .\II Fees: S — — -- - ('hvakNo. Check :\nxnml: ('ash \m,au n: I, Total Project Cost: S �i ❑ Paid in Full ❑Outstanding it..w1ce Due: NECHONS: CONNI'MicrIONSF.RVI(TS 5.1 ('unstruction Supervisor t.icense(('St•) license Numhcr I'\p r;aiol h;ltc Name of('SI. I Iulder (\� � QQ list l'SI. I'spe Description qol mid Street �j U I I Ih1ilJin6's 110 In 15,000 al. It.l 7(b R Rc,trivW 1&2li111111 MWIlin ('ityi loon.Stale.LII' . . \I Mason RC' RlNdin 0,%crin %AS w'indow.uid Sidin .— SF .Solid Fuel Ilurning Appllallccs ct�, � 1I �Lap PIanoff l'ele hone � I Iltilllatnin F lla dres Demo n 5.2 Rr Istered home Improvement -Contractor(HIC) g 7 L P� QAW II IC Itcgislr li n Nimltlur I(. girl iuu Uutr IIIC'r(;ol puny�mcdirI NC Mcgi. it Ji 1v . No..jadC Strcrt 0.0.JJUU��AA ��TTLLII// Email address 0-al C1 /Town.State ZIP rele hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this atYidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No...........O SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR`A,,,,PPnnLIE(�S FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize l Cl CIA\ to act on my behalf,in all matters relative to work authorized by this building per it application. Print Usawr's Nw1 (Electronic sillnuturvi 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. I'rinl t ssncr's or,%wholih-a,\gent'I Nanro 1h.lectnuve Slgn,uunl )ate NOTES: I. .\n Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered cuntractor (nut registered in the Hume Improvement Contractor(HIC) Program).will nrr have access to the arbitration program or guaranty fund under NI.G.L.c. 142A. Other important information on the HIC Program can be found at %„l.l m,r., s v.t Information on the Construction Supervisor License can be found at tl)„ mo, �:'s 111, ? \\'hen substantial work is planned,pro%ide the infunnatiun below: rot aI flour area I s+ it . __ I including garage, finished basement attics,decks or porch) Grtii Iis ing area 114, It.I .... -_ habitable room court I \umbcrol'tireplaces .... -..... Numberofbedrooms _ Nomhcrol'hathrooms - _. — Numberul'hall'haths .. .. . . I I pe otheatiog it iteol - Numhcr of decks, pordles l\pe. f�OUhnl_' i\ilelll I�Ilcloscd ,.l)I.ell t. "loial Friject Squarc Footage"nla.� be substituted I-or"lolol ProjeO Cost" � Ig/7 ma. Hie Commonwealth of Massachusetts - CITY OF )i•+i Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR /7erf+e+l Vut ,Oil Building Permit Application To Construct, Repair. Renovate olish a One-or 71vu-Family Dwelling This Section For Official Use Oi Building Permit Number: Date Applied: _ qWXV Building Official(Print Nine) Signature Date SECTION 1:SITE INFORMA N 1.1 Property dress: , 1.2 Assessors Map& arcel Numbers I.I 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 11) Frontage(fl) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.I_c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: +ublic❑ Private❑ n s Zone: _ Outside Flood Zone? Municipal ❑ On disposals)s>'stem ❑ 1 Check if P P SECTION 2: PROPERTY OWNERSHIP' 2.1 A nerLof�ReAord: P'lC4�> Nanic(Printl City.State ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Desccpipu n of Proposed Work-: &11 l&(-e �✓/9Ci'�.)� or,-,IA_ T /?W ZAr 6c / 7 H�e r✓ • S LlWc�/I 1.2/i xi0 oKl S /''�L,�t /�'s+.✓l.tc<..rr SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building S % y cy 1. Building Permit Fee: E l Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. 1'luntbing S 2. Other Fees: S 4. Mechanical tll\'AC) S List: 5. :\Ishanical (Fire S Total All Fees: S -- Su ,ression) Check No. _Check Amount: Cash:\mount-__ 6. Total Project Cost: S/fS- ,lJ� ❑ Paid in Full ❑ Outstanding Balance Due: .......... #3d (a 11 frq c for 3aa SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervise License(CSL) �v " `Wn_ License Number lxpiration D;u¢ N ante of C:S I. 1 Ider I-ist C'SL I'pe(see below)NIT No. ;md Strcet Type Description X&, G -� U l inrestri-led(11 Idin+s u' to 35,000 cu. 11.) C'ilyll'otvn,Slate,ZII'—�j— R Restricted 1&21:.... Dwcllin+ M Nlaxm RC Root-in,C'uverin WS Window and Sidi- SF Solid Fuel Burning Appliances J I Insulation role hone ('.mail address U Demolition 5.2 R5,gistered Hurt ImprovemeW Contractor(HIC) I IIC ompan) ne or I lIC Registrant: ame I IIC Registration Number Expiration Date No.jjrt(toStrect JI/ Email address Ci !Town, State,ZIPTelephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 .........L®' No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize ,74 S- to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owners Name(Electronic Signature) Dale SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information cotttat ed in this application is true and accurate to the best of my knowledge and understanding. Aid T ry /`-z y �a I not Ott ner s or,\uthorrzed Agent's N';une(Electronic Signature) Dale NOTES: I. An Owner who obtains a building permit to do Itisiher own work,or an owner who It an unregistered contractor An registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty fund under NI.G.L.c. 142A.Other important information on the HIC Program can be found at t}yt_y ioN.s Hop oca Information on the Construction Supervisor License can be found at tk oy y n(;u .you_lip, 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.) (including garage, finished basentent'atlics.decks or porch) Gross living area 1 sq. it.) _ Habitable room count Number of fireplaces_ __ Number of bedrooms ---- Number of bathrooms ---- Numbcr of halr'baths 1'�pe of heating system ------_-------- Number ofdecksi porches pc orcoolinc system -.— _ ._.._ .. -------__ _._-- Enclosed __Open 3. "ro(al Project Square Footage'may be substituted for"rood Project Cost"