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19 BRIDGE STREET - BLDG JACKET ALSO 19 Bridge Street } CITY OF SALEM, MASSACHUSETTS BOARD OF APPEAL 120 W SHING'IONS IxE.ET• SALEM,MASSAa[LJSE'rTS 01970 TELE:978-619-5685 FAX:978-740-0404 KIMBERLEY DRISCOLL MAYOR A n February 1, 2012 xm co CAM r �m Withdrawal without prejudice m D s 3 City of Salem Zoning Board of Appeals e}n — w cn Petition of JOSEPH BUKOWSKI requesting Variances and Special Permits in order to allow the first floor of the building on 19 BRIDGE ST to be used for commercial purposes, and for a Variance from the off-street parking regulations relating to such commercial use (8-2). On January 18, 2012, the Board of Appeals met to discuss the petitioner's request to withdraw the above referenced petition without prejudice. The following Board of Appeals members were present: Annie Harris (acting as Chair), Richard Dionne, Jamie Metsch, Jimmy Tsitsinos, and Bonnie Belair. At the request of the Petitioner, the Board of Appeal voted 5-0 (Harris, Dionne, Metsch, Belair and Tsitsinos on favor, none opposed) to allow the Petitioner to withdraw this petition without prejudice. GRANTED PERMISSION TO WITHDRAW WITHOUT PREJUDICE JANUARY 18, 2012 Annie Harris /— Salem Zoning Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the office of the City Clerk. Pursuant to the Massachusetts General Laws Chapter 40A, Section 11, the Variance or Special Permit granted herein shall not take effect until a copy of the decision bearing the certificate of the City Clerk has been filed with the Essex South Registry of Deeds. (Ititg of 'ittlem, ttssttclju�etts �4 0 ►N '�i s Pc1xrD >xf ApprA DECISION ON THE PETITION OF PAUL FRASER FOR VARIANCES AT 19 BRIDGE ST. (B-2) A hearing on this petition was held April 29, 1987 and continued until May 27 , 1987 , with the following Board Members present: James Hacker, Chairman; Messrs. , Bencal, Fleming, Luzinski and Strout. At the April 29, 1987 hearing, the petitioner waived all applicable time requirements under Chapter 40A. Notice of the hearing was sent to abutters and others and notices of the hearing were properly published in the Salem Evening News in accordance with Massachusetts General Laws Chapter 40A. The petitioner, represented by Attorney William Donaldson, is requesting a Variance from all applicable density and setback requirements and a Variance for use to allow construction of a single family dwelling on the property at 19 Bridge Street, which is located in a B-2 district. The Variances which have been requested may be granted upon a finding of the Board that: a. special conditions and circumstances exist which especially affect the land, building or structure involved and which are not generally affecting other lands,; building and structures in the same. district;._ b. literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship, financial or otherwise, to petitioner; c. desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. The Board of Appeal, after careful consideration of the evidence presented, and after viewing the plans, makes the following findings of fact: ' 1 . There was no opposition presented to the petition at the hearing; 2. The land and its location are unique to the district in terms of size, and not to allow the construction would be a substantial hardship to the petitioner; The construction of a single family dwelling at the locus will be an asset to the other residential properties in the neighborhood; 4. The petitioner has the approval of the Salem Planning Board for his plan; 5• Adequate parking is provided on site; 6. The prior existing building on the locus was destroyed by fire; 7. The petitioner modified his initial plans at the request of the Zoning Board of Appeal in order to provide for the safety of the public. DECISION ON THE PETITION OF PAUL FRASER FOR VARIANCES AT 19 BRIDGE ST. , SALEM page two On the basis of the above findings of fact, and on the evidence presented, the Board of Appeal concludes as follows: 1 . Special conditions exist which especially affect the subject property but not the district generally; 2. Literal enforcement of the Ordinance would work a substantial hardship on the petitioner; 3. The relief requested can be granted without substantial detriment to the public good and with nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. Therefore, the Zoning Board of Appeal voted unanimously, 5-0, to grant to Variances requested, subject to the following conditions: 1 . All construction be as per plans submitted and modified; 2. The petitioner obtain the necessary building permits and occupancy permit from the Salem Building Inspector; 3. Parking for one car be maintained on the site, as per plan submitted; 4. The petitioner adhere to the requirements of the Massachusetts State Building Code; 5. The petitioner meet all the requirements of the Salem Fire Department relative to fire safety; 6. Petitioner obtain proper street numbering from the Salem Board of Assessors. VARIANCES GRANTED ? � J aures M. Fleming, Esq. Vice Chairman, Board of Appeal A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK APPEAL FRJS; THIS Dt(i S!3::. I: A::Y. SHA--L BE VADE PURSIANT TO SECTION 17 OF THE IJi.SS. GENERAL LAWS. CHAPTER: EJ3, AND SH4_L BE FILED :717�'Y 20 DAYS AFTER THE DATE OF FILING OF THIS CK;SiON I;; T4E OFFICE OF THE CITY CiEE=;. PUSS%..':? TC GENERAL 1-44S. CHAFTER 804, SECT:,-N 11. THE VF..^.IANCE OP SP—IQ PER :IT GRk;itD KTEIC. SHALL li?7 "i 0E EFFECT UNTIL A COPY 0." THE:1El I;'',._'.. S::T'V. THE C'FT. FILATC; CF THE CITY CLEP.!: THH 'S D:,YS HAI' 'L=.FSEO a`;D RD PFP'4L HAS SEE` FILED. OR THAI. IF SJ�H APr[6_ H..S 5-LN FILE THAT IT .-S PEEN D''S*':-SE^ CR i IS REC—.;;;D IN THE S'U'H ESS,. R::;:..17R7 OF .^EELS AND 1.'•CEXED U5CEI. TF:E 1.4'AE OF THE CI; IF OF RECGRD OR IS RECGP.DED AND NGfED ON THE OWNER'S CERTIFICATE OF TITLE. BOARD OF APPEAL 9 D 0 c'. o o <� f z m ` 1 2xco QipG.E- x 1 12" 18' oo W 1 � V LouvRL LT G,►�LE1 r -- — 2, 4 — IV" o. 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DATE •This is a Mortgage Inspection survey and not an instrument survey, therefore this plot plan is for REFERENCE i BK:.7.3 F_PG'38 _.. ..__._ mortgage inspection purposes only. p lS T_ _ •This survey is based on survey marks of others. ... .... .. . . . .. .. ..... .... . . .. .. .... .... • Bushes, shrubs, fences and tree lines do not To WO/1C�STE C i7?i4L ED. CQED/i ,rJ necessarily indicate property lines. "F� "' "�"' --Y f� • In my professional opinion the building(s)are not loc The location of the building(s) as shown, either complied with the in the special flood hazard zone, as defined by H.U.1 local zoning set backs at the time of construction or is exempt •Whenever an offset is 1'± or less, an instrument sur from violation enforcement action under Mass. G.L. Title VII is recommended to determine prop. lines. Chapter 40A Section 7. •Offsets shown are approximate by tape survey. 64g^lic O S12-rl 7 Pr. yo' DoT 1720$ Q W a t 3 7--J3 4N� G'"Fti0 � R ) s� ONE S.-.L=:'A GREEN, SALEM NIASSACHUSETTS 01970 ._ (008) ,--5-9595 EXT. 311 FAX (008) 740-0404 WAIVER OF THE DEMOLITION DELAY ORDINANCE It is hereby certified that the Salem Historical Commission has waived the Demolition Delay Ordinance for the proposed demolition as described below, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. Address of Property: 190 Bridee Street Name of Record Owner: Hasbro, Inc. Description of Demolition Work Proposed: Demolition of building 41 (as noted on plan) conditional that the rooftop sign be placed in storage for future reuse or interpretive exhibit. Dated: 8/8/96 SALEM HISTORICAL COMMISSION By: l1° All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A DEMOLITION PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. JOB SITE COPY 3 � CITY OF SALEM BUILDING SALEM, MASSACHUSETTS 01970 PERMIT DATE JULY 1E 19 96 PERMIT NO. 381-199E APPLICANT FREDERICK CWICK ADDRESS 1E WELMAN ST (NO) (STREET) (CONTR'S LICENSE) CITY BEVERLY STATE MA ZIPCODE L1915 TEL.NO. NUMBEROF PERMIT TO ALTERATIONsroRv ONE FAMILY DWELLING UNITS 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) � AT(LOCATION) 0Q119_BR.IDGE STREET? DTRICT (NO) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION MAP' 37 LOT 0074BLOCK SIZE- 172171 SO. FT BUILDING IS TO BE FT.WIDE BY FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TOTYPE _ USEGROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: COMPLETE CONSTRUCTION OF NEW BUILDING AS PIER PANS SUBMITTED. J. J. J. AREA OR [ • - PERMIT � 0171 VOLUME ESTIMATED COST. -L 00Q1 FE (CUBICISOUARE FEET) OWNER NELSON RONALD BUILDING DEPT. ADDRESS 1B HOLLY Sl BY J. J. J THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PARTTHEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR t.FOUNDATIONS OR FOOTINGS. CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL ELECTRICAL,PLUMBING AND 2.PRIOR TO COVERING STRUCTURAL MECHANICAL INSTALLATIONS. MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 3.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS P GING INSPECTI APP VALSS ELECTRICAL INSPECTION APPROVALS z z 2 /13A7 l�f BOARD OF HEALTH S INSPIZCILQUPPF30VALS FIRE DEPT.INSPECTING APPROVALS OTHER CITY ENGINEER 12 CERTIFI AT OF OCCUPANCY Issued:/' b Permit It EI-`14 WO I aem UI 1 ILLBECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. AS NOTED ABOVE. OR WRITTEN NOTIFICATION. No. L/9 9- 9�z City of Salem _ Ward a 01 n' ' 'V ,��; APPLFCD ATIONN PERMIT TOB ILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complllete'lall items in sections:1, It, 111, IV, and IX- ZONING I. AT(LOCATION) �1 IS �L��t� �/ D(STREET) ISTRICT LOCATION No. s 8FF l OF BETWEEN AND BUILDING (CROSS slnaa caoss LOT SUBDIVISION LOT BLOCK SIZE 11. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE 9F IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 IeJ'/New building Residential Nonresidential 2 ❑ Addition(it residential,enter number of new 12 One family 18 ❑ Amusement,recreational Musing units added,if any,in part D,13) 19 ❑ Chruch,other religious 13 ❑ Two or more family-W � Za 3 ❑ Alteration(See 2 above) of units 20 ❑ Industrial 4 ❑ Repair replacement 14 ❑ T^+i. - r. - 21 ❑ Parking garage 4 96 C)(0 22 ❑ Service station,repair garage 5 ❑ Wrecking(if muPo'familyresidential,enter number 9-9 23 E] Hospital,institutional of units in building in Part D,13) �9 � a y� S• L,(0I 96 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) Ve vel -r ea, 25 E] Public utility 7 ❑ Foundation only _.,QO� r S-55J - 26 E] School,library,other educational 1W- Y e�'G` `iffy 27 F] Stores,mercantile B.OWNEfiSHIP �eyt 28 E] Tanks,towers 8 I1r41/Private(individual,corporation,non,•_' f \ 29 ❑ Other-Specify institution,etc.) 9 ❑ Public(Federal,State,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,college, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost ` a. Electrical........................................................................... b. Plumbing.......................................................................... c. Heating,air conditioning............................................. `-d. Other(elevator.etc.).:....`............................................... 11. TOTAL COST OF IMPROVEMENT $ Ili. SELECTED CHARACTERISTICS OF BUILDING •For new buildings and additions, complete Parts E-L;demolition, complete only Parts J&M,all others skip to IV E. PRINCIP L TYPE OF FRAME F. PRINCIPA OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 atv�a�onry(wall bearing) 35 Gas 40 - Public or private company Will there be central air 31 Ir1C=�'Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ErNo 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF TER SUPPLY Will there by an elevatoR 34 ❑ Other-Specify 39 ❑ Other-Specify 42 Irl-d� PPuublicor private company 46 ❑ Yes 47 ❑ No 43 ❑ Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 48. Number of stories ............................................................ floo 49. Total square based on exterior Has Approval from Historical Commission been received all floors based on a#edor dimensions ............................ for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.ft....................................................... �, 5' Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES �g Pest Control: 51. Enclosed............................................................................. sz. Outdoors................................._................................_ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?....... Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed ........................ Electric: Gas: 54. Number of Full.......................:................... -I Sewer: - bathrooms ( DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial........... .............. BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No V� (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No�(If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes—V'_ No Is property located in the S.R.A. district? Yes_ No'_� Comply with Zoning? Yes V No_ (If no, enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes, submit documentation/if no, submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes—Z No_ Is Architectural Access Board approval required? Yes No (If yes,submit documentation) Massachusetts State Contractor License# 19k2 d-eA Salem License # (3CCJ1t9 Home Improvement Contractor# 24heA Homeowners Exempt form (if applicable) Yes CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: r� / _ , f an extension is necessary, please submit i xa! ,5 jB in writing to the Inspector of Buildings. l a° S V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. 1. Owner or Lessee 01,76s 2. Contractor _ Builder's License No. 3. Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent a we a ree to conform to all applicable laws of this jurisdiction. Signature of applicant Address /r Application ate CJ `01 �y DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19 Fire Grading Building "Or Permit Fee $ 6 5-. B-O Live Loading Certificate of Occupancy $ Approved b Occupancy Load Drain Tile $ �-- Plan Review Fee $ T#TLE NOTES AND Data . (For department use) PERMIT TO BE MAILED TO: �� y DATE MAILED: �— Construction to be started by: /Qj Completed by: /6 4 � f VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN -For Applicant Use O N CITY OF SALEM BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please Print DATE JOB LOCATION Number Street address�/ Section of Town "HOMEOWNER Z2 tJ1 Name Home phone Work phone ry. PRESENT MAILING ADDRESS 1��1X 67 City/Town tate 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, rovided 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 onsible for all such work performed under the building permit. Section 109. . 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 saidpybxedu�,esrao requirements. HOMEOWNER'S SIGNATURE / /��„ 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;' 3;; ,✓ ness often results in serious problems, particularly when the Home Owner,, - 4'. - hires unlicensed persons. In this case your Board cannot proceed against ' -`` the unlicensed person as it would with licensed Supervisor. The Home Owner V* acting as supervisor is ultimately responsible. „3.„ 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. I _ i - -3!' .�1) a ay c- o 0 t y 1 �L I w �� --- 1-IF J vl in II I f- Q V FiC 11 f W, , 4F � P FIR..P ,7C ,• ,•1 �. i- �i � !�{ i ' I it�/ I - n�AHD L OT�� �• �i �\ i'I I : I Au D I F`w17 pHD INSP�pUE' est II Im I—` i F �•. rn ANCE @,1'iN TNr FIRE T '1 - 1 � - � �` _ •�,- �1 =-zea I_.. � R � T f s ,/ s0 \ 1 �'."-- .�mm F.ccru.c► G�' owc.7L \ h I - I _I :G ! — I 0 am - I 150 12- PAvL PR� S � � ALL PARTITIONS ARE 2 AK A- EXCEPT — WHERE NOTED OTHERWISE S A L E M M A< ALL DIMENSIONS AND MEASUREMENTS lJOTE-: MUST BE VERIFIED BY CONTRACTOR 1. F?>=Ft_2 10 nSP�c�F��.Ttv.w�._ SK r. ott . I• CHs ItiCwDED SCALE DRpwNBy DATE N6wSNEtTn ot,D Sf E7R AN010R OWNER 2A 901 1 of 9 1 1 of 17 < IS 5- � 010 INN G } SIN nc ED N ST0, © r,\ S . oma. I �1y � N CS, \ N � t3Ac �< � ` � C`� N u { Le ` •.. V3 > ooM v SCPrLE c-�) A _ Z8 A CONGRE'TE SLAB -z� -_ O _ N 2'- S X2-9 XIV, CHtMNEy FCcT1NU t1� 1 � I FOUNDA T/ON 70L q N ,/4 = / -4 NEW . 3 OF 9 - ._ v ,l• _�. 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',1� HAN�6R 11 1 Z X4 ON 24 oc. \ ' T 4- �I 1 ,.i o m 1 TYPICAL C-RO55 SECTICIM I f O A v lD The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR RECEIV p SALEM I�S$ECTtOhN�l I.t 2011 Building Permit Application To Construct,Repair,Renovate r emo is a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date A li//e//d�": 1n vyry�r N� 4Dalte ,U nJ Building Official(Print Name) Signature U 1 SECTION 1:SITE INFORMATION 1.1 PrQpeddr�e>ss: 1.2 Assessors Map&Parcel Numbers `� I GG' �Q� J l.1a 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(it) 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?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' / y7 Aur �: tJlLL`/VI AW City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIe(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description�o�f Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials Official Use Only 1.Building $ 1. Building Permit Fee:$ Indicate bow fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: i 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ r b (� ❑Paid in Full ❑Outstanding Balance Due: SenvT rp N o , co I i s SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) , License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling - Cityll own,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 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street 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 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 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 accvr st of my knowledge and understanding. JMCY a�L� ajsK( 6- l 6 Print Owner's or Authorized Agent's Name(Elec onic 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 x"vw.mass.-ov.'oci Information on the Construction Supervisor License can be found at www.mass.ro€ v/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" 1 1 $25 The Commonwealth of Massachusetts m }� Board of Building Regulations and Standards RECEIV F �; ' Massachusetts State Building Code, 780 CMR 1%SpECT10%AL SE RevivedMar 201/ 3 Building Permit Application To Construct, Repair, Renovate Or Demo�lltii�ssIh'a5 A 11; Zb One-or Two-Family Dwelling iQ�a jM This Section For Officia se Only Building Permit Number: Date pplied: + �40 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1�zp§k= �AA tM 4- 1.2 Assessors Map& Parcel Numbers 1.1 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(sy fl) Frontage(It) 1.5 Building Setbacks(ft) 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: Public Private❑ Zone: _ Outside Flood Zone'? Municipal f( On site disposal system ❑ Check if yes[] SECTION2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: t lam? aUKvwSk l ✓7Z s",A+I d47 d Namo(Print) City,State,ZIP Bit©G��iq7r1iv3q00 Ifit ls� No.and Street Telephone - Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Z I Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Deseri Lion of Proposed Work'-: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building $ 1. Building Permit Fee: S Indicate how fee is determined: O Standard City/Town Application Fee Electrical ❑Total Project Cost'(Item 6)s multiplier x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (I IVAC) $ List: 5. Mechanical (Fire $Suppression) Total All Fees:S 0 o Check No. Check Amount: Cash Amount:_ 6. Total Project Cost: S ,3 OOO — ❑ Paid in Full ❑Outstanding Balance Due: kA,IL TO H• Z) . ; M0.IL rib 6\. O , SECTION 5: CONSTRUCTION SERVICES 5.1 Construction,Supervisor License(CSL) �I li? t f., r i��.,nig. License Number Expiration Date Name ol'CSL Holder ter' List CSI-Type(see below) to arpr .and Street � Type Description N o U Unrestricted Buildin s up to 35,000 cu. ft. R Restricted 1&2 Family Dwellin Ciryrrown,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 Registered Home Improvement Contractor(FIIC) HIC Registration Number Expiration Date HIC Company Name or I IIC Registrant Name No.and Street Email address Cit frown,Slate,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 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. 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 a best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electr re.ignature) 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 %vkvkv.mass.gov/oca Information on the Construction Supervisor License can be found at www.nrass.gov/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 heating system _ Number of decks/porches_ Type ofcooling system_ Enclosed _Open 3. "Total Project Square Footage"may be substituted for`"Total Project Cost" i CITY OF SALEM, MASSACHUSETTS yJ') BUILDING DEPARTMENT 120 WASHNGTON STREET,3M FLOOR \ TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISGOLL MAYOR Tfiom S STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date /��/ ,t Job Location F R( U u ,t / 06 d qI Gam/ Home Owner Address I q �l� �lW ��1 v i /q A71 y I L Present Mailing Address 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 'I V CITY OF S:ULENf, L%L-1SS:ICHL'SETTS J` ERALOLYG DEPART ZN-r 120 7 3HLNGTON S-MFET, 3 °FLOOR YtiL. (973) 745-9595 KIMBE111 EY DIMCOLL F•LX(978) 7,W-9844 NLAY0,1 I'-10.%N3ST.P1'e u DIRECTOR OF PUBLIC PROPERTY/BUM0LNG CO\L%fISS[O' Construction Debris Dispasai AftIdavit (required ter all demolition and renovation work) In accordance with the sixth edition of the State Building Coda, 730 04R sectio l t Debris, and the provisions of tblGL e 40, S 54; n 1.5 Building Permit I#this is issued with the condition that the debris resulting from l 1, S I SOA. waste disposal facility as d efinc d by N(GL c The debris will be transportcd by: ti (nantc ut'hauler) The debris will be disposed of in ------ (panic of facility) —� ..__----(..tJJresa or riicility) . siynaturc u!'perntif apptiaurt — -- The C'onunonwealth of Massachusclts is i� Board of Building Regulations and Standards CI I1'OF Isr Massachusetts State Building Code. 780 CNIR SALEXI Building Permit Application 'ro Construct, Repair. Renovate Or D nolis a One-or Tuv-Fonulr DwL,11i,kq This Section For Official Use Only Building Permit Number: _ (, Dat Applied; _ J" b( zy K�Svz _ 7i I Z tluilding 011icial(Print Mane) Sigtla rc Dale SECTION I: SITE INFOR IATION Propert Address, f� Q� 11 Assessors Map& Parcel Numbers 1 1.1 a Is this an acce ted street?yes no Mop Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District 1'n,13010 file Lot Area(sy It) Fmnlage(11) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Reyuircd Provided Required Provided Reyuircd I'mviJeJ 1.6 Water Supply:(M.G.I.c.40.§Sy) 1.7 Flood Zone Informatlon: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: — Outside Flood Zone? Municipal O On site disposal ) Check if ycs❑ P posal s stem ❑ SECTION3: PROPERTY OWNERSHIP' 1 Owner(of Recy d: l>)W-L J . M 10 ;long/(I'nn 406� City.State.ZIP Nu.;utJ StreetM 2 A- ieiephorse �sEmnuai�l Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction ❑ Existing Building❑ Osvner•Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ ;accessory Bldg. ❑ Nwber of Units_ Other ❑ Specify: Brief Description of Proposed \York=: G Va SECTION a: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: I I.abur bur, .%latrrials) OMNI Use Only I. Building S I, Building Permit Fee:S Indicate how fee is determined: '. Electrical S ❑Standard City/Tusvn Application Fee ❑Total Project Cost'(Item 6)x multiplier _ —_x J. Plumbing S ]. Other Fees: 5 /- J. Mechanic,d I ll% \(') S Lisl: ?. %leellanieal (Fire Su„ressionl S rotal .\II Fees: Cheek No. ('h_ eck amount: Cash \m,nml: t, Total Project Cnsl: S �Ol) p p;tid in Full ❑Outstanding Bal;nice Due: SECTIONS: CONSTRUCTION SERVICES 5.1 ('onstruction Supervisor License(('SI.) I icensc Nunlher --' -- P\pir lion Date Nano ol'CSI. I Iuldcr I izt('St. 1\pc Isec I+elattl._—'- ------ 1.tpc Description No. .nlJ Street ---------------- ---- li t lnreslricicJ l Buildin,s li to 15,UIIn cu. Il.l _ It Restricted 1&21:Jnlil Dahill Citslroao..\late.Lll' -- '--.. . . %I llazun RC Rthlfin Coverin %S Window:wJ Sidin SF Solid Fucl Burning Appliances Insulation elc hone h:muil aJJresr D Demolition 5.1 Registered Home Improvement Contractor(HIC) IIIC Registration Nunlhcr Expiration Dulc IIIC Compun) Namc or IIIC Registrant Name No.wld Street Email address CityfTown.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 affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ..........❑ No...........O 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 platters relative to work authorized by this building permit application. Print Dttwcr's Nwne(Elccwnic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering I name below. I hereby attest under the pains and penalises of perjury that all of the information contain ut this application Is rue and accurate to the best of kn ledge and understanding.� (Tint I)wncr't or.\udulriicJ.\gent's Name I11%:ctro'M Sigiuuura Datc NOTE : I. :\n Owner who obtains a building permit to do his her own work,or an owner who hires an unregistered contractor (not registered in the Hume Improvement Contractor(HICI Program).will nu have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Othcr important information on the HIC Program can be found at it%%,l nl•1,s ;!+ 4.1 Information on the Construction Supervisor License can be found at,t it,t 2 \\'hen substantial work is planned,provide the inturmation below: row flour area Isy. R.) - —_.._I including garage, finished basement attics,Jerks or porch) Gross living area(sy. ft.) _._. Habitable room count ♦umber of fireplaces .... Number of bedrooms N timber tit'bathrooms — \umberofliallhadls I)pc of hcating s),Iclll Number ol'decks porchcs i I't lie,JP+ohllg St.ildlll I7I0owd (ll,ell 1, "I*,it.11 Prol"i Square l'JUlllge"Ilia\ be uhstitutcd ror Folal Project Coo" it CITY OF S,VZNf, Aiiss.kcfjL:sETTS 8LLLDLNG DEP.1A71tE`T 120 W.UHL%`tGTON STRIM, Jw FLOOR rM (978) 745.959S KiJ13ERr gy ORMOLL FAX(978) 740.9946 ,1(AYOIt DIREGTO I}tom u St pmx" g OF PLSUC PROPEA7Y/ILMnLYG CO-%EWSSION Elt Consruction Debris Disposal At'ttdavit " (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section if I.S Debris, and the provisions of MGL c 40, S 54; Building permit AI is issued with the condition that the debris resulting Prom 1 11 work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c I 1 I, S i JOA. The debris will be transported by: Loqri CkNl (name of hauler) The debris will be disposed of in (namao— tfa�lijyl '"---- I�ddrera of f��il+ty) v + rule afpermrt ipphCint �e2 (� �, CITY OF $.ULE.Nf PUBLIC PROPERTY DEPART N, iENT N�0WSY 0VIr011 .�rAYOa ISD'eA0YNG70N h1uT�SAL{M Vw�00.str77011•0 rm 9'L745r95"•P.ut 978•74&964 HOMEOWNER LICENSE EXEMMON Flew Ftti�t / Date Job Location I G� c rSWtewj N d l q D (� Home Owner Address p T 3 y 7 D Home Owner Telephone Sz 21 et / Pres Mailing Addreu ( G q � The current exemption of"Homeowners"was extended to include owaar-occupied dwellings of two Units or less said to allow such homeowners to engage an individual for hire who dos not Posues a lica1111%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'sW submit to the Building Official,on a form acceptable to the Building Official, thin 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 bylaws and regulations. The undersigned "homeowner"certiNa that he/she understands the City of Salem Building Departrnent minimum inspection procedures and requirements and that he/she .vill comply with said procedures and requ M LL HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTO See other side for state code 2S o� 4&2�D The Commonwealth of Massachusetts RECEIVED CITY OF ° Board of Building Regulations and B€ IIONAL SERVIC S SALEM Massachusetts State Building Code,780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair,R1k65ia{Bbrj1b=gisl& S 5 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Dat Applied:' Budding Official(Pant Name) - signature Date SECTION 1:SITE INFORMATION 1.1 Pro e ty dres • r 1.2 Assessors Map&Parcel Numbers 1.1 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����N-eorar Name(Pnn City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF"PROPOSED WORI{;(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work' r^n. �. , )C I !ri, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ 1. Building Permit Feu:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee - ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ I Other Fees: $ - 4.Mechanical (HVAC) $ -List: ` r 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No.: - Check Amount: Cash Amount:- 6.Total Project Cost: $ 66 ❑Paid in Full ❑Outstanding Balance Due: M rx l L. -ro (A • c�. CLIteJi F. U l IZ� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted l&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 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street 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 Issuance of the building permit. Signed Affidavit Attached? Yes ..........❑ No...........❑ SECTIONlra;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. Print Owner's Name(Electronic Signature) Date SECTION 1b: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) 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.a 142A.Other important information on the HIC Program can be found at wM1vw.mass. ov'oca Information on the Construction Supervisor License can be found at www.mass.-gov/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 heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" -� QTY OF SALEM, MASSACMETTS 2 BUILDING DEPARTMENT ,�5 1 h!' 120 WASFBNGTON STREET,3" FLOOR }�. 'ILL. (978)745-9595 KIMBERLEYDRISCOLL FAX(978)740-9846 MAYOR THomAS STTIERRE DIRECTOR OFPUBLICPROPERTY/BUILDING CONINUSSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date ^ // //(J�f Job Location ( l Home Owner Address N r—/n V( ��O�G tf �(.S J n ,AIr al n G Present Mailing Address ) /1✓� 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 'VV o jqp °o a Attorney-a member in good standing of the c Enrolled Agerri-enro b Certified public Accou mea tsdi t court of the jurction shown below. a certified public accountant in the jurisdiction shown below. lled ntant—duIy Qualifled to bar of the h practice as as an agent under the requirements of Treasury Department Cuctrtar No.230. d Officer—a bona fide officer of the tazpayePs organization. e Full-Time Employee a full-time employee of the.taxpayer, 1 Family Member--a member of the taxpayer's immediate family Q.e.,spouse,parent Child,brother,or sister). a Enrolled o practice ry n �e Cas an e is i cant Board for the Enrollment of p,chrazfes under 29 I1.S.C. 1242(the �1ne horny t Return Pre ed by section 10.3(d)of Treasury Department Circular No.230). Circular — authority to practice before the Internal Revenue Service is"ad by Treasury Department on 10.7(cj(1 vdr� You must have prepared the return in alion by the IR question and the return must 6e under exam nS ea Un�ed 2Cum PrepareY oergige 2"et€}hg qns F THIS D CU1RAriDN OF F q rigryE ISAOTSIGNED AND DATED, SHE PgUVER` 'h I`urg `c ons. RNEY wllJ ignation—Insert Jurisdiction(state)or .above letter(a-h) identification S' net pate I. I3 Farm 28Q rpm,,3,z004i , I ; G�4"53� �ZS The Commonwealth of Massachusetts Board of Building Regulations and Stand E1uEp CITY OF 1 Massachusetts State Building Code, 7 0L SERVICES SALEM 'NS �� Revised Mar 2011 Building Permit Application To Construct, Repair,Renovate Or Demolish One-or Two-Family Dwellin 4 P _ This Section For Official I tfrily S' Building Permit Number: - •Date Applied: Building Official(Print Name) Signature Date L J SECTION 1:SITE INFORMATION 1.1 Pro Addr s: 1.2 Assessors Map&Parcel Numbers r1 1 q �G ��4 fu4cu o r4n nI I 1.1 a Is this an accepted street?yes no Map Number Parcel Number F1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(it) 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?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownert of Record: Name(Print) City,State,21P No.and Street �"~' Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units O[her ❑ Specify: Brief Description of Proposed Worl2: SECTION 4:ESTIlY1ATED CONSTRUCTION COSTS Item Estimated Costs:Labor and Materials Official Use Only 1.Building $ 1. Building Permit Fee;$ Indicate how fee is determined: 2.Electrical $ -❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List:_ 5.Mechanical (Fire $ Su ression Total All Fees:$ GtJ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ � q ❑Paid ui Full ❑Outstanding Balance Due: M %A •p, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 7 License Number Expiration Date l Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Build in s 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 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street 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 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 a terin my name below,I hereby attest under the pains and penalties of perjury that all of the information con arced pplication is true and accurate to the best of my knowledge and understand' _ - JI)L-1- 90(2_100ww( 7 /�-- Print 0 er's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 0Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor 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.nrass.aov/oca Information on the Construction Supervisor License can be found at IyLi�/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" ° CITY OF SALEM, MASSAaR SE M s , BUILDING DEPARTMENT 120WASFUNGTON STREET,3"DFLOOR TEL. (978)745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMbIISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: ff Date J (� f j��' nt Job Location 1 7 (�� 91 br5r S7 SAL_M�it � 0('7 q0 Home Owner Address 1-1 zg L yy 6L 5 Present Mailing Address ! q U(1�'1� 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. ��//��++✓,, fr r, HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING INSPECT R 07Y OF SALEA MASSAGA SE M I BuiLDINGDEPARn ENr (7 , + 120 WA%W4GTON STREET,r FLOOR ItL(978)745-9595. RIIviBERLEYDRISGOLL FAX(978)740-9846 MAYOR THOMAS ST.PIEREE DIRECTOR OF PLsucPROPERTY/Bump=ODImsslomR Construction Debris Disposal Affidavit (required for all demolition and,renovation work) in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, 5 54; Building Permit# is 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 150A. The debris will be transported by: O W �eK (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Si ature of applicant Date J . , T The Commonwealth of MassachusRttEIVED ' Y OF Board of Building Regulations, L SERVICES SIALEM Massachusetts State Building 8o e,780 CMR Revised Mar 2011 Building Permit Application To Construct,Rep�I�RpRv�t6Or:�e DWQ3 a One-or Two-Family Dw;trig bs Section For Of€tcial Use Only +� Building Permit Number: Date App]' Budding Official(Print Name) Signature; _ Date 1 SECTIONA:SITE INFORMATION ` 1.1 roerjy Ad r s• 1.2 Assessors Map&Parcel Numbers 1 I K!n . &,S u4 91l--D 0V 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 Yazd 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 21 Owner Re c Ld� S�z�/ Name(Print) ,Cv City,State ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ net ❑ Specify: Brief Description of Proposed Work': jkkmU L � 1 OC�/'C z5!/C SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2 Other Fees: $ 4.Mechanical (HVAC) $ List: f a� 5.Mechanical (Fire Sup ression) $ -Total All Fees:$ GOOD � p� Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ OO D ❑Paid in Full O Outstanding Balance Due: PJt/�tl.ts'Y� TO Gi..O� S� tl SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder l .., R t AG L- f1�I t j�r List CSL Type(see below) No.and Street Type Description U I Unrestricted(Buildings no to 35,000 cu.ft. R I Restricted I&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 Registered Hgme,Improv �n�➢ontrr (HIC) HIC Registration Number Expiration Date HIC Comp an nine or gis ant Name No. tr Email address City/Town, Stat ,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...........O 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 under4e pains and penalties of perjury that all of the information contained in this application is true and accura to a be t of my knowledge and understanding. Print Owner's 6r Authorized Agent's Name(Electro ' ature) Date NOTES,: 1. An Owner who obtains a building permit to&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 sitivw.ma-ss.eov,`oca Information on the Construction Supervisor License can be found at www.mass. ovg /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" a Y QTYOF SALEM, MASSAaiUSETTS BUILDING DEPARTMENT 120WASHNGTON STREET,3"OFLOOR TEL. (978)745-9595 KIMBERLEY DRISCOLL FAX(978)740-9846 MAYOR MiOMAS ST.PIERRE DIRECTOR OF PUBLICPROPERTy/BUILDING COAsusslONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT., Datea7ol / i\ 311o. � / / �J /, Job Location �! D c6-Kp V� `r"� o �/��� U1`�/] "` ,vI // t� Home Owner Address / M 3 r�.04 q1 I l `4 [ d Present Mailing Address l / /��-CR-(.J L O' i c 1 C/ 66 12A I 61114 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 INSPECTO no-� c� 31bJS o p � I-Al t l f ` Q ty 4 lu i t - cv, on The Commonwealth of Massachusetts Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR 1Q! APR ! Iisef ar 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: Date App ied: /,fin Building Official(Print Name) Signature VDate SECTION 1:SITE INFORMATION C'JP 7erty %ess: .� 1.2 Assessors Map&Parcel Numbers 1.1 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 -n='ofRecord: ��1 li�UlUE�( q Namen) � City,State,ZIP � aL 5 /I A ¢ / bst � d No. f� and Street Telephone Email Address Ul SECTION 3:DESCRIPTION OF PROPOSED WOR10(check all that apply) New Construction 11 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: rief Description of Proposed Work K5 E5 a ff SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item � Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$, Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost $ U ❑Paid in Full ❑Outstanding Balance Due: �-i ( u{ m A t,+- , SECTION 5: CONSTRUCTION SERVICES ' 5.l onstruction Supervisor License(CSL) �G �i` (� . License Number Expiration Date Name(( S Fl lJer f ��� List CSL'rype(see below) �J �(/(/tw Type Description No.cunt Street U Unrestricted BuilJin up to 35,000 cu. tt. R Restricted 1&2 Family Dwellin City own,Stat ,ZIP M Masonry RC Roofing Covering INS Window and Siding SF Solid Fuel Burning Appliances t Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address Ci /Town State ZIP Tele hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G,L.c.152.g 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...........D SECTION 7a.OWNER AUTHORIZATION TO BE COMPLETED,WHEN 1. OWNER'S AGENT OR CONTRACTORAPPLIR FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize t9 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,l hereby a st under the pains and penalties of perjury that all of the information contained in this application is true an ac u to the best of my knowledge and understanding. Print Owner's or Authorized Agent's NaIcctronic Signature) Date m• NOTES: I. An Owner who obtains a building permit to Jo his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will nu have access to the arbitration program or Guaranty fund under NI.G.L.c. I42A.Other important information on the HIC Program can be found at www.mass.gov?oca Information on the Construction Supervisor License can be found at%vww.mass.(ovU.% 2. When substantial work is planned,provide the information below: "focal tloor area(sq.R.) (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 ofcooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ,,V,rJD 5 EAL Iot 13cZ�oU � woap 5�l Gst _ LL i _- ( GEM9AIT 4+ IT f i i i tit LEFT SIDE ELEVA71C kcc A�6 U�11t_ ' "Che Commonwealth of Massachusetts j Board of Building Regulations and Standards CITY OF � Massachusetts State Building Code, 780 CMR SALEM` Revised,l/ur 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. Date.Ap edi _111 Building Official Print Name Signat! Date i1 SECTION L•SITE`INFOIZI�i.�►T[Oi�F' : L 1 P e d ���� ����� 1.2 Assessors Map8c Parcel Numbersl� 9 �� 1.1 a Is this an accepted street9 yes no Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(It) 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❑ SECTION2: PROPERTY OWNERSHIP!` m�2.l O nerl of Resor t� J r Ul�-b wJ l S4z z d14 70 City,State,ZIP 7� V, 1,9 s�- ?,S1 5 �2_1 ss No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED 1VORK=(check all that apply) New Construction❑ xisting Building Owner-Occupied Repairs(s) O 1 Alteration(s) CVJ Addition ❑ Demolition e I Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Descr' tion of Pr sed Work': SECTION 4:ESThNATED CONSTRUCTION COSTS Itcm Estimated Costs: Official Use Only Labor and Materials I Building S I. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Costs(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4.XIcchanical (FIVAC) S List: 5.%fechanical (Fire Suppression) Total All Fees:S Check No. Check Amount: Cash Amount: 6.Total Project Cost: -S 0 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Wane of CSL Holder List CSL'fype(see below) No.;u►d Street Type Description U Unrestricted(Buildings up to 35,000 cu.11. R Restricted 1&2 Family Dwelling City/fo%vn,State,ZIP M h4asonry RC Roolinit Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date I IIC Company Name or HIC Registrant Name No.and Street Email address Ci /Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.4 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 ..........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 _ t9 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 enter(inthis ame b ow,I hereby attest under the pains and penalties of perjury that all of the information containapp' t' n is true and accurate to the best of my knowledge and understanding. TU 7 --1 '7 Print Owner'sjh Ruth ized Agent's Name(Electronic Signature) Date NOTES: I. An O n 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 I&I.G.L.c. 142A.Other important information on the HIC Program can be found at www.rmass.gov'oca Information on the Construction Supervisor License can be found at www.mass.;ov!dns 2. When substantial work is planned,provide the information below: 'rotal floor area(sq. R.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.11.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths 'rype of heating system Number of decks/porches 'type ofcooling system Enclosed Open 3. "'Total Project Square Footage"may be substituted for"Total Project Cost"