8 1-2 REAR ALLEN ST - BUILDING INSPECTION The Commonwealth of Massachusetts
RECEIVES
g I�ufc'I�a( tRJIC SALEM
t t li��'KKK� �L S �' CITY OF
Board of Building Regulations and S
01,
Massachusetts State Building Code, 7 fevised,tlur 2011
Building Permit Application To Construct, Repair, Reppy)aVr 4etnAh
One-or Two-Fmnily Dwelling ttuu��
This Section For Official Use Onl
Building Permit Number: Date A d:
9IX14
1 building Otlicial(Print Name). Signature- . . Date
Lo SECTION 1:SITE INFORMATION
1.1 Pr gear ddr t.2 assessors Nlnp&Parcel Numbers
�n D`�f2_ 64- i41 Sr
1.Ia Is this an accepted street?yes no Map Number Parcel Number
I�'6 n�inglnformation: I.d Pr ertyDlmensions:
Zoning Dist\rict' Proposed Use Lot Area(sq R) Frontage(Il)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yana
Re wired Provided Required Provided` Required Provided
q . \
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if yesC3
SECTIONZ: PROPERTYOWNERSHIPI"
P�mc(Print)
wnerl of R cor {n l i�h Q I Gi 7
City,Slate,ZIP —'
v-2 95 I are unsm E h .
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK°(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Altemtion(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Cl Specify:
Brief Description of Proposed Work-.*
UL 11d d Lk)1"f 3 0. '(Q WV
r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials)
1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard Citylfown Application Fee
2. Electrical S ❑Total Project Costa(item 6)x multiplier' x
3. Plumbing $ P Qther Fees: $
4.Niechanical (IIVAC) $ List:
5. \lechanical (Fire S Total All Fees:S
'u ressiun)
Check No._Check Amount: Cash Amount:
G. ' rtal Project Cust S ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
-
Name of CSL flolder List CSL'rype(see below)
No. ;md Street Type - - Description
U I Unrestricted(Buildings Up to 35,000 cu. It.
R I Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masonry
RC RootingCoverin
WS WindowardSidimit
SF Solid Fuel Burning Appliances
Insulation
Telephone Entail address 0 Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Regisuation 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.g 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 ..........❑ No...........❑
SECTION lac OWNER AUTHORIZATION TO BECOMPLETED 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.
�aC�rii S yVl l �' 7 - / Na
Print Owner's tt(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
Acontaiin this application istr a nd accurate to the best of my knowledge and understanding.
9 / 7 IS
's or, tharizeJ Agent's Name(Electronic Signature) Dale
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 Mt I have access to the arbitration
program or.guaranty fund under M.G.L.c. I42A. Other important information on the HIC Program can be found at
wvww mass.eov'oca Information on the Construction Supervisor License can be found at www.ntass.eov'dns _
2. When substantial work is planned,provide the information below:
'total fluor area(sq. R.) ,(including garage,finished basementlattics,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"rota Project Cost"
a
QTYOF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
TR 120 WASFUNGTONSEET,3" FLOOR
1IEL. (978)745-9595
FAX(978)740-9846
KIMBERI_EYDI2ISCOLL
MAYOR 7 I10NW STTIERRE
DIRECTOR OF PUBLICPROPERTY/BUILDING CONIMISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASES PRINT:
Date
Job Location 0 p1�z I1f" A//M S7. sal leim
Home Owner Address
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
o�
APPROVAL OF BUILDING INSPECTOR
OTYOF SALSA MASSACHUSETTS
` f BEnDn iG DEPARTAzmr
120 wASFmcToNSmmT,310RooR
7kL(978)745-9595.
FAX(978)740-9846
KIIvJBERLEYDRISOt7LL
MAYOR THMAS ST.PIERRE
DIRECTOR oPFLzuCPROPERTY/BwDm amaossiomit
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 c4O, S 54; Building Permit# i 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:
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address Jf facility)
atu of applicant
Date
_Unofficial Property Record Card _ _ — - — Page-l-of 1- —
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 41-0159-0 Account Number 0
Prior Parcel ID 11 --
Property Owner SMITH LACEY N Property Location 8 112 REAR ALLEN STREET
Property Use One Family
Mailing Address 8112 REAR ALLEN ST Most Recent Sale Date 5/2 712 0 1 0
Legal Reference 29491-585
City SALEM Grantor STONE,ELAINE E
Mailing State MA Zip 01970 Sale Price 258,900
ParcelZoning R2 Land Area 0.056 acres
Current Property Assessment
Card 1 Value Building 156300 Xtra Features 0 Land Value 86,000 Total Value 242,300
,
Value Value
Building Description
Building Style Old Style Foundation Type Brick/Stone Flooring Type Hardwood
#of Living Units 1 Frame Type Wood Basement Floor Concrete
Year Built 1900 Roof Structure Gable Heating Type Forced H/W
Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Gas
Building Condition Avg-Good Siding Wood Shingle Air Conditioning 0
Finished Area(SF)1285.5 Interior Walls Plaster #of Bsmt Garages 0
Number Rooms 5 #of Bedrooms 2 #of Full Baths 1
#of 3/4 Baths 0 #of 112 Baths 1 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.056 acres of land mainly classified as One Family with a(n)Old Style style building,built about 1900,having
Wood Shingle exterior and Asphalt Shgl roof cover,with 1 unit(s),5 room(s),2 bedroom(s),1 bath(s),1 half bath(s).
Property Images
pfl g
Disclaimer:This information is believed to be correct but is subject to change and is not warranteed.
http://salem.patriotproperties.com/RecordCard.asp 9/17/2015