12 ALMEDA ST - BPA-11-776 ABOVE GROUND POOL N I� The Commonwealth of Massachusetts
^ 'I Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7"edition OF SALEM
'e'er Revised Junuary
Building Permit Application To Construct, Repair, Renovate Or Demolish a l• =008
One-or Tivo-Family Dwelling
Section For Off ial Use Only
Building Permit Nu er: I D e Applied: 7H ,
' . I �
i
Signature: / Y ti
Building Commissioner/InspectorlaffulliFings Date
SEC ON 1:SITE INFORMATION
1.1 Propertyy Address: 1.2 Assessors Map& Parcel Numbers
i`L G42t1t�la
I.]a Is this an accepted street?yes lv� 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 Require) 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 yes❑ Municipal[IOn site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners of Record•
i�crst�k� t �� <r _Lk
12 AtnepA -z, "�1 1 . tA , 0i97u
Name(Print) Address for Service:
Signature I 'telephone
v 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. ❑ 1 Number of Units_ Other ❑ Speedy:
Brief D scription of Proposed Work:
_ �'._l;<' �-Si.=:iw af� 1�L.,�yl t✓l i�/✓.',.-i., Cam: '� h (�..r�i c:1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
I. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical S [3 Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (BVAC) S List:
5. Mechanical (Fire S
Suppression) Total All Fees: $
1 Check No. Check Amount: Cash Amount:_
6.Total Project Cost: S da 0-9 J ❑ Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Nance of CSl,I[older
List C'SI.type(sce below)
T e Description
Address
U Unrestricted(u2 to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwellingr
Signature M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
111C Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature 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...........0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, +-�US�}(-\-1f� 1-'-{�-{�,IJL`t-:: - 1 w-� , as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work authorized by this burl ing permit application.
<7._ lint, � s5)2- r
Signature ` Date /
�} SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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 Owner or Authorized Agent Dale
(Signed under the pains and penalties o1' er'u
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. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110,115, respectively.
2. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics, decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of hal0baths
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"
MORTGAGE INSPECTION PLAN
BOSTON
SURVEY, INC. 08-06483
P.O.Box 290220 Charlestown,MA 02129
(617)242-1313 MAIN (617)242-1616 FAX
APPLICANT. HARLOW-POWELL DEED/CERT., 25267-4
LOCATION: 12ALMEDASTREET PLAN REF., 2430-131
SCALE 1 inch=20 feet
CITY,STATE: SALEM,MA PREPARED," 10-08-2008
CERTIFIED TO:
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LOT 50 5512+/SF V
LOT 51 5819+1SF Lea
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2 STORY
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ALMEDA STREET
I YGa(�,nmbn AweY SeEraa
The pemanpm mmmam arc appmaimatmy lemld op drc mnAin6 to Federal Ennga�mY Management Agnu:Y
gmeed ns shown.Thay mthm wvtamed Io the ambmt p;the mpJm impravemrnu on This Wapnty fall in an
rcpahmncnu pCthe oral aaaioo Ixdinames in egecl a C. � am,as 2maC
the lime of conslmmion.M sra nsnnWl Rom violation C�aLl�INI / 6
en urni, all action m . i,iav Ttle VII,CheWm 40A, a�sa C1T� mmantllY t'artl No.? O u
Semi."/,and tWs IliM are m emraarLmrnu aCmejor Ile• p 7 Efrwi,,s Dian: L'
tmpmve .s eiaher waY eams peaty limn exrspt as psa G 5
ahnwn and uoled hmon, r UAJ� TE:7An2 G 18 8Raa Of nnli IX111 ,&v a nh8 ng).
Thls desigmtim is Dal nosed m an elevation cen.limle.
NOTE:This a aM a beal0aly a Nb tuvmna slavaY.ilds to pmmdaal cold uNriol sla nis for modslalin Lea^Inspections as adppt
by Ina Wssarinaeas BovA d Regislrebrl of pa lnin anal anal Iann snveYam,M oolR 6M.a,i ese be an,near ln,,nno is inn bad.alas plan is rM to ba
used br rarnNin9.Waina&V dead di sa4tam.of
CITY OF S.UEM
PUBLIC PROPERTY
DEPAR'i'atENT
W.o...s.o.snai
V.roe Uo WM"".rCW alUar•s.0 y VANIMMSefts o19Te
rxL I-V 4.99!•V.%&9,1&716964
HOMEOWNER LICLNSE EXEIMMOM
Pksaw Ftrtat .
Dan MA t 1
Job Location 12. AL Pe-D/-I S R(A-LE / nA , C) (47�
Home Owns Addtear
Flom.Owoar Telephone �� "]v 4 7c'9 -G
PresadtwhsgAddraes
The current exemption of"Homeownew"was extended to include owner-occupied
dwellings of two Units or lean and to allow such homeowners to engage an individual for
hire who.does not possess a Ec®K provided that that owner acts as supervisor.
DEFINM0N OF H0h=WW=
Person(s)who owns a pared of Lend on which hdsbe resides or intends to reaide an
which there isi or is intended to bsl,a one or two dmily dwel ft attached or detached
structures accessory to such use and/or firm structurea A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
'Iiameowner'shall submit to the Building O®ciak on a form acceptable to the Building
Official, that be/she be responsible for all such work performed under the Building
Permit,
The undersigned"homeowner'assumes responsibility for compliance with the State
[wilding Code and other applicable by-laws 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
grill comply with said procedures and requirements. A
HOMEOWNERS SIGNATL'RB
�J
APPROVAL OF SUILDLYG DiSPECrOR '4 4
Sea other side for state code