12 ALMEDA ST - BPA-16-885 MOVE POOL FROM SIDE TO REAR S 0 Gtl_ f�
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or 71vo-Family Dwelling
This$„et�3on For f) a�.Us� ,
BuildmgPntIDtc:lrhrmber . Date
Ap
fy° g ciml(Pmntrt��) s Date
t --
/1 ATC3TOP1.1:SI71g I11 OR1►Ii1TI01�7 P rh
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers C
1r 1 L I a Is this an accepted street?yes_ no Map Number Parcel Number N �,
h 13 Zoning Information: 1.4 Property Dimensions:
P D
11330 ,8'-
7aning District Proposed Use Lot Area(sq it) Frontage(it)
:C GD
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:
Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private' — Check ifyes❑
SECTiON2: PROM71TOWNERSHB?t
2.1 Owner'of Record: Q� � r v1(�".
'Z>0 Q P.�A H4�2WW yv
Name(Print) City,State,ZIP
t 2 A 1 -yi e c) C )72 239 g 6 t--)'4
No.and Street Telephone Email Address
: SECTION 3:DESCRIPTION OF PROPOSED WORK'(00k all that apply)
New Construction❑ Existing Building❑ Owner-Occupied pJ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ I Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Worl?:
2-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only "
Item (Labor and Materials
1.Building $ -7 cameo . 1. Building Permit Pee:$ Indicate how fee is determined*
2.Electrical $ 5p0 ❑Standard Cttyfrown Application Fee
O Total Project Cost'(Item 6)x multiplier - x
3.Plumbing $ 2. Other Fees;
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire Su ession $ Total All Fees:$
c
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ��OQr Cl p pyill O Outstanding Balance Due:
mpl tL-ccD gg 19 ro l 1. C) .
y.
SE-C (W 5: CONSTRUCT M S=VICES
5.1 Construction Supervisor License(CSL)
Y`4 y A�( P(]O L-S License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street -iipe ption-
U I Unrestricted up to 35,000 cu.R
R I Restricted Family Dwelling
City/Town,State,ZIP M
RC I Roofing Covering
WS I Window and Siding
SF Solid I=]Burning Appliances
I Insulr
Tel hone Email address D Demo&lion
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 /fown State ZIP Tel hone
SW MN MN&WORKERS'COMPENSiATUM ISlsURANCE AFFMIAVIT OLG.L c.152.§ 25QO)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Faihue to provide
this affidavit will result in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes .......... ❑ No...........❑
7s:0NVNr&RjMUTft,0RIZAT10N TO RV CONWLETEDW=N-„-
9RWNE"R'S NT 9R FQX M.]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.
Z7oJJ4LA v pbv a (1 ( 2 �
Print Owner's Name(Electronic Signature) Date
SECTION 7b-OWNER'OR AUTHORED AGENT DTCLARATI(HV
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
TEst'
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 find under M.G.L.c. 142A.Other important information on the HIC Program can be found at
M»v.mMLggv/oca Information on the Construction Supervisor License can be found at MMMfflMs.gov/dps
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'
MORTGAGE INSPECTION PLAN
BOSTON
9URV ' it's INC. 08-06483
EO.Box 290220 Charlestown,MA 02129
(617) 242-1313 MAIN (617)242-1616 FAX
APPLICANT: HARLOW-POWELL DEED/CERT. 25267-4
131
LOCATION: 12 ALMEDA STREET PLAN REF: 24feet
SCALE:finch=20 30-
CITY,STATE: SALEM,MA PREPARED: 10-08-2008
CERTIFIED TO:
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LOT 50 5512+ISF
p� nO\
�i lY LOT 51 5819+ISF
d1 '
I I �� pECN
Dams -
#12
\ 2 STORY m
ALMEDA STREET
Iota fd nawo�swnyswwae
The pcnwnem s oourrs am approximmely lemted on the y _ ecording ToFederal Energe aY Maagemem Agenry
groaml lee shown.They euha conformed m the sabock 3` AGE ` p;the msjm nnymvemeou on Iho"my fall in an
rwrvi�cmm�ts o(Ihc Ideal:onisg ordinances in cf(to �s;glwlm ns ZoneC
co lime ofcensmeundeorertc.emry fian..iolnion _-,• rN5 trommaY Panel No /QL
enfoo:cmem anion hinder M.O.L.Tide Vll,ms of Maio,
io, dp8'i
$eclimr T,aid that IM`re nm ro rncnaallmml5 oCmolor 1�• p Q' ERMiue Data:
impmvunwls eilhel way aaass plopasy lines sseepl as 5T0? OTE:Zone C is
areas of minunal Ilom]ing o slsadulgl.
shown unn owed hercan JE
UP This Zone C i IS not eased on an elevation0 shacdlo.
NOTE:ilk's ml a hw� a w awe irsurencc survey.Thin p rcps
nor as Matisse"BM amehosvl daMams Mr W"gage Lawn he"asass"es aoaplea
M IM Massaehusans Board
d Regslalpn of gdessional mess and IaM surveyom,MGMO,fi.dfi,and use Ira any surer pmpuse is WehmhM Tlis Plan is rest to be
used his n.,,M ag.PrMaimg deed deserts...or cans)