14 AMANDA WAY - BPA-16-424 POOL s The Commonwealth of MassachusettsSPECTIOHAL SER ICE
' Board of Building Regulations and Standards `CITY OF
Massachusetts State Building Code,780 SALEM
aQ{� 28 ,P D5sedMar2011
Building Permit Application To Construct,Repair,Renovate Ot Demolish a
One-or Two-Family Dwelling
This Seetion For Official Use Only'
Building Permit Number: Date Applied: .-
x
1� Building Official(Print Name) Signature V ate
�!!! SECTION 1E SITE INFORMATION _
1.1 Prgpy 1.2 Assessors Map&Parcel Numbers rfy Addr�ess:, wAj
L I a Is thisan 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❑
SECTIOON 2: PROPERTYAOWNERSHIP'
2.1,Q Nerr o Rec� :.Q.� L(3 V 1� M �_.s. ��-7
y� Narne(Print) City,State,ZIP
tq AKkv-dA wA,�A i � 82-§-- 7
No.and Street Telephone Email Address
SECTION 3:6ESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units O[her ❑ Specify:
Bi f Dese iption of Proposed Wor •0 !- U M
x / r— 4r t ti
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: 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: O��J
5.Mechanical (Fire $ Total All Fees:$
Su ression F '
Check No. Cheek Amount: Cash Amount:
6.Total Project Cost: $ zoo A 6 ❑Paid in Full . O Outstanding Balance Due:
?;± ,SECTION 5:' CONSTRUCTION'SERVICES
5.1 Construction-Supervisor Li`ceus`e'(CSL)
_ License Number Expiration Date
Name of CSL Holder 4' ^ 0\ it i'; d!',1
List CSL Type(see below)
No.and Street Type Deseription
U Unrestricted(Buildings 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 7ai 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
contaWecl in this appl cati is true and accurate to the best of my knowledge and understanding.
XPrint Owner's o�rized ent's Name(Electronic Signature) L ate
NOTES:
1. AD 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.mass.env.'oca Information on the Construction Supervisor License can be found at wwwanass.i ov/dam
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"
QT'Y OF SALEM, MASSAaR SE M
BUILDING DEPARTMENT
§ {y 120WASIRNGTONSTREET,3"OFLOOR
TEL. (978)745-9595
FAX AX(978)740-9846
MAYOR Tr10MAS ST.PIERRE
DIRECTOR OF PUBLICPROPERTY/BUILDING COMMISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT.
Date 1
Job Location `f /'( f4 A., f j(� 1f 4lk
Home Owner Address_ S,+`A
Present Mailing Address S A- M
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
1
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, k.1 1 ,
. . . . L- • _ . � .
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
InORT&R &E PHUT PORN
S.E.C. & ASSOCIATES, LLC
138 NEWTON RD. PLAISTOW, NH 03865
PHONE:603-382-5065
MORTGAGOR: MARK&KELLY LOUF DEED REF. BK.32384 PG. 41
ADDRESS OF PRINCIPLE BUILDING: 14 AMANDA WAY SALEM,MA PLAN REF. PL. BK. 402 PL.79
DATE OF INSPECTION: OCT.20,2015
SCALE: 1 =30'
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Certification to:MEMBERS.PLUS CREDITUNION
This Mortgage Plot Plan was prepared specificallyfor The approxi mate location of the principle structure/sconform
mortgage purposes only and it is not intended or represented with he'horiibntal building setback requirements in effectwhen
tobeapropertyline orlandsurvey. This plan is notto be used constructed and/or is exempt front violation:enforcement
to establishany of the property lines for.any purpose: No action.under Mass B.L.Title VI I;Chap.40A,.Sec.7.
responsibility is extended to the landowner oroccupant
This is a tape survey based on the location ofsurvey.markers ofothem The.principle structure on this plan is not
This plan is not to be used for building permits or any such me. located-within a.speeial Flood hazard,area as scaled fipm
FIRM:Map# 25009C-0418G.
Date;.7/16/2014
Prepared.for. LAW OFFICE OF MICHAEL E.LOMBARD _File No.34502 'SEC Job No. 25789
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