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17 APPLETON ST - B-12-219 INTERIOR UPDATES 4 t ZI G - ( caOF l Z$© The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY SALEM Massachusetts State Building Code,780 CMR Revised�d1far binr 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: - I D Applied: JJ Building Official(Print Name) - _ - Signature - SECTION I-SITE INFORNIATION Ll Property Address: ItL2 Assessors Map Sr Parcel Numbers I.1a Is this.tn accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.OQL c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system Cl Check if yesO SECTION2: PROPERTY OWNERSHIP) 2.l Ownert of Record:J / C me(Print) City,State,ZIP I ) S� 9.;)7-3 6-0105- No.and Stra [ Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify; Brief Descriptio of Proposed Work'• IB t C i Z-K rtt2: SECTION d: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Ntaterials . building Qe3C� I. Building Permit Fee:$ Indicate how fee is determined: I. Electrical $ OC�� ❑Standard City/Town Application Fee - ❑Total Project Cose(Item 6)x /mutt' tier X �} . Plumbing $ 00 L Other Fees: $ 4 M [ /��. echmtical (HVAC) $ Qd � List: --'-/7• 5. Mechanical (Fire $ Total All Fees:$ Su ression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ U ❑Paid in Full 0 Outstanding Balance Due: SECTION S: CONSTRUCTION SERVICES 5.1 Co\nstruction/Su�pe"ii]sorl License(CSL) rU �� 13 LC..-1,/7r�d 1 r '' 1 hS.S Div /i License Number Expiration Date Name of CSL Ilolder c/Q List CSL"type(see below) Naand Street }y\ ✓�^-11- Type Description U Unrestricted(Buildings up to 35,000 cu. 11.) t��l R Restricted 1&2 FamilyDwelling Cityfro n,State,ZIP M Nlasomy RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home rrov-ementCortractor HIC) r0 1 �7 tiQ-4 tr` ` � 2 HIC Registration Number Expiration ate IIJC Company Nam t;or 1F`Ic Regis rant N e sr> L1 lam c No.and Street Email address —�'� t jCJ 1 Ci /Tow Stale,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 Ishuance of the building permit. Signed Affidavit Attached? Yes .......... [4� No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE.COMPLETED WHEN. OWNER'S AGENT OR CONTRACTOR APPLIES 1 FOR .BUILDING PERMIT ' I,as Owner of the subject property,hereby authorize !�I1WJ 'I' -k0.5SQM act on my behal€, in all matters relg[ive-M�v •c authorized by this building permit app cation. neSv Y o� ri wner s Name(Electronic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION: By entering my name below, [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. Le-1/- � s 9 �r3 Print Owner's or Authorized Agent's Nam (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 NLG.L.c. I42A.Other important information on the HIC Program can be found at www mass.¢ov:'oca Information on the Construction Supervisor License can be found at wevw.mass.gov!dps -17 When substantial work i pylanned rovide the information below: Total floor area(sq. It.) i (including garage, finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms S Number of bathrooms 3. Number of half/baths Type of heating system F f4 Number of decks/porches Type of cooling system o Enclosed Open y 3. "Total Project Square Footage"may be substituted for"Total Project Cost" i I � ^� l I L �1 1 G fit r o r 13 ZINN 4 t� � 40 h> 10 c� C�6 r 17 APPLETON STREET 219-14 GIs# .a. T3z.. „ .mar COMMONWEALTH OF MASSACHUSETTS Map m 27 Block. CITY OF SALEM Lot 0225 , Category ALTERATIONS' rerlmt# 219 14,E .. BUILDING PERMIT Project# 7S-2014 000431.-:a,r; Est Cost: $58,000 00 s! }, Fee Charged;k-' $411.00 Balance Due: ai PERMISSION IS HEREBY GRANTED TO: Const. Class ` ' Contractor: License: Expires: Use Group i:,. (i , ri,"'':=t 3, -_ .`-'Leland Hussey Lot S1ze(sq'ft.): 5959.8792 ' Owner.' James Lily Units Gamed; vr.,; "1lj(,( '11-Applicant: Leland Hussey Units Lost: �` '41 _ r !AT: 17 APPLETON STREET Dig Safe# : r . *_ M.r =_.r,' ISSUED ON: 05-Sep-2013 AMENDED ON. EXPIRES ON: 05-Mar-2014 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATION INCLUDING ADDING WALLS,REMOVING WALLS,REPLASTERING,ADDING 2ND FL BATH,;REMODEL KITCHEN POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: I+ Fireplace/Chimney: D.P.W. Fire Health - Insulation: Meter: Oil: Final: House# Smoke: Treasury: Water: Alarm: Assessor Sewer: Sprinklers: Final THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2014-000470 05-Sep-I3 28038 $411.00 �1 Ix iT L ji3coTMSO 2013 Des Lauriers Municipal Solutions,Inc.