3 ARTHUR ST - BPA-10-150 FENCE, DECK RPR r ie
The Commonwealth of Massachusetts Town of
1 Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 7'a edition Building Dept
Building Permit Application To Construct. Repair. Renovate Or Demolish a
One- or Tno-Fumils Duelling
Section For 0 iicial Use Oni
Building Permit Numb r: Date Applied:
Q
Signature Cl
Budding Commissioner/Inspect o ildings Date
ECTION 1:SITE INFORMATION
1.1 royye�rty Address: 1.2 Assessors Map 6 Parcel Numbers
Ma Number Parcel Number
1.Is Is this an accepted street'?yes_ no p
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage III)
1.5 Building Setback (ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40.154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ on site disposal system ❑
Public❑ Private❑ Check if vesC3
SECTION 2: PROPERTY OWNERSHIP'
.t Awner of Record: Olt ur
—Li✓' ni) Address for Service:
Na I ^t)
S a Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
New Construction❑ Existing Building❑ Owner-Occupied lY Repairs(s) ❑ 1 Alieration(s) O 1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: G�
Brief Description of Proposed Work: FenG e
,
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Malerials
I. Building Permit Fee: S Indicate how fee is determined:
I. Building $
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) S List:
5 .Mechanical (Fire S Total All Fees: S
Suppression)
Check No. _Check Amount: Cash Amount:_
6. Total Project Cost: S ? _ 0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
r.
License Number Expiration Date
N;Ime of C'SLL 11pIJer Lnt CSL Type ype lace below)
Address Type Description
U Unrestncted J up to 35.000 Cu. Ft.)
Signature R Rsineted 1&2 Family Dwelling
N .Mason Onl
RC Resdential Raofn Covenn
Telephone INS Residential Window and Siding
SF Rendenual Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 .......... O No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, , 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.
Signature of Owner Date
SECTION 7b:OWN ERi OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
thal t s Cements and information on the foregoing application are true and accurate,to the best of my knowledge and
alf.
rn ante ! n
Signature o or Authorized Kgoint Date
Si ned under t ains and penalties of peru
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 W 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 10.116 and I IO.RS,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 halfbaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
1. "Total Project Square Footage"may he.uh%tituted for 'Total Project Cost"
' CITY OF SALLM
PUBLIC. PROPRERTY
�.,.,. DEPARTMENT
1 %N '/'.V V. '"0'.
Construction Debris Disposal Allid.nit
(rclluiied lur all demulltion :Ind rcnuratlun wurk)
In accurdance ith the sixth edition of the State Building Code, 7811 CNIR scctiuu I 11 5
Debris, and the provisions WAIGL c 40. S 54;
Building Permit H is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal lacility as defined by MGL c
111. S 150A.
The debris will be transported by:
(n�mc ut hudtr)
I he dchris will be disposed ufin
X)cvvAr
Lnldres. .a'Ix duel
� l IIJ1Ul l' / IKIII III .I I111111 u111
Q
CITY OF S.XLEM
PUBLIC PROPERTY
DEPARTMENT
.Vnroa I D WA9 WIGYOM s7uurr•&MAK NASACMSEM 01970
ttii r..2•73i9S"• F.%x 973.7W84
HOMEOWNER LICENSE EXEMPTION
Please?rime
Date
Job Location
Home Owns Address .9 9rth u,^ a�F
Home Owner Telephone 9,7A-
Preasw Mailing Addrese Z_s9.^-rh L t,
The current exemption of"Homeowners"was extended to include owneroccupied
dwellings of two Units or leas and to allow such homeowners to engage an individual for
hire who does not possess a license,provided that the owner acts as supervisor.
DEF1NMON OF HOMEOWNER
Persons) wbo owns a parcel of WW 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
OtYicial, 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 understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures an requirements.
HOMEOWNERS SIGNATLRE
APPROVAL OF BUILDING INS CTOR
See other side for state code