BAKERS ISLAND - BUILDING INSPECTION (12) r� The Commonwealth of;Mrssrchusetts
Bourd of Building Regulations and Standards I OR
Mrssachuseits State Bu M ilding Code 78U CR T"eduion MUM( IP�I I I 1
USE
r Buildmg Permit Applicntton To Cons rmct Reprir Renovate Or Demolish'u Rrriud Jnn(nrr,I
One or.'Tnxr F�u+iily Dwelling', •" / 'rxAY
This Set.Hian Far;Officiol Use.Onl
B,mldmg Permit Numhq ` Dnte Appliedi "
Signature � "-L��
11604ummissiun�r/Inspeuor Dtue;i _
�SECTIONleS1TE[NFORMATION ' i
1+1 Property}Address "� lt2 Assessors Map& Parcel Numticrs
l u is this un u��epted Street!yeses na_ Maq Number; Pun�l Num, j.
13 Zotdng;Informatlon I4 Property Dimensionsit
Zoning Distne[ Prgposed L:ot AM (sq,(t) Frontiige(f[)
I5 Bugdiag'.Setbacka,'_(tt)
d,
'Front Yord ;t, ' Side°Ywds - Rear Yard
£ Reyuired ! B�ovidedit
it
RegulreJ Provided :'RequiredPluvid�J
1:6 Water Supply (M.G, L c 40 §54j L7 Flood Zone Informatloo 18 Sewage Disposal System
Zone Outside Aaud Zotie7 ` " +
Pubhe❑ sPrivale O �:; Check if y`esp , Municipd❑ Oiislte disposa(sysiem ❑ l
SECTION2 PIR)p
HIRT
Y OWNEMMPfit
2t1 Owaerig[Rerord
BSkez!s;':Tslgnd :Assoca idn P.O. Brag 3$0 MatichestPr f,,MAFit
•tVume(PnnU .� AJdtess for Service
:'Signature. ' Telephoae -
SECTION 3 DESCRIPTION OF PROPOSED WQRKr(check nB thef ripply)„'„ ,
New Construction l7 EFisang,Building❑ Owner Oc�uPied,❑, Repnirs(s) �. r�Allemtion(s) O; Addit' Q,`; }
Demolition ❑ Accessory Bldg ❑ Numberof Uglts %Other ❑"'Specify. `F"
Brief Deription of Proposed World sc -
t
SECTION 4 ESTIMATED CONSTRUCTION COSTS
(tern Estimated Costctit
(Lnlior:attd'Mater(als)' _ '. OtilSieiUse Otily;
LBuildin S 2i0D¢ L Build/ng Permit Fee $ Indwatehuw ke is de[ermmed `.i.
g
2 `Elecincal .`- $ c ❑Stonddrd Ctty![owa Applicntion Fee
❑Total Project Cosh(Lem 6)r mulapher ><
3 P'L.imb rig $ �' Oihar:Fees $
4.Mechani sl ;(I(VAC) ; $ Lest �f
5 ,Mechiutical (Fire $
Su ression> 3' To[W Ai4,Fees $
6 Total Pro ect Cost $ Check Ng Cha.k Amount Cash Amitunt.
j ❑Pmd in:Full ❑OutsrSndmg up cc Due -
,SERVICES
53i:Licensed Construcilan S
JZ
,urfitsthaw'll taIll.000. U*
-It Z,
X-
Y.� O'l
Telephone WS cl
stfinion m rm
xPralon.hate
Telephone,'
�SECTION!6. WORKERS'COMPENSATION
WbAjfj C64'o'eaSatItUj7jjj�jd 66 jfrpdiYi-�'MUSt completed 'fid submitted withthis ApPi ICatfint Failure to pntJ Id
Is a
c tmu
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13 13S
SECTION 7a OWNER MTOMICOMPLETEDWHEN
I as Owner of the subject TM
property
pO rIV.hereby
. em y
rela4ve to,work authorized by this building it flcaf-
ECTION
Did
06�OWNEFV,OR XUTHORIZEOAOEN D]kCAk_A.T
m,
Rent hereby declare
chat thest¢tements and
b
f
1
77
r patt*
on-o
n
m me ry r or r egDng.appReat icn Amr
tCrue and
accurate uratc.toth ;bestv f nyi kh lbd Beand
Signature of Owner or"4 AUth -d Agent Date
mam and'" naltle3fofru NOTES-
-bULldtng perm[kto do hislhet awn work or an ownerwhobircshwun fi
_ program or guaranty fund finder M Q I~c. 142A.Other[mpartatit information on the HIC Program and ',
.; . :' Cans4uetwn Su tsar Licensing(CSL)>can be found m 760 Cbtlt Regulations 1(0 R6:wtd 110.R5 respahvely '
].Gross ilwng afrn(Sq?FL) Habitable room coum
',Number of fireplaces ' Number of bedrooms
Numbar atbathrod Numberut halF/baths
systemType aF heating Number of decks!poaht
;Type of r'aohng system -" EnUse&
TotalPmlectStjdare Footage'. tiny c SU 111 Project
�J.
Page 1 of 1
Card 1 of 1
Location BAKERS ISLAND Property Account Number Parcel ID 46-0127-0
Old Parcel ID 11 --
Current Property Mailing Address
Owner NOT AVAILABLE City
State
Address Zip
Zoning R1
Current Property Sales Information
Sale Date Legal Reference
Sale Price 0 Grantor Seller
Current Property Assessment
Card 1 Value
Year 2009 Building Value 69,200
Xtra Features Value 500
Land Area 0.884 acres Land Value 130,700
Total Value 200,400
Narrative Description
his property contains 0.884 acres of land mainly classified as One Family with a(n) Camp-Seas. style
building, built about 1955 , having Wood Shingle exterior and Asphalt Shgl roof cover, with 1 unit(s), 4
otal rooms , 1 total bedrooms , 1 total baths , 0 total half baths , 0 total 3/4 baths .
Legal Description
Click Property Images to Enlarge
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http://salem.patriotproperties.com/summary-bottom.asp 8/13/2009
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FFL (1209)
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10 OFF (390)
(260)
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CITY OF &XLEM
PUBLIC PROPERTY
DEPARTMENT
KI
HAraa 120wA3aN ToNSTaen S.LLFN..NwssAan.'ssrls 01970
Tm-,97/-74S-959S*FAx 97&740.9&4
HOMEOWNER LICENSE EXIDIPTION
Please Print
Date l �
Job Location
Home Owner Address
Home Owner Telephone r - 3- 26
Present Mailing Address
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 who,does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
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.
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 and requirements.
HOMEOWNERS SIGNATURE T
APPROVAL OF BUILDING IN VECTOR
See other side for state code