43 BAY VIEW AVE - BPA-12-519 INTERIOR RENOVATIONS - ------------
The C'onumonwealih of Massachusetts
s; '� Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 7SO C NIR S,\Lh\I
Building Permit Application To Construct, Repair. Renovate Or Demolish a
Una'-or Tuvr-Furnih'Du'rlling I
This Section For Official Use—Only
Building Permit Number: __ Date Applied:
rant �u' �f ,�s�' y
Building Official(Print Name)
Signature Date
SECTION is SITE INFORMATION
1 roperty A dire` ss J(� 1.2 Assessors Map& Parcel Numbers
1.1 a Is th' an: —1 5`�r"a/at�'� n Map Nun r Parcel Numtxr
I.3 Zoning Inrormation: I.d Property Dimensions:
Zoning District Proposed(Jse Lot Area(sq It) Frontage(11)
1.5 Building Setbacks(R)
Front Yurd Side Yards
Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Fload Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposals
Chock it' cs❑ y stem ❑
SECTION]: PROPERTY OWNERSHIP'
2.1 wnert of Record:
AV
N;une(Print) City.State,Ile
No.and Street Telephone Emuit Address I ( �[
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) CCx-4CL>, o iJ�t
New Construction❑ 1 Existing Building❑ 1 Owner-Occupied ❑ Repairs(;) ❑ Alteration(s) ❑ Addition ❑
Demolition Accessory Bldg. 07 Nunhberof Units_ Other ❑ Spccity:
Brief Description roposed \Nark': �� y 7j--�L Lam_
u 6U
SECTION a: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Omcial Use Only
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Tom] Project Cost'Mem 6)x multiplier _ _ x
1, Plumbing S 2. Other Fees: S
J. \Iah:mie.hl III\'.1(') S List:_ �.
S. .\lech:mical (Fire
ti uppressionl S Total .\11 Fees:
a. p Cho, k Vu. hek Anwnt: ,\njount:
❑plidinTotal Project Cost: S
Full 13 Outstanding Bahmce Due:
�I r
t• ^:t
SIA ION 5: C'ONSTRUcrION SERVICES
5.1 Construction Supenisor License(C'SL)
Limnsc Nunthar --' --- F\piratiou Date
I lower
I iil('St. I)fx Lies hcluwl
_ Mscriplion
It unrestricted I lluildin gs U0 nt 35,000 au. It.)
_ R Restricted l&,2 Family Dw nelli
Ciltifown.AWte,LIP AI Slason
RC Roolin Cuverin
.-.-- WS Window and Siding
5F Solid fuel Burning Appliances
Inadalion '
I'cle hone Fntnit address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
IIIC Registration NumK-r F%pirnliun Date
IIIC Compin) Name or IIIC Itagislrant Nano
No.mid Street Email address
City/Town.State,ZIP rele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 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...........0
SECTION 7a: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 None(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contaillg4n this application i tru and accurate to the best of my knowledge and understanding.
Ir is or:\utluxirc \year tcll�Icclrunic.Signature) Dale
NOTES:
1. An Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Cuntmctur(HIC) Program),will rro have access to the arbitration
program or guaranty fund under.I.G.L.c. 1 a2.A, Other important information on the HIC Program can be found at
t+w % m t,, ,t ,,.,I Information on the Construction Supervisor License can be found at
2• \\'hen substantial work is planned,provide the infunnntiun below:
Total flour area Isq. R.) _ I including garage. finished basement attics,decks or porch)
Gross living area(sq. it.l .___. _ _ _ habitable room count
\umber of lireploccs.__. Number of bedrooms
iNum her ofhathrounts - \'umberol'halfhaths -
I)pc of heating s)item _ _ Number of decks porches -
� h)pC of i++uhllg sy slant I?niloiCJ _ _ _ _llpen '
i
1. "total I'rojact Square Foolagc-nuq be substituted litr"1'olal Project Cost"
CITY OF S.UZM
PUBLIC PROPERTY
DEPARTMENT
Vwra. imv�.w,�ousewasr.sKa,�Vna,�oRsirrs0tf'0
rta.s-►�+srssss.K..z r.►�,o�w
HOMEOWNER LICE.rS6 EXEM"10N
Pkw Mat
Date t Z Ps01
Job Laeadon 445 11� LAB
Home Owner Addle ea. ►--
Home Owner Telephone —
Ptsaent Mailing Address Sesux-- _ hS zj+. % N f-
The current exemption of Homeowners"was extended to include owner-occupied
dwellings of two Units at leas and to allow such homeowners to copp an individual for
hire who.does not possess a Hcense,prnvided that the owner sets u supervisor.
DEFINMON OF HOMEOWNER
Person(s) who owns a pass:/of WW on which he/she resides or intends to raider on
which there is, or is intended to be,a one or two (imily dwelling, attached or detached
structures accessory,to such use and/or farm structures. A person who constructs more
than one home in a two yew period shall not be considered a homeowner. Such
"hosneowneP shall submit to the Building Omcial,on a form acceptable to the Building
Otllcial, that he/she be responsible for all such work performed under the Building
Permit
The undersigned "homeownd'assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undenigned "homeowner'certifies that he/she understands the City o(Salem
Building Department minimum inspection procedures and requirements and that he/she
mill comply with said procedures and requirements.
HOMEOWNERS SIGNATLW( /
APPROVAL OF BUILDING INSPECTOR
See other side for state code
4
CITY OF sm-EN(, Akss.ICHL'SETI'S
9l,LWLYG DEP.1AnL&NT
120 W'kSMLNGTON STREET. Y"FtOOA
Tit, (978) 74S.959S
KI BERFEY DROLL FAX(978) 740.9846
,tititY01! I3 GxU ST.FtM
DIREcTat or aL;auc aR0aeATY/8L•¢pL%4G Co.%nrrssrovEX
Constructlon Debris Disposal Afft
(required for all demolition and renovation work)
)
In accordance with the sixth edition of the State Building Code, 780 CMR section 1 l 1.3
Debris, and the provisions of MOL a 40, S 54;
Building permit N is issued with the condition that the dcbris resulting from
1 11 work shall be dis
I 1 I, S 130A. a propposed of in erly, licensed waste disposal facility as defincd by,ti1GL c
The debris will be transportcd by:
(north of hauler)
The debris will be disposed of in
(name o-dijy)
(J,dR78 Of lJCIIIIy)
I'ynamre olpermrt Jpphu
Tva