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44 BELLEVIEW AVE - BUILDING INSPECTION (2) 42�b CPrSI-� LU The Commonwealth ofMass��cc C.ppAl SERYfCS Board of Building Regulations 2hd Sian ds CITY OF ReviseddMar2011 Massachusetts State Building Code,780 CMR 3 S � � ,t h9 Mar Building Permit Application To Construct,Repa a ate r emolis a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number, " DatApplfed: .. % Building Official(Print Name) ..1 Signature aa .� „.,SECTION I:SITE INFORMATION 1.1 Property Address: / 1.2 Assessors Map&Parcel Numbers c1i� ll s I�O Ncx C�F�p L l a Is this an 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: Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Public kY' Private❑ Check if yes❑ p P y SECTION2: PROPERTYOWNERSHIP" �} Owner'of Record: Y xx(a Q �erey -5nlE j MI- OIR�O Name(Print) City,State,ZIP AN WL 9Ak3,JLc( c�°l �$3 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) ' New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed World': -Re u t� e3 i i v sy%i 1&a F© r✓�Etnb Coen t �r.1 ) n1n c 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).z multiplier z 3.Plumbing $ 2. Otlter Fees: $' 4.Mechanical (HVAC) $ :List: 5.Mechanical (Fire $ Total All Fees:$ Su ression 6.Total Project Cost $ rr �a/j �o Check No. Check Amount: Cash Amount: 2 lD ❑Paid in Full ❑Outstanding Balance Due: I __ SECTION 5: CONSTRUCTION SERVICE$ 5.1 Construction Supervisor•Liceuse:(CSL), License Number Expiration Date Name of CSL Holder c Z. 71 �-T - VAN „'l List CSL Type(see below) No.and Street -Type - Description. U Unrestricted(Buildings up to 35,000 cu.ft. R I Restricted l&2 Family Dwelling Cityfrown,State,ZIP M Maso nia 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.0,152.§ 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 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:-OWNERS OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information /contained in this application i aan rate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name JEleclronric Signature) Date NOTES: l. 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 M.G.-L.c. 142A.Other important information on the HIC Program can be found at nnan ass.eov(oca Information on the Construction Supervisor License can be found at www.mass. ovg /dns —27 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" ✓ a QTY OF SALEM, MASSACHUSETTSBUILDING DEPARTMENT120WASFRNGTONSTREET,3" FLOOR TEL. (978)745-9595 F KIMBERLEYDRISCOLL FAX(978)740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLICPROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date Job location y l 1 1[o_vee w 6e&v e �alevh Home Owner Address_ 50111ntie— Present Mailing Address So xv�e. 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 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 understand the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with such procedures and requirements. HOMEOWNER'SSIGNATUR ,••• APPROVAL OF BUILDING INSPECTOR ,1 t K O TY OF SALEA K ASSACHME M BIffiMCDEPARDEM 120 WA9MV7MS7RMT,3=RDGR 1L(178)745-9595. RrMRRR1F FAx(978)740.98" ]r jjlj��j,1, MAYOR NCUASST IRM DnmcTcacrpuBucpxcnmlBumDmamomoER Construction Debris Disposa/Afdavit (required for all demolition and,.renovatibn work) in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL coo, S 54; Building Permit B is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111,S 150A. The debris will be transported by.- (name of hauler) The debris will be disposed of in: name of facility) (address of facility) Signature of applicant Date