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46 BELLEVIEW AVE - BUILDING INSPECTION The Commonwealth of Massachusetts C[fY OF Board of Building Regulations and Standards JAI Massachusetts State Bu g 'ildin Code 730 CNIR SALEM 1 Ravised Xfnr 2011 Building Permit Application To Construct, Repair, Renovate Or Det a One-or Two-Family Divelling This Section ForOffieial Usti Onl Building Permit Numbera,': Date A Building 0(ficial( not Name) ECTION I:SITE INFORA ATION 1.1 Property �d7iess: 1.2 Assessors iVfap& Parcel Numbers (0 &Wkess%1 Fri iLty L la Is this an accepted street?yes_ no Map Number Parcel Number If 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.40,6 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑' Zone:_ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes13 SECTION Z:; PROPERTIG'0}YNERSHD?�' ':, 2.1 Owneri of Record• Ka��lwr� a- C t<c fi A"3 <if' 0 N eLL(ppPrrint) V City,dte,ZIP No.and Street - Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORI&(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 Work: eJ SECTION 4: ESTINLATED CONSTRUCTION COSTS- Estimated Costs: item Offielai Use Only Labor and Materials 1. Building S l..Building Permit Fee:S' fridicatehow fee is determined: 3. Electrical $ ❑Standaid.Cit iiC %vnAoplicationFee. ❑"[oral PioI# Costr(Item.6)x multiplier x 3. Plumbing S 2. Other Foes S S. Mechanical (IIVAC) S List: 5n t cnic tl (Piri. Mechanical o S total Al Fees: S Check No. Check Amount: Cast ;\nurun _Cash t:-- r l'ural Project Cu.SC f ❑ I and in Pail ❑ UuGtanding ISol:uue I)ua: SEcrION 5: CO;NS'l-RUCTION SERVICES 5.1 Construction Supervisor Liecuse(CSL) License Number -Expiration Date Name ofCSL Ilolder List CSL Type(sue belohv) No. and Street Type Description ID Unrestricted Duildin s u to 3,5,000 cu. R. Restricted 15t2 F;unil Dwellin Cityaown,State, GIP Nlasonr Routin Covering Window and Sidin Solid Fuel Burning Appliances Insulation Tcle huno Email address Dcmolitimh 5.2 Registered Hone Improvement Contractor(HIC) HIC Registration Number Expiration Date 1 IIC Company Name or IIIC Registrant Name No.and Street Email address Ci /Town,State 'LIP Tele hone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. M. § 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 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 Name(Electronic Signature) Date _ SECTION 7h: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the informntion contained in this application is true and accurate to th of my knowledge and understanding. le Print Owner s or Authurited Agent's Name(Electronic Signature) Dane NOTES: I. 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 Hones Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty timd under M.U.L. c. ld 2A. Other important information on the HIC Program can be found at www m:us.euv%oca Information on the Construction Supervisor License can be round at ww\v.iiass.wy�- 2. When substantial work is planned,provide the information below: rot i tloor:irea(s,+ It.) —(including garage, finished hasement/attics,decks or porch) tiro;; living area(sq. It.) _ Irabitable room count _ Number oFtirrphiec,.---_------- Number ofbedromns _-----_------------ Numher of bathrooms Nunhber of hml0aths ----.-- — I'cpe of ha.tting ;y;tem . .. ----- _-- Nnnhber of deck,'porches I\pa of canlin� ;yaem Enclosed r ipcn -------- --------------- 1 " It.11 I'rujeCl tail" I t. "Int.d I'ral;rt �yu:uc I� ,,t.i,a w.hy I c ,ub;hnit_d 6, i CITY OF S:V-Em �ti -usiwHUSETTS G(: LDLYG DEP.IIML&`iT 120 WASHLNGTON STREET, 3 a FLOO(t v' { T L (978) 745-9595 !<I.%[0&t ZY DRISCOLL FAA(973) 7•W-9344 L1YOR 1}i01Lt3 ST.PIEA1t8 DI:iECTOR OF Pt.OLlC PROPERTY�t3l'(LOLYG CO,LL\(15SlO.V ER Construction Debris Disposal Aftldavit (required for all demolition mid renovation work) In accordance with the sixth edition of the State Building Coda, 730 CMR section l 11.5 Debris, and the provisions of MGL c 40, S 54; ©wilding Permit t1 is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by NMI% o It 1, S I50A. The debris will be transported by: j (name ut'hauler) The debris will be disposed of in : (nonw Ut t'acdii�) 1,111 es.t Ut tat it,w ;ignamrU ut permit applicant latc CITY OF S.UX.Nf PUBLIC PROPERTY DEPARTMENT V IlWllt ru.rr. VAYOe t]0 7�wr,�npM.tnasr f UL8^VAMUpA MM o1 9"0 Th f}t1L9SN t+v f1}N&Iaw HOMEOWNER LICLNS9 E.XE.HPTIO1V Ptesse lrlaf Dare �/3 / / 3 / lob Emadon 6ef4a , ,w t Home Owner Addrw I n From Owner Telepbooe Present M&Mg Addles/ The current exemption of"Homeowner"was extended to inchwe,owner-occupied dweUings of two Units or toss and to allow nub homeownas to cupp an individual for Mrs who does not possess a 11COW4 provided that the owner acts as superviaor. DEFINMON OF HOMEOWNER Persons) who owns a pared of WW on which hdshe resides or intends to reside6 on whkb then I; or is intended to bet,s one or two Atmily dweWng, attached or detached sctures m wfesaory to such use and/or r2 JMxtum A pemot who constructs more Struhan one home in a two year period shall not be considered s homeowner, Such "ltomeownce shall submit to the Building OQkial,on a fonts acceptabls to the Building Official, that hdshe be responsible ror all such Permit wont performed under the Building The undesigrsed "homeownee ununes responsibility for compliance with the State Building Code and other applicable byqawt arsd relulations. The undenigned "homeowner"cestilles that hdshe understands the City of Salem Building Department minimum inspection procedures and requirements and that hdshe will comply with said procedures and ui entt HOMEOWNERS SIG.IA IL TOR kPPROVAL OF SUILDIVG OiSPEC - See other side far state code