29 BOSTON ST - BUILDING INSPECTION .� The ('onununwcalth of Massachusetts �
t Board of Building Regulations and Standards I ( Nt
l '7 Massachusetts State Building Code. 780iAIR. 7"' edition YII Nl( 11'.\1II1
{, I Is I.
Building Permit :\pplica To ('unsn art. Repau. ReIIO\ale Or Demolish a Kri i rJ / : : ,: :
rTtru-b"amili Otrrlling
"I'hi k Seenon For Official Use Only I
Building Permit( Number Date .\ lied:
q �
BUIIJII R Cuuuni..un •n I I •Ciu ul Ru Jduigs Date
L SECTION l: SITF INFORM:\"PION .--_---- _- --..
X 1.1 Property �\dddress: 1_ 1.2 Assessors Map & Parcel Numbers
-----
._�S�at9 ^._V 5ol�t^x MG
I.la Is this :m accepted street'. yes no Map Numher Par:rl \umber
1.3 Zoning Information: IA Property Dimensions:
Zoning Distrct Proposed Use — �Lut'A Ica tsy tit( Frunmge(it i
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
Requited Provided Re q:uu e wd PnrviJcJ RequiteJ Pl ulded
rWater Supply: (M.G L c. y0. §5J) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:Zone: _ Outside Flood Zone?
c ❑ Pri sate❑ Check if yes❑ Municipal ❑ On site dislxwsal system ❑
SECTION 2: PROPERTY OWNERSHIP'
I. Own r'of R rd:
Name i P l Address for Service: p
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building I� Owner-Occupied El Repairs(s) a- Alteration(s) ❑ Addition ❑
Demolition B Accessory Bldg. ❑ Number of Units____ Other ❑ Specify: ci "Ig 1FArnr1 I
Brief Description of Proposed Work'': _
- tL•s4r2 Cyr,
-_�Ajtt(TtN( s
SECTION J: ESTIMATED CONSTRUCTION COSTS
Estimated Casts
Item Official Use Only
il.ahorandMaterialsi
I. Building S I. Building Permit Fee: $ Indicate haw fee is det(crnuned:
❑ Standard City/Town Application Fee
?. Electrical S ❑ 'rural Project Cost' (Item 6) x multiplier x _
3. Plumbing S �. Other Fees: S
4. Mechanical IHY':\CI 5 List:
i. Mechanical (Fire 5
Su t ressiui, Total All Fees: S Z-J
�( Check No. Check Amount: _ Ca,h :lu n ont(
0 Total Project Cost: 31 Owl I 0 Paid in Full 0 Outsl:mdine Balance Due:
v '
SECTION 5: CONSTRUCTION SERVICES
5.1 I..icensed Construction Supervisor (CSL)
I_u:n,r Nunther--.- _ �'.,Irll.11 lull Uale �
Name It ('St.- Iloidcr --_— I.i,t CSL T,IV iwc heluw)
k e De,cn rum — J
\ddw,„ t
1. 'nrr,tncled u t m WO nU Cu I I.
R Re,lo, ed &_' Panuh Dwcllute
Simcuure .`I %Luunn Onl1
Rl ItcsidCnual Reuling ( t\cnne_
I pII \\S RC,nlCunal \\ JJe,V ."Id S,,ha
SF R:,id:nli.tl Suhd Pull lfuiuin_ \p tl i.0 ir.' In.l.il l.il i� na
D &Fitial DCnnhuuo
5.2 Registered Home Impro\ernent Contractor 4III0
II IC Cungswy Name or IIIC Rcgmuanl Nana Regmtraoon Numhrr
4 ddress
F-roauun D;ttc
Signature 1'elephoue —
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (NI.G.L. c. 152. § 2506))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fadurc (o pnt�ldc
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
as Owner of the subiect property hereby
authorize —__-- to act on my hehalf, in all matters
I
re!ative to .vork authorized by this building permit application. .
I
Signature of Owner ----- - Dater---- ----- -
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION
1 , as Owner or Authorized Agent hereby declare
that the sruements and information on the foregoing application are true and accurate, to the best or my knowledge and
behalf.
Prue Name .
Signature of Owner or Authorized Agent Date
(Signed under the pairs and penalties of egg )
NOTES:
I. An Owner who obtains a building permit to do his/her own work or an owner who hires an unregistered contract,-r
I not registered in the Hume Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important intiormmion on the HIC Program and
Consnvction Supervisor Licensing (CSL)can be found in 780 C•MR Regulations I I0.R6 and 110.R5, respecu,ch'.
' When,ubstantial work is planned, proslde the information below:
rotal flours area lSq.Ft:) ' (including garage, finished basemen Uattics. decks or porchi
Gross living area ISq. Ft.) Habitable room count
Number of fireplaces Number of hedrnonn _— -----._—._
Number of h,uhrooms Number of half/h:oha
k pe of heating system - _-- Number of deck,/ pur.hc, -- -- _ ----__.
I)peof cooling sy stem _ 1`.11closed
3 "r t('ll Project Square Rmlage" may he substi(uted for "rnt:d Profect Co,t... _-- J
CITY OF & .EIM
PUBLIC PROPERTY
DEPARTMENT
Kl)^.c� w,ywry L
MAYOR � � '130 wti4ONGTON STRM•S 'E,MAS&ACHLSETM 01970
TEL 975-715-9S95* FAx 9711-740.9816
HOMEOWNER LICENSE EXEIMMON
Please Print
Date C� -3-a�
Job Location 2c'\ Qr)SA<7`'\
Home Owner Address I
Home Owner Telephone "7 1 — 5 OAS
Present Mailing Address Z 9
r ^w�
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. x.
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 "homeowned' 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
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
.j •,. PUBLIC PROPRERTY
'is F. DEPART vIENT
eP.li � ti.\II \I, \L\a
I I 'I'S '43-95Vj I'\\: 1i78.'4.'• i4,.
Construction Debris Disposal Allidavit
(re"luired li)r all demolition and renovation work)
In accordance \\ith the sixth edition of the Slate Building Code, 7S0 C NIR section I 1 1.5
Debris, and the provisions ofMGL c 40, S 54;
Building Permit if 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 NIGL c
1 It. S 150A.
The debris will be transported by:
Iname of hauler)
The debris will be disposed of in
luumr ul lacility) �
(address of Iacllitvl
� Vk
Yi�nutwn nr p:unit applicant
°\- 3 - og
date