131 BRIDGE ST - BUILDING INSPECTION (5) 7z7
`4 The Cumnwmvealth of Massachusetts
Board of Building Regulations and Standards CITY OF
I'( Massachusetts State Building Code, 730 CNIR Revised A�Ea.l2U!!
Building Permit Application To Construct, Repair, Renovate Or Demolish a
Otte-or Two-Family Dwelling
This Sectiori Fbr dfficial Usa 0nf..
Buildiitg 'ermi Number:-
Building 011ictal(Print Name Y
),. Signatur Date
SECTION I:SITE INFORDLATION
Ll Froper,t�!Address: 1.2 Assessors Map&Parcel Numbers
Icb9P S4 �
1.1a is this an acce to street?yes no Map Number SN
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning-District Proposed Use Fat Aree(sq tt) Frontage(it)
1.5 Building Setbacks(It)
Front Yard Side Yards Required Provided Required Provided Requirded '
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal Systems
Public❑ Private❑' Zone: _ Outside Flood Zone? Municipal❑ On site disposal stem ❑Check iC a0 P P sY
SE�GT w!" PROPERTrOW(VERSH7P!'':
2.1 Owners oC Rccard:
.
Name(Print) City,Stat ZIP
(q Aj7409
No.and Street elephone Email Address
SECTION 3: DE CRIPTION OF PROPOSED WORW'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) W1 Atteratian(s) ❑ Addition Cl
Demalitlon ❑ Accessory Bldg. ❑ NumberofUnitj!gP I Other ❑ Specify:
Brief Description of Proposed %Vork :
SECTION 4: ESTILNL4'IED CONSTRUCTION COSTS
itemM�_c'
stimated Costs: OfRelal Use Only...
or and Materials Y .
1. 8uiidinI. BuildingPermitFee:3 indicate how fee is determined:
t. Glcctric ❑Standard.City/fownApplication Fes '
❑Total Pialact Costs(Item 6)x multiplier x
t. l titherFees:'.st ,Mechanf. ,Mcch.ml'ottlAll-- 11"k.No.1',,tal P .00 o - ---- ------
r f (� I'.lid in Frill . Cl t)iit,t:mlinl{ Ilal;tnc. Ihn:: - _ _
I �
sF.crION 5: cFINS-rIlUCPIOty SERVICES
5.1 Construction Stgtcrvisur License(CSI,) _ —
i.itensa Number Grpiratiun unto
Name of CSL I loldcr List CSL Type(see beluw)
Do Descriptiun
No. and SUM U Unrestricted Quildings u to 35,000 cu. 11.
R Restricted Ide2 F:unil uvrellin
City/rown,State,ZIP �I �4 0tinr
RC RuutSn Cuverin
WS window and Sidin
SF Solid Fuel Flurning Appliances
I Insulation
l'cle bona
Email address B Bemolit...
5,2 Registered Hume Improvement Contractor(FIIC)
FIIC Registration Number Expiration Bate
I tic Company Noma or FIIC Registrant Kline
Email address
No.and Street
City/Town, State ZIP Tale bane
SECTION 6: NVORKERS'CObIPENSATION INSU1MJNCE AFFIDAVIT(M.G.L.It. 152.1 25C(6))
Worker Cotnpensatian 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 .......... 0 No...,.......0
SECTION 70: OWNER AUTHORIZATION TO BE COd[PLETED 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 mutters relative to work authorized by this building permit application.
Date
Print Owner's Nwne(Electronic Signature)
SECTION 7h: OWN ERt OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the informntiutt
contained in this application is truc and accurate to the best of my knowledge and understanding.
Print Otvnar';ur Autitnri�cd:\gent's Nunta(Eleetrmlie Siguatura)
Dane
NOTES:
I. ;\n Owner who obnins a building permit to do hisrher own work,or an owner tvho hires an unregistered contractor
(nut registered in the biome Improvement Contractor(HIC) Program), will no have access to the arbitration
program or guaranty Lund under L%L(U. c. 142A. Other important information on the FI(C Program can be found at
tt tv tv mat;+.,env%ace Information on the Construction Supervisor License can be found at2. tt ww.nto>s.•�y_.IL{
7�vjientantial work is planned,provi.lu the inrormttion below:
finished bascutanVattics,decks or porch)
Oki. ILtbictble room cDuff. yVumberofbAroomsplaeus. —,_-- -------- Nunherofhalf .uhsirnnn.; --- .
-._ �.IIIIIllef it,leC6.i' 1•orclie;
I , � Ipen
pu, fCoohn•; •y.Ieol
� t `I.o it I'nq.•.t l,lll Ira Pd.l•;c' ❑Lly ha ❑Il+.nnd,,I t.n' f .r.li I'nq,:.t l ,i,t .
CITY OF sm-Em
PUBLIC PROPERTY
DEPARTMENT
V f.Y�LiY eurvw�
Vwrae I b Srv�wcsc„JnYr•1�ui4.V,�saow Jsm 01 f'0
TYL f"L7JLffff • Y.ul.f'L7Jo.7W
HONIEOWNER LLCLNSL EXEMPTLOV
Plow !rime
Date 3
Job Locatb. I 31 6f UA
Home Ownes Address
Home Owner Tolephaee
77
Pea"Mania g Address
The current exemption of"Homeowners"was extended to include o.wmr-occupied
dwellings at me Units or leas and to allow fuel,homeowners to engsw an individual for
hire who does not possess a Iitenso provided that the owner acts as supervisor.
DERNMON OF HOMHOWNMt
Perwo(s) who owns a patabl otlaad oe which hdshe reside or intmde to redder on
which there 1; or is Intended to bq a one or two !unity dwelling, attached or datacheal.
structure! accessory to such use and/or r'um strttcturea 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 001cial,on a form acceptable to the Building
Official, that hdfhe be responsible for all such worst performed under the Building
Permit
The undersigned "homeowiide assumes responsibility for compliance with the State
Building Code and other applicable bylaws and regulations.
The undenigned "homeowner"certiRes these hdshe undentands the City of Salern
8WIding Department minimum inspection procedures and requirements and that hdshe
.vill comply with said procedures and requirements
HOMEOWNERS SIGNArLM
.APPROVAL OF BUILDJVG OiSPECTO =—
See uther Side far sate code
4tA
;. CITY OFS,ILE,1,f, �N/L1SS,1CHU5ETTS
i ;• `� QCUxLNG 0EP.lant&vr
iHGVGTONSTUsr, 3 F cc,%
TM 973( ) 713-9593
'<I.t(OE2LEY ORISCOLL FV((973) 740.9344
,b L�YO IZ •[�tOS619 ST.P1E.RttB
OIZ4CMItOPPLaricPROPE3rY/Suan aCo.waSS/O.NER
Construction Debris Disposal Af'fIdavit
(rcyuirid for all demolition :wd ronuvation work)
in accordance wills the sixth edition of the State Building Cade, 730 CL1dR section I
Ocbris, and the provisions OeN(CL c 40, S Sd;
Building Parmit# is issued with the condition this wurk s that the dabrls resting from
hall be disposer!of in a properly licensed waste that resulting
disposal ty as defined ul IL(CL c
S I SOA.
—°n
1'hc tluhris will 6e trinspartcd by; ..
S.t A � ►�
urm
( a (t h aulc�
The dQbris will be disposed ot'in ;
_ Vs C
(n:lmu nt 1]alii�)
(idhett of•fatilu/
C
I'tlldUl(4 nrp�•rtnif i
j1PIIC.IIIr