8 BUFFUM ST - BPA-15-216 � i6 �� ��-s �' . ,
� "Phe Commomvealth of Massachusetts CITY OF
+ Board of I3uilding Regulations and Smndards SALEM
��� Massachusetts State Building Code, 780 CNIR Revised,Nur 2011
� Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Ttiva-Fnmily Dtivelln�g
— This Section For O�cial Use Onf .
N E3uilJingP.ermiWumber. ' DateApplied€ �
' nI � Duilding OtTicial(Print N;une) ��Signalure � . . � � Date
U SECTION L•SITE tNFORb(ATION.'
.�
t I.1 Properry Address: n �� C ' t.2 Assesson binp&Pnrcel�umben
� r, .3r-_
I.I a Is this an accepted street?yes no_ bfap Nwnber Narcel Number
�-- 1.3 'Loning InformnUon: 1:5 OopOty D�ensfons: ��
t � 0
"Luning District ProposeJ Use Lot Area(sy ft) �ronluge Qt)
1 t�$ BuildingSetbacks(R) �
��, Front Yard Side Yani+ Rear Y;vd
Reyuire� Providnl Reyuired Provided Required ProviJad
I.6 Wnter Supply:(M.G.L c.d0,§Sd) l.7 Elood Zone informntion: t.8 Sewage Disposal System:
- Public� Private O Z�ne. _ . ��k if I OZoneT Municipol JQ On site disposal system ❑-
SECT[ONZ: PROPERTYOIVNERSHIP"
2.1 Owner�of Record:
� S. AAgo►J � EMt1�1 �D N 8 8U U�f�l �"�:$?�-EH ,MA plq'iD
t��hme(Print) " ' � City,State,ZIP
8 '�u Uwt �'. 4Tg-4`T9-8846 aaron_ud���ya�+oo��+q
Nu.:md Slrect Telephone Email ddness
SECTION 3: DESCRIPT[ON OF PROPOSED�VOBK'(check nll that npply)
New Constructian❑ Esisting Building Owner-Occupied,IQ Repairs(s)� Altemtion(s) � Addition O
Demolitiun ❑ Accessory Bldg.O Number of Units Other � Specily:
�rief Dnscription of Proposed Work': W �� A a
thc �n eW /'
W u cr 51 k U I. - s —
SECTfON�: ESTI�IATED CONSTRUCTION COSTS
��� � Estimated Cosis: Of0cial [Jse Only
Labur anJ�laterials)
1. Duildin; � �. �QQ I• Building Permit Fee:$ Indicate how fee is determined:
❑StanJard City/Town Application Fea p
2. Electrical S �� �(TotalProjectCost�(Rem6)xmultiplier O� x 7
3. Plumbing ,'S � �O� 3�?QiherFees: .S
d.�Icchviical (HV;\C) S �0� � Lish
5. \(echanicul (Firt � � fatal All Fees:S
Su ressiun) '
Check Yo. Check Amowit: Cash Amount:_
G.Tut:il Praject Cust 'S $�000 ❑paiJ in Full ❑Outstandin;D�lance Due:
.. . .
SECTIOV 5: CONSTRUCT[ON SERVICES
5.1 Cm�struction Supervisur Liccnse(CSL)
� � � Liccnsc Number E.epiratiun Date�
N:mie uf CSL flulder
List CSL'fype(see below) .
Nu.:md Strect TYPe Descriptiou .
U Unnstricted Ouildin s u �to 35,000 eu. tt.
R ResUicted I&2 F:unil Dwellin
Ciry/I'a�m,Slale,"LIP M Naso �
RC Roolin Cuvcrin
WS NindowandSiJin
' SF Solid Fuel�uming Appliunces
I Insul�lion
Tcle hana Entail uddress D Uemolilian
5.2 Registered Nome(mprovement Contracror(NIC)
HIC RegisVation Number Espirulion Date
� f IIC Cmnp;my Nmne ur f11C Regislmnl Nnme
Nu.and Sveet � Email udJress
—_ Cit Lfu�vn State ZIP__ Tele hone
SECT[ON 6:WORKERS'COM1IPENSAT[ON[NSURANCE AFF(DAVIT(M.G,G.c.152.$2$C(�},
Workers Compensation Insurance affdnvit must be completed and submitted wiN this application. Failure ta provide
this nRiduvit will result in the denial of the Is9uance of the building permit.
Signed Affidnvit Attached7 Yes ..........❑ No...........O
SECTION7u:O�YNERAUTHORIZAT[ON:TOBE.COb1PLETEDWHEN' ;'
O�VNER'S AGENT OR CONTRACI'OKAPPLIE9 FOR BUILDING.PERMIT-
I,as Owner of the subject property,hereby authorize -
t9 uct on my behalf,in all mutters relative to work authorized by this building permit application.
Print Owner's Nanm(Elecwnic Signalure) Dule
SECTION 7b:OWNER�OR AUTHORIZED AGENT DECLARATION
� Dy entering my name below,I hereby attest under the pains and pennities of perjury that all of the information
wnt,lieJ in this npplication is true and acwrate m the best of my knawledge nnd understanding.
� ��
wner's or Ai ionzcd gent's Name(Elecuo $ig�ialurc Dnte
�OTES:
I. An Owner who obtnins a buildin�permit ro do his/her own�wrk,ot an awner who liires an unregistered contractor
(not registered in the Home Improvement Cuntnctor(FIIC)Program);will nut have access ta the arbihation
prognm or guaranty fund under��LG.L,c. 1 d2A.Other important information on the HIC Program can be founJ�t
�r�v�v.m:as.co�:'oea Informntion on Ihe Constmction Supervisor License can be FounJ at w��w.m:us.��o�:!dos
� 2. \Vhen substantial work is planneJ,provide the information belo�v:
fot�l tloor area(sq. ft.) `� .(including garage,finished basemenUattics,decks ur purch)
Gross living area(sy. ftJ Hnbitable roam count
Num6er uf lireplaczs `lumber of beJrooms
Numbcr oF bathroums Number uf hnlFPoatlis
Type uf heating system Number uF dcck�/porches
fYpeufcoulingsystem [nclosed� Open
1. "1'wal Project Syu:irc Foouige"may be.,ubsti�umd for"Tuial Project CosP'
�� C�7Y OF SALEIV� MASSA(��I'ISE'tl'�
� �,
i�" �. . '1 , BUlLDINGDEPARTMEN!'
�=ebn� 120 WASHINGTONS7REET,3ADI�Y,OpR
1�L(978)745-9595
KIIvIBERLEYDRIS�LL FAJc(97S)740-9846 •
MAYOR 7Y�oMns Sr.P�x�
DIREGTOR OFPi7BLICPROPERTY/BLIILDING COIvIIvIIS$10NER
Construction Debris Disposa/Affidavit �
(required for all demolition and renovation work)�
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit#
condition that the debris resulting from this work shali be disposed of in a p oper�ly I censed
waste deposit facility as defined by MGL c 111, S 150A.
The debris witl be transported by:
_ NoRT.� � c�R1►r�c
(name of hauler)
The debris will be disposed of in:
�WhMP5c6�' �oad Tt�►JsF� S+at►�an
(name of facility)
(address of facility) I�
Signature of applicant
_ 0 /26/�0► �
Date
� �
�
I
%"` \ C[T'Y OF SALEM, MASSACHUSETTS "
e`�
� � �\,,
fi �' BUILDING DEPARTMENT
''�� � ' �'�' 120 WASHINGTON STREET,3"O FLOOR
1'��:;?:,,s.'r �
\��,:,�� TEL. (978) 745-9595
FAX(973) 740-9846
KIIvIBERLEY DRISCOLL
MAYOR TrIOMAs ST.PtERRE
DIREGTOR OF PU[3LIC PROPERTY/BU[LDING COMNIISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
�ate � 26 2015 ` �
1ob �ocation Noe-r+� �AI�E�I - g �� 5�.��A�1'� , iVIA Olq"10
HomeOwner Address V T��I'1�l $'�• ShLEN�.� IVI�t Ol�l-10
Present Mailing Address C� ��U'�`'� S't'. �t�►�'l� ItiIP. OIQ�7C�
7he 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 euilding 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'S SIGNATURE
APPROVAL OF BUILDING WSPECTOR �
-- I ���
RESIDENC�
8 Buffum St.
Salem, MA 01970
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� Aaron Udy
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' � j PROPOSED ,
, � �� Fl_OOR PLANS I
PROPOPSED THIRD FLOOF� PLAN � ' 1 '; PROPOSED FIRST FLOOR PLAN �
i� 4 �, , SCALE. 1/4 -1 -0
SCALE: 1/4"=1'-0" —
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SCALE
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� � DATE
- , II/02/2014
; I ,i DRAWN BY CNECKED 8Y
�� � �UJP�91 J` AU
� �_f�I�tGRE ���
� � f��� ,� ,Tlf h:>5, T �-� I � I � PROJECT NUMBER
� 2014.02
� DRAWING PJUMBER
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PROPOSED SECONa FLOOR PLAN � � PROPOSED BASEMENT FLOOR PLAN A-�.O
1 SCALE: 1/4"=1'-0" - - 1 , SCALE: 1/4"=1'-0"
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