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0002 CEDARVIEW ST - BPA-14-629 � s C;� � �3� � /7 3 _ _ ��._L, � � Z�' - � `� ` � The Commonwealth oFNinssachusetts Board of[3uilding Regulations and Standards CI"PY OF ` �q� Massachusetts State Building Code, 730 CMR SALEM � � Building Permit Application To Construct, Repair, Renovate Or Demolish a 2ecised,tlur�p�l ' �, One-or Ttiva-Fmnrly D�velling Y (� This Section For Otlicial U a-Only : { v � Building Permit Number: I Date Ap ied: � Duilding Ofticiul(Pnnt N;une) �..� . . ��� - OC / , V�J � ��. Si�,nawre.: . . . Daf SECTION !:SITE INFORi�IATION' I.I Pruperty Address: - � �� - . �Z ('s i.�,�,o ����-� �- I1 Assessors blap g p�rcel Num6ers I.l a Is Ihis an accepted street?yes_ i�o_ bfap Nwnber � I arcel Number ' 1.3 'Loning p�formation; IA Property Dimenslons; "Luning Disirict Prupused Un— ��—' Lol Arca(sy It) frontage Qt) I.5 13uilding Setbi�cks(R) Front Yard Side Yan1s Reyuircd Provided Rear Yud , Reyuired Provided Re uired 9 Provided 1.6 Water Suppiy;(M.C.L c.J0,§Sd) 1.7 Flood Zone Informntion: 1'ublic� Private❑ Z��e� _ Outside Flood one? �•8 Sewa�Disposal System: � . _ Check iFyes�" Municipnl On site Jisposal system ❑ SECT[ON2: PROPERTYOSVNERSHIP� 2•I �vner�of Record: ' � - v e �o_. �A �-2 w- �T �1me(Pnnl) � � � q �� Z �Q ra r ctry,scu�e,z�p �i v�E�nl .S� . (��� • q `E 6-`i�t`��f Nu.mid Strect Telephone C•maJ AdJres; SECTION 3: DESCR(PTIOIV OF PROPOSED�VORKz(check nll that apply) New Construction❑ Existing Building� Owner•Occu ied P � Repairs(s) ❑ qlteration(s)� Addition ❑ Demolition ;lccessory Bldg,❑ Number of Units � �riefDescriptionof�ProposedlVork':�_ — Other ❑ Specil'y; ' �..+a s1 a.( �( -E-r I..., r� > �-r � �" � '� a-}.L, i!r A SECTION a; ESTIb1ATED COYSTRUCTIOY COSTS I[cin Estimated Costs: Labor and,�laterials) Official Use Only I. f3uilJing y � � O I, Building Permit Fee:$ fndicate how fee is deter ' � 0 ?. Efectrical �r ❑Standard CityITown App�Ication Fee mmed: 3 . Q 0 O p Tatal Pro 3. plumbing y ject CosP(frem 6)s multiplier ,r � � 0 ?. Other Fees: S ' °I. ��(cch�nical (EIVAC) $ Lish S. i\�I�ch;mical (Fire Su� ression) � r�c;,i,�u r�r5:s 6. Tnt:il Project Cost: .'S 2TJ �0� � .— Check No. Check Amounh Cash Amount: . ❑P;iid in Full ❑Outstanding O�lance Due: a �� � 1�3 . � �,5 � ,_ _ � . / � sECT�o�s: co�srRuc�r�ov sEav�cEs j.l Cunstructiun Supervisor License(CSL) ---- ---�— Ex imtiun Datn License Vumber P List CSL'fype(sce beluw)�� Nnme of CSL Holder . Type � ":: :�� Descriplion N�. and Svccl U Unnslricted Ouildin s u to 35,ODU cu. tlJ g ResVicted I&2 F:unil D�vellin . �( Mnson �Ity/[uwn,Smte,ZIP �t� gootin Coverin �yg \Vindav and Sidin SF Solid Fuel Buming r\ppliunces � Insulation . � p Demoliliun —�--- Email uddress 1'ek hone 5,2 Rcgistered Home Improvement Contrnctor(HIC) F���R�gis�b� Crpirution Dute FIIC Cumpany Name or kIIC Regislrant Name Email address No.mid 5«eet —� 'Cele hone , , , . �. � . '�- . Ci /Town,State,ZIP SECTION 6:�VORKERS'.COh(PENSATION INSURANCE AFFIDAVIT(b�:G.L.c. 152.§ 2SC(� Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this�ftidavit will result in the deniai of the IsSua�n�f the building permit. Signed Affidavit Attached? Yes .......... No....... ...❑ SECTION 7a:OWNER AUTHORIZATION.TO BE.GOMPLETED WHEN: O\VNER'S AGEIVT OR CONTRACTOR APPL�E3 FOR BU[LDING PERb1IT l,as Owner of the subject property,hereby authorize , W a ,�c�W-Lo. �-.a,-�` tg act on mY behalf,in all matters relative to work authorized by this buildin�permit appl cat�n. ` 3 K0.`�� � � V�e7�1l�, Date Prin[Owner's Nmne(Electromc SignaWre) SECT[ON 7ti:OWNEIi�OR AUTtIORIZE AGENT DECI.AIL�TION 6y enterin�my name below,I herebN attest u�nder the pains:md enalties of perjury that all of the information coutained in this upp��cation is true nnd n�e to the st of y knowledge and understanding. �CC V 2 Q 2 I Dat, Print Owner's or Authorized AgenPs N+une(elecuunic Signatu �o�rEs: ' (notOregister doinbhe Home In p ovement`Contr'ctor(1IIC)P�ogram)nwill not`have access to tlee arbitmtiont�actor p`�S�a�nl��,����i fnfor�m t on oo he Conatru[io�n Sup rvisor Li ef�ise c.1n be f und atC P�o m��i�s��nd a[ � Z. \Vhen substantial�vork is planneJ,proviJe the infa��11 aludinel�ara e tinished basemenda�i�s,decks or porch) fotal tluor�rea(sq• ft.) � i (�"�� -`�`� ( y H16 table room count_T_____.__-- � n c., r'— _ . Gross living area(sq. tt.) 1 , (n O!_,.T �iiinber of bedrooms Vumberoffireplaces l viii���eroFhalf/baths I Number uCbathrooms �- � �u�»ber of decks!porches 9 i. ��YPe uf he�ting system �� Cncloscd.______.__°Pen 'Cype oi cooling system ). "Ibtal Project Syu;�te Fuotage"in�y be substi«�red fur`"�utul Project CosP• �::�ry"� � ; CITY OF 5�1L.E�,t, ti�.-1SS:\CHUSETI'S 1 . s ' �CI1.D4\G DEP:1RT1lE.VT ���� �1 �`� �` l?O CS/:1SHCYGTOV STREET, 3'�O�.pOR ���'�� It..t (978) 7�5-9595 F.L�c(978) 7-f0-9845 KI1iHE.RLcY Dt2ISCOLL �1�L�1YO;t T2�tOaL�S ST.PIERstS DI�£CtOA UF PI;BLlC PROPERTY�BCILDL�IG CO�Ot155IONET L'onstructiun Debris iDisposal �Ftidavit. (required For all dcmolition and renuvation work) In accorJance with the sixtlt edition of the State Building Coda, 730 CMR sectian ( l I.5 Debris, vtd die provisions uf�fGL c 40, S 54; Huilding Pertnit i� is issued�vith the condition that the debris resulting from this work shall be disposcd of in a properly licenszd�vastn disposal Facility as defincd by ��(CL c l l l, S i SOA. "Chc dchris will be transportcd by: y T�rn.�d �"7`21^ t2 () C A 72FT�G¢f ' (namc oFhau�er) 'C6e ilebris �vill be disposed of in ; � (damc of tacdity) —� --?--�o l+o t P ST' I��-�-�,[� '(J�(II't5S OY(IIpIIL�) ���� I sign�ture ut ermit applicant '— � ���-- '�� i,�, .,�r.i., _.__ -- - - - - --- -- --- _. _ _ _ _ _ _-- _ _ __�_.__________. ;,��`'`��" � C[TY OF SALEM, MASSACI IUSETTS �"' � �j� BUILDING DEPr1RTMENC \���y.; �� 120 WASHINGTON STREET,31D FLOOR �._ms,� 'I�L. (978) 745-9595 Fnx(978) 740-9846 - KIMBERLEY DRISCOLL MAYOR TY-IOMAS ST.PIERRE DIRECTOROF PUBLICPROPERTYIBUILDING COMNIISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date 2 ti � Job Location_�`_� l� ,`�(/G'�J ,) `�/�pQ �� Home Owner Address r l.2 Gl�r'�/L (�/ S � Present Mailing Address � �"�� 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 8uilding 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'S SIGNATURE �/ 2L � APPROVAL OF BUILDING INSPECTOR �W+K� [/i�i�--�— r �'/�`c �� 1 E �� �Ji1� .r.1Yj� 1Y�1clJSi�1l.L1l�JL' 1�S . . � ��;7 1 „ BLu.Dt�G DeP.+xr�cE.�r � Yl'r � �� 1?O \Y/.iSHL�IGTON ST[tEET, 3 FL.00R � ���" 'I�i. (978) 745-9595 F.�.r(978) 7�50-9846 KI�(gF1LLEY DAISCOLL VYAYOR THont�s ST.Prs.exs I DIRECTOR OF PLBUC PROPERTY/BCIlDNG CO�Ll1ISSIO�ER � �Vorkers' Cmnpensation Insurance AtTiduvit: Uuilders/ContractorslElectricians/Plumhers :\ i �licant Infnrmatinre Plcase Print Le ibl ! V,Itltl' (l3�sineiwOrganiraiion.9ndividu,J): 2 Address: ,P( Gt/(/� C� . C� . City/State/7.ip: 6����M/•� ��y�ne N: � ! �� C ,/ Arc you an cmployer7 Check the approprixte boY: 'f ype uf project(requlred): I.� 1�m a cmploycr with 4. � I am a gcncrel contracto�and I 6. ❑hcw ronawc[ion einpinye��s(full anJ/or part-time).• have hircd the xub-contractars ?.Q 1 mn a sole prapnetor ar p;utner- listud on the attached aheet.� 7. �madelin� � .hip anJ havc no cmpioyces These sub-contracrors havc 8. � Demolition �wrking ti>r mc in uny capaciry, workzrs'comp. insuranca 9, � Duilding�dditiun �No worken•' comp. insurance 5. 0 We�re a corparation mid its , �� ���,� ofticers huve zxercised thcir �����cvical repaus or addieions 3, am a homcowner doing all work right of exempliun per MGL I 1. Plumbing rcpuirs or additians � myxlE(\o workcrn' mmp. c. 152, §I(4),and wc have no 12.0 2ooF rcpuirs insuranca.reyuired.) t ampluyeea. [No�vorkcrs' . �; � Other curtip. iiuurance nyuireJ:J . � •nny upplicvn tlu[dmckn 6ux dl mwt alw fill wi ihe xctiun M:lowyhowing iheir workui mmpenu�ian pulicy inli�rm�tiun. �I Luncuwm.rs who suhn�it Ihis�Rld�vit indicming ihcy arc doinK all work and thrn hirC uWlide conimctors mml fuhmil a new aff•divil indic�ling such �('nn�ncwo ihul ch�ck ihi�bua mw��no.h�a1 an a�lili�iuwl ahx!shuwin�Ilu mm�c of thc sub<umncton�nJ ihcir wnrkcro'wmp.puliry infufmmion. I um un eurployer(hat is pravidi»K�vorkers'cunaprusada�i�e�urancejor my eurp/oyees. Qelow Is J�e pollcy und Jub sile injormation. Insumncc C:nntpany Vamt: � _.._._.'_— Pnlicy i!ur SclGi�u. Lic. H: ___,__ Expirution Datz: � /ob Site Address: � Ciry/State/Zip: . ,lttnch a copy uf lhe n'oricers'compensattou pulley declarutlan p�ge(showing the pulicy number snd expirotlon date}. F'ailure w secure cuveragG;u mquired unJer Scelion 25A ut'MGL c. �52 can lead ro the imposition ofcriminal penalties of a iinc up m 51,500.00 anJ/ur one-year imprisonmcn4 as tvcll as civil penaltics in thu fortn uf a STOP WURK ORDER anJ a line of up[a 5�50.00 a Jay �gainst tht viulamr. 13e advi,cd that a capy uf this.+tammcnt may�:furw�rdcd ro Ihc OI'licc of . 6rvcstigmiuns ul'ihc DIA far insurenct urvcngc vcriticatiun. � /du hereby crrtijy uader hr puins ai�� iallies ojperjury�/m(1hr i�ejurmutlon provideJ�Luv is�rue mrJ currecG - S'��n� i i t' Datu' � i� . Phone�!� �' /C C OJ'/iriv!use ady. nn not w.he in rlii.s u�ru,(o be couipfrled by city o�lorvn afJiriuL City or'I'u�vn: _..__. . .__ Pcrmit/IJccnse# --'--.._—. _.__----_. .. .___..-- I+�uing.\ulhurily (circle unc): � I. lSua�d uf Ileat�h 2. OuilJin;;Department 3.City/fut.0 Clerk A. Electrital (nspcctur 5. Plumbing Inepecrov � G. 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