30 CHERRY HILL AVE - BUILDING PERMIT APP ,a;---_, -- --- I he Coinnwnukcjhh ul \IassaChtuells --
I I J I!
t• BnurJ %tt BwlJinL: Krgul:wuro ,utJ St.utJ.trJs � \II \It II' \III 1
Massa,hoselis Sue Building ('odc. 'SU( MR. "" :Jiii,vl \I
�O j+
i l3uilJim_ I ennit :\ h t C:uum To (•nnaruiL n 0.'Repair. Rernu l h Demolish .r
I)ttr i,1 Too-l-totnh lhtrlhn('
I his SCen,m For Official l',C Unly '
ButWtn�• Permit NUrrl hr _ Daw :\Pphe rVo
- J - - --- -
S;_nalure
13uJJdic lmunn,i, nrr I t I 'riot' d IAnWmp, Ud:c
SF.( I'ION I: SITE: I\'FUR\1:\ 1'I4)N
1 1.1 PrF}'rtr .\dd res:: 1.2 \ssessors \lap & Parcel Numbers
r \la \umher I'.ti,cl Nuniha
I III Is this .m .tcceptCJ sum se,, +r^
..'. ?:osist -'.ea farm;ir,lnnk I.r`..Prope-rly Dimensions:
i
I
Zo nng Di I,trt Pmlxaed I'se Lot Area(sq II; F„m;.;pe i:u
1.5 Building Setbacks IfU --- - --
Fn,nt Yard Side Yams Rear Y:ud
NruuurJ FntuJeJ t Rc yuurd Pmtsided Reyuned Pin W, I
1.6, Water Supply: t.\i.G L:. 40. §`1t 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Tune: Outside F4wJ Zone"
Puhiir ❑ Pn cate❑ — \hmtetpul ❑ On site Jtel>,twl ,,,tciu ,J
Check it yfs❑
SECTION l: PROPERTY OWNERSHIPt -_ — -
�2.6 Oanert of Record:
..\.w:. I'nnt t Address for Set,ice: i
---- —
Stgn:-mrr Telephone --�
SECT[UN J: DESCRIPTION OF PROPOSED WORK' (check all that apply)
Nc!" ( ,tn;Cm ti,rn 7 .Existing Building 0-mr ;r Ocrnprcd ! Rep;wsi]) L i Ittr.dntrtJ.t ❑-
Dewill :Ion ❑ Access,•-iry Bldg. D Number of Unit,__!_. (.c
6tr,l :.1r c. r r un;, of Proposed %i/urk-: — _-- _ _
i
r SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated G»ts: Official Use Only
tI ahor and Malertalsl
I~I Bull file ) I UUp ; I. Building Permit Fee: 5 Indicate fill%% lee t, JciCI mined:
I-- ❑ Standard City%l,ivsn :\pphcaunn Fee
'. Flectncal !
❑ Total Prn)ect Cast them GIsmultiplier
t Plumhtng S 1 '. Other Fees: 5 —
1 SkChamcal 11\':\Ct S Liss: _ -- -- ---
1 i \les hamcal !Fire S — ----
1u t ae„t• nt F,t.tl :\II Fees
('heck No _ l'heck .\m.nuv l ash \nit wit
n Fotal Project Coll S Z( 0 p L) tZPaiJ to Full O Out tandem• B.tl.tnse Due_ -
s�
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor ICSL1 --_- -- _— -- �- � w
Ll,imi Numhir __.._—._ L,InLw,�II I),Ili '
I'. 1 Nami, l ( SI- I luWir L"I l'SI. I Npe ,cc h:lor, I .
\Jobe,• I' C Di,i rI ,I l,n)
( ( IIli,in,IeJ pup 1,1 :• IM IU I a 1'I
R Re,u I,IiJ Lr_' 1'.IIIIII\
f;
' 11 FI�IJ.ull.11 S„I L11 I,I 11 uII n`\1L n_IInI I I u
-
r5,2 Registered Home Imprucement Contractor (MC)
HIC Comp.m, Name or MC Rcei,irint Nalne -- Reglsuauon Nwoho
\ddres, —... -
Fyruatl,al Usti
signature R'Iephune
SECTION 6: WORKERS' CONIPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance ittidivii must be completed :md submit(ed with this appbe:un)n. F.ulurc ho pooldc
this affidavit will result in the denial of the Issuance of the building permit. - -.
Signed Atfidavit Attached? Yes ......._. ❑ - Nu .... ❑ _.. -
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. , as Owner of the subject property herebv I-
authorize to act on my behalt. In all m.ltmn . ..
relative to w,.n k authorized by this building permit application.
i I
L..
Sienaiuieut Owner --- Date
SECTION 7A: OWNEW OR AUTHORIZED AGENT DECLARATION —A
f. , as Owner or Authorized Agent hereby Jecl:u'e
that the statements and information on the foregoing .pplication are true and accurate, to the best of my know ledge and
behalf. -
Print Name -
Slenature of Owner or Authorized Agent Date
I
i Signed under the pains and penalties of r u I �
NOTES:
I. An Owner who obtams a budding permit to Jo his/her own work,or an owner „hit hires :u) unre,a,teied i,tilt ra, 101
(nut registered In the Home Improvement Contractor (HIC) Program), will not have ucce5o to Ine .uhitianon j
program or guaranty fund under M.G.L. c. 112A. Other Important iinto,mauon on the 111C Pn,cr:nn and
Construction Supervisor Licensing ((SI_I can he found in 780 CMR Regulations 1 10 146 and 110 R5. re,pec Ll,cly 1
When +uhstantial work Is planned. pros Ide the intotmauon below:
F,,tal floors area ISq. H.i oncluding garage. tinuhed hasenicnUatucs, decks ,ir p,lr:h 1
Grl,s Irvme area ISq. Ft Habitable room count ..
Number fireplaces--- Number m hedrl,nn,
Number „or halhimmi, Nulrther„f h.1ltih,uh,
I s I,e ,.t he.lting +,+lem ____.-- Numher ,ddc,kN/ p,nvhc,
1 . ape „i s, „hng ,.,+lem .-- I`.n.I,-,cJ
i \. Tonal Project Square f:twi, gt' ma\ he ,uhsmuted h,r "f,aal Pr,)1"r C ,,f'
CITY OF smyL m
PUBLIC PROPERTY
DEPARTMENT
MAWS 130 WA9u1+G IM STMEW•SMJMK MAS1AOa-WM 01970
713-9.W74S-9S" * FAX 970.740-96"
HOMEOWNER LICENSE EXEIMPTION
Please Prtat
Date /
Job Location 3 o
Horne Owner Addresn 10 /> ,,,esL7 /l
Home Owner Telephone 9'7 fr - 4 v— v v s 9
present Mailing Address S a-w -r , -
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.
DEFiNMON OF HOMEOWNER
Persons) 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 dwellin& 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 hetshe 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 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