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5 DEARBORN ST - BUILDING JACKET I �\ The Coin nomcealth Of MassachLISCUS Board of 131.111ding Regulations and Standards \IINI( II'.\I.I'll IL NLASSaCI7l+5ettS State Building Code. 780 CNIR. 7"' edition 1 .SI. R R, Heal low,ai Building Pa'mit Application To COnstruc[, Repair. Renovate Or I)enurlish a One- or Tuw-Fami(v Dit elling, l -un\' —� This Section For Official Use Only \ Buildims Permit N her: Date Applied: yn� Signature: --- ,/ ._-------- it I3uildinp Cununissi er/ Iropector of Buildings Date SECTION 1: SITE INFORMATION 1.1 Pm Address: 1.2 Assessors .Nlap & Parcel Numbers 5 1 J� r11l::01�Yl ----- I.1a Is this an accepted .neet) yes no� Map Number Pancel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq fU Frontage Uit . 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Piv,ddcd 1.6 Water Supply: (M.G.L c.40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone.' Municipal ❑ On site disposal system ❑ Public❑ Private❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2 Owner]of Record: �7ffe e' � DP/] '�hC)rl7 Nat (Print Address for Service: (9- 5) -7"V4 - 5 ate 3 Signatur Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteratian(s) Addition ❑ Demolition ❑ Accessory.Bldg. ❑ Number of Units I Other ❑ Spccify: Brief Description of Proposed Work': Tns� �Il IQ (8 )�reS vin , i Idlna . SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item - (Labor and Materials) I. Building $ lO I. Building Permit Fee: $ Indicate how 1'ce is determined: ❑Standard City/Town Application Fee 2. Electrical ❑Total Project Cost' (Item 6) x multiplier s 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HV AC) $ - List; — i 5. Mechanical (Fire --- Su. ressiun) Total All Fees: S �L Check No. Cheek :\mount ('ash :\nuwne__._.. b. Total Project Cost: $ Ip S S. (� -- - 'I, J " ❑ Paid to Full � Outsrmdine Balance Due:_-- _---- ' SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor ICSI_I 6-7733 — _/r License Number Ispu,alon Date Name of('SL- I lulder �^ 1 L.Ist C'SL 1'%pe Isee heluw) A -- 1 I LNdr'h JI ! e f--f 611 crn I 7.r. e Dascri uom ,- \ddree. L nuesulcled III,to 15.000 Cu. 1-4.1 K Restricted I.e'_ Famth Dweller_ Slenau a 9 . J N1 \Luonn Only !-i RC Residential Kaoline('m rime Tclephtn \\'S Residential SF Residential Salad Fuel Huriun. \s tllauec bn(,Illuuou D ILe.IJalmal Demolition 5.� Registered home Improcement Contractor (HIC) I u b )9 SPJ-V If pS� Reglstrauon Numhrr HIC Company.Name or HIC R•gtstrant Name AJdr• s `�i'I ' H 1 U7�1 Or'+�q E.cpoatiun Date A lL Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. C. 152. § 25C(6)) Workers Compensation 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 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT X as Owner of the subject property hereby I f-"Z to act on my behalf. in all matters kd by this building permit application.er Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I, C`hits�-� ?_E)C' as Owner or Authorized Agent hereby declare that the statements and informatic:I on the foregoing application are aeu;accurate, to the best of my knowledge and behalf- Print Name Signature o'Owner or AuthorizJd .Agent _ Date (Signed under the Cains and penalties of perjury) NOTES: racwr 1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unre_isteied cunt (nut registered in the Home Improvement Contractor (HIC) Program), will not have access to.the arbitration program orr-guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program :md Construction Supervisor Licensing(CSL) can be found in 780 CMR Regulations 110.R6 and I I0.R5, respecti�cly '. When substantial work is planned, provide the information below: Total flours area (Sq. Ft.) -- (including garage, finished hasemenUattica, decks ur porchl Gross living area ISq, Ft.) Habitable room chum Number of fireplaces - Number of bedrooms -----— Numher o ut bathroms Number of a(hs / purehus fvpe of heating sy Jecks Number of eck stem _ - T}'pe of cooling s}'s(em - .- .. - Fnchlsed Upon -- — -- - 3. "Total Prryect Square Footage- may be substituted for "total Project Cost" j DATE: //- - U I I + � �itp Df �ar�m, a��aL�ju�Etz� PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BEING GRANTED 5 D�CtYbo✓yI 'Pr?1 Building Permit Application For: Location of Building I� '(Circle whichever applies) Roof, Reroof, Install Sidin Construct Deck, Shed,Pool Addition, Alteration epair/Replace, Foundation Only, Wrecking Other: PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: The undersigned hereby applies for a permit to build according to the following specifications:Owners Name jj tYI�YI 11X IMP. Contractor: A 9 A Seryi 5'�I�7ri5 Zb 1 Street, I inn- YV1 City StreaJ ff N nr-+h 5L _City I y State--PA Phone 019) 24N -5oW State M A Phone,MS) 7y I -,0�1 021 { Architect: City of Salem Lie#-I 105 Street City State Lic O5 HIP k I©I 6 09 State Phone ( ) Homeowners Exempt Form_yes_.LZno Structure: (please circle) Single Family, Multi Family# Other Estimated Cost of job S iq�01cp DO Will building confirm to law? yes no Asbestos?_yes J./.00 Description of work to be done: -TV,AA 11 13 5a inre,5 of yjn/ lj ScrilnQ A&A SERVICES, INC. Drawings Submitted:_yes no Mail Permit to: SALEM,MA 01970 A rg>ai 4i JoZ4,__.. X L VVWW.A-A§ Signature of Appli ation,SIGNED UNDER THE PENALTY OF PERJURY CONSTRUCTION TO BE COMPLETED WITHIN SIX(6) MONTHS OF PERMIT ISSUED DATE NO. Z APPLICATION FOR ' PEpMCf' 'fn • •� � . . . LOCATION PE"MIT GRANTED nPP� fo -. 2�� INSPECTOR F BUILDINGS CERTIFICATE OF OCCUPANCY . YES NO c. • a V The Commonwealth of Massachusetts v Pc)R Board of Building RcgulationS and Standards Massachusetts State Building Code. 780 CMR, 7 edition 1'11[ Building Permit Application To Construct. Repair. Renos'ate Or Denwlish a R, i.wd puma, One- or Tn o-Fumily Duelling 100S \- This Section For Official Use Only Building Permit Num er. Date Applied: Signature: AV Zg B - tit, ununissioner/ Inspec of Buildings Date SECTION 1: SITE INFORMATION __ f 1.1 Proper'} Address: 1.2 Assessors Map & Parcel Numbers J )2",4 Q a x/V J 7' 1,I u Is this an accepted street? yes L/nn_ Map Number ParCCI NWmher —� :.3 Zonin9 Information: 1.4 Property Dimensions: Zoning District Proposed Use -- I Lat Area(sy tt) Frontage tit) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard ! Required Provided Required Provided Required Piotdcd 1.6 Water Supply: (M.O L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System _/ Zone: _ Outside Flood Zone'? Municipal Puhlic (Id Private❑ Check ityes❑ p' On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'ofRecord�, �R� ST, LA a _�J _ [�[_6� s�a� �e2,v s r Name (Priul) Address For Service: 7L 77/ 3 Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Uniis_ ther ❑ Specify: BrierDe.sciiption of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Lahor and Materials) I. Building $ I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x I 3. Plumbing S 3. Other Fees: $ 4. Mechanical (HVAC) $ Lisc 5. Mechanical (Fire Total All Fees: S Suppression) Check No Check Amount: Car h Amount __ 6. Total Project Cost: (9,51 ❑ Paid in Full ❑ Outstanding Balance Due:_ 75 h r SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Connstnt'ruction Supervisor(CSL) CS D0 s/ �6 101" 1 M i✓lJ t' S License Number 6.vpoatior Date Nance of CS L- Ifolder List CSI_'fype Iscc bclowl "f c Description 4d - .� HAS L Unrestricted to lu 35.000 Cu. Ft.l -^/ C✓wr R Restricted 1&2 Family D%Nciline Sena mt e M %Lasonn Only RC Residcntia Roulmc(.'U\el'lll1 Telephone \\'S Resid_ ma�enl ial \V d , and S,dm esidee SF Rntial Solid Fuel Ifunune \pplrutcr Ina.illduu D Residential Demolition 5.2 Registered Ilonte Improvement Contractor(HIC) filC Company Name or HIC Registrant Name Registr:.lion Number Address E.apuation Date Signature SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6p Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide j 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 [,_/�•//� rid � LO /CiTc as Owner of the subject property hereby authorize_ / �.tt�.__G,/iv.. r y._K Ste_ ___—.—__.___to act on my behalf, in all matters relative to work authorized by this building permit application. -- Signature o 6w%!U�" -'7L -..--..-------- Dale ---- -- f SECTION 7b: OWNEW OR AUT ORIZED AGENT DECLARATION e, La as Owner or Authorized Agent hereby declare that the statements and information on the f regoing application are true and accurate, to the best of my knowledge and behalf. Print Va^te Signature of Ownelo Authorized Agent Date (Signed under the 2ams and penalties of perjury) " NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unicuistered contractor (nut registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL) can be found in 730 CMR Regulations 110.R6 and 1 10.115. respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/attics. decks or porch) I Gross living area ISq. Ft.) Habitable room count Number of fireplaces Number of bedrooms _ Number of bathrooms Number of halffbalhs Type of heating system Lfz c-%�-/L dumber of decks/ porches ----- "type of cooling system" Enclosed Open - 3. "Total Project Square Footage- may be substituted for -Total Project Cost- DATE: Cttp DfA�EIU, ftdLU�Eft � 9 PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BEING GRANTED Location of Building .J� [��Q!'/D0li'- Building Permit Application For: Circle whichever applies) Roof, Reroof, Install Siding, truct Deck hed Pool ns Addition, Alteration;Repair/Replace, Foundation Only, Wrecking Other: PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: The undersigned hereby applies for a permit to build according to the following specifications: Owners Name: 1&�iph �o y-P , Contractor: Chr; srnnhPr 7.nr7.y Street 5( rC�- City Street 11 s Norrh SrrPPr City SIL-- State_ Phone (ggf) '7-M - 5ALP3 State MA Phone (97,g) 741-0424 Architect: City of Salem Lic# 14 0 5 . Street City State Lic#0 5 7 7 3 3 HIP# 101609 State Phone ( ) _ Homeowners Exempt FormJes­k/no Structure: (please circle) ngle Faun l • Multi Family# Other Estimated Cost of job $ r]t $JCo bu Will building confirm to�Iaw?_yes no Asbestos?_yes ✓no Description of work to be done:_-7-jnS4-r/1 10 k lI (I e(,IL rw se»rn eo2 t r Znsdi�lf one 6.) -4-b6r laSg pn a r, y01-- Drawio s u miffed: es —WIXSERVICES � no Mail Permit to: 11b NORTH STREET X 4AT FM 114<4 9:B7o-- Signature of Applic lion,SIGNED UNDER THE PENALTY OF PERJURY CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE Department use only: Permit# Zoning N4ap/Lot Permit fee$ COMMENTS: t. 71 Z [n 9 m n (mil II vZl o p z �n lu H -1 } t x tea N ID © p �� a Z C+d O CD "'r - .n} ok � — t ;S!it'(y .: .�Pi ,.;is � � '• , . 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", 9'r pliM%t lr. i:�'' i:k": .:P 10R5r✓':id ' .. . . � _..., i ql RtA+l:d tT�Ylyi.H ...�%1'1•i��A� ,..,... tip01i 'ip�?tli:. o-Yro 4+\ cw•.'..MJ>°."7pMd` .... .. .. ;,, �{Fwis�i4ie�:'. a{ln.,. l .--ar►1NWvYb<:.;IdiarGb1" '�{.rDlt$f'9l'},l'Filit':':'i�'✓r�l`FtWM�a 4�,:�Ilt' ,'1'��a<' +� 'iiVitffv'.,;n : fir<�,py�•Ya' ' . CCkfl;f:!'�ItUi;1!1..'14kwww�l.�N'!s'ti'l,:,ci�'I'!`�'f�h't�'l� t't -r!LMt��1'•y,,"t:�; . . _ _9�SiSkY91`!�',�5-i`��p:}�' Q, .. .rlSqur :AI ;tni. en _R h gv1 -A ft a.l,. w •�ililciAr. �l1 mcs LL Zfl , C W m RI . ..4in +- - _ 6 _ awW a > U LU- "Ad'. O W a cn 5 ^ 0, �+ Warne: J Citp DfarPm, a��atju�Ett� PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BEING GRANTED Building Permit Appikatioo For. Location of Building_ SJ 1�F,.g)c '(Circle whichever applies) Roof, Reroof, Install Siding Construct Deck, Shag pool Addition, Alteration,RepairiRapiace,Foundation Only, Wrecking Other. PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: ' Tho undersigned brleby applies for a permit to build according to the Wowing speciticadow: OwoeriName:_ TC91-1.v Cr.t Cootraetor. CUar.a ��S (gym vttCCJLZ`Ta Strrat__ 5� -61i&1 g^&City-SA44p,�;, Street-,yv 1)044. Z) 5>. City Sig(-C. ,�..� sate"S phone ( ) Suter pama( 2,F) Architect: City of Salem LkJt Street Cily State Lid. CS_ R_3 -&w# J NC7S 71, State Phone ( ) Homaawoers Exempt FormL_.yas ao Stmomre: (Please eircle) Single Family, Muld Family _Other Estimated Cat of Job S /co Will building eon8lne to lawl,,,_yes tto Asbestos?�M_ono Deseriptien of work to be de@e: Drawinp Submitted: a no Mail Permit to: S,09CA;, A y, Signature APP��,$ GNED U THE PENALTY OF PERJURY CONSTRUCTION TO B ` OMPLETED WITHIN SDC tin MONTue OF PERMIT ISSUED DATE a. DgWtmeat use only: Pern Y Zoning Permit fee S CONG iTS