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7 E COLLINS ST - BUILDING JACKET 3 �AHS E fiLf--� APPROVED BY T44E ,MPECTDA PMOR TD A.PERMIT.BFING GRANTED CITY OF SALEM i No. 1 71 'ZOO ,y°"` .`'L �`\ Date NC Is Property Located in Location of the Historic District? Yes_No Building /7 Ecc�cru,c cz Is Property Located in the Conservation Area? Yes_No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construc Deck, hed, Pool, Repair/Replace, 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: 77 Owner's Name /71u C I�'Ic�iPler�P✓ Address & Phone 7 F, coi iiry.e Architect's Name Address & Phone Mechanics Name Address & Phone ( 1 What Is the purpose of building? /jJtuJ O�ayC' Material of building? c-Ll mek If a dwelling, for how many families? Will building conform to law? V4"-) Asbestos? Estimated cost 40, TD City License k N P' State License a 2C�'c�k L� Improvement �--- X Signature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE �047e.t l:>cc/c %mac/r- 1)&)2 2feA i MAIL PERMIT TO: r No. APPLICATION FOR PERMIT TO LOCATION I cn PERMIT GRANTED APP OVFD v I SPEQTOA OF BUILDINGS f r 3�G 10 oq IK 36 fLWNSil WTOEfft*94MD APPROVED BY T4IE jMP =DBPOWRTDAPEJ34fTJWJNCGRANTED CITY OF_SALEM No._�l/ (1 > \ Date 1b13��bS is Pmpwty Located in Location of Cw Historic DWdw Yes No ✓ anildlns 7 f Co/lln s S� IS Rapwty Located in the Carwarvaygn Area? YM No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Root Rgmajinstall Siding, Construct Deck, Shed, Pool, /Replace 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 Pab l 4 hda iYt I ugh e , Address & Phone fc�J Col/ins Sf. (9-79) 7yy- 2Fa-a Architect's Name Address & Phone j 1 Mechanics Name Address & Phone whw is to propose a taY ft? w e l l I rla M"w d btarl kv? D U a dwaiwg,for tow many femfllss? ww llril "corMam to law? gS Asbestos? Eslirnsted cost 10« — City umm• N �'' Stare Liomw e ansis Lwto....at Y 6 �� /1 Signature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE II 1 cola'f ��yne .VA(, r?n Cn�AIMRA 4L/V4I d dl.Shi,cWAe/ MAIL PERMIT TO: hWeOvher- 16 No. � APPLICATION FOR PERMIT TO LOCATION PERMIT'GRANTED c 20 OVfD INSPECTOR F BUILDINGS : i The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY y Massachusetts State Building Code, 780 CMR, 7"edition OF SALEM Revised Junuury Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or 7hvo-Family Dwelling This Sectio o Official Use Only Building Permit Number• at pplied: //// Signature: `G -x-v Y ld-110 Building Commissioner/Inspector of Build Date SECTION 1 1 FORMATION 1.1 Property ddress- 1.2 Assessors Map& Parcel Numbers 2 �_L CTlC'Cjf(�(\� C�� i I.[a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water apply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage D/(sposal System: Public Private❑ Zone: _ Outside Flood Zone? Municipal @YOn site disposal system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner f Rid: �Co1'� He,(• ' 7 Name(Print) Address for Service: Signature Telephone SECTION 3: DESCRIPT!PN OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) bl Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': pG SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ s c) G I. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (11VAC) S List: 5. Mechanical (Fire S Su ression Total All Fees:S Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: S 5 OG 0 paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) `7 r,`) G C) ' Ck.u/'', z IL1 _ License Number Expiration Date Name of SII.-11 der �v �T List CSL"rype(see below) 2 i. QS CC>M'^im`3 / .r Description :1Jdress /1'�A _i q 1Q u Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling signature - / - M on Only � RC Residential Roaring Covering Telephone C) / 0 !'� Residential Window and Siding 4 J "J Sf Residential Solid Fuel Burning Appliance Installation / D Residential Demolition yq 5.2 Re��istered H me Improvement4�e actor(HIC) `� / I Lr �� l��l� i Registration Number I I I C Company Name or HIC Regist Name �AJdres's j-'' � t �'�f S'S� Expiration Date Signdtdim Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 the building permit. Signed Affidavit Attached? Yes.......... No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, j l Ev LE 1 Y-L/ V-M as Owner of the subject property hereby authorize C {'\A -),/S �Z n f to act on my behalf,in all matters relati=tkhorized by this building permit application. s.t.,� L- � v Si tureofOwner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I <j r1 V V ��l />, as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. S� v f- t R�J1 � 1 Print Name i &_ r' — `I f 1 Signature of Owner or Authorized Agent Date (Signed under the pains 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 unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will&of have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I0.R6 and 110.115,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage'may be substituted for"Total Project Cost" What is the current use of the Building? Material of Building? � � It dwelling.how many units? /�C win the Building Conform to law? Asbestos? 7' — Archited's Name Address and Phone Machanles Name Address and Ptwne Consbvction Supervisors License# HIC Registration# — Estimated Cost of Project SS4-4=L-- Permit Fee Cak ulatlon Permit Fee S �0 •o 3 Estimated Cost X S71317000 Residential _--... . --- Estimated Cost X$11/51000Commercia'--------- An Additional S5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of perjury Date e N S x a l EITY OF PUBLIC PROPERTY DEPr1RTMMNT MAroa 130 WARUNGTcw SrILM• subly SrAssaaHLshris Ot970 TEL M7454S"•FA3c gM74048N APPLICATION FOR THE REPAIR. RENOYATION CONSTRUCTION DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTINC3 STRUCTURE OR BUMDIN 1.0 SITE INFORMATION .. Location Nana: �4 )Akz4- , Building: Property Address:---I---- -- -- -- -- - ------ ---- - � - Property Is located in a:Conservation Area YIN Z) Historic District Y/N /VcD 2.0 OWNERSHIP INFORMATION 3.1 Owner of Land Name: ^ Address: Telephone: 7�-- —9 a,�( 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New [Approximate molition Existing year of Area per floor (sf) Renovatednstruction or renovation existing building New Brief Description of Proposed Work: 1 Qu//ic2erU � -- - - Mail Permit to: u -- 5.. The Commonwealth of\4assachusetts Board of Building Regulations and Standards CITY OF assachusetts State Building Code, 730 CNIR SALEM M Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling '[his Section For Official Use Only Building Permit Number:- Date Applied:; E x uilding Official(Print Name) ., tgnature - - ^� Date SECTION 1:SITE INFORNLYhON. roperty ress: 1.2 Assesso Map 3c P r umbers 1. a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public ter Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes[] SECTION 2:`PROPERTY OWNERSHIF Ownert of Record: 4�1 PM ��- C:•1:• �) 70 11 I Mac I��-•, )_ Name nnt) City,State,ZIP - 3 Asa cal(f-� ST g J S ?`fy 5 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply), New Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) 01 Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work': -erg(m to"I t �c�c' � "7m,.bSl,o tir a✓ SECTION 4: ESTINL4TED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials L Building $ O L Building Permit Fee S Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical 1 G ❑'Cotal Project Costa (Item.6)x multiplier x 3. Plumbing S 2. Other Fees: S t. M-chanical (IIV.\C) S List: i. Mechanical (Fire 5 Sup session) _ Total \II Fces:S '/ Check No. Check Amount: Cash Amount: total Prnject t ost: S /j O S� l 0 Paid in Full Cl Outstanding B tLutcC DIL: SECTIONS: Co;YsrRwrION SERVICES C 5.1 Construction Supervisor License C des KA _ License Number E.epiruion Date Namz of CSL I Folder ' List CSL Type(see below) Type Description No. and Street —� Unrestricted 2 Fati n s u el ing cu. ft. R Restricted l5c2 F:unil Dwelling City/Town, State,ZIP NI iVlasonr RC Rooting Coverin \VS window and Siding Burning Appliances I Insulation "1'ele hone Email address D I Demolition 5.2�tRjegiste-red Horne Improvement Coontractor(IIIC) ' (p'? f (ti.�( Ids ��� k` / MC Registration Number Expiration Date I IIC l_'�npany Nu e or IIIC Re tstrnnt Natne No.and Street Email address City/Town, State, ZIP 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 .......... No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO DE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize tole n my behalf, i all matters relative to work authorized by this building permi plication. tint Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Autlwrired:4gent'3 N;une(@lccnronic Signnnoe) Date NOTES: l. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under NLG.L. c. I t2A. Other important information on the 1-11C Program can be found at www.m;us.� ovioca Information on the Construction Supervisor License can be found at srw•w.mass.,�o���dL 2. When substantial work is planned,provide the information below: -Total floor area(sq. ft.)-_ _(including garage, finished basement/attics, decks or porch) Grosi living area(sq. ft.) -_ Habitable room count Number of tiropl;tccs-" - - - Number of bedrooms _-- —_-- Munbcrorbathroonts Number ofhaltibaths --------- — Tvpc of heating system - __ - .-- _----- Number of decks/porches ----.-___--- I\pe of cooling iy.lcm_"_---------._.-_ Inclosed "—" -- Open i " [wal I'n,jecr Squ:uc Footaga" may be subttitntcd roi"T,tA Project('ost"