24 EDEN ST - BUILDING JACKET The Commonwealth of Massachusetts RECEIVED
Board of Building Regulations and StandMPECTIONAL SE VICfeGrY OF
i SALEM
4l, ^
Massachusetts State Building Code, 780 CMR Re L/ur 2011
Building Permit Application To Construct, Repair, RenovaINrM41h 4 4'
One-or Tivo-Family Dwelling
� ) This Section For Official Use Only
I Building Permit Number: Dat pplied:
Ln lAt
6
Building Otllcial(Print Name). Signature Date
" SECTION 1:SITE INFOR"NIATION'
L I Property Aridress: 1.1 Assessors Alap&Parcel Numbers
I
1.I a Is this an accepted street9 yes w 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
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:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal s stem ❑
Public 11� Private❑ Check if es❑ p y
SECTION2: PROPERTY OWNERSHIP,'
` Ot^e,"of Recorr� V (i V vu
t1
l�me(Print) / City,State,ZIP l / 1 I �l
iarSVlU,1*0kJ:S(Q6& A
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Erl Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.Cl I Number of Units_ I Other Cl Specify:
Brief Description of Proposed Work:
SECTION 4: ESTkNATED CONSTRUCTION COSTS
Item Estimated Costs: Ofticial Use Only
Labor and Materials)
1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cosh(item 6)x multiplier x
3. Plumbing $ 2`s Qther Fees: S (-
4. Mechanical (HVAC) S List: -
5. Mechanical (Fire S rotal All Fees:S
Suppression)
�1Check No._Citzek Amount: Crash AmmmC_
6. Tutai Project Cost: S C V 610 + 0 Paid in Full 0 Outstanding Balance Due:
1
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction S!Etuailad
se(CSL)
License Number Expiration Date
Nine of CSL Holder List CSL Type(see below)
No. ,md Street TYpe'. Description
U Unrestricted(Buildingsa to 35,000 cu. It.
R Restricted1&2Famil Dwelling
Cityffown,State,ZIP M Maso
RC Roolm Covering
WS Window and
SF Solid Fuel Doming Appliances
I Insulation
Telephone Jrcss D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
IIIC Cmnp;my Name or HIC Registrant Name
No.and Street Email address
City/Town, State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GI.c.152.$ 2SC(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 Isivance of the building permit.
Signed Affidavit Attached? Yes ..........13 No...........C!
SECTION 7u:OWNER AUTHORIZAR TION TO BE.COMPLETED.WHEN'
OWNERIS AGENT O CONTRACTOR APPLIES FOR BUILDING.PERMIT'
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Dale
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By enFinis
me below,)hereby attest under the pains and penalties of perjury that all of the information
ai on is, ue and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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 got have access to the arbitration
program or guaranty fund under M.G.L.c. 1 J2A.Other important information on the HIC Program can be found at
www.mass.;oL �Information on the Construction Supervisor License can be Found at www.mass. o+'Jns .
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) xz .(including garage, finished basementlattics,decks or porch)
Gross living area(sq. 11.) 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 orcooling system Enclosed Open_
3. "fatal Project Square Footage"may be substituted tor-rotai Project Cost"
Commonwealth of Massachusetts RECEIVED
Sheet Metal Permit ItiSPECTICHA� SERVICES
Date: [ _ h�rnl8r APR 21 P 02
Estimated Job Cost: S a s 0 Permit Fee: S
PIanS Submitted: YES NO Plans Reviewed: YES _ NO
I J Business License 9 S0/ Applicant License k :3 �/P
Business Intixmaattion: / f Property Owne ob Location information: r
Name: (_Crn_�11 Name: re �!t ✓ �/n/e.,
Street: 60 b) e '� SY Lu� Street: ✓ �r .
City/Town:c", /r,. 1 - CityPrown: 5(" / 1 -e- l7/f1�
Telephone: 92 N J!' 1 r-' Telephone: Vo - D/' ,j
Photo 1.D. required/Copy or Photo I.D. attached: YES_ NO
slarr Illilill
J-t / :,N1-I-unrestricted license
J-2/ 1M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less
/
Residential: 1-2 family ,/ Multi-ramily_ Condo/Townhouses_ Other
Commercial: Office— Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. _ over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to he completed: New Work: _ Renovation:
I IVAC_ Metal Watershed Rooting_ Kitchen Exhaust System
Metal Chimney/ Vents_ Air Balancing
Provide detailed description or work to be done:
M I=w� Ne MC Ch i I O kt
0 % x 'T
INSURANCE COVERAGE:
r
I have a current liabilit Insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No❑
If you have checked Yes, Indicate the type of coverage by checking the appropriate box below:
A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
) Signature of Owner or ner's Agent
By chocking this boxb,thereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct Inspection required prior to insulation installation: YES_NO_
Prot-press Inspections
Date Comments
Final Inspection
Date Continents
Type of License:
By_ ❑ Master
ce_ ❑ Master-Restricted
City/Town ❑Journeyperson Signature of Licensee
Pennil?
-- ❑Journeyperson-Restricted License Number:
Fee —.--- ❑ ---
Check at:•i Sy•.y.utd:;S.�iVy'iIL
Inspector Signature of Permit Approval