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53 ESSEX ST - BUILDING JACKET � The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF a�. Massachusetts State Building Code, 780 CMR SALEM Revised Mar 011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Family Dwelling This Sect ioni For Official Use ly Building Permit Nu ber. Date Ap ed: Building Official Print Name) Signature Date SECTI N :SITE INFORMATION LI Property Address: 1.2 Assessors Map& Parcel Numbers S3 FSSex 'F. Safn /HA 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 ft) Frontage(11) 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 ❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' .I Owner'of Re(/`cord: //// ,)q SQln ?-J >USGN 4{b�f4 SQ/L`!+t I A -Atq 70 Name(Print) _ City,State,ZIP " es5erc Street Q7g-S9y-Oz47 %a/ey )aso �+ �of No.and Street Telephone Email Address 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 Units Other ❑ Specify: _Brie f Description of Proposed Work'-: Mkitt fin rranf rag l✓ol�< ti I f �rn bac do aEClfca( dat/eI5 ([s/nt rtu SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 1690 1. Building Permit Fee: $ Indicate how fee is determined: �. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ D/ 6. Total Project Cos[: $ JC n r'/10 Check No. Check Amount: Cash Amount ❑Paid in Fu I ❑Outstanding Balance Due: ,�� 4 4e, &Pwv,< ei SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.mid Street Type Description U Unrestricted(Buildings up to 35,000 cu.It.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mason ry RC Roofing Covering WS Window mid Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) FIIC Registration Number Expiration Date HIC Company Name or 1-IIC Registrant Name . ' 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 BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print 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. aS-I/IIZGrI Pri t O mer's or Authorized Agen ume(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 trot have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at w.vw.mass.,,ov.'oea Information on the Construction Supervisor License can be found at w"MolaSs.covidns 2. When substantial work is planned, provide the information below: Total floor 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' a .t APPLICATION FOR PERMT TO LOCATION .S3 Wised . PERMIT GRANTED Is INSPECTOR OF E UIL.DINGS 1 J 1 'PWNSMIl6 ISMA19#MD APPROVED BY 774E JMBPJ'rC=PRIOR TD A PEBWT RZINR GRANTkD CITY OF_SALEM No. \ DW ` Wad zm kv mom Is Pmpaly LocmWd in Location of n ru I MOM DWdat? Yaw No � lai]dins 53 CSS e y— ST Is PI*PN1Y Located In do Cow Amon Ma? Yo No Permit to: BUILDM PERMIT APPLICATION FOR: (Circle whichever apply) Roof, Remonf_Install S inp,_ Construct Do*, Shed. Paul. Rspai Other: r.,.S'T A L Z. �l f�y D C w C PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit to build accor&g.to the.folbwktg specifications: Owner's Name —Fc) rn I"1 e iq v L F �p 3� 6--e2LY Address a Phone 4 g e oY L-e-S E-c (979) z Ls 9 Architect's Name Address & Phone ( 1 Mechanics Name L Address A Phone 1 '4 9 ✓e)A tN ST"?..P A 6�DyJL 5 3 L -8 23 A WhM is en pupors it buYdle04 MMMm of maw Ir a dwalMq,for how nwm NOW wa terldrq oontonn to fwv7 AM►raos? E mated cm 3 50 aty uo.w r am*uorrw r05, 9 �-q 2 /�L � Slgrnture of Applicant SIGNED UNDER THE PENALTY' OF DESCRIPTION OF WORK TO BE DONE 7 PERJURY o m c 4— MAIL PERMIT TO: L P G C, b o �Y 1 y M A Ia Sr 1 p A bang A 0 1 1 co , �w���s APP�ovao aY� MR TO A VMW UM fa11WntD CITY OF SALEM Is P o"ll Loomed woe �o QMlel h IYmk OYMef9� YM No_ iwtlw of�� /yam S� a 5 � 4 Jr s N �l Y Aopwq Loomed In : Ella Oon��adon And . Yolk_No_ WAU MIO PM APPLACATM POR: Pwmk 10: (Chb wldOhfwar sp*) Rod, RMad, bull GWft COmliW Dook *wd, POK PLim nL aw LlML.r a COMPLEMY TO AV=W"U 0 PQDOSM TO TM INBPECTOR OF BUILDINGS: ' Tha undMMprrd hNaby appft for a pow* 10 bfflld a000l0slo fha.loNalfliffp CMwa Nmefa R u L:rFQ Addiaaa a Phafa LA �d ca V 1-�s S,-8 e wrsLy L � Ard*mft Nn we AftM a Phoffa t 1 Maohanba Nww L � •s, I V Addnoa a Phone "N a ss pup ss a k~ ife 'de- L � lim"d- - -01 Wo 0 ,�4 pal N for pour noW MniMt MINkOft=Wsmo1oWll e5 Ea�Md aMfL��=�M Llorw• fNfb uoNaa r d/��4 �I � new upowasiont Un. 0100911 of A~ LAL9WL Im Pa"TT' ap Pwi1m OUCIWIM aP WCW TO DE O L_'7,,�n., �C'r�in /`/',P �•CJ ,� 7C L4 MAIL PERMIT bnnY NA . � s � a� ��� � � � � � : .,. � , ��� :: .� � - .:3!:: .w 'pi!•.Fi'� .. . . Jr'.t:... � rT�. . - � . . _. • 1 • I• .. .:,a �',.'ti'. 4�__ 1 .pU" "T-qE f D APPROVED BY T44E JtiSPF.C=PMOR TOA.PEZIfT RFJNQ GRANTED ��y/J�/��g CITY OF_SALEM No�1L_.L_(/� \ Data q .. r in Locatim of to HW"k Didda? Yet__No _ Dnildioa �S C SSA( ) Is PMPwty Located at rn conWrA tlon Ana? Y48 No_ BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck. Shed, Pool, RepaidReplace, Other: PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build rding to the following specifications: Owner's Name i7� c 4 ./1Ve- Address & Phone X4 Architect's Name Address & Phone j ) Mechanics Name Address & Phone I y 5 �*A ,ti S P-e . c g729 What Is Itw Wpm of bA&q? St m"W of buYdrp? U`c If a dwWWV,for how many fmnfibs? Wo fxil WQ cordomt to law? V` Asbestos? EatYmM cW Svc UU aty Liowroa r ►J P` She LWWW _ amen ar�rosaaz S' re of t SKIINED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE / d S+- 2 rz MAIL PERMIT TO: S r .t No. APPLICATION FOR Q / PE RMIT TO LOCATION v!/ PERMITk GRANTED ' zp AP"G' `. INSPECTOR` F BUILDINGS e_ a The Commonw% ealth of Massachusetts I Board of Building Regulations and Standards CITY f r' itifussachusetts State Building Code, 780 CMR, Th edition OF SALI:M Revised January lllYn) Building Permit Application To Construct, Repair, Renovate Or Demolishja 1. 2008 One-ur Two-Family Dwelinq/ This Sectio For Official a Only Building Permit Number:: Date Alp/lied: Signature: Building Commissioned Inspec of B ildir Date SECTION 1 SITE INFORMATION 1.1 P drCs _ ' 1.2 Assessors Map Bt Parcel Numbers I.la 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(fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provide) 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❑ P P y SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of R cordYi�LeU ?Q.ro Name(Print) Address For Service: Signature Telephone J SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) N New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ N �i Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Propos d Work': r-e- aalo L / a r JJJ SECTION 4: ESTIMATED CONSTRUCTION COSTS i� Item Estimated Costs: Official Use Only Labor and Materials 1. Building S I. Building Permit Fee: S Indicate how fee is determined: D Standard City/Town Application Fee 2. Electrical $ .Q t ❑Total Project Cosr (Item 6)x multiplier .x 3. Plumbing S © Q 2. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. _Check Amount: Cash Amount: 6.Total Project Cost: S 0 / ZD 0Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) Xa !L Q41 - //IO6C/5 )`5 //P il I:.vpirationl ate Naincul C:SL•I IulJerL Type(see below):\dJrc Descri lion l nrestricted a to 35,000 C'u. Ft.) Restricted 1&2 Family Dwellin Si nature /1 q M Mason Only RC Residential Ruulin Covering Telephone WS Reside tial Window and Siding SF I Residential Solid Fuel Burning Appliance Installation D Residential Demolition 52 He is ercd om mpriavem}nt Cont6r�c��IC) II Comp•n. NameoriFIZCY7129�istrant Na Restratio Number n d ess J1jq U^ 8 Gsp' tion Dale Signature C 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 BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date me 7b: OWNEW OR AUTHORIZED AGENT DECLARATION U r 1 m "/ J O l / ,as Owner or Authorized Agent hereby declare that the the statemcVt�sand information on the foregoing application are true and accurate,to the best of my knowledge and behalf.� ,�,� n!<� o 4 Print Name Signature 1 wrier or#6thdFized Agent Date Si med under the ai and penalties ofperjury) 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(IIIC)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 780 CMR Regulations 110.R6 and 110.R5. 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.) Ilabitable 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 he substituted for"Total Project Cost"