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414 ESSEX ST - BUILDING JACKET The Commonwealth of Massachusetts f! CITY Borrd ol'Buildipg;Regulations and Standards <)F SALEM gr 1 •i� Massachusetls:State Building Code, 780 CMR Z'"fd�jon , d1)O �• , . J i RevisedJwnnart• �� Building Permit Application To Construct, Repair, Rcnpv,(tS ; .5molish a i, 2008 One-or Two-Family trig, This Section FqrJW1ci4J U nl Building Permit Number: A ted: Signature: -4Arlll Building Comblissioned Inspevifirof Buil n Date SECTI 1:SITE INFORMATION 1.1 Propgrfy Alms e S r 1.2 Assessors Map Qr Parcel Numbers I.1a Is this an accepted street?yes no Map Number farr1 Number 1.3 Zoning Information: 1.4 Property Dimensions- Toning District Proposed Use Lot Area(sg tl) Fromage(11) 1.5 building Setbacks{@) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided « 1.6 Water Supply:(M.G.I.c.46,§54) I.7 Flooci Zone lnformatfoo: 1.8 Sewage Disposal System: Public❑ Private - -Zone::_ Outside Flood Zone? Checkif es❑ Municipal On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.i O�w ert of Record: Name(Print) —r_ Address for Service•. Sianntu Telephone SECTION3: DESCRIPTION OF,PROPOSEDWO_RICs(c4 allthatapply) New.Construction,O I Existing.BuildingO Owner-Occupied ❑ Rapetrs(sj d' Alteration(s) ❑ Addition ❑ Demolition 011 Accessory,Bldg.❑ Number of Units ;Other ❑ ,Specify: Brief fDescription ofProposed Work2:_14;r 5ea R c Ge Clan S : ...r 7cso CS . ��"✓+ •F:. /riv Ce.( wlv --�d.G' S r5 �c I/� '3a SECTION 4 ESTIMRTED CONSTRI IONOST, Estimated Costs ' Item N:O,Illelal llee=Only (Labor-and Maiertali ;::.. - . , I. Building S I. Building Permit-Fee: S Indicate how tee is determined: 2. Electrical - -S - `❑Standard City/T"n Application Fee ❑Total Project Cost'(Ilem 6)x-multiplier x ). Plumbing S 2. Other Fees: S 4. Mechanical 01VAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No._Check Amount: Cash Amount:_ 6. Total Project Cost: S �j 3��©� ❑Paid in Full O Outstanding Balance Due: Oki o Gh _. J a SECTION 5: CONSTRUCTION SERVICES` .5.1 Licensed Construction Supervisor(CSL) fiDidentiall 'I -) ;Fig oP.„ ber lixpiralnion Uate Name of CSI.-I folder I I" -- e(see'below) U 'L _. 12� Desert .ion. Address , restrio-i .. to)5,000 Cu.IFr) stricledIB2 Famil Dwellers Signwurc uson Only sidential Roulin Coverin telephone sidential Window and'Siding sidential Solid Fuef'Bumin Appliance Installation sidential Demolition 5.2 Registered Home Improvement Contractor(HIC) )�-O y Tilt:comp apy t rye are Registration Number 99IIa J CIHIC 2�,� /, y nddrcssWCMMA01970 r7 / 9�� y-jjl V"� Expiration Date Signature Telephone --- ' SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152.S 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-.........0 SECTION 7a:OWNER,AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize / "� to act onmy,behalf,in all matters relativeto work authorized by this:building permit application. Signature of Owner Dote. SECTION 7b:OWNEW OR AUTHORIZED AGENT,DECLARATION I El c f�' l,•r•-v - ,as Owner or Authorized Agent hereby declare that the statements and information or the''foregoing,application are true and accuratrrto the best-ofmy knowledge and behalf{ Print Nume �� 1 . /f C Signat�)wner or Authorized Agent Dale 7wn the sins and, ndltin of 'u NOTES: er who obtains a building permit to do his/herewn work,or an owner who hires an unregistered contractor istered in the Home Improvement Contractor(HiC)Program),will rLgf have access to the.arbitration or guaranty fund under M.G.L.c. IJ2A.Other important information on the HIC Program and ction Supervisor Licensing{CSL)can be found in 780 CMR Regulations 110.116 and I Io.R5,respectively. bstantial work is planned,provide the information below: rea(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 oGbathrooms Number of half/baths Type of heating system' Number of decks/porches Type of cooling system Enclosed Open }, "Total Project Square Footage" may be substituted for"Total Project Cost"