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49 FELT - BUILDING PERMIT APP & PERMIT CARD The Commonwealth of' via g ElVtU 9AAL SERVICES CITY OF hltth n 1 � Board of Building Regulations SALEM by Massachusetts State Building Code,, 578t0ppCppMR((�� Revised Alor 2011 m Building Permit Application To Construct, RepziP,1k fl9k Dr DemolisTi a 1 i One-or Two-Family Dwelling \I This Section For Off["al Use Onl ` (� Building Permit Number: Da) -Applied: ` Yl Building Otliciul(Print Name) ; Signature - Date \`— SECTION 1:SITE INFORMATION` 1.1 Prop �Addrr , 1.2 Assessors Atop&Parcel Numbers 1.1 a is this an accepted street?yes 110 Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Require) Provided Required Provided Required Provided 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❑ On site disposal system ❑ Public❑ Private❑ Check if es❑ P y SECTION2: PROPERTY OWNERSHIP!' 2.1 t Mof Record: CM"� nt"i t�S �ft—I Wu ICU c/✓h�J O �shme(Print) City,State,ZIP 6U(IV e� 6��f?,t�tC .S ra Cyll� la 17-82 Es4uf 'rth c t �r ND�LUCf s, a� No.:md Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Altemtion(s) ❑ 1 Addition ❑ �1 iO. Demolition 0 Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work-: I 2S 1J 1,� �/ S UD DUPE S 9 Ll Vq_ C SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building S 7d po I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ P 9ther Fees: S 4.Mechanical (HVAC) S List: 5.Mechanical (Fire S Total All Fees:S Suppression) Check No._Check Amount: Cash Amount:_ 6. Total Project Cost: S '-7 0C)7 ❑Paid in Full ❑Outstanding Balance Due: Nat (_ -1-0 ", p. ChR1LA�0 4/2-9 - 1 r a / SECTIONS: CONSTRUCTION SERVICES / 5. �'1 Construction Supervisor License(CSL) S_O.7 R 2. l 5 I — ©� � — l l " O y-14�z U :r( License Number Expiration Dale Winne of CSL Holder list CSL'rype(see bclow) C�1t' S f�C�1 S� No.;u d Street /1 TYpe'. Description T� M/—�" � �aRC U Unrestricted 2 Famil tip-to elling 00 cu. It. Restricted I&2 F:unil Dwelling Cayfrown,State,ZIP Maso Roolin Coverin Window andSidin Solid Fuel Duming Appliances Insulation Tele hone &nailaddress5.2 Register/e�d Home Improvement Contractor �'/* HIC Registration Number Expiration Date vvv HIC Company Name or HIC Registrant Name No.and Street Email address City/Town, State ZIP Telephone SECTION 6:WORKERS'COMPENSATION I.NMJRANCE AFFIDAVIT(M.G.L:c.152.¢2$C(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 Isfuance of the building permit. Signed Affidavit Attached? Yes ..........❑ No...........❑ SECTION 7a;OWNER AUTHORIZATION.TO BE.COMPLETED,WHEM' OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING.PERMIT` 1,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 Owncr's Name(Electronic Signature) Date SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contai us, ncatio is true and accurate to the best of my knowledge and understanding. v Print owner's or uthorize Agcnt's Name(Electronic Signature) Dale 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 Llyl 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 f0tmd at %cwvv mass cov.oca Information on the Construction Supervisor License can be round at vvww•.mass.��ov-'dns 2. When substantial work is planned,provide the information below: 'rota) floor area(sq. ft.) '!Jncluding garage, finished basement/attics,decks or porch) Gross living area(sq. R.) 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 ofcoolingsystem Enclosed Open i. "Total Project Square Foolage"may be substituted for"'f utal Project Cost" Commonwealth of Massachusetts ` Citv of Salem 3 m 9 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit B-15-322 PERMIT T O BUILD FEE PAID:: $4$49.00 DATE ISSUED: 4/2 812 01 5 This certifies that CIFRINO THOMAS has permission to erect, alter, or demolish a_building,_ 49_FELT STREET Map/Lot: 270585-0 as follows: Renovation SELECTIVE DEMO: REMOVE FINISHES IN 1ST FLOOR LIVING ROOM KITCHEN, HALF BATH & 2ND FL BATH & SMALL REAR DECK Contractor Name: TIMOTHY RUSSELL DBA: Contractor License No: cs-078215 4/28/2015 Building Official Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request \1.\ { - All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. I All construction,alterations and changes of use of anyibuilding and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. I �;. s, .a The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials,a�provided on this permit. HIC#: "P�rsons contracting with u`nregisteretl contractors do not h cress to the guarani nd"(asset forth in MGL c.142A). Restrictions: t Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER.