2 FLYNN ST - BUILDING INSPECTION 1
i The Commonwealth of Massachusetts
�l Board of Building Regulations and Standards LUR
Nit'NI('III.\Ll IY
4 ' Massachusetts State Building Code, 7SO CNIR, 7ei edition (]SF
C.
r Building Permit Application To Construct. Repair. Renovate Or Demolish a Rrrised.huuf,u,
Otte- or Tnv-Fenn(\' Duelling 100S
This Section For Official Use Only
QBuilding Permit Number: Dale Applied:
Si mature: "`)
Building Commis sinner/ Inspee or of Buildings- Dale
SECTION 1: SITE INFORMATION
1.1 Property Address: 'l �'"n� 5-i— 1.2 Assessors Map & Parcel Numbers O
I; is this an accepted 5tlee!'? yes lit) hcr Purr! S'uuth•i
1.3 Zoning Information: 1.4 Propey rty Dimensions:
_ .�roa
Zoning District Proposed Use Lot Area(sq tt) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Pro�idrd
1.6 Water Supply: (MC L c. 40. §54) 1.7 Flood Zone Information: LS Sewage Disposal System:
Zone: _ Outside Flood Zone'! Municipal ❑ On site disposals stem
Public Private❑ Check if yes❑ ❑
p 1 Y
QQ SEECTION 2: PROPERTY OWNERSHIP[ 1 -tom
' (Aso- ofR�ecS CHE/�5 4� CHE �.Fn/JE 2 iE" 00 SI —
Name(Prtntl Address for Service:
7-a75-Vjk( av q7f- 8o15— &27y
gnatnrc Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) _I
New Construction Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addinon ❑
Demolition ❑ Accessory Bldg. ❑ Num��bJJer of Units_ Other ❑ Specify:_
V F Z 7 i BriefDescri tionutPLf{o�osedWurk : 1 (OX7._
reGr 0 P _rfa IA SP
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building 5 a O O O I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa (Item 6) x multiplier ..x
1. Plumbing $ 0. Other Fees: $
4. Mechanical (HVAC) S List
5. Mechanical (Fire S
Su ressionl Total All Fees: 5
Check No. Check Amount Cash :\mount:___
b. 'Total Project Cost: S '� O O() ❑ Paid in Full ❑ Outstanding Balance Due:____ _
i
�57
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL)
License Number Lx1inalion Dale
Namc of CSL- Mulder
Lot CSL Type(sec below) _
T , e Descri )(ion
Wdress
C 5.IN)0 Cu. Fl.l
R Restricted I&'_ Famil Dwelling
Signature M NI:uonn Onty
RC Residential Rooling L'O\el'mH
Telephone %%S Residential Window :mJ Sidme
SF Residential Solid Fuel limning \ ))h:mc: Insl.dlaWm
D RcsiJemi:d Urnwhuun
5.2 Registered home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Nnlnher
Address
E•:pirutiun Date
Signature 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 marers
relative to work authorized by this building permit application. -
Signature of Owner Date
tt SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
A S O S o, 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.
J SSorI ��sROCFt�s
Print Nam
Signature YOwner or Authorized Agent Date
(Signed under file nains 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 not have access to the at bitr:uiun
program or guaranty fund under '.I.G.L. c. 142A. Other important information on the HIC Pro,ram and
Construction Supervisor Licensing (CSL) can be tiwnd in 780 C•MR Regulations I IO.R6 and !10.R5. respectively.
'. When substantial work is planned, provide the information below: 1
Total flours area(Sq. Ft.l (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 hall/bail-is
Type of heating system Number of decks/ porches
Pype of cooling system Enclosed _Open _
3. "Total Project Square Footage" may be substituted for "Total Project Cost"
1
CITY OF SALE:Ni
PUBLIC PROPERTY
DEPARTMENT
130 wA"N(RUN SKEW•SALEK%L%0AC3&SEPIS 01970
TEL 978-73S-959S 9 FAx 978-740-984
HOMEOWNER LICENSE EXEMPTION
Please Print - - — —
Date
Job Location
Home Owner Address S a w\ ,o
Home Owner Telephone & 17 - 7 S -
Present Mailing Address F l v e7 pi s SO L m Yn kl O/4 7 D
i
The current exemption of"Homeowners"was extended to include owner-mcupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who,does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on
which there is, or is intended to be, a one or two family dwellin& attached or detached
structures accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she be responsible for all such wont performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned "homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING IN ECTOR
See other side for state code
City ot5alem, MA 5/14/2008
Parcel Map
I I - - -. .- .-,- 100007 10 0014
10 0004 Co
J
10 0608 Ir
10 0003
100013
(0
100012
-------
100010
0 feet 4 100011
Property].formation ❑ Surrounding Towns
Property ID 10 0009 0 ❑ Town Boundary
Location 2 FLYNN STREETOcean
Streams
MAP FOR REFERENCE ONLY Water Bodies
NOT A LEGAL DOCUMENT EParcelsasement
LI Buildings
u,ecause of different update schedules,current property selection:Parcels
assessments my hot reflect recent changes to property
poundoneg.Check with the Beard of Aa...to Cerfitth
pouhd.res used et time pr.sa..smnl.
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