14 1-2 FORT AVE - BUILDING INSPECTION (2) ;
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� fhc C'ummumvcalth of'Massachusc�b
� ;� DuurJ ul'BuilJing Regul•r�iuns anJ SmnJar�ls ���TY
1 ��� Massachusr�ts Sta�e BuiWing CoJe, 780 CMR, 7'"cdition OF SALEM
Rrvi��rJJwmary
O�I IluilJing Pnrtnit Applica�iun ToConstruct, Rrpair, Rrnurrte Or Demulish a /. :rxAv
� Onr-or T�vwFumilv DwrllinR
Thie Seaion Fa O.Rcid Use Onl
BuilJing Pertnil Number: Da1e Applied: � O
s������.�: — 9/3o/ia
� HuilJin�{Cumm� i� ned mpectorufBuildin�f f}a�e
SECTION 1:SITE INFORMATION
I.1 �_Qe�A�dd �reu:� 1.2 Aiu»on Map A Parcel Nnmben
[.� .� ,�-
I.la If this an acce led streel?yd no M�0 N�� Pa�eel Number
IJ o�n�ls�Informatba: � 1.4 PropeeSy Dlmeasloas:
Zonin�{Dis�ric� PrvpoxJ x Ld A�eo(sq Il) Fromoge(IT)
13 Bulldla�Setbaclu(fl) �
Fronl Yard SiJe Yud� Rar YW �
Rrquircd Pn�vided Required prorided ReQuired Provided � (��
5 a4 ��
t.6 Water Supply:(M.G.L c.d0,§54) �.7 Flood Zoee lofornuflos: Ld Sew��D4pow1 Sy�tem: �� '
Zune: OWide Flood Zona7
Public O Priva�e O — Munie�p�l O On�ite d(spwal syalem O
Check if a0 ��
SECTION2: PROPERTYOWN6R4NIP� �� a i
2.1 Ow er�o!Raord: I� �8 ��" fW�• � I
_ ��
- Nome IP int) � AJd�esf for Service:
� r�..�_ n,/,/_/,/-�r� �,
t7''� {aaY L�
Siyrhlu Telephone
SECTION J: DESCRIPTION OR PROP09ED WORK°(eAeck�U tAat�pplr) ���
- � � New�Conetruction Existing Building O Owner-Occupied O Repairs(s) O Altention(s) O Addition t7 Z��
� Demolition O Accessory Bldg. Number of Unib Other 0 Speeiry: � V� �
Brief Dexription of Proposed Work': riU.,�3Yrr�' � /t^.r acu�_2 /O �C �6� �
+. - G6� O
SECT(ON 4: ESTIMATED CONSTRUCTION COST9
Imm E�timated Cosn: ORlcfal Ufe Only
Labor and Materials
I. �uilJing S pOC1 I. Ouilding Pertni�Ftt: f Indicata how fee i�Ja�ertnined:
�. Elcetrical S O S�andard City?own Applicuion Fee �
O Total Proja�Co����Item 6).a muUiplier x
l. Plumbing S 2. O�her Fm: S e�
!. Mechanical �HVACI S List:
S. Mechanical �Firc S
tiu reeaion Toml All Fees:S
� Check No. Check Amoun�: Cuh Amount:
6. Tofal P�o)ecf Coff: S QOO ❑p��d in Ful� O Ou�sianJing Balance Due:
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�ECTIOIV S: CONJTRUCTIOIV JERVICES
S,� Liceaaed Con�lructloq Supervbor(CSL)
I.i.crueNumbn lixpim�iunl}�a
N;une ul l'SI.- I IulJtr I.is1 C'YL lype 1+�'e bclnwl
� Ihxti ion
:�JJreu U Unm�rictrJ u tu)3.000 Cu.F�.
R Res�ricud Id2 F�ntil lTvellin
� tiiyn�lure M M lM�
RC ResiJcntial Rwlin C'overin
I'.IcpMme WS ResiJrn�ial WinJowanJSidin
tiF Rai�krHid Sulid Fuel Bumin I� II�tIKY IIISIiII:111tM
� p RaiJrn�id Demolition �
3.2 Re`�tered Home Improvemesf Costnctor(HIC)
1 tIC Compony Nams ur HIC Rayiatr�m Nume Regisuaiion Number
AJJma Eapiralion Dale
tiiy�ulure Telephw�e _
SECTIOIV 6: WORKERS•COMPENSATION INSURANCE AFFtDAVIT(M.G.I�e. 1l2. / 23C(6))
Wwken Comprnsuion Insursnce alTidavit must be complaed and submitted with thia applica�ion. Failure to provide
this�fTidavit will rault in the dmid of the Is�uance of the building permit.
Signed AtTidavit Anached7 Ya ..........O No...........O
SECTIOIV 7�: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'9 AC6NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I.
, a�Ownu of the aubjecl property hercby
awhorize to act an my bel�alf,in all ma�un
relative to work aWhorized by thia building pemtit ap0lication. � -
Si ure of Owixr Date
SECTION 7b:OWNER�OR AUTHORIZED ACENT D6CLARAT/ON
� � �vy,�}- y ,a�Owner or Authwized Agmt hereby declare
�hat the statemenb and infortnation on the forcgoing application arc We and accurate,to the bal of my knowledge and
behalf.
u El`
Prinl Nome . �O .
Si �r IhorizedAgenl Date
Si unJer�he aina and Itief of 'u
IVOTES:
I. An Ownet who ubroins a building pertnit to Jo his/her own work,or an owner who him an unrcgistered cumraclor
(not rcgistered in the Home Improvement Conuxtw(HIC)Progrnm),will�g have access�o Ihe arbilretion
proyram or guarantY fund under M.G.L.c. IJ2A.O�Aa importanl information on ihc HIC Progrrm and
Construction Supervisor Licenain8(CSL)can be found in 7A0 CMR Regulations I IO.R6 and I IO.RS,mpactively.
? Whnn sub�wn�ial work is planneJ.provide�he inl'ormation below:
Twal floon area ISq. FI.) (including�rage. finished batemen�attics deck�or porch)
Grosf living uea(Sq.FI.I Flabilable room coum
Number of fireplaces Number ol'bedroom�
Number uf ba�htoume Number of ha1F/ba�hf
Type uF healing sys�em Number of�ecks/purches
Typeofcoulingsystem Encloxd ��p��
J. "Tuiol Project Syuare Fuo�age"may be subs�i�u�eJ for'Toiat Projec�Cost"
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CITY OF S.�LE.tii
PUBLIC PROPERTY
DEPAR'I�tENT
KlfO 'L!�O4lrty�
. �� I'�1Y,mun[.'7oM Sifg�T�SutK�4wa�oR'sms 019'0
.. TF1.97Lh19S9S�Fen.9'L7�0.7iN
HOtifEOVWER LICENSE EXE.riPTIO�f
,I
rte... rri.e
Du. a �a
Job Locatiou ���r !'ort �
Home Oane Addra� U �i- e..
Home Owma Telephon� �-�F�(- �
� Pteseat Mailin�Addtw l�{% �d- ,�.
Tha current exemption of"Homeownen^war extended W i�lude owna-0ccupied
dwelling�of two Unitr or Iw aad to allow such homwwnen w engage an individual for
I hire who doa not poasa�a Gcense,provided that the owna acti ar supanriwr.
DEFII1TfION OF HOMEOWNER
Penon(s) who owns s paroal otlaud on w6ich hdshe raides or intends w reaide, on
�I whic6 there ia, ot i� inteaded w be, s one or two family dwelling. attached or detached '
structura accessory to such use and/or Farm structura. A person who conatrucb more
'il thw one home in a two year period shall not be coasidered a homeowner. Such
"homeownd'shall aubmit w tha Buildin�Otflcial, on s form aeceptable to the Building
Ot3icial. that hdshe be resporoible for aq �uch work performed under the Building
Pmnit
7'he undenigned "homeownd'assuma responsibility foe complianee with �ha State
Building Code and other applicabte by-lawn and rcgulations.
The undmigned "homeowne�'certifia that hdshe undentands the City of Salem
Building Departrnent minimum inspection procedurea and requiremrnq and that hdshe
will comply with said procedura and equiremrnts.
HOytEOWYERS SIGNATf.'RE
APPROVAL OF BUILDf.YG CiSPECTOR
See other side For state code
4 , 5 6 � 8
� Z 3
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NOTES:
1. ALL SIDING SHALL BE CLAPB�ARD TYPE.
2. ft00F SHALL BE ASPHALT TYPE SHINGLES. A
A
B
B _
FINISHED GRADE
FINISHED GRAOE
NORTHEAST ELEVATION SDUTHWEST ELEVATION
C
C
D �
D
FINISHEO GRAOE
FINISHE� GRAOE
NORTHWEST ELEVATION SOUTHEAST ELEVATION
E
E pROJECT AO�RESS SHEET TITLE
SCALE: t/4" = 1' 14 1/2 FORT AVE. GARAGE ELEVATIONS
� I SALEM MA 01930
I--J ORAWING �ATE PROJECT TITLE SHEET N0.
1" aT FULL SCaLE �ULY 28, 2010 NEW GARAGE �
1 Z 3 4 5 6 � 8
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