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6 FOSTER CT - BUILDING INSPECTION (2) a� the Commonwealth of Massachusetts CI"fY OF Board of Building Regulations and Standards SALEibt /. Massachusetts State Building Code, 780 CNIR Revised.tlur 2011 �1 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: 7 Building 011ieial(Print Nnme). Signatur Date SECTION 1:SITE INFORMATION I. Pro erty Address: / 1.2 Assessors flap&Parcel Numbers I.1 a Is this an acce ted street?yes no__ Map Number Parcel Number o N 1.3 Zoning information: 1.4 Property Dimensions: so esrn Luning District Proposed Use Lot Area(sy tt) Frontage(It) s 1.5 Building Setbacks(ft) rq Front Yard Side Yards !Disposal ar Yard D Required Provided Required Provided Requ Providyjl O 1.6 Writer Supply:(tv1.G.L c.40,§54) t.7 Flood Zone Information: 1.3 Sewa System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipol te disposal system ❑ Check if es❑ SECTION2: PROPERTY OWNERSHIP, wnert of d: ( !fit 4 AT � S G �Vt1) thnte(Print) City,Slate,ZIP t & 97 �7Qan6 �t Ccat Gpnt Nu.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 ❑ 1 Accessory Bldg 13 Number of Units_ Other ❑ Speuify: rie'Description of Proposed Wurk': et t I SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only j Labor and Materials) I. Building S I. Building Permit Fee:S Indicate how fee is determined: ❑Standard Citylfgwn Application Fee ?. Electrical S ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Outer Fees: S i. Mechanical (FIVAC) S List: 5. Mcchanicai (Fire S Total All Fees:S Su ression) Check No._Check Amount: Cash Auuamt: total Project Cost: S o?0 Q00 ❑Paid in Full ❑Outstanding Balance Due: (� AI L-G-P L-6 r �� SECTIONS: CONSTRUCTION SERVICES 5.1 Corstruction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL'rype(see below) Type Description Nu.:md Street U Unrestricted(Buildings tip to 35,000 cu. It.) It Restricted 1&2 Family Dwelling City/fawn,Slate,ZIP Ni Mason RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances I I Insulation 'Tcle hung Email address U Uemalition 5.2 Registered Home improvement Contractor(HIC) IIIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address r 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 Wi ance of the building permit. Signed Affidavit Attached? Yes ..........❑ No...........❑ SECTION Tat OWNER AUTHORIZATION,TO BE COMPLETED.WHEN, OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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 Owner's Name(Electronic Signature) Date SECTION 7b:OWNERt ORAUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information twined in this app ' ation is true and a curate to the best of my knowledge and understanding. Print Owner's ur A uhorized Agcnt's Name(L'lectronic Signature) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor(FIIC) Program),will nn have access to the arbitration program or guaranty fund under NLG.L.c. 1 a2A.Other important information on the HIC Program can be found at www.mass.goy:! Information on the Construction Supervisor License can be found at tww�.miss.,ov.",IL 2. When substantial work is planned,provide the information below: 'total fluor area(sq. 11.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. It.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches I'ype of cooling symeni, Fnclosed Open i. ••I'oml Prujxt Syuare Foaage"may be substituted liu'Tut:d I'rojcct Cost" CQ• A CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTONSTREET,3LD FLOOR L1 l� TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS STTIERRE DIRECPOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date Job Location !_tp / $ (�(( �/ a. /�1u.( Home Owner Address (o 062D Present Mailing Address Co S � c`!ti(� "a az 9 4 The current exemption of"Homeowners" was extended to include owner-occupied dwellings of two Units or less and to allow such homeowners to engage an individual for hire that 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 dwelling, 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 work performed under the Buildrin'g Permit. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeowner" certifiesthat he/she understand the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with such procedures and requirements. HOMEOWNER'S SIGNATU ` APPROVAL OF BUILDING INSPECTOR CITY OF S.1LE, ;tip-USACHUSETTS ©L=LNG DEPARTJLENT 120 WASIA NGTOY STREET, 3' FLOOR TEL (978) 745-9595 F."(973) 7-10-9M K.t3[BEliLEY Dt7ISC0[1. AAYO:L THOnkS ST.P1zR ti R DInatzlR OF PL;BLIC PROPERTY/BUILDLYG CONNISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixdl edition of the State Building Code, 730 CMR section It 1.5 Debris, .uid the provisions of NfOL c 40, S 54; Building Permit 1#this work shall be is issued with the condition that the debris resulting m lll, S ISOA. d fro disposed of in a properly licensed waste disposal facility as defined by ttiIGL e The debris will be transported by: z.)or1l (rime of-hauler) The debris will be disposed of in 1 vgnature of permit applicant date