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6 FOSTER CT - BUILDING INSPECTION f The Commonwealth of Massachusetts Board of Building Regulations and Standards IP NII'Nh'II .\I-IlY Massachusetts State Building Code, 730 C NIR, 7"' edition I,S1: 1\ Building Permit Application To Construct, Repair, l2enoeate Or Demolish a KcrisrJ.huuiau r One- or Ttru-h'amih Duelling This Section For Official Use Only t Building Permit Num IF Date Applied: - Signature: 0 -> ---- Building CUmmIpllUltel'/ Inspeetur of Btiildings Date SECTION 1: SITE INFORMATION 1.1 Pro erh' KddO C / OL" 1.2 AssessorsMap & Parcel Numbers I.1a Is this all accepted sit eel) yes__-- no Nlap Number P;urel Number 1.3. Zoning Information: 1.4 Property-Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage (it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.QL c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone:' Public Private ❑ Check if yes❑ Municipal ❑ On.site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' ,Ownaer[I R �5ki- Grp N �� ❑n Address for Service: f7F- 766 -?AoZ Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction ❑ Existing Buildinglf Owner-Occupied Z Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work": ,WV I SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (I abor and Materials) Official Use Only I. Building $ / 0Q© oo I. Building Permit Fee: $ Indicate how tee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost (Item 6) x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) Total All Fees: $ �b � oC3 Check NoA62 Check Amount: 'LNCash :\mount: 6. 'Total Project Cost: $ /000. Paid in Full 0 Outstanding Balance Due:_—._.— SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Ispiratiou Dnc Name ul CSl_- Ifolder Lis( CSL Type(sec heluw) T , e Description \ddress C UnrestnctcJ w to l5.(N)0 Cu. Frr R Restricted I&'_ Fanllr Dsselling Signature M :Nlasonry Oniv _ RC Residential Rooting Cuserune Telephone - \\'S IA•sidential \VmJuw, :�od'S 1".1 SF Residential Solid Fuel liumino -\1 ib:mce Iml.11.tu,m D Residcnliul Demuliuun 5.2 Registered Home Improvement Contractor (HIC) HIC Company Nano or HIC Registrant Name Registration Number -- Address Fvnirlltiiil Dae Signature 'relephone 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 .......... O 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 matters rela to work authorized b this hUlldinyfierrrit application. i Si nature n'Owner SECTION 7b: OWNEW OR AUTHORIZED A(;PN-f DECLARATION as O•wnc r 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. Print Name Signature of Owner or Authorized Agent Date (Signed under the 2ams 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 cuntnwtur (nut registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS. respecti%ely. '. When substantial work is planned, provide the information below: Total flours area(Sq. Ft.) (including garage, finished basemenr/attics, decks or porchi Gross living area tSq. Ft.) Habitable room count _ Number of fireplaces Number of bedrooms -_ Number of bathrooms Number of halt/bath, Type of heating system Number of decks/ porches Type of cooling system Enclosed _ Open 3. "Total Project Square Footage" may be substituted for'TotaI Project Cost" CITY OF S.3LE.M PUBLIC PROPERTY DEPARTMENT VAYM 130 Wwur4GVm Sneer•SAteµ SIAssAa&scrts 01970 TEL 978-745-9S95 * FAx 97&74&980 HOMEOWNER LICENSE EXEIMMON Please Print DateaGbB Job Location `O c_OCGvz Sale Home Owner Address e- Ca Home Owner Telephone Present Mailing Address /Q s✓er cnaei ' 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 who,does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons) 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 work 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 requiremen d that he/she will comply with said procedures eq 'remen . HOMEOWNERS SIGNATL P APPROVAL OF BUILDING INSPECTOR See other side for state code J