24 FOSTER ST - BUILDING INSPECTION The Commonwealth of Massa chusetts E OR
z Board of Building Reguiuuons and Snindurds MUNK iPrll I11
Massachusetts State Butldmg Code 78U CibiR 7"edruon �yE
Building Permit Apphcudon To Construct Repair Rettovate Or Demolish u Re+t �d fX+ u++{
'' � <O or,T�ti analp;DwrRtng,;
ThtsSecu For Official Use;;Oniy
Ited:: fJ
BuE[dmg Permit Numher'' PP
_ I
Signature ' ,
` Builsting anutnsstancr!I t raf. �tngs , • Dote ---
tY
4
CTICtN t SiTE"LNRORMATION k
I L 2 Assessors Map 8c Parcel Ntimtters '
1
r
. w MJp A(umilef 1 t A PAICLt`lUmb"
La IS this anlAcCCpted sgteet+yes Ao
13 zoning.[nfartwttla4 r Lek Praprrty 1Dtmenstare „ " r
r 3
Zoning Utstncty +, t?roposed Use _-;� f ,,.:,: [ai AreA(sq tt) �+yge( - ^z
E R)
16 BrdldingSetbacits{ft) f
i Ftont Yard '.- Side Yudv'
' Provided ReiNited Yroyided Provided
. Required - �Regmtai ' .� 3
L6 Water SuPPI/ (M G Lc 40 $14j 17i fl7ood Zane InPormstlan y ' 1 g&eWagei pisposat System 4 `,
^h , t ZaAG site
pipi �IL4idG Flood ZAOBY�, Cm f'
-'. .:!'ubhe t7 ':Private❑ •; .`; : Ehenkrf t7° MtiideipAt�S Oti disposul',syst . ;.;
yes tFilift
r '
.7 SECAON2 'PRDPEItTYOWIBRSIi[Pr
r
2' O
, r t
T
SECd ION 3�DE5CR1PTION-144.
PROPOSED 4YORKz icheelt aBNhat apply?"`
f ,eWCDactionO E)ttsang$widtng'Od` Owner+Oacnptadrl7`4 ,ltepairs(s)°❑- r9Alternnuri(s)Y'O., ilddmnp`C]:.
ti-
in
IF
R 1 C 5 flJ Yk T t '8 •F 1 \Lf i jth� T 4 t _
1)emohtton,_ 4`❑ Accessary'L91dg ❑ Numberof llttits 1Others q,3pxEFy
Ff
fe-
t, r
x ¢
° SECTION 4 ESTIMATED CONSTRUCTSON COSTS ,
Item (L aEwr add Matenals) s
-; ' -' -_, $ :u���:;-.' L Butldrt�g PermdFee"�„ Iddtcate iw W fee)s detexmtned -
t L BuEiding r ❑Stsndard�Clry/t'tjEwnApplicatioriFoe ' �
,,«2-IF.=Eteemcal $ :` c ;p otdl'Project.CosM�'(Item t7 xmulaplier x'
r Y a
3 Pfutttbing, ,. t ,�h
` J iMechaalcal-,(FII'e, or s a ,s of s N -t l�{( , @5''$x
TChectcN4 Gm k Amowtt Gash AmtwnL
6tiTatal Project Cost `f=,$ f - O PauS in Fu11` tt7l— ❑Outstanding Bnlance`Dae,` ` ,r r
tlF
, 1 l
r ,
x
I 5If
_.�.. 2ry..,.a. t :, ::Y.. ...t•�i:,.."iPt.Ysl.... .w-. Y. at.�n,_r.f:.e..?... LSIP_ lr_ ....u-.w Yam... s
�' 1 /✓� pc�GN1 c
4
yy
Owosso MM. myn
Is
6-1 At"
NIM d&CuWRb6fiWVb Rliivlm�- ln�ill""1_2.�A.22 R&A
difie".
"TAR FJ?G Dmial
...........I'll,
10 D
idfi
.......... ....Y....... ......
M2 nwmveumut, -on riW�(HIC tu
6W;
....................
t Man' Mistibiffi, W W Wldtbd' 11W
=M,
...........q. ........
PINK".
r, Aeeeee,
wilo
Q"WOW
MAW
AWE
�F+CGAR111IONJ V-1-
r nS Owner or AZthorbed Agent hereby declare
All
nPPlication Urebve iiiwuccutate.�A asthe best of my tcnoWledge n '
IN
mat
ov,
jdgh"�...........
do b- _t[Ire
got's yq .................... Must:
....... ... ...
qqqqm- yp A
Number ct
tiTp i*n jed Open
— gaew..-.,...... . ....-�
..............
CITY OF SAL.&M. iNLxsSACHUsETTS
BunDLNG DEPARTMENT
130 WASHINGTON STREET, 3° FLOOR
b`f TEL (978) 745-9595
FAx(978) 740-9846
KN[BFRY EV 01LISCOLL
MAYORTHo><us ST.PtFRRs
DIRECCOR OF Pusuc PROPERTY/BunmLNG CO%L%aSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Codc, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
(name of facility)
(address of facili )
6
signature oki7erMit applic t
date
dcbris ft:doc
a
CITY OF SALEINI, ilNL•1S&ACHUSETTS
BUMI)I SG DEPARTNIE2vT[ • 120 WASHINGTON STREET,3'FLOOR
TEL (978)745-9595
FAx(978)740-98"
KI.iIBERSEY DRISCOLL THOMAS ST.PMRRZ
MAYOR
DIREcroR OF Pt;HL[G PAOP6A•IY/HL'ILDCVG COJLBSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /Please Print Legibly
Name l&uinccsiOrg/an'iz/ationrindividuall:�/� beiVAJ15 GIV57 s uCi76 / LL �
Address:— ,? ZAy �7�'6� /9/"'C16_ �76'1 p q
City/State/Zipy�y� ��� Phone #:? — //4 —5010
Are you an employer'Cheek appropriate bor Type of project(requiref:
I,R I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-titutc).• have hired the sub-contractors
2.El i am a cote pmpriemr or partner- listed on the attached sheet 7. Remodeling
ship and have no eruploynns These sub-contractors have 8. ❑ Demolition
working for are in any capacity, workers'romp.insurance. 9. Building addition
[No workers'comp. insurance S. ❑ We arc a corporation and its 10.❑Electrical repairs to additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MOL 1 I.0 Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.)t employees.[No workers' 13.0 Other
comp.insurance required.)
-Arty appbhmd that checks bo%pl must also till out the sectten below showing their workers'compensation policy information.
I I Wrrreowrs;ar who submit this affidavit indicating they are doing all work not then him onside eon"whors most submit a Crew,affrbvit indicating such
m:C,mma .that cheek this hM,must anaohed sr$ath iliorut sheet showing ten owns of ten mrb•wntrazaora and their workers'comp.policy infa mmam.
l am an employer that is providing nrorkers'compensadon Insurance for ray employees. Below is the policy and job rife
information. -
Insurance Company Name:
Policy#or Self-ins.Lie.#: /I Z 8 Expiration Date:
Job Sire Address, 2 S�E/) ` City/State/Zip: �9 L
Attach a copy of the worker$'compensation policy declaration page(showing the polity number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal f"aicies of a
fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the forest of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of
Investigations of the DIA for insurance coverage verification _
l do hereby a fy, nder tit/r/�/° aced penalti of perjury that the information provided ub qa!s t
rn e an comet
i t ere: Date: o
Ph o
Offrcial use only. no not write in this wee,to be cumpleted by city or town oricial.
City or Town: Permit(License#
Issuing Authority(tircle one):
I.Berard or Health 2.Building Department 3.Cityffown Clerk 4. Electrical Inspector S.Plumbing Inspector
6.Other _
Contact Person: Phone#: