2-13 FREEDOM HOLW - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
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 A lied:
e L
Building Official(Print Na ) SignaGtx
SECTION 1: SITE INFOR T O
1.1 Pro er Address: 7 1.2 Assessor-n?ap&Parcel Numbers
!6' % �' <` , — �'/ ill-�J�l
L la Is this an accepted street?yes no Map Number - Parcel Number
1.3 Zoning Information: _ J 1.4 Property Dimensions:
oning D�is� Proti6-sed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided -
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow ert of Record•
Name(Print j�LU 9,7 City,State,ZIP
No.and Street Telephone Email Address ice/
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied Repairs(s)/& I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units S17 1 Other ❑ Specify:
BriefDekscriptiono5fProposedWork': /� (J /IZi t ��
Uo)/i
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1.Building $ t,?69 0l1 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ r� El Standard City/Town Application Fee
Total Project Cost'(Item 6)x multiplier x,
3.Plumbing $ _0 2. Other Fees: $
4.Mechanical (HVAC) $ w List:
5.Mechanical (Fire $Suppression) zi Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ���, 0 Paid in Full 11 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 ructio Superyl�or ense(CSL)
qZ
6 License Number Expiration Date
Name of�SL Holder
// aA List CSL Type(see below)
No.a d Stre t, Type Description
/Q ��/],&&e� � � U Unrestricted(Buildings u el ing cu.ft.)
(,/Ur/`(C R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
'o I Solid Fuel Burning Appliances' O Insulation'
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.g 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 CONTRACTO AA,aJPPLIES FOR B LDING PERMIT
1, as O er of the subject p hereby authorize
to behalf,in a matters elative to work authorized by this building permit applica ion.
ca,L
rint wn 's Name(Electr is Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I h attest under the pains and penalties of perjury that all of the information
cent ' in this application true nd accurate to the best of my knowledge and understanding.
L 'Y %✓%�
P nt O ne s or AuthorizedAgent's Name(Electronic Signature) Date
NOTES:
1. 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 arbitration
program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (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 half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
J
CITY OF S. .Fm, iNLxsSACHUSETTS
• BUnDLNG DEPARTMENT
130 W.+sHINGTON STREET, 3" FLOOR
TEL. (978) 745-9595
FAx(978) 740-9846
ICI.\{gERLEY DRISCOLL
MAYOR THomm ST.PmERRE
DIRECTOR OF Pl13LIC PROPERTY/HITLD[NG CmmassIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 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:
go -��
(name of hauler)
The debris will be disposed of in
name of.. cility)
(address of facility)
signatur permit applicant
date
a<n �,Jir.a�
Offic.5.1me,A a` 1�irs&f§wain¢`, 091----lsdo1a License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration 149839 Type: Office of Consumer Affairs and Business Regulation
Expiration V1312014 DBA 10 Park Plaza-Suite 5170
low Boston,MA 02116
MERCURIO CONSTRUCTION �. ;
MICHAEL MERCURIO
127 OAK STREET
WAKEFIELD,MA 01880,::;= ;:,;.%� Undersecretary� Not valid without signature
* N'lassachusctts- Department of Public Safcty
Board of Building Rcgulatiens and Standards
Construction Supervisor License
License. CS 91942 ,
MICHAEL L MERCURIO
127 OAK ST
WAKEFIELD,MA 01880
Expiration: 11412013 ,
('n......ionvr Trk: 9263
CITY OF S�U.ENvl, INLASSACHUSETTS
• BUILDING Dm,,RTNIE2NT
120 WASHINGTON STREET, Yo FLOOR
T EIL (978) 745-9595
FA..t(978) 740-9846
}O),iBFRT Y DRISCOLL
MAYORT�iOMAS ST.PIERRa
DIRECTOR OF PUBLIC PROPERTY/BUII.DING COMMSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 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
I��/�NIt)171zw�J�17name of acilit
(address of facility)
/gsignaturpermit applicant
date
JcbriulTJuc
From:East Coast Properties LLC 978 745 9684 04/12/2012 10:34 #157 P.001 /001
PROPERTY
rn MANAGEMENT
TA �ST COAST y a� , SECTION
1Le ll PRQPy;�TjE S, LLC NATIONAL ASSOCIATION Of REALTORS�
FAX TO: BUILDING DEPARTMENT 9 w w��
CITY OF SALEM
RE BUILDING PERMIT APPLICATION
HIGHLAND CONDOMINIUM AT SALEM TRUST
VILLAGE AT VINNIN SQUARE CONDOMINIUM TRUST II
DATE: APRIL 12,2012
THIS FAX WILL CONFIRM THAT THE BOARD OF TRUSTEES OF THE HIGHLAND
CONDOMINIUM AT SALEM TRUST AND THE VILLAGE AT VINNIN SQUARE
CONDOMINIUM TRUST 11 HAVE AUTHORIZED THE CONTRACTOR NAMED IN THE PERMIT
APPLICATION TO PERMIT WORK AS DESCRIBED.
IF YOU NEED ANYTHING FURTHER, PLEASE DO NOT HESITATE TO CALL.
E T COAST PIROPE I S, LLC,MANAGER
i
REAL ESTATE AND PROPERTY MANAGEMENT
400 HIGHLAND AVENUE,SUITE 11 email: EastCoastPro@aol.com Phone: (978) 741-2003
SALEM,MA 01970-1777 Fax: (978) 745-9684