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9 FRIEND ST - BUILDING INSPECTION ,. . -� a Che Cbmmumvcrlih of Massachusetts � ;, � OuarJ ul'Buiiding Rngul•rtiuns and Standar�s ��TY �y � Massachuseas State BuiWing CuJe, 780 CMR. 7'"rJition ��F tinLEM �� RrvisrJJurnmr�• , Iluilding Pertnit Applicatiun To Cunstrucl. Rnpnir, Rnnorrte Or Drmolish a l. :rN6Y , I Onr-or Trvu-Fumilv Dwrl/ing I This Section For OI'ficid Uu OnI � BuilJing Prrmil Nu r: Dale Applied: 1� sigeawrc: °' C� 8� �D�/`7 1 HuildinyCwnmis�ionedlnspec�auf8uildi f}r�e 9ECT10 t: SITE INFORMATION 1.t Pro rtr Addrea: I.I A���on Ma � Parcel Nu en / !� '1 G�ie�.fl �'slr v�f� ° I.Ia Is this on acce ted street°yes � no Map Num� Pa�ce Number !..) Z nln In�ormat7oa: i.d ro Dlmeoslonr. � Zoni g D� PropoxJ Ux La Aiea(sq Il) Fmm�R � 1.3 Bulldlas Setbaclu(R) From Yard SiJe Yard� Rear Yerd Rrquircd Pruvided Requircd Provided Requind Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zooe loformatloo: 1.8 3ew��e Dlspoaal Sy�tem: Zune: Oul.�ide Flood Zone? Public O Private❑ Check if a0 Municipd O On�ile disposal sys�em O SECTIONS: PROPERTYOWNERSHIP� 2.1 ner'o n � �� X Nu 1 � A a for rvice: ' ���2.�,�;�73-��� Signat Te ephone SECTION D: DESCRlPTION OR PROPOSED WORK�(c6celc all t6�t apply) New Conetnution O Existing Bui�ding O Owner-Occupied O Repairs(s) ❑ Alleration(s) ❑ Addi�ion ❑ Demolition ❑ Accessory Bldg.� Number of Unib Other O Speciy: � Brief Description of Pro ud Work': /�iaye �� � �r�r a�-7 --��„�-� � �/ ��o,,.< .,� .�n �.1 ,�G�c G �dc-0_r� SECTION 4: ESTIMATED CONSTRUCTIOIV COSTS Ircm Estimated Cosb: 011lcial U�e Only Labor and Materials I. �uilJing 5 �(`� �• Duilding Permi�Fee:�S Indicate how 1'ee i�Jetermined: �. Elrctrical S O Slandard CitylTown Applica�ion Ftt - O Total Projat Cos�'(Imm 6)� multiplia x J. Plumbing S Q 2. Other Fen: S a. Mechanical (IIVAC) S � Lisl: 5. Mechnnical (Fire S �I Tu�al AI�Fees: f Su «ssion Chrck No. Check Amount: Cuh Amount: X b. Tofal P�oject Coft: S �61t1j �p��d in Full ❑OutstanJing Balance Due: ��y� � � ►- , tiECT10N S: CONSTRUCS'ION S�RVICES S.1 Llcen�ed Con�truclloo Juparvbor�CSL) I.iccrue Numbe� Ii\pIfJlWll U:IIC - N�une ul'l'SI.- I IulJer � I.isl CSL�1'>pe 1�bdow) '. � � [k�cri ion .. :\JJresa U UnrestricteJ u iu 73.000 Cu.F�. � R Nes�ricted IS2 Famil Uwellin � tiiyna�urr M M� �� � RC ResiJentiol Rwlin Coverin 1'.I.pMme WS ResiJeniial WinJowamlSiJin SF RniJrnliel Sulid Fucl Bumin A II�VK'C If15liIIJ11U11 D Re�iJrntiul Demo�ition 3.2 Re�blered Home Improvemmt Coetnctor(HIC) I IIC Company Name ur f11C Rr�{iYlrant N:une Rrgis�wion Number I wJJma Erpimcion Darc �I siy�w�ure 'rckytxx�e I SECTION 6: WORKEFt3'COMPENSATION INSURAIVCE AFFIDAVIT(M.G.L.a 152.f 7SC(6)) Worken Compmeation Insurance atTidavi�must be complqed and submitted wi�h this applicalion. Failurc to provide this andavit will rosult in the deniel of�he luuance of the building pertnit. Signed AfTidavit Atteched? Yee ..........O No...........O I SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN II OWN6R'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT � , a+Owner of the aubject property hercby aWhoriu to act on my behalf,in all matters relalive to work authorized by thia building pertnit applicalion. � Si umofOwner � �°« SECTION 96:OWNER�OR AUTHORI2ED AGENT DECLARA'ftON . . � i^ py t�L ,aa Owner or Authorized Agent hereby declare that�he statemenb and information on�he foregoing appiication ore We and accurale,W the best of my knowledge and behalf. - '��Y�� x r.i�i g 3b Fa S alure - ner or Aulhorized Agenl ��� Si unJerthe ainsud rwltiaof 'u NOTES: I. An Ow�er who obtains a building permit to do his/her own work,or en owner who him an unrcgistered contractor (nol rcgistered in�be Home Imprvvement Convocta(HIC)Progrom),will�yQ(have access to the arbitration I progrrm or guaranry fund under M.G.L.c. IJ2A.Other important information on�he HIC Program and Conslruction Supervisar Licensing(CSL)can be found in 7R0 CMR Regulalions I I O.R6 and I IO.RS,rcfpn:tivrly. � � When subslantial work is planneJ,provide the informalion below: Tolal floon area(Sq.Ft.) (including garage, finished baument/attics,decke or porch) Grou living uea(Sq.Ft.) Flabi�able room count Number af fireplacn Number of bedroom� Number of ba�hroums Number of half'/bathf Type uY healing sys�em Number of Jecks/purches Type of couling system Enclosed (>pen ). "Toul Project Syuare Fiw�age"may be substiwtaJ for'To�al Pmjnct Cos�" . . � .�•�'� .,: CITY C)F SALLM '� r�r,. PUBLIC PRc�PRERTY - ,�." � _ �. , ' : '-`''�`� DEP:�K"I"�IENT ''�,..,.�;, :�����: � �.. , � ; � -- �,i .�,�„�: � iJc����.,,iu.,,.,�,.,ii�r.i�r . ..�i i ,i. ��.�.;�� . . .. i . :i�' �- I�I - '�'3-'i;.�1;�5 � I��\:'J7M�'J:�'�5��, C'onstruction Dcbris Disposal ,�Ytidavit (r�yuirr� liir all Jrnwlition an� r�nuvatiun wurk) In accurdancr with th� sixth �dition oFthc Statc Buil�ling Code, 7S0 CA9R scction I I l.� Dcbris, and thc provisiuns uf MGL c �30, S 54; Duilding Permit i� is issucd with the condition that the dcbris rcsultin� from this �vork shall be �li,poscS ot in a pruprrly licrnsed waste clisposal 13cility as defineJ by MGL c l t l. S I 5(�A. Thc dchris �vill hc Iransportcd by: ,��%� �d��k �namc oC haulcr) I he �cbris will be dispused uf in : �7a Cl�t �3j�o5A-t _ %�6!?�h S/O� Cr" _ � (umne ul 1'acility) � �r,��os� -/� .� I;�ddrc.s�d�l�cilily) I �.�'��/X/ � .ignaturcufpermit.ipplicant _ � 3r�o � ,t�ie -- -� . .�cni i..r..,.,. �.. ' ' CITY OF S.�L.E.�I ' PUBLIC PROPERTY DEPAR'ItitENT w.o►�ar�r o.eti��� .Wro� '� � I�i�A9uMcioN tnF1T�Suri�4w�AOR'Qrn01l.'0 7kj.9'.}7�S�7S9!� F.�l�.97L7J69iN HO,N�OW�IEA LICENSE EaCE.riPTIOY Pkw Pri�t � � �► �D Job Loeaoios � �� � s� Home Oaoe�Ad� � �=wir� �- s.9-C� Home Oanar Talep6on���) ���-a��6 Piesaot MaiBn�Ad�ea ��Er-a �sT� �LL� The current exemption of"Homeownen"wa�extaided w inelude ownar-accupied dwelling�of tavo Unib or Iw aad to allow auch homeownen w eagage an individual for hire w6o.doa nat posseat s Iicm�e,provided that the ownQ act�as�upacviaor. DF.FIIVITION OP H011�OWNER Person(s)who oww a pae�cei ot laod on whiah hdsha raida or intend� w raide, on whic6 there i�, or is intended w be. a oae or two lamily dwelling attached or deqched structiva acceseory to �uch use and/or farm strueturea. A penon who construct� moro thaa one home in a two year period shall not be considered s homeowner. Suc6 "homeownd'shall submit tc the Buildin�Otllcial,on s focm aeerytable to the Building Ofticial. chst hd�he be reiporoible for all euc6 work performed uader the Huilding Pamit Tha undeni�ed "homeownel'a+sumd re�pomibility for compliuuo witb the State Buildin�Code and oeha applicable by-laws and rcgulations. The undmi�od "homeownel'cerdfia that hd�he undmtands the City of Salem BuildinQ Dryartment minimum inapection procedura and requiremmb and (hu hdshe will comply wich said procedura and rcquiremrnts. HO�IEOWYERS SIGYATL'RE �c�iry"� a--- � ,+►PPROVAL OF BUfLDf.YG L�iSPECTOR See other side for state code )i '� `a � '•n ,\ ` �. \`� I� a ` ��� � `-� . `; ,\: � ' . 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