44 CALUMET STREET - BUILDING JACKET f"��"i44�CaZumet ,St � � �� � . �
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CERTIR T F OCCUPAN
• CITY OF SALEM � �; 356
6. a SALEM, MASSACHUSETTS 01970 ' oi8alem BuiM n De
DATE JULY 09TB �96 PERMIT No. 356-1996
APPLICANT MILTON HAMILTON ADDRESS WUDK 1400
(NO.) (STREET) (CONTR'S LICENSE)
CRY BEVERLY STATE MA ZIPCODE 01915 TEL.NO.
PERMR TO (_ STORY
NEW BUILDING ONE FAMILY NUMBER OF 1
) .
(TYPE OF IMPgOVEMEHf) NO. (PROPOSED USE) DWELLING UNITS
AT(LOCATION) 0044 CALUMET STREET 7 ZONING
(NO.) (STREET) DTRICT
BETWEEN AND
(CROSS STREET) (CROSS STREET)
SUBDIVISION MAP 10 LOT 0172 BLOCK LOT SIZE 0017569 SO FT
BUILDING IS TO BE FF.WIDE BV FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: BUILD NEW SINGLE FAMILY DWELLING AS PER PLANS. J. J. J.
AREA OR Q 96, 200 PERMIT
(CUBIC/SQUARE FEET) FEQ 581. 0m
VOLUME ESTIMATED COST$ .PV
OWNER CALUMET STREET REALTY TRUST BUILDING DEPT.
ADDRESS 12 CHARING CROSS BY J. J. J
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The Commonwealth of Massachusetts
o' t Board of Building Regulations and Standards FOR
�1 ! � Massachusetts State Building Code. 780 CMR, 7'"edition MUNIt'IP:V.I'I'1'
,/Jw Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised hoonn_c
One-or Tiro-Frunily Duelling 1, 2ix)R
This Section For Official Use Only
Building Permit Nu giber: / Date Applied:
Signature: w " W l -5v ell
of i Commissioner/In actor of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Proper4dd 1.2 Assessors Map & Parcel Numbers
L la Is this an accepted street? yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed.Use _ Lot Area isq 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:
Zone: _ Outside Flood Zone' Municipal ❑ On site disposal system ❑
Public❑ Private❑ al Check if es❑ P y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow t o Rec rd:
�f�tl�, �mli `I
Name(Print) Address ror Service:
Sew � fi 7
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) Alterations) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost(Item 6) x multiplier x
3. Plumbing $ 2. Other Fees: $ C��
4. Mechanical (HVAC) $ List: _
5. Mechanical (Fire $ Total All Fees: S
Su ression)
Check No. Check Amount. Cash Amount:
6. Total Project Cost: $ 4 r. r� — ❑ Paid m Full ❑Outstanding Balance Due:AWL � �
SECTION 5: CONSTRUCTION SERVICES r
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Nance of CSL- Holder List CSL Type(see below)
Tvpe Description
Address U Unrestricted(up to 35.000 Cu. Ft.)
R Restricted 1&2 Family DHellin
Signature M Masonry Only
RC Residential RoofingCuverin
Telephone WS Residential Window and Sidra
SF Residential Solid Fuel Burnetg .A iliancc In,tallawm
D Residential Demolition
5.2 Registe o t tractor(HIC)
HIC Compan IC Registrant Registration Number
r 7
Addres
�( ��j Expira io Date
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 9 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 a building permit.
i Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7s: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CI.ONTRAC/T�OR APPLIES FOR BUILDING PERMIT
1, 5 �1 7� l Ar[•' � I as Owner of the subject property hereby t
authorize r f 2. to act on my behalf, io,all matters - -•�
relative to work authorized by this building permit application.
�7?•e ( bn�C�
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I as Owner or Authorized Agent hereby declare
that the state ens d information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Print N
Signatu of wner or Authorized Agent Date
(Si tied unde the sins and nalties ofperjury)
NOTES:
I. 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. 132A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 Io.R6 and 110.115, respectively.
2. When substantial work is planned, provide the information below:
Total floors 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 I
Type of cowling system Enclosed Open
3. 'Total Project Square Footage" may be substituted for"Total Project Cost"
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