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40 HANSON ST - BPA B-14-818 The Commonwealth of Nlussechuselts)�PECTIONAI SE VICE crry of �. Board of Building Regulations and Stand s LEN1 Massachusetts State Building COde, 730 CMR 'S A ,� ,ti"tr?011 , h Building Permit Application To Construct, Repair, Renovat, emolish a One-or Tivo-Family Dwelling This Section For Official Use Onl Building Permit Number: Date Applied: ZZ Buiiding Oficial(Print Name). Signature- Date SECTION l:SITE INFORNIATIOi* l.�y�perf Addrress: ( 1.2 Assessors tNnp Sr Parcel Numbers L rK.'t V Map Number Parcel Number 1.1a Is this it,. accepted street?ves___ no__. P 1.3 Zoning Information: 1.4 Property Dimensions: > LotArea(s Frontage(0) Zoning District Proposed Use 4 ItJ 1.5 Building Setbacks(ft) Front laud Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 NVater Supply:(hLG.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❑ Check if es❑ SECTION 2: PROPERT FONVNERSHIPI' t2. 0wnerl of Record: e(r� VVL.�not) City,State,ZIP v�_ AtAS�' on�s7uU7�35 tmct Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check II that apply) New Construction❑ Existing Building❑ Owner-Occupied Cl Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work: Ift i I SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and��laterials riumbing uilding S S 0 00.0� 1. Budding Permit Fee:S Indicate how fee is determined: ❑Standard Ciry/Tywn Application Fee lectrical S ❑Total Project Costt(ftem6)x multiplier e S 2. Other Fees: S cchanic:l (Hvi\c) S List: echanical (Fire S rotal All Fees:S Suppression) Check No._Check Amount: Cash:\mount: I d. Total Project Cult: 0� ❑Paid in Full ❑Outstandin, Balance Due:_ f '1 -78• 7 �,ZS- �' C f( v1, —P t FO l_L, — fgp&LvD 4('2S c SECTION 5: CONSTRUCTION SERVICES 5.1 C'unst rue tion Supervisor License(CS L) f f ; .�. License Number Expiration Date Name of CSL Holder List CSL'rype(see below) "type Description No. and Sued U Unrestricted(Buildings tip to 35,000 cu. It. I2 Restricted U2 Family Dwellin C'ityfl'own,Stine,ZIP M Masonry RC Roolin Coverin WS Window and Siding SF Solid Fuel Duming Appliances I Insulation 'felt hone Email address U Demolition 5.2 Registered Home Improvement Contractor(HIC) � HIC Registration Number Expiration Date HIC Cunnp;my Name or kI1C Registrant Name - No. and Street Email address City/Town,State ZIP rcle hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 .......... 0 No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize t9 act on my Behalf,in all matters relative to work authorized by this building permit application. I Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print owner's or Authorized Agent's Name(Electronic Signature) Date 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 Flume Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty turd under M.G.L.e. 142A.Other important information on the HIC Program can be found at Wwvv.nnass.wv:'oca Information on the Construction Supervisor License can be fbund at www.mass. ov:',IL When substantial work is planned,provide the information below: Total floor area(sq. Ii.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. 11.) Habitable room court Number of fireplaces Number of bedrooms Number of bathrooms Number of half/batlu Type of heating system Number of decks/porches Type of cooling system. Enclosed Open_ 1. "foul Project Square Footage"may be substituted for"Toed Project Cost„ CITY OF SALEM, MASSACIHUSETTS BUILDING DEPARTMENT ftci 120 WASI-IINGTONSTREET,YD FLOOR �jatis TEL. (978) 745-9595 F KIMBERLEY DRISCOLL FAX(978) 740-9846 MAYOR THOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT* Date II((-- \ Job Location y FF,, k 0 ys Short S c Home Owner Address LI© S G vi 7 Present Mailing Address r>0t V 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 that does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)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 dwelling, 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 understand the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with such procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING INSPECTOR hvr CITY OF S�UzNf, AISSACHUSETTS ` BL'(LDLNC;DEPAR-MEET S , 130 WASHLNGTON T4EET, Y4 FCaoR stir '' Tt.-L (978) 743-9595 KIN BF_RLEY D[tISCOLL F.&,x(978) 7-10-9844 &LAYO;t T2 imw ST.FILUS DtREtTQR OF PUSUC PROPERTY/BCiLDCYG C0\(A(I55[O,vee Construction Debris Disposal Af'tidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5 Debris, and die provisions of MGL c 40, S 54; Building Permit k 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 tNIGL c 111, S 150A. The debris will be transported by: y y v\orth 5 4oft car 4l(1l S (nantn ufhaulcr) The debris will be disposed of in S40c'e CQ( Acnq . . (name ort'.icdity) —_---(address of facility) . signature ufpermit applicant