The URL can be used to link to this page

11 HERBERT ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts RECEIVE SF Board of Building Regulations and StandatldsS 'ECTIONAL $` R��(C1 OF // Massachusetts State Building Code, 780 CMR SdMar `i Revised Mar 2EM 0!! Building Permit Application To Construct, Repair,Renovate28513j oln a 8: 5 3 One-or Two-Family Dwelling OThis Section For Official Use Only Building Permit Number: Date plied: 1 Building Official(Print Name) Signature //Date "'.SECTION 1:SITE INFORMATION . J 1.�`rope Addr s� s: ; S 1.2 Assessors Map&Parcel Numbers 1.1 a 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(sit ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water ply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSIIIPt 2.1 Owner'of Rec 9-1: �w✓ a7�tG S9I'e vtA SS © Iy ��1 Name(Print) City,State,ZIP �I //i,rS-'f' S f . - ��- o � 1< 0 ,mac No.and street Te ephone Email Addres SECTION 3:DESCRIPTIO F PROPOSED WORK'(check a at apply) New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) 9VT Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': A-t- i Fj 'j�'�„t,..� .r ,tiQ i r "(--L' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only abor and Materials - 1.Building $ c o 1. Building Permit Fee:$ indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee , O D J ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ UOCJ 2. Other Fees: $ 4.Mechanical (HVAC) $ ,,,,� List 5.Mechanical (Fire $ / o t7 Su ression Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ >7p Oo ❑Paid-in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. Restricted 1&2 Family CityfFown,State,ZIP M Masonry Dwelling RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I 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.§ 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 CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize to act on my behalf,in all matte r ati to work authorized by thi4 building permit application. I C� — — 23 Print Owner's Name ctronic gnature ate SECTION 7b.OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pas enalties of perjury that all of the information in contained in this application is true and accurate to est of y owledge and understanding. Print Owner's or Authorized Agent's Nam (Electronic a ) 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.aov/oca Information on the Construction Supervisor License can be found at www.nmss.trov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.11.) (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" r OTY OF SALEA MASSAaiUSEM Burr DnvG DEPARTMENT 120 WA5HWGTONSTREET,3mROOR TEL(978)745-9595 YJAMERLEYDRISQ7LL FAX(978)740.9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLTCPROPERIY/BIALDING OpWgsSIONER Construction Debris Disposa/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 c40, S 54; Building Permit#i is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit 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 facility) Signature of applicant Date QT'Y OF SALEM) MASSACHUSEM '3 BUILDING DEPARTMENT` 3 yi tr 120 WASHNGTON STREET,3A0FLOOR TEL. (978)745-9595 FAX(978)740-9846 KIMBERLEYDRISaOLL j MAYOR TrTOMAS STTIERRE DIRECTOR OF PUBLICPROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date 2 3 (f \ Job Location Home Owner Address— Present Mailing Address 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 Y