9 HIGHLAND ST - BUILDING INSPECTION N V L a,I �-1 - 121 �
The Commonwealth of Massachusetts RECEIVED
a 'pt� Board or Building Regulations and StandIMPECTIONAL SE VICBTY OF
4'! Massachusetts State Building Code, 780 CMR SALEM
9 'p �p 1 R yc� I d4nr 2011
Building Permit Application To Construct, Repair, RenOVaWrA mlliSh P �
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number. Date Applied:
Z 1y
Building OI£cial(Print Name) Sig at re pate
SECTION I:SITE INFORNIATION
1. Prove t�MccepeteZd
+ 1.2 Assessors Map& Parcel Nun :rs
I.I a is t s astreet?yes no Map Number Par el Number
I�in Information: --- 1.4 Property Dimego�
7onmg )istrict Proposed Use Lot rea(sq ill, 1 Fmntage(ll)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
12
1.6 Water Supply:(M.6.L.e.d0,§54) 1.7 Flood Zone Information: L8 Sewage Disposal System:
Public L� Private❑ 7.011c: _ Outside Ilood1}me? /
Check it ycslY Municipal i� On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: Ol5 O
_(2'� Ifs le� At}DYl --- �" �r� �� 11/1 (�
Name(Print) .nyC` State,1. 1,
No. i� 1r eQ� ---- --Is14-/,sal �lyla _ � on ae*Corlo
��11 telephone (::mail Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction ❑ Existing Building Owner-Occupied Rcpairs(s) SYJ Alterations) Addition ❑
Demolition ❑ I Accessory Bldg. ❑ 1 Number of Units_L_ Other ❑ Spccily: _
Brie f Descri ption of Proposed SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials y
1. Building $ (9 DDD I. Building Permit Fee: $ Indicate how fee is determined:
�. Electrical ❑Standard City/town Application Fee
D�� ❑Total Project Costs(Item 6)x multiplier_ A
3. Plumbing _ $ l)D0 2. Other Fees: $
4. Mechanical (I[VAC) $ _ List: -�
5. Mechanical (Fire _
Sup ression) $ Total All Fees: $_
Check No. Check Amount: Cash Amount:
6. Total Project Cost: 5 -- —
p ()0� ❑ Paid in Full ❑ Outstanding Balance Due:
��T -rt, � N��fN t✓t�fl s�
F
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder u ,i %,; i r i .jti!,
� Piss List CSL"rypc(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu. f1J
R Restricted 1&2 Family Dwelling
Cityrrown,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SI' Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Nam lx;r Expiration llafz
❑C Company Name ur I IIC Registr nt Name
Nu.and Street -- Email address
City/Town,State,ZIP Tele hone
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 aBidavit 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
I,as Owner of the subject property,hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owners Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest tinder 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.
�I/�lrxlle.l $a,ton
print Owner's or Authbrized Agent's Name(Electronic Signature) Dante
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[Ionic 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.nmss.gov/dos
2. When substantial work is tanned, provide the information below:
Total floor area(sq. tt.)_ 'j? (including garage, finished basement/attics, decks or porch)
Gross living area(sq. ft.) JJ N Habitable room count (p
Number of fireplaces (Z_ Number of bedrooms _
Number of bathrooms _ _ Number ofhalf7baths O
Type of heating system _} - i �_ Number of decks/porches_2 _
TYpeofcoolingsystcm Enclosed.—_—J_ Open--- —
3. Total Project Square l7oota,,e"may be substituted fur"l'olnl Project Cost"'
MORTGAGE INSPECTION PLAN
All BOSTON
11-06030
SURVEY, INC.
P.O. Box 290220 Charlestown, MA 02129
(617) 242-1313 MAIN (617) 242-1616 FAX mpp@bostonsurveyinc.com
APPLICANT: OWALLEY BARTON DEED/CERT: 16400-54
LOCATION: 9 HIGHLAND STREET PLAN REF: 2-12
CITY, STATE: SALEM, MA SCALE: 1 inch =20 feet
CERTIFIED TO: SALEM FIVE MORTGAGE COMPANY, LLC PREPARED: 09-01-2011
W
OARAOEI
Ji
LOT 186
g OECK `'
ee
n
2 STORY
PORCH
A
70.00
HIGHLAND STREET
- i 6Wrc)BosrwSmveySvnwem -
the permanent structures arc approximately located on the jH OF M According to Federal Emergency Management Agency
ground as shown.They either conformed to the setback k' ASSgC maps,the major improvemegts pui s.prope4�fall ip an
requirements of the local zoning ordinances in effect at O tiG f'�J L-; o .
g GEORGE N ea designated as Zone.the time of construction,or are exempt from violation g ,,, g ,
enforcement action under M.G.L.Title VII,Chapter 40A, o C. Community Panel No.
Section 7,and that there are no encroachments of major COLLINS
improvements either way across property lines except as v
N0.417114 r Effective Date: " �1
shown and noted hereon. < 'pOF NOTE:Zone C is areas of minimal flooding(no shading).
This designation is not based on an elevation certificate.
NOTE:This Is not a boundary or title Insurance survey.This plan pre rdance to procedural and technical standards for Mortgage Loan Inspections as adopted
by the Massachusetts Board of Registration of professional ..
ears and land surveyors,250 CMR 6.05,and use for any other purpose is prohibited.This plan Is not to be
used for recording,preparing deed descriptions,or constr n.
CITY OF SALEM, NaSSACHNSETTS
BUILDING DEPARTMENT
aa5 � I 120WASHNGTON STREET,Y"FLOOR
� y,yurnj TEL. (978) 745-9595
FAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date �( � I ( L+
tt i
Job Location � 'Oh1A ,I
Home Owner Address wnc)
Present Mailing Address W\9ktnf1 8"h'e2A
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
CITY OF S,gzA f, A-u&S ClgUSETTS
j\\.A. OLILDLNG DEPAR-ME`(T
120 \q-. SNLNGTON STREET, }O FI OOR
TM (979) 745-9595
K MBERLEY DRISCOLL F.I..�c(978) 7-1&984,5
,bLAYOR
R-Io%LAS ST.PMgM
DIRECTOR OF PUBLIC PROPERTy/8L1LDCgG C0SL1,,5S,ONER
Construction Debris Disposal Aftldavit
(required for all demolition and renovation work)
In accordance with the sixtlt edition of tiie State Building Code, 730 0411
Debris, vid the provisions of,N(GL c 40, S 54; section l l 1,5
Building Permit It
this work shall be disposed of in a ro erl is tIicensed waste dis condition
racilithe debris resulting from
I l I, S 150A. p P Y P
ty as defined by NICL c
The debris will be transported by:
y 1
(name ot'haulcr)
The dehris will be disposed ot,if,
.— (name or tjadity) -
----(address of ti,�ilily)
siyndNre or'p r ut,tpptie.,nt
r
s