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4 HILLSIDE AVE - BUILDING INSPECTION (4) iThe Commonwealth of Massachusetts t Board of Building Regulations and Standards FOR Massachusetts State Building Code. 780 CMR. 71h edition MUNItIP:U.I'll' W USE 1 Building Permit Application To Construct. Repair, Renovate Or Demolish a Revised lanum.c One-or Two-Faatily Dwelling i• 2 oS This Section For Official Use Only Building Permit Number: Date Applied: Signature. 8 7 i ing Commissi •d Inspector of Buildings Date SECTION 1: SITE INFORMATION 1.1 Property Address, 1.2 Assessors Map & Parcel Numbers qV e is_ O_iD L la Is this an accepted street'?yes_ no Map Number Parcel Nuntlxr 1.3 Zoning Information: 1.4 Property Dimensions: & Zoning District Proposed Use Lot Area(sq 11) Frontage(Ill 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 F;l d Zone? Publicg Private❑ Check if a Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: 02QMif41sWili2 Name(Print) _ Address for Service: ` —.5 /9 — 6 L) Signature Telcphone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work": Qb a lz E c0uory P nr)1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $�'fndicate how feg is determined: ❑Standard City/Town Application Fee M�n/`.H t/rs�.. 2. Electrical $ ❑Total Project Costa(Item 6) x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ i J SC r 00 aid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date Name of CSL- Hulder List CSL Type(see below) Type Description 4ddress U Unrestricted i up to 35.000 Cu. Ft.) R Restricted 1&2 Family Dwelling Signature M Mason Onl RC Residential Rootin Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Bumm A chance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. $ 2506)) 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 .......... O 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. Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION &_?<"Ile f as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. 511C-on ✓✓Ior Print Name Signature of Owner or Authorized Agent Dat (Signed under the 2ains and penalties ofperjury) 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 and Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations I 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 Type of cooling system Enclosed Open 3. "Total Project Square Footage— may be substituted for 'Total Project Cost" CITY OF SALEM • •' PUBLIC PROPRERTY DEPARTMENT ., \l .•.. K l_1� `%'ail rtSG.'J.N):3c£T # Construction Debris Disposal Affidavit (required Cur all demolition ;uid renovation work) In accordance w ith the sixth edition of the State Building Code, 790 CMR section 11 l.5 Debris, and the provisions of NiGL c 40, S 54; building Permit - _ is issued with the condition that the debris resulting from ;Iris work shall be disposed of in a properly Licensed waste disposal facility as defined by MGL c I11. S 150A. The debris will be transported by: . (name of hauler) I he . ,�bris will be disposed of in : ��/ (Il.tf;C�Ir �l �� I CITY OF &U.E:N1 PUBLIC PROPERTY DEPARTMENT K1fO1F11.fiY tLw•,v 130 W SMNGWM STU=•SAI EM X%ZACHUSU S 01970 TEL 97674S•9S9S• FA)L 978-740.994 HOMEOWNER LICENSE EXEMPTION Please Print Date A w Z � Job Location/ J5' M 3 tz ra Home Owner Address 4v e sg ie /)i ✓n g Home Owner Telephone 9%fr' S 9 Q—,^/y(o 0 Present Mailing Address V /,'//S,ol Wi) P Sa I vr! 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 who.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 helshe resides or intends to reside, on which there is, or is intended to be, a one or two family dwellin& 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 understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code CITY OF SALEM DEPT OF PUBLIC PROPERTIES ABOVE GROUND POOL INFORMATION PRIVATE POOLS—CONDITIONS 1. Private Pool —Definition Any pool intended to be used primarily by occupants of a one or two-family dwelling. Any such pool more than 24-inches deep or having a surface area greater- than 250-square feet (18-foot diameter) requires a building permit before installation, enlargement or alteration. H. Permits Applications for a permit shall be accompanied by a certified plot plan (scale not less than 1.9, _ 20') fully dimensional, showing pool location on property, relation to adjacent structures on property, relation of adjacent structures on property, location of all fences and gate. M. Pool Location No side of any pool shall be closure than six (6) feet to side or rear property lines. Pools are not allowed on front yards without obtaining Variance from these requirements from the City of Salem Board of Appeals. IV. Safety Requirements Pools will be surrounded by a fence at least four(4) feet high and no further than 25 feet from the sides of the pool. Rail fences will not be permitted. One, 3-foot wide gate with closing and locking device will be permitted. V. Electrical Requirements After receiving a permit from the Building Department to construct a pool, the installer must obtain the service of a licensed Electrician to do all required electrical wiring and grounding of the pool. License electrician is required to pull electrical permit from Electrical Department. (The Electrical Department is located behind the Central Fire Station, 2nd floor.) (Applicant) S-V-N STRF-F- USA f U i I { I HOUSE I i i 1 , 20' D:.-. POOL / h P � X FENCE Scale 1"=20' SURVEYOR'S STAMP MORTGAGE INSPECTION BAY STATE SURVEYING ASSOCIATES INC. JOB# 3 Z-243 100 CUMMINGS CENTER, SUITE#316J, BEVERLY,MA., 01915 Sr4l�/V1 NOTES: LOCATION :.....................f...../ ...rfi.............:. _ 1)This is a mortgage'inspectioh survey and not an Instrument survey,therefore this plot plan Is for SCALE : 1" = 70 DATE :....LU...Z6'�G .......... mortgage inspection purposes only.It is NOT to be used to establish boundaries or for the REFERENCE : 6 K' ?S s 04 { Z�0.. construction of any type of improvements. ""'G' ""' ' 2)This survey is based on survey'marks of others. .... SC R.�� 3)Bushes,shrubs,fences and tree lines do not ................................................... necessarily indicate property lines. 4)Whenever an offset is I+-or less,an instrument_ TO �A LEi1'► FIVE /vtvr4T G0121p survey is recommended to determine property .••...,� lines, and any possible encroachments. The location of the building(s)as shown,either 5).Offsets shown are approximate,and are to be complied with the local zoning setbacks at the time of used only for the determination of zoning, Not to construction or is exempt from violation enforcement be used to establish property lines. action under Mass.G_L.Title VII Chapter 40A Section 7 0)In my professional opinion the building(s)are not located In the special flood hazard zone,as defined by H.U.D.MAPg 25 O/G 2. 6i5RA6krY 0 13 Et � -r Doerr pGL. r-sfY-Bleletc Q Nth low f kX s��ar�E�Y #4 THAT UMUD 70 ALTERATIONS. PICATNIN CONTAINED ON IS DOCUMENTSHALL MOTAPMY l•-! t L� 5 ��E �# V`E , TO COPIES. MORTGAGE INSPECTION BAY STATE SURVEYING ASSOCIATES INC. JOB# 3 Z-Z¢3 100 CUMMINGS CENTER, SUITE#316J, BEVERLY,MA., 01915 LOCATION : 5r4 L: . f. / Arv............. . NOTES: ........ 1)This is a mortgage inspedton survey and not an ...•. Instrument survey,therefore this plot plan is for SCALE : 1" = ZO DATE :....�U.-Z6-©G............. mortgage Inspection purposes only. It is NOT to be used to establish boundaries or for the construction of any type of improvements. REFERENCE : z e' `f...P��.{2.8�_. 2)This survey Is based on survey'marks of others. F Sicx ....... 3)Bushes,shrubs,fences and tree lines do not .................................................. necessarily indicate property Ilnes. 4)Whenever an offset is I+-or less,an instrument �r�i LE/j/{ F{V E OrQ survey is recommended to determine property TO: ........................................N............... !�!P lines,and any possible encroachments. The location of the building(s)as shown,either 5).Offsets shown are approximate,and are to be complied with the local zoning setbacks at the time of used only for the determination of zoning, Not to construction or Is exempt from violation enforcement be used to establish property lines. action under Mass G_L.Title ViI Chapter 40A Section 7 6)In my professional opinion the building(s)are not located in the special flood hazard zone,as defined by H.U.D.MAP# 2S O/O z. -S-rQ f-• 4 �, s6 N �F GERAUN?Y Q ` 485� r>h� 0 0 PGL, r srY-B�elefc Q NSF � t� t 51-A-rrie y #4 IF UM SURVOtti"89OWT nmT3a mumsbTo UFMALMOMPOKS. _ FMnQN COWAMIM ON �.. ♦J A ,/`9 ISOOCUMENTBHALL NOTAPPLr . ro covies