Loading...
12 HOWARD ST - BUILDING INSPECTION The Commonwealth of Massachusctts i� Board of Building Regulations and Standards CI'I'1'OF �1•�'i, Massachusetts State Building Code. 780 CNfR SALLM Building Permit Application -ro Construct, Repair, Renovate Or D nolish a One-or Two-FanulP Drellin,e This Section For 011icial Use Onl C JBuiillding Permit Number: Date Applied: Building 0117cial(Print None) Sign Da e SECTION I:SITE INFORRIAT ON I. Pro erty ddress: 1.2 Assessors N & P Number I.la is this an accepted street?yes no \I;;P Numher Parcel NuruNr 1.3 Zoning Information: 1.4 Property Dimenslons: Zoning District I'mpu,ed use Lot Area(sq IN Frontage III) 1.5 Building Setbacks III) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Pm ate❑ Zone: _ Outside Flood Zone? Municipal ClOn site disposal y Check i"cs❑ P pnsul s stem ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 w/ e 'of Recogrd: N:une IPru't UI .Slate.ZIP M-77/-3137 ld/l'fiv//ee� �LuLioe No.and Street Telephone Email ddress SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied O Repairs(s) ❑ Alteration(s) ❑ Addition Cl Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Spcciry: DriefDescripti ��/ onofProposed \Vork': ��' Ly 7 [w)JNBsnril 9C;/ Sljnvl/E->L r //VS zr Zvi AAJbQ1J�v %&E&2l-errr AP CC/LP �4fbnn� SECTION 4: ESTIJIATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and .Materials) Official Use Only I. Building S I. Building Permit Fee: S Indicate how tee is determined: Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier _ _ x . Plumbing S '_. Other Fees: S J. \lah:mical nlll'.1('1 S Lisl: S. .\IcchanicalIFire -- - -__ ----- . tiu,�rcisionl S rotal .\ll Fees: 1 Check No. ('hcck:\nlulnit: l',uh \nwunt _ Tolal Prnject Cost: S a,000 ❑Paid in Full ❑Outstanding Bal:mce Due: K%4�L- w SECTIONS: CONSFRUCTIONSERVICES 5.1 Construction Supen isor License(C'SL) License Number -- F\piradon Rae Nuntc of l'SI. I)older -- I ist('St. I'i pe(sec ---------------------- ---------- 'I')pe Dcscriplion Na. .utd Street U I hirestricted Ifluddin-s kin In 15,3)00 rtr. tt.) __ R Restricted 1&2 Farb) Ih%ellin Cit)iroan..Stale.LIP %I Mason RC Roolin Coserin ...—. K'S Window;md Sidin SF .Solid Fuel Burning Appliances I J Insulation Nic hone [:.mail address F D Denwlitien 5.2 Registered Home Improvement Contractor(HIC) I IIC Registration Number Expiration Date I IIC C'ompan) Nome or I IIC Itegktranl Name No.cmd Street Email address City/Town,State,ZIP Tde 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.......... 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 matter relative to work authorized by this building permit application. Print Dwnci s Narne(Electronic Signature) Date SECTION 7b:OWNER' 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. !2- I'rim s\ner's or Authorind Agent's Name(electronic Signature) Date NOTES: I. An Owner\vho 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 no 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 -s.i Information on the Construction Supervisor License can be found at\\\sus me.:g 2. 11'lien substantial work is planed,pro,,ide the information below: total flour area(sy. 11.) _ 1 including garage, finished basement a(tics,decks or Porch) Gross li\ing area Isg. tl.t _ _.,. _ Habitable room count \'umber of fireplaces_.... Number of bedrooms _ Number of bathrooms Number of Itmlf ha(hs I)peotheatingsysteln _ . _ _ Numhcr )I'd"ks, porches I\pe of cooling s\Stein Fnclosed (teen �. "I'alal Project Square Footage"ntay be substituted litr"I'otal 1'roik:0 C'osl" i CITY OF S.UZNr, AksS.kcFic,'SETTS ©Lt(DLNG DEP.1RT1tLNr 1 10 120 W,kiHLVGTON STAFgt, Y°FLOOR rM (973) 74S•9193 K13(BFRLBY ORMOLL FAX(978) 740-994 MAYOR TNOsW ST.PlFR" `` D'1=04 OP PL 8L(C PROPEAT V/9j: .OLVG COJOrtSS(ON EIt I . Construction Debris Disposal Attldavit (required for all demolition and renovation work) rn accordance with the sixth edition of the State Building Code, 780 CMR section 111.1 Debris, and the provisions of MGL a 40, S 14; Building Permit M is issued with the condition that the debris resulting from 1, S 110A. Ihi work shall be disposed of in a properly licensed waste disposal facility as defined by NIGL c 11 The debris will be transported by: (name of hauler) The debris will be disposed of in : S �t Te 4.4 151 2 (name of fuihty) Leib 4vui s M4 (�Jdmr of r�nhty) uynarure ofperm,t pphunt Le CITY OF S UY. NI PUBLIC PROPERTY DEPAM. LENT MAVGG i asv�wu�c7or snasr•s�u.,a Nw�oRscrnol•'o ria.•i-71i95"•FAX f.ti7,o9aw HOMEOWNER LICLNSE EXE.M"10N Pleaw Feist Date lob Ucadors / chi hP Wef,p 57` 54te-4n, rvc,+ Home Owner Addtea S BS n= Ho=0woW TelgAone - Present Mailing Address , 1, ec- The current exemption of"Homeowners"was extended to include ownw-occupied dwellings of two Units of less and to allow such homeowners to engage an individual for hire who.does not possess a licenser provided that the owner acts as supervisor. I DEFINITION OF HOMEOWNER Peron(s) who owns passel of land on which he/she reside@ or intends to resider on which there is, or is intended to be,a one or two family dweWngl,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;OQlc 4 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 reguladons. 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 requi I ronents. HOMEOWNERS SIGNATL'RB ,APPROVAL OF BUILDING 04SPECTOR See other side for state code