46 IRVING ST - BUILDING INSPECTION (2) V
� The C'ummonwcalth of Massachusetts '
� Board ul'Building Regulations and Standards CITYMassachusetts State Building Code, 780 C'MR, 7*edition OF SALEM
lRevised Jurnavv
Building Permit Application To Construct, Repair. Rrnorrte-Ur Demolish a
One-or rip#Nfumily Dwelling
This do For Official U nl
Building Permit Nu t(l'iber: Date Ap ted::L.,
Signature: 'J "' � /o/
Ruilding Commissioner/Inspector of Buil*0 IV Dote
SECTIO :SITE INFORMATION
.1 P,rpperty Address: 1 1.2 Assessors Map A Parcel Numbers
9 'n I r`'i1 vrC :i
1.12 Is this an accepted street?yea no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Am(sq 11) Frontage(11)
1.3 Building Setbacks fill
From 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:
Publ' Private❑ Zone' _ Outside Flood Municipal❑ On site disposal system ❑
Check if e
SECTION 2: PROPS OWNERSHIP'
2.1 nee'of Record: -y—
�(-') =a VI k' 4 S�-
N to(Print Address for Service: '
5 -7 8 7�/ a 6, s-s
Si ure Telephone '
SECTION 7: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) O Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ umber of Unit_ Other ❑ Specify:
Brief Description of Proposed Work'.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building S 1. Building Permit Fee: f Indicate how fee is determined:
2. Electrical $ O Standard City/Town Application Fee
O Total Project Cost'(Item 6)x multiplier x
). Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
echan S. Meical (Fire S
5u chane Total All Fees: S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: 5 i 0 Paid in Full 0 Outstanding Balance Due:
SECTION S: CONSTRUCTION SERVICES
S.I Licensed Construction Supervisor(CSL)
l.icciRtsidenlial
Expiralion IYate
Name ot'C'SI.• budder list e below)
fIYescri ion
Address Uricted u to 73,000 Co.Ft.
Rted 132 Famil Dwelling
Signature M ()ttl
Rntial Raclin C'overin
1'clepMute WResidential Window and SiJin
SFlial Solid Fuel Burning Appliance Installation
D Raidential Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC Company Name or HIC Registrant Name - Registration Number
Address
i Expiration Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.IL e. ISL f 2SC(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 ..........o No...........O
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 matters
relative to work authorized by this building permit application. -
Si urn of Owsier Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I P-P—Y\r Y C A fin % je=b ,as Owner or Authorized Agent hereby declare
that the s t ments and i tformalionon they foregoing application are we and accurate,to the best of my knowledge and
f pp
beh -ze ✓1 , WJ
Pr'nt a
Signature of0%Wneror Authorized Agent Date
Si under the pains and penalties of 'u
NOTES:
1. An Owner who obtains a building permit to Jo his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home improvement Contractor(HIC)Program),will rUg have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 MRS,respectively.
�. When substantial work is planned,provide the information below:
fatal tltson area(Sq. Ft.) (including garage, finished basement/anics.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
1. "Total Project Square Footage"may he substituted for"Total Project Cost"
CITY OF S.0 EM, iNL-ksS.ALCHUSETTS
• BUILDLNG DEP+1RT%iENT
120 W A.SHLNGTON STREET, Yo FLOOR
TEL (978) 745-9595
FAX(978) 740-98"
KI.NiBFRr RY DRISCOLL
itiUYOR THO.'�L1S ST.PIERRS
DIRECTOR OF PUBLIC PROPERTY/BCII.DNG CONMISS[ONER
Construction Debris Disposal 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 c 40, S 54;
Building Permit# is issuedwith the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
CI-le .4
(name of hauler)
The debris ill be disposed of in
(name of facility)
(address of facility)
signature o permit applicant /
date
dcbriu�T J.x
CITY OF S.ULE.NI
PUBLIC PROPERTY
DEPARTMENT
u.varar nar'�
Vwrw �]a w'�autw.7an atfesr•3Ks•t Vwsuoassan Otf'0
>�•-F�•s-inns•f..■.na�+a�sw
HOMEOWNER LICENSE EXEMPTION
Plea"Frirat /
Dets U a
Job Location 3 (o -- r v 1 ✓t s S
Home Owner Address -T-r C Ln �
Horns Owner Telephone S, 7 e-, / - .;t fa. f-5'
Presses Mailing Address I c. Tir V, %1 S
The current exemption of"Homeowners"was extended to include owneroccupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
him who does not possess a licersse6 provided that the owner acts as supervisor.
DEFD=ON 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
strictures accessary to such use and/or farm structurea. A pawn 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"assumea 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 SIGNAMME (j
n�
,APPROVAL OF BUILDING LYSPECTOR ������/�/��
See other side for state code