28 JAPONICA ST - BUILDING INSPECTION !
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I(,� ,� The Cummonµealth of Massachusctts
I�Y �� Board o(Building Regulations and SlandarJs Town of
� 'Nassachusetts State Building Code, 780 CMR, 7'"edition �
�v, BwWing Dept
Building Permit Application To Cunsuuct, Repair, Renova�e Or Demolish a �
One- or T��a-Fumilt•D�rr!ling
� � This Section F ' I Use Only .
Buiiding Pertni� Nu er: Dat A plied:
Y /�,�0 7�1� f c��
Signaturc �
Budding Commissioned Inspec�m o Building� Date � �
SECT : SITE INFORMATION
I.I Property Addresr. . 11 Assesson Map& Parcel Numben ..
<� � ,�a , 4� �T�• I
I.la Is this an accepmd streeC?yes t�no_ Map Number Parcel Number I
I.3 Zoning Informatlon: � 1.4 Property Dimenslone: �.
�/ Sin �'�j
Zoning Drstnct Propo ed Use / Lot Area(sq fl) Frontage(fl)
1.5 Buildtng Setbrck�(ft)
Front Yard Side Yard� Rear Yard
Required Provided Required Provided Rcquired Rovided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Informalion: 1.8 SewaQe Dl�po�rl Syetem:
Public Private ❑ Zone: _ Outside Flood Zone? Municipal n site disposal system ❑ ��
Checkif es0 �.
SECTION 2: PROPERTY OWNERSHIP� �
2.1 Owner of Record: � —
a� u /Gfv� �_C.� �4�v�o r. •� ,S'T
�j��� Address or Service:
�w . /�7a'— b�o V '.rd?�.3
' nature Telephone
SECTION J: DESCRIPTION OF PROPOSED WORK�(check all that apply)
New Construction O Existing Building❑ Owner-Occupied ❑ Repairs(s) � Alteration(s) O Addition O
Demolilion O Accessory Bldg. O Number of Units Other ❑ Specify:
Brief Description of Proposed Work�:�y � %{fu � c� et...Av i�,+ai .rJ
/.1.X Tc� ' JZ GSr W..S9' �
SECTION 4: ESTIMATED CONSTRUCTIOIV COSTS
���m Estima�ed Costs: Of(Iclal U�e Oaly
Labor and Mamrials
I. Building S �� _�y I. Building Permit Fee: S Indicate how ke is detertnined:
2. Electrical E ^' �Standard Ciry/Town Applica�ion Fee
❑Total Project Cost (Item 6)x mul�iplier x
J. Plumbing S —1 2. Other Fees: S .
4. .�fechanical �HVAC) S ---� Lisl:
5. Nechanical (Fire 5 ��
Su ression Total All Fees: S
Check No. Check AmounC Cash Amount
6. Torol Project Cost: S ��Gd 'r�— ❑ paid in Full ❑Ounianding Balance Due�
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SECTION S: COIVSTRUCTION SERVICES
� S.I Licensed Constructlon Supervisor(CSL) ��3Sd �+ �a "'� '��
" Liccnec Numbcr Eapiruuon Da�e
!�%� ��
�, N;�roc oYCSL- liplder_ Liei CSL Type�xc lxluwl � �
'� � �b�� T� Descn uon
Address ,
U Unre>�nc�ed u to)5.000 Cu. Ft.)
R Restriclyd I&2 FamJ DwelLn
i natur M �fason Oni
RC Residenual Roofin Coverin '�
Tclephone WS Residenual Window and Sidin
a SF Resideniial Solid Fuel Burnin A liance Installation
� �'7� � � —rd a''� D Residential Demotition
� 51 Reglstered Homt Improvement Contractor(HIC) ��f,�7�
i�� �
HIC Company Name or HIC Rrgistrant Name Registration Number
!_..� �
A s p -'.�-1�/d
�y�_� y ��- Eapira�ion Date -
S�gnaturc � Telephont
SECTION 6: W RKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.� 25C(6))
Worken Compensation Insurance andavit must be compleled and submined with this application. Failure to provide
this aflidavit will result in the denial of the Issuance of the building pertnit.
Signnf A�Javit AttacheJ? Ya .......... ❑ No...........❑
SECTION 7�:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�, - � , as Owner of the subject property hereby
au orize ��' to act on my behalf,in all matters
relative to work authoriz d b this building permit application.
� " 7�L��S
aturc of Owner Date
SECTiO1V�b:OWNER� OR AUTHORIZED AGENT DECLARATION
�
►, T�., _yQ �sy,���.r ,as Owner or Authorized Agrnt hereby dcclare
that �he statements d information n the foregoing application are true and accurate,to the best of my knowledge and
behalf. ,
!
Ptin ame
'�' —l —c, P
Signaturcof0 nerorAu�hor� Agent Date
Si ned under� e ains and nal�ies of r�u
NOTES:
I. An Owner who oblains a building pertnit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contrac�or(HIC)Program),will�have access to the ubitration
program or guaranty fund under M.G.L. c. 142A. Other important infortnation on the HIC Program and
Co�struction Supervisor Licensing(CSL)can be (ound in 780 CMR Regulations I IO.R6 and I IO.RS, respectively.
2. When substanlial work is planned, provide ihe in(ortnalion below:
To�al floors area(Sq. Ft.) (including garege, finished basemenUattics, decks or porch)
Gross living area�Sq. F�.) Habi�able room count
Number of fireplaces Number o(bedrooms
Vumber o(bathrooms Vumber of halfibaihs
Type of hea�ing sysiem Vumber of dceks/porches
Tvpe o(cooling system Enclosed Open
3. "Total Projecl Syuare Foo�age"may he +ubsmwed for"Total Project Cost" ��.
4 � � CITY OF S.�LE.`t, �L�SS.�CHL'SETTS
BL'IIDL�IG DEP.►R'T�l&�iT
� 1'_O WASHINGTON SIREET, 3�O F100R
. T'EL (97� 7�5-9595
F.Vc(97� 7iQ9&16
���gFRi FY DRISC011.
�iAYOR �+oa�.�s ST.P[Erexs
DIAECTO�OF Pl.BLIC PROPEATY/HCIIDLVG CO�L�QSS[OrElt
Wurkers' Compensation Insurance At'tidrvit: Duilder�/Contractoea/Electricirns/Plumben
annifcant Inform�tion Plcax Print Leelblv
V��Tit Idusin�v.Organintioroln�Lv�duull' �-ir� �� f-N����a,J� l77C
e
�7�(�fCSS: ��� ` -R— � .
c�ryisr�c�z�P: -S� rno�� a: �jir-.s�z— a6�� �
�re you ao employsr?CAeek the appropriate bos: Type of project(requlre�:
I�' I am a cm lo a witII�� 4. � I am s gcn�ral contruwr and 1
P y 6. ❑Nnw comwction
employea(full and/or part-time).• have hircd che wbcontracmn
2.Q I am a sole proprietor or panner- listed on the attuhed yheet � �� ❑ RemoJeling
;hip anJ hove no employed Thex subcontracton have 8. ❑ Ikmolition
working for me in any capxiry. workm'comp.insutance, 9. � Duilding addition
(No workesa' comp. imunnce 5. � We aro a cor�wrution and io
� rcquireJ.)
oPlcers have ezercixd their �O.Q Electrical rcpain or addieions
3.� I am a homeuwncr doing all woAc righe of cxemprion per MGL �� Q P��mbing repain w additioro
myself.[\o worken'comp. c. I SI.§I(4).utd we have no 12.0 RooC erpsirs
insurance rcquircd.] � employeea. �No worlcen' �;,Q 01ha
comp. in.Kurance required.J
� •nny applicanl ilut eMceb Eoe I I muN aiw fill w11h�seclim below a6oaie��Iqir�vorkm'compen'yion pility inPormaUoM1 �
�I L+meurvnen who suMnit I�n aflid�vil indiotin`Ihey»Joinp ill wak a�d tAce hi�e ougide controaron mwl suhmil a new alifJavil indiotiM auek
=C.mirrwn ilul chaek�Ai�box muq anxhed an sWiiiwd+hs�showin�Ja nome ollM ruA.con�nc�ps and thc4 wurYan'cwnp.piliry infpmotia�. �
/um aa employer rha!&pravidlnR worArert'rompensarloa lntrroncs fai ay emp/uyees Bs/nw/i�he pofley nnd Jab r!a
injormu�ion. �
In.,ursnce Company Name:.�e.� �-r�-J / �
Policy p ur Self-ina. Lic. p: d� n E�pirrtian Date:
!ub Sire AdJress: ,�.�' 0,,.�., „ ,�e �T - City/StatrlZip: ����4
,�nrc6�copy of the worYen'compen�rtlo�polley dalantbn pa�(�howin6 th�pollcy oumMr rnd e:ptr�No�dab�.
h'ailure to xcure cove�age a�requircd un�kr Scction 25A of MGL e. 132 can lead to ihe impo�ition of criminal�xnalNes of a
fine up�0 51,500.40 anA/or one-year imprisonmen4 as well as civil penultira in the form of a STOP WORK URDER and a fina
uf up to S?30.00 a Jay against the violamr. 11e aJvi.�d thnt a copy of this�tatem¢nt mry be forward�d to the OI'Pce of
Invcsugaiiunx ol'�he n1A For insurance rnver�ge verificulion.
/Jo hereby • ' undrr r purne und peim/der ujperfury tbar rh�infwmu�lon providrJ ubovr is trrit urtd rar�td
�n, r i ir � � 1)um� -� -�'_�
Ph�inc�: .SS7d� . �� y ^5'0 5?_f—
iO�riu!ust oidy. Do no�wriK in rhir ar�u, io be ro�np/a�ed by crry oi�own n/J7riuL
City or 7uwn: ___ __ Ycrmit/I.Iceme p
-- _ - -
� Issuing.\uihurily (circleune): ��----. - . ._..— �
� I. Itwrd uf IIe�Uh 2. Huildln� Ueprrlmenl J.Cily/1'own Clerk J. Electrical (nspector 5. PlumbinR Impector
� 6. O�hrr _— -.-
� lunlaclPcrson: _. _ . --. --. Phonep•
_,i
' ` " �� CITY OF SALC:M
r�y J� Pt�BLIC PRc)PRERTY
�;•.l.y �y:
'� ' `��=� DEl'.�ll"I'LtENT
�1M V .
. �,I �� . , � � �; �\ "�i;•..�. �"-�..:iil � ��ii �i. \I�,.�� . � • 'I � .
� III '�'Y.'J;.�i:a: � I �\ 'i'X '�_ 'ril��
l'nnstrurtiun Debris Disposal .aftidavit
� (rryuirc� li�r �II Jcmolition :uiJ rrnuv:uiun �wrk)
� In :iccunl�ncr ��i�h th� sizd� eJition ol'thc Slatc Duil�ing CoJc, 7S0 CA1R s�ction I I I >
Drbris, .inJ �hc pro�'isiuns uf'�1GL c 40, S 54;
DuiWing Permit M is issucd with lhr conditiun th�t thc dchris resulting from
ihis �vurk shall br di.posed uf in a pruprrly liccnscd wa,te �lisposal lacility �s defiucJ by MGL c
I l l. S ISfiA.
Thc dchris ��ill bc uansportcd by:
� /I� z�� S� a�- �'..���� �
�• - 1 n�me ul liaulcr) °
l hc Jrbris will bc disposed of'in �
�9riz�/� <�_2P
luainr u� lacilny)
I �� � � �.
�.iddre.. u(I�aililVl
I < /
.icndlwc nl�p: rt ap�ilic�nl
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NOTES
2 REFERENCES
�
DEED: BOOK 6654 ; 337
A� PLAN: PLAN IN BOOK 5 ; PLAN 41
e PLAN BOOK 113 ; PLAN 99
� ��
��A� PLAN BOOK 202 ; PLAN 1
�
FIELD 800K PAGE INSP. BY DRAFT. BY CHECKED BY
T6 28 C/T TPB GCC
CERTIFICATION
� 1 CERTIFY THAT THIS PLAN WAS MADE FROM �Q���.1H OF�qssqc ,
' AN INSTRUMENT SURVEY ON THE GROUND
N 30"20'02"W 80.01' — W BETWEEN THE DATES OF JANUARY 23 AND �� GE�RGE �� .;�
i � � � JANUARY 27, 2008 AND ALL STRUCTURES ARE �LLINS v 'E
rI—^ LOCATED AS SHOWN HEREON. � 9NO�af�s4
� . SHEO . vJ 97/ O�FSSIOo-'��n jF
ACCORDING TO THE FEDER.4L EMERGENCY � S R�E�` r
No.sornaoN�ca srReer ' MANAGEMENT AGENCY(F:E.M.A.) MAPS, THE .
Pao� No.24J " ;er W MAJOR IMPROVEMENTS ON THIS PROPERTY `�
BEVERLYMCSWIGGIN LOTS 42&43 �' :. a FALL IN AN AREA DESIGNATED AS ZONE "C" �
BOOK6831 ;PAGE302 W / SEANi � , �
0 6470 s.F. sooKzc �, 9 0 (NOT IN FLOOD). �
o� � � �
t �� ���� ��'�" W ; � CERTIFIED PLOT PLA1�9
Z � �v-�,.✓ �-�u< J� o `oo � m LOCATED AT
�.o� � � t a 28 JAPONICA STREET
E �, ORIVEWAY Z SAL EM, MA.
1.5 STORYw� � SCALE: 1 WCH = 20 FEET DATE: JANUARY 31, 2008 -
��� 1� 8 "� . - w PREPARED FOR: BRUCE DAIGLE
No.2S � 28 JAPONlCA STREET
// ; SALEM, MA.
2.0' voacH w
1� - 2.8' 80.00' � ! 226.E - �
� N31'03'00"W
~ BOSTON
JAPONICA (PUBLIC-40.0'WIDE) STREET SURVEY, INC.
UNIT C-4 SHIFWAYS PLACE
I CHARLESTOWN. MA. 02129
(617)242-1313
JOB # 08-00120 FILE # 08-00120-1/31/OS
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