29 JAPONICA ST - BUILDING INSPECTION The Commonwealth of Massachusetts
i' Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised ar 2011
Building Permit Application To Construct,Repair,Renovate Or Demsh a
One-or Two-Family Dwelling
\Y� This Section For Official Use Only
Building Permit Number: Date Applied: �-
7
Building Official(Print Name) Signature r Date `
SECTION 1:SITE INFORMATI N
1.1 Property Address: 1.2 Assessors Map arcel Numbers
29 Japonica St
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Christian & Sarah Murphy Salem MA 01970
Name(Print) City,State,ZIP
29 Japonica St 978-223-2563 christian@apentec.com
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building IN Owner-Occupied fffi 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Renovation of kitchen./Hininc3 area.
Removal of non—structural walls. Demolition of chimney.
-Reinforce floor.
SECTION 4: ESTIMATED CONSTRUCTION COSTS ,
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 10, 000 1. Building Permit Fee: $�Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
1 0 00 ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 7,000 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount: -
6.Total Project Cost: $ 18,000 0 Paid in Full ❑ Outstanding Balance Due:
t
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
- Name of CSL Holder
- List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Rooting Covering -
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
Ci /Town,State,ZIP Telephone
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 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
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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,1 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.
Christian A. Murphy 9/24/2012
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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 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 can be found at
www.mass.eo0oca Information on the Construction Supervisor License can be found at www.mass.gc�iss
2. When substantial work is planned,provide the information below:
Total floor 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"
, S
CITY OF SOU F-, I, iL1SSACHUSETTS
BLILDLN,G DEPIRTM&NT
130 WASHNGTON STREET, 3�FLOOR
T EL (978) 745-9595
F.ix(978) 740-9846
j<IN(B Ri FY DRISCOLL
i1 iAYOR T Ho.%(ns ST.PIERAz
DIRECTOR OF PUBLIC PROPERTY/SUILDNG CO\L\lISSIONER
(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 It 1.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with 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
l It, S 150A.
The
1�debris
will be transported
by:
WC�G
( ameofhauler)
The debris will be disposed of in :
—_— (namc of facility) ---
----(address of Facility)
signature of permit applicant
date
IcbnsalCJw
CITY OF S.Ux.1VI
PUBLIC PROPERTY
DEPARTMENT
NT
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HOMEOWNER LICLNSB EXEMPTION
Poem" "I
Due
lob Locatka Ql t)9n0n<« 5{
Home Owner Addresser 'v
Homo O�swow Tellopbonns g 2 3 S6 3 /q
Present Marling Addrssa�nOHlsa S�_ �GM ///�
The current exemption of"Homeowners"was eatauW to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possese a lianas provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Person(s) who owns a parcel of lard on which he/she resides or intends to reside.on
which there is, or is intended to bs,a one or two f tinily dwelling; attached or detached
souctures 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
"}xomeownce shall submit to the Building Oalcial,on a form acceptable to the Building
Official, that he/she be responsible for all such worts performed under the Building
Permit.
The undersigned "homeowner^assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regufadonst.
The undersigned "homeowner'certilles that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
mill comply with said procedures and requirements.
HOMEOWNERS SIGNAMW
APPROVAL OF BUILDNG NSPECTOR
See other side for state code