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435 LAFAYETTE ST - BUILDING INSPECTION (2) , r The Commonwealth of Massachusetts Is�3. Board of Building Regulations and Standards CITY OF j\UII Massachusetts State Building Code, 780 CMR SALEM V� Revised,blur 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Family Dwelling This Section For Official Use Only Building Permit Number: 1 Date Applied: - Building Official(Print Name). Signature-" - D.We SECTION I-'SITE INFORNIATION 1.1 Property�d FAY 1.2 Assessors blap& Parcel Numbers tF133 Z L Ia Is this an accepted street?yes ✓ no Nlap Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: /4000 /S 0 Zoning District Proposed Use Lot Area(sq R) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required ProviJed 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public fY' Private❑ Zone: _ Outside Flood Zone? Municipal t7 On site disposal system ❑ Check if yes❑ SECTION 2:, PROPERTY OWNERSHIP 2.1 Owner[of Record: D LOWS T*N,rVAJ -0 y 4AkSE iv1,7c 4c1/ �syLp,NT !!ii v/4 7 hme(Print) City,State,ZIP L,O✓t M.TL 14 aT e Y3S LAr- fC71E Si �4�9 5 V V- S.70 cnA CA,(T, ^ie 7— No.and Street 'telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building Owner-Occupied D( Repairs(s) Alterations) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ NwnberofUnits— Other ❑ Specify: Brief Description of Proposed Work': Aeacki A.OW1� L.G✓is�L $4l)AQOP At✓8 1477L< M FLy&4 AIOi'dAp r !S V S.F A6/N S M L L /�Jar.�'/t P✓rw/O oar ) 1t- j3a7}/AaOm / Ct.0 1,\J' 0t.4 D1Q 9c W r141_ . / 9441 D .4-C N �O/GET w.4s LEaK /J SECTION 4: ESTENIATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building S /Q &0a 1. Building Permit Fee:S - Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S / 000 ❑Total Project Costa(Item 6)-x multiplier x 3. Plumbing S ZOd 0 2. Other Fees: S � „ I `� x 4. N z, 00 ctttechanical (HVAC) $ 0 List: . I // (✓ 5. Mechanical (Fire $ Total All Fees: S Su ression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: S /.S06100 ❑Paid in Full ❑Outstanding Balance Due: _ � 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 LIP to 35,000 cu. it.) R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date Ii IC Company Name or HIC Registrant Name No.and Street Email address City/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 Is§uance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No........... ❑ SECTION jai OWNER AUTHORIZATION TO BE COMPLETED WHEN. OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. ' Print Owner's Natne(Electronic Signature) Date SECTION 7b:OWNEW 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. Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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 NI.G.L.c. I42A.Other important information on the HIC Program can be found at www.mass.�oL b"OCiI Information on the Construction Supervisor License can be found atwww.mass.''ov!dns '27 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" CITY OF SM-04 PUBLIC PROPERTY DEPART-MENT Vwwe t sO vUwsrcPor,sroar 0 sua+t VAoaow scm 01 f'0 II HOMEOWNER LICLNSB EXX.MffIO,V Pfasse Print Dw V/0// Job[aeadoe 'f 3s 4A64YM,6 S T �q L 6rti1� �rt.f ©/9 7 a Home Owns Addeees .5 e Home Owns Telephone T75 - 5-9 y- 5-7-0 Y Pro"Mailing Address S'AVse .#S 400VC The current exemption of"Homeowner"was esteodad to include owner-occupied dwellings of two Units or fees and to allows sucb homeowner" to engage an individual for hire wbo does not possess a licensm.provided that the owms sets"supwWsat DEFINITION OP HOMHOWNEX Pown(s) who owns a parcel of toed on which hdshe resides or intends to redde6 on whkb there U6 or is intended to be4 a one or two ramify dwelling, attached or detached atrucnxm accessory to.such use and/or rearm sWmfures. A person who conswicta more than one home in a two year period shoal not be considered a homeowner. Such "homeowner"shall submit to the Building Oi icisk on a four acceptable to the Building OPAcia4 that he/she be responsible for all such work performed under the Building Permit The undersigned "homeowner'assumes responsibility for compliarsce with the State Building Coda and other applicable bylaws and retuladont The undersigned "homeowner certifies that helshe understands the City of Salem Building Department minimum inspection procedures and requirements and that heshe .vill comply with said procedures and r ements. HOMEOWNERS SIG:tATI W Q .APPROVAL OF 9U/LDIYG OiSPECTOR See other side far state code CITY OF S.U�ENl, TNLksSACHLSETI'S • BUIMNG DEPAR-MENT • 130 WASHINGTo,4 STREET, 31D FLooR \ o- TEL (978) 745-9595 Fmx.(978) 740-9846 KIN{BERI EY DRISCOLL MAYORI`HO:strs ST.PIERR& DIRECTOR OF PUBLIC PROPERTY/BUILDN(;COMMISSIONER 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 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 111, S 150A. The debris will be transported by: .� ul✓ivuaSR�� 8yr�� (name of hauler) The debris will be disposed of in Aafo% Give. 4,140-wd r _4W. (name of facility) D4wVf rQC( CA4., 9-L4 or9'7v (address of facility) i signature of permit applicant 13 d/ ' ate dd>ru�i�:Jx r 7 r ». tltl 1 v. T..-ice.}'+-�--F-';-+-� ! V � � I I ' �...-.r-•.-`-,....ham-F,.. - . ».. _ . . __s- r � ,.9 E ManSyy� F 4C`s L EYN i ♦ R t' � s Y I. ff j x� r Q' i � 4 x a st M - , J v 4 4k'4..N)F 4r.-. IM L4T11-17`t( /Z-Wow') Ik`� . . a