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30 LEACH ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One or Two Family Dwelling This Section For Official�m­Only, T.757, 1,1 -4 �4 BuildingPermit Applied' .,ermi I �;IMJb 41, Of a" Mi �. Building Offtcuab��t,Narn � 1 Date 7 SECTION ktEfN operty)Address, 1.2 Assessors Map& Parcel Numbers 1.la Is this,an accepted street?ye 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 13 Private El Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yesEl SECTION PROPERTY;O)VNER 2.l,_-Qwner'of d*recor N e�(Print) City,State ZIP No.and Street Telephode Email Address SECTION k DESCRIPTION OF PROPOSED WORK!(check i all fl a,- ' p 10 (ehe New Construction El Existing Building 0 Owner-Occupied Cl Repairs(s) 0 Alteration(s) 0 Addition 11 Number Upild 11 Demolition 0 Accessory Bldg. El Number of Units Ot er 0 Specify: I . Brief Description of Proposed Work : ,P- SEcTION4: ESTI I%1ATtb.CON§MlJCTION COSTS .', C ' A. Estimated Costs: t" Use Only Item (Labor and Materials) Offf int U Fee- Indidatehow.fee is,deteftnined-� l. Building Jf`,BuildihgTemut . Itt'Standard City/Town Application Fee. - 2. Electrical 3 lj'T. 6iaFPi6je&Cost (Item 6),x multiplier x' 3. Plumbing r Fees es, $ 4. Mechanical (HVAC) $ List:, 5. Mechanical (Fire Suppression) Check Io h66k.No. Chock.Amo. untf :Cash Amodat: Total Project Cost: $ PPaid in Full bOutstanding Balance.Due:l SECTIONS: GONSTRUCTION.SERVTCES '. rConstruction Supervisor License(CSL) License Number Expiration Date Holder List CSL Type(see below) . ,TYpey �" Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town, State,ZIP M Mason ry RC Roo' Coverin WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Tele hone Email address D 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 City/Town, State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.GL;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 • t 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 matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:,OWNER t 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. �9t� A©. J—, 2-DI Z Print Owner' r Authorized Agent's Name(Electronic t ure) 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 .the Home in 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.inass.gov%oca Information on the Construction Supervisor License can be found at www.mass.eov<Ins 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" CITY OF SALEM, . LkSSACHUSETTS BL'tmiz\,G DEPARr%[MNT 130 WASHNGTON STREET, 3'FLOOR `�'`�`'°"'� TEL. (978) 745-9595 FAx(978) 740-9846 KINIBERL.EY DRISCOLL �LiYOR THo.Nw ST.PIEm DIRECTOR OF PUBLIC PROPERTY/BUILDNG 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 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 111, S 150A. The debris will be transported by: &1& (�W(2-04 (name of hauler) The debris will be disposed of in QQ(n� V � (name of facility) (address of facility) signature of permit applicant date dcbris�l't�diC CITY OF S.USDof PUBLIC PROPERTY DEPARTMENT V\ rN.rYLl wva ��e v�.o..K,�,o.,srt.ar• sw.u��t�o�aw sure as s-o MI.1'L 7+17f1t • FAA 1'67+47w HOMEOWNER LICLNSB EXE.MWIOV Finnan hint Date Dcc z �/Z-- lob Location Home Owner Aedrear Home Owner Telephone �� o Present M=Ung Address The current exemption of"Homeowners"was extended to include owner-occupied dweUings of two Units or lose and to&Howr such hemeawnars to eagags an individual for him who.does not possew a licensed provided that the owner acts as supervisor. DEFINMON OF HOMPOV/M Parson(s) who owns a pared of land on which he/she rerida or intends to reside. on which there is6 or is intended to bel, a one or two family dwelling attached or detached smmcturee accaaory to.nick 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 OQicial, on a form acceptable to the Building Oiltcial, that hdshe be responsible for all such wort performed under the Building Permit. The undersigned "homeowner'assumes responsibility for compliance with the State Building Code and other applicable by6Iaws and regulations The undersigned "homeowner'certifies that hdshe understands the City of Salem Building Oepartment minimum inspection procedures and requirements and that he/she .vill comply with said procedures and requirements HOMEOWNERS SIGNATL APPROVAL OF BUILDING D;SPECTOR See other side far state code 30 LEACH STREET. 375-13 GIs# :" 6920 COMMONWEALTH OF MASSACHUSETTS Map 33 ;r sioek. r y CITY OF SALEM Lot: " 0585 Category y, DEMO Pernitt#, 375-13 1 ` ,. BUILDING PERMIT Project# v", IS-2013 001418 Est. Cost: $1,000.00 Fee Charged: $25.00 Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO: Const. Class:-� ' Contractor: License: Expires: Use Grou .r P'i ` applicant Lot Size(sq. ft.): 3450.8232 r Zomng "' ,' R2 ' - .,:Owner: XIANG FA XU ' Units Gained:' -Applicant: XIANG FA XU Units Lost:,."'" AT: 30 LEACH STREET DtQ Safe#: ISSUED ON: 26-Oct-2012 AMENDED ON: EXPIRES ON: 26-Mar-2013 TO PERFORM THE FOLLOWING WORK: THE COMPLETE REMOVAL OF THE BASEMENT KITCHEN AND REMOVAL OF PLUMBING BEHIND FINISHED WALL,AND ALL PARTITIONS THAT CONSTITUTE A LIVING OR SLEEPING AREA IN ANY WAY(AND ARRANGE INSPECTIONS FOR ALL WORK DONE)jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: '. Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final: House# Smoke: Water: Alarm: Assessor Treasury: Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signatur w Fee Type: Receipt No: Date Paid: Check No: Amount: BUIiL-SSYNi O,TAMT-OWNER OR CONTR.ft§f1J4A4LP9t510 26-Oct-12 0557 $25.00 A,fR.pNGP FOR PERIODIC INSPECTIONS DURING ISTj'LC,TION.SEE CURRENT BUILDING CODE FOR LIST OF REQUIRED INSPECTIONS. C—L 978-619-5641 TO SCHEDULE AN INSPECTION GeoTMS®2012 Des Lauriers Municipal Solutions,Inc.