Loading...
2 LEE ST - BUILDING INSPECTION (3) The Commonwealth of Massachusetts �. OF Board of Building Massachusetts Regulations and Standards CITY SALEM h S Building Code, 730 CMR �71 Revised blar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling ThissectionForofficiatusionl Building Permit Number:.. at' Appited, Budding Official(Print Name) Signatur Date SECTION i. FORiNIATIOr4 .1 Pra2e�rty Address: 1.2 Assessors Map& Parcel Numbers '�, Lee -trc'e}- l.I a [s this an accepted street?yes_ 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: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO "d� SECTIONZ;' PROPERTY'OWLVERSH7PL' 2.1 �r'�ofRecohllAL�DUB �C3� /UA 6�tny '7p Name�(Jrii t) City,State,ZIP 2 L�� +— C(-7 3r7 Slay No,and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORKs'(chee.k ail that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Descrip,tt�IIg�,n of Proposed Work': e-.nbj`60S i('eJ)oJQh n SECTION 4: ESTINLATED CONSTRUCTION COSTS- Estimated Costs: frem Official Use Only Labor and Materials) 1. Building g I.,Building Permit Fee:$' Indicate how fee is determined: 11 2. Electrical ❑Standard.Cilyttown Application Fee.. ❑Total,ProjcctCost(Item.6),cmultiplier x 3. Plumbing S ?, Other Fees: S �r 1. M-ch:mical (IIVAQ $ List: 5. Mech:wical (Fira S cession) _ l'otal All Fees:S Check No. _Check Anwunt: Cash An cunt 6 I'oml Project Cos ❑ It: S Paid I l :nd in Pull 0 Out;taudim" Ilnlanee Dua: ' 1 SECTIONS: CO,NS'rRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Licenst Number -"_ Expiration Date Name of Ifolder List CSL e see below $Milp Description No. and Street stricted Duildin s u to 33,000 cu. ft. ricted 1&2 Fmni1 DwellinCity/Town,State, ZIP nrtin Coverinow and5idin�Fuel naming AppliancesationTale hone Email address olition5.2 Registered Horne Improvement Contractor(HIC) egistration Number Expiration Date I IIC Company Name or IIIC Registrant Name No.and Street Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 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 ..........0 No...........l7 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 my ehalf, in II afters relative to work authorized by this building permit application. w^ Tint Owner's Name(Electronic Signature) Date SECTION 7b; OWNER' 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 r\uthorin:d Agent's Nano(Electronic Signature) Date NOTES: I. :\n Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Hume Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program can be found at www mas3j-ov%oca Information on the Construction Supervisor License can be round at www.mas .guv'dL Z When substantial work is planned,provide the information below: Total flour area(sq. it.) —(including garage, finished basement/attics,decks or punch) (iro;; living area(s(l. it.) _ habitable room count _ Number of tirepLtecs Number of bedrooms ----- - -- ----------------- Number ufbathrooms Number ofhalbbaths _—_-_---- -—------------ l'vpe of hooting ;y;trim ---- —,— Number of decks/porches Enclosed _ t)pen --_---- —_- ... -------- ------------- - � 1. `fit.d I'r,q�et 1yu.u"a P„ ,t.i•yr"inay he snb;tihit: for"I' r.tl I'ru td l'o;t" Y I. i CITY OFS.1. ZNf, j),Ws.1CHU5 y•�;,� ETTS �'};t• � )c Ot:tLDLVCDEP.IRTM&NT 16'h3" VGTO.4 STXEST,, 1"FLOOR rEL (978) 7I.5-9595 <IMOERLEY DRISCOLL FVC(973) TW-9345 ,� UYOR "1�tDac�Sr.Ptaw3a 0ME=rt.OF PI:OLIC PROP ERTY/aVtLOLVC,CoullISSIO.NEQ Construction Debris Disposal Affidavit (required for all demolition and renuvation work) In accordance with tha sixth edition afthe State Building Coda, 730 CMR section l l LS Debris, and the provisions of MOL c 40, S 54; ©wilding permit f#this worksteall be is issued with the condition that the debris resulting front l It, S 1 5OA. disposed of in a property licensed waste disposal raoility as defined by A4CL a The debris will be transported by; (n�ma ut'haulcr) '('he debris will be disposed of in : (nanm ur tacdil/) ;i;;namrC ut � hit avplic.mt - CITY OF S.U-&NI PUBLIC PROPERTY DEPARTMENT VArae b WU"PWrcM huaR a UL"k KASAGft W OI9V M 1'f7,f stet a 11AX 93446-mo HOIKEOWNER LICENSL E.XE.NMION Phase t Date lob Homo Owner Address ED 1 e 5 i— mom Owow Telephone q?4g Present Mailing Address no current exemption of"Homeownere wag extended to imiudo ownw-occupied dwellings ortwo Units or leas and to allow such homeowners to en p p an iv," for hire who does not possess a lieu provided that the owner acts err aupandaor. DEFINMON OF HOMED WNEB pown(s) who owns a patteal olland on which hdshe resides or fatends to resddg6 on which there 116 or is intended to bo, a cae.or two Atmily dweWng. attached or detached structtud accessory to such use and/or [arm atructurva A person who constructs more ch one homehall in a two year period s not be considered a homeowner. Such " so homeowne "3W submit to the Building Ot]leiat on a form acceptable to the wilding PerOffImit, ia1, that hdshe be responsible for M such work performed under the Building Permit The undersigned "}homeowner"asanmes responsibility for compliance with the State Building Code and other applicable bylaws and regulation The undersigned "homeowner'certilles that hdshe understands the City of Sslenr Building Department minimum inspection procedures and requirements and that hdshe Nill comply with said procedures and uiremmta HOMEOWNERS ERS S[GNATL-M iPPROVAL OF SU/LDrVG LVSPECTOR See other side for Stara coda