410 LORING AVE - BUILDING INSPECTION - "7-7-2 �
moo.
The Commonwealth of N[assachusetts
LUilding
OF
Board of Building Regulations and Standards CITY M
Massachusetts State Building Code, 780 CNIR SdMarRevised Mnr 20!l
Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two Family Dwelling
This Section For Official Use Only
Building Permit Number: _ Date Applied.`;
Building Official(Print Naive) _ . SignatureDatE
.
SECTION 1: SITE INFORMATION
L I Property Address: �1p /kpx;r YC e V r l.2 Assessors Map 3c Parcel Numbers
1.1 a Is 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: 1.8 Sewage Disposal System:
Public fitI Private❑ Zone: _ Outside Flood Zone? Municipal® On site disposal system ❑
Check if yes❑
SECTION 2:, PROPERTY OWNERSHIPL
2.1 Owneri of Record: D
Name(Print) City, Late,ZIP
No.and Street 4— Telephone' Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK''(Icheck all that apply)
New Construction ❑ Existing Building j Owner-Occupied Repairs(s) ❑ Alteration(s) $L Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: -
Brief Description of Proposed N0
rk2:
Z4 OfG
L D
SECTION 4: ESTIMATED CONSTRUCTION COSTS
[rem Estimated Costs: Official Use Only.
Labor and Materials)
I. Building $ 1. Building.PermitFee $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ s
❑"Total Project Cost (Item b)x multiplier x
3. Plumbing S 2. Other Fees: $
l. \dzchanical (IIVAC) $ List:
5. \Iechanical (Piro $
Sn i ression) _ 'Coin\:\Il Fees: $_
Check No. Check Amount: Cash Amount:
To O Ital Project Cost $ ,
i �� aid in Full ❑ Outstanding 13u1;1nca Due:
SECTIONS: CONSTRUC['ION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Dale
Name of CSL Ifolder
List CSL Type(see below)
No. and-Street jR
e I . Description
Unrestricted Buildin-s u to 35.000 cu. 11.
Restricted I V) Fnil DwellinCityfrown, State, ZIP Mason Rootin Covcrin Window and J'idin
SF Solid FrICI [turning Appliances
[ Insulation
rele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(IIIC)
1-11C Registration Number Expiration Date
I lIC Company Name or f11C Registrant Name
10�YZ0 (� vt? 4e
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 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
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; 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 y know a nderstanding.
Print Owner's or Authorized Agent's Name(Electron ignature) Date
NOTES:
1. 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 [ionic Improvement Contractor(HIC) Program),will not have access to the arbitration
program or guaranty fund under\I.G.L. c. I42A. Other important information on the H[C Program can be found at
uww.massoov-ioca Information on the Construction Supervisor License can be found at www.mass.izoy.dL
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch)
tiros; living area(sq. ti.) -- — Habitable room count_
Number oftircplaccs Number Of bedrooms ----_--
Number of bathrooms Number of halt"baths
I'vpo of healing iystam ------ — Number of decks/ porches --
1' 'PCof Cooling iy;tem_-----_---_—.-- Enclosed . -- - -- Open —__--
1. I ot'll PCUjeCt `qu:11"C FootHi,e- may be iubStlnnCd Lot PI'oicct Cott"
CITY OF S UEM
PUBLIC PROPERTY
DEPARn. LENT
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HOMEOWNER LICLNS6 EXEMPTION
Pfeasa THit
Data i
lob Locadon A U
Home Owner Address ✓ -e
Home Owner Telephone -
Preasot Mailing Address
The current exemption of"Homeowners"was eaterded to include owner-occupied
dwellings o[two Units or fees and to allow rich homeowners to engage an individual for
hire who does not possess s Eee0144 provided that the owner acts as supervisor.
D INMON OF HONZOWNHR
Penon(s) who owns a pausal of land on which ItdsM resides or intends to resider on
which than is, or is intended to be,a one or two family dwelling, attached or detached.
structures 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
-homeowner"sW submit to the Building OQkial,on a form acceptable to the Building
Otllcial, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "}tameownd'asaunses responsibility for compliance with the State
Building Code and other applicable bylaws and reguladorua
The undenigrned "homeowner"certifies that hdshe undentands the City of Salem
Building Department minimum inspection procedures and requiremen d that hdshe
Will comply with said procedures and requirem
HOMEOWNERS SIGNATURE
,kPPROVAL OF BUILDING NSPECTOR
See other side for state code
' I
`IVY
Y CITY OF S�1LEtif, tiLAss.1CHUSETTS
•l.t� j,t;� . ;y 01:1LOLNG DEP.IRnL&NT
120 WASNLGTON STREET 3.O
N FLOOR
TEL (978) 745-9595
RUC(978) 7-td-934S
I<!J[DERIEY DILISCO[l.
�b1.�Y01i 71101t"ST.PIERAB
MxECTOA OF PI:OLIC PROPERTY/BCILOLNG CONNISSIONER
Construction
hon Debris Disposal At'ftdavlt
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section ( l 1.5
Debris, and the provisions of tb1GL c 40, S 54;
Building Permit !k is issued with the condition that the debris resulting from
! 1, S l SOA.
this work shall be disposed of in a properly licensed waste disposal facility as defined by 11vIGL c
(
The debris will be transported by:
J2019J
(name ut'hauter)
The debris will be disposed of in :
doh _
vex
(name of facility) PIZ
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1 Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-037793 F'
IS
e
DUCIUN VAKUBIIIN
410LORINGAVS#1j;5.
SALEM MA 01970 '
Expiration
`J..G.� 0611412014
Commissioner
Bw wer Yakubian -Pn�Address 410 Lorin Av
cfty Salem cw* Essex stm MA Zlocode01970
Lender Uot Eastem Bank Address 195 Market SL Lynn MA 01901
y 14•
9' Open Porch 9' 11' 9' Open Porch 92
31
IV
Bedroom Mud Room Bedroom Mud Room
Kitchen 19r Kitchen 19'
Bedroom Bedroom
AIR 4.6'
Bath Dining Room 6' Bad Dining boom �.
Bedroom 4.9 Bedroom AIN
Living Room Living Room
23' 23'
Open Porch Den Open Porch Den
�. 28'.
V "� r