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10 LOVETT ST - BUILDING INSPECTION (2) Fhe Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR A 1 ReriS 1In1o!/ a., Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Funfily Dn elling This Section For Official.,Use Only � Building Permit Number: Date p%plied: L�177xv Building Official(Print Mane) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Addr ss: 1.2 Assessors Nlap& or I Numbers Ib Lv�e�S�ieefi� 1.la 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 It) Frontage(11) L5 Building Setbacks(ft) - Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Recor i) / ep b �.�IiN S i1�. S 4Ile V✓N M ✓} IS t 9 ?Z� N:une(Print) I City,State,ZIP 00 C�✓e� S � 07-32o a �a�s.�/in-3 'e�� q%rorr,� No.and Street 'telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building Owner-OccupiedWIT Repairs(s) ❑ 1 Alteration(s) 21 Addition ❑ Demolition - ❑ 1 Accessory Bldg. ❑ I Number of Units Other ❑ Specify: Brief Description ofProposed Work': -i0 9 zn, c oboJ is r �r s SECTION J: ESTIDIATF.D CONS tICTION COSTS Item Estimated Costs: (Labor mid Materials) Official Use Only I. Building S LIC0 O,C)o I. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S J�OO . 00 ❑Total Project Cost'(Item 6)x multiplier X 3. Plumbing S Qr DO 2. Other Fees: S J. \Icchanical (HVAC) S List: _ s%5„\Illrecchanical (Fire S _— ssion) Total All Fees: S Check No. _Check Amount: __Cash Amount h. To[•al Project Cost: S y$a�,©p ❑ Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of C'S1. 1(older --- List C'SL Type(sec below) No. and Street Type Description 11 unrestricted(Buildings no to 35,000 cu. It.) _. R Restricted 1&2 FamilyD%%elling City(fut�n,Slutc,ZIPM Mason ry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation 'I'cle hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) f IIC Registration Number Expiration Date I IIC'Company Name or I IIC 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 .......... ❑ 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 ace r5te,to the best of my knowledge and understanding. 7 zS Print Owner's or Authorized Agent's Name(Electronic Signature) P ate 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 Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 1 4'2A.Other important information on the HIC Program can be found at k�%�t+_.w;i,- o,i Information on the Construction Supervisor License can be found at 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 Numberofbathrooms Numberofhalfbaths 1. pe cheating s)stent -----_-----_.-- Number ofdecks, porches___------ -- l)pcofcoolingsystcnt_ Enclosed _—_-----—Open ----._-- 1. "'folal Project Square Footage-may be substituted fitr-n,lal Project Cost. CITY OF S UF. NI PUBLIC PROPERTY DEPART1dENT LI fOt�t.aY.urvv i %Awn 13s Q/AWWL�Ofl lTfaR Siu/y MwaAOw>tr'7701f'0 M rs-745.73"•F.ut 976-746.964 HOMEOWNER LICLNSE EXE.N[PTIOM Pleaw Prime Dam 7 // Job Location 10 A 01970 Home Owner Address a o fi Home OwnerTelepboee 7— Prssmt Mailing Address -.5r, wit? Tie current exemption of"Homeowners"was extended to include owner-occupied dwellings of two Units or less and to allow such homeowners to engage an individual for hire who does not pow=a liaasss4 provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Pason(s)who owns a pacel of land on which he/she resides or intends to reside.on which there is, or is intended to be,a one or two family dwelling, attached or detached structures accessory to such use and/or farm structure. A person who constructs more than one home in a two year period shall not be considered a homeowner. Such "Isomeownce shall submit to the Building OQlci4 on a form acceptable to the Building Official, that he/she 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 by-laws and regulations. The undersigned "homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedure equirements. c HOMEOWNERS SIGNATURE APPROVAL OF SUILDLNG 6NSPECfOR See other side for state code CITY OF S.U.E.`i, j1.LiSSACHL'SETTS OLMDLNG DEP.IRTULNT 120 WmjAC4GTON ST xEfiT, Y°FLOOR rM (978) 745-9595 F.LX(978) 740.9846 Kl\®ERIEY DR(SCOLL ,vIAYOR Tko-%us ST.PIERRt3 DIRECTOR OF PLBttc PROPERTY/SCUMLYG CONL\IISSIONER 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 1 11.5 Debris, and the provisions of MGL a 40, S 54; Building Permit t! 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 11, S 150A. The debris will be transported by: ��D�ar✓1 (narne of hauler) The debris will be disposed of in : Ui7/ t(name of facJity)y) (address of facill siynunsre of permit applicant \ �2 date Lbn vR Lc � amaw Flu uaem �u � i w i I me 1 ®ex 0 I ___- ° ° 1 F 640� Y Yv I I 1 I d � I _r---� (—'— null �. 700 w � � a Imu�em wm�me® I I 1 I terse n eel n 10 Lovett Street �, O'SULLIVAN ARCHITECTS Salem, MA AFiGHITEOTI�LiE . OESION . PLANNING N 6V.PM HIREET.BULDINUM9.BUIIE MO.LttNFIELD.I.MBYlON45ET)601P10 T: aaj)IIeG-IM7-P: l7Bt)2q}�E83 •�ywvlovullNenervM1l[eeb.eem iV