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17 LOVETT ST - BUILDING INSPECTION (5) The Conimomvealth of Massachusetts REC. JVE Board of Building Regulations and Standards IN'SPEGTIU. AL � NI Massachusetts State Building Code, 780 CMR Revised,ttar?211 Building Permit Application To Construct, Repair, Renovate Or Pe O u P One-or Two-Family Dwelling t This Section For Official Use Only Building Permit Number: D, Applied: 2y,.ro 1/ / uiWin•OI11Cml Print Nmne). _ Signature Date D 6 SECTION L SITE INFORMATION` I. Property Address: /.7 LeVe i l S1 - 1.2 Assessors Nlap& Parcel Numbers I.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(sy 11) Frontage(11) 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public[3 Private❑ Check if es❑ SECTION2: PROPERTY OWNERSHIP! 2.1 Own&Mein: -rllh� �'aleir) /yd /g7/5 t�thme(Print) f City,State,ZIP—' /% (_ove_f+,S 1 . 97f-gf34-10y3 No. and Street Telephone Email Address SECTION 3. DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ 1 Existing Building❑ I Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition Cl 1 Accessory Bldg.❑ 1 Number of Units_ I Other ❑ Specify: �of Descriptio of Proposed Work-: /✓fl/��/1 /'�' X �L ' she-d/ byr / P /' SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only [(cut Labor and Materials) I. Building $ I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ PgtherFees: S � Lt. Mechanical (FIV;\C) S List: c 5. i\lechanical (Fire S 'rotal All Fees: i Su ression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ L/OQ© • OO ❑ Paid in Full ❑Outstanding Balance Due: Mra\ LG-D -M "-o . II(-7114 I SECTION 5: CONSTRUCTION SERVICES 5.1 Cmistructioti Supervisur License(CSL) P r _ License Number Expiration Date Name ofCSL holder' jyIr tic List CSL'rype(see below) Type Description No. and Street U Unrestricted Duildin s Lip-to 35,000 cu. It.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP NI Masonry RC Roolma Covering WS window and Siding SF Solid Fuel Burning Appliances I I Insulation -" —Telephone Email address U I Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Cump:my Name or HIC Registrant Name No. and Street Email address Cityfrown,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 Isivance of the building permit. Signed Affidavit Attached? Yes .......... 13 No........... ❑ SECTION 7n:OWNER AUTHORIZATION,TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize t9 act on my behalf,in all matte relative to work authorized by this building permit application. PrOwner s N to( tromc Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 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 Signauve) 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 in the Home Improvement Contractor(HIC) Program),will nor have access to the arbitration program or guaranty fund under�NLG.L.c. 142A.Other important information on the HIC Program can be found at ��o www.mass. v'oca Information on the Construction Supervisor License can be found at wtaw.mass. •ov!dns . 2. When substantial work is planned, provide the information below: "rota) floor area(sq. ft.) '%;(including garage, finished basement/attics,decks or porch) Gross living area(sq. It.) 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"rued Project Cost" CITY OF SALEM, NIASSACHUSETTS A � BUILDING DEPARTMENT � Ali 120 WASHINGTONSTREET,3"D FLOOR TEL. (973) 745-9595 FAx(973) 740-9346 KINMERLEY DRISOOLL MAYOR THONfAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONINQSSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date // ' y— /Y A ,� Job Location Love tT V V of /QWl 'v, Home Owner Address cS a fry / Present Mailing Address c. ` Lnj The 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 that does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel 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 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 Official, on a form acceptable to the Building Official, that he/she be responsible for all such work 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 understand the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with such procedures and requirements. HOMEOWNER'S SIGNATURE��e� APPROVAL OF BUILDING INSPECTOR