7 MARCH STREET CT - BUILDING INSPECTION (2) �
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� The Commonwealth of Massachusetts CITY OF
��9 Board of Building Regulations and Staudards SALEM
� Massachusetts State Building Code, 780 CMR Revised Mar 2011
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Building Permit Apptication To Construct, Repair, Renovate Or Demolish a
��� One or Two Famaly Dwel[tng
� 1 ^"� ' '- �This S�ot�on For O�Ficial Use Only '` > �";Q " ` v� Y
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4h.��. >I� :ii Mp'3. Z �, t ,�E
Building PermitfNumber ' �' �e p ied . „ _
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�Buttding Offic�al(Prm[,Name)��k ' ..t , ignaYure � ��- , „ . �� x �
Dae
'. SECTION 1: SITE INFORIVIATION = -,'"_
1.1 Property Address: 1.2 Assessors Map & Parcel Numbers
� Ma�CV� S'�✓"ce-{- �ov✓ �4
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 Setbacics(ft)
- Front Yard Side Yards Rear Yard
� Required ProviAed Required Provided Required Provided �
1.6 Water Supply: (M.G.L c. 4Q§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
/ Zone: Outside Flood Zone?
Public E3 Private ❑ Check ifyes❑ Municipal L�On site disposal system ❑
�'SECTION 2'i PROPERTYbWNERSHIP,';" , •t = _ :: % '` ` '
,... :
2.1 Owner'of Record:
Mc� a � �-- �al�vr w��l c�( q�
Name(Print City, State,ZIP
1 MarCv� S�i�eet Ccx.�� q�� saoqss�t MA�i.v�n �3@vhSY��Gom
No. and Street Telephone Emai]Address
` SECTiON 3: DESCRIP.TION OF,PROPOSED WORI{Z(che.ck all that';apply) - �
New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) C� Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
BriefDescriptionofProposedWo Z � � OY Q IS�^ �
� � �
� - .... � �_. . . : . ' it.. � '
SECTION 4: ESTIMATED.CONSTRiJGTION COSTS ,� •�- • ` ` �
�
Item Estimated Costs: ��. OfSaial Use Oq1y
Labor and Materials x f
1. Building $ OJ 1 Buildmg Permit.Fee $ Indicatehow fee is determined:,.
❑ Stand`ard Ci,tylTown Application Fec:'
2. Electrical $ �� ❑ '�otaL Pcoject Cost',(Item b):x multipli$c x �
3. Plumbing � -- Q � 2 .Qtti,eiFees '$ : �,;_
4. Mechanical (HVAC) $ List: '
� <..
5. Mechaoical (Fice � Total All Fees. $ : t
Su ression) Check No. Check Ainount = <~' Cash Amount
6. Tot�l Project Cost ��� �� � ❑ p�id in_Full � � ❑�Outstanding$alance 17ue
� �.���T"�-����
—
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� � � �� ' � ���S�EC`PION�S: CONSTRUCTIONSERVLCES ".> � �-� '� �� � � ��' � ' �-
5.1 Construction Supervisor License(CSL)
� License Number Expiration Date
Name of CSL Holder '
List CSL Type(see below)
a—"r ,.
No. a�d Street -�,Type ^�.;.�� �rt Description�,
�� U Unrestricted Buildin s u to 35,000 cu, ft.
R Restricted l&2 Famil Dwelfin
Qry/Town,State,ZIP M Mason �
RC Roofin Coverin
WS Window and Sidin
� SF Solid Fuel Burning Appliances
� I Insulation
Tele hone Email address D Demoli[ion
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Narne .
No.and Street
Email address
Ci /Town, State,ZIP Telephone
` SECTION 6: WORKERS' COMPENSATION INSLIRANCE AFFIDAVIT(M.G;L. c. 152:f§, 25C(6))
Workers Compensation Insurance affidavit must be completed and submi[ted 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 i`
OWNER'S AGENT OR CONTRACTUR APPLIES FOR BUILDL�IG PERMTT'.
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
SF.CTION 7b: OWNER'. OR AUTFIORIZED f1GENT DECLARA-TION ' "
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.
UGUl� � (/ /�,�r�L
rint Owner's or Au[horized Agent's Name(Etectronic Signature) Date
NOTES:
L 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. a 142A. Other important information on the H[C Program can be found at
�acvw.iriass. ov�oca Information on the Construction Supervisor License can be found at w��w.mass.eo�:ctns
2. When substantial work is planned,provide the information befow:
Total floor area(sq. ft.) (including garage, finished basemenVattics, decks or porch)
Gross living area (sq. ft.) Habitable room count
Nwnber of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Encfosed Open
3. "Total Project Square Footage"may be substituted for"Total Project CosP'
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,;;ti.�"` CITY OF S.1I.E1�I, �L-�SS.�CHU5ETTS
, B�:ILDL\G DEP.\R'I1lE.�iT
� � '� ' '�' � ` 130 1�.1SHINGTON STAEET, 3"D F1..00R
`�. �.�., z� ���a� ��s-�5�s
F.,.r���a� 7�o-�aas
���FRT RY DRISCOLL
tiL�YOR Tt-to�G+s sr.P�xxs
DI2ECCOR OF PL'BLiC PROPEA'fY/HCILDL\'G CO�L�IISSIOrER
Canstruction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section 11 LS
Debris, and the provisions uf biGL c 40, S 54;
Building Permit i# is issued with the condition that the debris resulting &om
this work sha(1 be disposcd of in a prop�rly ticensed waste disposal Facility as defincd by NfGL c
111, S I50r�.
1'he debris will be transported 6y:
C CP S�I IGl
(namn af hauler)
'Che debris will be disposed of in :
—�.c�1��- _
(name of Facility) � . �
_1�1�wbi,c�a S� ���cY��
(addres.a oF fhtilit%)
s � a f pa�mit applicant
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; CITY OF S.�L.E.tiI
PUBLIC PROPERTY
� DEPAR'T.tiiENT
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w1O� i ao v�w�.rsm.l+.ur�su.+�wa�oR am o�f-o
iti 1'L1�i73ff�Y.ut f'L7�O�W
HON�OW�IEA LtCE,�IS6 EXE.rtPTI0�1
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xom.o�.+e�+�,._ � n-���-�i, s+ �
Hom�O�var Telep600� 9�-Q s>?n 4 S�Z R
Presmt Mailin�Addrear � M��rL, St C f
Th�ourreot acemptios ot"Homeow�eaw"wa�e�taded w iaalud�o�-oecupied
dweUln�t ot two Uniu at 1w aad to aUow a�ch homww�nees W aaQs�m individual tor
hirs who.doa not poaia�s liom�Pi'ovided t�at thI ow�aQ acb a��uparviaor.
DEFIIYITION OF H011�OWNER
Penon(�) w6e o�a piu+eei ott.pd os aMc6 hd�ratda�or iatend�w raid�. os
whia6 thera i� or i� inteaded to M.a on�os taro family dweWn� aetaehed or detached
�wenua seceswry w ruch u�and/or farm�Weturea, A penos who comaucts moro
chan on�hom� in s nvo year paiod�ha11 not b�eonsidaed a homeownar. Sueh
..}fomeowned'ahall tubmit W th�Buildin`OQleial,an s fortn acceptabll W t1u Buildin�
OPAeial. that hdeh�b�mponsibt� for�Il �ucb worlc performed uadar cht Buildins
Pmnit
The undari�ned "homeownd as�uma reaponsibiGty Cor complianc�with �h�Sht�
Huildin=Cod�ud otha appliab(t by-law� usd ro�ulstioru
The undmi�ed "homeowna''certifia thal hd�he undmtandi tha City of Sslem
ewldin` Departrnmt minimiun irupection procedura and requiremrnb and that hdshe
.vill comply wi�11 �aid proca�dura uid requiremrnts.
NOtitEOWYERS S[GYATL'RE i
;\PPROVAL OF BUILDLYG L�iSPECTOR
Sea oiha sida for sqte cod�
. :,
3rd FIOOC AttIC
y.
Smoke/Carbon detector � O
,_
2"a Floor Hall Way O �— Smoke/Carbon detector
Maryann Kocur
7 March Street Court
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Maryann Kocur
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SALEM , MASS
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PROPOSED ADDITION
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