18 MARION RD - BUILDING INSPECTION The Conunonwcalth of Massachusetts
I � Ft A2
Board of Building Regulations and Standards
Nit INI('ll'.\'.I'll
t j MaSSaCllLlsettS State Building Code, 780 C'NIR, 7"' edition tilt
Building Permit Application To Construct. Repair. Renosate Or Demolish a Rciive l.1alf,W)
One- or Tit'u-1 iunih,Dit elling /. _00S
This Section For Official Use Only (�
Building Permit N tuber: Date Applied:
it tg oonuills amilAnsficcior of&iddings Date
—�
SECTION 1: SITE INFORMATION
Ll Pro// �i
p/erly Address: 1.2 Assessors Map & Parcel Numbers
is
( l.la Is this an accepted street? yes _ a�_ Map Number P:ucel Number
r
1.3 Zoning Information: IA Property Dimensions:
4 Zomng District — Proposed Use
Lot Area(sy lt) Frontage (It)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
I _ ReyuireJ Provided ReyuireJ Provided Required Pnrvidcd �
1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal 1
Zone: _ Outside Flood Zone''
Public Private❑ Check if yes Municipal f On site disposal system ❑�
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ' ✓SG
Name
� ((PPrintt)) Address for Service:
IGJh"'."�._ —.f. �C7�eAtcn�r�rr..�r"v Q7Sr��16C5"—ilR'o.� __
a Ignamre Telephone _
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Q?nstrucuon Existing Building 151- Owner-Occupied ❑ Repairs(s) ❑ Alter_tion(s) §Z.. \dditi.m ❑
--Deemmollition ❑ i Accessory Bldg. ❑ Number of Units Other ❑ Spccify: _.—_J
Brief riel Description of Proposed Work':,N\3'�)
I
j SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ QD
L Building Permit Fee: $_ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ 0 ❑Total Project Cost' (Item 6) x multiplier .x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ b List
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash :\nu,unt -_
b. Total Project Cost: It 7 SQL OPaid in Full ❑ Outstanding Balance Due:____-_
I
i
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number F,\piratiun Date--
Namc of CSL- 11older
List CSI_'p}pe(see belusvl _
\JJress Type r Desci loon
L Unrestricted 1 u r m 350)0 Cu. Ft.)
R Restricted I:c'_ Famll\ Deelhne
Signature M Masonn Only
RC Residential Routine C'otcrme
Telephone \V'S Residential \Vlnduw ;wd Sidme
SF
EResidential Solid Fuel llunune \ >>hancr In,t,ill.iw-n
U Rasidenuul Dcuudwon
5.2 Registered Ilome Improvement Contractor (HIC)
HIC Company :Name or HIC Registrant Name Registration Number
Address
Expiration Date
gnaturr Telephone 1
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. I:more 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
V OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,.�NFie�4S !T' C.r�lL+Joh as Owner of the subject property hereby
authorize to act on my behalf, in all m:tters
relative to cork authorized by this building permit acplication. _
Signature of Owner _ Date _.
f�— SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
i
/ p
I L LhAnLes /a_�2r7o^__....-_ _ _. as Owner or Authorized Agent hereby decl:ue �
that the statements and inF)rmation on the 1 Iregcing application are true and accurate, to the best of my knowledge and
behhal/r. [L I
Prim= me
�,.c--ems �.c7r _uST -oob�
Signature of Owner o Authmized Agent Date o
✓ (S(gned under the ain%and penalties of perjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or:n 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. I.12A. Other important infornuttioa on the HIC Program and
Construction Supervisor L :easing (CSL.)can be found in 780 CMR Regulations 110.R6 and 110.R5, respectively.
'. When substantial work is planned, provide the information below:
Total flours area(Sq. Ft.) _ (including garage, finished base men t/att it:s. decks or porch)
Gross living area tSq. Ft.) -__ Habitable room Count _
Number of fireplaces_ Number of bedrooms -_
Number of hathroums _ Number of h::lt/baths
Type of heating system __._ Number of decks/ porches
Type of cooling system Enclosed ---- Open
3. "Total Project Square Footage- may be substituted for "Total Project Cost"
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
HAvaa 130 WA"N.ROM SMW 0 WAMC VASKA00 MM 01TM
7ffi.9 W745.9S95• FAY:97L7409"
HOMEOWNER LICENSE EXEMPTION
Pteau Print
Date — e,s' z
Job Location aq /�Jo ,D le/� M��p/ /3
- Ts
Home Owner Address �l A' Mr�2 no r .Po�a r S!i/�c.», .Cf�s±ss �•� -
Home Owner Telephone �4 ZZ 7j,'.5=Hx6� /'i! I -, —�/� -44SX9
Present Mailing Addrea /f( 1y1i4e�6r� i?v;90 Sislr_nw /j1/JtcAG�_w.S .TI S _ x
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or leas and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons)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 dwellin& attached or detached ,
such use and/or farm structures. A n who constructs more
structure accessory to P�
than one home in a two yew 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 understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE /
APPROVAL OF BUILDING INSPECTOR
See other side for state code
1
CITY OF SALEM
PUBLIC: PROPRERTY
DEPARTMENT
I�: U '• L".,.., '.11.+II f • 1\II11, \L\• \i •. I . • _I'I -.
I I I V•R.-t;. i;a; • 1 \v. 'i'B V: 1.14,,
Construction Debris Disposal .-affidavit
(required Ibr all demolition ❑ id renovation work)
In accordance \%ith the sixth edition of the State Building Code, 780 CNIR section 1 11.5
Debris, and the provisions of.b1GL c 40, S 54;
Building Permit it is issued with the condition that the debris resulting front
this work shall he disposed of in a pruperly licensed waste disposal facility as defined by MGL c
111, S 150A.
The dehris will be transported by:
Q CL�(L
(name of hauler)
The debris will be disposed of in
(uamr ut laeilily)
fat � �.�� �+ ���L� mr�•
1:Iddre;i ur gcllitv7
.Ignalwe , t p:nnit .ygtheant
,lalr
MARION ROAD
L=61.00' R=858.88' 23.44
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7,936 S.F. 90
1 13.65'
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OF MASS9c
02 DENNIS yG
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2 ' McMANus
#35 40
a P
SUH`�
TO: METRO CREDIT UN/ON. MORTGAGE PLOT PLAN
I CERTIFY THAT THE DWELLING SHOWN IS LOCATED ON
THE GROUND AS SHOWN AND CONFORMED TO THE IN
ZONING SETBACK REOUIREMENTS FOR SALEM, MA AT
THE TIME OF CONSTRUCTION, OR IS EXEMPT FROM SALEM, MA
VIOLATION ENFORCEMENT UNDER M.G.L. TITLE l
CH. 40A SEC. 7. DATE.' 11128107 SC4LE.- 1" = 20' JOB. N0. 97155510
NOTE — THIS PLAN WAS PREPARED FROM LANDMARK
A TAPE SURREY AND IS INTENDED FOR
MORTGAGE PURPOSES ONLY. OFFSETS ENGINEERING & SURVEYING, INC.
SHOWN ON OR SCALED FROM THIS PLAN 58J CHESTNUT STREET
ARE APPROXIMATE AND SHOULD NOT BE LYNN, MA 01904
USED TO DETERMINE PROPERTY LINES (781) 592-7016