135 NORTH ST - BUILDING INSPECTION (2) W-lat is the current use of the Building? —TOOID614 125iU'Z
Material of Building? �� it dwelling.how many units?
Will the Building Conform to Law?�t S Asbestos? '1
Archited's Name R
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# _HIC Registration# T A
Estimated Cost of Project$ 2000 Permit Fee Calculation
Permit Fee$_L`�-- Estimated Cost X$7/$1000 Residential
-- --- Estimated Cost X$11/$1000 Commercial------ -- - --
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated // J
specifications. Signed under penalty of perjury GLL i�
Date
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
MAYOR
M VA*MCMSMW a S,1Lrbt,MAXAC MM OI970
7U.M745-M a FAX M740.9114
Worken' Compensation Insurance AAldaWt: BnUdeyContrutorsmecb(ei&=AMbmT�
Anofkant Information mu
Mt Laftly
Name(Bmiaes>/ dtmq: �2�,n n vv, '�
Address: 1.35 Noram,
City/SIIIAMp: S a,(�w M R 1)19-)o Phone# 918 7 45 3to 9to
Are you a•amplsyor7 Check the appropriate bon
1.❑ I am a employer with 4. ❑ I am s Sound contractor snd I Typo of Projeft(requbvd :
employe"0116 and/or Part-time).* have hired the subwnttactare 6. New conannedao
2.01 am a sole pnvdetw or partner, listed on the awched sheet t 7. ®Remodeling
ship and have no employees These mb.00ntsaetas have
working for me in any capacity. woskm'comp.inmrro . g ❑Demolition
a
(No workma' comp. insurance !. ❑ Ws ace a corpoeatim and its 9. Ong boa
required] oHlcers haw eserciaed their 10.❑Electrical repaiet or additions
3-q I am a homeowner doing all work right of exmnption pet MGL 11.❑Plumbing repulse or additions
my off) 'comp. c: 132,41(4),an ave d we h no 12. Roof repair
t employees.[No workers'
so
Any WHOM 60_ camp romance requited.) 13.❑Other
t Hem wba abaft toh estaesvYmugslso tan ma dw W do'trio,menses; aak>tw.M"porky ini m th a
tCeaaaetaedrtebakddsban matsmsebdaa deodrademtdmouWbem at
aasomm at"saw1E�v sbkdiceftmet<
ehoeiaa dw s®s of dw ad irk"atom•oemp.payay 6damstlm,
Ian an rmployer that ken providing,workers'compensation beswroeee jor my
lwjormadow employees Below Lthe pol/ry anti fo1 do
irtsunnce Company Name:
Policy N or Self-ins.Lie N
Expiration Date:
Job Site Address:
Attach a copy of the workers'compensation Ciostatemp:
Pe policy declaration page(showing the policy number and axpdradoa date)6 Failure to secure coverage as required under Section 25A of MGL a 132 can lead to the fine up u S 1,500.00 and/or one-year imprisonment,as well as civil rrnpoaidon of criminal penalties of a
of up u 5250.00 a day a penalties in the form of a STOP WORK ORDER and a ties Y against the violator Bo advised that a copy of this statemem may be forwarded to the OfIIce of
Investigations of the DIA for insurance coverage verification
[do hereby cardA under thepabas and penglda ojperjlk tke In jornsatiow provldtd above Is bat and corm* 4
Phone •-7�+
00clal use only, Do not write 4 this area,to be completed by city or town ofJfeld
City or Town: Permitviceasd 0
Issuing Aruhor7(circle ):
1. Board of Heg Department 3.Chyfrown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
eron Plane M•
Stephanie and Jason Wachtel
135 North Street
I. Current 3�d Floor Plan Salem, MA01970
(978) 745-3696
Existing Bedroom
i
.1 stairs > > > >
Let
eve
-� *�' �� EnsYng wall outlet
HVAC Unit(m cetl�ng of - - - � -- ,: ,fie s_I
ic accessible via 2 z A Yi igr' nS; —j' [ � ,�� -- ,I ,sue HVAC Mam qp,'l s .x q��
removable panel)` ,� -- =- ----- 'g =--
, A','Rol 'i Existing recessed II hts(new '(
construction)
Existing Office Existing Bathroom
II. New 3r•d Floor Plan
l -
R
Existing Bedroom
Stairs > > > >
ne it+ I Sh�%recessec
lights
to center of hall _
HVAC Unit(In ceiling of n l -- - _- f. -
attic accessible wa 2 x 4't - R a HVAC Mam R -� 1 '.
removable panel) f5 ,,. - "_ -k'i'� Fa' .d�-s^r A�:::_ !) � ' > )
___ __ __
I �
s.New all and a ® 2.New smoke detector
roast door
(aligned whh m
E existing skylight) n-', 3.SM1ift wall outlet
i.A p
p }
New Nursery Existing Bathroom
CITY OF SALEM
PUBLIC PROPERTY
\ DEPARTMENT
KI�'xce�Fv DRISI'OLL
MAYOR I30 wASMNGT0N kRFbT $A'e K Jt.tstAalusETcs 01970
7Fi 979-74S-9595# FAX:979-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date A-13• o
Job Location Lyh
Home Owner Address_ 5a m
Home Owner Telephone 312 • -1 y 5• 4t
Present Mailing Address (_S o ML')
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 who,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 j
"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
PUBLIC PROPERTY
DEPARTI4IE�1T f
1:I�mcn cv D�15CULL
NtAVOI 130 WASMMc.w"bftwr J.LLk1s,vASSAQIt:St:TIS 01970
Tm-979-74S-9S"#FAX 976740.9g"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: V• azV4d Building:
Property Address—t3-5-N o h �✓1 - —-- - - -
5altim (Y\R o1s-10
Properly Is located in a;Conservation Area Y/N N Historic District YIN M
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Cason . aAr1A 5}I p4ta ni[, W ach+r�
Address: (,5tx-ry\c)
Telephone: 9 IS- 145. 3t,91,
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing Z'
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing 1 u O U
Approximate year of Area per floor (so Renovated
construction or renovation 199b
of existing building New
Brief Description of Proposed Work:
Ivlst41 1L Woj vjjJ'A L, rot)�wf Aavf on 3Y- Ftaor (Cone
QAi&) b urG t A- b xlZ ' �It�rstvl{ avid hcll.Jo•1. ProJt� mwlvt�
AgAin somt tiK1ski ek-t, Yi W Jwa Hv pc, coo.1�cyjii�, a, 01
J
—_-- Mail Permit to: Tn,�r a ry�4 c .oha rn c W ti Lrl j 135 Nn o'h --