150 NORTH ST - BUILDING INSPECTION (3) w ,
a7 The Commonwealth of Massachusetts --" -
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALL'M
Revised.tfur 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fundly Dwellh t{
This Section For Official Use Only
Building Permit Number: Date Applied:
"fbriw U l_
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 LPert\ Addr ss: ^ 1.2 Assessors Nlap& Parcel Numbers
27
1.la Is this an accepted street?yes no Map Number Parcel Nam cr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(It)
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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Re ord: '
ortrckce a-5i,�i/tc�ei ���tsSO,�J s/¢ �;ru r�� 0 r 2
; Ile•(P� City,Slate,ZIP /
Aso nta2rt� S3 �7��Ys 6vs ��l d U2oia-
Nu.and Street "telephone VEmail ress
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Spccil' :
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and %lateriais)
I. Building S 0 00 (f 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S 9mo ❑Total Project Cost'(Item 6)x multiplier x
3. plumbing S '5000 2. Other Fees: S
4. Mechanical (I1VAC) S List:
5. ,Mechanical (Fire S --
Su xession) Total All Fees: S
Check No. _Check Amount:
6. Total Project Cost: S �O 190 ❑ Paid in Full ❑Outstanding Balance Due: _
) ,304 ,00
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(C'SL)
I.icensa N-Ibcr hspirotion Date
Name ol'C'SI- I]older
List CSL Type(see below)
No. and Slrcel 1'ype Description
U Unrestricted Buildings up to 35,000 cu. 11.)
R Restricted IK2 Fmnil Dteellin.
C'itydfown,State.ZIP M Nlson
ry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
'I c lc hone I?mail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
I 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.§ 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) Dale
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 accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agcnts Name(Electronic Signature) 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 not have access to the arbitration
program or guaranty fund under M.G.L. c. I42A.Other important information on the HIC Program can be found at
tltl�t.m;)>..ggc Iya 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. 11.) Habitable room count
Number of fireplaces Number of bedrooms - — ---------
Number of bathrooms Number of ItaICloalhs
1. pc of heating syslmn _--------_____-- Number of decks, porches_
Type of cooling system ----
--. . -_ Enclosed Open
1. "Total Project Square Footage-may be substituted fix-Total Project Cost'
y
CITY OF S'UY. NI, '*YL sSACHUSET rS
Bl:II.DLVG DEPARTMENT
1 120 W.ksHLNGTON STREET, Y°FLOOR
T EL (978) 74S-9595
FAX(978) 740.9846
KIJtHERLEY DRLSCOU.
AAYOR THo.+w ST.PtERtttn
DIRECTOR OF PLHLIC PROPERTY/81LAZI IG COMMISSIONER
Construction Debris Disposal Afriidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section l 11.5
Debris, and the provisions of MGL a 40, S 54;
Building Permit # 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
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
2!2-
signature of per t applicant
l� w
afC
I.hn vl(,6�
CITY OF S.U&M
PUBLIC PROPERTY
DEPART'NLENT
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w.oe t�v��l+.aar•su„w ws�owams ON'0
rY,.sw�,s-ss•s•Y..x r.ar,o.sw
HOMEOWNER LICENSE EXE.MMON
Pkw Fsiet
Dw ev lzo /
Job I.ocados /50
Home owrer Address 7)a Wg p — S
Home owner Telepbone
Presest MaiWts Address .,,s"i' Vi9lzw St-
-no current exemption of"Homeowners"was extended to include ownw-occupied
dwellings of two Units or few and to allow such homeowners to engage an individual for
hire who.does not possess a geensq provided that the owner acts as supervisor.
D INMON 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 shag not be considered a homeowner. Such
"homeowner"shag submit to the Building OQieiak 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 bylaws and regulations.
The undersigned "homeownes''certifies that he/she undmtands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOIMEOWNERS SIGNATURE
APPROVAL OF BUILDING DMECTOR
See other side for state code
14
�a o The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 201l
Building Permit Application To Construct,Repair, ovate Or D olish a
One-or Two-Family Dw ng
This Section For O cial Use Only
Building Permit Number: AAC Applied:
G
Building Official(Print Name) Signa Date
SECTIO 1:SITE Mt TIO
1.1 Property Address: - sessors Map&Parcel Numbers
i5o nJo.�r.Y T. l tom• 47 "dop
1.1 a Is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Proyperty Dimensions:
(V Sro
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
t
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided-
1.6 Water Supply:(M.G.L c.40,§54) 1.7 F.Iood:Zone-Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check ifyesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:Aucoffy SHiPrEY BEyso nJ/� of 70
Name(Print) ' City,State,ZIP
/ea wv27-W Sir. 5/�.Z BS ya Ca)
No.and Street Telephone — V Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building EY Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) W' Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Z Other ❑ Specify:
Brief Description of Proposed Work': 7L CO/VdE¢T / P"�Arloy !te 2 PrtxkriGK AV _
e•udal� �'rS>trir drsfn/ls � �.dcsf�t �vD er+vor/Pr
C v d ho is
SECTION 4:ESTIMAT ONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials �--
1.Building $ Q 1. Building Permit Fee:$ Indicate how fee is determme .
2.Electrical $ �� ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ OQ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Five $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $�iSOv 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Rooling Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,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 Issuance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........❑
SECTION 79:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,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:OWNER'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 accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Siguature) Date
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. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at HMy.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq.ft.) 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"Total Project Cost"
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ZONING DISTRICT - R2
REQUIRED EXISTING
LOT AREA 15,000 4,440
LOT WIDTH 100 86'
FRONT 15 1.1
SIDE 10 0.8'
REAR 30 12.4'
LOT COVERAGE 35% 1 58%
MAP 27 LOT 245
ROBERT C. MEZOFF JR.
CYNTHIA L. MEZOFF
1 STODDER PLACE
1.5'
1't-�j 0.8' LOT AREA = 4,441
i
w 54.00' 12.4'
Ugarage/carriage house
Q2 parking spaces
J
n MAP 27 LOT 2-
9 9, DANIGAYLE HAF
5,CC,r/py y,,OA16 Wtt> STEPHEN R. HA
J c deck 148 NORTH STF
►/ o 0 4't
Uj bulkhead coo
OMAP 27 LOT 246
#150 9.0'
o
a rn `-
e- y
0 1
4.2' 49.34,