9 OAK ST - BUILDING INSPECTION fhe Commumvealth of Massachusetts
� � �'� ---- — crry of --
a� �j'��- l3oard of[3uilding Regulations and Standards
ap��4;, ' Mnssachusetts State [3uilding Code, 780 CMR SALGNI
'y.��, . Reria�rJ.1/ur=0//
Building Permit Application To Construct, Repair, Renovate Or Denwlish a
Our-ur Twu-Fuinilv�we!lin,��
"Phis Section For O(ficial Use Onl
Building Permit Number: Date Applied:
[3uilding Ot7icial(Print Nwne) . Si�;nature �te
SECTION 1:SITE INFORM1IATION
1.1 Property Address: L2 Assessurs Map.4� Parc 1 umbers
�l oA� ��-
I.I a Is this an accepted street?yes� no Map Num6er I'arccl Number
1.3 Zaning Infarmation: I.J Property Dimensions:
R-z-
Zoning Dislricl ProposeJ Use Lul Arca(sy It).. Pronluge(�i)
1.5 Building Setbacks(ft)
Front Y;vd Sidc YarJs Rcar Yard
Reyuired Providcd Requircd Provided Reyuircd PravideJ
1.6 Water Supply:(M.G.I.c.J0,§SJ) 1.7 Flood one Information: 1.8 Sewnge Disposal System:
Zont: � Ouvide Fiood Zone?
Public,� Private❑ Check ifyesO Municipal,$-On site Jispwul system ❑
SECTION2: PROPERTYOWNERSHIP�
2.1 Owner�of Reco
/��tt�� ��. 1-4�-,� '1(�uSi �d���, ��. n t�'�Y_'�
N;un�(PrinQ Ciry,Smtc.'l.IP �
`� 0E�-� �`� �'1f�-'1'��-�1 � Q +n-S�_Re,`�
Nu.and Street "Pelephune FIIIJII AtICR:55
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
NewConstruction❑ EsistingBuilding� Owner-Occupied„Q.� Repairs(s) ❑ Alteration(s)J� Addition ❑
Demolition ❑ Accessory81dg. 0 NumberofUnits L Other ❑ Specil'y:
Brief Description of Proposed Work': � N
5
�
SECTIO�a: ESTIAIATED CONSTRUCTION COSTS
Itein Estimared Costs: Ot7iciul Use Only
Labor and \laterialsl
I. 6uilding g G� a e� I. Building Perniit Fee: S fndicate how fee is detennined:
'. Flectrical g �Standard Ciryll'own Application Fee
. a��^� ❑Total Project Cost��Item 6)s multiplier x
3. Plumbing S ( o� o, 2. Otherfees: S ��h � �
1. .\Ixhanical IHV:\(') 5 List: v .
S. �\Icchanical IFire g
Su�uessiun) Total :\II Fees: S_
Chcek Nu. CheeA Amuunt: Cush :\muunt
G. Tuhrl Praject Cost 5 �"�� p p�id in Full O Oulstanding [3al;mce Due:
�` ,�e�G �a��
��� � � ���
r��,�� ���-���- 9 �� sfi
SE('"1'ION 5: CONS'I'RUC'PION SF:RVIC'F.S
5.1 Cunstruction Supervisor L.icense(CSL)
I.iccnx Nunthcr If.�pimlion Du�c
Namcu(CSLlluldcr --�— ---
List Ctil.�Opc Iscc bclu�cl
No. and titrecl ��ype Dexriplion
U UnrcstricicJ 13uildin�s ii io 35.000 cu. Il.l
R RestricteJ Ide? I��unil D�cellin�
Cil�'lfu��n.Slalc.7.IP M M;isun
RC Roulin�Covcrin
W'S Winduw and Sidin -
SF SoliJ Fucl Burning Applianccs
I Insulatiun
"fcic honc Ifinail ndJnss U Demolitiun
5,2 Registered Ilome Improvement Contr;ictor(HIC) .
IIIC Rcgistrotiun Nwnbcr I'.spir,uiun Uatc
I IIC Company Numc or I IIC licgistmnt Nmnc
No. w�J Street Emuil aJJres�
, Ci lTown, State,ZIP Telc hone
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 Attached7 Yes .......... ❑ No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COM1IPLETED 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.
Pnnt Owner's Name(Electronic Signalure) Date
SECTION 7b:OWNER� OR AUTHORIZED ACENT DECLARATION
By entering iny name below,I hereby attest under the pains and penalties of perjury that all of the information
��ined in,this appli ation is irue nd ac ate to the best of my knowledge and understandin�;. .
/ A
�i,�,�l `� �---- �-2a - l �
I uu O��ncr's ur AuthurizcJ Agcn �Namc Iilcctrunic Signature) Dutc
NOTES:
i. :\n Owner who ubtains a building permit to do his;her uwn work,or an owner who hires an unregistered contractor
(not registered in the Hane Improvement Contractor�HIC) Program�,will i�o�have access ro Ihe arbitration
program or guar;mty fund under\I.G.L. c. 1�12A.Other important information on the HIC Program can be (uund at
y����.ni;i.,.�,�v��c:i Information on the Construction Supervisor License can be found at q�����.nr_ig:.g��� 'J��_
?. 11'hen substantial work is plmined,provide the inf'ormation below:
Total flour area�sy. ft.) _�including garaga, finished basement'attics,derAs or pordil
Gruss li��ing area Isy. R.1 Habitable room coimt_
\'wnbcr uf tircplaccs---- — Vumber of b�drooms -------_-_--_--_—
Numher uf bathroums Vumbcr uf halCbaths
1)pe uf hcating spsicm -------- ---- Numbcr uf deeAs�porches------ - --
-('ypeofaoulin¢ syslent _ f-:nClosed OpCn
1. "foial Projecl Syuare Puutagc"ma�� b�sub,�i�utcJ ti�r"futal Prujact Cnst„
� CITY OF S.�LE.�t, ��L�SS.�CHL'SETI'S
' BI;ILDLVG DEPARTIE�:T
' 120 W.iiHL�IGTON STAEfiT, 3iO FZOOA
� I�L (97� 715-9595
F,�c(97� 7�9846
!ClSBERLBY DRLSCOLL
1�UYOR 17to.�us ST.Pce�us
DfAECTOt OF Pl:BLIC PROPEA7Y�BCIIDLYG CO]OIISSIO�ER
' .Construction Debris Disposal At'fidavit
(required for all demolition and renovation work)
[n accordance with the sixth edition of the State Building Code, 780 CMR section t I I.5
Debri�, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the dcbris resulting from
this work shall be disposcd of in a property licensed wasta disposal faciliry as defincd by bIGL c
, l 1 l, S I SOA.
� The debris will be transported by:
Gt�gS{��—i� Vclar�L3. �..5�'j��A-�
(nrme oYhauler)
The debris will be disposed of in :
(name of'Faciliry)
4' O��. ST �A�-�M i'-'�A_
(addre�s oP facility)
siyn�wre of permit applicant
tIAfC
� khnulfJ�w
� CITY OF $.�L.E.�i
PUBLIC PROPERTY
DEPAR'I'�(EN'I'
U,a...n�Y..
w�.�a. i]0a��u.r.,aM�r.,sr.su.,l w,a�ow,fms olf'0
itL 9:L7i19S!!�F.�t f.'L7J69W
HONEOW�IER LICE.�1S6 EXE.�[PTIO�I
Ptew hi�t
Dw Co�2�" 1�
!ob Laeatias � �c�k- S^ Ss� ��.r� 1 ,�t,r�
Hom�Ow�ner Ad�es� -�A^C1�
Hom�Ow�ner 7elep6oe� � ��- 423 - �.148
�,eoc�s wam�,.
The cunent acemplion o["Homeownen"war actadad to inelude oaaar�ccupied
dweUin�ottaw Unit�ar Iw aod w alloa sueh homaownen W masQe an individua! for
hirs who doa eot possar a Geen�provided that th�oana acb ar aupmvisor.
DEFII�l11TON OF HOMEOWNER .
penon(s)who owm�a p�ree)ot iaod on w6ieh hd�raida�or intend�w raidq,on
which thais ir,-or is intended to be.a one or two family dwellfn�at�ached or detached
stncnuea acceswry to euc6 uae and/or farm awcnua. A penoo who coosauca moro
chan one hoau iu a two yar pwiad�haU not be cowidaed s homeowna. 3ue6
��}�aneowner'ahall aubmit w the Buildin�O�eial.on s toea aueptable to the Buildin�
Ot�feial. ehat hdahe be resporuible for all auc6 work perfoened uader the Buildin�
PmniR
Tha undeni�ed "homeownd'as�uma raporoibiliry for compliarxe with the State
Buildin�Code and oeha appiieable by-laws and ro�ulations.
The undmi�ed "homeownd'cerofia that hd�he undmtandi the Ci ty o!Salem
8wldin� Oryartrnrnt minimwa insparion proeedura uid requircmrnu and thu hdshe
wiU compiy wi�h eaid proce�dura and requiremmts.
HO�tEOWYElL4 SIGYATL'RE � �
,�PPROVAL OF BUfLD(.�fG G�iSPECTOR
See o�ha side for stata code
' 52�5"6/16"
16'-91V16"
11._0" �3'-�" ,2'-01/4" ' � 8'-11/4"
��nk� DW
�_ ' _ ' ' ' dispozal ' — — — O O I
i
i �i r _ _ ' _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ "
� � rn I
� �
g 5 T.�. � I
5 ove GUESt � `O "
� 6ED ROOM �0'4"" MASTEP, BATH
00
13����2 , , KITCHEN �S w S
i i � �
i � .. p
� � �
i � V
i i
� ' ' � � MASTER BED ROOM �a�-3 va
C�
REF. �
F-
w
i 2T-219/64" N
O
J
U
14'6"
14'-051/6 " -� � �'.
�
22'-5"
TV
UP ,� �p DOWN
8'-3 5/16" 4'-111l16"-�'
r
SHOWER �
, , l I
,
° � ' ... __
OFF]GE - -- ' ' �T
❑� --- —� -
o � �0,.8„ - _ _
� _ .
,r-,,,z�� o
2/23/11
LAPERGHIA RESIDENGE 2nd Floor Date: Drawing Number
W&D 9 Oak St. 5alem Ma Revised: 6/1/11
STACK ReviSed:
.��irre Cti'Qed�arks C�7nc.
F'ro"z Entran� �rchitectural�llr�6rk Pe"'SPd:
i4�-43ia�� 14���° �enerrC�akQ�t Cahalem, C4T'ao�97o 5cale: 1/4"=1'-0� i��
� � '�er� a.� �� � ra�Nn 6 : �.r.�. , AWl �,��,' �.
� v_. ---- —
52'-5 3/16" `
—16'-911/16"
11'-0" �3'-0" , 2'-01/4" ' H'-11/4" �
51nk1 �
� __ _ _ ' ' d:s�osal DW— — — r— � �
i �
� N� � - - - - - - - - - - - - - - - - - - - - - I
� �
� 1
g 5 T.�i. � � ��
s ove GUEST
� BED ROOM �o�-0�� MASTER B�,TH
00
13'-i t/2" KITCHEN �S W S
� � �
� � �
� � 0
� � �
i
� U
i i
� � � � MASTER BED�OOM ia�-3 va
�--�
REF. �-
w
27'-2 19/64" �
O
�
U
14'$„
14'-0 51/6 "
�
2z-5��
�I
i
, � Qs Up DOWN
8'-3 5/to' 4'-111/16"�
I
SHOWER O - :; ����CII . _
� � - ,. .
. � .
� OFF]CE `- � (.� - - - : J
O �0,_8,� "�_/' - --- -
; o O _ .
, ,r-,,,z�� o� � ' : -
�
� LAPERCHIA RE5IDENCE 2nd Floor Date: 2/23/11 Drawing Number
W&D 9 Oak St. Salem Ma �evised: 6/1/11
STACK �evised:
��ine tC�6�dwarks c7nc.
Fr°"t: E"rrance �lrchitectural�llx�6rk �e'"�ea:
�t
�4�-0° 5cale_ 1/4 =1'-0 ';, •
ia'-4 3/4° C�ene�r C�ak Q7t. OFalem, GCfa o�97o Aw� .'
_ �el/�F'`zz9����—_ �rawn� R.T.L. � --
1
1' _ _ --- ---- —