12 OAK VIEW AVE - BUILDING INSPECTION T-0 - N - ZZ8 e� 'l4a71i
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applie
Building Official(Print N re) Signature ate
SECTION 1: SITE 11NFOINATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
L is 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 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:
Zone: _ Outside Flood Zone?
Public 0� Private❑ Check if yes0 - Municipal gi-l6n site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
��N/tZ NH1L S/rtLE7/J . M.a. D/970
Name(Print) City,State,ZIP
/2 91d•945•7?*7
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ 1 Addition
Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': 7D ,��lb!/FiYrUpP j/r/- —AX) 7/,r* e,07,Xr i y�
A 2 57UQy l rICA11 F4
h&zf/l /s 730msFD aN /ZkE�/s Xy 17-mem-w) egPirF/,v zw-wM SJ
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1-0 OGd - 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ f A0p 1 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 159 "j-d o [Kaid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
,/o a/,V /-/. '�/L pp/Zrj� License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) L(,
395 ./Esi�`fzsoi/ .11r�
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.R.
�AL Ply—
&1/1 QQ R Restricted 1&2 FamilyDwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
97�-S8J- /59L ✓NA/Gat�"�j/nB/C. etir 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
/3/S J/v , �G/'ene/L
No.and Street Email address
MsnfTl.�/�At7, Mia. 0/995. '/B/�.3/—o?/O
Ci /Town,State,g Tele 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 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,/Oh'N N. �/CA P/ILLO
to act on my behalf,in all matters relative to work authorized by this building permit application.
ypw/EL
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.
O to 10 •l9
Print Owner's or Authorized Agent's Name(Ele nic Signature3 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
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.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"
CITY OF S U-F--,%f, lY xs&Ll.HUSEl 1S
BUILDING DEP.1UNLEINT
120 WASHIINGTON STREET, 3aa FLOOR
TEL(978) 745-9595
F.%-x(978) 740-98-i6
KI.NfBEnEY DRISCOLL
.YL'tYOA THOStAS ST.PI&QRS
DIRECTOR OF PL•BLIC PRO PERTY/BUll-OLNG.CON LMISSION El
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Annlicant information P►cate Print Legibly
.N:Imt:(Businusa,Orginiralidrvindividual):
Address: 21U• /3/5.
City/State/Zip:�feilSit�lf71'i�.h7ov, de`245 (hone hl: __ '76,1—G31—Q?
Ere you an employer?Check the appropriate box: 'ryps of project(required):
11.E I am a employer with—Jo 4• 0 1 am a general contractor and 1
employees(Nit and/or part-rime).• have hired the sub-antrsctors B' ❑Naw construction
2.❑ I am a sole proprietor or partner. listed on the attached.rheet t 7. Remodeling
ship and have no employees These subcontractors have It. Q Demolition
working forma In any capacity. workers'camp.Insurance. 9. 0 Building addition
(No workers'comp.insurance S. Cl We are a corporation and its
required.) officers have exercised their 10.❑Electrical repairs or additions
J.❑ 1 sun a homeowner doing all work right of exemption per MGL I I.[]Plumbing repairs or additions
myself.[No workers'Gump, c. 152,11(4),and we have no 12.❑Roof repairs
insurance requiredJf employees.[No workers' IJ.QOthet
comp,insurance required.)
•Any ari llca is dial0wka bax.el l mug aim 1111 uut the aceliva below ahawing lhek"I rrY mmpensadun puacy inlinm ulo4
t I hvnuuwrnvr who Suhmit this aRldsvis indleaing they art doing all work and thou hire ounidecemmorare mug submit a new amdavit:ndlawris rush.
:Conimuiors that uhcek this box most aaoehod an addtdurud sheet Showing the name of the mf♦eonita$Wrs and their"riggers,comp,policy InfotSnados.
l um on rntplayer that/s prav/dlnB workrrs'compratadent Insurance for my employer% Brlaw is the polity and Job site
injormalloa.
Insurance Company Name: C>1 wpe-> a'a.IS. L�
Policy 4 or Self•ins. Lic.ll: A510 96,1 q. Expirution Date•A-23-
JobSilarAddress: _2. eQAre✓IEh/ AV9- City/Statetzip., SALV''I, '740
Altach a copy of the workers'componsatlos pulley declaration page(showing the polity number and expiration data}
Failure to secure coverage as required under Suction 25A of MOIL c. 152 can lead to the imposition of criminal penalties of a
tine up to SI,500.00 and/or one-year imprisonmen4 as well as civil ponAtias in the farm of STOP WORK ORDER and a tine
of up to 5270.00 a day against ilia violator. Ile advised that a cupy of this statemunt may be furwardud to the Of tica of
bavvvig-Auras of slid DIA far in.mrmice cavcraga vcdlleutium
/Ju hrrrby rrrrljy attJir rhr pulps wnd penahlas ujprr/ury that rhr brfararudar proviJad ubuvr is trot and eurrret
ii:n;nure: �ar6 Ihlta: �,?U�/9.
r t,112,i 31— 0310
U/Jic•iu!Sur ugly. Oa not rvrite in thlr unay to he aamplited by city at town n/Jlrla!
city nr7uwn: _ Permit/1.lccme.9
kitiing AWhurily (circle one).-
1. Iloard of Ileallh 2. Iluildint;Dcpartnimlt I.City/fnwn Clerk J. filectrlcal i tipector 5. Plumbing inspector
6.Other
r'4n19C1 I'crsnn: .... __ Phone 4:
f
IVY
CITY OF S�1LzNf j%LkSSACHUSFTI'S
t BUIWNG D EPARTtExr
TON STREET, 1 FLOOR
-� TEL. (978) 745-9595
ICf 0FRI Y DRISCOLL F.+x(978) 740-9346
NLAYOR TPIONW ST.PIERM
DIRECTOR OF puouC PROPERTY/8L'ILDL1tG CO3L\lI55IUNER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section l l 1.5
Debris, and the provisions of tMGL c 40, S 54,
Building Permit 1k this work shall be is issued with the condition that the debris resulting from S 150A. disposed of in a properly licensed waste disposal facility as defined by IVIGL c
The debris will be transported by:
_/VfI7lT1lS/IJ� �.q,pT/Nr�,
(name ofhauler)
The debris will be disposed of in
_-en�0717215/Z>6
(name of tacility)
(address of facility)
� t
signature of permit applicant
I�
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At 11i 14 1ILI trCif Y CUTK. Ctit IA MAtil,
May 13, 21)trl
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City of 5a lesti Rn:Ird of Ahlwalo
Ion of DAN110. It, 1=lALL recllresal,g It Special 11crinir witioe secillln l.'s"A /Vr,rut'rrrRlrro�rr�,f
(r, :ind 'C'ivo-Fimi/y Residetaiirtl ,StrticttlrCA of the 8314Yn zoning Oltlitr.Incv tit allow l t
n8i4)n of,nn extyting non-c.onfnnving atrneture, in circler to expand aft exirting I 'A Atory dwelling
full two-story dwelling, over the existing footprint, for the property hicatttd ttt 12 l)AI�V1f.ri
NUE (111`forting District).
)lie Iwaring on rile above petition was opened oil. April. 'I(s, 2014 pursuant to �rl,ti,l,f h, 40i1, i I I.'i h
14 was closed )It that date with ttie following Salt;rn lioard of Aplwals intlrllacro prctimu 110%. Cuts
,Mr. Dionne, Air. Duffy, Mr. WarkinM, and Mr. Copelati (Alternate.).
entioner seeks a Special permit from Section 3.15 read •1 iaa•I'ut4Up l(rutftuti
pod of the Salcm %onutg Ordinance.
tents of fact:
In the petition dare-stamped 'March 24, 2014, the petitioner reclue%ted a Special t'erinit to order
expand ,in existing rtoncon£orrning single-family residen iat structure, by expanding tile; existing 1
story Cape Cod style dwelling to a full two story house, over, the existing btAling footprint,
Mr. Richard Griffin, project architect, presented the petition for the property at 12 Oakvicw r\vvntu
l'he existing structure is approximately 15 feet in height. The proposed structure will be, 23 feet .it
aches in height
he existing structure is non-conforming to the ten-four required. minimum width of Bide yard,
cisting building falls within fiv"e`feet of the east lot line. The existing lot is non•confornunl; with
an the required 15,000 square foot lot area and I00•£oor minimum lot width, with a lot ores or.
uare feet and a lot width of 50 feet. No changes to those non-conrorming dimensions
oposed.
he proposed structure would be in a Colonial style, and would be finished in clapboard.
c requested relief, if granted, would allow the Petitioner to expand the existing non-confri
gle-family structure to two stories from the existing V/2 stories,
the public heating, no members of the public spoke in favor of or in opposition to the propel
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