19 ORCHARD ST - BUILDING INSPECTION / Z, The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
/J 1` �0 Massachusetts State Building Code, 780 CMR, Tn edition OF SALEM
"I ��✓ Revised January
Building Permit Application To Construct, Repair, Renovate Or Demolish a /• 2008
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number, -Date A pp lied:
Signature: 4-7�
Building Co missioner/Insol5clorot Hunulngsrl 1 Date
SECTION IJSiiI7E INFORMATION
1.1 P pr Ad ress• V fN 1.2 Assessors Map& Parcel Numbers
I.Ia 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 11) 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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yesO Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qwner'of Record:
XName(Prin Add ss ffoor Service: r /
Il -
Signs are 'relephone
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ 1 Existing Building Owner-Occupied Repairs(s) ❑ 1 Alteration(,) ❑ Addition ❑ .
Demolition ❑ 1 Accessory Bldg.❑ Number of Units�i I Other ❑ Specify:
Brief Description of Proposed Work'-:
xt
SECTION 4: ESTIMATED CONSTRUCTION COSTS
It Estimated Costs: Official Use Only
Labor and Materials
i. Building S I. Building Permit Fee: S Indicate how fee is determined:
�. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S
Suppression) Total All Fees:S
Check No. Check Amount: Cash Amoun�
X6. Total Project Cost: S O ❑Paid in Full ❑Outstanding Balance Due:
l
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of CSL-I lolder List CSL Type(see below)
Description
.Address U Unrestricted u to 35,000 Cu. Ft.
R Restricted IA2 Famil Dwellinit
Signature M Masonry Only
RC Residential Roofing Covering
1"clephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address Expiration Date
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 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 .......... O No...........❑
SECTION 7a: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.
rbehalf.
ture of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
he statements and information on the foregoing application are true and accurate,to the best of my knowledge and
-
Print
Sgnature of Owner orAuthbriZed Agent Date
(Signed under the pains and penalties of perjury)
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 go
I have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 IO.RS, respectively.
2 When substantial work is planned,provide the information below:
Total floors 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 &UYL NI
PUBLIC PROPERTY
DEPARTMENT
KlfalJrfY ev"rn.
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TtiL 97L71}9S"• FAIL 971L746964
HOMEOWNER LICENSE EXEMPTION
Plena hint
Date 6— '
Job I.oeatias Y nr�_ �yt CY �`T , ✓4 1r�
Home Owner Address m -
Home Owns Telephone
Pressot Mailing Address /4 th-i'Lar--d X4. Yetrfn
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 owns acts as supervisor.
DEFINITION OF HOMEOWNER
Persons) who owns a parcel of land on which hdshe resides or intends to reside. on
which there is, or is intended to be, a one or two family dwelling, attached or detached
struct ues 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
"homeowner"shall submit to the Building Official, on a form acceptable to the Building
Official. that hdshe 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 r irements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
t'
CITY OF SALEM
� o PUBLIC PROPRERTY
,
DEPARTMENT
ENT
\I .'. M I�C�t.1J 11]L.JV 51IIkCT �).\I1 fl, fit.\1i t1111 J I. -
I'n:wry.704W5 •P\s;77t•:!S'tt1A
Construction Debris Disposal Affidavit
(required Iur all demolition:u%l renovation work)
In accurdancc with the silth edition of the State Building Code. 730 CMR section 1 11.3
isions of MGL c 40, S 14;
Debris. and the prov
is issued with the condition that the debris molting from
Ouilding Permit rl licensed waste disposal facility as defined by MGL c
this work shall he disposed of to a grope Y
111. S 150A.
The debris will be transported by:
C.
tea of hauler)
I•lie debris will be disposed of in
Ia�d�ll.d'I'acdity)
.,,nature of Ivintit applicant
.late
P; oND1T.4 CITY OF SALEM, MASSACHUSETTS
" BOARD OF APPEAL
{f C 120\C4\>I IIN(:I'UN 1'l ltl.l:I 0 $Al.l ipl,\Ir\5Sr\I:I ICSP:1'IS 01970
Iltl.r1:978-619-5685 ♦ Pnx:978-740-0404
KI%1RITH O'DRIS0)1 I.
%I:\1'1At
Notice of Decisions
At a meeting of the City of Salem Zoning Board held on Wednesday, N1ay 19, 2010 at 6:30 p.m. in Room 313,
Third Floor at 120 Washington Street, Salem, NIA, the Zoning Board of Appeals voted on the following
items:
Petition of: SANDRA MEUSE
Location: 19 ORCHARD STREET (R-2)
Request: Variances
Description: Variances sought from side yard setback and lot coverage to allow for the
construction of a second-floor deck at the rear of the existing two-family home.
Decision: Approved— filed with City Clerk on June 2, 2010
Petition of COLLIAM, LLC/LUKE FABBRI
Location: 1
Request: Special Permit
Description: Special Permit sought to alter and extend an existing nonconforming structure by
adding a 600 square foot addition as a second floor over a portion of the existing
roof.
Decision: Approved— filed with City Cl rk on June 2, 2010
Petition of AN HUI T. ANG
Location: 3 HENRY STREET (R-1)
Request: Variance
Description: Variance sought from number of stories to allow for the construction of two
dormers on an existing single-family home.
Decision: Approved— filed with City Clerk on June 2, 2010
Petition of: MICKEY L. BENSON
Location: 150 NORTH STREET (R-2)
Request: Special Pertnit
Description: Special Permit sought to convert an existing historic carriage house into one
dwelling unit.
Decision: Approved— filed with City Clerk on June 2, 2010
Petition of CABOT STREET GROUP, LLC
Location: 24 CABOT STREET (R-2)
Request Special Permit
Description: Special Permit Sought to convert an existing historic carriage house into one
dwelling unit.
Decision: Approved— filed with City Clerk on June 2, 2010
(aver)
Page L of 2
Petition of: HIGH ROCK BRIDGE STREET, LLC
Location: 44 BOSTON STREET and 401 BRIDGE STREET (NRCC)
Itequest•. Variances
Description: Variances from building height (feet), buffer zone width, and number of parking
spaces to allow the construction of a 2-4 story professional office building with
rciail and municipal spike.
Decision: Approved— filed with City Clerk on June 2, 2010
This notice is being sent in compliance with the Marsa,husetts General Lows, Chapter 40 A, Sections 9& 15 and doer not
require actin by.the recipient.Appeals, if any, shall be made pursuant to Chapter 40,4, Section 17, and shall be filed within
20 ekrys from the date which the de<zsion was filed with the City Clerk.
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