39 OSGOOD ST - BUILDING INSPECTION (2) Ia:, The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Q) 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(DAY
Building Permit Number: to Applie
d �• G3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1 rOpel gt Address: 1.2 Assessors Map&Parcel Numbers OS(S S7 36 -6A70- 6
L I a Is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Qy �- .9r,2c-s t=
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 M� Private❑ _ Check if yes❑ Municipal ET Un site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of�Rtcord:
/�1 2Y �< �/�IGP� SACe^, D/97o
Name(Print) City,State,ZIP
39 DSGood 2yy-AFdj
No.and Street Telephone Email Address
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.p Number of Units_ _ Other ❑ Specify:
Brief Description of Proposed Wo&: &Qin,�Je. Y �tiJ'f9CC /rs��/�iT 4 eti C itie J
.s.{c�TiQcYlc Ge�ALt.S/GGiGiNI, /VG�.rI /La02S. LE'2 /nr:J.c cti...,..lcy
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ 1. Building Permit Fee:$ 4�dicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (IIVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 3000 13 Paid in Full ❑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(Buildin s u to 35,000 cu.ft.
R Restricted 1&2 Famil Dwelling
CiTy/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Tee-phone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) j 4;-sy7 3 3 1/_Iy
Orio l"' _�O GcrVTy(CloCS MC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
/r�1 VIM S , %e k./�%,it7CrC.eJe/YIS� Gom
No.and Street Email address
eT /ls9SS• nr97o g7`r-7yL/-O/o3
Ci /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 (/'FIT icic .S. 1�46&V0 S,<
to act on my behalf,in all matters relative to work authorized by this building permit application.
f y-9-/2
J
Print vner's erne(E a mie nature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of pedury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
y- IF-i 2
Print r' Authorize Agent's a(Electronic Signature) Date
wnes r
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.gov/das
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.) y' �— Habitable room count
Number of fireplaces Number of bedrooms 13
Number of bathrooms Number of half/baths 6
Type of heating system 6/1 S Number of decks/porches I
Type of cooling system /�A,9 Enclosed Open ✓
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
CITY OF S.U.E:NI, iN'LASSACHUSETTS
BUUMLNG DEPARTME.v'T
P 120 WASHINGTON STREET, 3' FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
1Q\IBERLEY DRISCOLL
MAYOR THo&w ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BURRING CON MaSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
pebris, and the provisions of MGL c 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 bee�transported by:
(name of hauler)
The debris will be disposed of in :
(name of facility
� e ,,54),c'--.�7
(address of facility)
gna of permit applica
date
JcbriulT.Jce
Unofficial Property Record Card Page 1 of 1
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 36-0270-0 Account Number
Prior Parcel ID 21 —
Property Owner HAGEN MARY T Property Location 39 OSGOOD STREET
Property Use Two Family
Mailing Address 39 OSGOOD ST Most Recent Sale Date 11111900
Legal Reference 4529-26 .
City SALEM Grantor
Mailing State MA ZIP 01970 Sale Price 0
ParcelZoning R1 Land Area 0.045 acres
Current Property Assessment
Xtra Features
Card 1 Value Building Value 125,800 Value 0 Land Value 76,400 Total Value 201,200
Building Description
Building Style Multi-Conver Foundation Type Brick/Stone Flooring Type Hardwood
#of Living Units 2 Frame Type Wood Basement Floor Concrete
Year Built 1890 Roof Structure Gable Heating Type Forced H/W
Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil
Building Condition Fair Siding Wood Shingle Air Conditioning 0%
Finished Area(SF)1952 Interior Walls Plaster #of Bsmt Garages 0
Number Rooms 10 #of Bedrooms 4 #of Full Baths 2
#of 3/4 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.045 acres of land mainly classified as Two Family with a(n)Multi-Conver style building,built about 1890,having
Wood Shingle exterior and Asphalt Shgl roof cover,with 2 unit(s),10 room(s),4 bedroom(s),2 bath(s),0 half bath(s).
Property Images
A
Disclaimer:This information is believed to be correct but is subject to change and is not warranleed.
http://salem.patriotproperties.com/RecordCard.asp 4/8/2012