4 PHILLIPS ST - BUILDING INSPECTION The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR
Revised,liar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Faurily Dtvel ing
This Section Far Official Use Onl
Building Permit Number: Date Applied: Z ZEE
ILL-
Z Zo I
lluilJing 011icial(Print Name). Signature- Date
SECTION t:SITE INFORNIATION'
\� 1.1 PruperatyRlr;t e3,� I 1.2 Assessors Map& Parcel Numbers
I.1 a Is this an ncce ted street?y s, no Map Number Parcel Number
1.3 'Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(R) j
1.5 Building Setbacks(ft) 1
Front Wad Side Yams Rear Yard
Required Provided Required Provided Required ProviJed
1.6 Water Supply:(M.G.L c.40,§54) l.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ — Check if es❑ P P y
SECTION 2. PROPERTY OWNERSHIP!`
2.1 Owner[of Record: r
\ Grelar4e C4S�U 1 (�yLD2 J � Ltm V ' \ 1�
Nthme(Print)' City,Slate,ZIP
H `' N% \\: � s S� 571�?vs -?S91 1 'tt'tf\r,S 00t' e-34k'1mvy�,
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ I Altemtion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work-:
fy%no — ur F—rsg . . comae w ,A1 � o
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing .S 2. Other Fees: S
I. Mechanical (HVAC) S List:
5.Mechanical (Fire S fund All Pees:S
Su ression)
Check No. Check Anwunk Cash Ammimt:
1'utal Project Cult: S t{ S , ❑Paid in Full ❑Outstanding Balance Due:
ry,C.J-
h
r
SECTION5: CONsT12UCTfONSERVICES
5.1 Coastruction Supmtiisur License(CSL) t
License Number Espiralion Date
Name ofCSL Holder List CSL'rype(see below)
Type Description
No.and Street
U Unrestricted Buildin s u to 35,000 cu. 11.
R Restricted 1&2 F:unil Dwellin
C'ily[fown,State,ZIP col Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
'fele hone Email address D Demolition
5.2 Registered dome Improvement Contractor(HIC)
111C Registration Number Expiration Dote
I IIC Cumpamy Name or HIC Registrant Name
No. and Street Email address
I City/Town, State ZIP 'role hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.IS2.§ 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:OWNERAUTHORIZATION:TO BE COMPLETED WHEN:
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT'
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Marie(Electronic Signature) Dale
SECTION 7b: OWNEW ORAUTHORIZED AGENT DECLARATION
By entering my name below, 1 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 try knowledge and understanding.
tX,, Grp J I f-4Loa � ��a-,r�w as �'e6 1q �.
Prim owl 's orutthorizcd Agcnt's Name(Electronic Si tutu )U Date
NOTES:
1. An Owner who obtains a building permit to do hislhcr own work,or an owner who hires in unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program),will sof have access to the arbitration
program or guaranty fund under NI.G.L.c. 142A.Other important information on the HIC Program can be found at
ssww.mas;.wv'oca hiformation on the Construction Supervisor License can be found at w%rw.mass.gov!dL
�. When substantial work is planted,provide the information below:
Total boor area(sq. ft.) (including garage, finished basementlaltics,decks or porch)
Gross hying area(sq. I1.) Habitable room count
Number of fireplaces" Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/parches
l'ypeofcoolingsystem Enclosed Open_
1. -total Project Square Footage"may be sub,titnted for"rood Project Cost'
CITY OF SALEM, MASSACHUSETTS
` BUILDING DEPARTMENT
�` lr 120 WASLUNGTON STREET,3" FLOOR
\Lr�nnxm`' TEL. (978) 745-9595
FAX(978) 740-9846
KINMERLEY DRISCOLL
MAYOR TTrIOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date ay gcb ) A
Job Location M S J ���m \
Home Owner Address l k IS J2I S S A LC m 01
Present Mailing Address yI?h t �� .P S S t S Xq L 6m VAO
The current exemption of"Homeowners" was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION 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 shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official, 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 by-laws and regulations.
The undersigned "homeowner" certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'SSIGNATURE /J\
APPROVAL OF BUILDING INSPECTOR
Commonwealth of Massachusetts ,
Citv of Salem
, 15
c
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
pM
- Return card to Building Division for Certificate of Occupancy
Permit No. B-14-652
EE PAID: $25.00 PERMIT TO BURILRD"k
DATE ISSUED: 3/3/2014
This certifies that TAYLOR SUSAN M TAYLOR GREGORY J
has permission to erect, alter, or demolish a building m, 4 PHILLIPS STREET Map/Lot: 160250-0
as follows: Renovation 632-14 MOVE PELLET;STOVE FROM ONE WALL,TO ANOTHER WALL
ke = a,r
Contractor Name: #
ik 7
� � 3/3/2014
Contractor License No: J
Buil I' ial i Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
The Building Official may grant one or more extensions not to exceed six months each upon written request. "
All work authorized by this permit shall conform to the:approved application and the approved construction documents for which this permit has
been granted.
All construction, alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the
entire duration of the work until the completion of the same. - n`.r ``� 9 t"' 51
is
The Certificate of Occupancy will not be issued until all applicable signatures by the Building_and FiiexOfficials are.provided on this permit.
Address numbers must be on the house/building at the time of inspections as required by M.G.L. Chapter 1.48;Section 59. If the address
numbers are not present, inspections will not be done and there will be a re-inspection fee of$25 00.
AN
HIC #: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Plan Review _ q s
Comments: A '
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Commonwealth of Massachusetts , \
y
City of Salem
„ 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
'.p�rev nn3
Return card to Building Division for Certificate of Occupancy
Structure CITY OF SALEM BUILDING PERMIT
Excavation PERMIT TO BE POSTED IN THE WINDOW
A '
Footing INSPECTION RECORD
Foundation
Framing
Mechanical
'Fayk++. a. he kS
Insulation INSPECTION:
BY '_ DATE
Chimney/Smoke Chamber
Final
+A** Plumbing/Gas
Rough:Plumbing T�. r"
Rough:Gas r
Ik k ti
Final
°x Electrical i �r
Service
Rough
Final _ -
i
trFire Department „ ;
Preliminary 'd4
Final ..
x Health Department
Preliminary
Final