19 PICKMAN RD - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards Town of
Massachusetts State Building Code, 780 CMR, 7"edition BuildDept
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Ttvo-Fmnily,Dwelling
This Section For Official Use Only
TB Permit Num r: Da[e Applied: ° 0
e: �t2r ^>Building Commasioner/Inspector of BuildingsSECTION l: SITE INFORMATION
ert Address: 1.2 Assessors Map& Parcel Numbers
is an accepted street?yes—_xf no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(R)
1.5 Building Setbacks(ft) I_
Front Yard Side Yards n I Rear Yard
Required Provided Required rovided f Required Provided
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal'System:
Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system O
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' f Record: �-j
�L
Name(Prin61Address for Service: S
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition
Demolition q Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': ty
/ r a
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building $ 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 $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) (. _� r �Pp
(.11 0�,)_ 1 t l l'��l� License @N2uSh�be<r x vauon Date
N.4rocc of CSL- Helder LN I List CSL Type(see below)
L e r�-.—��� L-�6 y 7 Descri tion
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 Family Dwelling
Signature M Masonry Only
//7- y R -- 1 3 &(o RC Residential Roofing Coverin
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) y�
4� -f M5r I
HIC Company ame or HIC Registrant Name Registration Number
ti n A/1A .o Mkt C ) `) 7
Addres J�y,7 �IiF ��pL T P aion Date
Signature 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
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.
Si nature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1 , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are we and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Date
Si ned under the eams and penalties of r u
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I 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"
Propasal Page# of pages
Nit
Mwr k 'i79- Zss UP9q
SD,I �s6, ,Yr Mq ol9yz 617 548 - 1396
Proposal Submitted To: _ Job Name __ Job#
Address Job Lrcation
I
Date Date of Plans
Phone If Fax# - Architect
or Nk
We hereby submit specifications and estimates for.—OL42-A --Q C �i—cj U'l — r C`�r--
r t wt t L Y
S ltiyo � L. '___T� . a Ic L.�7,te t., ✓e, rO 2 X / G .S �-.ed ✓-da�
19 X 4
r� Ja [n 4 / Gov-�Py' Y'o/O r g'i An Ar i(eI >aV
'
- n /mlw/ ,P �Ictt ��/�✓n l'' 3 P ,-f�GL1 �y y ,
!,-tn S , df/o S-F ref¢ L. !fir 2 Gf- rC T' —_y h.�CV 2x ,'f-,��✓15 i
Yl vse ? ✓ >< reofPf tea;
We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of:
$ �l h G 0 poilers
with payments to be made as follows: 54C) 3, 4-CO q-4- (? '-I j�-'-
k cr w r✓r
Any alteration or deviation from above specifications involving extra casts will be Respectfully
� � ��
executed only upon written order, and will become an extra charge over and w
submitted
above the estimate.All agreements contingent upon strikes,accidents,or delays
beyond our control. Note—this proposal may be withdrawn by us if not accepted within days.
2cceptance of Propont
The above prices,specifications and conditions are satisfactory and are Signature
hereby accepted.You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance Signature
NC3e19 - ..
EXTERIOR INFORMATION BATH FEATURES COMMENTS SKETCH
Type:2 -Bungalow Full Bath 1 Rahn :Average 1z
S Ht:1T -1&3/4 Sty A Bath: Rating: 10 10
Liv Units:I Total:l 3/4 Bath: Rating:
Foundation:3 -Brick/Stone A3QBth . Rating:
112
a e
Frame:l -Wood , Ba[h: , Rating: wot<
Prime Wall:01 -Wood Shingle A HBth: . Rating: 12 (408) 12
Sec Wall: % OthrFix: Rating: RESIDENTIAL GRID
Roof Struct:01 -Gable OTHER FEATURES 1st Res Grid I Desc:Line 1 1#Units 1 z 24 3
Roof Cover:01 -Asphalt Shgl Kitsi 1 . Ratin :Average Level FY LR.DRI D K FR RR BR FB HB L 0
Coloc PINK AKits: Ratin : Other FFL
View/Desir. Frpl:1 - Rating:Average Upper BMT
GENERAL INFORMATION WSFluei Rahn : Lvl2
Lvl 1
Grade:C -Avers a CONDO INFORMATION Lower Tas
Year Blt 1919 Eff Yr Blt Location: Totals RMsi 5 '.BRs:2 Baths:l HB FFL 35
Alt LUC: Alt%: Unit BMT
Jurisdict: Fact:. Floor: REMODELING RES BREAKDOWN 24 (1015)
Const Mad: %Otyn: Exterior: No Unit RMS BRS FL
LumpSum Adj: Name: Interior: 1 5 2 M
INTERIOR INFORMATION DEPRECIATION Additions: - — EFP
EFP
' Avq HVFL:STD Ph s Cond,GD -Good 26.% Kitchen: -
Prim Int Wal02 -Plaster Functional: %I Baths: s 4 1 4 e
Sec lnt Wall: % Economic % 'Plumbin ; a tz EFP s
Partition:T -Typical Special: % Electric: Totals 29 (1e4)
° Heating: e
Prim Floors:03 -Hardwood _ Ovemde: /°
Sec Floors: % Total: _ 26.2% General: 1 5 2 SUB AREA SUB AREA DETAIL
BsmntFir:12 -Concrete CALCSUMMARY COMPARABLE SALES . BMT -Basement -- 1,024_ 27.750 - _ _ 28,412 'Area_Usbl Descdp T% Qu ,Ten
Code DesrA tlon _ Area-SQ Rate-AV Unde rValue Sub ' /o k
Electdc:3 -T ical Size Ad'.:1.00496 Parcel ID_ _ Typ ' Date - Sale Price FFL First Floor 1,024 110.980 113,646
Bsmnt Gar. Basic$/SO:115.00 Rate
YP 1 TQS 3/4 Story 761 110.980 84,485
Insulation:2 -T pical Cons:Adj_0.960304
WDK _Deck 408 8.450 3,448
IntvsExt:S Adj$/SO:110.982 - - - _- ---- -_ --2 - - - ---. -- —
EFP Open Porch_ _ __ 232_ _ 22.320_ 5,179
Heat Fuel:l -Oil Grade Factor:1.00 .- �- _- _ _ _. -- -- OFP Open Porch 48 19.500 936 I fi
Heat Type:02 -Gravty H/Air - Other Features:28500 - - -- - - - - ---
#Heal Sys:1 Neighborhood Inf;1 ���
WKys/SQ: AvRate: In .Va10
%Heated: 100 %AC: LUC Factor:1.00 - Net Sketched Area:3,497 - Total: 236,106-- - .. - r -
Solar HW:NO Central Vac:NO Ad'Total:264606 Juris.Factor: Val/Su F&PARCEL
Size Ad 1785.25 Gross Area 3751 FiMrea 1785 _ L
%Com Wal %Sprinkled Depreciation:69327 Special Features:0 Val/Su N IMAGE
Depreciated I otal:195219 _ Final Total:195300 Val/Su Sz AsSC Patriot Properties,Inc
31-0022-0
SPEC EEALURE$LYARD ITEM$ - _ _-
Code Description A Y/S Qty Size/Dim - QualLCon Year Unit Price 0/S Dep LUC Fad NB Fa Appr Value 'JCod JFact Juris Value -'--
1�35 3010
t i - - !
30
o
More:N Total Yard Items: __Total S I Featues: TptaC. '
31 0022 0 1 of 1 Residential TOTAL ASSESSED: 342,700
Map Lot Suffix CARD Salem 12988!
PROPERTY LOCATION IN PROCESS APPRAISAL SUMMARY _
No._- _Alt Direction/Street/CityUse Code Building Value Yard Items Land Size Land Value Total Value Legal Description--- User Aid 19 PICKMAN ROAD,SALEM 101 195,300 0.148 147,400 342,100
OWNERSHIP - - - I - GIS Ref _
Owner 1:MATARAGAS ANTONIO -
Owner 2:MATARAGAS SHANNON Total Qvrd 195,300 0.148 147,400 342,700 Entered Lol Size -GIS Ref_
Owner3: - - - - -- -.. [j�iot
-N R - - Total Parrs)-] 195,300, 0,148, ,147,400 342,700 Total Land: .L
. Street 1:19 PICKMAN ROAD Source:Market Adj Cost ; Total Value per SQ unit/Card: IV Lvb /ParceC 191.96 Ins Date
Street 2: - Land Unit Type: Properties Inc.
- 08/11194
TwnlCiry:SALEM PREVIOUS ASSESSMENT Parcel ID 31-0022-0 USER DEFINED
SUProv:MA Cntry Own Occ: Tax Yr Use Cat _Bldg Value Yrd Items Land Size Land Value Total Value Asses'd Value _ _- Notes _ _ _ Date_ :Prior Id#1:72
FV _ __195,300 _ _0 10 _ 161,700 __ 357,000 _ 357,000 yearend __12/11/2006 PRINT Prior Id#2:
Postal:01970 T e: 2007 1101 � _ _ _
PREVIOUS OWNER 2006 1101 FV 184 66' 0 .148 137,800 322,600 322,600 year end 1212812005 _Date Time -Prior Id#3:
Owner 1:HAGGERTY FREDERICK LEO- 2005 101 FV 162,900 0 .148i 127,600 290,500 290,500 yearend roll 116/2005 Prior Id#1:
2004 1101 1_FV_ _ 150,100 _ __ 0 .148�� 118,100 _ 268,200 _ 268,200 roll _ _ _ _112012004 12/01/08 13:48:01 Prior Id#2:
Owner 2:HAGGERTY LINDA JEAN- _ _ _ _
Street 1:19 PICKMAN ROAD 2003 101 CV 150,100t 0 .148 - 118,100 268,200 268,200 conversion IR12004 LAST REV Prior Id#3:
Twn/Ci :SALEM 2003 1101 FV 92,0001 0 .148 135,200 227,200 227,200 Year End 1/7/2003 Date I Time Pf10r Id#1:
SOProv:MA Cntry 2002_ 1101 FV 76,000 _ 0 148' - 102,600 - - 114/2002 _06/02/06 11:49:59 :Prior Id#2:
Postal:01970 2002 101 T8 76,000 0 .148• 102,600 178,600 1214I2001 gfelix `Prior
NARRATIVE DESCRIPTION SALES INFORMATION PAT ACCT. 2988 ASR Map:
This Parcel contains.148 Acres of land mainly classified as Grantor- - 'Le 21Ref-,T e Date TAX Sale Code Sala Price 71Tst:;Verd Assoe:PCL Value"-Lr= r' ,•:+. Notes -_ Fact Dist:
One Family with a(n)Bungalow Building Built about 1919, HAGGERTY FREDER 25619-449 _ 4128/2006 359793 No INo �_ _ �_ - Revel Dist:
HavingPrimarily Wood Shingle Exterior and Asphalt Sh I Roof KING DONNA J 14406474 10/31/19971 137000 No !No Y 9 P 9 Year:
Cover,with 1 Units,1 Baths,0 HalfBaths,0 314 Baths,5 LandReason:
R__ooms,and 2 Bdrms.
OTHER ASSESSMENTS i BldReason:
- - - - - - -
" Code ! Desai INo Amount Com.Int
i I I
- - -i --- -- i BUILDING PERMITS_ ACTIVITY INFORMATION
-ROPERL CIOR '- Number ` Descri Amount 1C/O Lest Visit Fed Code F.Descn - Comment Date_.l_ -_ Result - i Name
Z RiS ONE F 100 U - - - __ _ C_ __ __ __- _ 212312000 Measured 270 PATRIOT _
Date-
- - -
o t I 8/11119941nspeded FK FK
P $_ y411998 64 6 Conv 3,000'
Item Code Desci % Item Cade Descn - -
n I
Census: ExmptFlood Haz:
--
- - --
D Too 7 Steep
s Street - - - - -'r- -- - - T - - - --
t �Traffc � ' � Sigrid ��� ,� ,�,kl,��z ,jlDArA ��-
LAND SECllOX(F�rst_Lines_onI -
LUC Depth/ _ . . LT -Base r _ ..-... Neigh .. -°.. _ (o-r-_ - -Appraised-.. A@ a I Spec- J �.. _,.__.,...
Code' Descdption No of Units Umt Type Land Type Unit Pri Adj Neigh Ing1 /° Infi2 % Infi3 % h fact Use Value Notes
Use
N i .9 - o -�_I. Infiu : Mod _ Value- .Class , Land Code, .
p - ..
_ a nceUnits' Factor Value
101 One Family 6450 S .Ft. Site 11.85 1.928MG 1 019 ' 147,355 � 147,400
Lot Are Fami 61 Front Ft Site IMG 019 {
• � I l
Total AC/HA:0.148072 : Total SFISM:6450.00 l Parcel I MG L Total: 147,355 Spl Credit Total: 147,Q0I
�� LUC:101 One Family • Prime NB De � �
Disclaimer:This Information is believed to be correct but is subject to change and is not warranteed. Database: FY2008 apro 2008
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
$I 6 I IT # SAi I M. \I.Ali
I I W8.74i-9595 0 1:\N: 97S 74 98 4
Construction Debi-is Disposal Affidavit
(TCLIL[iied l'or all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CNIR section 111.5
Dcbris, and the provisions ot'MGL c 40, S 54;
Building Permit t
- is issued with the condition that the debris resultingfrom
this work shall be disposed of in a properly licensed waste disposal I'acility as defined by MGL c
I 11. S 150A.
The debris will be transported by:
e mn TV'enlyl Cle V,
(name ofliaLifer)
The debris will be disposed ot'in
0 C
(name of facility)
(address of facility)
zX
S I gnatul c of pe ril I it applicant
0
date