21 A PICKMAN - BUILDING INSPECTION The Commonwealth of Massachusetts Town of
U + Board of Building Regulations and Standards
Massachusetts State Budding Code. 780 CNIR. 7*edition Building Dept pt
Building Permit Application To Construct. Repair. Renovate Or Demolish a 1KVMN*dmm
One-or Aso-Famils•Dn ellrng
This Section For Official Use Only
Building Pe it N ber•
Dsle Applied: ' e�� r
2 — 0
Signature:
11, o �
Bu ding Commis n tw of Buildings Date
SECTION 1: SITE INFORMATION
1.1 ro rt Addr I 1.2 Assessors Map i Parcel Numbers
/ CILNn4s�
M Nr Parcel Numbs
I.I a Is this an ace ted street?yea ^o � umbe
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Dmrict Proposed Use La Area(sq R) Frontage(It)
1.5 Building Setbacks(10
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided '
eP e e T
1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private O
Zona: _ Outside Flood Zone? Municipal O On site disposal system O
Check if sO
/J SECTION 2: PROPERTY OWNERSHIP'
2.1/1A a rr�pa /e a� ( I 4 11 i'! ( T I l C`C/�4 /) S t
Name IPrint Address for Service:
Signature Telephone
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Eaiating Building O Owner-Occupied O Repairs(s) O Alteration(a) O Addition O
Demolition O Accessory Bldg.0 Number of Units_ Other O Specify:
Brief Description of Proposed Works: t I i (Cl"
0O 0fC
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Ofllclal Use Only
Item Labor attd Materials
I. Budding Permit Fee: S Indicate how fee is determined:
1. Building S
O Standard City/Town Application Fee
2 Electrical S O Total Project Cost(Item 6)x multiplier a
Plumbing S I. Other Fees: S
a. Mechanical IHVAC) S List:
s Mechanical (Fire S Total All Fees. S
Su remon
nn , Check No. _Chec a Amount: Cash Amount:
/5 h Total Project Cost S O V v ❑ Paid in Full 0 Outstanding Balance Due
SECTION S: CONSTRUCTIO SERVICES
,/ S.I Licenns�sed Construction Supervisor(CSL► > , / ' ' --7 /�6�6
v kv -14&�1 -7 � ( 4 Licen%r Number (o E_%ppiraLi�bLnaDLut_e,L
Nyae of L-r nHpIJ/np Lnt CSL Type Ixv heluwl v
AJJresa lad F�r` �/i��� f FOResideniial
Dexn ion
C C SignatureTelephone ntial Window and Sidinq'7 a (a 3 S/ 3 ntial Sohd FlBurnet A Nance Installation
Demolition
3.2 Regls red Vome Imprgvemeat ConVctor(HIC) `! 7�
fldtfw /l� h" I ' Y to
HIC Company lyl r HIC RegtstranI Name Reytstraum Number
.lF--Fi It W /�- v) 6" 5( ( I 2 6
Address jj_,, �(7 a/d-
Ic (.& Q ,kr (�^ I j s�3 Eapi kilo"Date
SigrtaNre Telephoto
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. IS2.J 23C(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...........O
SECTION 7o:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. 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.
Signature of(Tuner Date
ECTi 7b:O ERi OR AUTHORIZED AGENT DECLARATION
1, as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Prim Nam.
Signature of Owner or Authorized Agent Date
Signed under the pains and penalties ofperjury)
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 gg have access to the arbitration
program or guaranty fund under M.G.L. c. 1 a1A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and I IO.R1,respectively.
2. When substantial work is planned, provide the information below:
Total floors area(Sq. FL) - (including garage, finished basement/attics.decks or porch)
Gross living area I Sq. Ft.) Habitable room count
'Number of fireplaces Vumber of bedrooms
Number of bathrooms Vumber of half baths
Tvpe of heating cysrem Number ofJeckv porches
I pe ofcoobng cyslcm Encloscd Open
1 "Total Project Square Footage" may he.uh,titulej for"Total Project Cost"
CITY OF S.U.E.NI, 'L1vLkss..kaiusE-M
BUaMLNG DEPAJLr.% 'ST
120
WASHLNGTON STREET. )tl FLOOR
TEL (978) 74S-9595
FAx(978) 740-984
p1,CBEPI-Ey DRISCO"
I
�U►YOl ?tOhtAf ST.PIEItRi
DIRECTOR OF PL BUC PROPERTY/lIUMLING CO%MUSSIONER
Workers' Compensation Insurance AMdavit: Builders/Contractors/Electricians/Plumbers
Alt licant Information Please PrintLegibly
Valnte tBusine+ Oryamiatiorrtn.Lv��dual): c o c v- (° a
5 r
Address: 1'/�/ `'t (a Ole lee �
City/State/Zip: 5a k 6,.-q ci y I? ro Phone -
,ere you an employer'Cheek the appropriate boa: Type of project(requlrcoO.
1.0 1 am a employer with 4. 0 1 am a general contractor and 1.
Mnployecs(full and/or part-time)." have hired the subcontractors 6. ❑New construction
2. 1 am a sole proprietor ar partner- listed on the attached sheet : 7. ❑ Remodeling
.hip and have no employees These subcontracton have B. 0 Mmolition
.vorliing for me in any capacity. workers'comp.insurance. 9. wilding addition
I No workers'comp. insurance S. 0 We are a corporation and its III.(:] Electrical repairs ra additions
required.] 0111cers have exercised their
3.0 1 am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions
myself.(No workers'comp. C. 152.j 1(41 and we have no 12.0 Roof repairs
insurance required.]t employees. LNo workers' 13.0 Other,
comp. insurance required.)
'Any appaca t nun ditocW tax Of Room Am ran ma the arcuoa kalor showing their workets'cwrprnradon policy inAn natloa.
s I Lvneuwnar who sultans this aeldavil indicating They m Joins all work ant than him mmide cononam mum sntxetl a now an)davil Indicating wook
:f'.muaVn dW a'1Mek this km mud aaYMd an sldilitwrl that"wing than name of Mr wtksomraclmr and thaw wwkosa,cony.policy inrmnous.
/am an emp/oyer char is providing workers'rompemadoe insarowefsr my esrplayter edow/s the pNily oed Jolt side
informatiata
Insurance Company Name:
Policy N or Self-ins. Lie. N: Expiration Date:
Job Site Address: Ciry/StawZip.
attack a copy of the workers'compensation policy declaration page(showing the policy number gad expiration date).
Failure to secure coverage as required under Section 23A of.MGL c. 152 can lead to the imposition of criminal penalties of■
fine up to S 1.500.00 and/or one-year imprisonmen4 as well as civil penalties in the form of*STOP WORK ORDER and a ties
Of up to 5250.00 a day against the violator. Ile advi.*:d that a copy of this statement may be furwarded to the 01rice of
I if viceu Sit iutm oft fie DIA for insurance coverage veri iicution.
/do hereby a•rNljy ae ha pr sand rtiD7b�ef p /try that the istformadon provided above is true/and cor►ociL
/v 3 S l 3
O/Jlciui use an/y. Do nor write in this acreo to de.arnp/Ned by rity or town o/J8'imi
City or ru+vn: ecrmit/I.icenseN__. ,
issuing.\ulhurtly (circle une):
I. Iluard of MAIN 2. Building Department ]. City/fown Clerk 4. Flectrical Inspector 5. Plumbing Inspector
6. Mher
1. .ntacl Person: -_. _.. Phone#:
e
�S CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
?INV I
.I'.1 P. Nlhl ' Nly '•II
S•11 I'\I,
Construction Debris Disposal Affidavit
(required Our all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit N _ . - is issued with the condition that the debris resulting from
facility as defined b MGL c
apropertylicensed waste disposal fac y Y
of In
this work shall he dlslwscd
t 11. S 150A.
The debris will be transported by:
�Vl dti(A, A, rh P
I name of hauler)
'I'Ime debris will be disposed of in :
(flame Ur aCl Ity)
(address or lacility)
SIVIamre of permit applicant
date
Idni.,l(,Iw
a�i y od CITY OF SALEM, MASSACHUSETTS
BOARD OF APPEAL
' 120 WASHINGTON STREET, 3RD FLOOR
I SALEM, MASSACHUSETTS 01970
TELEPHONE: 978-745-9595
FAX: 978-740-9846
KIMBERLEY DRISCOLL 7�ol 2
MAYOR
i-
CIIY
November 2, 2009
Decision
City of Salem Zoning Board of Appeals
Petition of MARGARET HANNIFIN, seeking a Variance from side and rear yard
setback requirements, and for a Special Pemtit to alter a nonconforming structure, to
allow for the construction of a YxlY one-story addition to the existing single-family
house on the property at 21A PIC UM AN STREET, Salem,MA, in the Residential
Two-Family Zoning District.
Petitioner seeks a Variance pursuant to the Salem Zoning Ordinance,§4.0,Dimensional
Requirements.
Statements of fact:
1. The owner of the property,Margaret Hannifin, was present at the meeting. The
project's contractor,Andrew Ambrose,presented the petition.
2. In a petition dated October 2,2009,the applicant requested a Variance from side
setback requirements to accommodate the construction of a 3.5'x 3.0'addition to
the existing single-family house. The Building Inspector determined a Special Permit
under§3.3,Nonconforming Uses and Structures,was also needed.
3. A public hearing on the above mentioned Petition was opened on October 21, 2009,
pursuant to Mass General Law Ch. 40A, % 11. The pubic hearing was closed on
October 21, 2009,with the following Zoning Board of Appeals members present:
Robin Stein (Chair), Richard Dionne, Becky Curran,Bonnie Belair(alternate), and
Jimmy Tsitsinos (alternate).
4. There was no public opposition expressed at the meeting.
5. At its meeting on October 21, 2009,the Board of Appeals voted five (5) in favor and
none (0) opposed to grant Variances from the dimensional requirements of§4.0,
Dimensional Requirements.
The Board of Appeal,after careful consideration of the evidence presented at the public
hearing, and after thorough review of the plans and petition submitted, makes the following
findings:
2
1. Special conditions and circumstances exist affecting the parcel or building, which
do not generally affect other land or buildings in the same district, as the property
is oddly shaped.
2. Literal enforcement of the provisions of this ordinance would involve substantial
hardship, financial or otherwise, to the appellant.
3. Desirable relief may be granted without substantial detriment to the public good
and without nullifying or substantially derogating from the intent or purpose of
the zoning ordinance.
4. The applicant mayvarythe terms of the Residential Two-FanilyDistrict to
construct the proposed addition, which is consistent with the intent and purpose of
the City of Salem Zoning Ordinance.
5. In permitting such change,the Board of Appeals requires certain appropriate
conditions and safeguards as noted below.
On the basis of the above findings of fact and all evidence presented at the public hearing
including, but not limited to, the Plans,Documents and testimony, the Zoning Board of
Appeals concludes:
1. To allow for the construction of the addition as proposed,the requested Variance
from dimensional requirements for structures in the Residential Two-Family zone,
and a Special Permit for extension of a nonconforming structure, are granted.
In consideration of the above, the Salem Board of Appeals voted, five (5) in favor(Stein,
Curran,Belair,Tsitsinos and Dionne) and none (0) opposed,to grant petitioner's requests
for a Variance subject to the following terms,conditions,and safeguards:
1. Petitioner shall comply with all city and state statutes,ordinances,codes and
regulations.
2. All construction shall be done as per the plans and dimensions submitted to and
approved by the Building Commissioner.
3. All requirements of the Salem Fire Department relative to smoke and fire safety shall
be strictly adhered to.
4. Petitioner shall obtain a building permit prior to beginning any construction.
5. Exterior finishes of the new construction shall be in harmony with the existing
structure.
6. Petitioner is to obtain approval from any Gty Board or Commission having
jurisdiction including, but not limited to the Planning Board.
r
3
v Robin
Stein, Chair lls.a
"
Salem Zoning Board of Appeals
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD
AND THE CITY CLERK
Appeal from this decision, if any,shall be made pursuant to Section 17 of the Massachusetts
General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the
office of the City Clerk Pursuant to the Massachusetts General Laws Chapter 40A, Section
11,the Variance or Special Permit granted herein shall not take effect until a copy of the
decision bearing the certificate of the City Clerk has been filed with the Essex South Registry
of Deeds.