14 PICKMAN ST - BUILDING INSPECTION (2) ow
RECEIVED
<I,SPECTIONAL SERVICES
The Commonwealth of Massachusejiryb JAN 5 A 8 CITY OF
Board of Building Regulations and Stan``��ards SALEM
Massachusetts State Building Code,780 CMR RevisedMar2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For OfflciaV6se Only
Building Permit Number: Date pllliiied:: .41
,,,� Q 'n
Building Official(Print Name) Signature Dale
SECTION 1: SITE INFORMATION
11 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
l H P/cy--MA + 5—, Egf
Lla is this an accepted street?yes Vol no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq l) 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:
Public❑ Private ❑ Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
WIc�tAM-FGHprt�N(r. Wag« SAt-Em t rri\q O1g-)0
Name(Print) City,State,ZIP
I`I PICYSMArs1 ST, 7t,63- SS�S' Sb�`� SPI(tH�GHtn�� � AOL.�o
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
Owner-Occupied Repairs(s) ❑ 1 Altcration(s)-�K Addition ❑
New Construction 13 FExisting Building
Demolition ❑ 1 Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of ProposedWork2: rYloDll`H EX14Ylsa6 klTC.Rk'14 B`t REUoCA'Tl,nl(
'5iNlc. -4OVEN o rr)Q,W1 01A ,Ex,STSrOL- R,aTW lit REto<wT, �b iloofL
—fo maN-7I.a 3�flacow, Arin ADOIN� A Ncw
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ j() p�� L'Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ a t Oyu ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ $ 0 vU 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ a01 O'oJ ❑Paid in Full ❑Outstanding Balance Due:
E 1 :11 A c- VAL thus
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(Buildings up to 35,000 cu. ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mas;onry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
141C Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Down,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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and ac urate o th s of my knowledge and understanding.
Vy�Ll..IAM Wf6�c� � 1 S 201�
Print Owner's or Authorized Agent's Name(Electron c I nature) a Date
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. ovg /oca Information on the Construction Supervisor License can be found at www.mass.gou/dps
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.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfibaths
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"
I
�— 21' 11"— �
P
I
Existing First Floor Plan �
1T 3 15/16" t;vingroom
The Webcr Residence K
14 Pickman Street
M
Salem, MA side entry
A
Front
Front Door N
Spiral 43'4 3/8"
Stairs
39' 21/2" W r--Or2'5"
S
T
0
Kitchen Master Bedroom R
Family Room E
Rear E
stairs
T
side entry
P
I
Proposed First Floor Modifications C
Vvingroom
The Weber Residence K
14 Pickman Street Add half bath and M
Salem, MA closets
A
Front N
Relocate range Spiral
and add hood O Stairs
vented to outside
S
00 O Modify existing full bath T
and add door to
Q master bedroom
R
Kitchen 0
Family Room Master Bedroom E
Relocate
sink
E
FT
I '
�— 21' 11"
P
I
Existing First Floor Plan c
IT 3 15/16' Livingroom
The Weber Residence K
14 Pickman Street
M
Salem, MA side entry
A
Front
Front Door N
Spiral 43'4 3/8"
Stairs
39'2 1/2" r -2'S"
S
T
O
Kitchen Master Bedroom R
IEM
Family Room E
Rear E
stairs
T
side entry
P
I
Proposed First Floor Modifications C
Livingroom
The Weber Residence K
14 Pickman Street Add half bath and M
Salem, MA closets
A
Front N
Relocate range Spiral
and add hood O Stairs
vented to outside
S
0 o Modify existing full bath T
and add door to
Q master bedroom
R.Kitchen 0
Family Room Master Bedroom E
E
Relocate
sink
T
QTYOF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
a
120 WASHNGTONSTREET,3" Rom
TEL. (978)745-9595
KIMBERLEYDRISCOLL FAX(978)740-9846
MAYOR T}-IOINAS ST.PIERRE
DIRECTOR OF PUBLICPROPERTY/BUILDING CON&USSIONER
HOMEOWNER- LICENSE EXEMPTION
PLEASE PRINT:
O I — C)
Date
Job Location
Home Owner Address ) P)GK-m-ay"j 1j) S -A3 _6YvI fYl�
Present Mailing Address S Cl r is
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'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
CITY OF S'U E:NI, 1'L-kSSACHUSETTS
BUILDING DEPAR-rNIENT
• P• 120 WASHINGTON STREET, Vo FLOOR
' �� TEL- (978) 745-9595
FAX(978) 740-9846
KI%,(BERL.EY DRISCOLL
MAYOR Tri %w ST.P[ERRH
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
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
Debris, 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 be transported by:
(name of hauler)
The debris will be disposed of in
Re.P1n 15tt<-
(name of facility)
(address of facility)
1
signaturelorpermit applicant
115'2a)b
date
Jebriswl7Juc