29 PLEASANT ST - BUILDING INSPECTION fb- 2D I q - 5 q '6 f /r� ) 0
The Commonwealth of Massachusetts
' Board Of Building Regulations and Standards CITY OF
�f Massachusetts State Building Code, 780 CMR
SALEM
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised blar 2011
I One-or Two-Family Dwelling
This Section For Otfioial Use Only
Building Permit Number:
ate Applied:
DuilJing OtTicial(Print Name) � ti
. Stgnatme -
SECTION LSITE INFORMATION Date
LI Property Address: '
Z a `�\e .� �, 1.2 Assessors Map Sr parcel Numbers
I.to Is this an accepted street?yes Y^no_ Map Number ,... i ,„_
1.3 Zoning Information: I Ce•F u•z'bcr
Ld Property Dimensions:
Zoning D— ist— r— icf Proposed Ua�—
Lol Area(sy tt) Frontage(It)1.5 Building Setbacks(ft)
Front Yard Side Yards
Provided Required Required Provided Rear Yard
Required aired
y Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information:
I'ublicAl Private❑ Outside Flood Zone?
Zone: 1.8 Sewage Disposal System:
_
Check it'yes❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTYOWNERSHIP'
2.1 Owner'of Record:
2 9 QIG4 rn l� S F SGI�
N�hme(Pnnp (�evcn� rl/%I h
O
City State,ZIP
2 z No. mJStnct Z79 __rH J�f^� }b�l• +nCano+n'cS. �{
Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building M Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units
Brief Description of Proposed 5vurk': /Jk g 11 Other ❑ Specify:
a r \n C ef c
P.yv,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials) Official Use Only
I. Building $ I. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
3. Plumbing $ ❑Total Project Cost'(ftem 6)x multiplier x
2. Other Fees: S
4. ,Mechanical (FIvr1C) S List:
i. Mechmlical (Fire
Su ression) S Total All Fees:S
6. Total Project Cost: S �y Check No._Check Amount: Cash Amount:_
r ❑Paid in Full ❑Outstanding Balance Due:
/ 75-1 &'
SECTION j: CONSTRUCTION SERVICES
— Z - t J
5.1 Construction Supervisor License(CSL) License Number Espirution Date
Name of CSL Holder List CSL'rype(see below)
.type Description
4
No.and Street U Unrestricted(Buildin s u to 35,000 cu. flJ
J R Restricted 1&2 Family UWeIL1115.
/b S
f Mason
i
Cityll'own,State,LIP , RC Roofin Covering
Q wS Window and Siding
Y r' SF Solid Fuel Burning Appliances
rm ,S izg B f�Ys I Insulation
9? 735 D3S 7 �p D Demolition
lble hone Emml address 5_8-- rJ
16 q__
5.2 Registered Honte improvement 2f Sractor(HI 72:
IIIC Registration Number E,p,,ution Date
I IIC Cui any Name r C Regi tr nt Name
Email address
No and Sty:et e
c7 ( Telephone
Cit /Town,State,ZIP
SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 152.§ 2jC(�).
Workers Compensation Insurance affidavit must be completed and sue mitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building p
Signed Affidavit Attached? Yes .........'
SECTION 7a:OWNER AUTHORIZATION.TO BE PERMIT
CO BUILDIN MPLETED WHEN : '
OWNER'S AGENTORCONTRACTORAPPLlES FOR G
I,as Owner of the subject property,hereby authorize
t j act on my behalf,in all matters relative to work authorized by this building permit application.
Date
Print Owner's Nmne(Electronic Signature)
SECTION 7b-.OWNEW OR AUTI[ORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains an perjury that all of the information
d penalties of
contained in this application is true and accurate to the best of my knowledge and understanding.15 Q _
-�� as\IWO o Date
Print Owner's or Authorized Aguu s Name(Llccaulol St nature)
NOTES:
I. An Owner who obtains a building permit to do his/her own word,or an oillni ithavvenaccess to ires an ti the arb traegistered tion
conplot registered in the Home Improvement Contractor(HIC)Protractor
ram),
A. ormation on the
program or guaranty fund under M.G.L.n the Construction lSuperver isor License rtant f can be found anv mans am can be and at
www.mass.,,ov/oca information
2. \Vhen substantial work is planned,provide the information
below: a finished basementlattics,decks or porch)
(including g
total floor area(sq• ftJ Habitable room count
Gross living area(sq. ft.)___-- Number of bedrooms
Nllnnber of fireplaces Number of half/baths
Number of bathrooms ,umber of decks/porches�—
'fype of haatingsystem Enclosed —OPen
'type of cooling system
3. Footage"may be substituted fur"Total Project Cost"
"rotal Project Square
1
CITY OF S,:U E1,f, 1,L1SS:ICHUSETI S
l BUtLDNIG DEPART\LE,YT
t� y` 120 WASHLYGTON STREET, 310 FLOOR
h TEL (978) 745-9595
F.,Lv(978) 7.10-98 4S
K!\ffiEltLcY DRISCOI.L
&L-won THO.%tu ST.pmw
DIRECTOR OF PUBLIC PROPERTY/BUILDLN<; CO\ptI5SIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section l 11.5
Debris, and the provisions of bIGL c 40, S 54;
Building Permit It 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 tNIGL c
l 11, S 150A.
The debris will be'transportcd by:
y
y SRC` ts� olti
(name of hauler)
The debris will be disposed of in
(name of facility)
-----(address of racility)
i
signaNreufpermitapplieant —
,late — —
_y.
CITY OF SiU_EN1, NLASSACHCSETTS
'3 BUILDING DEPARTM(EINT
120 WASHINGTON STREET, Sao FLOOR
T Er- (918) 745-9595
F.ur(978) 740-9846
1CI\rBERL.EY DRISCOLL
vL1Y0)i TTIONIASST.PIER E
DIRECTOR OF PUBLIC PROPERTY/BUQDNG CO',NISSIONER
Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers
Applicant Information Please Print Legibly
Name 113usincsmOrgan izahiona ndividual): J .,w� 4 1 ` Y"�✓°o�
Address: ,-L C,rio 5 s A-,
City/State/Zip:,S, (e,4, .,T 14 Phone l : 977 :Z35-035 7
Are you in employer? Check the appropriate box: 'type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or pan-time)." have hired the sub-contractors n
2.X Irma sole proprietor or partner. listed on the attached sheet.: 7• Y-' Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers'camp. insurance. 9. ❑ Building addition -
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.) officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 ran a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself. [No workers'comp. C. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.) t employees. [No workers'
comp. insurance required:) 13.❑ Other
'•Any applicant that chucks box At must also fill not the section below sM1owing their workeri compensation policy inliannation.
I kwcownen,mho submit this affidavit indicating they ate doing all work and then hire outride contractors must suhmil a new affidavit indicating such,
$:�mtmcturs that check this box mast auacha3 an addid.ned ghoul showing the noire of the sub-contractors and their workers'comp.policy information.
1 ani an entpluyer shut is providing(porkers'conipeusatun insurance for my eirrpluyees, Belotp is the policy and fob site
iujorurutfnn.
Insurance Company
Policy A or Self-ins. Lic. it: Expiration Date:
lob Site Address: City/State/Zip:
Attach a copy of the workers' compensation pulley declaration page(showing the policy number and expiration date).
Failure w secure coverage as required under Suction 25A ot'NiGL c. 152 can lead to the imposition of criminal penalties of a
line up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and it fine
of up to$230.00 a day against the violator. Be advised that a copy of this statement may by forwarded to the Office of
investigations of d,c DIA for insurance coverage verification.
1 tha/tereby c•errif nder th puias and/mollies of perjury that the iafonnatioet provided above is true and c-orrec4
Date:
Official toe only. Do nut write in this area, to be courplefed by city ur lotprr affirlaf
Cirynrl'uwn:
Issuing Authurily(circle one):
I. Board of Health 2. Building Deparlutent 3.Citylrwvn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: _ . _. - Phone#: `
[
29 PLEASANT STREET 581-14
- . Gis#: 5827 COMMONWEALTH OF MASSACHUSETTS
Map: 35 f
Block. l CITY OF SALEM
Lot 0586 .�
ry
Categ o RENOVATIONS {
Permit# 581-14 BUILDING PERMIT
Project# JS-2014-001281
Est Cost:" $175,000.00
Fee Charged: $1,230.00
Balance Due:" $.00`� r PERMISSIONIS HEREBY GRANTED TO:
Const Class: I Contractor: License: Expires:
James Atwood/JRB Builders Inc. CONSTRUCTIO SUPERVISOR-066603
lot Siie(sg: fr.): 5958.1368 ,
•, . ,• _F.!k :�; Owner: 29 Pleasant St Salem LLC
Zoning. R2
CT its Gamed: "., Applicant: James Atwood/JRB Builders Inc.
IJmts Lost: , AT: 29 PLEASANT STREET
Dig Safe#: - + ,-
ISSUED ON. 30-Jan-2014 AMENDED ON: EXPIRES ON: 30-Jul-2014
TO PERFORM THE FOLLOWING WORK:
MAJOR INTERIOR&EXTERIOR REMODEL
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
Underground: Underground: Underground: Excavation:
Service: Meter: Footings:
0ugh: Rough: Rough: Foundation:
Final: Final: Rough Frame:
111-1-1 %i Fireplace/Chimney:
b.,P..W;2 Fire Health
Insulation:
Meter: Oil:
Final:
House 4 Smoke:
Treasury:
Water: Alarm: Assessor
Sewer: Sprinklers: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING ROC-2014-001286 30-Jan-14 1002 S1,230.00
Ity?n
GcoTMS®2014 Des Lauriers Municipal Solutions,Inc.