14 RIVER ST - BUILDING INSPECTION PUBLIC PROPERTY
DEPARTMENT
Kl.%IBFIU"DRISCOLL t
MAYO ` � „/ f�
1?0 WASHINOTON$'lREEL 4\wU14 MA15AIXl5hll5 01970
TEL-978-745-9S9S •FAx:978-740-9U6 ^�
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: (' KIJZR Building:
Property Address:
14 Mug 4�
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: 1�l t�AD i��J) 5T PaJ11�9� 'i{t 1 D(Z pt
Address:
14- RWrK1
Telephone: N L-f S I It O O 1 T I I W (),6-P T 61-T 'j$ 4-3 0
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition W) Existing 37
I ,FS
Renovation 5 Number of Stories Renovated A �k
Change in Use v New �G3 ,t1�1
Demolition D Existing �SD
Approximate year of f � Area per floor (sO Renovated s�(�
construction or renovation I
of existing building I I New S Sd
Brief Description of Proposed Work:
9T-PLAZ,r iof of r)4-v WK wwoo-,05, 1,0 pir(eA
Mail Permit to: U) b
What is the current use of the Building?
material of Building? WGUD 4e;J 5f gcJWlf dwelling, how many units?
Will the Building Conform to Law? Y13 Asbestos? �D
Architect's Name
Address and Phone f
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ yid Permit Fee Calculation
Permit Fee $ 141, Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build o the above stated
�� a
specifications. Signed under penalty of perjury
Date I I O
� of
y
y
u
A �
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CTI'Y OF SALEM
.0
PUBLIC PROPERTY
DEPARTMENT
WYOt laowstIONGMUSMW•s areoeoa;sarts01970
1IM.M745-9SlS•PAZ 41L74&%4
Construction Debris Disposal Affidavit
(required Let aU dem Mom and ravadon worst)
In accordance with da sixth edidoo of the Stays Building Cods.780 CMA section 111.5
Debris,and dw provisions of MGL a 40.S.%
Building Ift 0 is issued with the condition that die dalmis malting Ava
this work"be disposed of in a properly demand waste digmW etdUW as defined by M(3L a
1 l 1.s 130A.
The debris will be transported by:
A4 KAhIW)
i
The debris will be disposed of in:
Lii`P OuA0PAL- OwiP
(=aw of ftwity)
5WAX P5LDT9 OAQ 5 A trIj
(address of Peachy
A ) HAD 14,A))
s���fpem�ir appliaat
-� eats
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIMBERLEY DRISCOLL
MAYOR 120 WASHINGTON STREET •SALEM,NfASSACHUSETIS 01970
Txi 978-745-9595 ♦ Far:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please PH t
Date U n
Job Location �fK£rc
Home Owner Address I� RIUfR S Ym-r
Home Owner Telephone q 'f$ 7 W d lJ
Present Mailing Address I Lt Rlo rR SST
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 who,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 understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
Q
HOMEOWNERS SIGNATURE �t,. at ,
APPROVAL OF BUILDING INSPECTOR
See other side for state code
Homeowner's Exemption
The Code states that: "Any Homeowner performing work for which a Building Permit is
required shall be exempt from the provisions of this section(Section 109.1 —Licensing of
Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do
such work, and the Homeowner shall act as Supervisor."
Many Homeowners who use this exemption are unaware that they are assuming the
responsibilities of a Supervisor(see Appendix Q,Rules and Regulations for Licensing of
Construction Supervisors, Section 2.15). This lack of awareness often results in serious
problems,particularly when the Homeowner hires unlicensed persons. In this case your
Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The Homeowner acting as Supervisor is ultimately responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities, many
communities require, as part of the Permit Application, that the Homeowner certify that
he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.
. o
a
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT.311 FAX (978)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District, as per the requirements set
forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance.
District: McIntire
Address of Property: 14 River St.
Name of Record Owner: Stephanie Trainor Madigan& Daniel Madigan
Description of Work Proposed:
Replacement of windows with wood, true divided light, 6 over 6, single glass, clear glass windows with sills to
match the thicker sills on the building. Option to install exterior energy panel provided it is single glaze, clear
glass.
Dated: July 20, 2006 SALEM HISTORICAL COMMISSION
MMS�SION
By: C�; I O� / ` -/t
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals) prior to commencing work.