3 SALT WALL LN - BUILDING INSPECTION (3) yThe Commonwealth.of Massachusetts
a Board of Building Regulations and Standards CITY OF
4� Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Pennit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This ction For Mcial ,se O y -
Building Permit Numbe ate ppli
�a 77 , //
Building Official(Print Name) e Signature Da
SEC :SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
3 SALT iWP+tL r - rs �Q 5
L l a Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
t�'2 RR5IDCNTiRL '01;*122 sar'S 80.6G
Zoning District Proposed Use Lot Area(sq It) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
em I CJ t c) 36 3 r-_v
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Private CI—/ Zone: _ Outside Flood Zone?
,u �r Check ifyes[i?� Municipal eon site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owned'of ecord:
Chr,sc<�l�rynl �tiytiv2 5�ft�sr, 1 m� c)��l�o
Name.(Prmt) City,State,ZIP
3 st's�-S'wet►.L 1_�*J+.e zoz 3��.`t01� iCa�rytaeea�co��C1w'�..c:o
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction ❑ 1 Existing Building V Owner-Occupied Repairs(s) Z Alteration(s) Addition R(
Demolition Bel Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work': ' ev)Ne &&LA VIC)t< o S AC o•cre-
Aaa new 0?-a Ut-ce � sari .G,c GoaKs5&4
MA '1-u\k 'rso�.r'r 'TrAGc. aCS ECG
SECTION 4: ESTIMATED CONSTRUCTION COSTS -
Item Estimated Costs: Official Use Only
Labor and Materials -
I. Building $ 85 CCO 1. Building Permit Fee:$ Indicate how fee is determined:
lO' ❑Standard City/Town Application Fee
2. Electrical $ -
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ `C),CC)3 2. Other Fees: $
4.Mechanical (HVAC) $ 101C)CO List:
5.Mechanical (Fire $ ,/
Suppression) cD Total All Fees: $
�n)�CO� Check No. Check Amount: Cash Amount:
(� 3 6. Total Project Cost: $ t �, ❑ Paid in Full yy ❑Outstanding Balance�Due:
ce
� g�0 Mu �o (Ohf�kc�b>r
� a5
Dto
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) - 15 f p 3 1
k<5 UJy '�,_ s� ',nl �S License Number b Espiration Dale
Name oFCSL Holder _
� List CSL Type(see below)
105 L003S; SS
No.and Street Type Description
�!C(13 U - Unrestricted(Buildin s u to 35,000 cu. ft.)
V R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Sidin
I& `I fib t�S� �r \ SF Solid Fuel Burning Appliances
I\w ',�% �' 'M�i'1.0 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
H
HIC Company Name or HIC Registrant Name IC Registration Number Expiration Date
No.and Street
Email address
City/Town, 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 .......... 107 No........... ❑
w
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 elIle
to act on my behalf, in all matters relative to work authorized by this building permit application.
K1 r C P l C
Print Owner's Namee lec[ronic Signaturureh Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained 'n this pplication ' tru and accurate to the best of my knowledge and understanding.
M
Prflit Owner's opolAutyrized Agent's Name ecironic Signature) Date
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 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
wwyw.mass.-%Woca Information on the Construction Supervisor License can be found at\N%vsv.niass.eov/dns
2. When substantial work is p��lan/ned, provide the information below:
Total floor area(sq. ft.) OM1.�Q� Srs (including garage, finished basement/attics,decks or porch)
Gross living area(sq. ft.) ;i�66 .Y>,t� Habitable room count 71
Number of fireplaces 1 Number of bedrooms
Number of bathrooms Number of half/baths !Z N l .
Type of heating system ";r—Av " ma, Number of decks/porches 1
Type of cooling system PtW, Enclosed Open___
3. "Total Project Square Footage"may be substituted for"Total Project Cost" 2 Nd Obwr 1936 .C S
h
Massachusettsuscth- tticp irbncui'.st Public Jafctt
ILWJBoard of Buddim, Re ulations and Standards
construction.Supervisor License.
Licenser CS 56286
5
KELLEY J SCHEWS JR
105 LOCUST ST
DANVERS, MA 01923
{Y� r
E-xpiration: 9/3%t2.
[ .norms§ioxer - Tr#: 2036
rt +
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
. We 14:1 Y'ae,NI'll -
�Ittlst
I!��VnM UAI;I u.\i18 ELT a $.1 Ili.N,M.t U•N.1 , N'I IN JI9
7. .
0/.113.9iu3 a 1'tN v7N•7sq:1,yK,
Workers' Cumpenaation Insurunce Afndavitt Builders/Contractors/Electricians/Plumbers
► ) tlicrnt Information
Piers Print Le 'hl
ciIiIInc I ILnuwciOrganlra6.1tvI Javlduull: LL1 Ye.\/ 'S sc�C�)S
lddre..is: Laws;j ST
Phoned: 9"`�. 9 3r) cZ<ZT)
I .\re)ou an vurployer:'Check the appropriate bo
I.❑ 1 an,a empluycr with 4. 111D a guncral contractor jtndl 1)M of pnrjeet(nqulnd);
unlployccs(full and/ur pun-6111r).• huvu hired the suh-contrac r'' ❑new construction
'•❑ 1 am u sole prnpricux nr panncr- listed on the anachcd shee7• (Z'Remodelin j
ship and have no cmpluycus These subcontractors hava. [v�Demoliriun E,I�nysvlt
rking Air me in any capacity, workers'comp, insurance. ram/
No workers'cutup, insurance 3. ❑ We are a ca 0• ue RuiWin�addition
uired.] parstinn and it
ufRcen Iwvc csereined thei10.Q�Electrical repairs or additions
t a homeowner doing all work right of escmption per NIO11.[�Plumbing repairs or additions
LNes trorkers'comp. c. 132,§1 L4),and we have nrance required.j r crnPluycus. [NO workers' 12.L19 RuuII repaint
comp. insurance required.J11•❑Oilier
\nr.•,phcaa IIm checln Oee rl mum:dsu,tll ua,he Mecoul Lalew
' I1umw,wm s w llwwind Ines wwkue' uliey Inlivaaw,iwe
Ati uarmil state
mint vir hilivainy dilllevity au acting all work mat amd biro ads,side eu irandn,mw,.uhnr a new,arflaevil indicating Muck,
d•,nlnwn.n,hW check this kea mint arraAed an aaailiunal Mfaurl M11Uwiray ItW I,aeN Or the rlre.eanrraCrJra and 111eH wurkere'clamp,prrbcy Inllarmariue.
arn un ewployrr Ihur Jr prvrid/ng lvurkdn'cutnpenrnl/on lnrurrrnce far illy dmp/ayrer, Below/s the pulley and/ub sift
iulururu/inn.
Insurance C'ottpaoy Name:
Volicy it or Sulf•ins. Lic.o:
- .. . Eepirar,on Date:
Jub Site Addruss:
- C'nyaSlate/Lila:
Allach a eupy or iho workers'cumpcnaatlnn pulley declaration page(showing the policy numbar and expiration date).
"allure to.Wcura cuveruse as required under Suctiun 23A ul'JIGL c. 151 can lead to the imposition of criminal penalties of a
tine up ro.l'LSOO.t10 and/or uue-year irnprisonmunt, as wail ue civil lacnaltics in the 1'unn of a STOP WORK ORDER and a fine
o/up to 5250 00 is day istainsl the viola Jilt. Ile advi.+cd that a copy orihis stutcment may be lurwurded W the Wiice ill•
III\'ialhalpnla ill IIIC UI,► II]f IIIMn/:11'ee a;vcnge t eritieatiun.
/Ju la•rrhy r c•rli/y rurJer Ihr pr rn Ir J prn firs er rry Ihur 16 in/urmurlan pruviJrd ubuvv is Isar unr/correrC
�I:nno
I'I I n: • :r
U/jlciu/uLve un/y. no not ierire in d11.r urea, to be runrpleldd by city ur Imvn,r//icruL
- ('its or 1'nwn: __. Pennit/LIn•nye s I
1M%Wnsi Whnrity (circle nee):
II. llier J -If IlealUt 1.
G. Ihhv Ihuldi,, Uvp:,rtnlcul 1. is Clerk 4. Electric.11 hliperrur i, Plumbing InMpcetor i
I l'�.nLal 1'c nun: I
I'huov 1:
RGS . kss�
. -?6('a
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CITY OF S.�t.E.�i, �LkSSACHUSETTS
BLLMLNG DEPARTMENT
120 W.ASHLNGTON STRM. 1'*FLOOR
TEL (978) 745-959S
F. x(978) 740`9846
KIJ®ERiEY DRISCOLL
MAYOR THows ST.PrEswit
DmEGTOt OF PLBLIC PROPERTY/Bunxi G CONNISSIONER
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 l l 1.5
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: ,
�-�ys•��'��sc�«1 ate-si-��
(name of hauler)
The debris will be disposed of in
(name of facility)
(,iddress of facility)
Af c it applicant —
date
I.M1nvl(I•w
Professional land Surveyors B Civil Engineers
ESSEX SURVEY SERVICE 1958 - 1986
OSBORN PALMER ' 1911 - 1970
BRADFORD & WEED 1885 - 1972
PLOT PLAN OF LAND
LOCATED IN
SAL�i/ MASS.
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I hereby certify to the 51rL,!�-0l
Building Inspector that the pro
ZONE: Q( LOT AREA: �S6a0ST LOT FRONTAGE: Ipp jj posed construction shown conforms
to the dimensional zoning of
FRONT YARD: /Sri SIDE YARD: REAR YARD: 3Uf1 g4 Mass.
SCALE.
DATE: a �w o
REFERENCE: BK 222q/ PG 34 Chr' opher R. to ELS031311TIt
4 No.31317 o 3
104 LOWELL STREET
PEABODY, MASS. 01960
(978) 531-8121
FAX: (978) 531-5920
DENSITY REGULATIONS SECTION VI
TABLE I
RESIDENTIAL DENSITY REGULATIONS
R-C R-1 **R-2 **R-3
Minimum Lot Area (sq. ft. ) 80,000 15.000 115,060 25.000
inimum Lot Area Per dwelling unit WOOD 15.000 7.500 MOD
Minimum Lot Width (ft.) 200 too 100 100
Maximum Lot Coverage by all buildinas 20% 30% 35t 35%
inimum Depth of Front Yard (ft. ) 40 15 15 15
inimum Width of Side Yard (ft.) 40 10 10 20
inimum Depth of Rear Yard (ft.) 100 30 30 30
I'laximum Height of Buildings (ft.) 35 35 35 *+*45
Maximum Height of Buildings (No.of Stories) 2} 2i 2; 31
Maximum Height of Fences/Boundary Walls (ft .) 6 6 6 6
Minimum 'Distance Between buildinas on lot ( 100 40 30 40
='- These density regulations relative to height will apply to all housing pro-
jects even though financed in whole or in part by the U.S. Public Housing
Authority and/or Commonwealth of Massachusetts, Department of Community
Affairs, Division of Public Housing._ Specifically excluded will be housing
for the elderly constructed by the Salem Housing Authority.
*** Multi-family dwellings building in R-3 Districts on lots held under a single
ownership and consisting of, a minimum of two hundred . thousand (200,000)
square feet may be built to a maximum height of 50 feet or four stories in
height (2/3/75) •
Retaining walls , boundary walls and/or fences maybe built abutting the property
line. The height of the retaining walls , boundary walls and/or fences shall be
measured on the inside face of the structure on the owner ' s side.
Refer to Section VII -G for "Visibility at Intersections."
NOT TO SCALD
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