24 SCHOOL STREET CT - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SA
��� Revised Mar
Mar ar 2011
Building Permit Application To Construct,Repair,Renovate Or Deb ''b13sIS�E 0
One-orTwo-Family Dwelling INSPECTIONAL Y it',VICES
This Section For Official Use Only
Building Permit Number. Date lied:
Building Official(PrintName) - Signature Date
SECTION 1: SITE INFORMATION
IT1. Property A res : 1.2 Assessors Map &Parcel Numbers
c m , /r (,e
l.la Is this an accepted street?yes no Map Number Parcel Number
1.3 irg Information / 1.4 P operty Dimensions:
Zoning District Proposed use Lo t ea(sq t) F ntage
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided R uired Provided if
Provided
40 -El D7 �
1.6 ater Supply: (M.G.L c.40,§54) 1.7 Flood Zone Info tion: 1.8 Sewage Disposal System:
Public'' Private❑ Zone: _ Outside Flood Zone? Municipal On site disposal system ❑
Check ifyesl$'
.SECTION 2: PROPERTY OWNERSHIP' .
2. Owner'.of Rec rd:
TAmejPnnt City,Slate,ZIP
c?elL �� if! / �C;,ka�-re�,G�-y�. rr 6'11 (,0141
No.and Street Telephone Email Address —�
SECTION 3:DESCRIPTION OF PROPOSED.WORW(check all that apply)
New Construction 41 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ ,
Demolition ❑ Accessory Bldg. ❑ Number of TJiiit,s--x I Other ❑ Specify:
Brief Description of Proposed Work': Q (,/1 OT 1'0 0 rV 1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 0,0 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ In Total Project Costa(Item 6)x multiplier a
3.Plumbing $ 2 Other Fees $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount::
6. Total Project Cost: $' D O� ❑p?1d in Full ❑Outstanding Balance Due:
�LG�N S Cjn3 1 L_rc
` SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
cs-o�3�06 i �
TD A , Aq te ye License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
,706 6=20 LAC- (5 k!f t✓
No.and Street Type Description .
Unrestricted
(Buildings up to 35,000 cu.ft.
R Restricted l&2 Family Dwelling
City/Town,State,ZIP
Masonry
RC Roofing Covering
WS Window and Siding
p (� '/ n f��� SF Solid Fuel Burning Appliances
W 9,7o 4j,-1 J�N19/�lj�l:'/t'.lwift t"� I I Insulation
Tel hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
]- HIC Registration Number Expiration Date
HJfC Company Name or HIC Registrant Names
D Hof'o i� r✓�,°-ef r.l�r�v�y� y4hi�o Cd�t
No.and Street YZt {'Q- 0 /G7o �i),f y�C'G I/yd Email address
Citv/Town,State,ZIP Telephone
SECTION,6 }'.JIORKERS' 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 Iss a of the building permit.
Signed Affidavit Attached? Yes .......... No ...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED-WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FO/R�BUILDING PERMIT
I,as Owner of the subject property,hereby th nze
to act on my behalf,in all matters relati work authorized by this building permit application.
Ikke ias,�_(Ulkflll
PrintOwner's Name(Electronic Signa ) Date
SECTION7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hergurate
under the pains and penalties of perjury that all of the information
contained in this application is tru the best of M knowledge and understanding.
L -/P-
'Print Owner's r Authorized Agent' (Electronic Signature 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.eov/oca Information on the Construction Supervisor License can be found at wwiv.mass.gov/dpss
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
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"
CITY OF S.0 E.N4 .N%LXSSACHUSETTS
BUILDLNG DEPARTMENT
• I20 WASHINGTON STREET,San FLOOR
a s TEL (978)745-9595
FAX(978)740-98.46
KLNjB Rt-Y DRISCOLL
MAYOR THOMAS ST.PIEM
DIRECTOR OF PUBLIC PROPERTY/BL'ILDLNG CO%L�IISSIONFR
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information T^f Please Print Legibly
Name.(Busin Orgaaizmiorvindividual): �/(.d'711 /'t-1�14a'ex z Z
Address: 20 11 IzdiiP 7-2 z=e- /
City/State/Zip: : I III 01* 0/ 00 Phone#: /7S yet 4�Yy 4
Are you an employer?Check the appropriate box: T- ew
ct(required):
I.❑ I am a • oyer with 4. ❑ 1 am a general contractor and 1 nstruction
et ogees(full and/or part-time).• have hired the subcontractors
2_ am a sole proprietor or partner- listed on the attached sheet t ling
ship and have no employees These subcontractors have S. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9. O Building addition
(No workers comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL 1 I.[]Plumbing repairs or additions
myself.[No workers'comp. c_ 152,§1(4),and we have no 12.0 Roof repairs
insurance required.)t employees. [No workers' 13.0 Other
comp. insurance required.]
Any applicant that checks box A I must also fill uut the sectioo below showing their workers'comm ation patiry infomtadoo
'I In' wners who submit this affidavit indicating they are doing all work and then hire outside contrisom must wbmit a new,axidavit indicting such
:Comm ion that check this box most attached an additional shoet showing the name of the arb•eoovacws and their worker,'comp.policy infonnotim.
I um an employer that is providing workers'compensation insurancejor my employees. Below Is the pulley and jab site
informadoa.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S.N0.00 a day against the violator. Be advised that a copy of this statement tray be forwarded to the Office of
Investigati •of the DIA for insurance coverage verification.
I do hereby i sole ins and penalties of rjury that the information provided above' true and correct.
Si nature: ( pate f F
Phone#: I YJ LAID C
Official use only. Do not write in this area,to be completed by city or town ojfciaL
City or Town: _ Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: __ __ __, Phone#:
7- (963s
CITY OF SALEM =---_
ROUTING SLIP
New Construction y
Certificate of Occupancy— (4;8 ScH o nL_ 5 1 kKA Z `4 S Ck400
5T_ CT
LOCATION A DATE
ASSESSORS DATE d ��
lJ 93 Washington t. J
CITY CLERK DATE
93 Washington St. �
Lf q� V;PUBLIC SERVICES Qb(L" DATE u (�
r 120 Washington St.
Y WATER _DATE
120 Washington St.
CROSS CONNECTION DATE S �V
5 Jefferson Ave 1
PLANNINGAZ_ DATE 1 12a
1 120 Washington St.
)L CONSERVATION DATE
120 Washington St.
X ELECTRICAL DATE O .3D
48 Lafayette St.�( FIRE PREVENTION '( DATE ll7/
��r3C�Cz Pl�2vn� �
29 Fort Avenue
HEA DATE
1 ashington St.
BUILDING INSPECTOR ' DATE A � i)
�`�� 120 Washington St.
1
CITY OF SALEM
PLANNING BOARD
FILE #
FORMA-DECISION CITY CLERIC, SRL&M, MASS
46-48 SCHOOL STREET
On July 30,2015 by a unanimous vote of eight (8)in favor (Ben Anderson (Chair),Kirt Reider,Dale Yale,
Bill Griset,Matt Veno,Noah Koretz,Randy Clarke, Carole Hamilton) and none (0) opposed to endorse
"Approval under Subdivision Control Law Not Required" for the property located at 46 and 48 School Street
and filed on the following described plan: "A.N.R.Plan for Michael W. Becker at 46-48 School Street Salem,
MA" dated July 29, 2015
1. Applicant: Michael Becker 48 School Street Salem,MA 01970
2. Location: 46 and 48 School Street Salem,MA 01970 (Map 27,Lot 7)(Map 27,Lot 5)
3. Description: The applicant requests to create one buildable lot.
Deed of property records in Essex South District Registry.
Sincerely,
� _ A
Ben Anderson
Chair
Cc.: Cheryl LaPointe,City Clerk
°° °'T� Commonwealth of Massachusetts -�
3 q City of Salem ,;{�,]�
!iN
Inspectional Services
RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641
Application For Building Permit (One- or Two- Family Dwelling)
Permit No#: TB-16-1348 Date Applied: 11/18/2016
11/21/2016
Building Official(Print Name) Signature Date Issued
SECTION 1 : SITE INFORMATION
1.1 Property Address 12 Assessors Map&Parcel Number
2 SCHOOL STREET COURT —C — 27-0635
1.3 Zoning Information 1.4 Property Dimensions
R2 93030
Zoning District Proposed Use Lot Area Frontage(ft)
1.5 Buidling Setbacks(ft)
Front Yard Side Yard Rear Yard
Required Provided Required Provided Required Provided
15.00 0.00 10.00 0.00 30.00 0.00
1.6 Water Supply: 1.7 Flood Zone: Outside Flood 1.8 Sewage Disposal System
Zone?Check if
Public Zone: yes_ Municipal
SECTION 2: PROPERTY OWNERSHIP
Owner of Record
BECKER MICHAEL W 48 SCHOOL STREET SALEM MA 01970
Name Address
Phone Email
SECTION 3: DESCRIPTION OF PROPOSED WORK
Permit For: New Construction - 1-2 Family
Brief Description of Proposed Work:
CONSTRUCT A NEW DUPLEX(W 46-48 SCHOOL ST.
(Foundation permit was B-15- 1397) aka 2-4 SCHOOL ST CT.)
SECTION 4: ESTIMATED CONSTRUCTION COSTS/PERMIT FEES
Total Project Cost: $325,000.00 Payment Date Amount Paid Check No
Total Permit Fee: $2,275.00 11/21/2016 $2,275.00 3782
Total Permit Fee Paid: $2,275.00
THIS IS NOT A PERMIT
Commonwealth of Massachusetts
/
9 City of Salem
Inspectional Services
[-RECEIRTJ
120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641
Building Type: Two Family Existing Proposed
No.of Floors/Stories(include basement levels&Area Per Floor(sq.ft.) 0 0
Total Area(sq.ft.)and Total Height(ft.) 0.00 0.00 0.00 0.00
SECTION 5: CONSTRUCTION SERVICES
5.12 Registered Home Improved Contractor(HIC)
John HARVEY 30 A GROVE ST License Number: 183198
Name Address
(978)420-6446 SALEM, MA 01970 License Type: HIC
Phone City/State/Zip
Email lcharve@yahoo.com License Expiration: 9/14/2017
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT
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 On File? True
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 John HARVEY to act on my behalf, in all matters relative to work authorized
by this building permit application.
BECKER MICHAEL W 11/18/2016
Print Owner's Name(Electronic Signature) Date Submitted
SECTION 7b: OWNER 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 accurate to the best of my knowledge and understanding.
BECKER MICHAEL W 11/18/2016
Print Owner's Or Authorized Agent's Name(Electronic Signature) Date Submitted
NOTES:
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 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.gov/oca Information on the Construction Supervisor License can be
found at www.mass.gov/dps
When substantial work is planned, provide the information below:
I THIS IS NOT A PERMIT i
N°° ° Commonwealth of Massachusetts
�k��
i7
fq City of Salem ,,
3
Inspectional Services
RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641
Application For Building Permit (One- or Two- Family Dwelling)
Permit No#: TB-16-1348 Date Applied: 11/18/2016
11/21/2016
Building Official(Print Name) Signature Date Issued
SECTION 1 : SITE INFORMATION
1.1 Property Address ^^ 1.2 Assessors Map&Parcel Number
48 SCHOOL STREET 27-0005
1.3 Zo _ 1.4 Property Dimensions
R2 27492
Zoning District Proposed Use Lot Area Frontage(ft)
1.5 Buidling Setbacks(ft)
Front Yard Side Yard Rear Yard
Required Provided Required Provided Required Provided
15.00 0.00 10.00 0.00 30.00 0.00
1.6 Water Supply: 1.7 Flood Zone: Outside Flood 1.8 Sewage Disposal System
Zane? Check if
Public Zone: yes_ Municipal
SECTION 2: PROPERTY OWNERSHIP
Owner of Record
BECKER MICHAEL W 48 SCHOOL STREET SALEM MA 01970
Name Address
Phone Email
SECTION 3: DESCRIPTION OF PROPOSED WORK—_
Permit For: New Construction - 1-2 Family
Brief Description of Proposed Work:
CONSTRUCT A NEW DUPLEX 0 46-48 SCHOOL ST.
(Foundation permit was B-15- 1397) aka 2-4 SCHOOL ST CT.)
SECTION 4: ESTIMATED CONSTRUCTION COSTS/PERMIT FEES
Total Project Cost: $325,000.00 Payment Date Amount Paid Check No
Total Permit Fee: $2,275.00 11/21/2016 $2,275.00 3782
Total Permit Fee Paid: $2,275.00
THIS IS-NOT A PERMIT
Commonwealth of Massachusetts =�
iQ
m City of Salem ; 2
" Inspectional Services
RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641
Building Type: Two Family Existing Proposed
No.of Floors/Stories(include basement levels&Area Per Floor(sq.ft.) 0 0
Total Area(sq.ft.)and Total Height(ft.) 0.00 0.00 0.00 0.00
SECTION 5: CONSTRUCTION SERVICES
5.12 Registered Home Improved Contractor(HIC)
John HARVEY 30 A GROVE ST License Number: 183198
Name Address
(978)420-6446 SALEM, MA 01970 License Type: HIC
Phone City/State/Zip
Email lcharve@yahoo.com License Expiration: 9/14/2017
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT
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 On File? True
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property hereby authorize John HARVEY to act on my behalf, in all matters relative to work authorized
by this building permit application.
BECKER MICHAEL W 11/18/2016
Print Owner's Name(Electronic Signature) Date Submitted
SECTION 7b: OWNER 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 accurate to the best of my knowledge and understanding.
BECKER MICHAEL W 11/18/2016
Print Owner's Or Authorized Agent's Name(Electronic Signature) Date Submitted
NOTES:
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 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.gov/oca Information on the Construction Supervisor License can be
found at www.mass.gov/dps
When substantial work is planned, provide the information below:
THIS IS NOT A PERMIT
5
��° °"+ Commonwealth of Massachusetts 4 s.
f o
3 H City of Salem Ui
Inspectional Services
RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 n5641
Application For Building Permit (For Buildings other than a One- or Two-Family Dwelling)
(This Section for Official Use Only)
PIN: TB-16-1346 Date Applied: 11/17/2016
I
:Building Official(Print name):
SECTION 1: SITE LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
2 SCHOOL STREET , Salem, MA
SECTION 2: PROPOSED WORK
Are Building plans and/or construction documents being supplied as part of this permit application?: No
Is an Independent Structural Engineering Peer Review Required? Yes[—] No❑
Brief Description of Proposed work: NEW CONSTRUCTION - NEW DUPLEX (See B-15-1397).
SECTION 3: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION, ADDITION, OR CHANGE IN
USE OR OCCUPANCY(Check Here_if an Existing Building Evaluation is enclosed(see 780 CMR 34))
Existing Use Group: Proposed Use Group:
SECTION 4: BUILDING HEIGHT AND AREA
Existing Proposed
No. of Floors/Stories(Include basement levels)&Area Per Floor(sq.ft.) 0 1 0.00 0 1 0.00
Total Area (sq. ft.)and Total Height(ft.) 0.00 1 0.001 0.001 0.00
SECTION 5: USE GROUP
SECTION 6: CONSTRUCTION TYPE
Undev Land
SECTION 7: SITE INFORMATION(re r to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disp al: Trench Permit: Debris Removal:
Public Check if inside Flood Zone ❑ Municipal will not required ❑ Licensed Disposal Site
or o�
El
Identify Zone: Is ee closed ❑ or specify:
Railroad right-of-way: Hazards to Air Navigation: MA Historic commission Report Process:
Not applicable ❑ Is Structure within airport approach area? Is their review completed?
or Constant to Build Enclosed ❑ Yes No ❑ Yes ❑ No ❑
SECTION 8: CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Occupant Load per Floor Does the building contain a sprinkler system?:#Error
Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
THIS IS NOT A PERMIT
°" Commonwealth of Massachusetts
t t7
3 9: City of Salem
Inspectional Services
RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641
MICHAEL BECKER 22 HAWTHORNE BLVD SALEM MA 01970
If applicable,the property owner hereby authorizes
JOHN HARVEY 30A GROVE STREET SALEM MA 01970
To act on the property owner's behalf,in all matters relative to the work authorized by this building permit application.
SECTION 10: CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
Name Phone Email Registration Number
Address Discipline Expiration
Date
10.2 General Contractor
Company Name
CS-093706 CONSTRUCTION SUPERVISOR
JOHN HARVEY License no. and License Type if Applicable
Name of Person Responsible for Construction
Address: 30A GROVE STREET SALEM MA 01970
Phone (978)420-6446 Email Address JcHarve@yahoo.com
SECTION 11: WORKER'S COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152§25C(6))
A Worker's Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application?False
SECTION 12: CONSTRUCTION COST AND PERMIT FEE
Total Estimated Costs(Labor and Materials): $325000.00 Building Permit Fee: $2275.00
Enclose check payable to the City of Salem, Ck#
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
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 accurate
to the best of my knowledge and understanding.
(978)420-6446
Please print and sign name Title Telephone
Address: 30A GROVE STREET SALEM MA 01970 Date: 11/17/2016
Municipal Inspector to fill out this section upon application approval: 11/18/2016
Name Date
r THIS IS NOT A PERMIT