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98 SCHOOL ST - BUILDING INSPECTION (3) GK 13014 4 Zg -7" The Commonwealth of Massachusetts RECEIVED �OY 1 Board of Building Regulations and Standar FECTVAW L S RVI(SSAL OF Massachusetts State Building Co ,de 780 CI� ALEM q(, Revisedgt/ur20/l Building Permit Application To Construct, Repair, Renovate , VWliphla One-or Two-Family Dwelling lUt This Section For Official Use 0nl N Building Permit Number: Date. ppliedt 1 Building Oilicial(Print Name). Signature" Date SECTION 1:SITE INFORMATION' 1.1 Property Address: 1.2 Assessors Map Br Parcel Numbers II.I a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Properly Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(11) 1.5 Building Setbacks(it) Front Yard Side Yanis 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: Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ — Check if es❑ Po y SECTION2: PROPERTY OWNERSHIP 2.1 Owner'of Record: n S n 19�0 x �ONPVLC ( 62taW-Powej.- City,State PIP '�me(Prifnntt) I2 tlu-II qn 2-2,1 3Ors �� �c2hoo,wM No.and Street Telephone Email Address -- SECT16N 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building Owner-Occupied I Repairs(s) ❑ 1 Altemtion(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of ProposedWork2: KOMOUNIIS 1\ -0 afQLgue+S Au t5lcEZM�CA'L Rt=(tOV\�1Ci pt.3D lZcPUAawjS PrLL PIAAn&gN - (ZtEa,V1U..L, GNlN.N!� 1 X 1 TLi LL 11 Ai'\i;zwt\ + 0 k jc RALF l`3. c A"ao n , E k ifUti� SECTION 4: ESTIMATED CONSTRUCTION COSTS Itcm Estimated Costs: Official Use Only Labor and Materials i. Building S i O- L7 0o I. Building Permit Fee:$ Indicate how fee is determined: vn ❑Standard City/Town Application Fee 2. Electrical S t 2 t) ❑Total Project Cost'(Item 6)s multiplier s 3. Plumbing S 19 .ocvo 2P?Qther Fees: S 4.1%Icclumical (HVAC) S List: 5. \lechanical (Fire S Total All Fees:S Suppression) Check Na._Check Amount: Cash rlmotmt:_ x G.Total Project Cult: S t { U op ❑Paid in Full ❑Outstanding Balance Due: fly\Cd r SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisur License(CSL) License Number Expiration Dale Name ofCSL Holder .. List CSL'Type(see below) TYpr Description No.;aid Street U Unrestricted(Buildings up-to35,000cu. ft.) R Restricted I&2 Family Dwelling City/Town,Stale,ZIP M Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Dane HIC Company Name or HIC Registrant Name 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 Is§uance of the building permit. Signed Affidavit Attached? Yes ..........❑ No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE.COMPLETED,WHEN! OWNER'S AGENT OR CONTRACTOIbAPPOES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize t9 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 ORAUTHORIZED AGENT DECLARATION By entering my name below,i hereby attest under the pains and penalties of perjury that all of the information contained in tl is application is true and accurate to the best of my knowledge and understanding. k4 r 2z�1-5�- Print Owners or Authorized Agent's Name(Electronic 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 LLoj have access to the arbitration program or guaranty fund under I.G.L.c. I42A.Other important information on the HIC Program can be found at wivw.mass.:ol �Information on the Construction Supervisor License can be found at www.mass. ov'dns 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 rypeofcoolingsystem Enclosed Open 3. "Total Project Square Foolage"many be substituted for"'rutad Project Cost" QTY OF SALEM, MASSAC HUSETTS BUILDING DEPARTMENT y jr S 120 WASHINGTON STREET,3ftD FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: Date f} I I"► 2oI Job Location q2 SClFpU l_ s SA---v UENA , n 0\<:i-70 Home Owner Address 0\9—) Z) Present Mailing Address YL (A- a1E"I-3,4 tAA , OIq?Q 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 QT'Y OF SALEM, MASSAaiUSE TTS BuulDnvGDEPARTA ENr 120 WASHwGTON STREET,3'm FLOOR 1)3L.(978)745-9595 FAX AX(978)740-9846 MAYOR THomAs STYzRRE DIRECTOR OF PUBMPROPERTYAUI DING CObIIv MONER 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 c40, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: W " ram NA (name of hauler) The debris will be disposed of in: (name of facility) (ad dress of facility) Si ature of applicant 2oI �— Date Details Page 1 of 1 f�Vima vebiil-ofJ bx: cuiiv20 Ceof Pollc 53,ty and Sec.,. ty(ECPSS) Mase(;iFlorae Stae Apid s ensee Details Full Tame: "" a n h!c I ] J I N A MCMAHON ender: R Vw.ner Name: 7ress: BEVERLY MA p 01915 o nt : U 'ted tates rmition icense o: CS-069!453 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 12/6/2012 Issue Date: Expiration Date: 10/20/2014 License Status: Expired Today's Date: 4/17/2015 Secondary License: Doing Business As: atus Change: Expired Ck o Pre-requisite Information No Discipline Information Documentium Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=258403& 4/17/2015 C/ L) �T The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building Cade, 780 CMR ReviseJ,tlar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a NOne-or Two-Family Divelling I This Section -Official Use Onl BuildingPenoitNumber: DateApp 'ed: Building Olticial(Print Name). Si+ ure, ' Date SECTION 1:SITE INFORbIATION' "1 o erty AJ, dress: C�j 4 e C'_J_ 1.2 Asses n hlap&Parcel Numbers L I a Is this an accepted sWeett?[�y`'es dnlo Map Number Parcel Number 1.3 Zoning Information: IA Properly Dimensions: Zoning District Proposed Use Lot Area(sy R) Frontage(It) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard ReyuireJ Provided Required Provided Required Provided 1.6 Water Supply:(b1.G.L c.y0,§Sd) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP!' 2. wner� f Rccor (� �CI�� � e(Pnnt) I Ciry State, a Nu nnJ Sued` � Telephony � Email Addrcsg SECTION 3: DESCRIPTION OF PROPOSED'\VORK3(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work": SECTION a: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials I. Building S I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2�Qther Fees: S 1. �I,chanical (HVAC) S List: 5. Mechanical (Fire S 'total All Fces:S Suppression) Check Na._Check Amount: Cash Anwunt:_ 6.Total Project Cost: .'S ❑Paid in Full ❑Outstanding Balance Due: 1 N/22 L SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Mulder List CSL'fype(see below) No.;md Street Type Description U I Unrestricted(Buildings tip to 35,000 cu. 11. R I Restricted 1&2Fmnil Dwelling City/Town,State,ZIP M I Masonry RC I Roofing Covering INS Window and Siding SF Sul id Fuel Burning Appliances 1 I Insulation Telephone Email address D Demolition . 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street - Email address City/Town, State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.151§2SC(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 Is4uance of the building permit. Signed Affidavit Attached? Yes ..........❑ No.........., ❑ SECTION 7s:OWNER AUTHORIZATION.TO BE.COMPLETED.WHEN' OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING.PERMIT' 1,as Owner of the subject prope ,hereby authorize t9 act on my behalf,in all matte r lative to wor autl or' ed by this building permit application. Print Owners Name( Nctronic Signature) DA to SECTION 7b:OWNERI 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. Print Owner's or Authorized Agent's Name(Electronic 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 eat have access to the arbitration program or guaranty fund under 1I.G.L.c. 142A.Other important information on the HIC Program can be found at 1esvw m3sr u)v:'oca Information on the Construction Supervisor License can be round at w�v:'dns 2. When substantial work is planned,provide the information below: Total floor area(sq. R.) 9 .(including garage,finished basement/attics,decks or porch) Gross living area(sq. 11.) 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 ofcoolingsystem Enclosed Open 1. "Total Project Square Footage"may be substituted for Total Project Cost" IRON 0345'57'W ROD I T3.00'/ -,IRON SET ROD SET W O iq '7 d T � 47 � V IRON ROD IRON N SET ROD U) IRON — SET ROD 29.75' S05'26'18'E SET ~59.5Q' 1 w IRON n ROD coSET tc v 3 z a AREA = 4551 t S.F. o P' IRON o ROD tO m SET z (V W N IRON IRON ROD ROD SET SET 63.18' _ N054f03"W LAFAYETTE STREET PLAN SHOWING LOT STAKING _ LOCATED AT 387 LAFEYETTE STREET SALE M s,•„��;: PREPARED FOR PAMELA P. KNIGHT SCALE V' = 20' JUNE 26, 2012 NORTH SHORE SURVEY CORP. 14 BROWN STREET / SALEM- MA_ 01970 978-744-4800 # 3774 l