11 SETTLERS WAY - BUILDING INSPECTION J
I W
The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
"` (This Section For Official Use Only) = - -
Building Permit Number; - 'Date Applied: Us Building Offiaal -
-- - SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
0q
No.and Street C /Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Buildin Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use Oe Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ NQ_Q-%
Is an Independent Structural Engineering Peer Review required? ` - r� ,, L Yes ❑ Ng,A-
BriefDescriptionofProposedWork: ReA"E K-44i1k 4�1�bsMJC\
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY..- -
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 13
Existing Use Group(s): Proposed Use Group(s):
-. - SECTION 4:BUILDING HEIGHT AND AREA
.._. Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) -
iota]Area(sq.ft.)and Total Height(ft.)
�-' = ::SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E:- Educational ❑
F: Facto F-1 ❑ F2❑ 1 Hi Hi Hazard H-1❑ H-2❑ H-3 ❑ H74❑ - H-5❑
1: Institutional I-1❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 - R-2❑ R-3❑ .R.4 fa
S: Storage S-1❑ S-2❑ - - U: Utility❑ Special Use❑and please describe below: - -
Special Use: .
zip -ry "+'= 'S SECTION 6:CONSTRUCTION TYPE(Check as applicable)",' - "
IA IB ❑ IIA ❑ IIB ❑ ILIA ❑ 11I1113 IV 17 VA ❑ VBO
-- ..- SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: .Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
- permit is enclosed❑ -
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or 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 an Sprinkler System?: Special Stipulations: - -
A/�
{"•"' SECTION 9: PROPERTY OWNER AUTHORIZATION
Na and Atddresg o('Pr perry Ow r
Nae`(Print) No.and Street City/Town
m .Zip, .
Property Owner Contact Information: -
�1y
Title Telephone No.(business) Telephone No. (cell) e-mail a dress
If applicable,the property owner hereby authorizes
Name Street Address City/Town - State Zip -
to act on the property a owner's behalf,in all matters relative to work authorized by this building permit application. - -
r SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If buildin is less than 35,OOQ cu.ft.of enclosed s ace and/or not under Construction Control then check here Q and skip.Section 10.1 '
10.1 Re istered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address - City/Town State Zip Discipline Expiration Date
10.2 General Contractor
oGP �rn pr i OAC)
Compa Name
� S 09NU
Name of Person ponsible for Construction . License No. and Type if Applicable - -
(0 n J� U �CeSf cr pW 01930
Street Address - City/Town State Zip -
_ tWJ 75- I163
Telephone No. business Telephone No. cell e-mail address
• SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C(6
A Workers'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? Yes 13 No ❑ - -
a-, „fF= SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE "'
-
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ - . . . .
Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing - $ .. -
4.Mechanical'(HVAC) $ Note:Minimum fee=$ (contact municipality)- .
5.Mechanical (Other $ Enclose check payable to
6.Total Cost - $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and pen ' s of perjury that all of the information contained in this
application is true and accu�toe t of my 1 dge and derstanding.
r9?d' 375- I
Please print;a d sign name Title Telephone No Da
Street Address City/Town. State Zip -
ll , b �Mnnrc pahInspector to fill out this section upon apphcation approval: • ' + "
n . ,- . ...
i='o`Name, .:. .. - _` �-�, Date. ..
MAY. 22. 2012 10:40AM N0. 6857 P. 2/3
COLLINS COVE CONDOMINIUM ASSOCIATION
37 Settlers Way, Salem, MA 01970-5269
Katherine Arguelles May 21, 2012
11 Settlers Way
Salem, MA 01970
pear Kat,
The Collins Cove Board of Trustees is in receipt of your email dated
May 20, 2012 requesting the approval of the Trustees to renovate your
kitchen. As you know, section 18 of our Master Deed, addresses the
modification of any unit. Its language reads that the work must be done in a
good workmanlike manner pursuant to building codes and pursuant to plans and
specifications which have been submitted to and approved by the Condominium
Trustees.
You are required to obtain the appropriate building permits from the
City of Salem and post them prominently at your unit. We also expect that
you will inform your contractor to be considerate of your neighbors. While
you did not submit specific plans we expect that your contractor will submit
an appropriate plan to the City of Salem Building Department and forward a
copy to the Trustees.
You also wrote that you plan to replace the front door. As you know,
any replacement door must be the some door that is presently in place both
in style and color. The Collins Cove Trustees approve the project with, the
aforementioned conditions and wish you well with it.
Sincerely yours,
Jeffrey W. Conley
President
MAY. 22. 2012 10: 39AM N0 6857 P. 1/3
_ � R
33 East Marrimadc Street .
LoWel4, MAL01957
phone: 976-275�800 -
Fax: 976 45z-5696
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