20 TURNER ST - BUILDING INSPECTION The Commonwealth of Masslil@WA'O c, 4 CITY OF
s Board of Building RegulatF&&G'1"&AdX,�t1CL
` LEM
Massachusetts State Building Code, 780 CMR Revised Mar SA Mar
p 1011
lV Building Permit Application To Construct�l�w ,, Aodafel�rDmolish a
One-or Two-Family Dwelling
This Section For Official Use Only
1 Building Permit Number: Date Applied:
.g II I�
Building Official(Print Name) Signature U - Date
SECTION 1: SITE INFORMATION
1.1 Property Address: �O�o /V1�1✓ 1.2 Asses ors Map& Parcel Numbers j
t
I.1a Is this an accepted street?yes_' no Map Numbe Parcel Number
1.3 Information: r �l 1.4 to er +Dimensions: LIB-- J
Zoa ng istric Proposed Use 7- Lot Are (sq ft) .Rootage(ft))
1.5 Building Setbacks(ft) "
Front Yard Side Yards Rear Yard
Required Provi ed Required. Provided Required Provided
/. -ram.
1.6 Wat r Supply: ( .G.L c.40,§54) 1.7 Flood Zone Information 1.8 Sewage isposal System:
Public Private❑ Zone: Outside,Flo d ne? - Municipal On site disposal system ❑
Check-if ye
SECTION 2: PROPERTY OWNERSHIP'
2. Own
Name(Print / City,State ZIP
, • V /
No.anJ Street I Telephone Email Address
SECTION 3:DESCRIP ION OF PROPOSED WORK2(che all that apply)
New Construction ❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) Alteration(s)V I Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units' Other ❑ Specify:
Brief Description of P oposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only '
Labor and Materials
1. Building $ a, S �—Q �� 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical
❑ Standard City Town Application Fee
$ . t/
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ s 2. Other Fees: $
4. Mechanical (HVAC) $ S List: -
5. Mechanical (Fire $_ -
.. —� Total All Fees: $
Suppression)
heck No. Check Amount: Cash Amount:
6. Total Project Cost: $ IV-15 ❑Paid in Full ❑Outstanding Balance Due:
C42�mil"". q l�6" C -I cL —CJ 1 a-c 1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS—)
Du oc I l
C V\C�O�)w License Number Cykitatiod Date
Name of CSL Holder
List CSL Type(see below)
Al N d Sa•et� n— l Type Description
\JP�JI A q ) 5 I U Unrestricted 1 (Buildings2 Fmi u el ing cu.ft.
J v� R Restricted 1&2 Family Dwelling
C�ty/Town,State,ZIP M Masonry
� RC Roofing Covering
WS Window and Siding
p SF Solid Fuel Burning Appliances
\ l' VOIJ� �,«�/� I Insulation
Tele hone Email address D Demolition
5.2 Regis(ered Home Improvement Contractor(HIC) 1 /
� �� e[
V \ �- 1-n Reg a ation Number xpirat n ate
HI Com an or H istrant Nam
V �VICi �7�JI^Q_�
N . d Street I T Email address
City/Town, State,ZIP / Telephone
SECTION 6: RKERS' COMPENS ION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit mus a completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issu ce of the building permit.
Signed Affidavit Attached? Yes .......... No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as net of. subject pro rty,hereby authorized C 18� ,
to act on ehalf,in all ers relative to work authorized by this building p it application.
UI-- 6-
Print w s Name( lee o ' Si gt re) Date
tX SECTION 7b: OWNERS OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
containe ' this applicatio is true and accurate to the best of m knowledge and understanding.
Pri er r A rize ge is me ronic re) 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
www.mass. og v/oca Information on the Construction Supervisor License can be found at www mass. ovg /dus
2. When substantial work is planned,provide(ktp information below:
Total floor area(sq.ft.) -5-, (including garage,finished basement/atti s,decks or porch)
Gross living area(sq. ft.) Habitable room count Z-
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfibaths 7
Type of heating syste Number of decks/porches
Type of cooling system 4 Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
supervisor License: CS-104096
Construction Supervisor
Construction
Sup group"hick contain 0 I N r' +
Restricted Buildings of any use 9 of enclosed , ,
Unrestricted- 991 cubic meters) ERIC A TOWNE less than 35,000 cubic feet( -
ONE MAPLE TERMV
'space. NEWBURY MA 0
tl CA--
Commissioner Expi ration:
..tin 08117/2017
tts
assa cause
ssess a current editionrevocation of this license.
t, Failure ui di Code is cause MASS.GOVIDPS
'( State Buildto p ing —^
DIPS Licensing informationviisit_W W W --
�Trr.
...,..w-w.. ._.»'•.yet.:
License or registration valid for individul use only t �pnnvrxo�zwealL/^Q
before the expiration date. If found return to: Office of Cossaioer Affairs&Basiaess Regulation
1 Office of Consumer Affairs and Business Regulation
0 Perk Plaza-Suite 5170 OME IMPROVEMENT CONTRACTOR
1 Type:
Ype:
stration:egi 181273
Boston,MA 02116 -x
oxpiration:4-�W_10,120117Intlividua4
�
ERICA TOWNE
ERIC TOWNS t� ..
of valid out signature ONE MAPLE TERRACE
NEWBURY MA 01951 U
- nderseereta"'
The Commonwealth of Massachusets
Department of industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation insurance Affidavit:Builders/Contractors/Mectricians/Plumbers.
TO BE PILED WITH THE PERMITTING AUTHORITY.
InformationApplicant
Name(Business/Organiz�atinon/Individual):
Address: /V a 1
City/ fate/Zip: LTV✓ Phone#: . 7 ��
Any as employer'CYeek appropriate �/, T
ypePro (required):
I. l snaempioyc'vith employees(fWl and/ n-ti /• construction
2.01 am a sole proprietor or pannership and have no employees wee k rg forme in a Ing
my capacity.INowwkers'comp.insunme required.)
3.Q I sic a homwwner doing all work myself[No workers'comp.insurance required.)'
10 0 Building addition
4.❑Iaoa do all anand wintehiring contractors mcasatioall work on my property. twill
wore tw all cmaracuars either have wakens'compenvtion imaeance err are sole 11.0 Electrical repairs or additions
proprietors with W employees. 12.0Plumbing repairs or additions
5.❑1 am a genial connector and I have hired the sub•conasctom listed on the studied sheet. 13.01toof repairs
These wycgmacmrs have employees and have workers'emop.insunnect
6.�We an a whpmetion and its officers have exercised their right ofexemption per MGL c. 14. Other
152.51M and"have no employees.(No workers'comp.imarance equired.)
*Any applicant that checks box#I most also fill out the section below shaving their workers'compensation policy information.
t Hommweers who submit this affidavit indicating they an doing all work and ten him outside correctors must submit a new affidavit indicating such.
tComactom chat check this bon most attached an additional sheet showing the name of the sut- um sons and sate whether or not tense eeales have
employees. if the wbcamectom have employers,they teat provide their workers'comp.policy number.
I am an employer that is providing workers'compensation fnsur for_my employees. Below is the policy and job site
information.Insurance Company Name: ^� -�
Policy#or Self-ins.Lic.#: "' ����5 CD Expinuio te:
fob Site Address:.S 7 /L-/l�It�1 \ City/StatelLip:
Attach a copy of the workers'compensation policy(eeleralion page(showing the policy number and expi date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fee up to 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance
coverage verification.
I do hereby c�e pains a aahies of perjury that eke information provided above is true and correct
Si natc,
Phone M
official use only. Do not write in this area,to be completed by dry or town ofjidaf.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Heakh 2.Building Department 3.City/I'owa Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
.�a Berkshire Hathaway GUAii
13ERKSHIRE HATHAWAY P.O. Box A-H • 16 S. River Stret
GUARD COM ANIES Wilkes-Barre, 80 -673- 461
570-$25-9900 (Toll-Free 800-673-246`.
FAX 570-823-205
www.guard.coi
October 12, 2015
R Agent: ROSE INSURANCE AGENCY
REAL ESTATE TO RENOVATE LLC
66 Loring Avenue
1 MAPLE TERRACE P.O. Box 958
NEW BURY, MA 01951 Salem, MA 01970
Phone: 978-745-6464; Fax: 978-745-7386
5 Note: A binder from the Workers'107273
Binder#: 107273 Compensation Plan Administrator, which
4120
Policy #: you may have already received or will be
10/07/2015 - SO/07/2016
Policy Period; receiving shortly, serves as your proof of
coverage until cancelled or your policy is
issued.
erkshire Hathaway GUARD!
opportunity
As the servicing carrier selected by the state to handle your policy, Berkshire Hathaway GUARD Insurance
Companies (specifically, our subsidiary, AmGUARD Insurance Company) is pleased to have the
to with the,
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resources will be available to assist you.
Our Customer Service Department is available by phone at 1-800-673-2465 Monday through Friday,
8:00 AM to 5:00 PM EST. After hours, you can leave a voice mail, send an e-mail (csr@guardcom), FAX us
Our mailing address is listed in the upper right
(2-570-823-2059), or complete an on-line forth (accessible from the Customer Service section o our
policyholder Service Center at www.guard.rnm).
corner.
To make a payment: and credit card. Payments can be mailed to
We accept payment via check bank check, direct draft (EFT),
PO Box 785410, Philadelphia, PA 19178-5410.
9 To report a claim or
S 1loss8 -NEW-CLMS(1-888 639 2567) — 24 hours a day, seven days a wee
k.
Call us immediately at -88
24
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report fraud
Call our Fraud Special Investigative Unit via our Fraud Hotline at 1-800-673-2465, ext. TIPS —
9 hours a day, seven days a week.
To request Certificates of Insurance Department at
You can either fax us at 1-570 823-2059 or call our Customer Service
2-Soo-673-2465. Either way, be prepared to provide the company name, address, fax number, and
contact person of the entity requesting the certificate.
To cihtain spwke from a specific discipline:
You can feel free to address your issue to the attention of the following individuals.
Email Address Extension Fax Number
Dgnartment _ tart Name 1300 570-825-6211
Lori Decker csr@guard.com 570-829-4587
Billing csr@guard.com 1300
Audit Dawn Aigeldinger 1300 570-825-2990
Loss Prevention John Bohn
csr@guard.com 1300 570-820-7968
Underwriting Dawn Aigeldinger csr@guard.com 1300 570-825-0611
Claims Lisa Krzywicki csr@guard.com of this
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HQ: MA(WC Your Business is Our Business
RECTO I
CITY OF SM El1I, NLkSSACHUSETTS
• BUILDING DEP.kRnIE2NT
130 WASHINGTON STREET, 3•°FLOOR
VIM
TEL (978) 745-9595
FAX(978) 740-9846
KI\tgFRt FY DRISCOLL
MAYOR THO&W STYIEUR
DIRECTOR OF PUBLIC PROPERTY/BUHM NG COMMSSIONER
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 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
1 11, S 150A.
The debris will be transported by:
(name of hauler)
�Vt C d1�)
The debris will be disposed of in : Q
(name of facility)
(address of facility)
'gnature of ermit applicant
/ b
date
dcbri.tffdm
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 41-0016-0 Account Number 0
Prior Parcel ID 11 —
Property Owner NICKOLDS ANN ADAMS Property Location 20 TURNER STREET
Property Use One Family
Mailing Address 20 TURNER ST Most Recent Sale Date 3129/1993
Legal Reference 11798-258
City SALEM Grantor LARKIN FRANCIS G/MUMFORD JOANN
Mailing State MA Zip 01970 Sale Price 122,000
ParcelZoning R2 Land Area 0.067 acres
Current Property Assessment
Card 1 Value Building Value 171,100 Xtra Features 0 Land Value 105,200 Total Value 276,300
Value
Building Description
Building Style Colonial Foundation Type Brick/Stone Flooring Type Hardwood
#of Living Units 1 Frame Type Wood Basement Floor Concrete
Year Built 1739 Roof Structure Gable Heating Type Forced H/Air
Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil
Building Condition Good Siding Wood Shingle Air Conditioning 100%
Finished Area(SF)1014 Interior Walls Drywall #of Bsmt Garages 0
Number Rooms 5 #of Bedrooms 2 #of Full Baths 1
#of 3/4 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.067 acres of land mainly classified as One Family with a(n)Colonial style building, built about 1739 , having Wood
Shingle exterior and Asphalt Shgl roof cover,with 1 unit(s), 5 room(s),2 bedroom(s), 1 bath(s),0 half bath(s).
Property Images
SFL
Disclaimer:This information is believed to be correct but is subject to change and is not warranteed.
FI/e number. 160316-33 UNREGISTERED LAND
Alforne : LAW OFFICE OF MARC MIDDLETON Deed Book 11798 pa a
258
Lender: Plan Book Pa a Lols
Owner: ANN ADONIS NICKOLDS REGISTERED LAND
Re Book Sheet Lnt(.1):
Date: 3/17/2016
Cerli Icafe o Title
Assessor•s Ma 41 BIk. Lot 16
Census Tract
MORTGAGE INSPECTION PLAN Scale: =25
20 TURNER STREET, SALEM, MA
i
A.P. 41 -16
2925 S.F.
LOT 41-14 o b LOT 41-17
N tri
2 STY
a #20
. Q .
� Q'I
170• TO 45.0'
~DERBY S EET
TURNER STREET
CERTIFICATION
I CERTIFY TO THE ABOVE ATTORNEY,BANK,AND THEIR TITLE INSURANCE COMPANY THAT THE MAIN BUILDING,FOUNDATION OR
DWELLING WAS PI COMPLWVCE WITH THE LOCAL ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED(WITH RESPECT TO
STRUCTURAL SETBACK REOUIREMENTS ONLY)OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS.GENERAL
LAW TITLE VH,CHAPTER 40A.SECTION 7.
NOTE:BUILDING APPEARS TO BE CLOSE TO, ON OR OVER THE PROPERTY LINE.AN EXACT LOCATION WOULD REQUIRE AN INSTRUMENT
SURVEY.
FLOOD DETERMINATION
BY SCALE,THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY
25009CO419G AS ZONE X DATED 7-16-2014 BY THE NATIONAL FLOOD INSURANCE PROr.R AM