42 CIRCLE HILL ROAD - BUILDING JACKET �ls�10
The Commonwealth of Massachusetts �ITY O t
/1 Board of Building Regulations and StandardsSALEM
Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
7 his Secdora Fur OPlicisd Use Ont
Building Peta3h I3mnber.. Date Applied:
Twe
iJ ldiul;Want{Prim Name) Sigiianao
{=—[ SECTION 1'.SITE Il�TPq$NIATTON'
�-- 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Alar „I u'll (� 1 C)G d3g1 a
].Is Is this an accepted street?yes no Map Number Parcel Number
1.3 aning Information: 1.4 Pro erty Dimensions:
lc �unn l aOpSg3 100
Zoning District PmposedUse Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards 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 yeR
SECTION2: PROPERTYQWNERSHIPi
2.1 Ownert of Record: C s A p, U 1930
Name(Print) 4. City,State,ZIP
(n1C Email Address
No.and Street Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all tLat apply)
New Constructi nX Existing Building❑ Owner-occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Worle: tL
SECTION 4:EST)11 ATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials
1.Building $ 000 1 Building i nh Fee:$ Indicate how fee is determined:
Standard City/Town Application Fee
2.Electrical $ aac>00 Il Total Project Cost9(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees:
4.Mechanical (HVAC) $ OO List:
5.Mechanical (Fire $ Total All Fees:$
Suppression
^^�r-�� Check No. Cheek Amount: Cash Amount:
6.Total Project Cost: $ a`�(7"ocso p Paid is Full ❑Outstanding Balance Due:
TD 2'(D
S 0 1- lru--�'-N 5 1 tJ -FL_f-0
m
SECTION 5 CONSTRUCTION 9&RVICES
ff 5.1 Construction Supervisor License(CSL)
RO �tMr:nR!'1C'� License Number Expiration Date
Name of CSL Holder '—
List CSL Type(see below)
eAArllic
No.an Street Type Description
�i Q U Unrestricted(Buildingsu to 35,000 cu.ft.
R I Restricted]&2 Family Dwelling
City/rown,State,ZIP 1 I M Masonry
—� N E 1,3 3 0 �lso� S 1 I RC Roofaig Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 D) 601`10 ROS-�ZVA RP l2 yCn\ND. Cat'\ 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 MURIANCE AFFIDAVIT(ALG.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 .......... No...........❑
SECTION 79:OWNER AUTIR)RUA11011 TO I>E C01liPLETEJI WHEN
WNER'S AGENT OR CONTRACTOR. FOIL HU I NG PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION lb-OWNEW 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.
bJlkl/V' 611C1144-r- x5l 1.
Print Owner's or Autho ' gent's Name(Electronic Signature) Dat
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hues 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.aov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count A
Number of fireplaces 1 Number of bedrooms 3
Number of bathrooms 3 Number of half/baths 0
Type of heating system Number of decks/porches 0,
Type of cooling system Cn cl a:.l Enclosed Open cl
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
69-U3 `Q-
CITY OF SALEM
ROUTING SLIP
�—' New Construction
Certificate of r'O�ccupancy
LOCATION 4; (. �{Q� DATE 10 s lC
ASSESSORS /`— DATE4 /a 16
93 Washington St.
CITY CLER DATE /L
93 Washington St.
PUBLIC SERVICES ATE
120 Washingto t.
WATER DATE LdI
120 Washington A. In
CROSS CONNECTION jVi! "ATE ( t' (� A"
5 Jefferson Ave
PLANNING DATE t O (o
120 Washington St. /VL 1
CONSERVATION DATE
120 Washington St.
ELECTRICAL 01 DATE D
48 Lafayette St
FIRE PREVENTION DATE
29 Fort Avenue
HEALTH DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.
Commonwealth of Massachusetts
Sheet Metal Per r "
44,
t
Date: p2�—! / Permit#
zon MAR 22 Ak //.
Estimated Job Cost: $ ®� Permit Fee: $ t0 3
Plans Submitted: YES NO Plans Reviewed: YE/S, ^� NO
Business License# Applicant License# 7 J
1
Business Information: / Property Owner// i1 Job Location Information:
Name: G �� C"-/l j✓�� Name: 1 `
" !/c r 6 A/<�d�-
Street: L")A- C/ Street: 1-1,9- c `�l
e J
City/Town: A -�-�5�'"" City/Town:
Telephone: L ? S? �ll Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staffinitial
J-1 /M-1-unrestricted license
J-2/M-2-restricted to dwellings tories or less and commercial up to 10,000 sq. ft./2-stories or less
Residential: 1-2 family Multi-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. Zver10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: `- Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
Cell JA/
mAl�� 3 2-q- TO G C,
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes to❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box[],I hereby certify that all of the details and Information I have submitted(or entered)regarding this"cation are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issu or this application will be
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General La
Duct Inspection required prior to insulation installation: YES NO
Proeress Inspections
Date Comments
Final Inspection
Date Comments
Type of Li e:
By Master
Title
❑Master-Restricted
Cityrrown
❑Journeyperson. Signature of Licensee
Permit# `
❑Journeyperson-Restricted 3 Q
License Number:
Fee$ ❑
Check at www.mass.gov/dpi
Inspector Signature of Permit Approval
N 8736'03 E
24.74'
#1
306'
ro
-p 111 O
20,717±SF /
\304 \
PROPOSED PLOT PLAN
"MCGRATH PARK" LOT 2
CITY OF SALEM CIRCLE HILL ROAD, SALEM
1 " = 30' OCTOBER 12, 2016
NORTH SHORE SURVEY CORP.
N 87'36'03" E
24.74'
# /,// n
/ II
E o /
3017
-37
20,717±SF /
-SLS HOF Ss
O
,/ { GAIL L. m
,\ /' h� 1� #3 o SMITH y
NO.35(A3
N 73 / Doh! ��FSRFGISTEF�O woe
5993)• � � •' �' 'avu nNa 5�
AS BUILT PLAN
LOT 2
CIRCLE HILL ROAD, SALEM
"MCGRATH PARK" SCALE 1 " = 30' MAY 8, 2017.
CITY OF SALEM NORTH SHORE SURVEY CORP.
14 BROWN STREET, SALEM, MA
978-744-4800 #1567
f �
Certificate Number: B-161253 Permit Number: 113-16-1253
Commonwealth of Massachusetts
City of Salem
This is to Certify that thePot Land Building.............................................................. located at
Building Type
42 CIRCLE HILL ROAD..................................................................... in the .....................................City o............................
........................................
Address Tw /City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY
New single family home
WILLIAM& CHERYL GALLAGHER
This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and
expires ...............................Not Applicable unless sooner suspended or revoked.
Expiration Date
Issued On: Thursday, August 10, 2017
pONatT7M� Commonwealth of Massachusetts Az
3 City of Salem
- 120 Washington SL 3rd Floor Salem,MA 01970(978)745-9595 x5641 '
Return card to Building Division for Certificate of Occupancy -
Permit No. B-16-1253 PERMIT TO BUILD
FEE PAID: $1,540.00
DATE ISSUED: 11/8/2016
This certifies that WILLIAM & CHERYL GALLAGHER
has permission to erect, alter, or demolish a building 42 CIRCLE HILL ROAD Map/Lot: 90342-0
as follows: New Construction - 1-2 Family CONSTRUCT A SINGLE FAMILY HOME
10/13 Fire Prevention recd 3 sets of prints 8r plot plan for review. '\
10/28 2 add'I sets of plans given to Bldg Dept. by contractor for review.
Contractor Name: ROSS DIMAMBRO
DBA:
Contractor License No: CS-107473
11/8/2016
Building Official >' Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
40 t-xy
All work authorized by this permit shaihi:rnform to the approved application and the approved construction documents for which this permit has been granted.
1
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a Jocation clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. J A
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
r
HIC#: -Persons contracting with unregistered contractors do not have access to the guaranty fund-(as set forth In MGL c.142A).
Restrictions:
r ra W ' aaA1f .r,nit site.
All Pe Car, a .)ro2oa�.` `tae r P'_ Y NER.
CCJJ �Ciivv
qN-617- 77p5
/ ^fin,
A 120 Washington St,3rd Floor Sakem,MA 01970(978)745-9595 x5641
Return card to Building Mvision for Certificate of Occupancy
VIM Structure CITY OF SALEM BUILDING PERMIT
Excavation PERMIT TO BE POSTED IN TH'E WINDOW
Footing INSPECTION RECORD
Foundation l 2
Framing Ok
Mechanical
Insulation 0 :2 INSPECTION: F , BY �n DATE '
Chimney/Smoke Chamber
Final O I
,0 Plumbing/Gas
Rough:Plumbing VK
Rough:Gas 0�," ®F %��//l,•�W�'
Final ry�j ���
oR`-_,Z6 r>
Electrical
Service
Rough 3 Z;,//-7
Final
90 Fire Department
Preliminary
Fin 2
Health Department
Preliminary
Final