4 CLEVELAND ROAD - BUILDING JACKET The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
\ Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Fancily Dwelling
1_\ This Section For O ,cial Use Only
'Qy Building Permit Number: 16ate Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: �� 1.2 Assessors Map& Parcel Numbers
I.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use 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:
Public ❑ Private ❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP`
2.1 Owner of Re(�ord:
C b rI (mil bvfr `�A� Qm /A 0147 0
Name(Print) City, State,ZIP
'"J] � �( 677(
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION CO TS
Item Estimated Costs:
Labor and Materials) Official Use Only
1. Building $ 5 3 I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑ Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ i List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $
6. Total Project
Check No. Check Amount: Cash Amount:
Cost: [$ (y5. 13
1 0Paid in Full ❑ Outstanding Balance Due: .
9
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 7 1 ( p'7 k f` 3
R�DIA ` 6,C( I(' License Number Expirati7 Date
Name of CSL Holder
l;� rt'uLgu's
List CSL Type(see below)
C�.
No. and Street Type Description
i7Y �' 6170 U Unrestricted(Buildings u to 35,000 cu.ft.
77 �t� I,,�1 _ R Restricted 1&2 FamilyDwelling
City/Town, State,ZfP
M Masonry
RC CoveringRoofing Window
� WS Window andndSiding
SF Solid Fuel Burning Appliances
d I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Lowey M e 1PYt�r HIC RreA i((stbbratio N b Ex vati n Date
HIC Com any Niamg r HIC egis rant Name
�3r _.E_ no� �e t
No.�nd�treet IVIA 01 f70
�'V� E
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 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
1, as Owner of the subject property,hereby authorize A1 , �16` r ka Inn e
to act on my behalf, in all matters relative to work authorized by this building permit application.
Pnn[ vi er s Name Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true d a;curate o the b t of my knowledge and understanding.
Print Owner's or Authorized Agent's ame—(Eleetro e`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.gov,/oca Information on the Construction Supervisor License can be found at www.mass. og v/dps
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
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"
UPC 10330
No.153L •
HASTIH38. UH
(llit> of �islem,
ICE
A
' Raarb of Appeal
2001 SEP 2b P Z 3b
DECISION OF THE PETITION OF CAROL PERRY REQUESTING A VARIANCE FOR
THE PROPERTY LOCATED AT 4 CLEVELAND ROAD R-1
A hearing on this petition was held September 19, 2001 with the following Board
Members present: Nina Cohen, Chairman, Richard Dionne, Stephen Harris and Nicholas
Helides. Notice of the hearing was sent to abutters and others and notices of the hearing
were properly published in the Salem Evening News in accordance with Massachusetts
General Laws Chapter 40A.
The petitioner is requesting a Variance from left yard setback, as well as a Variance from
the 30 per cent lot coverage, for the property located at 4 Cleveland Road the property
located at 72 Proctor Street located in an R-1 zone.
The Variances, which have been requested, may be granted upon a finding by this
Board that:
a. Special conditions and circumstances exist which especially affect the land, building
or structure involved and which are not generally affecting other lands, buildings and
structure involve.
b. Literal enforcement of the provisions of the Zoning Ordinance would involve
substantial hardship, financial or otherwise, to the petitioners.
c. Desirable relief may be granted without substantial detriment to the public good and
without nullifying or substantially derogating from the intent of the district of the
purpose of the Ordinance.
The Board of Appeal, after careful consideration of the evidence presented at the
hearing, and after viewing the plans, makes the following findings of fact:
1. Attorney Scott M. Grover represented the petitioner.
2. Plans were submitted showing the addition to the property.
3. There was no opposition to the proposed addition.
4. Petitioner stated she needed more space for her teenage sone
r
DECISION OF THE PETITION OF CAROL PERRY REQUESTING A VARIANCE FOR
THE PROPERTY LOCATED AT 4 CLEVELEND ROAD R-1
pagetwo
On the basis of the above findings of fact, and on, the evidence presented at the
hearing, the Zoning Board of Appeal concludes as follows
1. Special conditions exist which especially affect the subject property but not the
district in general.
2. Literal enforcement of the provisions of the Zoning Ordinance would involve
substantial hardship to the petitioner.
3. Desirable relief can be granted without substantial detriment to the public good and
Without nullifying or substantially derogating from the intent of the district or the
purpose of the Ordinance.
Therefore, the Zoning Board of Appeal voted 4-0, to grant the Variances requested,
subject to the following conditions;
1. Petitioner shall comply with all city and state statures, ordinances, codes and
regulations.
2. All construction shall be done as per the plans and dimensions submitted.
3. All requirements of the Salem Fire Department relative to smoke and fire safety shall
be strictly adhered to.
4. Petitioner shall obtain a building permit prior to beginning any construction.
5. Exterior finishes of the new construction shall be in harmony with the existing
construction.
6. A Certificate of Occupancy is to be obtained.
7. Petitioner is to obtain approval from any City Board or Commission having
jurisdiction including, but not limited to, the Planning Board.
Variance Granted
September 19, 2001
Richard Dionne Vhf
Board of Appeal
r
DECISION OF THE PETITION OF CAROL PERRY REQUESTING A VARIANCE FOR
PROPERTY LOCATED 4 CLEVELAND ROAD R-1
page three
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND
THE CITY CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of the
Massachusetts General Laws Chapter 40A, and shall be filed within 20 days after the
date of filing of this decision in the office of the City Clerk. Pursuant to
Massachusetts General Laws Chapter 40A, Section 11. The Variance or Special
Permit granted herein shall not take effect until a copy of the decision bearing the
certificate of the City Clerk that 20 days have elapsed and no appeal has been filed,
or that, if such appeal has been filed, that is has been dismissed or denied is
recorded in the South Essex Registry of Deeds and indexed under the name of the
owner of record or is recorded and noted on the owner's Certificate of Title.
Board of Appeal