9 COLLINS STREET - BUILDING JACKET The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised Mar 2011
VUU Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Sectron,For O a Use.. my c `,
Building Permit ' ,Number D to Applied:.-
Building Official(Pont Name) ignature ^zf
z i , Dat -.
`SECTION L• SITE INFORD'IATION
1.1 roperty Address: P11Assessors Map& Parcel Numbers
ber Parcel Number
1.3 Zoning Information: perty 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:
/ Zone: _ Outside Flood Zone? Municipal l DiOn site disposal system ❑
Public (7 Private❑ Check if yes❑
SECTION 2: PROPERT
; Y OWNERSHIP''`.
2.1 Ownerr o Reco. 5:a l e wt Name(Prriint)�,, / ( GyCity,,�SSttate,ZIPS,! ]
G/Y W l 11,P1 sT_ V �/ z��l `7S
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WOW(check all that'apply)
New Construction ❑ Existing Building Owner-Occupied Repairs(s) Alteration(s) ❑ Addition ❑
Demolition Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work2.
e
+ a in- Yt A t
e!h
SECTION 4: ESTIMATED CONSTRUCTION,COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
11
1. Building $ Je 1 Building Permff.Fee $ Indicate how fee is determined:_
❑ Standard Ciry('[own AppLcatron Fee
2. Electrical $ ❑Tot41Project Cost' (Item.6)xmultiplfer x
3. Plumbing $ 2. Other Fees'$
4. Mechanical (FIVAC) $ List:
5, 'Mechanical (Fire $ Total All Fee s:$-
Su ression
Check No. Chec k Arno tint.
Cash r\mount:.
G. 'Coral Piro,ject Cost: $ �l �•(� D p paid in Full ❑ Outstanding Balance Due:___
— be,( / o
�� a
t ,
SECTION 5: CONSTRUCTION SERVICES
rCSL
Supervisor License(CSL)
60a� License Number\ Expiration Date
:NameerI List CSL Type(see below)
�(J /�. Type Description
49 �&h // /ri U Unrestricted(Buildin s u to 35,000 cu, ft.)
�/To y C/ R Restricted 1&2 FamilyDwelling City/Town, fate,Zip Ivt Masonnn
RC Roofin
WS Windo
SF Solid Fppliances
I Insulat
relz hone Email address D Demol
5..y22 Registered Home Improvement Contractor (/HIC) /3 H[C RegistExpiration DateH,CCompany N�a�t�e�ort HIS R�:gistra� m7 ann�Sjtr�et• ,, 1, O�/ - „/ /�/ ddress
City/Town, State, ZIP `T j 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 Issuance 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
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Dale
SECTION 7b: OWNER' 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 est of m knowledge and understanding.
Print Owner's or Authorized Agent's Name(Ele0fonic 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 not have access to the arbitration
program or guaranty fund under t*vLG.L. c. 142A. Other important information on the H[C Program can be found at
www.mass,00w"oca Information on the Construction Supervisor License can be found at www.inass. o %dDs
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
J_ '"Total Project Square Footage"may be substituted for"Total Project Cost"
i� CITY OF SALElm, I+LkSSACHL'SETTS
• BL'iLOLNIG DEPART\i&NT
120 WASHIINGTON STREET, 3'ta FLOOR
TEL (978) 745-9595
+ F.+-e(978) 740-9846
KI BFRT EY DRISCOLL
MAYORTrIOh[AS ST.FIERRB
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO.\MJISSIONEl
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A a tlicant Information PILait Print Legibly
Name(Busiixy&Orginizatiarvindividual):
Address: 39 hi at r'iA 6 Sc_j,,(e_
[O
City/State/Zip:M401 PY111r 0Z�Y/ Phone
Are you an employer?Check the appropriate box: Type of project(required):
1.0 1 am a employer with 4, 0 1 am a general contractor and 1 6. ❑New construction
employees(fell and/or part-time).* have hired the sub-contractors
2.0 1 am a sole proprietor or partner. listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These subcontractors have V. 0 Demolition
working for me in any capacity. workers'comp. insurance. 9, 0 Building addition
(No workers'comp.insurance 5. 0 We are a corporation and its
required.) officers have exercised chair
10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'cump. C. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees.[No worker'
comp.insurance required.] 13.0 Other
•Any opplicam that chucks box 91 must also fill out the wetioa W.ow showing their wakens'compensation policy information.
t 1 rwneownen who submit this affidavit indicating thry ate doing all work and than hire o4gido-eont actots must submit a now,amdavit indicating such
:Cumrautors that chsck this box most attached an additional shot showing the noting of the subcontractor and their worker'comp.policy information.
l um an employer that Ir providing workers'compmrsadon htsarance jar my employers. Below Is thr policy and fob site
informaNan.
Insurance Company dame: A
Policy hl or Self-uu. Lie. fl;L)C I— 31-5 37D�/��O Expiration Date�
Job Site Address: � /�l'h S s City/State/2ip:_r ^�,� Z✓/
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Suction 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1,500.00 and/or one-year imprisonmen&as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Orrice of
Investigations of the DIA far insurance coverage verification.
l do hereby certify under thepains Pont:I as afperjury t/rat the information provided ah ve is true and correct
S sn:lltlrc:% r% Dato:
r o *
Ojftial use auly. Do not write in this area;to be completed by city at town offleh t
City oe"town: Permititicense
Issuing Authority(circle one):
1. llourd of Health 2. Building Department 3.Cilytrmvn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: _ Phone it:
�P CITY OF SALEM, MASSACHUSETTS
l '� # DEPARTMENT OF PLANNING AND
COMMUNITY DEVELOPMENT
K16BRRLEI'DRISCOLL
MAYOR 120 WASHINGTON STREET ♦ SALEM,MASSACHUSETTS 01970
LYNN GOONIN DUNCAN,AICP TELE:978-6r9-568,5 ♦ FAX:978-740-0404
DIRECTOR
HOUSING REHABILITATION LOAN PROGRAM
BID FORM - EMERGENCY REPAIRS
Property: 9 COLLINS STREET, SALEM MA Owner: Linda Pothier
SefiHorr YYoI L ltenl # Price
f f1. i lt�}i�f Ct,eplacc Muni
I.I Tree Branch Removal /Trimmin $ 3
1.2 Demolition
l.3 Sheathin $ - Ia00.U0
1.4 Ride Vent $ ? S00,00
1.5 As halt Root re lacem:nt $ 3`1f)O,DO
t.6 Rubber Roofs re lacement $ 3100,00
1.7 Facia Boards Gutters and Downs rr,uts $ 1', 06.00
l2ubl'er,Rotsl itcp<rtr '�
2.1 1 Rubber Roof Repair $ a0 c
—' - —.
3. l I Wall Fran nkl'C g2!Lf.a�auc -
3.2 — Demolition Is 1001)
3.3 New Framing $ IQ 00 00
3.4 New Siding $ a 60.0
TOTAL BID
I, the undersigned contractor, have inspected the above listed property and understand the extent and character of the work
to he completed as described in the Work Write-Up. The bid includes every item identified in the Work Write-Up by the
respective numbers. The bid shall remain in effect for a minimum of thirty (30) business days after the bid opening.
I propose to furnish all labor, materials, and equipment necessary to accomplish all work described
in the Work Writc-Up for the sum of _
PJ&-AJ fh00f fAJ 51X huNdrCA SI XL�/ Dollars ($ j5 o6,00 ).
1 would be able to start the project on 2012 (estimated date).
I agree to begin the work within thirty (30) calendar days of the Notice to Proceed and complete the work within sixty
(60)calendar days. I agree to fully guarantee all labor and materials for one (1) year from the project completion date.
CCUr,tte- EAJVlrON M G,j F,t
Company Name Phone Number
Signature ( uthorized Representative Da e
9 Collins Street Page I Bid Form
1{( -r
4l( 9 COLLINS STREET
� �l 4 q t •�*i
� Y y
•
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE_
JOB LOCATION ` Co ! l( 4 c �7�
Number Street address Section of Town
"HOMEOWNER _ �/ G�c� f d-f L�.olr 7
Name Home phone Work phone
PRESENT MAILING ADDRESS2—
City/Town State Zip Code
The current exemption of "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor. (State Building Code Section 109.1 .1
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six 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 shall be responsible
for all such work performed under the building permit. Section 109.1 . 1 )
The undersigned "homeowner" assumes responsibility for compliance with the State
Building code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she un erstands the City of Salem
Building Department minimum inspection proc res d requirements and that
he/she will comply with said ocedures a ui menu.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL JO, 41
NOTE: Three family dwellings 3 00 cubic larger, will be required
to comply with State Building Ca e Section 127.0, Construction Control .
HOME OWNER'S EXEMPTION
The Code states that: "Any Home Owner performing work for which a building
permit is required shall be exempt from the provisions of this section
(Section 109.1 .1 - Licensing of Construction Supervisors) ; provided that is
a Home Owner engages a person(s) for hire to do such work, that such Home
Owner shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for Licensing Construction Supervisors, Section 2.15) . This lack of aware-
ness often results in serious problems, particularly when the Home Owner
hires unlicensed persons. In this case your Board cannot proceed against
the unlicensed person as it would with licensed Supervisor. The Home Owner
acting as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,
many communities require, as part of the permit application, that the Home
Owner certify that he/she understands the responsibilities of a supervisor.
On the last page of this issue is a form currently used by several towns.
You may care to amend and adopt such a form/certification for use in your
community.
r...:��'A�.. .,'�*�':ae,1�y+'rKrttl^,*4�.�res�=,�r'�+rv-^+a.,.r^tima�^�.ri.,=.•°tea'^ids^„�y,��v aT.�uT....rr�"�'"'F';...r :'�y +-f.^..+.,. ^�"�5++„"h.F'M��at� •.�<"FjS,tet.�.
.Et
FIELD COPY
BUILDING _.
CITY OF SALEM
SALEM, MASSACHUSETTS 01970 PERMIT
Y.LID.TION
*COUNT
DATE May 4, 19 93 PERMIT No, 141-93
APPLICANT Victor Pothier ADDRESS Salem.MA ----- _
INO.I � 15TA[ETI - (CO-l-'S JFFNSU
IDLIKT
OT TTT.TTnn - NUMBED OF
PERMIT TO S "'>' 1_1 STORY T)Sn7F'(.LTt\TC: DWELLING UNITS TGXI
ITVPE Ot 1MRA0VEMENTI N0. IFROROSEQ USE.
AT ILOCAT,ONI 9 Collins StryPt WA rA 9 ZONING
DISTRICT
(N0.1 ISTAEETI
BETWEEn AND
ICAO{a STREET) ICROSS STREET?
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS.TO BE FT. WIDE Bt FT. LONG BYFT. IN HEIGHT AND SHALLJ'CONFORM IN CONSTRUCTION
1
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION -
!- ITvv[I
REMARKS: Install red ceaartsliingles on one side only
CALL FOR INSPECTION 745-9595
AREA ORPERMIT
VOLUME ESTIMATED COST $ r%,nnn nn FEE S 70 On
:C',81C SQUARE FEET$
Victor E. Pothier
DWNER Co ins ., 5 len, M 01970 Bohn J. Jennings
A;D.Ees ASTAW INSPECTOR OF BUILDINGS
i T % .. .�♦.' .: .. � ..� a +. �
INSPECTION RECORD
DATE MOTE P000A955'- COrtICUMf AND ■EMAMMS IMi►[CTOO
Plans must be filed and approved by the Inspector before a permit will be granted.
No. IL11-V City of Salem Ward_
,IS PROPERTY LOCATED IN THE �c � :
HISTORIC DISTRICT? Yes No X w
IF SIDING, HAS ELECTRICAL
PERMIT BEEN OBTAINED? YesNoX Home Phone # 7Yi 579l�
APPLICATION Bus. Phone #
FOR
PERMIT TO ROOF, REROOF OR INSTALL SIDING
Salem,Mass.,
TO THE INSPECTOR OF BUILDINGS:
The undersigned herebv applies fora permit t bu� i//ld//according to the following specifications:
Owner's name and address v/G S�7/;
ppp p Architect's name
Mechanic's name and address —
/,1bV1}—'�'VV� Location of building,No. -C
What is the purpose of building?
Material of building? e 0 Cl C-e���,� S Asbestos?
If a dwelling,for how many families^.
Will the building conform to the requirements of the law? �,O S
Estimaked cost Contracto ic.
Signature of applicant
REMAR S 'SIGNED UNDER THE
Al e- w R & R S f i lQ,c PENALTY OF , ERJURY.
No._L_.G.2 Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location Lf C p l j t L,s a
PERMIT GRANTED
s^ 2 —isy3
Approv d
irt9 In for
W'TJI r W i t I 172 •hi
JJ' i"f AH t JULI: "i lu l{
Ci7t
-.FF CE
Eag t afzrt� ��r1achueefflIi i t-1:;. : jr1:ICE
SALEM. MASS. of j uxr?t SALEM, HASS.
A
JUNE 20, 1979
DECISION ON PETITION OF ROSARIO RICHARD, 9 COLLINS STREET (R-2 District)
A hearing on this Petition was held on June 20, 1979 with the following Board
Members present: James Boulger - Chairman; Arthur LaBrecque; Douglas Hopper;
John Nutting; and Associate Member Edward Luzinski. Notices were sent to
abutters and others, and duly published in the Salem Evening News on June 6,
and 13, 1979 in accordance with Mass. General Laws, Chapter 808.
E
The Petitioner represented himself before the Board requesting a variance to
construct a second apartment .in the existing house to be located on the second
floor.
The Board voted to grant the Variance to allow a second apartment in the
existing single family residence, also that a variance be granted from the
side yard requirements to allow for the stairs from the second floor. The
variance was granted with the following restriction: - That the exterior
stairway from the second floor be covered.
VARIANCE GRANTED WITH RESTRICTION
'APPEAL fRCi.1 THIS DECISION, IF ANY. SHALL DE tf.ADE PURSUANT TO SE0071 17 OF THE MASS. Atme'K: s H. Boulger, Jr.
CE%'ER:;L LG:S. Clia?::R 803, ACD SHALL I,-- FOEJ '+'.'I MiN 20 DAYS AFTER THE DATE OF FILING hairman
OF THIS DECMON IN THE OFF:-.E CF.THE CITY CLE ,'{.
P}',< 1T T "uASS. :i2k'VAL :A03S ^.. ..-^.'.'i ER �:/?! ' :il:'. 11. THE VARIANE C? SPECIAL PER UT -
iR,i!TE9 HMIf4, SrIALL 1701 TA':'_ MEC 1 UiiL A Cri'1 OF THE _. :Ii'. b-!+':":'i.THE CERT-
°i DF 7tiE CITY CLERK TSAT fG CAPS HAVE cLP .-. "'.+) -0T 4PPZAL HAS BEEN FILED,
CR TY?T, IF SUCH All APPEAL HAS BEEN FILEXT.iM1i IT HAS Lc iI PI .%SED OR DENIED IS - - - -
REMRDED 11-1 THE SOUTH ESSEX REGISTRY CF DE.DS AiND INDEXED UN JER THE NAME OF THE OWNER
OF RECORD OR IS RECORDED AND NOTED ON THE OVINEP,'S CERTIFICATE Of TITLE.
BOARD OF APPEAL -
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK.