2 COLUMBUS AVENUE - BUILDING JACKET V
2 Columbus Avenue
llll
No. 153L-2
HASTINGS. MN
LOS ANGELES-CHICAGO•LOGAN.ON
MCGREGOR.TX-LOCUST GROVE.GA
U.B.A.
Iq Ll` 35 to G
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY 9 Massachusetts State Building Code, 780 CMR RECEIVED SALEM
INSPECTIONU, SEI y��° SaMarzoll
Building Permit Application To Construct, Repair, Renovate Or Demobs' a
One-or Two-Family Dwelling
This Section For Official Use Only
Un Building Permit Number: Date Applied:
I IU I� h
Ln Building Official(Print Name) Signature Date
�ll`/ SECTION 1: SITE INFORMATION
— 1.1 P/rJ9ljp ty Ad//dress: /1' 1.2 Assessors Map&Parcel Numbers
2 C-O�a. ....6J f
L l 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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
CI54 roles .ScLL MA on9 :F16
Name(Print) 1J City,State,ZIP -' 1 n
'L Cb� , L „c /fit 912-CHI-X41 %QAA � ke�Pup ,rK . Cocv-,
No.and Street Telephone Email dress
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building X Owner-Occupied �, Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units I Other 0 Specify: o• :e
Brief Description of Proposed Work': r: 1 c ' 'Aw
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I.Building $ 69 2 V 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Q Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ G92 Q ❑Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
\' 5.1 Construction Supervisor License(CSL)
0- S�I l
e�lI O5 I , 0. S icense Number Expiration Date
Name of C Holder List
1 1
List CSL Type(see below)
I2 36 U
No.and Street A Type Description
�Q�/�-S+ M/X n\9LS U Unrestricted(Buildings u to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
C / SF Solid Fuel Burning Appliances
9U`6-I 1( CI�QD.0 tr6v:I� G(�O. L o� I Insulation
Telephone �' Email ad ress T D Demolition
5.2 Registered Hgme Improvement Contractor(HIC)
6
f`O!•1 S, HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant yName / 'I /� 1
(ocp � et ow, .1 err , �..:lY 2 In� (fit: #IVcf lave. r0O
CKs I�r1 Email address
Ci /To , 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 Issuance of the building permit.
Signed Affidavit Attached? Yes ..........A No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize �s! c(V L a r
to act on my behalf, in all matters relative to work authorized by t is building permit application.
Ur5 x \—��t tU1iL-1 its
Print Owner's Name(EI tronic Signature) - Date
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 best of my knowledge and understanding.
Print Owner or Authorized A nt's Name(Electronic 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 M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.inass. og v/oca Information on the Construction Supervisor License can be found at www.mass.eov/des
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 halfibaths
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"
I
Tqj of *Ul>emr massac4usctts
Public Prangrtg Uelturtment
Nuilbing i9epartment
One *Plem (Breen
5119-745-9595 gxt. 3911
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
April 20, 1993
i
Gladys T. Smith
2 Columbus Avenue
Salem, MA 01970
RE: 2 Columbus Ave.
Dear Ms. Smith:
It has been determined by the City of Salem Building Inspectors that
the garage located at the above reference property is considered to be an
unsafe structure according to the Massachusetts State Building Code Section
123.0.
You are hereby ordered to contact this department within twenty four
(24) hours of receipt of this notice as per Massachusetts State Building
Code Section 123.2 as to your intelPt to rectify this hazardous situation.
!
Sincerely
ohn J. ings, III
Assistant Building Inspector
JJJ:bms
r cc: Councillor Nowak, Ward 1 i
Certified Mail #P 009 22� 290
/2clmbs/
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