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114 COLUMBUS AVENUE - BUILDING JACKET� • 114 COLUMBUS AVENUE 41 r 1 - No. City of Salem Ward / �N,cnrmry- a APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant tocompleteall items in sections:1, ll, lll, IV,and IX. 1. AT(LOCATION) u4 02w R5 RAVS AUF ZONING DISTRICT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE 11. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION'USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ❑ Addition(It residential,enter number of new 12V One family 18 ❑ Amusement,recreational housing units added,Aany,in part D,13) 19 E] Chruch,other religious 13 E] Two or more family-Enter number 3 ❑ Alteration(See 2 above) of units....................................................... 20 ❑ Industrial ❑4 � Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 21 Parking garage Enter number of units ........................... 22 ❑ Service station,repair garage 5 ❑ Wrecking(//multifamily residential,enter number [:] 23 E] Hospital,institutional of units in building in Part D, 13) 15 Garage 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only26 E] School,library,other educational 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP 28 E] Tanks,towers 8 Private(individual,corporation,nonprofit institution,etc.) 29 ❑ Other-Specify 9 ❑ Public(federal,State,or local government C.COST *(o Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, 00 machine shop,laundry building at hospital,elementary school,secondary school,college, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ - at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost a. Electrical ........................................................................... .,da�� b. Plumbing.................................. ................ .db c. Heating,air conditioning............................................. d. Other(elevator.etc.)..................................................... 11. TOTAL COST OF IMPROVEMENT $ e[No tv III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J& M, all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL 30 Masonry(wall bearing) 35 Gas 40 V Public or private company Will there be central air 31 Wood frame 36 Oil 41 Private(septic tank etc.) contlil'wning? 32 Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ® No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 ❑ Other-Specify 39 ❑ Other-Specify 42Public or private company 46 ❑ Yes 47 EYNo 43 Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 48. Number of stories ............................................................ 49. Total square feet of floor area, all floors,based on exterior HRS Approval from Historical Commission been received dimensions ........................................................................ for any structure over fifty(50)years? Yes_ No 50. Total land area,sq.ft. .............................................. Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed............................................................................. 52. Outdoors............................................................................ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed............................................................... Electric: Gas: 54. Number of Full........................................... Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial...' BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ Nom (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes`- No_ Is property located in the S.R.A.district? Yes_ No Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes,submit documentation/if no, submit Board of Appeal decision) If new construction,has the proper Routing Slip been enclosed? Yes_ No Is Architectural Access Board approval required? Yes_ Nom (If yes,submit documentation) Massachusetts State Contractor License # ©73Q43 Salem License # Home Improvement Contractor # ( 111515 Homeowners Exempt form(if applicable) Yes_ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary, please submit CONSTRUCTION IS TO BE COMPLETED BY: q 3 in writing to the Inspector of Buildings. V. IDENTIFICATION • To be completed by all applicants Name Mailing address-Number,street,co,,and state ZIP Code Tel.No. 1. rGoec;;LE6 5E 7 1 Owner or t(4 OCLU PA Lessee �DVJA.- -tz-; L 2. c ' 4o Pokm sv Contractor 'A Builder's u Q0 6 ! A License No. S52-9117 Architect or 62-341 413 Engineer I hereby certify that t ropose ork is author ed the owner of record and that I have been authorized by the owner to make this application as his authorized;Kent and wear to fo t applicable laws of this jurisdiction. Signature of applican Address4o D r Appli tion date �[L, e� DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building FJCC _ GJ3 FOR DEPARTMENT USE ONLY Permit number J/ Building n ' 2 Use Group Permit issued �� 19 9J Fire Grading Building Permit Fee $ 0 Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ Plan Review Fee $ I o� LE NOTES AND Data - (For department use) �d roo m c,wco 'V e- L/ ?Z Vr e — PlVGk 10 r* J ./ �. C. V'c PERMIT TO BE MAILED TO:--Fc) L V U DATE MAILED: ., 3 Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN -For Applicant Use O N ✓�i V 04l1/1711J9Zll1Bt�!/L C�v���tI�QP.tt�. ���' �r� vf7rafe�e4 ,�. aa.o .�toe.oatia. Nlcuei Dultadit: Governor Kentaro Tsulsumt Chairman er4 08!08 Charles J. Dineno MT) Administrator MEMORANDUM TO: All Buildina Dcpartmentsiziatc Building Inspectors FROM: Charlrs J. Ditt=o. Administrator DATE. October 31. 19II8 SUBJECT: MGL C40. ti54. Added flv e59/ S9 M the Agra or 19117 The ahnvc•mennoned statute requires that dcbns resulting from the demolition. rcis INny, fehybllltallyq ur Other MIMI bn til a budding or structure lie disposed of in a propene hta:nsee olid *VM d taciluv as deflnc&i by MGL c111. 5150A and that budding permits or hcepsrs arc in mduaw.tbe bilins Of the 13C1111Y al which 'tic said dcbns Is ui be disposed. .THIS REOUIREME.NT DOES NOT APPLY TO NEW CONSTRUCTION. In order to stmolfv the prot:cas and of pmvude unilirmitv- we arc astactima a cupv 11, a dorm whttb wu Can either reproduce and use as it is since Inc completed form Will be alWrJted to the nlllco mpX y!bA vo ux permits or liccbor reproduce it on your Iciterhead ml In talc of municipal,commerctal.industrial,or multiunit housing comtruction. the contractor may yon know the dumpster subcontracuir at the time of the building permit apputation. In such caws, the copy atlaebetl of an Af idavtt can be used The complete law is conlamcd in the Nrncmncr issue n( CODEWORD which will he mailed to you in the nen two weep. If you should have any question, please let us know. CJDiAM AFFIDAVIT As a result of the provisions of MGL c 40, 554, I acknowledge that as a condition of Building Permit Number all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. I certify that I will notify the Building Official by a" months maximum) of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment to the Building Permit. Date Signature of Permit Applicant (Print or type the following information) Name of Permit Applicant Firm Name, if any Address In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: _ LAILt_ W bAQvEie (Location of Facility) Sign ure of Permit t x(8/43 Date COMMONWEALTH OF MASSACHUSETTS E—k DEFAR:'MENT OF INDUSTRIAL ACCIDENTS _ 600 WASHINGTON STREET aures Gamooei, BOSTON, MASSACHUSE'T'TS 02111 -omm,ssione• WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licenseciperminec) with a principal place kbusines sidence at: 40 C,-14- ©1 33 (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [ ] I am an employer providing the following workers' compensation coverage for my employees working on this job. Amc-&"" 4L.(cg 4oLtozs ius. Co. wcc (�re1z�-sZ 4� Insurance Company Policy Number 1 am a sole proprietor and have no one working for me. (Kl am a sole propriet , general contractor homeowner (circle one) and have hired the contractors listed below who have the following workers compensation insurance policies: I.UDWG>'`N2. fps Cb �°o�u-1 e�� cB�oc�as7 Name of Contractor Insurance Company/Policy Number LEKQ,KAu SLC-c tQ Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number [j I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto arc not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sea. 1(5)), application by a homeowner for a license or permit may evidence the legal scams of act employer under The Workers' Compensation Act I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to $1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of$100.00 a day against me. Signed this 8 day of S�tp C ( (3E X, 19 (513 Licensee/Perminec Licensor/Permirror TXAW WALL 'LA WIUbaw �U�r'l�l� sNER7iI�►J4 kPPROVED Ev?A Ric. -rtLC- 3cch3 ct to approval by any other vy.C„ � FuO��A7E} �lJj��d F�LDOIL .uJr.;Hy ju tion. OrvALEM, ✓ASS- FliE `-?VJEN'1 l0N RU--ql,AU By / lit ( - tt PINTS A4E APPROYEO SO!ELY FOR 1OFNTIFICATIOYOF �� ALL FIRE PROTECTION F FIRICESRARE SLBJINOTECTION DF/� uW FINAL 76T AND It:cleCTION,FOR C051P11Itt1X19.1' ANC£WITH THE FIRE CODE. k a'4`441��lo" �1 J �Xfs't,�Gi! S�TrI:1�O £?CCE12loIQy �211.1T-6IP..1O� � PI,I�CEai- 'F�)rL i l4 co�u l` 185 ►!� E .40 -Pr✓AA '5--T- SI,L.EM KA, 4St(tM2(:jIS-"\Nk)l P llq 3d / v p au 13f �k,�'�12 � ��:� z�i��rr��a�fl�3� Rt :_ IVED D2.r'il aa` rr,"'°tt� APR i C 1154 AN 97s CITY t;_c::a'3 UrFICE VItU_IA?A F. ABBOTT SALEM, MASS. JOSEPH F. DOYLE JOHN M.GRAY,SR. MARCH 23, 1976 - ARTHUR E. LAURECQUE JANE T. LUNDREGAN - - DONALD E. EAMES - EME1YP. TbNC4 DECISION ON PETITION OF GEORGE A.AND RENATE NOWAK FOR A VARIANCE AT 114 COLUMBUS_AVENUE (R-1 DISTRICT) . Hearing on this petition was held on March 23, 1976 with Chairman John M. Gray, Sr. , and members Jane T, Lundregan, William Abbott, Arthur LaBrecque and Associate Member Donald Eames present. Notices were duly mailed to abutters and others in accordance with Massachusetts General Law, Chapter 808. The petitioner George A. Nowak represented himself before the Board. He stated that he wished to extend the existing front porch 6 feet 4 inches. Said porch would be closer than fifteen feet to the front property line and therefore in violation of Article 6 of the Zoning Ordinance, R-1 District. The petitioner stated that he needed the additional room to accomodate his large family. The Board voted unanimously to grant the petition as requested. . The Board noted that the neighborhood in question is an old neighborhood and l that most of the lots and the houses are non-conforming. The petitioner has a large side lot, and the Board felt to deny the variance to add on to the front porch would be a hardship to the petitioner because of the size and shape of his lot, therefore the Board granted said variance as requested. Appeals from this decision, if any, shall be made pursuant to Section seventeen (17) of Mass. General Laws, Chapter 808, and shall be filed within twenty days (20) after the date of filing of this decision in the office of the City Clerk. The variance granted herein shall not take effect until a copy of the decision, bearing the certification of the City Clerk that twenty days have elapsed and no appeal has been filed or that if such appeal has been filed, that it 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. A copy of this decision has been filed with the Planning Board and the City Clerk. GRANTED SALEM BOARD OF APPEAL Secretary r