8 CONNERS ROAD - BUILDING JACKET 74520 40% P4
The Commonwealth of Massachusett 017
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Board of Building Regulations and Standards '?it' 0' tj yaLt4 gitV CITY M
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Massachusetts State Building Code, 780 CMR
�U� Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate WhDJUolkSa A, 4
21
�— One- or Two-FamilyDwelling
,,
This Section For Official e Only
bo Building Permit Number: Date plied:
-- Building Official(Print Name) Signature Date
1
SECTION 1: SITE INFORMATION
1.1 Property address: 1.2 Assessors Map& Parcel Numbers
$ ,�•r�r..et� r�
1.1 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 pply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage sposal System:
Public Private❑ Zone: _ Outside Flood 7oru,9 Municipal On site disposal system ❑
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1�0 ne 'of�ecord• �
v�l O/970
Name(Print) City,State,ZIP
AD t 9 t_ 97.P-F36-,fe11
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Ir Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief D ription of Proposed orkZ: ^-1.,..
op
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 2p }r— 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ so�0„ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List: 1d'.
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
�l 49 (} ,h // List CSL Type(see below) (J
No.and Street JpJCp T e Description
Q U Unrestricted(Buildings u to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
Ci /Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
�Il e ^ `.nI Solid Fuel Burning Appliances
(�* I 115� `Bf L6�,+ Insulation
Telephone /1M mail address D Demolition
5.2 Registered Hom Impr vemen ont actor(HIC)
HIC Registration Number ,xpira ion Date
HIACwmWam or HICgist N e
No. d treet Email address
9 > y-do/e
tt /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 Issuan of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGPERMIT
I,as Owner of the subject property,hereby authorize J'F'✓L/ r>4
to act on my behalf, in all matters relative to work authorized by this building permit application.
/
r,tt O—cr's�( ec�l�-honi6Sign ure) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest WLcder the pains and penalties of perjury that all of the information
contained in this application is true and curate t the t of y knowledge and understanding.
Print Owner's or Authorized Agent's N ( ec lc i afore 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dns
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"
CITY OF & .F.M, IA—kSSACHUSETTS
` BUMDLNG DEPjLR't'NIENT
120 W.isHINGTON STREET, YD FLOOR
TEE- (978) 745-9595
FAX(978) 740-9846
lCI1iBFRt FY DRISC011
MAYOR T Homks ST.P[ERRs
DIRECTOR OF PUBLIC PROPERTY/BUMMNO COM(ISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris,and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
A--E _-bl
(naMe of haul r)
The debris will be disposed of in :
(na a of facility)
2?1 22L—
(address 6f fa
s�gnatu o 'ermit app icant
-- �
date e
dc6riwfLJac
CITY OF S.UX,1N1, L'IASSACHUSETTS
B1:u.DQVG DEP.iRTSIENT
(t 120 WASHINGTON STREET,3aa FLOOR
T L (978)74S-9S9S
FAX(978)740-98"
iQ,,%tBFRi FY DRISCOLL
MAYOR DIRECTOR.
ST.PiERR13
DIRECTOR OF PUBLIC PROPERTY/BUnDING CO\L%MIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information n Please Print Legibly
zp
Name(BusimxS Organizatiorv�indi��vidggual):
Address:�� C 7�JI fQlt.t o /�
City/State/Zip: 1� /z�:t• Phone#:
Are an employer?Check the appropriate box: Type of project(required):
1. I am a er w employer with� 4. ❑ 1 am a general contractor and 1
P y 6. ❑N construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.: 7• emtxleling
ship and have no employces These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9• 0 Building addition
[No workers'comp. insurance 5. We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their p
3.❑ I am a homeowner doing all work right of exemption per MGL I 1-0 Plumbing repairs or additions
myself.-[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.]t employees.[No workers' 13.0 Other
comp. insurance required.]
'Any applicant that chocks tore 91 must also fill out the section below showing their workers'compensation policy information.
'I Itmeowrcn who submit this affidavit indirriing they are doing all work and then hire outside c04tr4aM must submit a new affidavit indicating such
-Comm,:sin that check this box most attached an additional short showing the name of the sub-eontrscton and their wohero'comp.policy information.
I am an employer that it providing workers'rompensadon insurance for my empluyem Below it the policy and Job site
insurance C ,R y2�
Insurance Company Mama._(c/!Q._.L.t,go,�,_/
Policy#or Self-ins.Lic(�#:._. ./7t.�'/ C�� Expiration Date: 9LO/
Job Site Address: e l 11 7vts City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the fort of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby crrt jy ei the s penalties ofpeelury that the informadon provided above is true and correct
SiLrat ire' Date, /
Phone#: 7rF— rDDt/•- 00/R:
Official arse only. Donee write in this area,to be completed by city or town official
City or Town: Permit/I.Icense#
Issuing Authority(circle one):
1. Board of Ilealth 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other.
Contact Person: ___ Phone#•
COFFY
Certificate Number: B-16-834 Permit Number: B-16-834
Commonwealth of Massachusetts
City of Salem
This is to Certify that the Single Family Building located at
Building Type
8.CONNERS ROAD............................................................................ in the .....................................City gf Salem
................................ .................................................
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY
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, July 27, 2017 /• // _
`�� - ' � "� • " —7.7,:--Commonwealth of Massac�.iusetts-
� .� n
3 - City-of SJ1e
- 120 Washington St,3rd Floor Salem,MA 01970(976)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Permit No. B-16-834 PERMIT TO BUILD
FEE PAID: $210.00
DATE ISSUED: 8/2/2016
This certifies that STROUT MICHAEL STROUT ALLISON E
has permission to erect, alter, or demolish a building_ _8_CONNERS ROAD— Map/Lot: 360328-0
as follows: Repair/Replace REPLACE THE KITCHEN, ROUGH-IN SECOND,FLOOR BATHROOM,
INTERIOR REPAIRS, NEW WIRING, NEW HEATING SYSTEM
Contractor Name: PETER STROUT I - -
DBA: PETER STROUT GENERAL CONTRACTING
Contractor License No: CS-022467
8/2/2016
Building Official �/ Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withins xi months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
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 location 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.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials-are provided on this permit.
HIC#: 171475 "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions: J/JJ
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Commonwealth of Massachusetts
3 v Citv of Salem
120 Washington St,3rd Floor Salem,rsn 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Structure CITY OF SALEM BUILDING PERMIT
Excavation PERMIT TO BE POSTED IN THE WINDOW '
Footing INSPECTION RECORD
Found 'on
Framing 40
Mechanical
Insulation INSPECTION: BY ` DATE
Chimney/SmokeC amber
Final b / �.
:tet Plumbing/Gas
Rough:Plumbing
Rough:Ga
Final "" te I/h<-(-,A) 60,�[
\
Electrical
Service
Rough O
Fina
1 11 FirQWartment f
Preliminary
i
Final
Health Department
Preliminary
Final
44 Bedford Street
P.D.Box 1450
Middleboro,MA 02344-1450
508-946-4300
June 10, 1994
SALEM BUILDING DEPT BOARD OF HEALTH
SALEM TOWN HALL SALEM TOWN HALL
SALEM, MA 01970 SALEM, MA 01970
RE: INSURED: John and Hele Mari_
PROPERTY ADDRESS 8 Connors Road, Salem, MA
POLICY NUMBER: 02
DATE OF LOSS: 04-26-94
A claim has been made involving loss, damage or destruction of the
above captioned property, which may either exceed $1,000.00 or cause
Massachusetts General Laws, Chapter 143, Section 6 to be applicable.
If any notice under Massachusetts General Laws, Chapter 139, Section
3B is appropriate, please direct it to the attention of the writer and
include a reference to the captioned insured, location, policy number,
date of loss, and claim number.
Sincerely,
d7P 'yU& %n"
Dennis Manning
Property Claim Representative
The Standard Fire Insurance Company
(800) 422-3340 x726
On this date, I caused copies of this notice to be sent to the persons
named above at .the addresses indicated by first class mail.
L-487-o