8 CRESCENT DRIVE - BUILDING JACKET C/ sC eH l/�`✓
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74520 40% P4
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?� CITY OF SALEMI, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
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a ! 120 WASHINGTON STREET, .SRO FLOOR
,'1 � 9MMeP SALEM, MASSACHUSETTS 01970
I STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978.740-9846
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Kazimierz Pierga
8 Crescent Ave
Salem Ma.01970
October 4 ,2005
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VIOLATION NOTICE
PROPERTY LOCATION 48 Crescent Ave
The above listed property has been found to be in violation of the following State Codes
and/or City Ordinances
E' :Mass. State Building Code 780 C.M.R. section 110 permits.
This office has no record of a permit for the deck being constructed on the rear of the
property.
'('W-D�ro pL -'6<
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Thomas J. St. Pierre
i Building Commissioner/Zoning officer
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The Commonwealth of Massachusetts RELD
c Board of Building Regulations and Standards `PE CTIMassachusetts State Building Code, 780CMR 011
Building Permit Application To Construct,Repair,Renovate Orl*na
/T One or Two-Family Dwelling
►v 1 This Section For Official Use Only.
Building Permit Number a Y Date-Applied
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Building Officia((Pnnt Name) Signature .
I ''SECTIONI:SITE INFORMATION; <`
1.1 Property Ad ress• 1.2 Assessors Map&Parcel Numbers
R nioLo n K
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(it)
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? Municipal❑ On site disposal system ❑
Check if yes❑
"n SECTION2i PROPERTY OW'NEERSHIP, ,
2�A r�u/'ofRe�rdY ! �R G 1Q C�d'��VM A/
Name(Print) City,State,ZIP
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No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(cheek all that apply) r
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/61!
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Off Mal Use'Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined;
❑Standard City/Town Application Fee
2.Electrical $ biotaf Project Cost'(Item 6)x multiplier x
3.Plumbing $ 3 2. Other Fees: $ �/�
4.Mechanical (BVAC) $ ''List: -1
5.Mechanical (Fire $ .Total All Fees:$
Suppression) "--
Check No:. Check Amount: Cash Amount: ,
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
5�t�M p.t t�-ca Tt� �i •� .
`01_0_�rQ UAo,7,�
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SECTION 5: CONSTRUCTION'SERVICES
5.1 Constructton'Supervisor License(CSL)
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Co' ( L License Number Exp' lion ate
Name f CSL Holder �r•.
List CSL Type(see below)
No.and Street !T Type Description ,
U I Unrestricted(Buildings no to 35,000 an.ft.
R Restricted 1&2 Family Dwelling
City/f , tate,ZIP t1l M Masonry
RC Roofing Covering
( WS Window and Siding
SF Solid Fuel Burning Appliances
/ V I Insulation
Telephone Email address D Demolition
5.2 Register $$$`eed/oomeee Improvement Contractor(HIC)
ion r L—( C
HIC�m Nsine HITR�g�trantN����` HIC Registrar E v
No.afid Stre6t / k /c./ � O/�o Email address
City/Town,State,ZIP W W Tele hone
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 7ai OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR$UMDING PERMIT
1,as Owner of the subject property,hereby authorize hrA
to act on my behalf,in all matters relat' a to work authorizeo by this bm ding permit application.
Print Owner's Name(Electronic Si tore) D e
SECTI 76c 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
containeed� hi
in this application is true and accurate to a best of my knowle e d understanding.
Print Owner's or Authorized Agents Name(Electronic Signature) plite
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
w'ww.mass. o>s v,'oca Information on the Construction Supervisor License can be found at www.mass.aov/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"