4 CROSS STREET - BUILDING JACKET I'he C'onunumss'cullh ul Ibl:usachuscm
r Iloard ol'Buiiding Regulations ;Ind Standards CI FY OF
tl' "'lussachusctls State Building Cude,-780II SALI-AI
Building Permit APPiictlion To Construct, Repair, Renovate Or Della lash a
()`te-Or ruu-Pivadt Dsrrllin.y
Phis Section For 011iciJI Usc Only
Building Permit Number: pli ;
IIuilJiny glliciJl IPrinl N;une) SigllJlu
Daly
SECTION is SITE INFORMATION
I.I Property Address: 1.1 Assessors Map& Parcel Numbers
I.In Is this an acce led sere— no 'tlup Nunahur Purcel Numher
I.! Zoning Infortnatlont �-J 1.4 Property Dlmenslons:
' •j��DU-i — fall �
Zoning District I'nipuseJ lJse LIII Arcn(sy Itl
I•mnluyc(Ilj
I.! Building Setbacks(R)
From Yurd Site Yunls
Required I'rvviJcd Required Provided Rear Yard Reyuind Provided
1.6 Wster Supply:IM.G.1.u. 40.§14) 1.1 Flood Zone Information: 1.8 sewage Disposal System:
Ihlblic Prh ate 0 zone: _ Outside Flood Yore?
Check If es0 Municipal 1in s!H Jispusul s)stcm 0
"writes of Roe SECTION I: PROPERTY OWNERSHIPI
f�dt
N,rmulPnl ) C"'I�'� 1'1nw
Nu..Ind tercel •Z
re ephune Elndil Address
SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existiny Buildiny Owner•Oceupied 0 Repairs(s) Aiteratlon(s)At Addition 0
Di hlion (03 Accessory Bldg. ❑ Number of Units / Other ❑ Speciry;
Brief Description of Proposed \York*,: /G✓7��� �✓_ , ��
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
11..ahur;md.\lateriols) O(llclol Use Only
I. Building j I. Building Permit Fee: f Indicate how lie is determined:
'. Vlecrical j 0 Standard City:Tcl Applicalion Fee
11'lunlhing j ❑Total Project Cost'I Item 6),1 mulliplier
� 1. \IeclLmic.J ill\ \(') j List:
\1echJnic.11 IFne
�u gcsiUnl j rol;II 11 Fees: S
Iblal Project CnN: jam• ('hcd, vo, - __( hecA .\nwullt: l',i,h \nnnuu:
��-� 103 R, d in Full Q On[tlanding 11,I1.mce Due:
St:("1'IU,N .S: ('ONSI-R11("' ION SFRVI('FS
t traction Supe tour license IC Si-) :`plr:Z4 Dale
I ❑emc Nunlhcr
. ante of -' I „Idcr I lit
I)cieription
N,1. . lid sIreet ll lMreivicrcJllludJinsti loit,UuOcu. Il.l
�^ li me,lrieteJ I.(•?r.unil I)eellin
\laruu
City aT ll,tilale.Lll' NC Itmilin Guerin
p'S N'inJuw,wJSidin
-' Sp Solid Fuel Ilurning Appliances
= � I milli
l i
— I) Dentoliliun
f mni ;1 Jrc,s
-role bona
!.2 Reglslered Ilume Improvement Cuntrnclor(HIC) III(. Itcgisl r lispirul nnDale
I IIC C011tpin) Nwlle of illC Iteglilralll Nallle ItlTall a--Ae
Nu. wtd Street
Ci ITown.Stale ZIP
Tel
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. 1l2. 2SC(6))
with this application. Failure to provide
Workers Compensation insurance affidavit must be completed and submitted
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes Cl
No...........
SECTION Tat OWNER AUTHORIZATION TO BE CODIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property,hereby authorize
to act an my behalf,in all mutters relative to work authorized by this building permit application.
Date
Print U-1 Ws Nwne(Ekelrunic Signature)
SECTION 7b:OWNERI OR AUT11ORIZED AGENT DECLARATION
By entering lay name below. I hereby attest under the pains and penalties of perjury that all of'the information
eontai t this applicatio ' Ira and accurate to the best of my knowledge and understanding. y
Dwu
hill Ut tc a :\uthurireJ,\�enl'. seine lhlectn,d •Signature)
Nou!is
1 )nut registered 131115
ne In pro inIf Panlantit ermjt lCmuralcturtHlC) Program).s her own work.or n oil m, shave access to the arbiu hirclian ditiun lredur
Pli 11 or guarini)I pro nuluun on the Construction Supers sor License can be round at
tion on the C Prugmin c'1ntbal'faund al
Jll
2. \\'hen substantial+writ is planned, pro,ids the infurmalion below:
t including garage. finished basement attics,decks or porch)
rotal Moor area I;y Il.l . — ------ Ilabitablc room.aunt _ ..
Groin lis ing area l iy. ll.l .._. \unther ul bedrooms
\umi,Vroftireplaccs ,. ... _ \unlber lit hall'h;uhs
♦unlher,,fi,;llhraul+ls \'unlherol'daki. pordles
I\pe of healing i),lem In:In,eJ ..11l`en
1'\he„t �p„Illly i\Neill
l 1,,ial I'ngecl S,luare I'ootegd lu,q be .uh Nilulcj tiV"rolal Project foil'
i
1 ' ,
�. <•r ��.;'� -r n `+', nrt r, r` ,.i� ...a fi.�.' r�+,. �7r.a»�^y:,p'"#ye.,�+s.. xr,.
� ,�/� • ' � *� # "`�- :Elie Coinrnonwealth uf'Massathusetts
k* rBoard of Budding Regulations and Stttdards. ";CITY "'. £° g
m OF SALEM; ► i , Massachusetts State'Building Code, 780 CMR, 7 edition d
J �„✓✓ f ., 4 Revived J 1 w7 !.
Building:Permit Application To Construct:Repair,'Renovate Or Demolish a ?INAN `
a One-ui TivwFuniily Dwelling x
x ` This Section For OfRcial Use Onl
v ` Buddmg Permit Num Data Applied:;
-
. "Pwm ata' "Signature':-
* r? I" , ,,, „ tiuddint{Cwnmissioned•Insp�atorufBuildings' ' (ate; « • E`,
s �3
« -it *" - SECTION I SIT ON n"
Fr • +"`' s� , r cat ,uy,. ,�. .: ,v r ,,.. :.� a".n. '`st
1 1 Pro Addrew y
a lx►tY y } T1.2 Assessors Msp 8 ParedNnmben :* * $ T ,.
t'1 ( IsI is ice ted.slreet�yes. no .�-'" '€ �p Mop Number,`: a gA.:'°^tPaicel Number
~ '` Ly: Zooing:loformad0sXit x
Dlmeasloos: 4 v
" ( e a 'AT,
party..
" '` �ZoningDistrin •,�,rPioposedUse ,g i rLdAreh(sgR)„'« $Frenuge.lfl)
13;Bullding3elback,�R) #
w .lc•xe ;-" s- ' ... ., m,..� .ors Lrx k% 9,� 2T sv� a..;.. i
1 ro _ ," •. "f Front.YUd k E ,Silo Yards „x >. « ,•..F p�
1 F ! f �
�• r'M '�iRequired: '�'Previded _°( a Required Provided + Regwmd ,?' , Pro'vided x„
Nta n.ID IDd" 'rP �.yY xM r�'
w b 16 Water 3npply (M.O:L c 40 §54) 1 7�Flood Zone Infagetat a:', 111 Sewage is
ystem:' t * a r
Public0 . PrivaleO "sp Lone = ,,OuUideFloodZone?-^4" b. "pw :r : • v, gs 1 eg
ChECIFif aO ,.,." Munkipal0l�sitgdnposwLsystem0 �r # .
i n',' :2.`IOwnersOf RICO [O 2 rPR PERTYOWNGRSH IP'
j 4
- vex tX¢" i - s {f3ri.{'+.ts
Name Add
q + `° ress faServic
^
kr'{� N ac;. S S� a xrr a t". .,,.' . IF
777PF k
$iwature +n';. .y .t•' i ¢ aga r ..y'a'"'r_ r`.$',Tekphone.7o�•e 7�Yy" , ' £ €y �a.,% ..
„�( .<,� - 4 SECTION 3:DESCRIPTION OR PROPOSED WORKS(check nil that apply) se. 44*a
a$ K3) h
New Constnicnon 0 ,Existing Buildmg O Owner Occupied D' Repsirs(s)f 0 Alteretion(a) O+ !Addition4 p1.4
rtionY4 O 'A'ccessory Bldg ONumber of Uiiiq'� Other O Speedy fa g. d e+ « iL`�//,«'RTv$'# ` S r"k +« `.b' dcf a .rA i" X .:.7.,:° ..A'" ,..T^d" .` .' ' w u nr •r£ w �p'"n• ,r ,y"f ir`' S,y, t
a ` ' �`.fir ^ "SECTION 4:ESTIMATED CONSTRUCTION COSTS',
^'" hemrem * W 1 EstimwW,Costst a, ART £+
Labor and Materials t: oo,pv'OlRelal Use Onlj.
a ,
t I:°Building' ` i Sys v,'" it iBuilding Permit Fee S Indicate how fee is determined 4,c K
2::Electrical 0 Standard Cityllown Applietion Fee n ' ' " `'
O Total Project Costi(Item 6)r multiplier
)..Plumbin w
g a S L u -,«, 5: 2 1OtherFees,i S W.
4 Meehonicaf;(FIVAC) ;' S e ' �? List ---- t ti •` r
Pt.
. v � i5;Mcchanical;(Firc f ter+ r ' ; r A ` . « k 1,ra aNie� ,
Su reisiori `Total All Fea S t ""
'{., w ea ss rxw" 4 r-+wk s 'iT' T+'+ J5''`
6::Tota1 Project Coat.; S Check Na.'_Cheek Amount Cash Amount
v g r y r k r O Paid inFUll " .t+ "O Outstanding Balancij
3. t _ E7riy
T « n" fg,-.c,R S µ �"
*�a"'�q^ �_ . e y ,,,�, ,yCp Gy � 9 4 rr:.yl r r s ., � C i k'- � 'ten' "• r'x i 4 w: .¢w p K' a . rs i ua e
�D.®r, X «k Vg 53r r rt, ' }y F'�`4r �L4•. � } r � ,
k r�:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of CSL-I lolder List CSL Type(see below)
-r Description
AddressU Unrestricted(up to 33.000 Cu.Ff.)
R Restricted 1&2 Family Dwellin
Signature _ _ M 'Masomy Only
RC Residential Rooting Covering
Telephone . .'., WS Residential Window and Sidin
SF Residential Solid Fuel Bumin A fiance Installation
D Residential Demolition
5.2 Rlegbtered Home improvement Contractor(HIC) /4 /S-4b
1IIC Comp an N�.yryryee ur fly(.Registrant Name Registration Number
Address �rJ6 G?e—7q� 3da c/ Expiration Date
Signature Telephone f/'' Ddi'
SECTION . WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.a 152.1 2SC(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..........O No...........O
SECTION 7e:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, /4/J l.)e if e , as Owner of the subject property hereby
authorize_ iy t to act on my behalf,in all matters
relative to work authorized b t 's building permit application.
Si tune of Owner V Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
I,�c2 J�rat He 1111,�zf/f as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
/J.a c t
Print Name
Signatu Owneror Whorl Agent Date
(Signed under the pains and penalties ofperjury)
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 gI have access to the arbitration
program or guaranty fund under M.G.L.c. 1 d2A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS,respectively.
2. When substantial work is planned,provide the information below:
Total Iloors 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
). "Total Project Square Footage"may be substituted for"Total Project Cost"
l
��� �/ ��azs s�-�
- --
Certificate No: 255-13 Building Permit No.: 255-13
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical Permits
This is to Certify that the RESIDENCE located at
--------------------Dwelling Type-------------------
4 CROSS STREETin the CITY OF SALEM
- _- -------------------- —Y ------
Address Town/Cit Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
OCCUPANCY PERMIT FOR(UNIT# 1)
This permit is granted in conformity with the Statutes and ordinances relating thereto,and
expires . . -_ .............................. unless sooner suspended or revoked.
Expiration Date
Issued On: Fri May 31,2013
-l--l-
3eoTMS® P
2013 Des Lauriers Municipal Solutions Inc. ----------------------
-_--_ -`--------------------
I ----------------------------------------------------------------------_---'---
L
Certificate No: 255-13 Building Permit No.: 255-13
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical Permits
This is to Certify that the RESIDENCE located at
-- --------—-- - — - -----------------
Dwelling Type
4 CROSS STREET in the CITY OF SALEM
Address TowrYCity Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
OCCUPANCY PERMIT FOR (UNIT #2)
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires .............. unless sooner suspended or revoked.
Expiration Date
Issued On:Fri May 31, 2013
�1
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc. -----------------------------------------------------------------------------
'L
'.4OSS R ^S TREET s5 13
C
GIs# 5895CONiLiriuty WEALTH OF MASSACHUSETTS
.c
Ma , -. n
Is pk CITY OF SALEM
Lot i¢w s'r III 03m :' j �..
Category ++ RENOVATIONS
';jet# IS'13 00150 ..x " BUILDING PERMIT
,EI St. -Z;-, 12,000.00
Fee Charged: $89.00;, pv
Balance Due:" $.00',,4tlPERMISSION IS HEREBY GRANTED TO:
Const Class:: Contractor: License: Expires:
Raymond Young - General Contractor-75091
Lot Slze(sq.ft) 3199M76 zr
Owner: Raymond Young
L g
:.iUnits Gained: ,+ `� `'` -iApplicant: Raymond Young - -"
IUmts Lost: AT: 4 CROSS STREET
Dig Safe#: .4ti
ISSUED ON: 20-Sep-2012 AMENDED ON: EXPIRES ON: 20-Mar-2013
TO PERFORM THE FOLLOWING WORK:
UPDATE 1 KITCHEN AND I BATH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET/ _
Electric Gas Plumbing Building !
Underground: Underground: Underground: Excavation:
Service_ Meter ^^ Footings:
Rough: - Rough'. � �/`, - ` Rou h®�f f ^da _ f Foundation;.
Final: �i.�o�ts �Ji'�'ti Final: Final PL `y�'-, a' Rough Frame �•�J / %�//f
t�
ILtr - Fireplace/Chimney: ,
D.P.W. Fire Health
Insulation:
Meter: -. ..Oil:
_ Final: �•U'//�/" �j/ 7�/( 3
House# Smoke: D�RKC
Treaswy:
Water: _ ii!ar:n:- - Assessor— - ..
Sewer: Sprinklers: Finny,
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLAT
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Roiling REC-2013-007209 20-Sep-12 231{ $89.00
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GeoTMS®2012 Des Lauriers Municipal Solutions,Inc.
��.�ONDITR,q�
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VSQVE AD
.CITY OF SALEM
y '
° CITY OF SALEM MASSACHUSETTS
BUILDING DEPARTMENT
120 WASHINGTON STREET,3RD FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THOMAS STYIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
May 11, 2012
Annette Dumas
4 Cross Street
Salem Ma. 01970
R.E . Zoning
Dear Ms. Dumas,
I have researched the records of this Department to confirm that 4 Cross Street is a legal—
grandfathered non-conforming (Dimensionally) two family located in the R-2 Zone.
This letter is for zoning purposes only and does not imply conformity with any other codes.
Tho St.Pierre
/.ted rte,
Building Commissioner/Zoning Officer
cc. file