8 CROSS STREET - BUILDING JACKET The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
� � 1 Massachusetts State Building Code, 780 CNIR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Divelling
�( This Section For Official Use Only.
Building Permit Number: Date Appl ed',.'
n�„ z
Building Official(Print Name) :Signature Date
SECTION I SITE INFORMATION -
LI Property Address: 1.2 Assessors Map& P cel Numbers
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
I EfE
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site dis osal system ❑
Public❑ Private❑ Check if yes❑ P p
SECTION2:, PROPERTY OWNERSHTt
2.1 Ownert of Record: p.c
i- j�1Av 2a Ce�,✓lLF,tA -S ii(-0 ?K ✓' A
Name(Print) City,State,ZIP
Gsze�s� S 5 0 R (a(4 b`t 71
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building Owner-Occupied Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ I Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work : R� n+ "—? .g— jQf aH
t S vva Q w3
SECTION 4: ESTINUTED CONSTRUCTION COSTS-
Estimated Costs: Official Use Only-,..
Labor and Materials
1. Building I. Building Permi[Fee S Indicate how fee is determined:
❑. Standard.Citydown,Application Fee..
2 Electrical .$ . i' - -
- ❑ Cotal Pioject Cost (Item b)x multiplier x
3. Plumbing S 2. Other Fees: S
i. Mechanical (HVAC) 3 List:
5. Mcchunical (Fire $
Suppression) Total All Fees: .S
Check No. Check Amount: _Cash Amount
". fntul I'rnjcet cost ) 1 5 5o a ` >. -
� ❑ 1 aul in Full ❑Outstanding 13ubutce Duo:
SECTION 5: CO:NS'rRUCT1ON SERVICES
5.1 Construction Supervisor License(CSL) 9 k-i 7 L3 S - �-
'rt -Z�, %-,,(-:� }, _ License Number Expiration Date
Name ofCSL Ilolder
^� List CSL Type(see below)
ft'
G ��( il , jvtoc sT
No. and Street TYPe. Description
U Unrestricted Duildin g s u to 35,000 cu. 11.
icy A 10. C,� ! 1 /� � l � �-0 R Restricted I&2 Famit y Dwallin
City/"Town,State, ZIP M Alasonr
RC Routln Cuverin
WS Window and SidM—L
SF Solid Fuel Burni
I Insulation
"relz hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 0 c> �
Ct. b-a 2.V— Ca" 1-11C Registration Number Expiration Date
I IIC^Cu�mpany Nana or I1IC Regisrrnnt Name
I'Vd Street Email address
City/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 Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ 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
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNEW 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's or Authorized Agent'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 find under M.G.L. c. I42A. Other important information on the HIC Program can be found at
u%V%VAMtS.I,uv.oc Information on the Construction Supervisor License can be found at wwvtv.m;us.eoV dL
2. When substantial work is planned,provide the information below:
Total floor area(sq. It.)._ (including garage, finished basement/attics, decks or porch)
dross living area(sq. It) _ Habitable room count_
Number of tiroplaces_ Number of bedrooms -----_--
Number of bathrooms __ _ ``umber of halbbaths - -- -.
Icpe of heating systrm - _ .- _ -- Number of docks/porches _-_"-----_---
I}Pe of cooling sy;tcnl _ --_ Enclosed .— -_Open _ _—_--
i. ' I�rtal I'rojcct Syu,ua I�notagc"m:ry he sub;tihucd t;tr"1'��til Prujzd ('o;t'.
1/2ss I�S��t�5a3
CITY OF SALEM
BUILDING DEPARTMENT
120 Washington Street, 3rd Floor, Salem, MA 01970
ABANDONED AND FORCLOSED PROPERTIES REGISTRATION FORM
PROPERTY INFORMATION p
Address: �a ` J(j �S�st e(�� Parcel ID # H3� LO�V
Square Footage of Building: 3�W Number of Stories: ---
Sprinkler System: Yes_ No x (Operational yes/no)
Pipe System: Yes x No_ (Operational yes/no)
Fire Detection System: Yes x No_ (Operational yes/no)
OWNER(S) -OF RECORD ('attach additional sheets if necessary)
Owner: BANK OF AMERICA
16001 N Dallas Pkwy
Address: Addison,TX 75001
Tel. No.: 213-345-6264 E-mail: vpr@bankofamerica.com
CONTACT RRUk@kTeYV&Jt F'dotices
Name: Safeguard Properties
Primary Address (No P.O. Box) 7867 SAFEGUARD CIRCLE VALLEY VIEW OH 44125
800-852-8306 800-852-8306
Business Tel. #: Non-Business Tel. #:
E-Mail Address: codecompliance@safeguardproperties.com
Emergency Telephone # - 24hr/day 800-852-8306
IS THE PROPERTY LISTED FOR SALE? Yes _ No_x
N/A
If yes, Real Estate Agency
N/A N/A
Address: Tel. No.
VACANT BUILDING PLAN: Please check which applies.
1. _The building is to be demolished.
2. x The building is to remain vacant.
3. _The building is to be returned to appropriate occupancy or use.
SIGNATURE OF OWNER(S)/OWNERS AGENT: � G2%
DATE: 1-21-16
REGISTRATION FEE $300 Cash/Money Order/Cert. Bank Check
2/25s Vi5`6u(-o5)-3
REGISTRATION:
All owners, including banks and mortgage companies, must register abandoned and/or
foreclosing residential and commercial properties with the Director of Inspectional
Services.
"All property registrations are valid for one year. An annual registration fee of three-
hundred ($300.00) dollars must accompany the registration form. The fee and
registration are valid for the calendar year, or remaining portion of the calendar year, in
which the registration was initially required. Subsequent registrations and fees are due
January 1st of each year and must certify whether the foreclosing and/or foreclosed
property remains abandoned or not.
Once the property is no longer abandoned or is sold, the owner must provide proof of
sale or written notice of occupancy to the Director of the Inspectional Services.
ENFORCEMENT & PENALTIES
Failure to initially register with the Director of Inspectional Services is punishable by a
fine of three hundred dollars ($300.00), each day being a separate offense.
Failure to maintain the property is punishable by a fine up to three hundred dollars
($300.00)for each month the property is not maintained.
MAINTENANCE REQUIREMENTS
Properties subject to this section must be maintained in accordance with all applicable
Sanitary Codes, Building Codes, and local regulations. The local owner or local property
Management Company must inspect and maintain the property on a monthly basis for
the duration of the abandonment.
The property must contain a posting with the name and 24-hour contact phone number
of the local individual or property management company responsible for the
maintenance. This sign must be posted on the front of the property so it is clearly visible
from the street.
Adherence to this section does not relieve the property owner of any applicable
obligations set forth in Code regulations, Covenant Conditions and Restrictions and/or
Home owners Association rules and regulations
The complete Ordinance can be viewed on our website at:
ham://satem.com/Pages/SalemMA Clerk/ordinances
�: _ #iPSBttPR ULTRASEAL®by Relyco www.relyco.com
PDOaCt
ITY 'F SALEM January'21 2016 6365000
Ni
u ,LW" F a .� a '- F 'rr 4p"` {¢'- r- .: .yt �`," *.F 'r e i
x 4 � -x'- .,�'* '*' J ^�
ment No Date t r Description ' , �'
Lr r Net Amount
1175846539 01 X01/21/116 acant R operty Reglstratloynvx,q e Via' .+ �+
i ,a 300.00 17R
'171'
}T' r
i u 300 00 t s
i'>�` �r TOtaI �r $ ■^E S t y
Aw"•.'ae .�1"Y .�+"�Y��,.*k1 tr " +d 4 `"' t R
'� yy r�r s}r .,. 1 «' �. i q�;,X :• Jf�f !rr'*" .},��'' 4�� �'�n. � 33 1er}��`�.�-' � -�� '
t '
'�r 3t f °3sr ..} � y# #+ $, *1 '•4�".�"' #5� `� n` ; te' *+.r�r fi^c .: �. ���, m.+t #k *l3
a 442.r re
ayr } {L �ar rf"Yt r¢.1� T'r d'�"k',R . r1� "-+.r++x t-.y"x��'vy£
Safeguard Properties Management LLC F .,W JPMorgan Chase Bank tN A ,°k ° a \
7887 Safeguard C
ircle # ,
Columbus OH56 x1544/441 6365000 r
..�,= 5 a� i a�
5 ?° UalleyhView, OFI 44125 w
.¢ 216 X39 2900 . e= fi January 21h201& ,. e#' 300 0 ,m _ s
CA NPP-oT1$S � *�F' � '�tt i�e�l?� �, z�
PaY, R'""THREE HUNDRED DOLLARS AND O/foo <'s :x t aS F tf R �z y : x`F} y z ? n
i �� '�. ^'r rrr 4 .aj� t1gs 'w '�a'�> L�'7sa�' "` i4`'.#a s �^re'"�,•, *+� m
aP t r^W t`R r- r . +a D
To The € CITY OF SALEM a
FcurcHK �3RD-FLOORr ka 6 ✓; r E o
� "{.•hB6k6tilFLL $°�,r:a � �!'s':Fo- 4 '+t ' � r m °x�� "�'` �>��v''�T*sF^rs Authonzed:Signature��fir " � �``\
11'636500011' 1:044115161631: 986619162911'
'See Reverse Side For Easy Opening Instructions' -
6365000
CUTCHK "
7887 Safeguard Circle
i Valley View, OH 44125
216 739 2900
Safeguard
PROPERTIES ,
Return Service Requested
CITY OF SALEM
BUILDING DEPT.
120 WASHINGTON STREET
3RD FLOOR
SALEM, MA 1970'