19 CROSS STREET - BUILDING JACKET DATE:
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A.PERMIT BEING GRANTED
Location of Building
Building Permit Application For:
`(Circle whichever applies) Roof, Reroof, Install Sig' ct Deck, Shed, Pool
Addition, Alteration, epair/Replac Foundation Only, Wrecking
Other:
PLEASE FELL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for a permit to build according to the following specifications:
OwnersNamei-Mich6le-I \Ah InY1 Contractor: Chri atophar 7.nr7V
Street Jq CM`y, C . City&efn street_I19 North Straat City_GalPm
State ry)R Phone )-117( ol State MA Phone(97g)_741-0424
Architect: City of Salem Licq 1405
Street City State Lic#0 5 7 7 3 3 HIP# 101609
State Phone ( ) Homeowners Exempt Formes no
Structure: (please circle Single Famil , Multi Family# Other -
Estimated Cost of job$ /-I 5'7!- . nn
Will building confirm to law?✓des no
Asbestos?_yes 1-/ no
Description of work to be done:
In 4j i I ( v n 1 t 1 ylr-)ul
ERVICES
Drawings fitted: es_� no Mail Permit to: 115 NORTH STREET
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Signature of Applicapon, SIGNED UNDER THE PENALTY OF PERJURY — • -
CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
Department use only: Pe t# Zoning Map/Lot i
Permit fee$ (� V
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1� The Commonwealth of Massachusetts
\ 1 �
Board of Building Regulations and Standards CITY OF
I'►1 I Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date A lied:
1
Bwlding Official(Print Namr
e) ye gn Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
11 (,,04s ; r er �*-00,;;n-0
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zonin Information: 'L4'P.ropertyDimensions: O
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
0r -7r i
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
//v SECTION 2: PROPERTY OWNERSHIP' �1
2.lnnlnel�IrGLofRecorNnK-1,�h+h �IC�OVI� G7G J41A- Ak 01 1-70
Name(Print) .� I Ci State,ZIP
No.and Street Telephone I Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
yx New Construction Existing Building❑ Owner-Occupied K I Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief DescriptionofP posedWork2: l71 G
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 26QO, 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $
❑Standard City/Town Application Fee
N
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ A-- 2. Other Fees: $ �^
4.Mechanical (HVAC) $ N A List: <
5.Mechanical (Fire $ '
Su ression (J/� Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 2 /Q0.-' 0 Paid in Full ❑Outstanding Balance Due:
t
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted uildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date_
No.and 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: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
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Au[ riz Agent's Name(Electronic Signature) ate
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. ova /oca Information on the Construction Supervisor License can be found at www.mass.gov/dys
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 halfibaths
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'
19 CROSS STREET
_ _ J
,5j
/W
No. 153L-2
HASTINGS. MN
LOS ANGELES-CHICAGO.LGGAN.OH
MCGREGOR.TX-LOCUST GROVE.GA
U.S.A.
Citp of 6alem, 41aggarbu!5at!5
i F Vublic Propertp -epartment PY
\ , Wuffbing Mepartment
One ibalem Oreen
(976)745-9595 Cxt. 380
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer May 15, 1998
Sophia Whalen
Norman Walczak
28 Baldwin Street
Peabody, Mass. 01960
RE: 19 Cross Street
Dear Sophia & Norman:
Due to a complaint received by the Neighborhood Improvement Task Force, I
conducted an inspection and found the following violations:
1 . Front porch, stairs and railings are in need of repair or replacement.
2. Rear porch needs to be repaired or replaced.
3 . Broken windows and missing screens to be replaced.
4 . Motorcycles in yard and miscellaneous items need to be removed.
5 . No street numbering apparent on structure.
Please notify this department within fifteen (15) days upon receipt of
this letter, to in_`orm us as to what course of action you will take to rectify
these violations. Failure to do so will result in legal action being taken
against you.
Thank you for your anticipated cooperation regarding this matter.
Sincerely,
Thomas St. Pierre
Assistant Building Inspector
TSP: scm
cc: Pat Carney
Councillor Flynn, Ward 2
0
eitp of *alem' Alxoarbuattz
4 Public Propertp Mepartment
Wuilbing Mepartment
®ne 'balem green
(978) 745-9595 Cxt. 380
Peter Strout
Director of Public Property
Inspector of Buildings
Zoning Enforcement Officer
April 25, 2000 AVh
0
ply
Sophia Whalen
Norman Walcak
28 Baldwin Street
Peabody, Ma. 01960
RE: 19 Cross Street
Dear Sophia&Norman:
This office is again in receipt of complaints at the above-mentioned property. The
problems were not addressed in the two years that has passed since this office last
contacted you.
1. Front porch is still in disrepair.
2. Broken windows and missing screens.
3. Two derelict motorcycles still in yard.
4. No street numbering on building.
5. Pile of wood in backyard must be removed.
Please contact this office within ten (10) days to discuss this matter. Failure to do so will
result in legal action being taken against you in Salem District Court.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
Ca- ��
Thomas St. Pierre
Local Building Inspector
cc: Mayor Usovicz
Councillor Flynn
Citp of balem, BaggacbUgettg
j3ublic Propertp IDepartment
AW[bing ]Department
One balem Green
745-9595 ext. 380
William H. Munroe
Director of Public Property
Inspector of Buildings
Zoning Enforcement Officer
February 13, 1991
Daniel Geary
Director of Constituent Service
City of Salem
93 Washington Street
Salem, MA 01970
RE: 19 Cross Street
Dear Mr. Geary;
On February 12, 1991 an inspection was made at the above referenced
property. Complaints have been received of unwelcomed varmits entering
the dwelling. Upon inspection it was noted that there was an opening
present at the left rear corner of the house.
It is our recommendation that this hole be repaired and a pest control
agency be contacted for extermination of any creatures present inside.
If you need further assistance please contact me at this office.
Siincrreely,
David J. Harris
Assistant Building Inspector
DJH/eaf
citp of 6alem, A.as;oarbu5etto
Vublit 3propertp Mepartment
iguilbing Mepartment
One balem Oreen
(978)745-9595 Cxt. 380
Leo E.Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer May 15, 1998
Sophia Whalen
Norman Walczak
28 Baldwin Street
Peabody, Mass. 01960
RE: 19 Cross Street
Dear Sophia & Norman:
Due to a complaint received by the Neighborhood Improvement Task Force, I
conducted an inspection and found the following violations:
1. Front porch, stairs and railings are in need of repair or replacement.
2. Rear porch needs to be repaired or replaced.
3. Broken windows and missing screens to be replaced.
4. Motorcycles in yard and miscellaneous items need to be removed., V
5. No street numbering apparent on structure.
Please notify this department within fifteen (15) days upon receipt of
this letter, to inform us as to what course of action you will take to rectify
these violations. Failure to do so will result in legal action being taken
against you.
Thank you for your anticipated cooperation regarding this matter.
Sincerely,
Thomas St. Pierre
QAssistant pBuilding Inspector p o
TSP: scm V-A
cc; .Pat..Carney
Councillor Flynn, Ward 2 ` p n