5 CUSHING STREET - BUILDING JACKET $Z 50 c�I` 2 Fs `I L
e The Commonwealth of Massachusetts RECEIV 0
Board of Building Regulations and Standard$NSPECTIONAL ERWQfi SALE M
Massachusetts State Building Code, 780 CMR
,j{e e-3t 2011
Building Permit Application To Construct, Repair, Renovate tt�f♦a2 N jS
One-or Two-Family Dwelling
This Section For Official Use Onl
Building Permit Number: Date.App ' }
Building Official(Print Name). Signature Ante
-- SECTION I:SITE INFORMATION`
t. ro erty ddre
f I y� L2 Assessors+Alap&Parcel Numbers
n I11G t e+
I.I 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 II) 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 es❑
I SECTION2: PROPERTYOWNERSHIPt'
2.1 pwnert of Record:
2 _e t �" � / 4
• J�/r� + C Vl � P.� ��C ( l�n J C�-y Gt /s //{7 /1L
N'fine(Print) City,State,ZIP nn /�l 'J7? J a �'!fSt:t'�/P,/ Y)2u( �l/l�e/�r 41 � .(�
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑:j Existing Building iF Owner-Occupied ❑ Repairs(s) Off I Alteration(s) V1 I Addition ❑
Demolition ❑ I Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Propo Work=: t
V ed `L L L
SECTION q: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building S t. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S
❑Total Project Cost'(Item 6)x multiplier s
3. Plumbing .S P 9ther Fees: S
d.Mechanical (11VAC) S List:
' S.Mechanical (Fire S
Suppression) Total All Fees:S
h Check No._Check Amount: Cash Amount:_
6.Total Project Cost: S V O ❑Paid in Full 13 Outstanding Balance Due:
Mf +i%
1
(
i R
SECTION 5: CONS"fRUC'f[ON SERVICES
5.1 Construction Su ery/I rlisor License(CSL)
�l � � License Number Espt ution Date
/�
Nantc ofCSL Holder List CSL Type(see below)
zoo 6-Re Ve S --Ty - Description
t No.,rod Street
n U Unrestricted DuilJin s u -l0 33,000 cu. It.)
��/I�&/y'( /�/7 - 6� R Restricted I12 Famil Dwellin
City/Town,State,ZIP M Masonry
RC Roolin Coverin
WS Window and Sidin
f/ SF Solid Fuel Burning Appliances
WS t/uZD Et/t/� 1Cf�a1/Zl.`et��/�r/DOIt' 1 Insulation
Telephone
Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No. and Street Email address
Ci /rown State ZIP Teletatione
(
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 Is§uance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........❑
SECTION 7a:OWNER AUTHO.RIZATION.TO HE COMPLETED,WHEN
t
OWNER'S AGENT OR CONTRACTORAPPLIESFOR BUILDING PERMIT'
1,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
t
Print Owner's Nmn:(Electronic Signature) Date
SECTION 7b:OWNEW ORAUTHORIZED AGENT DECLARATION'
By entering my name below,)hereby attest under t ains and penalties of perjury that all of the information
contained in this application is true and accurate t th st o my kno edge and understanding.
k C' , e �`c S c � 3 - /2- �/S,
Prim Owner's or Authorized Agent's Name(EIccuo i ignatu ) .r 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 fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www mass.cov!oca Information on the Construction Supervisor License can be found at vvwvv.msss.aov:'dns
-------------------
2. When substantial work is planned,provide the information below:
rotal floor area(sq. R.) (including garage, finished basementlattics,decks or porch)
Gross living area(sq. It.) 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 Enclose) Open_
i. "Total Project Square Footage"may be substituted I'or"Total Project Cost"
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The Commonwealth of Massachusetts
L� Town of
Board Building Regulations and Standards 'a
r Massachusettsis State Building Code. 780 CMR, 7"edition Building Dept
�p Building Permit Application To Con5stpct,Repair, Renovate Or Demolish a
�t One-or Tv, -Fmnilt tvrlling
This action F Offt ial Use Only
!Building!Permit N ber: Date pplied:
✓ !-( 6
Building Commissioner/Inspector o Bu din Date
SECTION 1:SITE INFORMATION
1.1 Propert Address: 1.2 Assessors Map& Parcel Numbers
� af C/2,-_
t.I a Is this an accepted scree['?yes_ no_ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Distnct Proposed Use Lot Area(sq B) Frontage(B)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal E3 On site disposal system 13Public 13 Private❑ Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1�Own rot Record*-
am (Print) o Address for Service:
V of -�
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied 0 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work:
�e ryt P�/i i y z ✓ _Lr
K P /
/ Or. S4 ^P if it,v d 2,(11. FK 1z 20sI"1y7
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building E —� I. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S O Total Project Cost'(Item 6)x multiplier x
3. Plumbing E Co U 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire $ i Total All Fees: S
Suppressionj
� Check No. _Check Amount: Cash Amount:_
6. Total Project Cost: S � � 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) CS TW- (12,
t2I,CbLl ry License Number Expiration Date
N�mc of CS HyWer/ /� fJi
�PL�•fXY.dA List CSL Type Isco below)
Address Type I Description
U Unrestricted(up to 35,000 Cu.Ft.)
Signature R Restricted 1&2 Family Dwelling
r� M Mason Only
�7 �' /2-5 L _�j' RC Residential Roofing Covering
TelephoneWS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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...........C3
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. G2 LC ar as Owner of the subject property hereby
authoriz Cca CN c2 to act on my behalf,in all matters
rel atie to work authorize this b ildi�ppermit application/
Si nature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements andinformation on the fore oing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Dater
(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 no have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I IO.RS, respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"
� GU�11�6 5' ��
IMOM"I
lw� p , ,
z,
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIMBERLEY DRISCOLL
N4AYOR 12-0 WASHINGTON STREET♦ SALEM,NtASSACHUSE'17S 01970
Tra.:978-745-9595 ♦ FAX:978-740-9846
Notice of Violation
PROPERTY ADDRESS
5 Cushing Street
Salem, Ma
January 28, 2009
Mr. Panajot Ruci 0�
5 Cushing Street
Salem, Ma. 01970
Dear Ms. Correa
As a result of the inspection conducted by this office, the Health Department
and Fire Department on January 23 it has been determined that two illegal
dwelling units exist in the basement and attic floor of 5 Cushing Street.
These units are violation of the both City of Salem Zoning Ordinance
and constitute various violations of the State Building Code 780 CMR for
lack of required egress,fire separation, minimum natural light and
ventilation, fire alarm devices etc.
You are hereby directed to remove these units in their entirety.
You must obtain a building permit for this work and arrange for a licensed
plumber and licensed electrician to obtain permits and inspections for
removal all plumbing and electric work currently installed in the apartments
within 10 days of your receipt of this notice. Failure to do so will result in
further actions being brought against you, up to and including the filing of a
criminal complaint at District Court.
Sincerely,
Thomas McGrath
Assistant Building Inspector/Local Inspector
CITY OF SALEM
�( � ! PUBLIC PROPERTY
DEPARTMENT
KIMBEUEY DIUSCOLL
MAYOR
124 WASHINGTON S'CRIikL'C 1 SALLM,MnsSecNuse.1'1'S 01970
Tri.:978-745-9595 ♦ FAX:978-740-9846
C(&Health Dept., Fire Prevention, Mayor's Office