9 CUSHING STREET - BUILDING JACKET 74520 400 P4
The Commonwealth of Massachusetts Town of
�►y� Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 7" edition Binding Dept
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 Applied: G
Signature: 2
^ Bui in mmissioner/inspector of Buildings Date
\V1 J\ SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
Map Number Parcel Number
1.la Is this an accepted street'.r yes� no
'-- 1.4 Property 1.3 Zoning Information: P Y Dimensions:
Zoning Disrnct 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 ,
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 disposal system ❑
Public❑ Private❑ Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
Name(Prim) Address for Service:
5-170 -,S�/
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
XBrief Description of Proposed Work': J
1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. Building $ _ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town App ication Fee
2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire S Total All Fees: $
Suppression)
Check No. Check Amount: Cash Amount:
X
6. Total Project Cost: $ ' paid in Full 0 Outstanding Balance Due:
SECTION 5. CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
��l^� "���� License Number Ex pi anon ate
N,4me of CSL- Hplder List CSL Type(see below) t-/
Address Type Description
_ - - U Unrestricted(up to 35,000 Cu. Ft.
Signature R Restricted 1&2 FamilyDwelling
Si
Si M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered ome Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
e(e cp Expiration Date
Signature Te ephon.
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........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative towork authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1, ,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.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of per'u
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I 10.116 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 dumber of decks/porches
Type of cooling system Enclosed Open
3. 'Total Project Square Footage"may be substituted for"Total Project Cost"
u� +
7 --- ----- The Connmonw'eal(h of Massachusetts
Board of Building Regulations vid Standards CITY OF
Massachusetts State Building Code, 7SO C NIR SALENI
Building Permit Application To Construct, Repair, Renovate Or Denwlis u
One-or TovrFamil' Uu ellin.K
This Section For Official Use Onl
Building Permit Number: Date Ap lied:
9 - Li 10 Z� 1)
Building 011icial(Print N;une) V , ignat Date
SECTION 1:SITE 1 O ATION
L I Property Address: 1.2.Asse ors Map arcel Numbers
C onj)l:M 4 K 57( (el 0
I.I a Is this an accepted street?-yes - no Map Number Purcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R .Z -�q26
Zoning District Proposed Use Lot Area(sq 11) Frontage Ill)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage gisposal System:
Public 13 Prirate❑ Zone: _ Outside Flood Z,__?
Check iYes Municipal On site disposal system ❑
SECTION2: PRGPERTYOWNERSHIPI
2.1 Ownert of Recurd73� \
rl r r r L7rDCD rcJMia n S srY, t AA a-� 012 30
N;una(Pont) C ily.Smtc,Z IP
9 �l,�h�ry
No.and Streea s� g}d�368- wm t felephune Einail Addnr
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_-g_ I Other ❑ Spcciiy:
Brief Description of Proposed Work:
SECTION 4: ESTIA)ATED CONSTRUCTION COSTS
item Estimated Costs:
(Labor and .Materials) Official Use Only
I. Building S I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical S ❑Standard CityiTown Application Fee
1.
❑Total Project Cost t Item 6)x multiplier _ x
Plumhi°g S ,. Other Fees: S
J. \lechanic:d ill\AC) S List:
-. .Mcchmtieal Wire — ----- ------ _.
tiu+vession) S Total :\II Fees: 5 "—__ - --------- ------.—" .
Check .No. _ ('heck Amount: ----Cash Amount.
. Total Project Cult: S ❑paid m Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(C'SI.)
Lieens¢Nundter-- -- _-- pcpirnion Date
N:unc ol'l'til. I IulJer
List CSI. (see hcluwl
No. :utdtitrect I)PC Description
U UnrestnctnJ(Iluildin"up to J5,000 cu. ft.l
R Restricted 1 r2 Famil l Dwe11111
C itvirmil,.State.LIP M Masotiry
RC Rtwlin'Co%erin
-. WS Window and Siding
SF Su1id fuel Burning Appliances
Insulation
'rcle hone F.mail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
ITIC' Registration Numhcr I?vpiratiun Datc
I IIC C'ompan) Name or I IIC Registrant Name
No. and Street Email address
Cityrrown,State.ZIP role hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152. 1 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 7s: 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(Electrunic 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:\uthoriied Agent's`Lune(Electronic Signature) Dute
?TOTES:
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 Hume Improvement Contractor(HIC) Program),will Ligill 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 m.r,, L;o% ,,.,i Information on the Construction Supervisor License can be found at w>t w.ma:=>o% 1p,
2. When substantial kkork is planned, pro\ide the information below;
Total Iloor area(sq. ft.) _ (including garage. finished bascmcnt anics,decks or porch)
Gross liking area Isy. It _ Habitable room count
Number of fireplaces _ _ Number of hedruoms
ooms
mber
I'\tths
lie ofan1thtgrsYstem _ — -. 1`�ttcm er ol'decks,tpk rches-Open . _... ... i,
t, "folal Project Square Footage-ma) he substituted lir"Total Project Cost'
o I,
CITY OF SALEM
u PUBLIC PROPERTY
DEPARTMENT
KIMBFRLF_Y DRISCOLL
MAYOR
120 WASI IINGTON STRFFT♦ SALEM,MASSACI-IDSFTTS 01970
TFL:978-745-9595 ♦ FAx:978-740-9846
May 6, 2008
Ms. Maureen Amenda
9 Cushing Street
Salem, Ma. 01970
RE:Legal Occupancy of 9 Cushing Street
According to our records,this property is a legal grand-fathered, non conforming 2 Family
dwelling located in an R2 Zone.
This is meant in no way to confirm the said property is in complete compliance with building,
plumbing, electric or Health Codes.
Since
Thomas St. Pierre
Building Commissioner/Zoning Officer