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18 DALTON PARKWAY - BUILDING JACKET The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR e Massachusetts State'Building Code,780 CMR, 7 b edition MUNIUSlALITY Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January . Ore-orTwo-FamilyDweRbig 1, 2008 This For Official Use Only . / Building Permit Number. Date Ap Signature: Building Commissioner a ro ildmgs Date SECTION I:SPPE INFORMATION 1.1 Pro erty Addres 1.2 Assessors Map&Parcel Numbers 1 3 �GE � ` _USA C�1\. � 1.1 a Is this an accepted street?yes_ no_ Map Number Parcel Number 13 Zoning Informatio 1.4 Property Dimensions: Uc, Zoning District Proposed Use. Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks (ft). Front Yard Side Yards Rear yard- - Requimd Provided Required - Provided - Required Provided - 1:6 Water Supply: (NLG.L c.40, §54) 1.7 Flood Zone Information: . 1.8 Sewage Disposal.System: Zone Outside Flood Zone? . Public❑' Private❑ — Municipal On site disposal system ❑ ' Check if yest SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Reco &- ` (� d.a rye a �(L e \� i$ \) ,`fin t i1 �w n �4\enn; V�c� 410�0 Name(Print) Addr=for Service Signature - Telephone - SECTION 3;IIESCRIP'I'ION OF PROPOSED WORK2'(cheak all that apply)" h'ea'CcnsCs�'a C "&x st := Buildin^J Own^r^ccu ^d C Re ai s`''.0 "atem cur^) G'' h'dt'duc ❑ Demolition ❑ Acce'ssory B)do: ❑ TJumber of l)nits_ Other Specify:_.-, Grief Description of Proposed Woric: O SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ 3� �; 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ C Standard Cityrrown Application Fee ❑Total Project.Costi(Item 6)x mulupiier . x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Stropression) Total All Fees:$ Check No. Check Amount: Cash Amount 6,Total Project Cost: $ 3. (o : ❑Paid in Full 12 Outstanding Balance Due: ___ SECTION 5: CONSTRUCMR—SMN -ES 5.1 D Licensed Construction Supervisor(CSL) s n �o�aa''�J< n C r•��•-t license Number .Expiration Date. Name of CSL-Holder W�• Su• `Ie Type(smbelow)4�h ListCSLT C .'e' `Dcsception U c Unrestricted to 35.000 Cu.Ft Signature ��C-� .: R RestrictedI&LFatml Dwellm . . - .� M MRsomy.Only Telephone. RC . Residential Roofing Cove2n - WS Rmideotial Wmdow and Siding- SF Residential Solid Fuel Burning Appli2n=Installation Residential Danolition - 5� Registerep Home 1 ro vent Contractor(MC) �P HIC Company ame or HIC Registrant N Registration Number e �� -�-{I� d(q� 1 Expiration Date - 5ignature.' _ Telephone . . SECTION 6:WOR Ci- S' COh3i ENSATION INSURANCE AFFIDAVIT M.G.L.r-IS!-g z5C(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 AttacbrO Yes :........ - No...........❑ SECTZUN 74:O ER 4U.M. DAMATTON TO BE•CpNF1'T ETEli yJ N:.. OwNER'S AGENT C9IL<CON FRAC1'OR AT M9.FOB SIJII ii(� 'PET,211iffI`.. . .' I, tern F! . c n S' I as Owner of the subject property hereby authorize t to act on my b ehaX in all matters relative to work authorized by this building permit application - - Signature of Owner ... Date SEMm1V . 0(�'ia�YNEV.O A-U]H�RIUD A EIA DLA4 ©IiT .. . _ 1;,�C'A t r., 1�6•�n -( 'iTF�- -' a3'0«'uet-ot`AIirhbtizgd Agent 1ierhhv deFlare tI�at the =tafiments and infonuahonon Lhe i�rteotn_ application aret'rue and:accurate,-to the best of my lut arledi?.c and !. L a �i t Signature o caner or Authorized Agent Date - (Signed under the pains and penalties of perjury) 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 IvLG.L. c. 142A.Other importamt information on the HIC Program and Construction Supervisor Licensing(CSL) can be found in 7S0`CMR Regulations 110.R6 and 110.R5,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 ofbedrooms Number ofbathrooms Number ofhaMatbs Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3, Total Project Square Footage"maybe substituted for"Total Project Cost 3 ,�� The Commonwealth of Massachusetts r TzY OF Board of Building Regulations and Standards iaL 2AL RY iG .; Massachusetts State Building Code, 780 CMR A 1,'' Revised Mar 2011 Building Permit Application To Construct, Repair,Renovate afD�1 lisga R 2' 00 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Dat plied: t Building Official(Print Name) Signature 6ate n SECTION 1: SITE INFORMATION JG 1.'�rope¢Ev4d�e� 1.2 Assessors Map&Parcel Numbers L I a is this an accepted street?yes no V Map Number Parcel Number \J 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 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 la�6n site disposal system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2 O net o.[Record: o, NC-QZL 10A Name(P ht + ° City,State,ZIP I DR L OFCASs9 4. No.and Street V Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Propose Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $�`�$ 0. 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 8 �� ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ (�®9 . 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression Total All Fees: $ 25�� Check No. Check Amount: Cash Amount: 6. Total Project Cost: M ❑Paid in Full ❑Outstanding Balance Due: M ►� tt_ -rb C. U)o ILA s 2D SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1D- JktAXAVV�c�<Tr 6 License Number Expiration Date Name 01 SL Holder -- ��LL V List CSL Type(see below) No.and Street Type Description .��/7 D 1 U Unrestricted(Buildings u to 35,000 cu.ft. V� R Restricted 1&2 Family Dwelling City/Town, State,ZIP- M Masonry RC Roofing Covering WS Window and Siding y/ 7 11 SF Solid Fuel Burning Appliances ��'-I�3 3 / �D j��Gs•AI LEI L I J Insulation Telephone —� Email address D Demolition 5.2 epistered Home 1 prov ent Contractor HIC) � /! Q �,�2) � �Jp L Imo, a� tom'/ �LQ tit ��A �1�('e- / IC Registration Number Expiration Date HI Co p Name or`HIC Re istr nt Name �c m t And�jet/� p,.z ry O mail address r /Town, State,Z 9 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 Authorized Agent's Name(Electronic Signature) Date 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.gov/oca Information on the Construction Supervisor License can be found atmLNnv.mass.gov/dAs 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 half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" 18.DALTON PARKWAY t , t INSPECTION REPORT DATE: �Z-.29-7s" ' ADDRESS: OWNER: �ooc!6�`/Fr�� USE GROUP: G J NUMBER OF STORIES: 3 Q NUMBER OF ROOMS BY STORY lv�,.-�,'�f`/j .S"Tr, gy�iC' HOW HEATED: //Q� bst Qf / /rf .�v,9r�n by 74S f GAS: YES NO: , NUMBER OF SANITARIES: °I NUMBER OF APPROVED EGRESS DOORWAYS: REMARKS:- FEE RECEIVED: YES NO: ,��ell, .MAV-QI J QEALTY BUS, 617.567.7111 MERCANTILE-INDUSTRIAL-COMMERCIAL RES. 617-665-3186 108 MAVERICK STREET EAST BOSTON, MASS. 02128 April 24, 1975 MR. John Powers, Building inspector City of Salem 40 Broad Street Salem, Massachusetts re: One duplex, 1 Circuit Court 18 Dalton Parkway Dear Sir: In accordance with Section 111 .43 and Section 120.3 of the State Building Code, I, as the agent for the owner, hereby request an inspection of the premises at 1 Aimoviet Court Streerand 18 Dalton Parkway, and the issuance of a Use and Occupancy Certificate. One half of the property is now vacant. It is my understanding that compliance with Section 120.3 may be used in lieu of Section 111 .43. Entry to the premises may be obtained by contacting Mr. R. Dell Orfano, Realtor. Would you kindly acknowledge that you have received this letter by signing and dateing the attached copy, and returning it to me in the enclosed envelope. urs ery truly, Enclosure: $25.00 Fee On 19 I received this letter and the fee of $25.00 for the issuance of a se and Occupancy Certificate Building inspector ��a4195 i MAV-,ZIS" JQEALTY BUS. 617-567.7111 MERCANTILE-]N DUSTRIAL-COM M ERCIAL RES. 617.665.3186 108 MAVERICK STREET EAST BOSTON, MASS. 02128 ±. April 24, 1975 MR. John Powers, Building inspector City of Salem 40 Broad Street Salem, Massachusetts re: One duplex, 1 Circuit Court 18 Dalton Parkway Dear Sir: In accordance with Section 111 .43 and' Section 120.3 of the State Building Code, I, as the agent for the owner, hereby request an inspection of the premises at 1 Circuit Court Stree and 18 Dalton Parkway, and the issuance of a Use and Occupancy Certificate. One half of the property is now vacant. It is, my understanding that compliance with Section 120.3 may be used in lieu of Section 111 .43. Entry to the premises may be obtained by contacting Mr. R. Dell Orfano, Realtor. Would you kindly acknowledge that you have received this letter by signing and dateing the attached copy, and returning it to me in the enclosed envelope. urs ery truly, Enclosure: $25.00 Fee On 19 I received this letter and the fee of $25.00 for the issuance of a se and Occupancy Certificate Building inspector