6 DANIELS STREET - BUILDING JACKET ; . The Commonwealth of Massachusetts
Department of Public Safety
\IaN.ctchu,ells Slate Building Code(780C NIR)Seventh Edition
City of Salem
Buildinig Permit Application for any Building other than a I- or 2-Family Dwelling
(rhis Section For Official Use Only)
Building Permit Number. Dace Applied: IBuilding Inspector:
00 SECTION 1: LOCATION (Please indicate Block s and Lot 0 for locations for which a street address is not available)
� D/a,>, lvLr, ,Al, 01 1-4A(LlOrv.7 f1i - s-- Co --inn
No. and Street Cih• /Town Zip C"de Name of Building lit applicable)
SECTION 2:PROPOSED WORK
If New Construction check here 0 or check all that apply in the two rows below
Existing BuildingdM— Repai Alteration 0 I Addition O Demolition O (Please fill out and submit Appendix 1)
Change of Use O 1Change of Occupancy 0 1Other O Specify:
Are building plans and/or construction documents bring supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review requingZ Y Nu 0
Brief Description of Proposed Work: .� -V 2 n �3 4 "'
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) 0 ExistingRFactory
UseGroup(s): Proposed UseGroup(s): r
g Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No. Floors/Stories(include basement levels)&Area Per Floor(sq. ft.)
rea(sq. ft.)and Total Height(ft.)
SECTION A USE GROUP(Check as a 'Cable)
embly A-1 ❑ A-2r O A-2nc O A-3 O A-4 0 A-5❑ B: Business O - E: Educational O
F-1 O F2 O H: Hi Hazard H-1 O H-2 0 H-3 0 H-4 O H-5 O
tutional 1.1 ❑ 1-2 O I-3 O 1-4 O M: Mercantile❑ ReaidenHal R-lO R-2 O R-3❑ R-4 O
age SI ❑ S-20 U: Utility 0 Special Use Oand (rase describe below:
U.se: SECTION 6:CONSTRUCTION TYPE(Check as a licable)
Ina HAO 1180 IIIA ❑ 1IIBO IV 0 VA 0 VBO
SECTION 7:SITE INFORMATION(refer to 780 CMR I11.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit:- Debris Removal:
Public O Check it outNidv Iluod Zone❑ Indicate municipal 0 A trench will not be Lrcen.ed DiNFv:zd tiitr O
ru aired 0 or trench ur.pccdy:
I'rwate❑ or mJcntih Zone: nr on.ite Nc.tem 0 permit iN cndu.r.1 ❑
Railroad right-of-way: Hazards to Air Navigation: �L\ Ih.tm l , innu�•on ltaa u�a l'n
r\ot \pplireble 0 I,Sirtioure:.rthm.urpurt approach urra� IN their rec ic%% completed.'
n l',m�cnt to Iknld cndovd 0 Yv,O ur No❑ Ye,❑ \u ❑ .
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
C.e( wupi,v I%peof loml roc hun: Occupant load per Hour:
I h,,,the building cont.un.:n Spnnkler St Ntcm..' Special Stipulation.:
SECTION 9: PROPERTY OWNER AUTHORIZATION '-=• ►«
r'
.Name and Add re�x,1 of Property Owner
RoE%9ri ?iuscl,l)tri
Name(Print) No.and Street Cily/rown zap
l+naperty Chvner Contact Information: +
Title Telephone No. (business) Telephone No. Icell) a-mad address
If applicable, the pngpertc,owner herebv authorize+
Name Street Address City/Town State Lip
to act on the +ru pert% owner's behalf, in all matters relative to work authorized by this building permit a + plication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If buJJin ix less than 35,0Wcu.IL of endued s+ace and/ur not under Comiruction Contrul then check here Oand ski cd Sion 10.1)
10.1
Re istercd Professional Responsible for Construction Control.
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Cum any Name: -
Name of Personae Rrrn4ible for Construction License No. and Type if Applicable
C44rns y P-e-e Q(b�, ,tr Jnyg c7 E 4c
Street Address City/Town State Zip
Tele one No. (business) Telephone No. cell email address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.SS2.fi 2SC(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes O No O
SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6) =f 2 S-7 Sr-
1. Building f Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical f appropriate municipal factor)=f
3. Plumbing f
4. Mechanical (HVAC) f se Note: Minimum fee f (contact ici altt )
/T/ Y(
5. Mechanical (Other) f "
Enclo check payable to r b
6. Total Cost f —7S 0-0 (contact muntct alit )and write check number here _
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 tit my knowledge and understanding.
19ea pe print and pign name ritle relcphune Nu. Date
1;11ee1 :\ddrv, Cih'iTo%%n State Zip
Municipal Inspector to fill out this section upon application approval: t, LWIAr
\'ante )a to
t �
i
L , - --- The C'ulnn)omvealth of Massachuscits
I)oard of Building Regulations and Standards C i FY OF
Massachusetts State Building Cute, 780 CNIR ti,\LI'\I
Building Permit Application To Construct, Repair, Renovate Or Demolish a
I One-or Tuu-firrni(r Dwe/tinp
This Section For Official Use Oil �F
Building Permit Number: Date Applied:
E
Building 011icial(Print Nine) Signature D
SECTION I: SITE INFORMATION
1.1 Pro/pern ldres3/,• / / /— 1.2 Assessun Slap& Parcel N ben
I.la Is this an acce ted street?yes no Nlap Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Pnlpowd tJw. Lot Area(sy 11) Frontage(II)
1.5 Building Setbacks(R)
Front Yard Side Yards Rcar Yard
Rryuircd i'roviJcd Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40.§Sa) 1.7 Flood Zone In(ormalton: 1.8 Sewage Disposal System:
Public❑ Private❑ Zonr: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Chrck if yes❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Ownert of R ord• �r /
IYIIcf�ef�� JJc(A Oil>( SQ 1eW. ✓III (; ( 970
N;une(Print) 1 City.State,ZIP
(7o�%el S f 9,1'9-74r- 9069
No.and Street Telephone Email Address-
SE TION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alleration(s) O 1 Addition OF
Denwlilion ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
evils Wi'o tx-S t, (-A /A/f4 Vr l2P�D arPtrf'ys
- Yc / =
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estinmted Costs: Official Use Only
(Labor and ..\Iaterialsl y
I. Building S 9 d S I. Building Permit Fee: S Indicate how lee is determined:
'. Electrical S ❑Standard Citffosvn Application Fee
❑Toml Project Cost'l Item 6)x m liplier — x
I ?. Plumbing S ?. Other Fees: S -
J, Mcdlanicai Iil\.\('I S List:- --___
l tiu�rrasiunl S Total .\Il Fees: S -_..-_ . .
/ r-�C, Check No. _.._('heck Amounl: _ _ C'.uh \mru w:
o. Total Project Cost: S / / a S ❑ Paid in Full ' ❑Outstanding Ilul:mce Due:
SECTION S: CONSI'RUC'fION SF.RVIC'F.S
5.1 C'onstruction Supen'isur license(C'SI.) q{ -J \ 5' 19_3-12
.. ._ / --�- _ ------ I Iccnx Nwnhcr P\ptr;uinu Dote
Name O(IL'Sl. I Iu k cr
/ 7 l'SI. I)Pe(,cc helaw)
[_0J I)JArv_J _---_ ' _—_.------ 'f)pu Description --
// No. and Sacel
_�q ��� l4trcsuicicJ(ILliWin�s a to 15,11(10 cu. It
�Tc7fJ C(, re Rntricled Ia? f.nnil D\\cllin
Cigift \n,Slate.Lll' ..—._ �SI Slaion
RC Roo in Cocerin
---_. A'S Window and Sidin
c7 SF Solid Fuel Ilurning Appliances
78I 6S�{ SS6 p I Insulation
I cic hone Fnlail address D Demolition
5.3 Registered llome ImprgQp'Ive tent Contractor(HIC) 6 i6 9 v161-9,
(b w ev pow& KPW(6CY-e�h III ' Regisuutiun Nunlllcr F\piratiun Ume
I IIC C III an) Name or I IIC' Ita istront Name
F40. S (:IO 6 O"
Cj IJEtyffO� ��6 mall addressown,State,ZIP fele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 ZSC(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 oft a building permit.
Signed Affidavit Attached? Yes .......... No...........Cl
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 matter relative to work authorized by this building permit application.
Print Owner's Nwne(Elccwnic Signature) DJIC
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.
I ed lbw 9—,�A -/dam
Print Owner's or Authorized Agem's Nante(h.lectruntc Signature) Duty
VOTES:
1. In Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
(nut registered in the Hone Improvement Contractor(HIC) Program),will nn have access to the arbitration
program or guaranty land under\I.G.L.c. la'A. Other important information on the HIC Program can be lbund at
,,,,,\ m.n. .\ ,`,.I Information on the Construction Supervisor License can be found at
2. %%'lien substantial work is planned, provide the information below:
rota) 11our area(sq. n ) _ _._I including garage, finished basenICIA31tics,decks or porchl
Gross living area Isy. 11.) __-- _ Habitable rountcount
\luubcr oi'lircplaces _ Number of llcdrooms -
Vunthcrot'bathrooms . . . _ . . Numberol'halfhadls
I'%pc of heating s)s(cm Number o1'decks pordws
� I'\po of COltllilg i\51CI❑ I"IIc IUscd Ocell
1. "f.u.l1 I'fUjeCl Stluarc I',on:lge"111;1\ he suhslinitcd IUr"ro(al Project Cost-
6 DANIELS STREET I' MEN"
r
Citp of *alem, jffia!5gaCbU.5Ctt5
public Prnpertp department
�3uilaing Mcpartment
One foalem Oreen
(978) 745-9595 Cxt. 380
Peter Strout
Director of Public Property
Inspector of Buildings
Zoning Enforcement Officer
November 1, 2000
John Nestel
6 Daniels Street
Salem, Ma. 01970
RE: 6 Daniels Street
Dear Mr. Nestel:
After reviewing our records, we have found the above mentioned property to be a legal
grandfathered non-conforming four (4) family residential use.
This is to determine use only and in no way is meant to confirm or deny whether said
property is in compliance with all building, plumbing, gas, electric, fire or health codes.
Sincer
r
`Peter Strout
Zoning Enforcement Officer