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11 DEARBORN STREET - BUILDING JACKET ire rw uNo 153E9aTc� HAGTIN08. 11N POF 14 g 3 SOPA O STs A-S A S(n,J(D k fAIK i LY lib d S� vv �E; up t ,r y�tiroernr�,�a! CITY OF SALEM, MASSACHUSETTS BOARD OF APPEAL 120 WASHINGTON STREET. 3RD FLOOR SALEM, MASSACHUSETTS O 1970 - ,p TELEPHONE: 978-745-9595 FAX: 978-740-9846 KIMBERLEY DRISCOLL MAYOR November 2, 2011 Decision City of Salem Zoning Board of Appeals Petition of LAWRENCE GALLAGHER requesting Variances from lot area per dwelling unit and off-street parking regulations, for the property located at 31 DEARBORN STREET (R-2), in order to use the single-family house as a two-family house. A public hearing on the above Petition was opened on October 19, 2011, pursuant to Mass General Law Ch. 40A, § 11. The hearing was closed on that date with the following Zoning Board of Appeals members present: Rebecca Curran (chair), Richard Dionne, Jamie Metsch and Bonnie Belair (alternate). , Petitioner seeks Variances pursuant to Sections 4.1 and 5.1 of the City of Salem Zoning Ordinances. Statements of fact: 1. Lawrence Gallagher represented himself at the hearing. 2. The single-family house located at 11 Dearborn Street contains a second unit, which the petitioner seeks to legalize. Space exists for four tandem parking spaces, or two standard spaces. 3. In a petition date-stamped September 13, 2011, petitioner requested Variances from lot area per dwelling unit and from off-street parking regulations in order to allow the use of the second unit. No exterior construction is proposed. 4. At the hearing, no one spoke in opposition to the petition. The petitioner submitted several signatures of abutters indicating their support. The Board of Appeal, after careful consideration of the evidence presented at the public hearing, and after thorough review of the plans and petition submitted, makes the following findings: 2 1. Special conditions and circumstances exist affecting the parcel or building, which do not generally affect other land or buildings in the same district; the house is large, and its use as a single-family home causes a financial hardship to the appellant. 2. Desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the zoning ordinance, since a two-family house is in keeping with the neighborhood. 3. In permitting such change, the Board of Appeals requires certain appropriate conditions and safeguards as noted below. On the basis of the above findings of fact and all evidence presented at the public hearing including, but not limited to, the Plans, Documents and testimony, the Zoning Board of Appeals concludes: 1. Variances from Sections 5.1 (Off-Street Parking) and 4.1 of the Salem Zoning Ordinance are granted to allow for use of the property as a two- family home. In consideration of the above, the Salem Board of Appeals voted, four (4) in favor (Curran, Metsch, Dionne and Belair) and none (0) opposed, to grant petitioner's request for Variances subject to the following terms, conditions, and safeguards: 1. Petitioner shall comply with all city and state statutes, ordinances, codes and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner. 3. All requirements of the Salem Fire Department relative to smoke and fire safety shall be strictly adhered to. 4. Petitioner shall obtain a building permit prior to beginning any construction. 5. A Certificate of Occupancy is to be obtained. 6. . Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to, the Planning Board. 7. Petitioner is to provide two permanent, year-round, unobstructed off- street parking spaces. I 3 8. Petitioner is to gate the section of fence obstructing the driveway to allow free access to the parking spaces. Rebecca Curran, Chair Salem Board of Appeals f A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the office of the City Clerk. Pursuant to the Massachusetts General Laws Chapter 40A, Section 11, the Variance or Special Permit granted herein shall not take effect until a copy of the decision bearing the certificate of the City Clerk has been filed with the Essex South Registry of Deeds. A. ONDIT�.AO CITY OF SALEM9 MASSACHUSETTS .3 BOARD OF APPEAL 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01 970 TELEPHONE: 978-745-9595 FAX: 978-740-9846 KIMBERLEY DRISCOLL 1, ., n LI) (J MAYOR November 2, 2011 Decision City of Salem Zoning Board of Appeals Petition of LAWRENCE GALLAGHER requesting Variances from lot area per dwelling unit and off-street parking regulations, for the property located at 11 DEARBORN STREET(R-2), in order to use the single-family house as a two-family house. A public hearing on the above Petition was opened on October 19, 2011, pursuant to Mass General Law Ch. 40A, § 11. The hearing was closed on that date with the following Zoning Board of Appeals members present: Rebecca Curran (chair), Richard Dionne, Jamie Metsch and Bonnie Belair (alternate). Petitioner seeks Variances pursuant to Sections 4.1 and 5.1 of the City of Salem Zoning Ordinances. Statements of fact: 1. Lawrence Gallagher represented himself at the hearing. 2. The single-family house located at 11 Dearborn Street contains a second unit, which the petitioner seeks to legalize. Space exists for four tandem parking spaces,or two standard spaces. 3. In a petition date-stamped September 13, 2011, petitioner requested Variances from lot area per dwelling unit and from off-street parking regulations in order to allow the use of the second unit. No exterior construction is proposed. 4. At the hearing, no one spoke in opposition to the petition. The petitioner submitted several signatures of abutters indicating their support. The Board of Appeal, after careful consideration of the evidence presented at the public hearing, and after thorough review of the plans and petition submitted, makes the following findings: 2 1. Special conditions and circumstances exist affecting the parcel or building, which do not generally affect other land or buildings in the same district; the house is large, and its use as a single-family home causes a financial hardship to the appellant. 2. Desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the zoning ordinance, since a two-family house is in keeping with the neighborhood. 3. In permitting such change, the Board of Appeals requires certain appropriate conditions and safeguards as noted below. On the basis of the above findings of fact and all evidence presented at the public hearing including, but not limited to, the Plans, Documents and testimony, the Zoning Board of Appeals concludes: 1. Variances from Sections 5.1 (Off-Street Parking) and 4.1 of the Salem Zoning Ordinance are granted to allow for use of the property as a two- family home. In consideration of the above, the Salem Board of Appeals voted, four (4) in favor (Curran, Metsch, Dionne and Belair) and none (0) opposed, to grant petitioner's request for Variances subject to the following terms, conditions, and safeguards: 1. Petitioner shall comply with all city and state statutes, ordinances, codes and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner. 3. All requirements of the Salem fire Department relative to smoke and fire safety shall be strictly adhered to. 4. Petitioner shall obtain a building permit prior to beginning any construction. 5. A Certificate of Occupancy is to be obtained. 6. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to, the Planning Board. 7. Petitioner is to provide two permanent, year-round, unobstructed off- street parking spaces. V 3 8. Petitioner is to gate the section of fence obstructing the driveway to allow free access to the parking spaces. Rebecca Curran, Chair Salem Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the office of the City Clerk. Pursuant to the Massachusetts General Laws Chapter 40A, Section 11, the Variance or Special Permit granted herein shall not take effect until a copy of the decision bearing the certificate of the City Clerk has been filed with the Essex South Registry of Deeds. CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASFIINGfON S'T'REET♦ SALEM,MASSACHUSETCS 01970 'PE.:978-745-9595 ♦ FAx:978-740-9846 70. August 25, 2010 Mrs. Cecelia Gallagher 11 Dearborn Street Salem, Ma 01970 RE: 11 Dearborn Street Conversion to 2 family dwelling Dear Mrs. Gallagher Your property is zoned where 2 family dwellings are an allowed use but your lot size is insufficient for conversion "by right". You will need relief from the Zoning Board of appeals in order to legally convert the house to a 2 family dwelling. There may also be required renovations within the building to meet applicable Building Codes. I am enclosing the application for the Zoning variance. You will need an Architect to prepare plans describing the proposed changes to your house or to provide me with a letter saying the existing layout meets code. The Architect could also help you prepare the application for a Zoning Variance. Sincerely, Thomas McGrath Assistant Building Inspector r" coxulT CITY OF SALEM, MASSACHUSETTS 5 _ PUBLIC PROPERTY DEPARTMENT 9 � �.P 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. JSOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 November 14, 2003 Lawrence Gallagher 11 Dearborn Street Salem, Ma. 01970 Dear Owner: This Department has again received a complaint that the illegal basement apartment is again occupied. Under Massachusetts Law 780 CMR, Section 106-4 you are required to contact this office to arrange an inspection of this unit within 15 days upon receipt of this letter. Sincerely, Thomas St.�-ierre Acting Building Commissioner cc: Tom Phillbin Councillor Bencal Cecelia and Lawrence Gallagher 11 Dearborn Street Salem, Massachusetts 01970 December 7, 2001 Dear Karen, We are sorry to inform you that the Building Inspector, Thomas St. Pierre, will no longer allow us to rent the basement apartment. It's with much regret, therefore, that we must ask you to vacate the apartment as soon as possible. Please let us know if we can be of any assistance to you in making this move. Sincerely, Cecelia and Lawrence Gallagher cc. Thomas S. Pierre Counselor S. Hayes CITY OF SALEM, MASSACHUSETTS �6 PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR fsa' SALEM, MA O 1970 �' •- _,w�" TEL. (978) 745-9595 EXT. 380 FAX (978) 740-9846 STANLEY J. USOVICZ, JR. PETER STROUT, DIRECTOR OF PUBLIC PROPERTY MAYOR @Y® Y P October 29, 2001 Lawrence Gallagher 11 Dearborn Street Salem, Ma. 01970 Dear Owner: This department has received a complaint that you have a basement apartment at the above-mentioned address. Under Massachusetts Law 143-780 CMR, Section 106.4 you are required to contact this office to arrange an inspection of the basement within 15 days upon receipt of this letter. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Thomas St. Pierre Local Building Inspector cc: Mayors Office Fire Prevention Councillor Hayes the unders ed complainant,request that a criminal complaint issue against the accused charging the rffense( fisted below. If the accused HAS NOT BEEN ARRESTED and the charges involve: Salem District Court 65 Washington Street 7 ONLY MISDEMEANOR(S),I request-a hearing ❑ WITHOUT NOTICE because of an imminent threat of Salem, MA. 01970 ❑ BODILY INJURY ❑ CGNIMISSION OF A CRIME ❑ FLIGHT ❑ WITH NOTICE to accused. 7 ONE OR MORE FELONIES,I request.a hearing O WITHOUT NOTICE ❑ WITH NOTICE to accused. ARREST STATUS OF ACCUSED 7 WARRANT is requested because prosecutor represents that accused may not appear unless arrested. ❑ HAS HAS NOT been arrested INFORMATION ABOUT NAME(FIRST MI LAST)AND ADDRESS BIRTH TE SOCIAL SECURITY NUMBER �s— I LgkIrcn Le- Gcl �/99�P'' PCF NO. MARITAL STATUS F is hpeel,-60'A S�Lr Pe DRIVERS LICENSE NO. STATE SC, *' /I c) Q I GENDER HEIGHT WEIGHT EYES L Ae 1AIR RACE COMPLEXION SCARS/MARKS/TATTOOS I BIRTH STATE OR COUNTRY DAY PHONE I :MPLOYER/SCHOOL MOTHER'S MAIDEN NAME(FIRST MI LAST) FATHER'S NAME(FIRST MI LAST) INFORMATIONCASE COMPLAINANT NAME(FIRST MI L/A�ST) //1 / ,/J COMPLAINANT TYPE - PD r /t« �ILQ Oe 7o^qS y /'i fry , ❑ POLICE ❑ CITIZEN OTHER ADDRESS PLACE OF OFFENSE (�� ✓VR s✓(i75�1 �T' -ref — 3�G� F/r, eCl7dln `.77 `�fj /Cs.1 / q INCIDENT REPORT NO. OBTN Ls r l e /{A (/ M 7(J CITATION NO(S). OFFENSE CODE ll DESCRIPTION ` / OFFENSE DATE 7 G C hrP —�t-n ,'�e(J�,, 1 VARIABLES(e.g.victim name,controlled substance,type and value of property other variable information;see Complaint Language Manual) OFFENSE CODE DESCRIPTION OFFENSE DATE L r ,z VARIABLES OFFENSE CODE DESCRIPTION / OFFENSE DATE 3 VARIABLES -1EMARKS CO LAINANTS SIGN U DATE FILED X �4r,' ,o �{ } O�O� COURT USE ONLY A HEARING UPON THIS COMPLAINT APPLICATION DATE OF HEARIW i IME OF HEARa IMN'G, COURT USE ONLY WILL BE HELD AT THE ABOVE COURT ADDRESS ON S AT 1 N S E DATE PROCESSING —Q NOTICE SENT OF CLERK'S HEARING SCHEDULED ON: (e�Q NOTICE SENT OF JUDGE'S HEARING SCHEDULED ON: HEARING CONTINUED TO: APPLICATION DECIDED WITHOUT NOTICE TO ACCUSED BECAUSE: ❑ IMMINENT THREAT OF ❑ BODILY INJURY ❑ CRIME ❑ FLIGHT BY ACCUSED ❑ FELONY CHARGED AND POLICE DO NOT REQUEST NOTICE ❑ FELONY CHARGED BY CIVILIAN;NO NOTICE AT CLERK'S DISCRETION • , PLAINT TO ISSUE ❑ PROBABLE CAUSE FOUND FOR ABOVE OFFEUM79) ❑ NO PROBABLE CAUSE FOUND NO(S). ❑ 1. [12. [13. BASED ON ❑ REQUEST OF COMPLAINANT ❑ FACTS SET FORTH IN ATTACHED STATEMENT(S) ❑ FAILURE TO PROSECUTE ❑ TESTIMONY RECORDED:TAPE NO. ❑ AGREEMENT OF BOTH PARTIES START NO. END NO. ElOTHER: \1\' ElWARRANT ElSUMMONSTOISSUE COMMENT ARRAIGNMENT DATE: ,CCR-2(09104) (COURT COPY �� :, s-sum •, r ... _T APPLICATION FOR APPLICATION NO.(COURT USE ONLY) PAGE Trial Court of Massachusetts CRIMINAL COMPLAINT of District Court Department 1,the undersigned complainant,request that a criminal complaint issue against the accused charging the offense(s)listed below. If the`accused HAS NOT BEEN ARRESTED and the charges involve: Salem.District Court 65 Washington Street D ONLY MISDEMEANOR(S),I request a hearing D WITHOUT NOTICE because of an imminent threat of Salem MA- 01970 D BODILY INJURY D COMMISSION OF A CRIME D FLIGHT D WITH NOTICE to accused. D ONE OR MORE FELONIES,I request a hearing D WITHOUT NOTICE D WITH NOTICE to accused. ARREST STATUS OF ACCUSED D WARRANT is requested because prosecutor represents that accused may not appear unless arrested. D HAS HAS NOT been arrested INFORmATIoNABouTAccuSED NAME(FIRST MI LAST)AND ADDRESS BIRTH DATE SOCIAL SECURITY NUMBER L] 4 ez �..... ( ,. r p/r/ PCF NO. MARITAL STATUS /� )�(+ •rte f rrr • t DRIVERS LICENSE NO. STATE GENDER HEIGHT WEIGHT EYES HAIR RACE COMPLEXION SCARS/MARKS/TATTOOS BIRTH STATE OR COUNTRY DAYPHONE EMPLOYER/SCHOOL MOTHER'S MAIDEN NAME(FIRST MI LAST) FATHER'S NAME(FIRST MI LAST) INFORMATION COMPLAINANT NAME(FIRST MI LAST) J �- COMPLAINANT TYPE PD •+ 1 ( ( t! �' ! ! `,` + ( D POLICE D CITIZEN l40 OTHER ADDRESS r, PLACE OF OFFENSE 11 _ I've_ i _ . p r r ,,,I � INCIDENT REPORT NO. OBTN ( (r+ CITATION NO(S). i OFFENSE CODE DESCRIPTION ;.P'C` // OFFENSE DATE 1 VARIABLES(e.g.victim name,controlled substance,type and value of property other variable information;see Complaint Language Manual) OFFENSE CODE DESCRIPTION - r OFFENSE DATE Z VARIABLES .) y /l ' VVARIAB-LES CODEDESCRIPTION OFFENSE DATE 3 REMARKS C9MPLAINANTSSI AT}R /r DATE FILED COURT USE ONLY A HEARING UPON THIS COMPLAINT APPLICATION l DATE OF HEARING TIME OF HEARING COURT USE ONLY 30 1 WILL BE HELD AT THE ABOVE COURT ADDRESS ON J - (G, AT �— � DCCR-z(08/04) 'COMPLAINANT'S COPY N 1 Ut- tAl:I J _... Trial Court of Massachusetts N SUPPORT OF °F— District Court De artment N� F N FOR CRIMINAL COMPLAINT P COURT DIVISION ed alleges the following as a ❑ full Oro partial statementbasis 4or the offense(s)for which as criminal complaint is sought. 171i � rl'—_L7 �'✓ems ------- ------------------------ --------- - -------------- D/ --��Lch --- ''---��r- ---1- —----------- �N ��- 1--�PL`-�- / H /i1✓l5 e fen"ti' � ------ y� --/�--------------- ----- J'`y",-c",5 Gni R�, 'k L /� - —J}- --- ---- ----------/- r� --- ---------------- - ----------- -- -f---� --------- G ----- ----� _ -- o (Use additional sheets i/necessary) PRINTED NAME SIGNATU I AM A DATE SIGNED O jr� D X � ❑LAW ENFORCEMENT OFFICER 7/cA as– Th S �] ) �// IIIVVV/// �� y� ❑ CIVILIAN COMPLAINANT OR WITNESS ' •• • • • c • RX91 9 IL91-- ------------------------------------------------------------------------------------------- _________________________—_________ – – – --- – – _–_______--- –____– ____-- – ___--___--___ ----------------------------_------------------------------------------------------------------- ___------------------------------------------ -------------------------------------- ----------- REMARKS SIGNATURE OF CLERK-MAGISTRATE/ASST.CLERK/JUDGE DATE SIGNED X DC-CR-54 (7/04) _ G J �� APPIIOYED CITY OF SALEM s.. r =i01�IN�Ol In Aopwb Lacmd h Lematim1 (� Nowodoa�Ylon Yo�No_ artus.a �'� ( ��2G✓�h�� r waprq L000bd h Nn CGrAWAdon ANO . Yak_No Ponnk b: MIO D PENT APPLICAIM POIk (Ckols which apply) ROOF ftW IrWW SM gyp, ConWW Dock, Shad. POA PLEASE PLL our UMLY•©OWLETSLY TO AVOW DSLAYS N PIIOINls TO THE INSPECTOR OF BUILDINGS: '. hsnby q*W for a permit to bulld a000lftlo ft ImNorwq Owrnrs Nsma Llialyenopk,r Adam a no I I (lea ovl SL u9li AP&Aocft Nmn Adaass A Phone f rr I 11-M —ios Noma + I h i J rv�e Adam a Phan 7 a l-cl u -��faU g((�� Whl rt b p�dn al buNngl �'d W a(W� kru s c - s je 1' t) -4 & mil"d, al N a ' NI 11MI OuNdtiq oontaw b lao►9 GOWABOd aoat pA►Lwm o d am i�;. it (-fall WS flIE PENAL � 1 OF DESCMI OF Wi01rI TO of DONE MAIL PEFUrT( ll �eorhor w sit - fi S d0 NotLv 1 ��w,rs loaar%�J�a f S/✓� / Ol1NNfISd LVJ NOLLr911ddr '��ANi111N��EA��pO A�Ilpyip Alf ZiIE .1�11 mA�!•$MKi WIAN1'�p C CITY OF SALEM roWd n.=�`' �.w.. .r ea i+ov.sr tm�r,e ti in.00r�.ronw.n . Pwmtt to NUAW PWW APPUUTM PM Aft w aftw opm w RKOA hum ow ,Ca mum Dfa k Shwk Pool, PLaM M L,our LMMLY A OaRlMLY TO AVOW ORAVS M PW)08 q TO n+E'HWOO TOR of WAUMNO& lb* Wd-'radon' Wd hKaby aaowa for • POM* to bUNd eo go.opilm �p i 0~6 NWO _ L iL A I ry Gi 14 (!t vl- APsww tI DLIA009ti ( M) 7�r c? 3 Z AMhkmft NW tfa AddM=A Phoro M.dW NWW Aadn�A moron. c No left a*Aft for how a"INdw YID tddry fay" Arwers �M1M �© b(7. y a qr Llo�w���_t�tlor�• _ am -- sp�w,M.a Appiowtt ���POW",oeAcarnm oP"rD w "n 0 w Li)eir is r� kG ni-l-- 4 0 ��.wi t-) 12 i, ..l'O 7P IAI(-, r u. n v yerAeryd(f ko(JR-r S-Foye 0IdIG IAtt L PST I u r-) 0.i 1It , rile i1wuj � o >o tzer uh+ • � � .+-� � � � �. � . . � � i � ,� �-.��� ��°� �n �� � �� I I ��� ,� f-� i � gas f �Q � U -7 RECEIVED 'File Commonwealth of Massachusetts I ERVIG Board of Building Regulations and Standards 'Iary Massachusetts Stale Building Code, Aso etila 1,14 NOV J CITY ORevised blur 2011 ° y Building Permit Application To Construct, Repair, Renovate Or Demolish a S One-or Tivo-Family Divelling This Section For Otticial Use Only Date Building Permit Number: A PFlied: II S t Building ORieial(Print N:une). Signature Date SECTION 1:SITE INFORtNIATION' ` A 1.1 Property Address: 1.2 Assessors Niap& Parcel Numbers Ma Number Parcel Number I.I a Is this an accepted street?yes no P 1.3 'Coning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard RequircJ Provided Required Provided Required Provided t.6 Water Supply:(M.G.],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 es❑ SECTION2: PROPERTY OWNERSHIP, 2. O/w�ner o/fRey�rd: SC.t2-('� #74 N�me(Print' / City,State,ZIP �Jd -oZ`5Q5J 7u�eM�-,oOr'ir+ SC(•ISNCd No.and Street Telephone Email AJJress SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work-: t<e 0 e- e- t SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials)- 1, Building S b GGr> 1. Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S A P,Oilier Fees: S 4. Mechanical (FIVAC) S R List: 5. Mechanical (Fire S 'rotal All Fees:S X Suppression) Check Na. Check Amount: Cash Amount: 6. Total Project Cost: .S0261 G6 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 ConstructimcSupervisor,Llceilse(CSL) " License Number Expiration Date Name of CSL Holder List CSL'fype(see below) No. and Street Type - Description U Unrestricted(Buildings up;to 35,000 cu. It.) R Restricted 1&2 Family Dwelling City/fown,State,"LIP M Masonry RC Roolin Coverin WS Window and Siding SF Solid Fuel Burning Appliances 1 I 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 City/Town,State ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. I.SL§ 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 t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Nome(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 hereby attest u er the pains and penalties of perjury that all of the information contained in this application is true and cu a to t of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) 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 nol 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 i%,w.ntass.��ov:'oca Information on the Construction Supervisor License can be round at www.mau.nov'dus 2. When substantial work is planned,provide the information below: 'total floor area(sq. R.) ;(including garage, finished basementlattics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathroums Number of half/baths Type of heating system Number of decks/porches 'type of cooting systeni Enclosed Open_ 3. "folal Project Square Footage"may be substituted l'or"Toad Project Cost" The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2017 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: D e Appl' Building Official(Print N e) re _ Da e — SECTION 1:SITE INFORMATION 1.1 Property ress: 1.2 Assessors Map&Parcel Numbers I.la 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 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? Public�. Private❑ Check if yes Municipal$T On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP` 2.1,�,0 err of eco d: - c- tCd ea° aU e^ec�yl —�c /er /�A bl`) 7,0 Name(Print) City,State,ZIP 1 /l ,r�oarl 57�. 97ZA5-73 33 1(f , r ,o��;� seflSr�• /� No.and Street Telephone Email Address' SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) v New Construction❑ Existing Building Iif Owner-Occupied ❑ 1 Repairs(s) €L Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed W k'': Y'+O G. n .Sc o r' 7 r' r� 6SS' tl d v Al 0 G ev' le erc e a SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ do" D u t) 1.^Building Permit Fee:$ Indicate how fee is determined:' 2.Electrical $ U U +7 ❑Standard City/Town Application Fee , ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ p U J 2. Other Fees $_' 4.Mechanical (HVAC) $ List:,, 5.Mechanical (Fire $ Suppression) Total All Fees: $ t 3 Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ❑paid in Full ❑Outstanding Balance Due: ' rAoi Jwk- SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) GK-GAayt �I'�FtL{_, License Number Expiation Date Name of CSL Holder List CSL Type(see below) ./is IS6'>atll !-rat No.and Street Type Description �-Lwr p, vl 97O U Unrestricted(Buildingsg u 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 R78 S7g 14t.I I Insulation Telephone Email address D Demolition 5.2 Registeri i Home Improvement Contractor(HIC)HIC Company I I re or HIC Registrant Name HIC Registration Number pi ion Date //�YZL 6 9 P CaNcmST VCI" 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;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 ace to th t of my knowledge and understanding. 3 c,5ea uo{t-euu ��e /1 25 13 Print Owner's or Authorized Agent's Name(Electronic Signature) Date m 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 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 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" I i