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12 DEARBORN STREET - BUILDING JACKET 12 DEARBORN STREET otr> 3 (fit of 19ttlEm, massar4usetts Public Propertq i9ePnrtment Nuilbing Department (One #idem (6reen 500-745-9595 Ext. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer July 11 , 1996 John Theodorakopoulos 408 Essex Street Salem, Mass . 01970 RE : 408 Essex Stree t Dear Mr. Theodorakopoulos : Thank you very much for your response to the letter dated on April 10 , 1996 regarding the above mentioned property. An inspection was conducted and found all violations corrected. This office will notify all the appropriate departments and the Ward Councillor that this situation has been brought to a satisfactory conclusion . Sincerely, Leo E . Tremblay Inspector of Building LET: scm cc: Dave Shea Jane Guy Councillor Flynn, Ward 2 APPLICATION ❑ ADULT NUMBER Trial Court of Massachusetts FORCOMPLAINT ❑ JUVENILE District Court Department ❑ ARRES1 ❑ HEARING ❑ SUMMONS ❑ WARRANT COURT DIVISION The within named complainant requests that a complaint issue again„a the within Salem District Court named defendant. charging said defendant with the offense(s) listed below. DATE OF APPLICATION DATE OF OFFENSE PLACE OF OFFENSE 65 Washington Street 5/28/96 1 2/96 408 Essex Street Salem, MA. 01970 NAME OF COMPLAINANT City of Salem Building Department NO. OFFENSE G.L. Ch. and Sec ADDRESS AND ZIP CODE OF COMPLAINANT City of Salem Sign 3-37 One Salem Green t Ordinance Sections 3-38 Salem, Mass. 01970 'A-39 2. NAME,ADDRESS AND ZIP CODE OF DEFENDANT John Theodora_kopo_u_los _ 408 Essex Street 3. Salem,--Mass.--01970 - -----------------_._.-._- 4. COURT USE A hearing upon this complaint application DATE OF HEARING TIMEOFHEARING COURT USE ONLY will be held at the above court address on / AT 6 ONLY CASE PARTICU S 4B9 SPECIFIC NAME OF VICTIM DESCRIPTION OF PROPERTY VALUE OR PROPERTY TYPE OF CONTROLLED NO. Owner of property, Goods stolen,what Over or under SUBSTANCE OR WEAPON person assaulted,etc. destroyed,etc. $250. Marijuana,gun,etc. 1 2 3 4 OTHER REMARKS: Failure to comply to the City of Salem Building Department d SIGNATURE OF COMPL ANT DEFENDANT IDENTIFICATION INFORMATION — Complete data below if know . DATEOFBIRTH PLACEOFBIRTH SOCIAL SECURITY NUMBER SEX RACE HEIGHT WEIGH EY HAIR OCCUPATION EMPLOYERISCHOOL MOTHER'S NAME(MAIDEN) FATHER'S NAME COURT USE ONLY.._ 7, 7_ ,7,:,y M DATE DISPOSITION AUTHORIZED BY NO PROCESS TO ISSUE ❑j At request of complainant ;, Complainant failed to prosecute ❑ Insufficient evidence having been presented PROCESS TO ISSUE TYPE OF PROCESS 0 Sufficient evidence presented ElWarrant c Defendant failed to appear ❑ Summons returnable 1 0 ❑ Continued to 0 v COMMENTS DC-CR2(3/88) Chit of i�ttlPm. ttssttcl�usPtts ; je' Public Propertu Department ++ d,3geq�e.�9 Nuilbing Department (One ftlem 6rrm 508-745-9595 Ext. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer April 10 , 1996 John. Theadorakopoulos 408 Essex Street Salem, Mass . 01970 RE : 408 Essex Street Dear Mr. Theodorakopoulos : In February, I contacted you in person and requested that you apply for a permit for the existing sign that overhangs the sidewalk on Essex Street . You apparently have chosen to ignore my request and the fact that an insurance bond is required for this sign. Please contact this office within five ( 5 ) days upon receipt of this letter as to what course of action you will take to rectify this matter . Failure to do so will result in legal action 'oeing taken against you . Sincerely, Leo E . Tremblay Inspector of Buildings LET: scm Cc: Ellen Dubinsky Councillor Flynn, Ward 2 Certified Mail # P91 991 903 refusal, order or decision. The action of the Building shall be filed annually with the city clerk. Any failure to Inspector may be annulled or modified only by a decision of 4 renew such bond shall be sufficient reason for the revocation of the 5 members of the Board.If the action of the Inspector is of the permit for the sign to which it applies. modified or annulled; the Building Inspector shall issue a 3-10 SAME— CERTIFICATION BY SUPERINTENDENT permit or order in accordance with the decision of the Board. OF STREETS. ETC. 3-34 VARIANCES IN SPECIFIC CASES. No permit required by 3-38 shall be effective until the The Board of Appeals may vary the provision of this Or- superintendent of streets,and the city electrician in the case dinance in specific cases which appear to them not to have of illuminated signs are securely fastened so as not to been contemplated by this Ordinance,and in cases wherein endanger persons upon the sidewalk or street. its enforcement would involve practical difficulties or 3-41 SAME — DURATION OF PERMIT. unnecessary hardship, if, in each instance, desirable relief Permits required for signs or structures over a public may be granted without substantially derogating from the sidewalk or public way shall be effective only until revoked intent and purpose of this Ordinance but not otherwise. Any by the Building Inspector, or until the sign for which the decision to vary the provision of this Ordinance shall be permit was required has been removed. unanimous and shall specify any variance allowed and the 3-42 GENERAL PROVISIONS. reasons therefor.Each decision of the Board of Appeals shall No billboards,signs or other advertising devices shall be be filed in the office of the City Clerk within thirty days after erected or maintained on or over the public ways of the city, the hearing and a copy of the decision shall be sent by mail or or on private property with public view of a public way or delivered to the appellant and any other person appearing at public park or reservation, except as may be permitted by the hearing and so requesting in writing. Failure to file such statute,the rules and regulations of the Outdoor Advertising a decision within thirty days after the hearing shall be Authority legally established thereunder, the provisions of deemed to the approval of any variance sought. this code and the ordinances of the city consistent therewith. :1-35 CONDITIONS AND SAFEGUARDS. 3-43 SAME — REPAIR AND MAINTENANCE. The Board of Appeal in granting variances shall set forth All billboards,signs or other advertising devices erected or appropriate conditions and safeguards whenever, in its maintained within the city shall be kept in repair, painted opinion, they are desirable. and in good condition,The Building Inspector may order the 3-36 PENALTIES. removal of any billboards,sign or other advertising device in Any sign owner or owner of property on which a sign is any location where the maintenance thereof constitutes a fire located who violates,or permits a violation of this ordinance, hazard,is dangerous or a menace to public health or safety, shall be subject to a fine of not more than$20.00 a day if the when the use thereof has been abandoned,or the permit for violation continues more than 90 days after(a)the date of the its use has been revoked by the Building Inspector. notice referred to in 3-29 hereof is given, or (b) continues 3-44 SIGNS IN RESIDENTIAL DISTRICTS. more than 15 days after the date of conclusion of any appeal In any residential district as defined in the Salem Zoning therefrom. Ordinance, there shall not be any sign except as follows: 3-37 SIGNS OR STRUCTURES OVER PUBLIC WAYS. A.One sign,not exceeding two square feet in total area,at- Signs or structures over public ways shall,when erected, tached to the building or on a rod or post not more than four be at least ten (10)feet over the sidewalk.Signs or advertis- a feet high and at least three feet in from the street line, and ing devices over a public way shall be at least twenty (20) stating only the street number or name of the occupant or feet over such public way. occupants of the lot,or both,except that in an R--C and R-1 3-38 SAME — SURETY BOND. district, such a sign may also identify professional offices No permit required for a sign over a public way or sidewalk and other home occupations (see Section 5., B. Special shall be effective until surety company bond in the sum of one Permit Uses paragraph 1., A., (4) of the Salem Zoning thousand dollars($1,000.00)conditioned to save harmless the Ordinance as adopted August 27, 1965, and as amended in city from any claims for or by reason of the maintenance of August 27, 1965, September 2, 1969 and August 1, 1972) such sign, and shall be on file with the city clerk. provided that such a display be not more than one 3-39 SAME — TERM OF BOND. non-electric announcement sign of an area not greater than All bonds required by 3-38 shall be for a term of one (1) 11h square feet and attached against the building and not year from the date of permit issuance. A renewal thereof protruding therefrom. 6 � 7 refusal, order or decision. The action of the Building shall be filed annually with the city clerk. Any failure to Inspector may be annulled or modified only by a decision of 4 renew such bond shall be sufficient reason for the revocation of the 5 members of the Board.If the action of the Inspector is of the permit for the sign to which it applies. modified or annulled; the Building Inspector shall issue a 1-40 SAME.— CERTIFICATION BY SUPERINTENDENT permit or order in accordance with the decision of the Board. OF STREETS. ETC. 3-34 VARIANCES IN SPECIFIC CASES. No permit required by 3-38 shall be effective until the The Board of Appeals may vary the provision of this Or- superintendent of streets,and the city electrician in the case dinance in specific cases which appear to them not to have of illuminated signs are securely fastened so as not to been contemplated by this Ordinance, and in cases wherein endanger persons upon the sidewalk or street. its enforcement would involve practical difficulties or 3-41 SAME — DURATION OF PERMIT. unnecessary hardship, if, in each instance, desirable relief Permits required for signs or structures over a public may be granted without substantially derogating from the sidewalk or public way shall be effective only until revoked intent and purpose of this Ordinance but not otherwise. Any by the Building Inspector, or until the sign for which the decision to vary the provision of this Ordinance shall be permit was required has been removed. unanimous and shall specify any variance allowed and the 3-42 GENERAL PROVISIONS. reasons therefor.Each decision of the Board of Appeals shall No billboards, signs or other advertising devices shall be be filed in the office of the City Clerk within thirty days after erected or maintained on or over the public ways of the city, the hearing and a copy of the decision shall be sent by mail or or on private properly with public view of a public way or delivered to the appellant and any other person appearing at public park or reservation, except as may be permitted by the hearing and so requesting in writing. Failure to file such statute,the rules and regulations of the Outdoor Advertising a decision within thirty days after the hearing shall be Authority legally established thereunder, the provisions of deemed to the approval of any variance sought. this code and the ordinances of the city consistent therewith. 3-35 CONDITIONS AND SAFEGUARDS. 3-43 SAME — REPAIR AND MAINTENANCE. The Board of Appeal in granting variances shall set forth All billboards,signs or other advertising devices erected or appropriate conditions and safeguards whenever, in its maintained within the city shall be kept in repair, painted opinion, they are desirable. and in good condition,The Building Inspector may order the 3-36 PENALTIES. removal of any billboards,signor other advertising device in Any sign owner or owner of property on which a sign is any location where the maintenance thereof constitutes a fire located who violates,or permits a violation of this ordinance, hazard,is dangerous or a menace to public health or safety, shall be subject to a fine of not more than $20.00 a day if the when the use thereof has been abandoned,or the permit for violation continues more than 90days after (a)the date of the its use has been revoked by the Building Inspector. notice referred to in 3-29 hereof is given, or (b) continues 3-44 SIGNS IN RESIDENTIAL DISTRICTS. more than 15 days after the date of conclusion of any appeal In any residential district as defined in the Salem Zoning therefrom. - Ordinance, there shall not be any sign except as follows: 3-37 SIGNS OR STRUCTURES OVER PUBLIC WAYS. A.One sign,notexceedingtwo square feet intotal area,at- Signs or structures over public ways shall, when erected, [ached to the building or on a rod or post not more than four be at least ten (10)feet over the sidewalk.Signs or advertis- a feet high and at least three feet in from the street line, and ing devices over a public way shall be at least twenty (20) stating only the street number or name of the occupant or feet over such public way. occupants of the lot,or both,except that in an R—C and R-1 3-38 SAME — SURETY BOND. .. district, such a sign may also identify professional offices No permit required for a sign over a public way or sidewalk and other home occupations (see Section 5., B. Special shall be effective until surety company bond in the sum of one Permit Uses paragraph 1., A., (4) of the Salem Zoning thousand dollars($1,000.00)conditioned to save harmless the Ordinance as adopted August 27, 1965, and as amended in city from any claims for or by reason of the maintenance of August 27, 1965, September 2, 1969 and August 1, 1972) such sign, and shall be on file with the city clerk. provided that such a display be not more than one 3-39 SAME — TERM OF BOND. i nonelectric announcement sign of an area not greater than All bonds required by 3-38 shall be for a term of one (1) 11h square feet and attached against the building and not year from the dale of permit issuance. A renewal thereof i protruding therefrom. 6 � 7 refusal, order or decision. The action of the Building shall be filed annually with the city clerk. Any failure to Inspector may be annulled or modified only by a decision of 4 renew such bond shall be sufficient reason for the revocation of the 5 members of the Board.If the action of the Inspector is of the permit for the sign to which it applies. modified or annulled; the Building Inspector shall issue a 4. 3--40 SAME— CERTIFICATION BY SUPERINTENDENT permit or order in accordance with the decision of the Board. OF STREETS. ETC. 3-34 VARIANCES IN SPECIFIC CASES. No permit required by 3-38 shall be effective until the The Board of Appeals may vary the provision of this Or- superintendent of streets,and the city electrician in the case dinance in specific cases which appear to them not to have of illuminated signs are securely fastened so as not to been contemplated by this Ordinance, and in cases wherein endanger persons upon the sidewalk or street. its enforcement would involve practical difficulties or 3-41 SAME — DURATION OF PERMIT. unnecessary hardship, if, in each instance, desirable relief Permits required for signs or structures over a public may be granted without substantially derogating from the sidewalk or public way shall be effective only until revoked intent and purpose of this Ordinance but not otherwise. Any by the Building Inspector, or until the sign for which the decision to vary the provision of this Ordinance shall be permit was required has been removed. unanimous and shall specify any variance allowed and the 3-42 GENERAL PROVISIONS. reasons therefor.Each decision of the Board of Appeals shall No billboards, signs or other advertising devices shall be be filed in the office of the City Clerk within thirty days after erected or maintained on or over the public ways of the city, the hearing and a copy of the decision shall be sent by mail or or on private property with public view of a public way or delivered to the appellant and any other person appearing at public park or reservation, except as may be permitted by the hearing and so requesting in writing. Failure to file such statute,the rules and regulations of the Outdoor Advertising a decision within thirty days after the hearing shall be Authority legally established thereunder, the provisions of deemed to the approval of any variance sought. this code and the ordinances of the city consistent therewith. 3-35 CONDITIONS AND SAFEGUARDS. 3-43 SAME — REPAIR AND MAINTENANCE. The Board of Appeal in granting variances shall set forth All billboards,signs or other advertising devices erected or appropriate conditions and safeguards whenever, in its maintained within the city shall be kept in repair, painted opinion, they are desirable. and in good condition,The Building Inspector may order the 3-36 PENALTIES. removal of any billboards,sign or other advertising device in Any sign owner or owner of property on which a sign is any location where the maintenance thereof constitutes a fire located who violates,or permits a violation of this ordinance, hazard,is dangerous or a menace to public health or safety, shall be subject to a fine of not more than $20.00 a day if the when the use thereof has been abandoned,or the permit for violation continues more than 90 days after(a)the date of the its use has been revoked by the Building Inspector. notice referred to in 3-29 hereof is given, or (b) continues 3-44 SIGNS IN RESIDENTIAL DISTRICTS. more than 15 days after the date of conclusion of any appeal In any residential district as defined in the Salem Zoning therefrom. Ordinance, there shall not be any sign except as follows: 3-37 SIGNS OR STRUCTURES OVER PUBLIC WAYS. A.One sign,not exceeding two square feet in total area,at- Signs or structures over public ways shall, when erected, tached to the building or on a rod or post not more than four be at least ten (10)feet over the sidewalk.Signs or advertis. o feet high and at least three feet in from the street line, and Ing devices over a public way shall be at least twenty (20) stating only the street number or name of the occupant or feet over such public way. occupants of the lot,or loth,except that in an R—C and R-1 3-38 SAME — SURETY BOND. district, such a sign may also identify professional offices No permit required for a sign over a public way or sidewalk and other home occupations (see Section 5., B. Special shall be effective until surety company bond in the sum of one Permit Uses paragraph 1., A., (4) of the Salem Zoning thousand dollars($1,000.00)conditioned to save harmless the Ordinance as adopted August 27, 1965, and as amended in city from any claims for or by reason of the maintenance of August 27, 1965, September 2, 1969 and August 1, 1972) such sign, and shall be on file with the city clerk. provided that such a display be not more than one 3-39 SAME — TERM OF BOND. non-electric announcement sign of an area not greater than All bonds required by 3-38 shall be for a term of one (1) 11h square feet and attached against the building and not year from the date of permit issuance. A renewal thereof i protruding therefrom. f 6 7 r refusal, order or decision. The action of the Building shall be filed annually with the city clerk. Any failure to Inspector may be annulled or modified only by a decision of 4 renew such bond shall be sufficient reason for the revocation of the 5 members of the Board.If the action of the Inspector is - of the permit for the sign to which it applies. modified or annulled; the Building Inspector shall issue a :Ho SAME— CERTIFICATION BY SUPERINTENDENT permit or order in accordance with the decision of the Board. OF STREETS, ETC. 3-34 VARIANCES IN SPECIFIC CASES. No permit required by 3-38 shall be effective until the The Board of Appeals may vary the provision of this Or- superintendent of streets,and the city electrician in the case dinance in specific cases which appear to them not to have of illuminated signs are securely fastened so as not to been contemplated by this Ordinance, and in cases wherein endanger persons upon the sidewalk or street. its enforcement would involve practical difficulties or 3-41 SAME — DURATION OF PERMIT. unnecessary hardship, if, in each instance, desirable relief Permits required for signs or structures over a public may be granted without substantially derogating from the sidewalk or public way shall be effective only until revoked intent and purpose of this Ordinance but not otherwise. Any by the Building Inspector, or until the sign for which the decision to vary the provision of this Ordinance shall be permit was required has been removed. unanimous and shall specify any variance allowed and the 3-42 GENERAL PROVISIONS. reasons therefor.Each decision of the Board of Appeals shall No billboards, signs or other advertising devices shall be be filed in the office of the City Clerk within thirty days after erected or maintained on or over the public ways of the city, the hearing and a copy of the decision shall be sent by mail or or on private property with public view of a public way or delivered to the appellant and any other person appearing at public park or reservation, except as may be permitted by the hearing and so requesting in writing. Failure to file such statute,the rules and regulations of the Outdoor Advertising a decision within thirty days after the hearing shall be Authority legally established thereunder, the provisions of deemed to the approval of any variance sought. this code and the ordinances of the city consistent therewith. :1-35 CONDITIONS AND SAFEGUARDS. 3-43 SAME — REPAIR AND MAINTENANCE. The Board of Appeal in granting variances shall set forth All billboards,signs or other advertising devices erected or appropriate conditions and safeguards whenever, in its maintained within the city shall be kept in repair, painted opinion, they are desirable. and in good condition,The Building Inspector may order the 3-36 PENALTIES. removal of any billboards,signor other advertising device in Any sign owner or owner of property on which a sign is any location where the maintenance thereof constitutes a fire located who violates,or permits a violation of this ordinance, hazard,is dangerous or a menace to public health or safety, shall be subject to a fine of not more than $20.00 a day if the when the use thereof has been abandoned,or the permit for violation continues more than 90 days after(a)the date of the its use has been revoked by the Building Inspector. notice referred to in 3-29 hereof is given, or (b) continues 3-44 SIGNS IN RESIDENTIAL DISTRICTS. more than 15 days after the date of conclusion of any appeal In any residential district as defined in the Salem Zoning therefrom. Ordinance, there shall not be any sign except as follows: 3-37 SIGNS OR STRUCTURES OVER PUBLIC WAYS. A.One sign,not exceeding two square feet in total area,at- Signs or structures over public ways shall,when erected, tached to the building or on a rod or post not more than four be at least ten (10)feet over the sidewalk. Signs or advertis- a feet high and at least three feel in from the street line, and ing devices over a public way shall be at least twenty (20) stating only the street number or name of the occupant or feet over such public way. occupants of the lot,or both,except that in an R—C and R-1 3-38 SAME — SURETY BOND. district, such a sign may also identify professional offices No permit required for a sign over a public way or sidewalk and other home occupations (see Section 5., B. Special shall be effective until surety company bond in the sum of one Permit Uses paragraph 1., A., (4) of the Salem Zoning thousand dollars($1,000.00)conditioned to save harmless the Ordinance as adopted August 27, 1965, and as amended in city from any claims for or by reason of the maintenance of August 27, 1965, September 2, 1969 and August 1, 1972) such sign, and shall be on file with the city clerk. provided that such a display be not more than one 3-39 SAME — TERM OF BOND. i nonelectric announcement sign of an area not greater than All bonds required by 3-38 shall be for a term of one (1) 1% square feet and attached against the building and not year from the date of permit issuance. A renewal thereof i protruding therefrom. f 6 i 7 The Commonwealth of Massachusetts Board of Building Regulations and Standards C[TY OF NI Massachusetts State Building Code, 730 CMR Sur I� Revisedd M Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Family Dtvelling This Section For OfficiayUse Building Permit Number: Data , pp dr ' Building Official(Print Name) Stg lure D SECTION L SITE INFO)&VTIOrif LL Property 1 1.2 As ors Map & Parcel Numbers i ,� 1.la Is this an accepted street?yes_ no Nlap 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: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTIONZ:, PRO PERTY'OWNERSHD?' 2.1 Owner-'of ecord: ty1�r,G�/ �n�t � I Name(Print) —may Ctry,State, P I �Z�artn -S— ` I No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF.PROPOSED WORIC''(cheek al hat apply), New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Prj Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': ' SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: [rem Official Use Only,.; Labor and Materials I. Building S L Building Permit Fee:S ' Indicate how fee is determined: ❑ Standard.Cityfrown Application Fee 2. Electrical S ❑'totalProjectCost3.(Item6)xmultiplier - x 3. Plumbing S 2. Other Fees: S 4. Mechanical (FIV.\C) S List: i. \(eeh:nical (Fire S Siiression) total :Vl Fees: s — — Check No. Check Amount: Cash ;\mount:. 6. Total Project Cost: S r 0 Paid in Pill[ ❑ Outstanding 13alanco Due: SECTION 5: CONSTRUCTION SERVICES L5.1onstruclio rS tpervisor 'cense(eCSL) .epua ut e of CSL (fold• � — List CSL'Type(see below) NO 'Type Description No. and Street ` � p U Unrestricted BuilJin s up to 35,000 cu. It. R Restricted ISe2 Family y Dwellin City/Town, State,ZIP M Masonry RC Roofing Coverin WS Window and Siding SF Solid Fuel Burning Appliances J �n [ Insulation "Ccle hone Email address D Demolition 5.2 Registered Hone Imp oveme r Col ctor(HICC FI[C Registration Number 4Exp n Date lie o FI C ❑me No.and a Email address City/Town, State,ZIP I Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be cam ed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc the building permit. Signed Affidavit Attached? Yes .......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERAIIT [, as Owner of the subject property,hereby authorize � RB_F 21• G 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 atte unde the pains rid penalties of perjury that all of the information Cont, ne i this a711tipn is Sir and curate a be of my knowledge and understanding. Print wi is or Authorized:\;att's Name(Electr nie Stgt.lure) Date NOTES: I. An Owner who obtains a building per t 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 H[C Program can be found at vtv.ntass <,ov/oca Information on the Construction Supervisor License can be Found at www.iitass.sovi(I(I . 2. When substantial work is planned,provide the information below: Total door area(sq. ft.) _(including garage, finished bascment/attic.s, decks or porch) Gros; living;u'ca(Sq. ft.) 1-labitable room count Numberoftiraplaces_.-- Numberotbedrooms __-- Numbero[bathroonu NunnberoFhalt'baths --------- -- fvpe oflleatittg .iystcln - "-- __— -- Number ofdacks/ porches Fnclosed"—. -_Open ---_—_-- - t `I otal Project tiyu irc Poot i utay be ub ioited t;,r' I'llyd I'iojcct ('o;t" _ t The Commonwealth of Massachusetts OF Board of Building Regulations and Standards CITY M � Massachusetts State Building Code, 780 CMR SdMar r Revised Mar 2011 I 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 A . . Building Official(Print Name) Date SECTION 1: SITE-INFORMATIO . s 1.1 Propert Ads: 1.2 Assessors Map&Parcel Numbers 11 k1z-;,Ar rVlef5T 1.1 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 ft) 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: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION 2:>PROPERTY OWNERSHIP'.; ' .x 2.1 .Owr.. i �o r _.t.. 1 ! . 911�m Name(Pri r-- � SECity, State,ZIP G /' No.and-Street Telephone Email Address SECTION 3: DESCRIPTION'OF PROPOSED WORK''(cheok all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': �— !b. SECTION 4:ESTIMATED CONSTRUCTIOIN COSTS Item Estimated Costs: i Official Use Only Labor and Materials 1. Building $ 1. Building Permit Fee.$ Indicate`how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ a ❑TotalProject Cost (Item 6)X multiplier x - 3. Plumbing $ 2.,OtherFees $ ,. 4.Mechanical (HVAC) $ List: ,tea 5. Mechanical (Fire $ Su ression Total All Fees: $ 4. Check No _ Check Amount Cash Amount. 6. Total Project Cost: $ 0 Paid in Full, . 0 Outstanding Balance Due:' . SECTION 5i`CONSTRUCTION SERVICES: 5.1 Construction Supervisor Lice e(CSL) SRV6,& X� n License umber Expirato ate Name of CSL Holder ' List CSL Type(see below) Ccs»e q ti s No.and Street Type �.". Description `" U Unrestricted(Buildings up to 35,000 cu. ft.) City/Town, State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Sidin SF Solid Fuel Burning Appliances p�q' �p�pj I Insulation Telephone Email address D Demolition 5.2 Registered Home Improve ent Contractor(HIC) , a)e3 HIC Co AA is�OMffk �O HIC R�tra�tiioonn Nib_/ { Expi do Date S b No. and et Email address Ci /Town, State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M G.L;c. 152. § 25C(6)) ._ v. . A Workers Compensation Insurance affidavit must be ompleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issua e of the building permit. Signed Affidavit Attached? Yes ........ . No........... ❑ SECTION 7a: OWNER AUTHORIZ ATION,,TO BE COMPL ETED WIDEN e-" , 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. 1 Print Owner's Name(Electronic Signature) ate 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 containe this)application is true and accurate to the best of my knowledge and understanding. Print Owners or Authorized�Q—entt''sName(Electronic Signature) Date yNOTES: 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.rnass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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"may be substituted for"Total Project Cost" FCBuilding he Commonwealth of MassachusettsBoarduf Building Regulations and StandardsCI'I'1'OF , SALL Massachusetts StateDuildingCode, 73BCViR ' tm'' "Permit Application To Construct, Repair, Renovate Or Deiiiolish a One-or Two-Fumilt•Dwellh tf This Section For Official Use Only Building Permit Number: I Da AApppp"liie�d:- _ Building 011icial(Print Nwne) Signature ' 1 SECTION 1:SITE INFORNIATION 1.1 Propertypddr � ' 1.2 Assessors Nlap& Par I Number I.1 a Is this an accepted street?yes_ no Map Number Parcel Numlxr 1.3 Zoning Information: 1.4 Property Dimensions: Tuning District Proposed tlu: Lot Area(sq 11) . _Frunlagu(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal s)stcm ❑ Check ifes❑ 2.1 Owne tF.•sT-Recor SECTION2: PROPERTY OWNERSHIP' J d• - 170 Naive IPnnt `' Uty.Slate.LI Nu.and Street T M felephune Email Address SECTION 3: DESCRIPTION OF PROPOSED WOR='(checkaatapply)New Construction❑ Existing Building❑ Owner-Occupied ❑ Repddition ❑Demolition ❑ Accessory Bldg. ❑ Nutnberof Units_ OBrief Description of Proposed Work-: SECTION a: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) Y I. Building S 1. Building Permit Fee: ITMEnte how fee is determined: '. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost(Item 6)x multiplier x _ 1. 1 IumM°g S ?, Other Fees: S 4. ,Mechanical 111\':1('1 S 5. .\lechwmic:ll I Fire Su>>rcssionl S Tutal :\II Fees: S ----- ------ Check No. Check:\mount: _ _ Cash AmounC G. Total Project Cost: S , ❑P;mid in Full 11 Outstanding l3al:mce Due: � _ - SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supe�rvissoorr License(C'SL) cnsc i.ic Numbcr Iicpiraur r IT to N:unc of C'SI. I I"Mur w __—____— _-- List CSI.1)Pe Uee hclowl—_�=J 11 �- 1)pe Dexriptiun ,per U l Inrestricted t Buildin n u' io 75.000 cu. IL) A__yJ-��, __.._ R Restricted l&2 Family Dscellin k M MasonRC' Rootin C'overinW'S Window and SidinSF Solid Fuel Burning Appliances fz� 1 Insulation Ismail address D Demolition 5.2 Registered Home 1 rprovS rent Contractor(HIC) I IIC RegiTtratilon Numbcr lispir tiu )ate I IIC C'om ;tl?-N; •nr I IIC I c istr• e No.an S •et Email address City/Town.State,ZIP "relc 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 Issuanc 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 owlev f4-1 1ry'e to act on my behalf,in all mattersrelative to work authorized by this building permit application. J9 � LrGI Print Owner's Name(Electronic Signature) J ate SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under th 'ns and penalties of perjury that all of the information contained in thi ication is true and accurate to a be t ly ow edge and understanding. Print Owner's or ACithorizcd Agent's Name(Iilcctronic-Sig!:nurc) 'tc 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 Hume Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under I.G.L.c. 142A.Other important information on the HIC Program can be found at wires.ma,, �;o%, L.i Information on the Construction Supervisor License can be found at �o dp, 2, When substantial work is planned, provide the information below; Total floor area(sq. ft.) t including garage, finished basement'attics•decks or porch) Gross living,area(sy.:11) - _ Habitable room count _ Number of tire)Slaces'_—_ -- Number of bedrooms --_---_--- Nunrher of bathrooms Number of half haths F\pe of heating s)stem . :. Number of decks, porches . .. F)pe of Cooling s�stelu I'lMosed Open i. "fotal Projcct Syuarc Footage" miry be substituted for"Total Project Cost"