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68 DERBY STREET 779-12
OF MASSACHUSETTS
Map fi; s 41' rr a w
Biock CITY OF SALEM
Lot:,-, q 0337,,,;;
Category. ,--; 101 New Single fainly
Penmt# ^^ 779-12," • ., `�_.� - BUILDING PERMIT
Project# s ' JS-2012-002106
Est Cost , is $124,000 00 .� , ,r
FeeCharged:j :$000,;!.:
SalanceDue:: "$.00- '- �! Ihr ., .': PERMISSION IS HEREBY GRANTED TO:
Const. Class:.,
• � yi Contractor: •Lzc'ezzse: Expires:
UseGr6up ..:-'. `'`Je,.. "^ - "'uNEALLEVY CONSTRUCTIOSUPERVISOR-030030
Lot Size(sq ft.)
Owner: Neal&Jay Levy
.lits Gained:: `-"-----Applicant: NEAL LEVY
Units Lost:' ;J.. AT: 68 DERBY STREET
Dig Safe#:'I:.:.
ISSUED ON: 03-Apr-2012 AMENDED ON: EXPIRES ON: 03-Sep-2012
TO PERFORM THE FOLLOWING WORK:
NEW SINGLE FAMILY HOME(PLEASE REFER TO PERMIT#521-12 FEE HAS ALREADY BEEN PAID)jbh
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas - Plumbing Building
Underground: Underground: Underground: Excavation:
Service: Meter: v
K74-1e,
Footings:
Rough:-%��/ '✓ Rough: t �'1 /],� Rough:U` FJ�+�'� G� Foundation:
Final: 7/�2��L � Fin Final:/�/\//ry� .:�I 1 Rough Frame:
',i4, sjf
// Q•ti / A`v O, Fireplace/Chimucy:
D.P.W. Fire Health
Insulation:
Meter: pit" - I
House# -71 Final:Smoke: + " •7/t7 '/
Water:
Assessor Treasury:
Sewer: S ri Final:
THIS PERMIT MAYBE REVOKED BY THE CITY OF SALEM UPON VIOL ON OF ANY OF ITS
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING REC-2012-002325 03-Apr-12 x $0.00
IMPORTANT OWNER OR COPT ACTOR pqi ST
ARRANGE FOR PERIODIC IPrii-c "{'NS DC:iNG yy r��� An 1�mnvsNt;CA
CONSTRUCTION.SEE CURREti=. BUILDING CODE Call ��" �F1ia �� Y
CHAPTER 1 FOR LIST OF ,EOIJIRED INSPECTIONS.
CALL 978-619-5641 TO SCHEDULE AN IiN5FECTION
GeoTMS®2012 Des Lauriers Nlutlieipal Solutions,Inc.
Tn .
Certificate No: 779-12 Building Permit No.: 779-12
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical permits
This is to Certify that the NEW SINGLE FAMILY located at
Dwelling Type
68 DERBY STREET in the CITY OF SALEM
----------------------------------------------------------------------------- ----------------------------------------------------------------------
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
68 DERBY STREET
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires _ unless sooner suspended or revoked.
Expiration Date
"C441
----------
Issued
Issued On: Fri Jul 13, 2012 ------------- —
GeoTMS®2012 Des Lauriers Municipal Solutions,Inc. -------------------------------------------------------------------------------
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
�
Massachusetts State Building Code, 780 CNIR Sd far Revised Nlar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
+� One-or Two-Family Divelling
This Sect ion,For Official Use Ohl
Y
Building Permit Number Date pltedr`;< .
Building Official(Print Name) '.; - Signature_. - - Date:
SECTION L SITE INFORINIATION
1.1-Proper d s:�f �+ 1.2 Assessors blap& Parcel Numbers
1.1 a Is this an accepted striae . 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.01 c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2 PROPERTY OWNERSHIPS ":
2.1 Ownert of Record:
9, 11 k✓b / Ca�o tm M�r 0
Name(Print) City,State,ZIP n
to -�r u -fit gl7p:��i -5; Gl /� C
No.and Street Telephone Email Ad less
SECTION 3: DESCRIPTION OF.PROPOSED WORle.(check all that apply);
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work:
t o bad WAY r00 inn P_ e r P reo A64
SECTION 4: ESTENUTED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Lklaterials
1. Building S 0Q 0 1 Building Permit Fee S Indicate how Feb is determined:
a. ElectricalS ❑ Standprd.City/Town Application Fee
3 [3Cotal Project Cost(Item.6)x multiplier x
3. Plumbing S 2. Other Fees: S -
1. Nfechanical (HV:\C) S List:
i. Mechanical (Fire $
Sub cession) _ "total:\ll Fees: $
a V Check No. Check Amount: Cash :\mount: -
n. "total 1'rnject Oust: 3 /� 00 ( ❑ Paid in Full ❑ Outstanding Balance Dua:_--__---
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS 0I S40
License Number Expiration ate
Name of CSL I[older
Lis
J /� ,,o t CSL Type(sae below) /�_
7 6 y( U k T /Y Tye Description
No. an et
U Unrestricted 2 Faint su el ing cu, ft.
Restricted l9e? Faintly Dwellin
City/"row�LIP f NI Masonr
RC Roofing Covering
WS Windowand Siding
_ SF Solid Fuel Burning Appliances
`�&� �!o yJ �-�� �r �Jfrd-e.SZY'lylCaSegNlat' I Insulation
"role hone Email address Q,Cot 1,vA D Demolition
5.2 Registered Home Improvement Contractor(HIC) t t{ -6aLy 2 /
L-,k AG V4. Q V�`21 LLC FIIC Registration Number ExpirauonDate
I IIC Company nA Name or t1IC Registrant Nat
j e
7 � 0 0 V e eul
No.an Street Email address
r a w4IAI(v MA-0190 7 7,, &9/P6 VA23
City/ wn, State, PIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. M. § 25C(6))
Workers Compensation Insurance affidavit mast 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 DE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR
"APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize L ty-c At7v� .LC�✓ V ICQS LLC
to act on my behalf, in all matters relative to work authorized by this building permit application.
bC VJi' '� �L 5 � 2o13
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 accurate to the st of my knowledge and understanding./ /
Rem
(Tint Owner's or Authorized A,cnt's Name(Electronic Signnturz) 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 not have access to the arbitration
program or guaranty fund under M.G.L. c. 112A. Other important information on the H[C Program can be found at
%aww-.mass.,,uv�%oca Information on the Construction Supervisor License can be found at www.mass.�o��'dL
F2. When substantial work is planned, provide the information below:oor area(ski. R.) (including garage, finished basement/attics, decks or porch)
iving;trea(sy. tl.) _ Flabitable room count
r ofbathrooms Number of hal6bathsr heating system Number ofdecks/ porchesrcoolin"system Enclosed-- Open
}. "Total I i�.�joct Squnro : tM:Ige wav t e iub,titutcd Col. 1"3t:ll PIojaet Coat" --
a
w t
0,173 ,OD
:a The Commonwealth of Massechuse(ts
Board of Building Regulations and Standards Cl fY OF
MaSSarh USelts State Building L•'M
.y. ., 6 Code, 730 CivIR SAL
Ir,•,i.,�•d.u„r_nil
rr Building Permit Application "ro Construct, Repair. Renovate Or Demolish a
Une-ur Tow-FLmilt Du fli){l'
This Section For Official Use Onl
Building Permit Number Date: pplied:
lludJmg OlLcial(Print N;une) Si t�-
31 G�
yrature Dale
SECTION 1:SITE INFORMATION
LI Property Addr ss: 1.2 Assess rs Map& Parcel Numbers
�Y s/ v7 9e
I.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1A Property Dimensions:
4 , 3 zoo yS Zoning District Proposed Use -/ Lot Area(s4 11)
Frontage(Il)
1.3 Building Setbacks(11)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required 4 Provided
is 6 /o i0 34;` Ze—
1.6 Water Supply:(M.G.1.C.4U.q Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ Zone: _ Outside Flood Zone?
Check fif es❑ Municipal On site disposal s)xtnn ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owners of Record:
Name(Pnol) U bWle.LIP
/YS CifT o 5� q78 5z9 6�s AicP,2.!t
Nu.and Street Tele hone —
P hmml Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction�f, Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ I Number of Units_ Other ❑ .Specify:
Brief Description of Proposed Work :_/I/W
_•�F_ �.vl_AMS'
SECTION 4: ESTIMATED CONSTRUCTION COSTS
licm Estimated Costs:
(Laborand Materials) Official Use Only
I. Building S d ooC,_ I. Building Permit Fee: S Indicate how fee is determined:
'. Electrical S ❑Standard CityiTosvn Application Fee
i. Plumbing S p� 000 — ❑Total Project Costs(Item 6)x multiplier ---_ItC7 O _. Other Fees: S -____
q. \lechmtical 111\':1('1 S U LisC—._—_.
-' \fechtmical 1Fire ------ ---- ----- -.
Su, rQssion) S 'rowl U Fces: 3 -
Total Project Cost: S Check No. -
__('heck:\nwunt:
l Zlfj oov 0 Paid in Full 0 Outs(anding Bal:alce Due:
r !►
SECTION 5: CONSTRUCTION SERVICFS
5.1 Construction Supervisor License(CSL) 2
License Number Pgtilalian me
N;Ime ul'('SI. I lulder
List CSI.1)Pe(see —
_2 ---
__[.___ PC Description
No. and Street
U I hresoicicJ I Ih1ilJin•s li at 15,11110 w. 11.1
L A4 -_QZ. .�___ - It Restricted I L,2I;anvil J D110111VI
Citci roen.Slue./W NI Masonry
• RC Roofing Cverin
--__ W'S W'indow;md Siding
nn / 7W— SF Solid Fuel (turning Appliances
1'29 fZ (/EALLEUy< ✓✓� I Insulation
1'elc hone 19nail ad nss
9 D Demolition
5.2 Registered Home Improvement Contractor(HIC)
IIIC Rcgisualiun Numher livpiratiun Dule
III C'C'ompan) Name or IIIC Registrant Name
No.and Street Email address
City/Town.State,ZIP 'rele 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 ..........)K 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 authori 15
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nano(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:\u0nriicd Agent's N;une(Ilectronic 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 Hume Improvement Contractor(HIC) Program).will na have access to the arbitration
program or guaranty fund under \I.G.L.c. 1 a_'A.Other important information on the HIC Program can be found at
ma,. % ;,re Information on (he Construction Supervisor License can be found at
2. When substantial work is planed, pro\ide the information below:
Total flour area(sq. R.). 4, 7000 I including garage, finished basement attics.decks or porch I
Habitable room count
Numberol'lireplaces __ _/ . . ..._ Numberof'Ndruoms 7—
Number ol'bathrooms . _y -, j _ . --- \umberofhalI*hatlis
f)pc of heating s)stem / .. ._ . -. -_ Number of'decks, porches _
I I\pc 111 C011i lllg i1 i1C 111 _ / I�I1C IOlel1 _. __ - _-(]Pell i
� 1. ''total I'rojec( Syu;IrC Puolagd'nuq he suhstiul(cJ I'or"fot;d Project('ust"
CITY OF SALEM
ROUTING SLIP
New Construction_
Certificate of Occupancy L
LOCATION _DATE
1! ASSESSORS DATE
93 Washington St.
t� C RK DATE
N 93 Washington St.
PUBLIC SERVICES DATE
120 Washington St.
T
TER DATE
Washington St.
OSS CONNECTION DATE
fferson Ave
PLANNING, -0 jJ 2& DATE lo(3j�lI
120 Washington St.
CONS ATION DATE
ashington St.
,. ELECT L DATE
48 L fa�a yette St.
VTIRE PREVENTION DATE
(V29 Fort Avenue
HEALTa DATE
1 ashington St.
BUILDING INSPECTOR DATE
120 Washington St.