12 EAST COLLINS STREET - BUILDING JACKET�9� � �°ir;� S'���.�t
�DNDITq,q CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3R0 FLOOR
9 1 a SALEM, MASSACHUSETTS 01 970
TELEPHONE: 978-745-9595 EXT. 380
'iyfNEDD� FAX: 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
May 2, 2012
To Whom it May Concern
RE: 12 East Collins Street
According to our records, it has been determined that the property located at 12 East
Collins Street is a legal grandfathered non-conforming two (2) family dwelling.
This is to determine use only and in no way meant to confirm or deny whether said
property is in compliance will all building, plumbing, gas, electrical, fire or health codes.
Sincer ly,
Thomas St. Pierre
Zoning Enforcement Officer
�. GIB- 7 CGS
The Commonwealth of Massachusetts FOR
n Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code,780 C�MR,7'�ed}Up�ri`a! rr'` USE
'h a Rev sed January
Building Permit Application To Construct,Rep r,Renovate Or De(ngI ih. ._ 1,2008
One- Tw -Family elling
s Secti. For tcial Use Only
Building Permit Number: ate Applied:
Signature: LMV-2 � i .
Building Commissioner/Inspect of B m Date
SECT? 1:SITE INFORMATION -
1.1 Properly Adgr�ss: 1.2Assessorsrsll4ap,&F,,g tl trmkers�
�� 1 Co11 �2 C
Map
1.I a Is this an accepted street?yes_ no
Number .. " Parcel Number' -
13 Zoning Information: IAA Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(io .
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? Municipal❑ On site disposal system ❑
Public❑ Private❑ Checkifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: n /
V1 cl n 4 l_ n f,- (;.
Name(P� Address for Service:
vnm l 'Qtc a 9 - 9)6 -
.Signature _ Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check 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: 5-eA r
r 1 Zo — U F Plr�(f V
Jr(_ --3n C II /
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only -
Labor and Materials - --
L Building $ 1. Building Permit Fee:$ _ Indicate how fee is determined: -
❑Standard City/Town Application Fee _
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier - x -
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Su cession)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 36 b ea ❑paid in Full ❑Outstand ng Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) / T Tr)
License Number [ Expira
tion
Date
Name of CSL-Holder him List CSL Type(see below)
Address _ Salem MA 01 Q70 Type DescriptioD
U Unrestricted(up to 35,000 Cu-Ft)
Signature R Restricted 1&2 Family DwellingM Masonry Onl
Telephone RC Residential Roo6n Covering
�y WS .Residential Window and Siding
97 y iT y� SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
52 Registered Home Improvement Contractor(HIC) \4,)-0 �!
HIC Companifmw LLU Registration Number
61 R IPff=ue '''� /)
Address Salem MA 01970 -�/�
q zg 2y y*1`(5 E pn'atron Date _
Signature Telephone -
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152.§ 25C(6))
Workers Compensation lnsuiance 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/FOR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, �0 `1 l" �I.ai✓7 as Owner of the subject property hereby
authorize �, ��J ,n.l - to act on my behalf in all matters
relative too work authorized by this building permit application.
Signature of Owner' Dine
// SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
as'Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
- behalf._ - - - -
�/I 6�
Print Name
Signature of Opener or Authorized Agent Date
(Signed under the pains and penalties of -
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 and -
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I 1 OR6 and I I O.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 of bedrooms
Number of bathrooms Number ofhalf/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
1 'Total Project Square Footage"may be substituted°for"Total Project Cost"
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
\\\WWWllpppiippp Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
-Tl1lsSection For Qf 1 1 U58';Only
Building Permit Number D to Applied
Building Official(Prm[ Signa e Dat e -
SECTION 1: SITE INFO
11 P mope y Addres�5,; 5 1.2 Assessors Map& Parcel Numbers
1.1a 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? Municipal ❑ On site disposal system ❑
Public El Private ElCheck if yes❑
SI CTION 2'i PROPRTX OWNERSHIP'
2.1 Own of Recor
Name(Print) City,State,ZIP
/Z f4s5 Cy��iiJS 97Y-foo�'77�� /IC7d1 ®�nC'45f.
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION O$PROPOSED WORK'(check 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 Pro used Work':Ate
/Il�ui '�ttLti�.J o'�nld, Q
n Zr��l/vr sad �ti dr,v��:
SECTION 4: ESTIMATED.CONSTRUCTION
Estimated Costs ;,„
Official Use Only
Item Labor and Materials -
1. Building $ 3 ODD 1 Buildmg Permit Fee $ ." Indicate how fee is determined
2. Electrical g Ob — ❑ Standard City%Town Application Fee
❑TotaB;Pro3ect Cost (Item 6)x multiplier, x
3. Plumbing $ /(� obi 2 Other Fees $
4. Mechanical (INAC) $ List. s:
5. Mechanical (Fire $ — Total All Fees $
SUppression) '
Check No. Check Ambaftt - . Cash Amount,
6. Total Project Cost: $ C,3�d06, ❑Paid in Full ❑ outstanding Balance Due
c�3 3O to -D e
N 2�, W�LSD-22PY 301
SECTIONS; CONSTRUCTION SERVICES
5.11 Construction Supervisor License(CSL) 1113413
...J zlid� �allfet ��(� License Number Expiration Date
Name of CSL Holder
pp
List CSL Type(see below)
No. and Street .Type °. .'. . " Desenpt(on
A ll, "n 0 U Unrestricted(Buildings up to 35,000 cu. ft.)
G J O'er City/Town, State,ZIP R Restricted 1&2 Family Dwelling
M N(asonr
RC Roofing Covering
WS Window and Siding
I SF Solid Fuel Burning Appliances
7
j / /� %dtC,s"i (,yM('/� T n(ef I Insulation
Telephone Em ddress D Demolition
5.2 Registered Home Improvelrt t Contractor(HIT) 1,6V
6 ld ,a 7117
/7 , r� Na HIC Registration Number Expiration Date
HIC Comp n Name or HI Registrant Name
o an ��l�atf �r17l� )(galleJ/0,(-a,W tr�"V
No and Stre� �=.spa-»�� mail address�
City/Tow n, 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: OWNERAUTHORIZATION TO,BE COMPLETED.WHEN;
OWNER'S AGENT OR CONTRACTOR fAP/PLIES FOR BUI DINNGPERMIT
I, as Owner of the subject property, hereby authorize 1 oda
to act on my behalf, in all matters relative to work authorized by this building permit application.
T,4�it� txsc /0`1911Z
PrmtOwner's Name(EI ctronic Signature) Date
SECTION 7ti: OWNER'OR AUTHORIZED AGENT;DECLARATION '
By entering my name bet , I hereby attest under the pains and penalties of perjury that all of the information
contained ' is ph ton is true and accurate to the best of my knowledge and understanding,
Print vner' 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 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.inass.eov/oca Information on the Construction Supervisor License can be found at vvww.ntass izov%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 hat[/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"
Control NO: 36392
THE COMMONWEALTH OF MAS
SACHUSETTS
DEPARTMENT OF LABOR
b
r`
DIVISION OF OCCUPATIONAL SAFETY
19 STANIFORD STREET, BOSTON, MASSACHUSETTS 02114
LEAD-SAFE RENOVATION CONTRACTOR LICENSE
DONALDSON HOME IMPROVEMENT LLC
23 ELLIOTT DRIVE
LOWE_LL MA 01852
LICENSE: L11000864 EXPIRES: Friday, October 07, 201E
IN ACCORDANCE WITH M.G.L. C. I11, § 19713(b) AND 454 CMR 22.04, THIS LICENSE IS ISSUED BY
THE MASSACHUSETTS DIV. OP OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR THE
PURPOSE OF ENGAGING IN LEAD-SAFE RENOVATION AND MODERATE-RISK DELEADING WORK.
THIS LICENSE IS VALID FOR A PERIOD OF FIVE (5) YEARS.
"1'I1IS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C. 111,
§ 19713(b)(2) AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION AND MODERATE-
RISK DELEADING WORK.
HEATHER" . ROWE,ACTING C MMISSIONER
co
PnntN on Ra do P.m
DONALDSON HOME IMPROVEMENT LLC
23 ELLIO"I""I" DRIVE
L.OWILL. MA 01852
Elm
BEDROOM
3c
UILD NEW
60" FP,ENCH DOOK5
5'-0'
8 27/32" 8 27/32"
INSTALL NEW r----BBBUILD NEW
24"VANITY BAThPOOM
BUILD Nlf N
KNEE WALL 1
BEDROOM
3b
INPLL WALL
BEDROOM
3a
EBUILD CLOSET
N BACK WALL
UILD
NEW CLOSET
N5TALL NEW
_ CLOSET DOOR
0 3'_g" DN
F
PROPOSED ThIRD FLOOR PLAN
Scale: I /4" = I -0" Optlon 5
EAST COLLIN5 STREET 5ALEM
PROP05ED THIRD FLOOR PLAN
PETER 50UHLERI5 751 .254.8500 ANDREW BOIMILA 505.042.0032