15 ESSEX STREET - BUILDING JACKET 15 Essex St. 1
f
JOB SITE COPY
3CITY OF SALEM
BUILDING
' a SALEM, MASSACHUSETTS 01970
PERMIT
DATE
OCTOBER 28 96 PERMIT NO. $24-1996
APPLICANT ADDRESS 9
JOHN HINCH b1LEY-ST e06 I
(NO) (STREET) (CONTR'S LICENSE)
SALEM MA 01970 - -
CITY STATE ZIP CODE TEL.NO.
PERMIT TO
REPAIR REPLACEMEN TWO OR MORE FAMILY NUMBEROF 4
(_)
(TYPE OF IMPROVEMENT)__ NO. __STOflV (PROPOSED USE) DWELLING UNITS
AT(LOCATION) 0015-ESSEX STREET .�._£, / ZONIDISTNG I -
(N0.)--(STREE-R
BETWEEN AND j
(CROSS STREET) - (CROSSSTREET)
SUBDIVISION MAP 41 LOT 0120 BLOCK LOT 5422 SD FT �
BUILDING IS TO BE FT.WIDE BY FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: RENOVATIONS TO REPAIR FIRE DAMAGE: WALLS , BATH FIXTURES, WINDOWS R DOORS.
AREA OR (CUBCall for Permit to Occupy_0+ 000 PERMIT
i -�
VOLUME � I�'IGSOUARE FEET) - . - ESTIMATED COST.cc p � CFEE
$ 125. 00-
OWNER PHELAN PROPERTIES TRUST - - %r;f7d-' 11[&dl'qq _
ADDRESS III DERBY STREET BUILDING DEPT. L. E. T
THIS PERMITCONVEYS NO RIGHTTOOCCUPY ANY STREET,ALLEY OR SIDEWALKOR ANY PARTTHEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS -
- ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED By THE JURISDICTION,STREET OR ALLEY GRADES AS WELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE
REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR
i.FOUNDATIONS OR FOOTINGS. ELECTRICAL,PLUMBING AND
2,PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS.
MEMBERS(READY TO LATH). , NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
3.FINAL INSPECTION BEFORE OCCUPANCY. -
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS P UMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
�6 o
BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE
D T.IIINSPECTING APPROVALS I
j. lY
OTHER CITY ENGINEER n ^
2 2
"EEO UNTIL THE FASN'OTEDABOVE.
ERIIV,,LL BECOME.'IULL AND VOID IF CONSTRUCTION WORK IS -�LCTIONS INDICATED ON THIS CARD
_ '.ED THE VARIOUS OT STARTED WITHIN ` 4ONTHS OF DATE THE FERM!T IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE
is
ON, , OR WRITTEN NOTIFICATION.
4ao�
\� The Commonwealth of Massachusetts RECEIVED/�T Board of Building Regulations and Standa4j4PECTIONAL SE VCCE
L�t1 Massachusetts State Building Code, 780 CMR
�1�.,�,,��c�C�pq q q R 2`
Building Permit Application To Construct, Repair, Renovatelbi,4Vo&N a Revised
One- or Two-Family Dwelling August 15, 2013
This Section For Official Use Only
Building Permit Number: Date Applied:
Signature: 'lt`tti. `' IQ/, I 1 it
Building Commissioner/Inspector of Buildings Date �f
SECTION 1: SITE INFORMATION,
1.1 F pertgAdss:(— 1.2 Assessors Map& Parcel Numbers
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(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:
Public❑ Private❑ Zone: — Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 Owner/[of R ord:
Name(Print) Address for Service:
-f ifl-
Signature Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other A Specify: ��S IPGg4I if`
Brief Description of Proposed Work':
lot// Gclf3 ' dlL 5 1- y°
C^� W V
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ i 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard'City/Town Application Fee 01
❑Total Project Cost' (Item 6)x multiplier f
3.Plumbing $ 2. Other Fees: $
4.Mechanical (BVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
C Check No. _Check Amount: Cash Amount:
6. Total Project Cost: $ /4����r / ❑Paid in Fall 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed:Construction'si;jervisor(CSL) /b Z y
t
(cf%iQ'Kd L�7r r ..t�t License Number Expiraton 6ate
Na of CSL yolder n n—
List CSL Type(see below)
Addr Type Description
U Unrestricted(up to 35,000 Cu.Ft.)
4� R Restricted 1&2 Family Dwelling
Signatur .�p A `�/��U�� M Masonry Onl
I ` i ! RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 R i� ed Hyu}e r verb g � �dr(HIC) /�/�� ^7
Hl om an k yet/r IC Re istraCntONLame s1�t Registration Number
p CN s .4 1 C� 3 / �,/
Addres ��l�//�� s,� / t�
9��'"Zy/'3"[ 7 / Expfratioif Date
Signature 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 .........x No ...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ,161-w/ , 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.
Signature of Owner Date ONZI
SECTION 7b: OWNER' 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.
Print Name �/
� 7 �
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
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 110.R6 and 110.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 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"