365 ESSEX STREET - BUILDING JACKET � 365 ESSEX STREET O �
6P _
Plans must be filed and approved by the Inspector
prior to a permit being granted
p CITY OF SALEM cwt:
No.y 8� LAp Ward '
HISTORIC DISTRICT? N e (if Date
IF FOR SIDING, HAS ELECTRIC bme Phone � yy' X65- y
PERMIT BEEN OBTAINED? Y N Bus. Phone
APPLICATION * �»
FORk
PERMIT TO
Remodel bathroom ,
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to theme
following specifications:
Owner's name and address William Guenther
Architect's name NA
Builder's name Scott K. Derderian
Location of of building, No. ;,t
365 Essex Street
What is the purpose of building?
Dwelling w
If dwelling, # of units? 1 Material of bldng? Wood frame/clapboards
Will building conform to law? yes Asbestos? nog;,_.
�m-
Estimated cost $1200 . 00 City Lic.# 1445 State Lic.# 061440
Signature of Applicant
SIGNED UNDER THE PENALTY OF PERJURY—
DESCRIPTION OF WORE TO BE DONE
Addition of shower to existing bathroom: * ;
remove non-structural closet wall , where closet will
become new shower stall , relocate water closet and lay. ,
insulate exterior wall and add exhaust fan to vent thru
roof .
Mail Permit to: Gaal-;
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APPLICATION A FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDNG
Location
PERMIT GRANTED
epp : a
B 11 ng Ins cior
C n frc, r✓fo r'
i
City of Salem, Mass.
ELECTRICAL DEPARTMENT
V 44 Lafayette Street
PAUL M. TUTTLE ,CITY ELECTRICIAN
DATE . . . .... . . . . .
To: INSPECTOR OF BUILDINGS
Salem, Mass.
Electrical Contractor
/ J/ (Signature of Applicant)
ISll- ..................................................
..
--- ----------------------........................-----............
has signified their intention of performing the required electrical
work, viz: removing and later replacing all electrical wires, fixtures,
receptacles, etc., on outside of building located at:
6SsS� - Street
in conjunctions with a wall siding installation to be made by:
Jx.!..(.t. f.........................Siding Contractor
lJ/ 97Q
ISSUEDBY ........ ....................................... ........ .........
This is a requirement, preliminary to the issuance of a permit
for the sidewall installation by the Inspector of Buildings.
ORIGINAL-SIDEWALL INSTALLER
PINK COW-BLDG.INSP.
YELLOW COW-ELEC.FILE
City of Salem, Mass.
x ELECTRICAL DEPARTMENT
r ' 44 Lafayette Street
'o
PAUL M . TUTTLE ,CITY ELECTRICIAN
DATE . . . y �.:1
To: INSPECTOR OF BUILDINGS
Salem, Mass.
--------------------------------------------------------------------------
Electrical Contractor
(Signature of Applicant)
--------..tl-iu � j"Q---------.........
-` _� ; X113 . - --------------------
has signified their intention of performing the required electrical
work, viz: removing and later replacing all electrical wires, fixtures,
receptacles, etc., on outside of building located at:
Street
................................ S y-/----------------- ----------••-------------------
in conjunction with a wall siding installation to be made by:
'J'=) Siding Contractor
.........................
-- _
� vs
y
/z li 1 �G
----••---- -----= ................../ --- -
ISSUED BY ii
This is a requirement, preliminary to the issuance of a permit
for the sidewall installation by the Inspector of Buildings.
ORIGINAL-SIDEwALL INSTALLER
PINK COPY-BLDG, INSP.
YELLOW COPY-ELEC.FILE
City of Salem, Masa.
ELECTRICAL DEPARTMENT
44 Lafayette Street
` PAUL M. TUTTLE ,CITY ELECTRICIAN
DATE .gl//, 7'9 . . . . . . . . .
To: INSPECTOR OF BUILDINGS
Salem, Mass.
Y % ----- -- -- - -----------------------Electrical Contractor
ISignatU of ApplicantI �++
----- lE.�-A------ - -----` ''-=-�-----------is EUS�-�5, trt-..........�l A-.......
------ ......—......--
has signified their intention of performing the required electrical
work, viz: removing and later replacing all electrical wires, fixtures,
receptacles, etc., on outside of building located at:
--- l/ �� P ?.2 �.......................... ................... Street
in conjunction with a wall siding installation to be made by:
f` ;"—z------------ ------- ----Siding Contractor
0
ISSUED BY
This is a requirement, preliminary to the issuance of a permit
for the sidewall installation by the Inspector of Buildings.
ORIGINAL-SIDEWALL INSTALLER
PINK COPY-BLDG.INSP.
YELLOW COPY-ELEC. FILE
City of Salem, Mass.
x ELECTRICAL DEPARTMENT
44 Lafayette Street
PAUL M. TUTTLE ,CITY ELECTRICIAN
DATE. . . . . . . . . . . . . . .
To: INSPECTOR OF BUILDINGS
Salem, Mass.
. - ---------•-------------- Electrical Contractor
(Signature of Applicant)
G(-.C_...�O.. ..re--.-_ eL2 .! ....................... ............._-
.365)2 A'-P
`e --------- _------ --------------------------•--------
has signified their intention of performing the required electrical
work, viz: removing and later replacing all electrical wires, fixtures,
receptacles, etc., on outside of building located at:
E�✓?t..-- 1 P Street
in conjunction with a wall siding installation to be made by:
: .............. Siding Contractor
--------------•-------------- .......
ISSUED 8 ----------------------------•-----------•------------------------------
-----/
This is a requirement, preliminary to the issuance of a permit
for the sidewall installation by the Inspector of Buildings.
ORIGI NAL-SIDEW ALLINSTALLER
PINK COPY-BLDG. INSP.
YELLOW COPY-ELEC. FILE
City of Salem, Mass.
ELECTRICAL DEPARTMENT
�r y' 44 Lafayette Street
4Yom r
PAUL M. TUTTLE ,CITY ELECTRICIAN
DATE . . . �? : X .tl. . . . . . . . . . . .
To: INSPECTOR OF BUILDINGS
Salem, Mass.
(
..... Electrical Contractor
(Signature of Applicant)
r( l t c
------ -� �
1»9----------------------- -------------- -------------------------
has signified their intention of performing the required electrical
work, viz: removing and later replacing all electrical wires, fixtures,
receptacles, etc., on outside of building located at:
Street
in conjunction with a wall siding installation to be made by:
ZzlJ-- rc f{ „ ✓ / -'l fSiding Contractor
- - --.- -----------------------
----------------------------------------------------------
ISSUED BY.
---------7------------------------- -
This is a requirement, preliminary to the issuance of a permit
for the sidewall installation by the Inspector of Buildings.
ORIGINAL-SIDEWALL INSTALLER
RNN COPY-BLDG.INSP.
YELLOW COPY-ELEC. FILE
G'V_
l Zq QI
The Commonwealth of Massachusetts RECE
IVILU
Board of Building Regulations and Stand41G?ECT1G11At SE VIC�kY OF
Massachusetts State Building Code,780 CMR SALEM
���tt ��QQ � �vj,��'Mar201/
Building Permit Application To Construct Repair,Renovat I desi3f ai
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number. a e Applied:
Building Official(Print Name) SignatLYe Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
3c,S C=,S ex st
l.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 11) Frontage(lt)
1.5 Building Setbacks(it)
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 ZO%of Re &I solJem Hn 0 /970
Name(Print) City,State,ZIP
3 �_S ESSe)( S 978 M-6701?
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied 19" Repairs(s) Gal Alteration(s) ❑ I Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': P e r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ & _ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ i
❑Total Project Cost (item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ �
4.Mechanical (HVAC) $ List: b
5.Mechanical (Fire $ -
Su ression Total All Fees: $
r Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ��j// �SJ ' ❑Paid in Full ❑Outstanding Balance Due:
(0��tL-SID -Th ��Z�
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS -n5-7-73'3 OS & i
Ch� �S��herZorzv. o License Number Expiration Date
Name of CSL Hdlder
1-s V n '0 f �1 List CSL Type(see below) (�
No.and Street T Type Description
Sal e-m A A n /) I q-?C) U Unrestricted(Buildings u to 35,000 cu.ft.)
��'l I�7 l ) �1 llJ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
(� /I LI �/ SF Solid Fuel Burning Appliances
� -7 'Q I� I CZO(ZI./�Q'QS�J�✓lie Q1� I IInsulation
Telephone it address D Demolition
5.2Rtttegistered Home ImprovementContractor(HIC) /O/(009
RASeryites Lac ChgI lzaher Zorzq HIC Registration Number Expra[ion Date
HIC Company Name or HIC Registrant Nam
III Noc'-�-�-, S+ �'�nL�_6tt�JCt-a �rytces. cor�
NciyerYi Mg O1q"10 97k-7�i1 b4ay 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 COPLETED WHEN
OWNER'S AGENT OR CONTRACTO PP IES FOR WILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act onAN behalf, in all matters relative to work authorized by this buj ing permit application.
Qr lL ;7 n— �c
Print Owner's NarneWlectronic 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 Authorized Agent's Name(Electronic Signature) Date
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.eov/dpss
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"