B-17-266 The Commonwealth of Massachusetts ,1 i
Board of Building Regulations and Sthndaridd° )N''L SE;'r FOR
WMassachusetts State Building Code,780 CMR MUNICIPALITY
/� USE
Building Permit Application To Construct,Repair,Rd&ak4Vem i A Revised Mar 2011
��t One-or Two-Family Dwelling
4 V This Section For Official Use Only
Building Permit Number: Date Applied:
1
]Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
ccacto(- Sf.
l.la Is this an accepted street?yes X 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 4 4
ate Supply:(M.G.L c. 0,§5 ) 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 Record: \� 7
Name(Print) City,State,ZIP
&3 �rac 6034 -7531
No.and 9treet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Buildings Owner-Occupied Er Repairs(s) Zr Alteration(s) ❑ Addition ❑
Demolition a Accessory Bldg.❑ 1 Number of Units 2 Other ❑ Specify:
Brief Description of Proposed Work 2: rn., 1
I aG .r L,2 6 K, O
UD J
SECTION 4:ESTIMATED CONSTROCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street
Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
Ci /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 COMPLETED WHEN
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.
)�sh�:a
Print Owner's Name(Electronic Signatu ) 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 Agents 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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dRs
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"
I - �
CITY OF SALEM, MASSACHUSETTS BOARD OF APPEALS
----� PETMON FORM
CITY OF SALEM,MASSACHUSETTS
* t BOARD OF APPEALS
f 120WA9-IiNGTON STREET',3►m FLOOR
�,. SALEM,MASEACHUWTTS01970
X. Thornes a.Plerre Director of I n5pectiord Se vk es
Phone 978.619.5541/ Fac:978-7400"6
KuAaSRLBY DxtscoLL Erin Wwsffer,gaff Planner
MAYOR Phone 978�619 / Fax:978.740-0404
TO THE BOARD OF APPEALS
The Undersigned represent That he/she is/are the owners of a certain parcel of land located at:
Address: 5 1"UC- ' NCYUt Zoning District: A I-
An application is being submitted to the Board of Appeal for the following reason(s): This statement must
describe what you propose to build,the dimensions,the zone property is in,and the zoning requirements.(Example:
I amproposing to construct a 10' x 10' one story addition to my horne:looted at 3 Salon Lam in theR-2 Zoning
District. The Zoning Ordinance requires the minimum depth of the rear yard to be 30 feet. The current depth of my
rear yard is 32 feet;the proposed addition would reduce the depth of the rear yard to 22 feet.)
For this reason I am requesting:
( }Variance(s)from provisions of Section of the Zoning Ordinance,specifically from
(i.e.minimum depth of rear yard).
What is allowed is (ft?sq ft?stories? W), and what I
am proposing is (ft?sq fi?stories?W).
(-I A Special Permit under Section 3.3. of the Zoning Ordinance in order to_nf QCT so�i h
new c',P' i chto ek mj_ (fie, �
( )Appeal of the Decision of the Building Inspector(described below):
( }Comprehensive Permit for construction of low or moderate income housing(describe below):
Current Property Use: F � I *ff_ Are Lot Dimensions Included?('IIS Yes ( )No Why?
(&a4le:Pwo Family Home)
The Undersigned hereby petitions the Board of Appeals to vary the terms of the Salem Zoning Ordinance and allow
the project to be constructed as per the plans submitted,as the enforcement of said Zoning By-Laws would involve
practical difficulty or unnecessary hardship to the Undersigned and relief may be granted without substantially
derogating from the intent and purpose of the Zoning Ordinance.
t •
CITY OF SALEM,MASSACHUSETTS BOARD OF APPEALS
PE MON FORM
The following written statement has been submitted with this application:
( } For all Variance requests a written Statement of Hardship demonstrating the following must be attached:
a) Special conditions and circumstances that especially affect the land,building,or structure involved,
generally not affecting other lands,buildings,and structures in the same district;
b) Literal enforcement of the provisions of the Ordinance would involved substantial hardship to the
applicant;and
c) Desirable relief may be granted without substantial detriment to the public good,and without nullifying or
substantially derogating from the intent of the district or the purpose of the ordinance.
d) For all Special Permit requests a Statement of Grounds must be attached.An application for a special permit for
a nonconforming use or structure shall include a statement demonstrating how the proposed change shall not be
substantially more detrimental than the existing nonconforming use to the neighborhood in accordance with
Section 9.4 Special Permits.Such a statement should include reference to the following criteria:
a) Social,economic,or community needs served by the proposal;
b) Traffic flow and safety,including parking and loading;
c) Adequacy of utilities and other public services;
d) Impacts on the natural environment,including drainage;
e) Neighborhood character;and
f) Potential fiscal impact,including impact on City tax base and employment.
{ } For all Comprehensive Permits for construction of low or moderate income applicants should refer to M.G.L.
Ch.40B§20-23.
Previous applications to the Board of Appeals involving this property have been submitted with this petition
form. The Building Commissioner can provide documentation ofprevious applications to the petitioner or his
representative.
�1(�,, �` i If d fferenI from pelitioner.
petitioner: i! I[:1 C10, `-b n gC 1+ Property Owner:
Address: 145 Ft f t AftQ e- Address:
Telephone: 569 -65 -101 ) _ Telephone.
Email:Mf u nne,ll 99 t'C0 MC6K .Ot;� Email:
Signature: MkCSignature:
j (Attached consent Terser is also acceptable)
Date: 10!20- Date:
If different frwn petitioner:
Representative:
Address:
A TRUE
ATTEST Telephone:
Signature:
Date:
CITY CLERK DATE DPCD DATE
This original application must be filed with the City Clerk
Photo Rendering
145 Fort Avenue
Existing:
c�
�a
4 tt 1
f
Proposed:
�ti T 4
S Tys
� 7
JJ
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Statement of Grounds
145 Fort Avenue
I am proposing two new constructions at my home located at 145 Fort Avenue. The property is located
in the R-1 Zoning District. My home currently has the following measurements:depth of front yard is 48
feet,width of easterly side yard is 13.8 feet,width of westerly side yard is 10.8 feet,and depth of rear
yard is 12 feet. The existing structure is non-conforming to the zoning ordinance because the current
depth of rear yard is less than the 30 feet minimum. I am petitioning for the Board to grant a special
permit in accordance with Section 9.4,Special Permits upon finding that my proposed changes will not
increase the nonconforming nature of my home or be substantially more detrimental than the existing
nonconforming structure to the neighborhood.
My proposed alterations are on the second floor of my home as follows: to add a 6'x 22'deck in the
front and a 10'x 22'—e 1.5 story addition in the rear. This new construction will be built within the
existing footprint of my home and will not change the aforementioned measurements. The Zoning
Ordinance requires the maximum height of buildings to be 2.5 stories. The current height of my home is
2.5 stories;the proposed addition will conform to this ordinance.The Zoning Ordinance requires the
minimum depth of front yard to be 15 feet and minimum width of side yard to be 10 feet. The proposed
2"d floor deck will not extend beyond the existing front porch and will thusly continue to conform with
these ordinances.
My proposed constructions will be consistent with the style and character of my home as well as of the
Willows neighborhood.My proposal also meets criteria for potential fiscal impact due to the fact that as
the square footage of my home would increase,the City's tax base would also increase.