12 NICHOLS STREET - BUILDING JACKET f -12 NTCHOTS STREET t -
�e'`�i CITY OF SALEM, MASSAC-IUSETTS
BUILDING DEPARTMENT
' 120 WASHINGTON STREET,31D FLOOR
TEL. (978) 745-9595
KIMBERLEY DRISCOLL FAX(978) 740-9846
MAYOR THoMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
March 16, 2015
To Whom it May Concern
RE: 12 Nichols Street
Salem, Ma. 01970
According to our records, it has been determined that the property located at 12 Nichols
Street is a legal grandfathered 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.
Sincerely,
Thomas St. Pierre
Zoning Enforcement Officer
s
,r QTY OF SALEM, MASSACHUSETTS
Ss f 1 BUILDINGDEPARTMENT
120 WASHINGTON STREET,31D FLOOR
M.� TEL. (978)745-9595
KIMBERLEYDRISCOLL FAX(978)740-9846
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
December 30, 2014
Elizabeth Rennard
City Solicitor
93 Washington Street
Salem, Ma. 01970
RE: 12 Nichols Street
Dear Beth,
I am requesting a lien to be placed on the property located at 12 Nichols Street. Enclosed
is the copy of the bill from Baystate Building &Remodeling for the emergency work
done to the property.
Thank you for your cooperation in this matter.
Sincer y,
Thomas St. Pierre
Director of Inspectional Services
Invoice Page 1 of 1
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The Commonwealth of Massachusetts RECEIV _pViC. S OF
Board of Building Regulations and Standartil¢,SpECT104'a� S` CI Y
Massachusetts State Building Code, 780 C SALEM
Re�ged�"or 2011
!� Building Permit Application To Construct,Repair,Renovate lRed lis�tl
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) - Signature Date
t 1SECTION 1:SITE INFORMATION
t•(1 1.1i�pe�Add rt¢sA 1.2 Assessors Map&Parcel Numbers
I— I A 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 OWNERSHHPt
2.1 Ownert of Record•
G2ar, Pq ( ¢ V�'- PAC'S S
Name(Print) - '�— City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work:
re.� mil• S hn41 ( Irou /JbV'G
7--noki4 v PmG 'yt !/v, ti2owCj
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ tD0 • Od 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Coati(Item 6)x multiplier ` x -
3.Plumbing $ 2. Other Fees: $ -
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ - -
Su ression Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:.
SE C) -(o Lp tJT
S mw T- 1 4
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
,b
i,—p y Q IZ 2 License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
1 t�/~4 S
No.and Street Type Description
S (�} 4 S S d 14 ! (� Unrestricted(Buildings u to 35,000 cu.ft.
Restricted 1&2 Family Dwelling
Citylrown,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) t
1--CL .k \0a �2 Registration
/� 37 1 Ei`17- (v.
HIC Registraon Number Expiration Date
HIC omp y Name or HIC Registran(Name -
t,t-�u c, k- a u C s t
No.and Street Email address
C ✓t �n �kckS5 . 7Y1-711-329 1-
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 ..........t�g- No...........❑
SECTION7ae OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize *b A. �0 5 Q. U S t,
to act on my behalf,in all matters relative to work authorized by this building permit application.
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 best of my knowledge and understanding.
�( 1pGz L -13_
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
w-Zvw.mass.eov,'oca Information on the Construction Supervisor License can be found at www.mass.=ova /dns
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"
1