7 UNION STREET - BUILDING JACKET
s
ONDIIa CITY OF SALEM, MASSACHUSETTS
BOARD OF APPEAL
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
TELEPHONE: 978-745-9595
tNE D�� FAX: 978-740-9846
KIMBERLEY DRISCOLL L!-i7
MAYOR
December 28, 2010
Decision
Gty of Salem Zoning Board of Appeals
Public hearing: Petition of JOSH GILLIS, seeking a Variance from rear yard setback,
and a Special Permit to extend a nonconforming structure, in order to enclose and
roof over a 12' x 11'4" porch on the second story of the existing two-family home on
the property located at 7 UNION ST. (R-2 Zoning District).
A public hearing on the above Petition was opened on December 15, 2010, pursuant to
Mass General Law Ch. 40A, § 11. The heating was closed on December 15, 2010 with the
following Zoning Board of Appeals members present: Robin Stein, Richard Dionne,
Elizabeth Debski, Rebecca Curran, Bonnie Belair (alternate), and JimmyTsitsinos (alternate).
Petitioner seeks a Variance pursuant to Section 4.2.1.2 of the Gty of Salem Zoning
Ordinances.
Statements of fact:
1. Marcus Springer, architect for the project,presented the petition. Petitioner and
owner Josh Gillis was also present at the hearing.
2. In a petition date-stamped November 19, 2010, petitioner requested a Variance from
rear yard setback in order to enclose and roof over an existing porch on the two-
family house at 7 Union Street.
3. No one at the hearing spoke in support of or against the petition.
the Board of Appeal, after careful consideration of the evidence presented at the public
hearing, .Ind after thorough review of the plans and petition submitted, makes the following
findings:
1. Desirable relief may be granted Without substantial detriment to the public
good and Without nullifying or substantially derogating from the intent or
purpose of the zoning ordinance.
2. The applicant may vary the terms of the Residential Two-Family Zoning
District to allow for the proposed enclosure of the existing porch.
f�
3. In permitting such change, the Board of Appeals requires certain appropriate
conditions and safeguards as noted below.
On the basis of the above findings of fact and all evidence presented at the public hearing
including, but not limited to, the Plans, Documents and testimony, the Zoning Board of
Appeals concludes:
1. A Variance from rear yard setback is granted to allow for the proposed porch
enclosure on the two-family house at 7 Union Street.
In consideration of the above, the Salem Board of Appeals voted, five (5) in favor(Stein,
Curran, Debski, Dionne and Belair) and none (0) opposed, to grant petitioner's requests for
a Variance and subject to the following terms, conditions, and safeguards:
1. Petitioner shall comply with all city and state statutes, ordinances,codes and
regulations.
2. All construction shall be done as per the plans and dimensions submitted to
and approved by the Building Commissioner.
3. All requirements of the Salem Fire Department relative to smoke and fire
safety shall be strictly adhered to.
4. Petitioner shall obtain a building permit prior to beginning any construction.
5. Exterior of the building is to comply with the submitted plan.
G. A Certificate of Inspection is to be obtained.
7. Petitioner is to obtain approval from any City Board or Commission having
jurisdiction including, but not limited to, the Planning Board.
el'�,),;4 4 /,Ln'(
Elizabeth e s
Salem Board of Appeals
A COPY OF TI-IIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD
AND THE CITY CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts
General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the
office of the City Clerk Pursuant to the Massachusetts General Laws Chapter 40A, Section
11, the Variance or Special Permit granted herein shall not take effect until a copy of the
decision bearing the certificate of the City Clerk has been filed with the Essex South Registry
of Deeds.
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Ulf Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair, Renovate Or Demolish a
,(11•/I_1y11y` One-or Two-Family Dwelling
Budding Pe mrt Number Daie pph
Da e
1.1Prggpe,r//ty Address: 1.2 Assessors Map& Parcel Numbers
� C 7 1,N•6N
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:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system El
Public❑ Private❑ Check if yes[]
SECTION 2:":PROPERTY O,WNERSHIPr
2.1 Owner'of Record:
7 Uh o„
Name(Print) J City,State,ZIP
U -sill 7 t/" �SZDZ�( I eta �oef T/�cMslSts.c an,
land Street Telephone Email Addr ss
SECTION 3 DSCRIFTION;OE PROPOSED WORKz(check all that apply) ,
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other DYfpecify: U SO Z�
Brief Description of Proposed Work: , / 5 !/ 1/ �✓o G'J9�
.SECTION 4 ESTIMATED CONSTRUCTION COSTS U,
Estimated Costs:
Item Offieral`Use Only ,
Labor and Materials
1 Butldu g Permit F,ee $ Indtcatehow fee is detennmed
1. Building $ �-�
r'� b ❑ Standard,;Ctty(Town Apphcaho Fec K x
2.Electrical $ A P'{
❑Total rotect Cost'(Item 6)zmulttplierK-, x
t a k x
3. Plumbing $
4. Mechanical (HVAC) $ a c
5. Mechanical (Fire $ Total All'Fees $
Suppression) ,
Check No Check Amount t ,Cash Amount
6. Total Project Cost: $ /zr �$� ❑paid un'Fullr, O Outstanding Balance Due .i
SECTION 5: CONSTRUCTION SERVICES
F:Name
Construction Supervisor License(CSL) 93��s- /�
�_�/e I(X —C trrll e, License Number Expiration Date
of CSL [offList CSL Type(see below)�d Street '' Type , .Description .
�IJOY'� !/ U Unrestricted Bwtdm s up to 35,000 cu. ft.)
R Restricted 1&2 Family Dwelling
Cuy/Town, State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(yJ Y p .--Joe to ��1y�pJ�z�j, I Insulation
Telephone Email address D Demolition
5(.22 t7Reggiisteredd�Home Improvement Contractor(HIC) /70
z 70 /G S /3
YC 8"r (//Cel/205/Y`GS �O�G,� HIC Registration Number Expiration Date
wrpa ly ja e q HIC Registrant ame
�G/fr
Ng. an Srt're�et� Email address
/City/Town, State,ZIP D 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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
kcontained
tering my name below,I hereby attest under the pains and penalties of perjury that all of the information
in this application is true and accurate to the best of m knowledge and understanding.
)rfrlrcowner's or Authorized AS&Rtt Name(Elect tgnature) 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.rmtss.govoca Information on the Construction Supervisor License can be found at www.mass.Lovdos
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"
Tom Petersen
Architects 0 Planners
Mr. Thomas J. St. Pierre, Inspectional Services Director June 28,2012
City of Salem Inspectional Services
120 Washington Street, 3`d floor
Salem, MA 01970
Re: Solar Panel Installation
Gillis Residence
7 Union Street
Salem,MA 01970
Hi Tom,
I've reviewed the proposed solar panel installation at this location to evaluate the existing roof
structure and the connection of the panels to the roof.
Criteria: Applicable codes: 8d'Edition Residential Code(2009 International Residential
Code with Massachusetts Amendments)
2001 Wood Frame Construction Manual
Design roof load: 40 psf live load, 15 psf dead load, 55 psf total load
Design wind load: 110 mph, 35 psf
My findings are as follows.
1. The new solar panels will imply an additional dead load of 3 psf. The existing roof structure
(2x8 roof rafters @ 16"o.c., with knee wall and 2x6 ridge, +/- 8'-0" span to knee wall and
+/- 15'-2" overall span) is sufficient to bear this additional load.
2. The solar panels are attached to the roof with the SolarMount-I rack system by UNIRAC. The
rack system, roof connections and connection spacing are rated for 110 mph. This project
requires the larger Solar Mount I-2.5 beam (2.5"high)and spacing of flange foot connection to
roof at 48"o.c. maximum. Flange footing connections to the rail are not required to be staggered.
The flange foot connections to the roof are 3/8"diameter x 4" long lag bolts.
I therefore certify that this installation complies with the applicable codes and design loads
mentioned above and is acceptable for approval. Please let me know if you have any questions
on this information. Thanks!
` ,SgED A,?,
Sic rely yours, w PS F. PFp VTR
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NO ELL
Tom Petersen °c NJ �y
Cc: Kelcy Pegler, Roof Diagnostics OF MpssP�O
6 Country Lane•Howell,New Jersey 07731 •Telephone 732-730-1763,Fax 732-730-1783
< Lo t Lt t L Lt t
LLL
ue
�Y Victomel
12 PANELS
ROOF
AZIMUTH:159
PITCH:IS
INVERTER:
TRINA r
# � PONE 3.0.0 a..w.
` c J 12 PANELS
15TRING OF 12 ROOF DIAGNOSTICS
SOLAR AND ELECTRIC. LLC
`5 SITE MAP
' JOSHUA GILLIS Y.aE.„o„
TMS-295A05 1 UNION ST
PANELS-295w SALEMMA 01910
DATE:21,JUNE, 2012 DWO NO.: 7.53
Roof Mounted PV Array-2.940kW DC
TOTALS: PV system specifications
Modules 12 TMS 245 PA05.08 NEC 690.53
I String of 12—VDC:452.4 Rated operating current:8.85A TO Utility
Vmp:30.1 Rated operating voltage:240V Y
Ira 7.8 A Max.system voltage:542.88 National Grid
pp' Rated short-circuit current:9A Exterior Interior
VOC 542.88 Polarity of grounded conductor:Ungrounded
Max.Voltage:390V Utility
Meter M
Nema 3R
combiner Box 5-#8 THHN/ GE60A 4#8THHN
3 strings fused 2 Hot,2 Neutral 4#8 THHN Disconnect AC 2 Hot/1 Nuetral+ 1
@I5A +1 equip Ground DC Disconnect 2 Hot/1 Neutral 20A fuse protection equip ground
In''%PVC 40 amp 600V 1 equip ground In PVC
1\ located on In'%PVC
12 trina Inverter 2 Pole 40A
Back-fed
245w /
D Inverter / A breaker
modules disconnect PONE3.0 Illfff/// disconn nect
1 String of 12 DC
---- ----- , M
AC t
___ __ _ ______ __
I
L-------------------------------------- ----
DC grounding electrode conductor- #6 THHN
LG Solar Panels 3KW-HR
Maximum power at STC:245 Centron GPRS Existing
MPP voltage:29.8 Smartmeter t Main
MPP current:8.23 Single Phase Building distribution
Open circuit voltage:37.0 125A Grounding panel
Short circuit current:8.67 w/ wireless Electrode Main:100 A
Module efficiency: 15.2 connection
Maximum system voltage:600 V
Maximum series fuse rating:20 A
Power tolerance:0—+3%
NEC 690.8
Continuous=125%
Ambient Temp=83+40=123' F factor of.76 NEC 690.7— Based on-12'F.the cortection factor is 1.20 x 37.0 VOC X16— 542.88<600 VOC max
Series Ise=8.67Ax 125%10.4A/.76-13.7
Using#8THHN(194"F) Roof Diagnostics, Inc Drawing: RD-SK Z.53
All work to comply with NEC2011. Name: Joshua Gillis
CAllo duct for
is UL listeduse One Line Diagram Address:7 Union St
Conduit for DC will be PVC outside and Metal
inside wherever necessary. Salem Ma 01970
Ambient record low:-12 degrees F. Solar Installation Phone: 781 8203029
Ambient record low high:83 degrees F
EXHIBIT A
s u n r u n SOLAR FACILITY ADDENDUM CONTRACT
r WO-1 4 70 ow
PH137NVCBNABF
THIS SOLAR FACILITY ADDENDUM CONTRACT("Addendum")is made by and between SunRun,Inc.("Sun R n")and Roof Diagnostics Inc('Contractor")for
the design,engineering,procurement,installation,and construction of the Solar Facility described herein.This Addendum hereby incorporates, in total,
the terms and conditions set forth in the Amended and Restated Master Solar Facility Turn key Contract('Contras"),and all schedules and exhibits thereto.
executed by Sun Run and Roof Diagnostics Inc in March 10,2011.Capitalized terms contained herein have the meanings set forth in the Contract.
It is agreed:
SO AR�LILTfV
TOTAL SOLAR CUSTOM
Contract Price:$12,808.25
Host Customer:)oshua Gillis
Street Address:7 Union St Apt 2,Salem,MA,01970
Rebate Level:$0.40 per watt
Utility:National Grid
TECHNICAL SPECIFICATIONS
System Size
Descri lion P Rating
Standard Test Condition Direct Current(STC DC kW) 2.940
CEC Alternating Current(CEC AC kW) 2.568
Generation Equipment
Photovoltaic collectors Manufacturer Model number STC DC rating Quantity
Array 1 Trina Solar TSM-245PA05 245 W 12
Inverters Manufacturer Model number - Efficiency Quantity
Array 1 Power-One PVI-3.0-OUTD-S-US(240 V) 0.96 1
Total Number of Panels: 12
Total Number of Inverters: 1
05/25/2012 PH137NVCBNABF-H(Custom) Page 1 of 2
EXHIBITA
s u n r u n SOLAR FACILITY ADDENDUM CONTRACT
'�
SOLAR FACILITY DESIGLI DIAGRAMS
Attach the single-line diagram and aerial-view module layout for the Solar Facility to this document.
ASSIGNMENT
When transfer of the title to the Work occurs pursuant to the Contract,title to the Work shall be transferred to the Person("Assignee")designated in
Exhibit A-1.
MISCELLANEOUS
Neither this Addendum,nor the Contract,creates any employment,agency,partnership,joint venture or other joint relationship between the Parties.
Should a conflict arise between the terms of this Addendum and the terms of the Contract that cannot be reconciled,the terms of this Addendum shall
govern;provided however,agreement on a conflicting term in this Addendum shall not operate to modify the conflicting term in the Contract for future
addenda executed between the Parties.This Addendum may be executed in counterparts,each of which will be deemed an original,but all of which taken
together will constitute but one and the same instrument.
SUNRUN,INC. ROOF DIAGNOSTICS INC
siAlliGQn Davis Signature
Suril Operations
Name Name
Tide Title
6/14/12
Date Date
05/25/2012 PH137NVCBNABF-H(Custom) Page 2 of 2
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Z fhe Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
y ) Massachusetts Slate Building Code. 780 C'MR, 7'"edition OF SALFM
Revised Jwttary
Building Permit Application To Construct, Repair, Renovate Or Demolish a /. :IXAV
One-or Two-Family Dwelling
This Section For Official Use Only
1\ Building Permit Number: 4 1, Date Applied: t�
r-
Signature: jt /� 14.0
Building Co4mi i r In for of Buildings fate
S ION 1: SITE INFORMATION
1.1 Property Addres : 1.2 Assessors Map& Parcel Numbers
N O 1-1
I.1a Is this an acee sl . yes ve, no Map Number Parcel Number
IJ Zoning Information: 1.4 Property Dimensions:
Zuning District Proposed Use La Ares J;j 11) Frontage(11)
1.5 Building Setbacks(ft)
From 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: 1.2 Sewage Disposal System:
Public� Private O Zone: _ Outside Flood Zone' Municipal eOn site disposal system O
Check if esCI
SECTION 2: PROPERTY OWNERSHIP'
rNewConstruction
rt of Record:
) ^ Address rot Service:
' l re• ne- , / 12'L Telephom
SECTION 3: DESCRIPTION OP PROPOSED WORKS(check aB that apply)
O 1 Existing Building 1 Owner-Occupied O Repairs(s) ❑ 1 Alteration(s) Url Addition O
Demolition III Accessory Bldg.O 1 Number of Units X I Other 'O Specify:
Brief Description of Proposed Work': TZe.w...e d..V S.,r`wd fc'L,%o.% �. tS y+a.saJ ret_arMs.
I-<sr Vt Ko tCAW Vu i'taow*. ♦f 14esd.a f P..e.ee.l E_-%snaa, T, ALt4r Aw#%,
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofllclal Use Only
Labor and Materials
I. Building S *r O Io 1. Building Permit Fee:S Indicate how tee is determined:
O Standard City/Town Application Fee
2. Electrical S 8, 044 O Total Project Costa(Ilem 6)x multiplies x
J. Plumbing S M 006 2. Other Fees: S
4. Mechanical (11VAC) S C" List:
S. Mechanical (Fire S O
Su ression Total All Fees:f
6. Total Project Coat:, S Check No. _Check Amours(. Cash A punt:
to Sr doe O Paid in Full O Outstanding cc Due:
(1
�6
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) A40 714 41714011
QILA iJ Liecnse Number ENpiraliun Mic
Name of(.'St.-I lulder I.isl CSL T)pe(see below)
—1 4)u rut L Cue J .Lwaw,cs.s'1A f Description
.A�ss U Unrestricted u to 35,000 Cu. Ft.
R Restricted Id2 FamilyDwelling
Signature M M On'
9? i- 3 ytr O f- 6 RC Residential aoulin C overin
1 deptione WS Residential Window anJ Sidin
u ty 91>s^`�sitb—/t Z2 SF Residential Suhd Fuel Bumin A liame Installation
D Residential Demolition
5.1 RegbteredHome Improvement Contnclor(HIC) /''i635 .O
F(uw 1� `e tt sx� Registration Number
I IIC Company Name ar IIIC Registrant Name
'7 f3w.tce,� k s.t. 12e,.tt Z were M� out SJ _ „ /14 ) ya t t
Address ^ Ex nation Date
e y�r.,. Otis• 3sb• 0626 p
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. ISL f 23C(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...........O
SECTION 7n:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. J o A�P 6-M i'S as Owner of the subject property hereby
y authorize P_ bay C t�+ 'S to act on my behalf,in all marten
relative to work authorized by this building permit application.
to I25 ��%1D
Si of Owner Dote
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
1, ed,,,N&AL S e�(LJLAJ ,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 ....ate Q f sl 1a 2.es 7-atd
SignSignatureof Owner o Aulhoriizedd Agent Mid!
(signed under the pains and Penalties of 'u
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 rag 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.
�. When substantial work is planned,provide the information below:
Tidal ,loon area ISq.Ft.) /600 (including garage,finished basement/attics.decks or porch)
Gross living area(Sq. Ft.) Ifoo0 Habitable room count (D
Number of ttreplxes 1 Number of bedrooms tt
Number of bathrooms t Number of half/baths I
Type of heating system Number of decks/.pumhes t
Type of cooling system Enclosed Open t
). "Total Project Square Footage"may be substituted for"Total Project Cost"
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PROPOSED
a The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 786 CMR, 7" edition OF SALEM
Nrvixed Jannury
U Building Permit Application To Construct, Repair, Renovate Or Demolish a /• -1008
/ One-or Ttvo-Fu ilv Dwelling
This SectiqK Fo Official Use Only
Building Permit Number: D e Appli
Signature: 1141,41
13uilding Comm usioner/I nslIteefor of BuiIdin Date
SECTION 1 SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.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 It) Frontage(It)
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?
Public Private❑ Check if yesO Municipal le�On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners of Record:
h. QtU.0 R vwt CW �.irr-.Mse
Name(Prin /- Address for Service:
�- � 41b=SF3. — t. 2Z
Signature 'Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction d Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': &)b r, o..) p.eP/y✓aa 154 7-15A — Uu j 12 + '2
i>aS[S 's'r iir� +.�•.`�� 'r=+tia r Fk-�o.a R-r . r2,- 1 t-9.s
/O
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building S It-1,00 p 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
?. Electrical S
❑Total Project Cost (Item 6)r multiplier s
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire S
Su re ) Total All Fees:S
Check No._Check Amount: Cash Amount:
6.Total Project Cost: S t7 J ❑ Paid in Full ❑Outstanding Balance Due:
lay
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 0.4.0"L 8 9 -4-1 - 16 r
3 6�f LC.y License Number Expiration Date
Name of CSI.-I[older
List CSL-]'ype Isee below)
-f Description
::\d�Jres r D 1 nrestricteJ(tip to 35,000 Cu. Ft.)
It Restricted 18:2 Family Dwelling
Signature M %Iwonry Only
Or-1 q -3 n, —06 76 RC Residential Roofing Covering
fclephone WS Residential Window and Siding
°f l F P-" —I I m C.�C"L SF Residential Solid Fuel Burning Appliance Installation
c f 9 fs(. L 1 2 t D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) ( el6 35Z�
ed� •�_n s Qrur, ,
IC Company Name or IIIC Regis� NaRegistration Number
`t Y3
4 / Af- 2
t
Address /iq:« Expiration Date
SigatF 'fclephone t
ure
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.$ 25C(6))
Workers Compensation Insurance affidavit must be •ompleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuan of the building permit.
Signed Affidavit Attached? Yes ..........d Nu...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
n
I, �a s�vn- Gt L4 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
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I, g I L)L- ,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
behalfyr^�
(�A J vtvLi_1 I
Prins ante
rGvvwrS Z-_
6tLL > It
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
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(IIIC)Program), will not have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115,respectively.
�. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) I" (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) 11+4 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"
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EXIST. COND
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dimension to be confirmed.
A-PLAN-01
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architects — a°"°" 4p"10 ..........-6"°°"°'" SALEM MA 01970 11 .18-2010
PROPOSED
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ALL DIMENSIONS TO EE
CONFIRMED IN THE FIELD.
3 I" 2'0° 3-0" 3'-1"
dlmen7n to be confirmed.
A—PLAN-01
W SPRINGER S P RIN G ER al(hile[la m 612.23]]°39 1/4"=l '—O"
3191"1,,,5°nest gym[@Wdn9ea °e[1c[9m 7 UNION STREET
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PROPOSED
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PROPOSED
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CHIMNEYAGA15T EXISTING
MASONRY TO MINIMIZE
DIMENSION OF THE PERIMETER
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ALL DIMENSIONS TO BE
CONFIRMED IN THE FIELD.
21-0113-0` 3'-1..
dimension to be confirmed.
_ A-PLAN-01
SPRINGER — ;,°NIS"o E.lol'l", m723370S9 7 UNION STREET 1/4"=l -O
aFChIt2Cts — BUPon,MA02210 1—1111H'IhIIC�.<om SALEM MA 01970 11 .18.2010
PROPOSED
14
The Commonwealth of Massachusetts CITY
Board of Building Regulations and Standards OF SALEM
{ Massachusetts State Building Code, 780 C'MR, 71h edition Reused Annary
Building Permit Application' o Construct, Repair, Renovate Or Demolish a
1, :(IfI,Y
( e-o Tuo-Family D 'ellIng
: h Section For Icial Use Only
Building Permit Number. " i I Date Applied: H A r2C_IiC 1 G �' t t
Building mmission 1 o of Iluildings Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�l w v u J S r,2oxT 2�
Ma Number Parcel Number
1.I a Is this an accepted street?yes no_ P _
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided =sitedisp�al
rovided
1.6 Water pply:(M.G.L c.40,§54). 1.7 Flapd Zone Information: em:
Zone: fJ Outside Flood Zone? l system ❑PublicPrivate❑ Check if es❑
SECTION2: PROPERTYOWNERSH
2.1_Ownert of Reco(d:
� Sh it. 11
Nuumee(Print) Address for Service:
S MrxC Y
Signature 'telephone
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Con st ruction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ I Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specity:
Brief Description of Proposed Work': AJ e� 1 eN
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials
I. Building S d, OCR 1. Building Permit Fee: S Indicate how I'ce is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost' (Item 6)x multiplier x
3. plumbing S ? Other Fees: S
4. Mechanical (IIVAC) S List: `
5. Mechanical (Fire S Suppression) Total All Fees: S -
Check No. Check Amount: Cash Amount:
6.Total Project Cost: S 8 O00• 6 _
0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) AM %f�onry
Zer1L
CQC.U�h A � ( ("- Expiration Date
Nan l C 'L- I IuWcr �•-K
�C �a V see below)
Addlos
k Uevit tour
7� trictcd a w35.OUO C'u. Ft.
icicJ IX:2 Pamil Uwellin
Si nlaturC n Only
RC' Residential RoutingC'overin
I'ekphone a ��- (+p 6 It 2,L WS IT,-, nE Window and Siding
( 6 U SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2' T ome!7r.oveGent Contractor(HIC)
(C.(L' t--s
I I IC'Cu any Name or!I IC Registrant Nmne Registration Numhr
i rAer ti- U� cam. nti�
nd 4 / IAf
Expiration Date
Signature 'relephone
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 Issuanc of the building permit.
Signed Affidavit Attached? Yes.......... V N............O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. Qcsotc � CF W;, as Owner of the subject property hereby
authorize 2 , " ... _ �O "3i rt-LCv to act on my behalf,in all matters
relative to work authorized by this building permit application.
-Sigiiature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I• �� -✓"`"" ,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.
Pnnl e
3- i� -ZOfI l
Signature of Owner or Author'.c Agent Date
(Signed under the pains and penalties of r'u
NOTES:
1. An Owner who obtains a building permit to Jo his/her own work•or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(IIIC)Program),will no 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 IO.R6 and 110.115,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 hait7baths
Type of heating system Number ofdecks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage- may he substituted for"Total Project Cost"
a The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 786 CMR, 7" edition OF SALEM
Nrvixed Jannury
U Building Permit Application To Construct, Repair, Renovate Or Demolish a /• -1008
/ One-or Ttvo-Fu ilv Dwelling
This SectiqK Fo Official Use Only
Building Permit Number: D e Appli
Signature: 1141,41
13uilding Comm usioner/I nslIteefor of BuiIdin Date
SECTION 1 SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.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 It) Frontage(It)
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?
Public Private❑ Check if yesO Municipal le�On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners of Record:
h. QtU.0 R vwt CW �.irr-.Mse
Name(Prin /- Address for Service:
�- � 41b=SF3. — t. 2Z
Signature 'Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction d Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': &)b r, o..) p.eP/y✓aa 154 7-15A — Uu j 12 + '2
i>aS[S 's'r iir� +.�•.`�� 'r=+tia r Fk-�o.a R-r . r2,- 1 t-9.s
/O
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building S It-1,00 p 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
?. Electrical S
❑Total Project Cost (Item 6)r multiplier s
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire S
Su re ) Total All Fees:S
Check No._Check Amount: Cash Amount:
6.Total Project Cost: S t7 J ❑ Paid in Full ❑Outstanding Balance Due:
lay
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 0.4.0"L 8 9 -4-1 - 16 r
3 6�f LC.y License Number Expiration Date
Name of CSI.-I[older
List CSL-]'ype Isee below)
-f Description
::\d�Jres r D 1 nrestricteJ(tip to 35,000 Cu. Ft.)
It Restricted 18:2 Family Dwelling
Signature M %Iwonry Only
Or-1 q -3 n, —06 76 RC Residential Roofing Covering
fclephone WS Residential Window and Siding
°f l F P-" —I I m C.�C"L SF Residential Solid Fuel Burning Appliance Installation
c f 9 fs(. L 1 2 t D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) ( el6 35Z�
ed� •�_n s Qrur, ,
IC Company Name or IIIC Regis� NaRegistration Number
`t Y3
4 / Af- 2
t
Address /iq:« Expiration Date
SigatF 'fclephone t
ure
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.$ 25C(6))
Workers Compensation Insurance affidavit must be •ompleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuan of the building permit.
Signed Affidavit Attached? Yes ..........d Nu...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
n
I, �a s�vn- Gt L4 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
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I, g I L)L- ,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
behalfyr^�
(�A J vtvLi_1 I
Prins ante
rGvvwrS Z-_
6tLL > It
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
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(IIIC)Program), will not have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115,respectively.
�. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) I" (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) 11+4 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"
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nsaslreer.s°ae st 7 UNION STREET
architects Bot1coM90E210 "'°" °°"""°""°m 11 -2010
SALEM MA 01970
EXIST. COND
UNION STREET
131-011
� o
I
111 I
6q
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FRAME OUT FIREPLACE AND
CIIIMNEY AGA15T EXISTING
MASONRY TO M INIMIZE
DIMENSION OF TI1E PERIMETER
SURFACE o
� � o
v
O
i u
Z-o-" - - -
4
fire �size fo�T
escape
ref
IIII
- -
F:�T
ALL DIMENSIONS TO BE
CONFIRMED IN T1E FIELD.
dimension to be confirmed.
A-PLAN-01
- SPRI—
NGER SPRING iR auNirn, m 617111.!°59 1/4"=1
119aso°91,sm1°s1 m°aur@s°m94.miiemimm 7 UNION STREET
architects — a°"°" 4p"10 ..........-6"°°"°'" SALEM MA 01970 11 .18-2010
PROPOSED
UNION STREET
FRAME OUT FIREPLACE AND
CHIMNEYAGA15T EXI5TING
MASONRY TO MINIMIZE
DIMEN51ON OF THE PERIMETER
SURFACE o
v
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fire I'-6" �Ize for rangy
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ref
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_ _ _ ♦ V— M
ALL DIMENSIONS TO EE
CONFIRMED IN THE FIELD.
3 I" 2'0° 3-0" 3'-1"
dlmen7n to be confirmed.
A—PLAN-01
W SPRINGER S P RIN G ER al(hile[la m 612.23]]°39 1/4"=l '—O"
3191"1,,,5°nest gym[@Wdn9ea °e[1c[9m 7 UNION STREET
architects — .101. 110"10 '°" "'°""e°"°m SALEM MA 01970 11 .18-2010
PROPOSED
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SPRINGER - - "firer„°m 1�V"=1 '-0”
architects SALEM MA 01970 11 -201 O
PROPOSED
UNION STREET
FRAME OUT FIREPLACE AND
CHIMNEYAGA15T EXISTING
MASONRY TO MINIMIZE
DIMENSION OF THE PERIMETER
SURFACE o
v
0
O
12'-Od"
T
Q 31
r � 0 m
ire �, I'-6" �rze for ran99
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ref
- - N
ALL DIMENSIONS TO BE
CONFIRMED IN THE FIELD.
21-0113-0` 3'-1..
dimension to be confirmed.
_ A-PLAN-01
SPRINGER — ;,°NIS"o E.lol'l", m723370S9 7 UNION STREET 1/4"=l -O
aFChIt2Cts — BUPon,MA02210 1—1111H'IhIIC�.<om SALEM MA 01970 11 .18.2010
PROPOSED
14
The Commonwealth of Massachusetts CITY
Board of Building Regulations and Standards OF SALEM
{ Massachusetts State Building Code, 780 C'MR, 71h edition Reused Annary
Building Permit Application' o Construct, Repair, Renovate Or Demolish a
1, :(IfI,Y
( e-o Tuo-Family D 'ellIng
: h Section For Icial Use Only
Building Permit Number. " i I Date Applied: H A r2C_IiC 1 G �' t t
Building mmission 1 o of Iluildings Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�l w v u J S r,2oxT 2�
Ma Number Parcel Number
1.I a Is this an accepted street?yes no_ P _
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided =sitedisp�al
rovided
1.6 Water pply:(M.G.L c.40,§54). 1.7 Flapd Zone Information: em:
Zone: fJ Outside Flood Zone? l system ❑PublicPrivate❑ Check if es❑
SECTION2: PROPERTYOWNERSH
2.1_Ownert of Reco(d:
� Sh it. 11
Nuumee(Print) Address for Service:
S MrxC Y
Signature 'telephone
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Con st ruction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ I Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specity:
Brief Description of Proposed Work': AJ e� 1 eN
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials
I. Building S d, OCR 1. Building Permit Fee: S Indicate how I'ce is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost' (Item 6)x multiplier x
3. plumbing S ? Other Fees: S
4. Mechanical (IIVAC) S List: `
5. Mechanical (Fire S Suppression) Total All Fees: S -
Check No. Check Amount: Cash Amount:
6.Total Project Cost: S 8 O00• 6 _
0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) AM %f�onry
Zer1L
CQC.U�h A � ( ("- Expiration Date
Nan l C 'L- I IuWcr �•-K
�C �a V see below)
Addlos
k Uevit tour
7� trictcd a w35.OUO C'u. Ft.
icicJ IX:2 Pamil Uwellin
Si nlaturC n Only
RC' Residential RoutingC'overin
I'ekphone a ��- (+p 6 It 2,L WS IT,-, nE Window and Siding
( 6 U SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2' T ome!7r.oveGent Contractor(HIC)
(C.(L' t--s
I I IC'Cu any Name or!I IC Registrant Nmne Registration Numhr
i rAer ti- U� cam. nti�
nd 4 / IAf
Expiration Date
Signature 'relephone
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 Issuanc of the building permit.
Signed Affidavit Attached? Yes.......... V N............O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. Qcsotc � CF W;, as Owner of the subject property hereby
authorize 2 , " ... _ �O "3i rt-LCv to act on my behalf,in all matters
relative to work authorized by this building permit application.
-Sigiiature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I• �� -✓"`"" ,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.
Pnnl e
3- i� -ZOfI l
Signature of Owner or Author'.c Agent Date
(Signed under the pains and penalties of r'u
NOTES:
1. An Owner who obtains a building permit to Jo his/her own work•or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(IIIC)Program),will no 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 IO.R6 and 110.115,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 hait7baths
Type of heating system Number ofdecks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage- may he substituted for"Total Project Cost"
14
The Commonwealth of Massachusetts CITY
Board of Building Regulations and Standards OF SALEM
{ Massachusetts State Building Code, 780 C'MR, 71h edition Reused Annary
Building Permit Application' o Construct, Repair, Renovate Or Demolish a
1, :(IfI,Y
( e-o Tuo-Family D 'ellIng
: h Section For Icial Use Only
Building Permit Number. " i I Date Applied: H A r2C_IiC 1 G �' t t
Building mmission 1 o of Iluildings Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�l w v u J S r,2oxT 2�
Ma Number Parcel Number
1.I a Is this an accepted street?yes no_ P _
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided =sitedisp�al
rovided
1.6 Water pply:(M.G.L c.40,§54). 1.7 Flapd Zone Information: em:
Zone: fJ Outside Flood Zone? l system ❑PublicPrivate❑ Check if es❑
SECTION2: PROPERTYOWNERSH
2.1_Ownert of Reco(d:
� Sh it. 11
Nuumee(Print) Address for Service:
S MrxC Y
Signature 'telephone
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Con st ruction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ I Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specity:
Brief Description of Proposed Work': AJ e� 1 eN
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials
I. Building S d, OCR 1. Building Permit Fee: S Indicate how I'ce is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost' (Item 6)x multiplier x
3. plumbing S ? Other Fees: S
4. Mechanical (IIVAC) S List: `
5. Mechanical (Fire S Suppression) Total All Fees: S -
Check No. Check Amount: Cash Amount:
6.Total Project Cost: S 8 O00• 6 _
0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) AM %f�onry
Zer1L
CQC.U�h A � ( ("- Expiration Date
Nan l C 'L- I IuWcr �•-K
�C �a V see below)
Addlos
k Uevit tour
7� trictcd a w35.OUO C'u. Ft.
icicJ IX:2 Pamil Uwellin
Si nlaturC n Only
RC' Residential RoutingC'overin
I'ekphone a ��- (+p 6 It 2,L WS IT,-, nE Window and Siding
( 6 U SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2' T ome!7r.oveGent Contractor(HIC)
(C.(L' t--s
I I IC'Cu any Name or!I IC Registrant Nmne Registration Numhr
i rAer ti- U� cam. nti�
nd 4 / IAf
Expiration Date
Signature 'relephone
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 Issuanc of the building permit.
Signed Affidavit Attached? Yes.......... V N............O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. Qcsotc � CF W;, as Owner of the subject property hereby
authorize 2 , " ... _ �O "3i rt-LCv to act on my behalf,in all matters
relative to work authorized by this building permit application.
-Sigiiature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I• �� -✓"`"" ,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.
Pnnl e
3- i� -ZOfI l
Signature of Owner or Author'.c Agent Date
(Signed under the pains and penalties of r'u
NOTES:
1. An Owner who obtains a building permit to Jo his/her own work•or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(IIIC)Program),will no 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 IO.R6 and 110.115,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 hait7baths
Type of heating system Number ofdecks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage- may he substituted for"Total Project Cost"
a The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 786 CMR, 7" edition OF SALEM
Nrvixed Jannury
U Building Permit Application To Construct, Repair, Renovate Or Demolish a /• -1008
/ One-or Ttvo-Fu ilv Dwelling
This SectiqK Fo Official Use Only
Building Permit Number: D e Appli
Signature: 1141,41
13uilding Comm usioner/I nslIteefor of BuiIdin Date
SECTION 1 SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.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 It) Frontage(It)
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?
Public Private❑ Check if yesO Municipal le�On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners of Record:
h. QtU.0 R vwt CW �.irr-.Mse
Name(Prin /- Address for Service:
�- � 41b=SF3. — t. 2Z
Signature 'Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction d Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': &)b r, o..) p.eP/y✓aa 154 7-15A — Uu j 12 + '2
i>aS[S 's'r iir� +.�•.`�� 'r=+tia r Fk-�o.a R-r . r2,- 1 t-9.s
/O
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building S It-1,00 p 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
?. Electrical S
❑Total Project Cost (Item 6)r multiplier s
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire S
Su re ) Total All Fees:S
Check No._Check Amount: Cash Amount:
6.Total Project Cost: S t7 J ❑ Paid in Full ❑Outstanding Balance Due:
lay
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 0.4.0"L 8 9 -4-1 - 16 r
3 6�f LC.y License Number Expiration Date
Name of CSI.-I[older
List CSL-]'ype Isee below)
-f Description
::\d�Jres r D 1 nrestricteJ(tip to 35,000 Cu. Ft.)
It Restricted 18:2 Family Dwelling
Signature M %Iwonry Only
Or-1 q -3 n, —06 76 RC Residential Roofing Covering
fclephone WS Residential Window and Siding
°f l F P-" —I I m C.�C"L SF Residential Solid Fuel Burning Appliance Installation
c f 9 fs(. L 1 2 t D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) ( el6 35Z�
ed� •�_n s Qrur, ,
IC Company Name or IIIC Regis� NaRegistration Number
`t Y3
4 / Af- 2
t
Address /iq:« Expiration Date
SigatF 'fclephone t
ure
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.$ 25C(6))
Workers Compensation Insurance affidavit must be •ompleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuan of the building permit.
Signed Affidavit Attached? Yes ..........d Nu...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
n
I, �a s�vn- Gt L4 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
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I, g I L)L- ,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
behalfyr^�
(�A J vtvLi_1 I
Prins ante
rGvvwrS Z-_
6tLL > It
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
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(IIIC)Program), will not have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115,respectively.
�. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) I" (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) 11+4 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"
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escape
ref
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ALL DIMENSIONS TO BE
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dimension to be confirmed.
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fire I'-6" �Ize for rangy
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ALL DIMENSIONS TO EE
CONFIRMED IN THE FIELD.
3 I" 2'0° 3-0" 3'-1"
dlmen7n to be confirmed.
A—PLAN-01
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MASONRY TO MINIMIZE
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CONFIRMED IN THE FIELD.
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dimension to be confirmed.
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