14 VALLEY STREET - BUILDING INSPECTION I� 14 VALLEY STREET
UPC 10330
NO® W'V';
HASTINGS. Mn
J.DIMENSIONS ''T M. DEMOLITION OF STRUCTURES:
48. Number of stories .......................A...........................
49. Total square feet of Noor area Has A
all floors.based on exterior ppr oval from Historical Commission been received
dimensions .....:.....:.......:..................................................... for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.ft............�!P...0.................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed............................ ................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. outdoors............_ Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed............................................................................. Electric: k,
Gas:
54. Number of Full........................................... Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial ........ BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No✓✓ '(If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ No✓✓ (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No_e-�
Is property located in the S.R.A. district? Yes_ No-,,-/
Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes No (If yes,submit documentation/if no, submit Board of Appeal decision)
X If new construction,has the proper Routing Slip been enclosed? Yes— No—
Is Architectural Access Board approval required? Yes_ No--t,—/'(If yes,submit documentation)
Massachusetts State Contractor License# If 4-a Salem License# / 34Yc1
Home Improvement Contractor # C> / Homeowners Exempt form (if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT
CONSTRUCTION IS TO BE COMPLETED BY: If an extension is necessary,please submit
in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street.city,and state ZIP Code Tel.No.
1. A N i oNrc 14� 7
*' -A / ✓A4.LA, ir
S . (n j4�,1 0 /9`/0 � cJ!-4
Owner or
Lessee
2. a
Contractor auiider's
License No.
3.
Architect or -
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorized agent and we agree tgcqntorm to all applicable laws of this jurisdiction.
Signature of appli Addr Agplication dale
�}2µS�"Lt�00dj • V -� -
N 9-9y City of Salerp. Ward /Y
4H.<b'LYfL -
0
APPLICATION
FOR
" PERMIT TO BUILD ADDITION, MAKE ALTERA ONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items u sections.1, It, /it, IV, and IX.
ZONING
I. AT(LOCATION) I DISTGICT
LOCATION J^,� rt
" ''1 ZOF BETWEEN I�F� /11 ISS V P AND �� 1
STREET) (CROSS STREET)
BUILDING LOT
SUBDIVISION LOW�BLOCK SIZE
II. TYPE AND COST OF BUILDING -All applicants complete Parts A
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEM LITTON"USE MOST RECENT USE
1 ❑ New building Residential Nonresidential
2 ❑ Addition(it residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
(rousing units added,if any,in part O, 13) 19 ❑ Chruch,other religious
13 ❑ Two or more family-Enter number
3 ❑ Alteration(See 2 above) of units......................................-............. 20 ❑ Industrial
21 C:] Parking garage
units
4 Repae replacement 14 ❑ Transient hotel, or tlof/^itory.-
Enter number of units ..........J.............. 22 ❑ Service station,repair garage
5 ❑ Wrecking(it muttAamily residential,enter number / 23 ❑ Hospital,institutional
of units in building in Part O, 13) 15 Garage
24 ❑ Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 17 Other-Specity 26 ❑ School,library,other educational
27 ❑ Stores,mercantile
S.OWNEJiSHIP 28 ❑ Tanks,towers
8 ZP,ivate(individual,corporation,nonprofit 29 ❑ Other-Specity
institution,etc.)
9 ❑ Public(Federal,State,or local government 't
C.COST (Omit cents) Nonresidential-De. ribs in detail proposed use of buildings,e.g.,food processing plant,
machine shop,laun I y building at hospital,elementary school,secondary school,college,
^ parochial school,P ting garage for department store,rental office building,office building
10. Cost of improvement ................. ................. $ , 0 0 at industrial plant.If se of existing building is being changed,enter proposed use.
To be installed but not included
in the above cost �^
a. Electrical........................................................................... �.RJ
b. Plumbing..........................................................................
c. Heating,air conditioning.............................................
it. Other(elevator.etc.)..................................................... —1
11. TOTAL COST OF IMPROVEMENT $ 1 `J UD
III. SELECTED CHARACTERISTICS OF BUILDING For flew buildinw and additions, complete Parts E-L;demolition,
complete only Parts J&M, all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
30 C] Masonry(wall bearing) 35 E] Gas 40 Public or private company Will there be central air
31 Wood frame 36 ❑ Oil 41 ❑ Pr to(septic t c,eta.) conditioning?
32 [:] Structural steel 37 [:] Electricity 44 [_ Yes 45 ryO
33 ❑ Reinforced concrete 38 ❑ Coal H. TYP OF W SUPPLY Will them by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ P is or peva company
46 ❑ Yes 47
43 Private(well,tide , n S
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building •�) FOR DEPARTMENT USE ONLY
C)Permit number
Building n Use Group
Permit issued _ 19 / Fire Grading
Building
Permit Fee $ ' 3 . O O Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $
Plan Review Fee $ co1
TITLE
NOTES AND Data • (For department use)
PERMIT TO BE MAILED TO:
DATE MAILED: i
Construction to be started by: Completed by:
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
O N
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pLA?is AREAPPRO DSOLEI:Y F�uOR'I+DENTIFICAWT:*ONJ—`�`^
TYPE ANO LOCATION OF FIRE PROTECTION DBI-C..�'•
ALL FME
ANC C+SFECTI0IC
FFOR COMPLETECOFIPU'
NKE%'11TH THE FIRE CODE.
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AJS
ROBERT J. SWAJIAN & ASSOCIATES, INC.
INSURANCE ADJUSTERS
161 SOUTH MAIN STREET
MIDDLETON.MA 01949
TELEPHONE(508)777-1400
FAX(508)777-2255
FORM OF NOTICE OF CASUALTY LOSS
TO BUILDING
UNDER MASS. GEN. LAWS, CH. 1399 SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
CITY (TOWN) HALL cAMF.
addresses
SALEM, MA 01970
RE: INSURED: ANTONIO & MARIANNA CAMADA _
PROPERTY ADDRESS: 14 VALLEY ST.
POLICY NO: HP101557
LOSS OF: FIRE
FILE OR CLAIM NO: RJS-12995
Claim has been made involving loss , damage or destruction of the
above captioned property, which may either exceed $1 , 000.00 or
cause Hass. Gen. Laws . Chapter 143 . Section 0 to be applicable.
If any notice under Mass Gen Laws Chapter 139 Section 3B is
appropriate please direct it to the attention of the writer and
include a reference to the captioned insured, location, policy
number, date of loss , and claim or file number.
ADJUSTERS
TITLE:
On this date, I caused copies of this notice to be sent to the
persons named above at the addresses indicated above by first class
mai 1 .• .
/ 2/11 /94
rr
� . '� Robert J Swe,ii n, Ad,iuster
♦HDW p
DMR
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
C98 No. _9 8 �/_9� Ward
CowoiT,�O
HISTORIC DISTRICT? Y Nv Date l 9�
M
IF FOR SIDING, HAS ELECTRIC Home Phone
PERMIT BEEN OBTAINED? Y N sq� "^" Bus. Phone
C/MINE�
APPLICATION
FOR
PERMIT TO
-2Gvt b f ��O
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications: ` '
Owner's name and address l�z—r,U , o -T CAMA,&A4 tq V� st
Architect's name
Builder's name
�lg ibl 4-l�c//
1A Ou5�2•.tc.� � oAt �a .
Location of building, No. _ /,/
What is the purpose of building? �TQAg�
If dwelling, # of units? Material of bldng? o
Will building conform to law? YE S Asbestos? . ! b
Estimated Cost pv City Lie.# State Lie.#
Home Improvement License #
Signature of Applicant yW
SONED dNDER THE PENALTY OF PERJURY
n ,{�
DESCRIPTION
IOF�WORK TO BE DONE
2LY 30 /!'('iYH.e�lxii. 6�/ LYS!'
V
Mail Permit to:� �����
No. Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location VOL.(f —
PERMIT GRANTED
19
Approved
c.� !d Insp for
A
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE 41 S - q l f //
JOB LOCATION ` � V�A-( 6F —e /-11'a LZu )d A✓6
Number I
/ Street address Section of Town
"HOMEOWNER �,u'7-ou , o C A naA¢ d A g q I - O � 3 -5--
Name
SName Home phone Work phone
PRESENT MAILING ADDRESS 14 V &LL r\/ ST'
SSA-L6, MA S 'S., o / 9 7 o
City/Town State Zip Code
The current exemption of "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor. (State Building Code Section 109.1 .1
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official ,
on a form acceptable to the Building Official , that he/she shall be res onsible
for all such work performed under the buildingon 10permit. Secti9.1 .1
The undersigned "homeowner" assumes responsibility for compliance with the State
Building code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that
he/she will comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE R�v�a
APPROVAL OF BUILDING OFFICIAL
NOTE: Three family dwellings 35,000 cubic feet, or larger, will be required
to comply with State Building Code Section 127.0, Construction Control .
HOME OWNER'S EXEMPTION
The Code states that: "Any Home Owner performing work for which a building
permit is required shall be exempt from the provisions of this section
(Section 109.1 .1 Licensing of Construction Supervisors) ; provided that is
a Home Owner engages a person(s) for hire to do such work, that such Home
Owner shall act as supervisor."
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for Licensing Construction Supervisors, Section 2.15) . This lack of aware-
ness often results in serious problems, particularly when the Home Owner
hires unlicensed persons. In this case your Board cannot proceed against
the unlicensed person as it would with licensed Supervisor. The Home Owner
acting as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,
many communities require, as part of the permit application, that the Home
Owner certify that he/she understands the responsibilities of a supervisor.
On the last page of this issue is a form currently used by several towns.
You may care to amend and adopt such a form/certification for use in your
community.
APPOINTMENT FOR FINASalem Fite Depd tment
L'
INSPECTION MUST F-ite Pnevent.Zon Sun•eau f APPOINTMENT FOR FINAL
MADE AT LEAST ONEE WEEK 48 La4ayette S-t�ceet INSPECTION MUST BE
Saeem Ma 01970 MADE AT LEAST ONE WEEK
AHEAD--------------- (508) 745-7777 AHEAD
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
i
In acconda.nce. with the pnov-i,,6.i,on.6 04 the Mab-6achu.6ett-6 State Su,(.2d,(.ng Code
and the Salem Ft-te Code, app.Pi.eatton .i,6 hereby made 4on appnovat o4 ptani,
and the i. -nuance o4 a ceAtt4tca to o4 appn.ovaZ 40�e a buZZd,Lng pe,m-i t by the
Salem Fvice Department. (Re4. SectLon 113. 3, Maes. State SZdg. Code)
Job Loca t i,on:
Owner/Occupant: c^ n Z.
�Av�i K�o e.l` C,/1.491i�2.J h— y 7i
Etectn,LcaC Contn.a.cton: t m 2 y
Fvee Suppne64ion Contractor: OtP
-m
u
vn-
AppZtcne o4 � 6w
Ap p.t:i,eant: Phone #: -7 <Ll
Addce,s-6 o4 C4 ty ox p
Appt-Lca.nt: 6 �c ��cti�� 8; Town:
Appnovat date:
Ce4t(.4.Leate o4 app-tova2 t,6 hereby ynanted, on appn.oved pians on, 6ubmtt-taZ
o4 pAoject de-ta.t-6, by the Salem FZte Department. A22 pians ace approved
4oZeZy 4on tdentt4tcati-on o4 type and ZocatGon o4 4ivice pn.otectLon deutceis
and equ,i.pment. AZ2 pZana ane aubject to app-,covat o4 any othe�c authoAi-ty
havtng ju4i.6dlcti.on. Upon eomptet-Lon, the appt, cant o,-c tm6tat-ten.(4) 6hatt
n.equeat an Zn,6pecti.on and/o.% teat o4 the 4ZJLe pnotectLon devtcea and
equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
ONew eon6tn.u.c t i.on.
Pn.opentg Zocati,on hays no eompt Lance wi th. the pn.ov.i,6ton.6 o4
Chapters 148, Section 26 C/E, M. G. L. , tetative to the
tm4tatati,on o4 approved 4iice atanm dev.ice6. The ownet o4
thi-6 pn.ope,rty .i.6 tequiAe t to obtain eompt-Lance a4 a
condition o4 obtatn.Zng a Bu,4td i.ng Permit.
Property ZocatLon i-6 .r,n compt Lance w.tth the pn.ovZ--ton s o4
Chapter. 148,/ Section 26 C/E, M. G. L.
ExptAati.on date:
T cess S.g Enatu.u.%e" o4 F-.,te 069i,c,4:aZ
Feejue: under ? . 00 So. Ft-
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In compliance with the provision of Section 113.5 of the Massachusetts
State Building Code, and under guidelines agreed upon by the Salem Bldg.
Inspector and the Salem Fire Chief, the applicant for a building permit
shall obtain the Certificate of Approval (see reverse side) and stamped
plan approval from the Salem Fire Prevention Bureau.
Said application and approval is required before a building permit may be w
issued. The Massachusetts State Building Code requires compliance z 3
approval of the Salem Fire Department, with reference to provisions of U. m w
Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts Q: F_ zo
General Laws, and 527 Code of Massachusetts Regulations. Ocn U-
z �n ;
The applicant shall submit this application with three (3) sets of plans, W zo
drawn in sufficient clarity, to obtain stamped approval of the Salem Fire 2 ►_ ¢ `•,
Department. This applies for all new construction, substantial o w w o
alterations, change of use and/or occupancy, and any other approvals as en a i
required by the Massachusetts General Laws, and the Salem Fire Code. a z - a
Exception: Plans will not be required for structural work when the
proposed work to be performed under the building permit will
not, in the opinion of the Building Inspector, require a
plan to show the nature and character of the work to be
performed.
Notice: Plans are normally required for fire suppression systems,
fire alarm systems, tank installations, and Fire Code
requirements.
Under the provisions of Article 22 of the Massachusetts State Building
Code, certain proposed projects may not require submission of plans or
complete compliance with new construction requirements. In these
cases, provisions of Article 22, Appendix T, and Tables applicable
shall apply. This section shall not, however, supersede the
provisions outlined in the Salem Fire Prevention Regulations, Chapter
148, MGL, or 527 Code of Massachusetts Regulations. All permits for
fire code use and/or occupancy shall apply for the entire structure;
fire alarm and/or smoke detector installation shall apply to the
entire structure based upon current requirements as per Laws and/or
Codes, but the existing structure may comply with regulations
applicable for existing structures.
Notice: Sub-contractors may also be required to file individual
applications for a Fire Department Certificate of Approval
for the area of their work. Such sub-contractors shall file
an Application to Install with the Fire prevention Bureau
prior to commencing any work for those areas applicable.
TMENT FOR F1NpE
pE T gE
Form 81X (10/90) pppOsTM"MFOvt T Be EFS ppSPE?T N STSONE w�K
INSPECA 0 EM SONE W 1Mp0E p 1 FA ..o
MpOE pNEpO......... ...
_ a COMMONWEALTH OF MASSACHUSETTS
DFXAR—,v ENT OF INDUSTRIAL ACCIDENTS
i
600 WASHINGTON STREET'
;aures. �anone�'
BOSTON. MASSACHUSETTS 02111
stone
WORKERS' COMPENSATION INSURANCE AFFIDAVIT
4 ro cit n1a (-CL
(I leen sear permtneet
with a principal place of businessiresidence at:
-- r ice
(Gryistateizip)
do hercbv certify, under the pains and penalties of perjury, that:
] I am an empi over providing the following workers' compensation coverage for my employees working on this
ob.
Insurance Company Policy Number
V<arn a sole proprietor and have no one working for me.
( J I 2M2 sole proprietor. general contactor or homeowner (circle one) and have hired the contractors listed below
who have the following workers' compensation insurance policies:
Name of Contractor insurance CompanyiPolicy Number
dame or Contractor Insurance Company/Policy Number
Name of Contractor insurance Company/Policy Number
[] I am a homeowner performing all the work myself.
NOTE: Please be aware that while homm,weer who employ perwas to m maintenance.construction or repair work on a
lin¢of not more than three ansa m w6id1 me homeowner alto rcresidesor on the grounds avpurtenaot thereto are not geveraliv
d wei ' Comvemauon Act(GL C. 152,ata. 1(5)). appiicuiov by s homeowner for a license
conssderea to be emoiovers trader the Workers
or permit may evsdeoce the legal trams of as empiover under the Workers Compensation Act.
! underttana that a copy of this statement will be forwarded to me Department of industriai Accidents' Office of insurance for mrerage
verification ana that failure to secure coverage as recurred under Sccaon 25A of MGL 152 can iced to me imposason of mminai penalties
consisting of a fine of up to 51500.00 ardor imprisonment of uo to one year and avii penaiaa in me form of a Stoo Work Order and a
fine or S 100.00 a day against me.
Signed this e ;) day of J �'` 19
Licensees Permirree Lieensori Permtaor
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