4-C RUSSELL DR - BUILDING INSPECTION The Commonwealth of Massachusetts FOR
Board of Building Regulations and Standards
y ` Massachusetts State Building Code, 780 CMR, 7`J'edition MUNICIPALITY
USE
Building Permit Ap ton Construct,Repair,Renovate Or Demolish a Revised January
p 0" One- or Two-Family Dwelling 1, 2008
S4ftion For Official Use Only
Building Permit N r Date Applied: o
Signature:
BmIZ51g Tommissioner ~or of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Addres . 1.2 Assessors Map&Parcel Numbers
4-C Russell Drive
1.1 a 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 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 OWNERSHIPr'
2.1 Owner'of Record:
Deborah F. Mendleson 4-C Russell Drive
Name(Print) Address for Service:
978-239-4563
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORIe (check all that apply)
New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other OW Specify Replace existing deck
Brief Description of Proposed Work': Remove and replace existing deck
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only:
1. Building $ 5,348.50 1 Building Permit Fee: 5.00 Indicate how fee is determined:
2.Electrical $ N/A *tandard City/Town Application Fee
3. Plumbing $ N/A ow Total Project Costa(Item 6)x multiplier 7.00 a 5.348
2. Other Fees: $ )
4.Mechanical (HVAC) $ N/A List: t1
5. Mechanical (Fire $ N/A C'
Suppression) Total All Fees: $ 42:43
6. Total Project Cost: $ 5,348.50 Check No Check Amount:$42.43 Cash Artiount._
❑Paid in Full ❑Outstanding Balance Due:
SECTION 5:;CONSTRUCTIONSERVICES'.
5.1 Licensed Construction Supervisor(CSL)
CS 18386 11-02-2009
RobeKU L'heureux License Number Expiration Date
Name of CSL-Holder List CSL Type(see below) U
1-B Hart Way, Salem, MA 01970 Type Description.
Ad U Unrestricted(up to 35,000 Cu.Ft.
4 R Restricted 1&2 Family Dwelling
Signature � M Masonry Only
978-578 4162 RC Residential Roofm Covering
WS Residential Window and Sidin
Telephone SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(BIC)
IRC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature 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 .........SL No ...........(7
SECTION 7a: OWNER AUTHORIZATIONC TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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:OWNER'OR AUTHORIZED AGENT.DECLARATION
I, Robert J. L'heureux 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.
Robert J. L'heureux
Signature of 0wh4r or Authorized-=t Date
(Signed under the pains and penalties of
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and l IO.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage,finished basement/anics,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"
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CITY OF S.M..ET , TANSSACH SETTS
BL DLNG DEP.L111h1E%T
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Construction Debris DispOW Affidavit
(m uired for all demolition anti rnevation wo,k)
In accaidance with the sixth edilinn nfthe Swe Building Cods, 780 CMR sectictn 111.5
Debes,and Ehe pretvisions of VOL c 10, $ -54,
Tsuilslino Permit t iu i+soWd wiliy dlgv conWtion that tho ticbris resulting fl.n
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111. S ICDA.
Thr. crhris w•i II he trir.si)wTcd by:
Dennis Warshaver
i.1allica;9'Uaaleij
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Northside Carting
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Salem, MA
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APR-23-2009 THU 02:25 PM APT FINANCIAL SERVICES �I FAX N0. 17_819354289 P. 01/01
American Properties Team, Inc.
i
TO: 4C Russell Drive
FROM: Jennifer Pappas, Property Manager
RE: Deck Replacement
DATE: April 23, 2009
Please be advised that the Board of Trustees for Pickman Park has approved the replacement of
your deck at the above referenced unit. This approval is contingent upon it matching the existing
deck The Board will not allow any design alterations.
We also require that permits be pulled in advance (regardless of what your contractor may ten
you), and then a copy of the fmal approved permit once completed must he sent to APT for the
unit file as well.
You will need to bring a copy of this letter to the Salem Building Department in order to receive
your permit.
Should you have any questions or require additional information,please feel 'free to call me
directly at(781)932-9229.
cc: Unit File
S00 WEST CUMMINGS PARK•SUITE 6050• WOaNRN •MA •01801.781.992.9229 •FAX 7819354289