10 SETTLERS WAY - BUILDING INSPECTION 1
The Commonwealth of Massachusetts Town of
\ Board of Building Regulations and Standards
Yo
k Massachusetts State Building Code, 780 CMR, 7"edition Building Dept
Building Permit Applic Construct, Repair, Renovate Or Demolish a
One- or Tis -Family Dwelling
This Sec 'on For Official Use Only
!Build!in$?enmi1 Numb DateApplied:uilding Com ioner/I t r uildings Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
� o S4�l I �s �/ati
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 R) Frontage(R)
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 O On site disposal system 13Public❑ Private❑ Check if yes❑ p � y
SECTION 2: PROPERTY OWNERSHIP'
.1 Ow�er of Recorgg..,, �f�
lnla� ;! df-oVL�t�lan 1 -?S1
corers Waif �� �eM
Name(Prim Address fo Service: �-
Signa' r Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
neyf Description of Proposed,Work=:
T r'AI ttn.t/ (i7 /1 ��r^OOVWv Ioy aSLV^AkeVI
C
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. Building S I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $
❑Total Project Cost (Item 6)x multiplier
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) S List: f
5. Mechanical (Fire S Total All Fees:S
Suppression)
Check No._Check Amount: Cash Amount:_
6. Total Project Cost: $ M 0 paid in Full 0 Outstanding Balance Due:
F
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) �T�
p}✓t, License Number Expiration Date
Name of CSL-Helder V
f �kWtilo -jr � g4 H6' List CSL Type(see below)
Addres T e Description
U Unrestricted(up to 35,000 Cu. Ft.)
azure - R Restricted I&2 Famil Dwellin
----ff M Masonry Only
RC I Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC 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.......... ❑ No........... 13
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S
(AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, l n k 4 & 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.
Si nature o nee Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
1, 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 Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
NOTES:
I. Art 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 I I0.116 and 110.R5, 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 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'
RONAN, SEGAL & HARRINGTON
ATTORNEYS AT LAW
FIFTY-NINE FEDERAL STREET
JAMES T.RONAN(1971.1987) SALEM,MASSACHUSETTS 019703470
JACOB S.SEGAL
MARY PIEMONTE HARRINGTON
GEORGE W.ATXINS, III
TEL(978)744MW
FAX(978)740.7493 FILE NO.
OF COUNSEL
JOHN H.RONAN
MICHAELJ.ESCHELBACHER
April 21, 2009
Mr. Jeffrey Conley
Collins Cove Condo Association
13 Settlers Way
Salem, MA 01970
RE: 10 Settlers Way, Salem, MA
Dear Mr. Conley:
As you know, I am attempting to install a bathroom on the lower level of my parents' unit
at 10 Settlers Way. It is my intention to have the bathroom completed before their return
from Florida on May 1 e. It was a difficult winter for my mother and I hope to buoy her spirits
by having the finished bathroom waiting for her when she arrives.
Attached for your review are plans showing the lower level as it exists and as it will look
with the addition of the proposed bathroom.
M a
My parents'nts lower level is at grade, has full sized windows a slider to the outside and is
opened up to their first floor (there is no cellar door). They spend the majority of their time
down there in the "family room". With my father turning eighty this year and my mother only
a few years behind him they'll be much better off without having to make so many trips up
and down the stairs,
The proposed bathroom in my parents unit will not impact any other unit. As you can see
from the layout provided, the bathroom will be entirely within the foot print of their unit. It will
be framed by adding two partition walls to cordon off the bottom right comer of the family
room. The partition wall at the top of the utility closet will be moved one foot so that a 36
inch handicap accessible door can be used to access the new bathroom space. The bottom
partition wall in the family room will remain in place but the door to the office will be moved
to the left to accommodate a 36 inch door into the office.
All work will be done in a good and workmanlike manner and in accordance with the
Massachusetts Building Code. The work will be properly permitted and inspected by the
Salem Building Inspector and Salem Plumbing Inspector. All connections for water and
sewer shall be made within my parents unit without interruption or interference with any one
else.
Kindly bring this matter to the immediate attention of the Condominium Trustees for their
approval. If 1 can be of any assistance or answer any questions, I can be reached anytime
on my cell phone (978) 697-3365.
Thank you for your attention to this matter.
Very truly your ,
John H. Fti9Ran
JHR:jbd
Enclosure: ��'
IJ
Pao FogaD
v C"s
04
WN
CITY OF SALEM
SL
PUBLIC PROPRERTY
DEPARTMENT
C: \1 M Ih,..,INltiu.1-r 4 ti.tii Vit. \LA,;If
I I I '1'8-'43.•);o; • I tY. 'i'8 '4: t.iL.
Construction Debris Disposal Affidavit
(required I'ur all demolition and renovation work)
In accordance tk itlt the sixth edition of the State Building Code, 780 C NIR section I 1 1.5
Debris, and the provisions of ty1GL c 40, S 54;
Building Permit N - is issued with the condition that the dcbris resulting front
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
I11. S 150A.
The debris will be transported by:
-..
0 v�_T 00 t&UA^
(name of hauler)
The debris will be disposed of in
Set�e�+µ—�i1nS4Q!1.- �`EGs't1lD�
(name tv tacihiv)
_tXVe AA tNl ✓�
laddrese ur l9cilityl
� n uco(pennit.y�plicant
date
I�
CITY OF S.Uf.\i
PUBLIC PROPERTY
DEPARTMENT
w�
MAroa 130w..vmcroa s,.ssr.s uma M�ot�r,:0,970
TU-97W45.9S"•FAx 97$.740960
HOMEOWNER LICENSE EXEMPTION
Plea"Print
Date
Job Location O 94lerS wa Iej lam 1* 01570
Horne OwnsAddre" U �S
Home Own Telephone S- 7 O o
Preset Mailing Address Ur ti LM 1 0
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who,does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside.on
which there is, or is intended to be; a one or two family dwellin& 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 be responsible for all such work performed under the Building
Permit.
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws 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.
HOMEOWNERS SIGNATURE l
APPROVAL OF BUILDING INSPE R
See other side for state code