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BUILDING JACKET l5- (-- 0 9 J l N1 a --- I'lie C omntotmeallh of blussachuxus Bo•ird of Madding Rcgulatians and Standards CI IT OF st ";15"chusals State Building Code, 790 C' SALEXI �l 1uildi119 Pernil Applicuioo To Construct. Repair. R uvate Or Den: lish a Unr ur Tivu•Pimnls Du elli •s,, this Section Fur Ot)ici sc Onl l3uilJiny Permit Number: Dal , pplicd: IludJmyUllinal(Pr. Mums) . iysmturc Um- SECTION It SITE I OR31ATIO I op ly AJJrns: 1.2 As ssurs di urcel Numbers I.Is Is this an acre led street? •a no \Lsp Nwnbcr I'arccl Number 1.3 Zoning lnfortoatlont 1.4 Property' enslons: Loniny Dutrics i'mposcd llse Lal Amu s Iq 14 ye(II) 1-5 Building Setbeclu Ill) Fronto Frunt Yurd Side Yunls Rear Yursi Rcyuircd Provided Reyuirvd . Provided Rcyuirud Provided 1,6 Water Supply:(M.G.I.c.JU 4 1.7 Flood Zone Informatlon: 1.8 Sewage Disposal System: Public vote❑ Zone: _ Oubide Fload Zone? Chcck if vs 0 Municipal O On site disposal 3).stem (3 2.1 Owners of SECTION 2: n OPERTY OWNERSNIPs Record: City.StuW.ZIP Nu.:mJ Street fete h�_ Emuil AJdrass SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ E ply) .rtsttng Building O Owner•Oceupied ❑ Repatrs(s) Qf Aiterattonpl p Addition O Dentulition O .accessory Bidg, p Number of Units BrieffDescriplionofPraposrd Work°: Other ❑ Spceiry: SECTION J: ESTIMATED CONSTRUCTION COSTS hens Estimated Costs: II abut and.\Luerials) OMCIa1 Use Only I. Building S 1. Building Permit Fee: 1 htdicate how fee is determined: 2. Illecirical S O Standard Ciry•Tussn Application Fee s I'lunihiitg S O Total Project Cash I Item 6),IN multi tier _ '. Other Fecs: \Iech.mic.d ill\ 1(') S LisC._ .____ 'i� FIry <u yes>ioni S rot:d \11 Fecs: Tntul Projcet C011 i 1 © DQ l heal, Vu. _(LaA l'.i,h \niuunt: � �• ^'/7❑P.iiJ m Full ❑Outstanding 11.d.mcc Dua: Az��J __. e e ('t)N,SFRUC 1()N SF.R'6'1('VA �s qlp Z7g. . R 7 20�� t,l ('unslructiun Supenizur License IC'tiL) It ;a ion \anleol'CSi. lhdllcr Ilstl'SLI\pel.xbeleal.__4.1._ _—_.._ Description IludJiu s lipto It UIIU al. Il.l ��R�t �u! n )— I( Re,IricteJl � I'.unil Il++alin Iiv�`•' \I \haiun ('it.%4m,it.SLAY./It­' KC' Rodin C,nerin y� q µg µ'inJuw.utJSiJio solid Fuel Ilurnin6 Applianc¢s Insulmiun f"�77 ✓ r �'�� 1) I7clnal1110n de Reno Pm:ni address 1' S.1 Registered Ilame Improvement Contractor(HIC) IIIC Itagiat�r hvpiruiou Dwa JET IIIC ConlpWn IteAistr nt Nwna J �$ ` L•mwl uJJra�ss/,./�1/ /p y� role hone CJ Ci row�ta ZIP SECTION 61 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.1.e. I�1. iSC(6)) Worker Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this afidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......••• 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 appligio 7* j Z 7 Will Print Uaner's Nwnn Ifilecwnic 5isnulum SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION B enlerin y nat low. I h e attest under the pains and penalties of perjury that all of the information Y contain in is cation ' and accurate to the best of my knowledge and understanding Wta 1'riilt t x err:\uthodh �mn's w •IIilectrenic Signalura) No'rES: \n Ussner sshu obtains a building permit to do his-her uwn work,or an asvner who hires an unfugisbitri io nvaaur I nut registered in the Home Impruvnnest Contractor(HIC) Program),will no have access to he arhitr be r pmg,aln or g,,% -,I Informal on on he Construction Su pen for Li elnse aan be round at,ormation on the HIC 1% W 11;in V%bat+l;,unJ m \\'hen substantial work is planned, provide the infunnatiun below: t including garage. finished basement attics. Jerks, perdu rotai liour area Isy• Il.l -- ilabitable ruuns count - (Iruis It%ing area 114- it .--... . .. .. Number of hedruenls \wuFer of lircplaces ,. _ \umber kit half hWllw \unl herot hathreunls - \usher ol'decks pord,es I\pc al'he.111114 j",Mll I�ucla,aJ ..11pen I'�I'e „1':oalulg ,�uem 1 -I.`I.II I'r,l�v,t S,lto re I`111 gJge" IILI) I+e Hlh,lllllled IiR.•l',Il.d PfU�ecl('tbt'• The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Divelling This Sectton:For Official Use;Only Building Permit Number: ' Date Appl ed . Building Official(Print Namatur - Date. - SECTION 1: SIYEjl4F6f MATION 1.1 Propert d s t L 1.2 Assessors Map& Parcel Numbers .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: Public❑ Private ❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2; PROPERTY OWNERSHIP'.' 2.1 OwnertJif-Rei ofd`: , t ` 1b'0t r l`¢F�, "�-�^ s vt., b'l� D/9`7C7 Name(Print) City, State,ZIP No. and Street Telephone' Email Address SECTION 3: DESCRIPTION OF:PROPOSED WORK'(check ajV46t,apply) New Construction ❑ Existing Building❑ Owner-Occupied Cl Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: EST 11VIATED C0 STRUCTION COSTSr, . Estimated Costs: [tern Official Use Only-, Labor and Materials L Building $ 1 Budding Permtf Fee: S-_ Indicate how fee is determined: Electrical S ❑ Standard City/Town Application Fee 2. ❑'Fatal Project Cost',(Itettt.6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (lIVAC) S List: 5. Mechanical (Fire $ Su r1 P ession) Total All Fees: :S Che Check Amount: Cash Amount: 6- Total Project Cost: S (( Paid in Cull 0 Outstanding Balance Duo: SECTION 5: CONSTRUCTION SERVICES 5.1 Cons t Supery License(CSC,) License Number Espu'at' i at Name of CSL 1161dcr (tom; List CSL Type(see below) V sok�� tr<I - — Type Description . No. and Street U Unrestricted(Buildings up to 35,000 cu. ft. '. __ R Restricted 1&2 FamilyDwelling - City/rown, State, ZIP NI Nlasonr RC Roofing Covering \VS Window and Siding SF Solid Fuel Burning t\ppliances I Insulation 'felt honer Email address D Demolition 5.2 Registered Home [m rov ment tractor [C) FIIC Registration Number E.e Wonate HI of nine o -1I ' i Natne No. an Email address City/Town, State, ZIP Tele hone SECTION 6: WORKERS' COMPENSATION INSURANC AVIT(M.G.L. e. 152. § 25C(6)) Workers Compensation Insurance affidavit must be com and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance a building permit. Signed Affidavit Attached? Yes .......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR B�U-I�LDDING PERMIT 1, as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized y this building permit application. Print Owner's Name(Electronic Signature) ate SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name belo",hierelyst der4pa'nsd penalties of perjury that ail of the information containeedd i��innLthis applicaticurat my knowledge and understandinPrintOwner's or Authorized lectronic Datz NOTES: I. 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. I42A. Other important information on the H[C Program can be found at oww.niass."ov/oca Information on the Construction Supervisor License can be found at svw-w.mass.eov LIM 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch) Gros, living area (sq. ft.) _ Habitable room count Number of fireplaces_ Number of bedrooms ----_-- Number oFbathrooitts Number of halubaths _ Type of heating system _—__-_-- Number of decks/ porches 1'ypeofcoolingsysicm- Enclosed ----Open — :.I'oGtl I'roject Squura Footage" may be substitutes) for fncd Project Cost" �03 26 $231 Sr. 1 The Commonwealth of Massachusetts V Department of Public Safety OMassachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) 110 Building Permit Number: Date Applied: Building Official: rSECTION 1:LOCATION(Please indicate Block#and Lot It for locations for which a street address is not available) U J 33 Carlton St. Salem Townsend House No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2 PROPOSED WORK . Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below IL Existing Building EX Repair I$ I Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application?Y Yes ❑ No IX Is an Independent Structural Engineering Peer Review required? Yes ❑ No Ix Brief Description of Proposed Work: Re;h j lri a�rnrrn �s In ft of fieldstone foundation ( MOST or-- AD cpe-lc Ic. ('jCr NG D ('1NV A U C�L-2.rSc� sal SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ F B: Business ❑ E: Educational ❑ F. Facto F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R. Residential R-]❑ R-2❑ R-3❑ R31❑ S: Storage S-1❑ S-2❑ U. Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ HIA ❑ IIIBO N ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit., Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-Way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? I i their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes CK No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: min> 1--(nD okb(v ,b ` `1 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Condominium 33 Carlton St. Salem Name(Print) No.and Street [Ci[ty/Town Zip Property Owner Contact Information: -7 T�i S a S31 � Wendy Walsh f7 978 314 6079 wedy.walsh2@verizon.net Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Jet Development 4 Wavne Ave. Ipswich MA 01938 Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) f building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 102 General Contractor Jet Development and Construction Company Name John Tacey G — QG(O Z7 g "/ fin. -it 2-7 jZorn Name of Person Responsible for Construction License No. and Type if Applicable 4 Wayne Ave. Ipswich MA 01938 Street Address City/Town State Zip - - 589-7077 itace@iet-development.com Telephone No. sines Telephone No. cell e-mail address SECFION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents most be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 21,500.00 Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ 21,500.00 (contact municipality)and write check number here SECTIO 3:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I here est un the pains and penalties of perjury that all of the information contained in this application is true and ac to to best o knowledge and understanding. John Tace Supervisor 781-589.7077 9/11/15 Please print and si a Title Telephone No. Date 4 W Ipswich A 01938 Street Address City/Town Sf_tate Zip `�� Municipal Inspector to fill out this section upon application approval: Name Date • 3 al a ri Salem Historical Commission 120 WASHINGTON STREET,SALEM;MASSACHUSETTS 01970 (978) 619-5685 FAX.(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving O Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance, District: Derby Street Address of Property: 94-96 Derby Street (33 Carlton StreW Name of Record Owner: Townsend House Condominiums Description of Work Proposed: Rebuild 16ft offoundation using the existing rock and stone. Mortar color to snatch the existing. There will be no changes to the design; material, color or ouhvard appearance of the foundation. Dated: July 15.2015 SALEM HISTORICAL COMMISSION By-�llX� The homeowner has the option not to commence the work(unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of n The Commonwealth of Massachusetts VUU/ Department of Public Safety Massachusetts u husetts State Building Code(780 CNIR) Building Permit Application for any Building other than a One-or Two-Family w 'n (This Section For Official Use Only) - Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 3 ft e 5-r SA c&rtll, xL - No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Cude used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ I Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: iJF-uJ �LRSN/.cfC�, SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ Existing Use Group(s): I Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 Cl A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ IL• Hi h Hazard H-I❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional l-1 ❑ l-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage Sl❑ S-2❑ U: Utility❑ Special Use O and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ Ill ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA C3 VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item) !im it: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ Aot be P rerench or specify: Private❑ - or indentify Zone: or on site system❑ ped❑ Railroad right-of-way: Hazards to Air Navigation: i t lir�'��nnn� �,�m 1 .usy I r ipss:Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed ❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?. Special Stipulations:. SECTION 9: PROPERTY OWNER AUTHORIZATION r Name and Address of Property Owner W A1:56,V 6 Ha2Y6- 3 g Ldn e�aa.✓s� ��}-z�afti 0j97o Name(Print) No.and Street City/Town Zip Property Owner Contact Information: AEU.354 VkC�nl _ Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu,ft.of enclosed space and/or not under Comtmction Control then check here O and ski-I Section 10.1 10.1 Registered Professional Responsible for Construction Control NrL,ntn�(Regis r`[ ^!� dr.pJrO,ne &VPf�e-mail rV Q/,g33 Registration Num erZ — 14 Street Address ` City/Town State Zip Discipline Expiration Date 10.2 General Contractor .-,I ET ,!)E fEG O?�M En/T R�� Cain/S T R UCT/�,✓ Company Name ,J,�2rf^✓ Y 78 Name of Person Responsible for Construction License No. and Type if Applicable Z-r iN y C!R , C'&e(96r0AV4/ AeA- 0/8 33 Street Address City/Town State Zip 9!-S9? 7D77 781 _�7_ '2a� J�f►Cr�c�'_/E,P���co�,t�E�t.IT, cuy Telephone No. business Telephone No. cell a-mail address SECTION 11:w0Ri:PR9'C0N1Pt°NSA I[ON IN3UKANC1' FFIDAVI'l M.G.C.c.152.§25C 6 - A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No ❑ - SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE, Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$4 y Va /60i 1. Building $ O r Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ d. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check able to �y� P Y• 6.Total Cost $ �jCJ r (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. JON�I CEY eQAIr-�PRc'TDi2 76�_S� 7077 Pleas runt�y'�igt�n�n - a Title Telephone No. Date L i� c,v �'<.e ' �EOl��E7DuJi� O 33 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date