B-19-592 - 0072-0074 BUTLER STREET - Building Permit f�v s�
The Commonwealth of Massachusetts
` Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
C" USE
a-- Building Permit Application To Construct,Repair,Renovate Or Demolish a lRevisedMar2011
LO One-or Two Family Dwelling
This,Section For Official Use Only
6'
Buikling Permit Number: Date Applied:
Building Official(Print Name) signatureDO fw
SECTION 1:SITE INFORMATION ,
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers '
1.la lls this an accepted street?yes no Map Number Parcel Number vw
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
R(Nuired 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?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSl3IP'
2.1 Owner'of Record:
Name(Print) City,State,ZIP
No.acid Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) f
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units i Other ❑ Specify:
Brief Description of Proposed Work':
OL-
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su cession) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Toltal Project Cost: $ d� — 13 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Ex iration Date
License Number p
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
i U Unrestricted(Buildin2 up to 35.000 cu.ft.
R Restricted 1&2 Family Dwellin
City/To",State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
t SF Solid Fuel Burning Appliances
I Insulation
Telephone.. Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
c
LAO HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP 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:OWNERS OR AUTHORIZED AGENT DECLARATION
hereby attest under the airs and penalties of edury that all of the information
By entering my name below,I h y P P P
contained in this appfieatigL is a and accurate to the best of my knowledge,and understanding.
ZW1 4 gy-e"Orl - I
Print Owner's or Autho zed Age ame(Electronic Signature) T
' 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.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.,gpy-/d-p—s
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"maybe substituted for"Total Project Cost"
f
07'Y OF SALE14 WSACHLISE7fi
BUMDW
UL.(978)74"595
B ERLEYDIMODI L FAX(978)740.984f
MAYOR TAMS ST1WW
DMECrMCFPUBUCP t /BU[LD c am�a a
Construction Debris Disposal Affidavit
(requiredfor all demolition & renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris,
and the provisions of MGL c40,S54;Building Permit R is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licenses
waste deposit facility as defined by MGL c 111,S150A.
The debris will be transported by:
�G'rh�le
(name of auler)
The debris will be disposed of in: y
(name of facility)
(address of facility)
Signature of applicant
(toda s ate)
G_�')
CITY OF SALEA MASSAIU-MEM
BUILDING DEPARTA ENT
120 WASHUgGTON STREET,3RD FLOOR
TEL(978)745-9595
KBOERLEY DRISCIDI L FAX(978)740-9846
MAYOR THomAS ST.PIERRE
DIRECTOR OF PUBLICPROPERTY/BUILDING 00N&SSIOMR
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:_
e
J013 LOCATION
HOME OWNER ADDRES�
PRESENT MAILING ADDRESS:_
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two(2)units or less and to
allow such homeowners to engage an individual for hire that does not possess a license,provided that the owner acts as
supervisor.
Definition of Homeowner:
Person(s)who own 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 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 be responsible for all such work performed
under the Building Permit.
The undersigned"homeowner"assumes the responsibility for compliance with the State Building Code and other applicable
by-laws and regulations.
The undersigned"homeowner"certifies that he/she understand the City of Salem Building Department minimum inspection
procedures and requirements and that he/she will comply with such Procedures and requirements.
HOMEOWNER'S SIGNATURE
_ZZW
9/
--------------
APPROVAL OF BUILDING INSPECTOR
Cummings
From: Adam Schoenhardt <inadamsgarden@comcast.net>
Sent: Thursday,June 06, 2019 5:47 PM
To: Stephen Cummings
Subject: 72-74 Butler Street new roofing building permit
.6 June 20*11'91
72-74 Bu,fle'r-.5treet Roofing replace.me.-rit
B I Id i h - I n, s - e cti, De pr iftm en t
U -9: _ p -on 'a.
8 a 10 ml,-- M- A,
Building InsIppc-tor,
Irsaac Kroll, trustee of 72-74 Butler Street
occupant of 72 Butler Street, and Oarth er of
p
pe.rm it for the r - of in' replamen t at 72-7,
0 cel
project'ect with the* roofing tracto' r.
01 i ng con .
6/10/2019 Unofficial Property Record Card
Unofficial Property Record Card - Salem, MA
General Property Data
9
Parcel ID 16-0073-801 Account Number
Prior Parcel ID 41 --
Property Owner KRULL ISAAC Property Location 72 74 BUTLER STREET
Property Use Condo
Mailing Address 74 BUTLER STREET U1 Most Recent Sale Date 12/4/2012
Legal Reference 31982-372
City SALEM Grantor FEDERAL NATIONAL MTG ASSOC,
Mailing State MA Zip 01970 Sale Price 108,000
ParcelZoning R2 Land Area 0.080 acres
Current Property Assessment
Card 1 Value Building Value 201,200 Xtra Features 2,600 Land Value 0 Total Value 203,800
Value
Building Description
Building Style Condo TnHs. Foundation Type Brick/Stone Flooring Type Hardwood
#of Living Units 1 Frame Type Wood Basement Floor Concrete
Year Built 1880 Roof Structure Hip Heating Type Forced H/W
Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil
Building Condition Average Siding Asbestos Air Conditioning 0%
Finished Area(SF)1200 Interior Walls Plaster #of Bsmt Garages 0
Number Rooms 6 #of Bedrooms 3 #of Full Baths 1
#of 3/4 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.080 acres of land mainly classified as Condo with a(n)Condo TnHs.style building,built about 1880,having Asbestos exterior
and Asphalt Shgl roof cover,with 1 unit(s),6 room(s),3 bedroom(s),1 bath(s),0 half bath(s).
Property Images
i
,,,
i
Disclaimer:This information is believed to be correct but is subject to change and is not warranteed.
salem.patriotproperties.com/RecordCard.asp 1/1
OLo
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
0 USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
q One or Two-Family Dwelling
This.Section For Official Use Only 4
v1
Building Permit Number: Date Applied: �
1
...1:
�- Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION >
' 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
I!Z z3 A4V' k2 ` p
`4a
l.la Is,this an accepted street.9 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 17 Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name(1'nnt) City,State,ZIP
No.and Street Telephone Email Address i � I
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building41030wner-0ccupied ❑ Repairs(s) ❑ Zteration(s)� Addition ❑Demolition ❑ Accessory Bldg. umber of Units Other ❑ Specify:
Brief Description of Pro wAL ork2:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:_ QUJ4 �✓�,
5.Mechanical (Fire $
Suppression) Total All Fees: $
X21- da Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 13 Paid in Full 13 Outstanding Balance Due:
{
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder List CSL Type(see below) t '
No.and Street Type Description
U Unrestricted(Buildin-gs up to 35 000 cu.ft.
R Restricted 1&2 Famil Dw ilin
City/Town,State,ZIP M Masonry
t _ RC Roofing Covering
WS Window and Sidin
i
SF Solid Fuel Burning Appliances
I Insulation J
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,City/Town,State,ZIP 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.
17
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
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.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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
important information on the HIC Pro can be found at
program or guaranty fund under M.G.L.a 142A.Other imp �
www.mass.Qov/oca Information on the Construction Supervisor License can be found at www.mass.fiov/dns
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"
�I
The Commonwealth ofMassachuselts
Department of Industrial Accidents
Office ofInvadgadons
600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers
Applicant Information Please Print Legibly
Name(I usiness/Organization4ndividoal):��.�
Address: �'Z (� S I
City/State/Zip: LPhone M ( ` -7`7
Are you an employer?Check the appropriate box:
4. I am a eneral contractor and I Type of project(required):
1.❑ I am a employer with ❑ g
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance.t 9. Building addition
ed) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. 1 zl homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their.workers'comp.policy number.
lam an employer that Is providing workers'compensation insumnce for my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Addwss: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cer dfy under the pains and penalties of perjury that the information provided above is true and correct
Si ature: �44aim- Date:
Phone#: ��� �i601
Ofilcial use only. Do not write in this area,to be completed by city or town offuial
City or Towin: Permit/License#
Issuing Autbiority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M
CITY OF SALEA MASSACHUSE M
r ~J BUILDING DEPARTAENT
• 120 WASHINGTON STREET,31D Flom
TEL(978)745-9595
KREERLEYDRISODIL FAX(978)740-9846
MAYOR THomAS ST.PIERRE
DIRECTOR OF PUBLICPROPERTY/BUII.DING 00maSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION___ ?
HOME OWNER ADDRESS: <i/�I�✓��
PRESENT MAILING ADDRESS:_ XA'Jt�Ki
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two(2)units or less arld to
allow such homeowners to engage an individual for hire that does not possess a license,provided that the owner acts as
supervisor.
Definition of Homeowner.
Person(s)who own 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 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 be responsible for all such work performed
under the Building Permit.
The undersigned"homeowner"assumes the responsibility for compliance with the State Building Code and other applicable
by-laws and regulations.
The undersigned"homeowner"certifies that he/she understand the City of Salem Building Department minimum inspection
procedures and requirements and that he/she will comply with such procedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Your Confirmation number is 2019060510041676
" • Date of Confirmation:6/5/2019
NOTE:When paying by ACH(Checking)it will take two business days for the payment to be debited from your bank account.Your
account number is not verified until this payment is presented to your bank.They have the right to return this payment if unable to
process this transaction against your account.
Your request for payment(s)of$59.95 has been received and is subject to approval by your financial institution. No email was entered
so a confirmation was not sent.
Account Information Payment Information
Name: ADAM SCHOENHARDT Payment Type: Credit Card
Note: QUICK PAY TRANSACTION Payer Name: ADAM SCHOENHARDT
Card Number: """""*""7629
Transaction Information
Transaction Quantity Amount Fee Payment Type
City of Salem-Inspectional Services 1 $56.00 $3.95 Credit Card
Building Permit
First Name:ADAM
Last Name:SCHOENHARDT
DBA/Company Name,if applicable:
Name of permitted/inspected property:
72 BUTLER STREET
Address of permitted/inspected
property:72 BUTLER STREET
Phone#:617-775-3966
Contact Email Address:
inadamsgarden@comcast.net
Total:$59.195