21 APPLEBY ROAD - BUILDING JACKET � PrpP v�g� �r�
Commonwealth of Massachusetts !L\
6
' City of Salem
� 9
120 Washington St,3rd Floor Salem,MA 01970(976)745-9595x5641
Return card to Building Division for Certificate of Occupancy
Permit B-14-765 PERMIT T O BUILD
FEE PAID:: $3$35.00
DATE ISSUED: 4/9/2014
This certifies that SGROI ROBERT W SGROI KIMBERLY A
has permission to erect, alter, or demolish a building 21 APPLEBY ROAD Map/Lot: 30034-0
as follows: Additions - 1 & 2 Family 738-14 PLACEMENT OF A GARAGE IN BACKYARD. SIZE IS 12' X
16' & IS MANUFACTURED BY REEDS-FERRY iNC. 10" SONA TUBES. HOMEOWNER KNOWS
THIS WILL BE CONSIDERED A GARAGE.
Contractor Name:
DBA: 0
Contractor License No:
N
4/9/2014
oc tie/ v Building Official Date
}J is permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
W Ziay grant one or more extensions not to exceed six months each upon written request.
V
tsJ� I work authorized b this permit shall conform to the roved application and the roved construction documents for which this permit has been ranted.
az F— � Y Pe PP PP� PP Pe 9
tJ W
W
t3- _01 construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
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v
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
HIC#: 'Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Commonwealth of Massachusetts
5 R City of Salem
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
M �
Return card to Building Division for Certificate of Occupancy
Structure CITY OF SALEM BUILDING PERMIT
�I
Excavation PERMIT TO BE POSTED IN THE WINDOW
Footing INSPECTION RECORD
Foundation
Framing
Mechanical
Insulation INSPECTION: BY DATE
Chimney/Smoke Chamber
Final
!s r Plumbing/Gas
Rough:Plumbing
Rough:Gas
Final
Electrical
Service
Rough
Final
rig I
Fire Department
Preliminary
Final
Health Department
Preliminary
Final
„ -.\. •s JOB S'7P COPY
'\/ BUILDING
CITY OF SALEM
SALEM, MASSACHUSETTS 01970
PERMIT
DATE
SEP19 PERMIT NO.SEPTEMBER 1E 96 533-199E.
APPLICANT OWNER/JOHN ANEZIS ADDRESS 215 NEWBURY ST 1530
(NO.) (STREET) (CONTRSLICENSE)
CITY PEABODY STATE Mn ZIP CODE 019EID TEL.NO.NUMBEROF
'�0t5-531—SEJC,
PERMITTO NEW BUILDING I ) STORY ONE FAMILY DWELLING UNITS 1
(TYPEOF MPROVEMENT) NO. (PROPOSED USE)
0021 APPLEBY ROAD ZONING
AT(LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION MAF, 03 LOT 0033 BLOCK SIIZE 0018421 SD FT
BUILDING IS TO BE FT.WIDE BV FT.LONG BV FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: INSTALL FOUNDATION /r�& r{BUILD�+NEp'W�'j'}StI1NrG+L'E( . `F{A}MyILY DWELLING AS PER F4_ANS. L
AREA OR ,all 1of F eI m*' ' V@�/UU�J PERMIT
VOLUME ESTIMATED COST$ 110, 000 FEE $ EE5. 00
(CUBICISQUARE FEET)
OWNER ANEZIS JOHN R
99 BIRCH STREET BUILDING DEPT.
ADDRESS BY L. E. T
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET.ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS
► ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES ASW ELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF AN V APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OFTHREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE
REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR
1.FOUNDATIONS OR FOOTINGS. ELECTRICAL.PLUMBING AND
2.PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS.
MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
3.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
n (// BUILDING(INSPECTION APPROVALS-( c PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION. /AA�PPPPRO/VALS
&24(
2 L 2 L-- /\ / — / 2
BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT SPECTING APPROVALS
OTHER CITY ENGINEERp �
2 2 �j�ulLC.?in 1-CeoG <1L
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. AS NOTED ABOVE. OR WRITTEN NOTIFICATION.
r-3--1/C. Li CUF'Y
CERTIFICATE OF OCCUPANCY
CITY OF SALEM Issued. irk �`�Permit : �"
�'`. .,.,•;. 1' SALEM, MASSACHUSETTS 01970 Cit of Salem Building Deot.
9���NINE D°�1r`
DATE SEPTEMBER 16 19 9F PERMITNO.
APPLICANT 0I•!hIER-TOHP•' ANEZIS ADDRESS 215 NEWBURY ST 1530
(NO I ISTREETI (CONTR-SLICENSE)
CITY 'ERDODY STATE MA ZIPCODE 0 1.960 TEL NO. 5V) 1 - El
PERMIT TO NEW BIUILDING
(_) STORY ONE FAMILY NUMBER OF 1
(TYPE OF IMPROVEMENT) NO )PROPOSED USE) DWELLING UNITS
AT(LOCATION)
0021 AP,PLEPY ROAD ZONING(NO, (STREETI DISTRICT
BETWEENAND
(CROSS STREET) (CROSS STREET)
SUBDIVISION MAG 03 LOT 0034BLOCK LOT 0018421 SO FT
BUILDING IS TO BE FT.WIDE BV FT.LONG BV FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS INSTALL FOUNDATION d DUILD NEW SINGLE FAMILY DWELLINr_, AS GER PLANS.
AREA OR 110, IZIQI QI PERMIT
VOLUME BE;.�_ it:?I
ESTIMATED COST FEE
)CUBIC/SQUARE FEET)
OWNER ANEZ I S JOHN R
ADDRESS 99 BIRCH STREET BUILDING DEPT.
By L. E. T
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET.ALLEY OR SIDEWALK OR ANY PART THEREOF.EITHER TEMPORARILY OR PERMANENTLY.ENCROACHMENTS
► ON PUBLIC PRUPtHIY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE.MUST BE APPROVED By THE JURISDICTION.STREET OR ALLEY GRADES AS WELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE
REQUIRED FOR ALL CONSTRUCTION WORK: POSTEDUNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR
1.FOUNDATIONS OR FOOTINGS. ELECTRICAL,PLUMBING AND
2.PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS.
MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
3.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
I 1 1
2 2 2
BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT.INSPECTING APPROVALS
1
OTHER CITY ENGINEER 2 2
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. AS NOTED ABOVE. OR WRITTEN NOTIFICATION.
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NOTE.' ASSESSORS' HAP 3 . LOT 34
THIS PLAN IS NOT TO BE USED FOR TITLE INSURANCE
PURPOSES NOR FOR RECONSTRUCTION OF PROPERTY LINES. ZONIN6.' R1 (RES/DENT/AL. ONE FAM/LYJ
REFERENCES'.
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CERTIFI Ali OF OCCUPANCY
' t�1 CITY OF SALEM Issued: ,?//,? ' Permit x:563 95
SALEM, MASSACHUSETTS 01970 City of Salem Building Dept.
DATE - - - 19 D"5 PERMIT NO. -
APPLICANT ' ' - ADDRESS S 1 Pi C:. .
(NO) (STREET) (CONTR'S LICENSE)
CITY - ''- STATE "�-( ZIP CODE "-1 '' TEL.NO.
NUMBEROF
:._ty 1-,I 17 ^1 Tra:'i �'AiE 11- 'i,M i'`•;: L
PERMIT TO " ---' STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
?iiCli_'.'. I-1L� 'lJ l-1� ZONING
AT(LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
pl A.E LOT °-`2''`F BLOCK SIZE—
SUBDIVISION
BUILDING IS TO BE FT.WIDE BV FT.LONG BV FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS. _u :f� l_ _ , _)'vit.i._II d I li_`joA'i CIIJ " _ fir-r L._L?' rj -'ER PI_r ��iE„ _
AREAORc 7�'Ai', PERMIT
@@
VOLUME ESTIMATEDCOST$ t. FEE .P�_
(CUBIC/SQUARE FEET)
OWNER -}i',)¢_7 ll'i..l F-1
BUILDING DEPT.
AnnRFSR .. ., .. .1. 1....1'i _; : ,._.,.-.I _ BY
(3 °' CITY OF SALEM BUILDING
SALEM, MASSACHUSETTS 01970
PERMIT
DATE C.'i_ 0E3L ".i
__ 19 _ PERMIT NO.
APPLICANT 1-'I Jt i;,l `{i�l,kcdi`..' ADDRESS l ') _t-.ItiL i � t
(NO.) (STREET) (CONTR'S LICENSE)
CITY STATE ZIP CODE ' - - - TEL.NO.
?.ir", ._ fi( 'DIVE :'Pdeil!—Y NUMBEROF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
AT(LOCATION) x' ( :i. 'i i?-"-''__c EIY• ';O 4l ZONING
DISTRICT(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
SUBDIVISION iYIR•' ,'o3 ). l07 SO FT
BLOCK SIZE -
LOT
BUILDING IS TO BE - FT.WIDE BY FT.LONG BV FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: , 11 :., ;� '=F'Iti" '.'ice L : 'i(�-� c� 1-(J'v'tii�i' i'�L.I '9 G:J t�i.'G'1_EBY 'ill PS r'ER i_, NS'
�_t i .�.
Li!! for "Per-Mia to.�;up
AREA OR AJ,V V =
�w I,"; i:h PERMIT
(CUBIGSOUARE FEET) ESTIMATED COST$ FEE
VOLUME
OWNER BUILDING DEPT.
ADDRESS -:r.-� '^ C I T' 7P't-T BY L. he 7
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS
ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE
REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR
t.FOUNDATIONS OR FOOTINGS. ELECTRICAL.PLUMBING AND
2.PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS.
MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
3.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
L f7
BOARD OF HEALTH GAS INSPECTION APPROVALS $R�REDEPT.ASPECTING APPROVALS
OTHER CITY ENGINEER 2 V - � `�f� 2
WORK SHALL NOT PROCEED UNTIL THE [AS
MIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS T STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION NOTED ABOVE. OR WRITTEN NOTIFICATION.
The Commonwealth of Massachusetts
Board of Building Regulations and Standards. CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mm•2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
IVVV�lll One-or Two-Family Dwelling
This Section For Official Use Only
t Building Permit Number: Date Applied:
I Building Official(Print Name) Signature Date
ql SECTION 1: SITE INFORMATION
1.1 Property Addr-A* 1 n 1.2 Assessors Map& Parcel Numbers
ai
1.1 a Is this an aecepte street? Y6 K 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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNER�ISHIP'
2.1 aAV-1P f(tecor{1s Col ��Gm , m a 0(y I7
U
Name( not .} �{ City,State,ZIP
al AI�PIQIai �G` j;v(3-g32-y-Iao
No.and�� Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
(' U t a t
SECTION 4: ESTIMATED CONSTRUCTI N COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ I U 6 l,'� 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) $ i List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
p�,I Check No. Check Amount: Cash Amount:
�7
6. Total Project Cost: $ d t) 1.�4 ❑Paid in Full ❑ Outstanding Balance Due:
5 CN� -r p �l • C7•
SEt�rt R- -) 112
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) -7 't T^7
Re�nu.N0 License Number l Expiratio Da e
Name of CSL older
iXTVcWAS C4 List CSL Type(see below)
No.and Street Type Description
01 U Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted 1&2 Family Dwelling _
City/ ,Statil 11p M Masonr
y
RC Roofin•Covering
WS Window and Siding
qy�r-}a_035 � SF Solid Fuel Burning Appliances
1 Insulation
Telephone Email address D Demolition
5.2 Registered ome Improvement Contractor(HIC)
LOCLAJ Home COvl 5-
HIC'Registration Number xpir tion Date
HIC Compan Nante r HICs[rant Name
� zGurnnlP2t riehQ -cho,.(one(� s"rP• 10we3.c m
No —d's r • .^^1 v 1,7 7 Email address
City/Town, State,ZZI tt„�`f' 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
1,as Owner of the subject property,hereby authorize `01'lP
t a on m behalf, in all matters relative to work authorized by this building permit application.
of
P nt wner's Name Elec[ome Signature) Date
SECTION 7b: OWNER[ OR AUTHORIZED AGENT DECLARATION
By entering my name )elow I hereby attest under the pains and penalties of perjury that all of the information
I
t in in th' appI c do is tr a and accurate to the best of my knowledge and understanding.
-7' 6 •I,6m Owner's or Authors gent's Name(Electronic Signature) 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.rnass._ov/oca Information on the Construction Supervisor License can be found at w�_uv/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"
r
7
$
The Commonwealth of Massachusetts MY OF
Board of Building Regulations and Standards SA LEM
rIt Massachusetts sachusetts R�visedVlar 2011
State Building Code, 780 CIVIR
nstruct, Repair, Demolish a
Building Permit Application To Co Rair
- , Renovate Or
60 One-or Avo-Family Dwelling
This Section FOLOLCm se OnlCJ y
Building Permit Number. Data an ie d
_
—Building OtTicial Name). Date Sipature,
LD
SECTION 19 SITE I NFOII IVIA 116M
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
7
Number
CD
,
1,1 a Is this an accepted street9 yes no Map Number Pawl Number
1.3 zoning information: Property Dimensions:
Zoning.District Proposed Use Lot Arm(sq ft) Frontage
1.5 Building Setbacks(R) cf�
Front Yard Side Yards Rear Yard
- Requimd Provided Required Required Provided
J
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.9 Sewage Disposal System:
IV -(M Zone: outside Flood Zo--' site disposal system E3
[Public 710private 0Municipal❑ On
SECTION 2: PROPERTY OWNERSHIP)"
Check If es❑
2.1 Owner$of Record'? lv\, Iq �L)
Q'r t ,-'� 4 ro FIJI
Mtme(print) City,State,Z
i - 9/
el6f_ 78 -7 VY
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK](check all that apply)
New ConstruedBuilding 0 Owner-Occupied pairs(s) Alteration(s) 13 Addition 13
Deni I olition [3 Accessory Bldg.Cl 1 Numberof Units Other 13 Specify:_
Brief Description of Proposed Work a, 14-
Z 17 0 D
SECTION 4:ESTIMATED CONSTRUCTN COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building 1. Building Permit Fee*S, Indicate how fee is determined:
n Application Fee
2. Electrical s
C3 Total Project Cost'(Item 6)x multiplier x
3.Plumbing S P Pther Fees: S
2
4.Mcchanicil (EIVAQ List,
5. Mcc=al (Fire
Sup re 4 z Total All Fces:,10"
Check No. Check Amount: Casl�Ajnount:
6.'rotai Project Cost: S d Paid ill Full 0 Outstanding Balance' Due:9" 0 6 I L
1A
V
SECTION 5: CONSTRUCTION SER ICES %
5.1 Construction Supervisor License(CSL) 13
License Number E.Xplration Uate
Nanie of CSL flolde '-7 s List CSL type(see below)
—S
Ty Descn t*
-Type' Plan
No.arid Street /Q-r L3✓ U Unrestricted(Buildings up to 35,000 cu.It.
R Restricted l&2 Family Dwelling
city1rown,State,ZIP 'M Masonry
RC Routine Covering
WS Window and Siding
V
S
SF Solid Fuel Burning Appliances
0, V3� I - I ,1 1 InsulaDemoltion
Telephone Email address D
�H AIQ
- 3
Improv,5.2 Registered Home "t ontractor(HIC)
HIC Registration Number Expiration Date
HIC Coin Ngie C R*Yz�Naflitro
J"n diiKC
No.and Street n Email address
-. �Cityrrown.State.ZIP 3 Telephone
SECTION 6:WORKERS'.COMPENSATION INSURANCE
NEVWCE AFFIDAVIT 152.4 2$C(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 Istuance of the building permit.
Signed Affidavit Attached? Yes_....'..:.C3 No...........0
SECTION 7a.OWNE4 JTHORIZATlOr4TOBE.COMPLETED..WHEN
OWNERS AGENTOR CONTI.A.CT ESIORBUILDING.PERMIT"
—P6 � ' �
t,as Owner of the subject propertyI (Y) r �,
hereby authorize �20f
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
SSE Co t -L—
P—rint Owner's Name(Electronic Signature) Date
'SECTION 7b:OWNEFORAUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contain ication is true and acqyrate to the best of my knowledge and understanding.
contained in this
P 7 'w'
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:-
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
t. (not registered in the Home,Improvement Contractor(HIC)Programyj will g_yt 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
Information on the Construction Supervisor License can be found at 3,vw%v.niass.-,ovA1vs
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) N .(including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Nuinbcrol'bathroorns Numberoflialf/baths
-rype of[,citing system Number of decks/porches
Enclosed Open
"rype o'coo'""sy"O",
1. "total Square Footage may be substituted for rotal Project Cost"
14
A
7 -s �f
o'4 d3 '1 4
The Commonwealth of Nlassaclulsetts INSP CTIO�t{ %RVI ES
Board of Building Regulations and Standards SALENI
(Massachusetts State Building Code, 780 CNIR lei% PRiig,511,90 8
n Building Permit Application'ro Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date App '
Building official(Print Nome). Signalpre Date
SECTION 1:SITE INFORb1AT10N
I.I Property Address: 1.2 Assessors Map 8r Parcel Numbers
21 Appleby Road 3 34
1,1 a Is this an accepted street?yes�3 Ito_ blaP Number Parcel Number
i
1.3 Zoning Information: 1.4 Property Dimensions:
15 000 6R `
q ) Frontage(I1)
Lot Area(s It
Zoning District Proposed Use
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❑ On site disposal system ❑
Public Cl Private❑ Check If yesCl
SECTION2: PROPERTY OWNERSHIP 1'
2.1 Ownerl or Record:
Robert W Sgroi Salem, MA 01970
)nse(Print) City,State,ZIP
21 Appleby Road 978-744-4109 SalemMA@aol.com
No. msd Street Telephone Gnail Addrcsg
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition Cl Accessory Bldg.Cl Number of Units_ I Other Qrspecify: Shed
Brief Description of Proposed lyork': -e �I
P acement of a shed in backyard -
0 Sited' size is 12 ft by 16 feet and is manufactured by Reeds—Ferry Inc.
It rr 50rJA i U6'�Es H w bws TrNl
SECTION 4: ESTIMATED CONSTRUCTION COSTS laPAZA44ta
Estimated Costs: Offlcial Use Only
Item Labor and Materials)
I. Building S 5200.00 1. Building Permit Fee:S indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical 5 ❑Total Project Cost](Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
L Mechanical (HVAC) 3 List:
5.;\lathanical (Fire rot al All Fees: S
Su ressiun)
Check No._Check Amount Cash:\mount:_
6. Total Project Cost: 5200.00 ❑Paid in Full Cl Outstanding Balance Due:_
Z 131 , AJ,Y , °N1^IT'1?4?NI SECTION 5: CONSTRUCTION SERVICES
5.1 Cuustruf[ctiornr Supervisor License(CSL)
S — q�j� 1I�( License Number Expiration Dale
•! C
Name of CS Holder List CSL Type(see below)
Type . 'j Description
No. and Street
U Unrestricted(Buildings tip to 35,000 cu. tl.
R Restricted 1&2 Family Dwelling
C'itylrown,State,ZIP NI Nfasonry
RC Rooling Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 Insulation
'rcic hone Email address D Uemolitiun
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
I11C Compmy Name or HIC Registrant Name
No. and Street Email address
' cityrrown,State ZIP fete hnnn
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...........0
SECTION 7a:OWNER AUTHORIZATION TOBE COMPLETED WHEN`' '
OWNER'S AGENTORCONTRACTORAPPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's N:wte(Electronic Signature) Date
SECTION 7b:OWNEW 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 tot best of mr knowledge and understanding.
908ar J)�rwr Lam? WMI
Print Owner's or Authorized Agent's Nante(Electronic Signature) 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 rro have access to the arbitration
program or guaranty fund under NLG.L.c. 142A.Other important information on the HIC Program can be found at
www.mass. v� b''Oln Information on the Construction Supervisor License can be found at svww.ma;s.nov:'dL
2. When substantial work is planted,provide the infor ition below:
rural fluor area(sq. It.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq. it.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
rype of heating system Number of decks/porclics
Type of cooling system Enclosed Open_
3. "Total Project Square Footage"nary be,ubstitutcd for 'rot:d Project Cost"
i
ISupplemental Information for Shed Permit
Robert Sgroi, 21 Appleby Road, (978) 744-4109
Page 1
Shed to be placed in backyard behind home.
Location will be 5 feet (minimum) from rear property line and at least 18 feet from
northeastern property line.
Shed size is either 12 X 16 feet, or, 12 X 18 feet, and will be purchased from
Reeds-Ferry Inc. (Hudson, NH).
Provertv Line
----------------------------------------i
� e
o �
HOME i
i Drivewav
L---------------------------------------�
Propertv Line
Robert Sgroi /�7 ' 4_____
i
CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
120 WASPUNGTON STREET,3'FLOOR
TEL. (978) 745-9595
FAx(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR TrIOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMNUSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date y 3 �y// 4 �J Y� �/ /�
Job Location °� l /4101 CACO�/f� /"P1/
Home Owner Address 2 ! � 'f-f6cr/ V
Present Mailing Address .2z 14MEfi7y I"
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 that 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 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 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
Supplemental Information for Shed Permit
Robert Sgroi, 21 Appleby Road, (978) 744-4109
Page 2
The following footing layout (SonaTubes) will be utilized. These diagrams
were provided by Reeds-Ferry Inc.
-- 7'•9 3/4' 7'-11 114'
5'-10 1/2'
I19'-7 13116"(To Confirm square)
I
5'-10 1/2"
3 Center tubes"A"to be 1 1/2'lower than outer
tubes to accommodate pressure treated 2x6.
12' x 16'
6'-5 3/4" 5'.4' --- 5'•11 114"
_T 5'-10 1/2"
21'-3 7/16' (To Confirm square)-
"A' "A" 'A" "A'
5'-10 1/2"
4 Center tubes"A"to be 1 1/2'lower than outer
tubes to accommodate pressure treated 2x6.
12' x 18'
Robert Sgroi �� / �//
I e - Iq - 10-21, -0- q f7i
'fhe 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 Avo-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
4 6 S
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors clap&c Parcel Numbers
21 Appleby Road 03 0034
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
18,295 68
Zoning District Proposed Use Lot Area(sq R) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Cl Private❑ Zone: _ Outside Flood Zone'?Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownerl of Record:
Robert & Kimberly Sgroi Salem, MA 01970
Name(Print) City,State,ZIP
21 Appleby Road 978-744-4109 SalemMA@aol.com
No.and Street "Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction ❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Altemtion(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ PN u Other ❑ Spccily: _
Brief Description of Proposed Work':
Installation of a Pellet Stove in cellar. Cellar has a poured cement
floor and has a walk—out door/slider to backyard. Supplemental
information is attached.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1. Building Stove $ 1900.00 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard city/Town Application Fee
2. Electrical S ❑Total Project Cost!(Item6)x multiplier x
3. Plumbing S 2. Other Fees: $
4. iblechanical (I-IVAC) $ List:
5. klechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:_
6. Total Project Cost: $ 2300.00 ❑ Paid in Full ❑Outstanding Balance Due:_
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
t
License Number Expiration Date
Name of CSL Holder
List CSL Type(nee below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu. ft.
R Restricted 1&2 Family Dwelling
Citylfown,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or I11C Registrant Name
No.and Slreel 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
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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 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(FIcetronic 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
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.uov/dos
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.) Flabitable 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"
it
1
Supplemental Information for Pellet Stove Permit
Robert Sgroi, 21 Appleby Road, (978) 744-4109
The stove will be in the cellar at the rear of the house, slightly to the right of the mid-
point.
The cellar floor is poured cement/concrete and has a walk-out (sliding glass door) to the
backyard.
The external vent will be positioned more than 4 feet (horizontal and vertical) from any
door or window. Rock/gravel is in place in the area (outside) below where the vent will
be located.
The stove and vent will be installed per the manufacturer's guidance.
SLIDING GLASS DOOR WINDOW
TO BACKYARD
Ep=,
STOVE
(FRONT OF HOUSE)
QTY OF SALEM, NWSACHUSETTS
t� lid'
BUILDING DEPARTMENT
3 -y fiYxs 120 WASHNGTON STREET,31D FLOOR
n TEL. (978) 745-9595
FAX(978) 740-9846
KINIBERLEY DRISCOLL
MAYOR THOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
S
Date /�,�
Job Location o9 / r7/ 19LAEel
V nJ4(-C1"V /'�I OI ZZO
Home Owner Address
Present Mailing Address
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 that 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 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 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