74 BAY VIEW AVENUE - BUILDING JACKET --74 B JP\U F-
No. � City of Salem Ward /
s
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all Items In sections:1, ll, 111, IV,and X.
ZONING
I. AT(LOCATION) L GV SII L1,-J DISTRICT
LOCATION
OF BETWEEN AND
BUILDING (CROSS STREET) lcnosstLOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING -All applicants complete Parts A-D
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,If any,In part D, 13) 19 ❑ Chruch,other religious
13 C] ..
Two or more tem. Enter number ❑
3 ❑ Alteration(See 2 above) at unite....................._......... ... _. _.....
. .
... 20 Industrial
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory. 21 ❑ Parking garage
Enter number of units ........................... 22 ❑ Service station,repair garage
5 ❑ Wrecking(lf multifamily resMentla,enter number 23 ❑ Hospital,Institutional
of units in building in Part D, 13) 15 ❑ Garage 24 ❑ Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
26 C] School,library,other educational
7 ❑ Foundation only 17 ❑ Other-Specify
27 ❑ Stores,mercantile
S.OWNERSHIP 28 ❑ Tanks,towers
8 ❑ Private(Individual,corporation,nonprofit 29 ❑ Other-SpecifyInstitution,etc.)
B ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nonresidential-Describe In detail Proposed use of buildings,e.g.,food Processing plant,
machine shop,laundry building at hospital,elementary school,secondary school,college,
10. Cost of Improvement .._.........__. g parochial school,parking garage for department store,rental office building,office building
.........._......__......._. at Industrial plant If use of existing building is being changed,enter proposed use.
To be installed but not included
In the above cost
a Electrical.........................._.........................................
_
b. Plumbing......................._..........._............................_...
c. Healing,air conditioning......................_..._._...........
d. Other(elevator.etc.)....__......_..._._......................
11. TOTAL COST OF IMPROVEMENT is O
III. SELECTED CHARACTERISTICS OF BUILDING-For new buildings and additions,complete Parts E-L;demolition,
complete only Parts J&Mall others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL
30 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air
31 ❑ Wood frame 36 ❑ Oil 41 ❑ Private(septic tank etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45E] No
33Relmorced concrete 3B Coat H. TYPE OF WATER SUPPLYby
34 ❑❑ ❑ Willthere es an elevator?47 ❑ No
Other•Spetity 39 ❑ Other•Specify 42 ❑ Public or private company
43 ❑ Private(well,cistem)
J.DIMENSM. DEMOLITION OF STRUCTURES:
48. Numbberero of stories ............................................................
49. Total square feet of floor area, Approval all floors,based on exterior Has oval from Historical Commission been received
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.ft.........-............................. Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed...........................................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoors......................................................................._... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed............................................_.............................. Electric:
Gas:
54. Number of l=ull............................. Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial ........... BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No (If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ No �If please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No
Is property located in the S.R.A.district? Yes_ No
Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No (If yes, submit documentatioNlf no,submit Board of Appeal decision)
If new construction, has the proper Routing Slip been enclosed? Yes_ No_
Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation)
Massachusetts State Contractor License # Salem License #
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX (6) MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street,city,and state ZIP Code Tel.No.
14 1127
Owner or
JOS7v 7 —k7
Lessee
2.
Contractor
Builder's
No.
No.
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signature of applicant Address App cation ate
y
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 Fire Grading
Building ClPermit Fee $ / Live Loading
Certificate of OccupancyApproved b
$ Occupancy Load
y:
Drain Tile $
Plan Review Fee $
T E
NOTES AND Data- (For department use)
O L-, L 00 Alt-
L
Ne v
00 e,
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: Completed by:
P \
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
oN
CITY OF SALEM
3UILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE /-0)
JOB LOCATION
Number 11 street address Section o1!�own
"HOMEOWNER C_5j_6g/LI ' ��T �Zi�P/� 7�� ' �75'D
Name Home phone Work phone
PRESENT MAILING ADDRESS 7/
Sa�� jlilc�c� �C
City/ own State Zip Code
The current exemption of "homeowners" was extended to include owner-occupied
dwellings of six units or—Tess—and to allow such homeowners to engage anin-
dividual for hire who does not possess a license' provided that the owner
acts as supervisor. (State Building Code Section 109.1 . 1
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends 1:6 -re-
side,
ore-side, on which there is, or is intended to be, a one to six 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 shall be res onsible
for all such work performed under the building permit. Section 109. .
The undersigned "homeowner" assumes responsibility for compliance with the State
Building code and other applicable codes, by-laws, rules 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 willcomply with said procedures and requirements.
HOMEOWNER'S SIGNATURE_ ��
APPROVAL OF BUILDING OFFICIAL
'10TE: Three family dwellings 3 .000 cubic Veet. glarcer/ ,-iill be required
.o comply with State Buildina Code Section 127.0. Construction Control .
HOME OWNER 'S EXEMPTION
The Code states that: "Any Home Owner performing work for which a building
permit is required shall be exempt from the provisions of this section
(Section 109.1 .1 - Licensing of Construction Supervisors) ; provided that is _ —
a Home Owner engages a person(s) for hire to do such work, that such Home
Owner shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations- -s-
for Licensing Construction Supervisors, Section 2.15). This lack of aware- ;
ness often results in serious problems, particularly when the Home Owner=
hires unlicensed persons. In this case your Board cannot proceed against"
the unlicensed person as it would with licensed Supervisor. The Home owner
acting as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,
many communities require, as part of the permit application, that the Home
Owner certify that he/she understands the responsibilities of a supervisor.
On the last page of this issue is a form currently used by several towns.
You may care to amend and adopt such a form/certification for use in your
community.