5 BRENTWOOD AVENUE - BUILDING JACKET 5 Brentwood Ave.
Business Certificate
v6..Cow o (Urtp of *stem, Aingarbugettg
DATE FILED , I iIn 'P
Expiration Date Type: KNew
. --�-6k N)� 1 � 2.� 0 `� 0
NumbeRenewal, no change
r—��00 _ ) 7 j p Renewal with change
In conformity with the provisions of Chapter one hundred and ten, Section five of the Massachusetts General
Laws, as amended, the un ersig ed hereby declare(s) that a business is conducted under the title of:
.� )' /,— c: ;. C
at. S 'd /- fl--) ( CUC'C, r/ /4c�C Ll�iJ7 A/Tel #
type of business a + c i U
by the following named person(s): nclude corporate name and title if corporate officer)
Full Name/ _ Residence Tel. #
/ /
c= S /f/ t-7 �c�7a S� /r 3�a /
Si na
-- - - - ---- ---------
------------------
on t9=the above named person(s) personally appeared before me and made an
oath that the foregoing statement is true.
---C I T Y CLERK-
- -----------------------------------------------------
Notary Public
(seal)
Date Commission Expires
Tden[ification Presented
State Tax I.D. # S.S.
(if available)
In accordance with the provision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5, of Mass.
General Laws, business certificates shall be in effect for four(4) years from the date of issue and shall be
renewed each four vears thereafter. A statement under oath must be filed with the town clerk upon
discontinuing, retinng, or withdrawing from such business or partnership.
Copies of such certificates shall be available at the address at which such business is conducted and shall be
famished on request during regular business hours to any person who has purchased goods or services from
such business.
Violations are subject to a fine of not more than three hundred dollars ($300.00) for each month during which
such violation continues.
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Poxrb of �PprA
F�_ 28
DECISION ON THE PETITION OF CHARLOTTE A. SHEA FOR A VARIANCE
5 BREN
AT TWOOD AVENUE_(A-1 )
A hearing on this petition was held April 15, 1987 with the-'follow ing Board
Members present: James Hacker; Chairman; Messrs. , Bencal, Fleming, Luzinski and
Strout. Notice of the hearing was sent to abutters and others and notices of
the hearing were properly published in the Salem Evening News in accordance with
Massachusetts General Laws Chapter 40A.
Petitioner, owner of the property, is requesting a Variance from side yard
setback requirements to allow construction of a two story addition, namely a
one car garage with bedroom above. Property is located in an R-1 district.
The Variance which has been requested may be granted upon a finding of the
Board that:
e
a. special conditions and circumstances exist which especially affect
the land, building or structure involved and which are not generally
affecting other lands, buildings and structures in the same district;
b. literal enforcement of the provisions of the Zoning Ordinance would in-
volve substantial hardship, financial or otherwise, to the petitioner;
c. desirable relief may be granted without substantial detriment to the
public good and without nullifying or substantially derogating from the
intent of the district or the purpose of the Ordinance.
The Board of Appeal, after careful consideration of the evidence presented at the
hearing, makes the following findings of fact:
1 . There was no opposition to the plan;
2. The proposed addition would not be detrimental to the neighborhood.
On the basis of the above findings of fact, and on the evidence presented at the
hearing, the Board of Appeal concludes as follows:
1 . Special conditions exist which especially affect the subject
property but not the district generally;
2. Literal enforcement of the Ordinance would involve substantial
hardship to the petitioner;
3. The relief requested can be granted without substantial detriment to the
public good and without nullifying or substantially derogating from the
intent of the district or the purpose of the Ordinance.
DECISION ON THE PETITION OF CHARLOTTE A. SHEA FOR A VARIANCE
AT 5 BRENTWOOD AVENUE, SALEM
page two
Therefore, the Zoning Board of Appeal voted unanimbusly, 5-0, to grant the
requested variance, subject to the following conditions:
1 . All work comply with all requirements of the Salem Fire Dept.
2. Legal building permit be obtained; i
3. Construction be done as per plans submitted;
4. Exterior to conform with existing house;
5. A Certificate of Occupancy be obtained.
VARIANCE GRANTED
z
Peter Strout, Member, Board of Appeal
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK
FfiOih. TH!E` 5[CI:'IJN. P Al. . SHi.LL BF:i°.^DY'i P`{IN p0^DAYS AFTER SECTION
DATEOF FILING
GE't:R4L LAs'(S. CES.!=:ER 805, AND SHALL RE FC'Y.IT
SECi'1611. TF:E VAS!A's CE C. S°-•'n! __
OF 7H.S D° 'S' IN Th D F.CE C' THE C..� CLERY,
P .. TO <S ,rt ei. L IS. C-�°TER £.-. r S 'rE C F,T-
GP.A!(;ED hEREr.;, SHALL Nom' +'-- EFFECT JNTiL A CO-
SHALL
OF eF
FIC i.i1CN OF .HE CIT) CLERF; iHAi 'c0 DAYS HA,E ELVSED furD Ne AP?EAS HS 5-- DIS
GR THAT, IF SJC6 AN APPEAL HAS EE=R FILE. THAT IT HI,S tiEEN DIS:.:IS"EO GP, 0='t!EO IS
OF RECORD DIOR THE
s OTH REC
ORDED NOTED rONF7HEF0vti'NER'S1-S AND I CERTIFCATE OF TITLEL.INDE� THE . :tE OF THE OV�idEP.
BOARD OF APPEAL
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIMaERLEY DRISCOLL
MAYOR 120 WASHINGTON STREET• SALEM,MASSACHUSEr6 01970
Trt 978-745-9595 ♦ PAx:978-740-9946
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
4 f licant Information Please
Print Legibly
Name(Busiiwss/Organization lndividual): yle
Address: ) -r "',4 v
City/State/Zip: v /'L42 Phone 0: 122L 2%S _E-3
:t.re you an employer? Check the appropriate box: T}pe of project(required):
1. am a employer with 4. ❑ 1.am a general contractor and 1 6 ❑New construction
era to ees(full and/or rt talle).� have hired the sub-contractors
P Y P' 7. ❑ Remodeling
2.❑ 1 ❑m a sole proprietor or partner- listed on the attached sheet.: i
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9, ❑ Building addition
No workers'com insurance 5. ❑ We are a corporation and its
� P officers have exercised their 10.❑ Electrical repairs or additions
required.] n
- 3.❑ 1 am a homeowner doing all work �right of exemption-per MGL 11.❑ Plumbing repairs or additions
myself.(No workers' comp. c. 152, §I(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp. insurance required.]
-Any applicant that cheeks box it l most also lilt out the action W. showing their workuts'eumpensatiun policy information
'1 omcuwmn who submit this an5davit indicating they are doing all work and then hoc outside contmc 0m,mist submit a new affidavit indicaing inch.
:Conrmuxs that check this box must attached an additional sheet showing the mane of the subKcmtraaon and their workers'comp.policy infermadua.
1 ual on employer that is providing workers'compensation Laurance for sty employees. Below is the pulicy and job site ,
informution.Insurance Company Name: (/e�7
Poliev N or Sel(ins. Lio. Expiration Date: J
Job Sire Address: a0 f J City/State/Zip: 4
Attach a copy of the workers' compensation policy declaration page(showing the policy until crand expiration date).
failure to secure coverage as required under Section 25A of:vlGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1,500.00 and/or one-year imprisonment,us well as civil penalties in the form of a STOP WORK ORDER and a fine
Of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
in%Otigaliuus of the DIA for insurmlec coverage verification.
l do hereby certify unde the pains mr pe tics pa ury that the information provided above is true and correct.
Sienauue. - Date:
Phan•:T:
Official usb only. Do not write in this area,to be completed by city or town njf ieia t
City or Town: Permit/License 0--
Issuing Authority(circle one):
I. Board of Ileulth 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other _
�' Contact Person: . .. _-- Phone p:
i
CITY OF SALEM
�• �� PUBLIC PROPERTY
�� '� DEPARTMENT
KIMBERLEY DRISCOLL -
MAYOR 120 WASHINGTON STREET♦SALLN MASSACHUSE-ITS 01970
1Fi 978-745-9595 • FAX:978-740-9W
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: wi Building:
Property Address S—U K fG �� lS S
Property is located in a; Conservation Area Y/N Historic District Y/N - �
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: a
Telephone: — a cc,
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: ST/,�0 �q.��Jc✓ �,�5 �� /�
Mail Permit to:
What is the current use of the Building?
Material of Building? z/ If dwelling, how many units?
Will the Building Conform to Law? / Asbestos? l
Architect's Name
Address and Phone ( )
Mechanic's Name c CZ7 / �L el ,ram
Address and Phone t I9 rw mod i4 C� ,c—
Construction Supervisors License# 621 F 7.2 HIC Registration# ✓06_�S r/
Estimated Cost of Project$ Permit Fee Calculation
Permit Fee$ IY 'O Estimated Cost X $7/$1000 Residential
Estimated Cost X $11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above st d
specifications. Signed under penalty of perjury X
Date
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