20 ALBION ST - BPA-11-702 DEMO HOME l`
L—T —
The Conunonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 730 CMR, 7"'edition OF SALE.Revised Junuarl,
Building Permit Application'ro Construct, Repair, Renovate Or Demolish a 1• -'oox
One-or Two-Family Dwelling
/ This Section For fficial Use Only
Building Permit Number: Date Applied: 1 i
U Signature: ) 1 L '
Building Cu issione s ctor of Buildings Date —�
SECTION I: SITE INFORMATION
1.1 Propertyo Address: 1.2 Assessors Map.4r Parcel Numbers
-mo �a,�
I.Ia Is this an accepted street'?yes ' no Map Number Parcel Num •r
1.3 Zoning Informatio 1.4 !Pyoperty Dimensions:
Tuning District Proposed Use 'Lot Area(sq It) Frontage III)
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❑ Private❑ Check ifyes❑ p p _ y
SECTION 2: PROPERTY OWNERSHIP' ylI 2.1 Owner'of Record. r �1 `L
S 1J X r lY�� Y��lJ
mt) Address for Service:
S-o'7
tore Telephone
'SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials
I. Building $ I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard Cityrrown Application Fee
2. Electrical S ❑Total Project Costs(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
_ 4. Mechanical (IIVAC) S List:
5. Mechanical (fire
i Suppression) $ � Total All Fees:S
Check No._Check Amount: Cash Amount:
6.Total Project Cost: S ❑Paid in Full ❑Outstanding Balance Due:
w� ��
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) /v
License Number Jla—pimltion Date
Name of -I IuWe
List C'SL l'vpe Ism below)
/'/�', Tv Description
dres 0/DCti ll I Iinrestricted(up to 35,000 Cu.Ft.)
e ` It Restricted 1 2 FamilyDwellin
Signs r M %lasonry Only
RC Residential Rooting Covering
I clephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
IIIC Company Name or IIIC Registrant Name Registration Number
Address
Expiration Date
Signature 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.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1, ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
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. 1 a2A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I 10.116 and I IO.RS, respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Ilabitable 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 he substituted for"Total Project Cost"
o CITY OF SALEM9 MASSACHUSETTS
•�� '� PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM. MASSACHUSETTS O1970
TELEPHONE: 978-745-9595 EXT. 380
FAX: 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
Section 116.0 S I�llC,l L � gtti11 c
DEMOLITION OF STRUCTURES
Structures over fifty (50) years old must have approval of the
Salem Historic Society
UTILITY DISCONNECTIONS REQUIRED
Authorized Agent Date of Disconnection
Water `/Hr Fr, ao 4p4s�l'uri ,,.
(see attached requirements)
I?`b - 61 q- Elf Its
ElectricalvgNew OQrS7 s'+.
Fire -7777
Health oj1 b• `14�- lt��a / `' 1,' \\.�`\
Yftitr/. 12
arA Y
Sewer rh F�. !20st,yk%
Salem Historic Commission
Dig Safe Number b I
Pest Control: i►'T
***DOCUMENTATION OF ALL THE ABOVE MUST BE ATTACHED BEFORE
PERMIT CAN BE ISSUED***
Fee for Demolition $5.00 application fee plus $2.00 per 100 square ft gross area,
Minimum $25.00
,",- Dew b �� 5Qc-c�fi CC- 0
nationalgrid
40 Sylvan Rd
Waltham MA 02451
March 3, 2011
Joseph Salamone
PO Box 2015
Wakefield, MA 01880
RE: Service Removal for Building Demolition.
Dear Joseph,
This letter is.to confirm that, per your request, National Grid has confirmed electrical
service and meters have been removed from 20 Albion St. Salem, MA on 2/28/11. If you
have any questions or need further assistance, please feel free to contact me at (508) 357-
4668.
Sincerely,
Christian Paquette
Customer Order Fulfillment
nationalgrid
nationalgrid
March 29, 2011
Joe Salamone
Re; 20 Albion Street_ Salem_ Ma.
This letter is to notify you that the gas service located at 20 Albion Street, Salem, Me
was cut off in sidewalk on 3/28/11.
If you have any questions, please feel free to contact me @ 781-907-2930
Sincerely,
Diane L. Stevenin
Customer Driven Construction
diane.stevenin@us.ngdd.com
781-907-2930
781-522-1056fax
40 Sylvan Road E-2
Waltham, Ma 02451
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
LC WAiI IIN(v IONS IRUT 1 S.\I I'M. `t.\S.i'v III SI 1.1S)IIV-
Tfl:WIS-74 9i95 • FAX:978J40-9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # _ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
l l 1, S 150A.
The debris will be transported by:
(narne of hauler)
The debris will be disposed of in
��D�N�r�•1 g�}bt.
(none of facility -�—
(address of(facility)
signature o permit applicant
date
Jehi i u(1'due