BAKERS ISLAND - BUILDING INSPECTION (38) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
!/ ) Massachusetts State Building Code, 780 CMR, Tn edition OF SALEM
"wwy� Revised Ju uory
h Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 2008
I One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied: . tv
Signature: sw
IBuilding Commiss ned Inspector Moss Date
S CT 1:SITE INFORMATION
1.1 P e Addre / Ah ! of 1.2 Issgrp Map& Parcel Number
1.1 a Is this an accepted street?yes_ no Map Number 6Parce umber
1.3•Zoafa laformatloo: t 1.� Property Dlm sions:
�� V � y 0 2
Zoning District Proposed Use Lot Area(s 11) Frontag (ll)
1.5 Building Setbacks(it) )S
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❑ Private Zone: _ Outside Flood Zone?Check if ycsCI Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O e t of R cord•
( -3?f/VD 'Q de
Name(Pri Address for rvice:
w. ?ou�,&NO1930 9 -W 9
Signature Telephone ��
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition RY
Demolition a Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Pro osed Work':
SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials) Official Use Only
I. Building S C)o I. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S ❑Standard Cityrrown Application Fee
❑Total Project Cost'(Item 6)s multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (B List:
S List:
5. Mechanical (Fire S
Suppression) Total All Fees:S
Check No. Check Amount: Cash Amount:
6.Total Project Cost: S C�]-�('
✓ �`L' 0Paid in full ❑Outstanding Balance Due:
f I
SECTIONS: CONSTRUCTION SERVICES
5.1 Llceq�7Cons ruction Supervisonr�(CSSL) R-5—
11lJJjlJ � Gw License umber 17x'piimtion Date
Name of CSL-ItolJ List C'5L Type Isee below) I/J/C I—C
tr'l' Q✓ Descri lion
r
:\JJres�s 1! /7 O ZQ u Unrestricted u to 35,000 Cu.Ft.
R Restricted 1&2 FamilyDwelling
Signature M Masonry Only
RC Residential Rooting Covering
-fclephone /fin o �ny WS Residential Window and Sidin
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registe om Im rov mentContractor(HIC)
111C Co y ame HIC Reg -trant Name Regi'stmli e u tber
Add / , Gspimtion Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 Iss ante of the building permit.
Signed Affidavit Attached? Yes ..........25 No...........O
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
SEC IO OWN t OR AUTHORIZED AGENT DECLARATION
1 /Otm��& ,as Owner or Authorized Agent hereby declare
that thestate me is and in ati�the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name t /'r Q,
!i
Signature of Owner or Autnord6d Agent Date
Si ed under the ains and nalties of 'u
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 rro have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 11016 and 110.115,respectively.
?. 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.) Habitable room count 6
Number of fireplaces J Number of bedrooms 4
Number of bathrooms Number of half/baths D
Type of healing system Number ofdecks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage'may be substituted for"Total Project Cost"
i
CITY OF SM EMs NLISSACHUSEM
BLELDLNG DEP.tRT!iLLrNT
120 WAAMNIGTON STREET. r Roos
'I1+L (973) 74&9595
Rtx(97r� 1�96N
KINCBEnEY DRISCOLL TltOhtAiST.PBIItRs
\MYOIL DIRECTOR Of PL BLIC PttOPERTY/n BDLVG COM0Sf10-*i ER
Workers' Compensation Insurance Arfldaeit- Builders/ContractorWElectrlclan&iPiumbOn
%liallcant Information
14010C Itluarw�rOrtamrsjno'nlnSrrduallt
Addmss-
Cily/ststNZi(C NM o as M T�a — 2a UT
.\re you se onspMyv!Cbscb the appropriate boat Type of project(requtrM:
1.Cl I am a cmpbya with 4. Q I we a Passel cossees e,and 1 6 ®New coasstrcting
employees(fwl and/or part-tims).n have hired the eab novae
1.Q 1 am a sole proprietor,or pertner- listed on the anschod ahead: It. Q Remodeling
:hip and have no employes Thus sub•comtaemn have a. Demolitias
working for ms in ANY capacity, workers'comp.imoaaos. 9. Building addition
I No workers'comp insurance S. ❑ We am a cooperating and is
otykas how eaareiaed their 10.❑Electrical repairs or additions
ream a h l ri of MOL 11. Pltimbin or additions
),� I am a honrwwner Doing all work YM ��per ❑ g�rs
myself.(No workers'comp. a 132.11(4),add sus haw nis 12.0 Roof repsire
insurance required.l r elnployeas.LNe workers' 13 Other
comp Waialeale!tequiseii.)
;Any applkan tti sass"eaa et mule AM no cal 11r aasUer derive dtsariy 4011 waAee'owAwowdow patsy faawwrle�
'I Ilrlwfirtwo who ru6wa eb aAld"idlaud"they an doing all mark and des hie Wain caaaara ntwr mama a now dffd wb witsd.6 err\
T,wtroam Ilia Aweb ilia bw r*ud jewhd M VJAUWd ahaa dowlty lea IMM ilea APb a* tarlala ad drab wa.awe'raw7.polry iabwrYW
1 nae ae eeryloys that k puvidwR workers'cew/rwsadee Joursaw for eq eay/oyara wino/s/AePNk7 eedM slat
in/ortwat/lets
Insurance Company Name:
Policy 4 or Self-ins.Lie.e: Expiration Dote:
Job Sire Addrese: City/SlaWZip:
.\mach a copy of the workers'coupoesuloo peEey docimilm pap(abowing the pallet'somber sad eaplradm dW)v
Failure to sa'euta coversp as required under Setting 2JA of MGL t 132 can lead to the imposition of criminal penalties are
/ine up to S 1.500.00 and/or one-year imprisonmaerl ere well as civil penalties is the form of a STOP WORK ORDER and a floe
Of up to wo.0o a Jay against the violator. Ile adviwd hats copy ur this atatemcm maybe furwarded to the wince or
Invc,ugatiuns of itto nlA for insurance coverage vcritleatieth
/de hereby certify under e i s find y rides a/oer/wry Aer fib inferadllw provided above above is are find a w►eat
�r.nurl: 1)ute /7�1J� Za 20A)
c a
P`II a ay- Zdal z��
OJJ7cie!w,e wI/y Oa not wrint in this wreq,to be,slwy/eted by city or rewe,01AI d
City orruwn: Ycrmit/Lltensel__
Isruing.\whunly(circle line):
I. Iluard ut IlraUb 1. Rwlding Department I Cilytrown Clerk 1. Electrical 6trpector 1. rluntbina Inspector
6.thher
.l..,all act reason: _ _ _. Phone a:
I
CITY OF SALEM
PUBLIC PROPRERTY
�. DEPARTMENT
1'.II: WIN f l "111v I'I 1
LC WAN10.1-ON)1'11kri )•11I 11,St.\K\1ill J I,•.1'1
rrl:'13•714.1W5 •1:%X:'/7/•74,'P44A
Construction Debris Disposal. Affidavit
(required l*or•all demolition and renovation work)
In accurd:mtx 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 N is issued with the condition that the debris resulting from
this work shall the disposed of in properly Licensed waste disposal facility as defined by MGL c
S I50A.
The debris will be transported by:
I none of hauler)
The debris will be disposed or in
(n:unt ul aci rty
,
addrero 1,1 taclu y►
vynalure of Iwlrmit,IpplicaM
dale
April 20 2010
Scope of work at Cottage of Robert Leavens, Map 46, Lot 89 at Baker's Island, Salem, Ma.
See drawing attached
Existing Porch roof to be supported and posts, railings, decking, deck framing and underpinning to be
removed in phases.
Demolition to be removed to approved transfer station on mainland
Phase One to be east porch
Phase Two to be west porch
Phase Three to be north porch
Phase Four to be south porch
New footings to be placed-poured concrete 4' deep or to ledge. If to ledge, they will be pinned
New pressure treated posts to new code dimension pressure treated framing for new decking
New decking to be 1" X 6" tongue and groove Ipe face screwed
New 4" X 4" Ipe posts to roof
New stairs at Northwest corner-pressure treated and Ipe to land on concrete pad
New handrail and balusters to code, with some sections possible code glass instead of balusters
Although I Robert T. Leavens possess both a valid Massachusetts Construction Supervisor's License and a
valid Massachusetts Home Improvement Contractor's License, this work and permit will be applied for
conducted as the homeowner. I will receive no compensation for this work.
i S;9 hEUI �
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Card 1 of 1 t�pfPrM� �o YP1Vr1 �� �� U
Location S ISLAND Property Account Number 11 Parcel ID 46-0089-0
Old Parcel ID 11 --
Current Property Mailing Address
Owner NOT AVAILABLE City
State
Address Zip
Zoning R1
Current Property Sales Information
Sale Date 1/1/1900 Legal Reference 6629-246
Sale Price 0 Grantor Seller LEAVENS ROBERT T
Current Property Assessment
Card 1 Value
Year 2010 Building Value 43,800
Xtra Features Value 300
Land Area 0,234 acres Land Value 88,500
Total Value 132,600
Narrative Description
This property contains 0.234 acres of land mainly classified as One Family with a(n) Camp-Seas. style
building, built about 1911 , having Wood Shingle exterior and Asphalt Shgl roof cover, with 1 unit(s), 7
total rooms ,4 total bedrooms , 0 total baths , 1 total half baths , 0 total 3/4 bath (s).
Legal Description
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