68 BARSTOW ST - BUILDING JACKET � w
Q Z45 '14"s 1-k 1�t - O 125
mQ The Commonwealth ofrviassachusetts RECEIVE
WBoard of Building Regulations and Standar(NWECTIOi�AL S_R`d�J�g OF
Massachusetts State Building Code, 780 CMR SALEhi Rev�isef(�ar1011
Building Permit Application To Construct, Repair, Renovate ��bli�h�i L
�n One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number. Date PPlied: w .
Ah
-Building Olticial(Print Name) Signature• Date
SECTION 1.SITE INFORMATION:,
1.1 Progarty Address: 1.2 Assessors Map&Parcel Numbers
1.In Is this an acce led street9 yes no Map Number Parcel Number
1.3 Zoning Information' IA Properly Dimensions:
Zoning District PniposeJ Us6 C� Lot Area(sy R) Frontage(11) ..
i
1.5 Building Setbacks(R)
Front Yard Side Yarilp' Rear Yard
ReyuimJ Provided -Required Prmmided- .Required Provided`
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 18 Sewage Disposal System
Zone: Outside Flood Zone? Municipal O On site disposd system ❑
II'
Public Private O. — Check if "es❑
SECTION2:: PROPERTY OWNERSHIP!'
2.1 Owners of Record: <A cif /0714 o i-1 7 F7
✓l`� - l� f f�J
tT�me(PrinO - City,State,Z P
70
No.and Strect Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner•Occupied ❑ Repairs(s) ❑ Altemtion(s) O Addition ❑
Demolitiun 1 ❑ 1 Accessory.Bldg.❑ I Number of Units_ 1.0ther O Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Itcm Estimated Costs: - Official Use Only
Labor and Materials : -
1. Building S I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Tgwn Application Fee.
2.Electrical S l7 ❑Total Project Costs(item 6)x multiplier x
3. Plumbing s 0 24 Qther Fees: $
4.Mcchanical (FIVAC) S - 0 List: C-�
5.i\[cchmtic 11 (Fire S Total All Fees:S
Su ressiun)
Check No. Check Amount: Crash Amount: I
G.Tutul Project Cast: S ❑paid in Full ❑Outstanding Balance Due:
SECTION 5: CONS'rRUCITON SERVICES
5.1 Construction Supervisor Liecnse(CSL)
License Number Expirdtion Date
Name of CSL Holder List CSL Type(see below)
Type :... `: - Description .
No.and Street e s
U Unrestricted BuilJin Lip-l0 35,000 cu.It.
R Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masonry
RC Roolin Coverin
WS Window and Sidinit
SF Solid Fuel Bunting Appliances
1 I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Espirution Date
HIC Company Name or HIC Registrant Name
No.®id Street - Email address
Citvrrown.State ZIP Tele hone
SECTION 6:WORKERS'COMPENSATION.INSURANCE AFFIDAVIT(M.glI c.152.§ 25C(ot,.
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this nffidavit will result in the denial of the Isivance of the building permit.
Signed Affidavit Attached? Yes..........O No...........❑
SECTION 7aeOWNER AUTHORIZATION.TO HE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES 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 Nance(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,)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.
��®// /d 2 7 �S
Print Owner's or Ath orizcd Aamt's Name(Electronic Signature) I 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 Contrnctor(HIC) Program),will uu have access to the arbitration
— —• —
program or guaranty fund under M.G.L.c. 142A.Other important mform on on the HIC-Ptagram can belotnd�- --
w�v'oca Information on the Construction Supervisor License can be round at www•.oass.aov/dns
2. When substantial work is planned,provide the information below:
'total floor area(sq. R.) N (including garage, finished basementlattics,decks or porch)
Gross living area(sq. tt.) 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
1. "rota) Project Square Footage may be substituted for•Total Project Cost"
dq a
CITY OF SALEM, MASSACHUSE M
BUILDING DEPARTMENT
120 WASHINGTONSTREET,3" FLOOR
TEL. (978)745-9595
F
KIMBERLEY DRISCOLL, FAX(978)740-9846
MAYOR THomm ST.PIERRE
DIRECTOR OF PUBLICPROPERTY/BUILDING COIaffSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date r e Z7 / S�
Job Location �R s .9�87rr� S1
Home Owner Address
/A�
Present Mailing Address 1 r /j✓)iE37a+ S7
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
CITY OF SALEA MASSAaA)SETIS
BEnDn cDEPAR7MENr
120 WASt>QCMNS7REET,3=ROOR
UL.(978)745.9595.
FAX(978)740.9846
K71vJ8ERLEYDRiSQ7LL
MAYOR 7MMASSTAIM
DIREcrcut cFpLmLTCPRmm/BuaDmBONER
Construction Debris Disposa/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 c40,S 54; Building Permit g is issued with the
condition that the debris resulting from this work shall be disposed of in a property licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
(name of facility)
3 0 s7�
(address of facility)
Signarfure of applicant
.ate
City of Salem Sign Permit Application Worksheet
RECEIVED
25-Oct-15
INSPECTION,^,L SERVICES
-
Jolie Tea Company
106 Essex Street 2015 QJ 21 A ID 49
Zoning(res/non-res) B5 V 5-2-
Entrance Corridor(YIN) N
Lot frontage 53 feet
-- Building or tenant frontage 46 feet
( #of businesses on site 2
Bldng dist from street center <100 feet
Multiplier 1
uiwo e' s y"€ 4_ t $sa.�
maximum area permitted 46.00 sq ft
Il I total proposed sign area 7.00 sq It
sign 1
Sign length 36.00 inches
height 28.00 inches
sign 2
length 0.00 inches
height 0.00 inches
sign 3
length 0.00 inches
height 0.00 inches
sign 4
length 0.00 inches
height 0.00 inches
sign 5
length 0.00 inches
hei I
ht 0.00 inches
�_ tat�i9ili`
maximum area permitted 32.50 sq ft(per side)
maximum#of signs permitted 1 signs
maximum height permitted 12.50 ft tall
sign 1
proposed sign area 0.00 sq ft _
length 0.00 inches
height 0.00 inches
proposed sign height 0.00 ft(approx)
sign 2
proposed sign area 0.00 sq It
length 0.00 inches
height 0.00 inches
proposed sign height ft
Application meets standards set
forth in the Salem Sign Ordinance Yes
Recommend approval Yes
,
.r •a Permit Number
i
APPLICATION FOR PERMIT TO ERECT A SIGN
NOTE:BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN Is ERECTED
1 Location, Ownership and Detail Must Be Correct, Complete, and Legible
Salem, Massachusetts
Date
To the Building Inspector:
The undersigned hereby applies for a permit to (Erect, ❑Alter, ❑Repair a sign on the following described buildings:
Street Address Zoning District
A., �� ❑ Urban Renewal Area o,Entrance Corridor
`lw" 1 ❑Historic District dNone
• Rfsys;l��►�S w� Use of Building
Telephone �. 8 . 40 15 floor CO 94 A4 Wa C4A.L.
• M L4l5-1P4 CdMp+V%J � 2 floor <ZE'1)1000-mT—
Address uy MAOI V floor leeilDe",(nki,
Telephone �( . 3ff. (..(p 11 4 floor
E-mail &K fp8® cdm G -iT-."¢T How many businesses are in the building? 7/
If a corporate body, name Frontage
of responsible officer
RUM �i �,(,}} Building C� linear feet
Construction Sup's License No CS - 0 3 7.g 7. Applicant's Space(if multi-tenant) 1,y linear feet
Address 5 V) cj;e L,_" 4&Arp ieOCr[pOyT I Property linear feet
Telephone I Mail Sign Permit to
E-mail f7Sign Owner u Sign Erector o Other:
. - are proposed,
Si Proposed
n 1 Sign 2 Si n 3
o Surface ❑Surface ❑Surface
uAight Angle to Building ❑Right Angle to Building ❑ Right Angle to Building
•Free Standing ❑ Free Standing o Free Standing
❑Awning ❑Awning ❑Awning
❑Portable(A-Frame) ❑ Portable(A-Frame) o Portable(A-Frame) _
❑Other(specify) - ❑Other(specify) ❑Other(specify)
Sign Materials Pv G Sign Materials Sign Materials
Sign Dimensions 56 u x 2 p �r Sign Dimensions Sign Dimensions
Sign Area C �y Sign Area Sign Area
'I s n s Its it
Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
Existing Signs
Type Sign Area To Be Removed? Sign Owner
❑Surface sq n ❑yes ❑no
❑Right Angle to Building sq It ❑yes ❑no
❑ Free Standing sq n ❑yes ❑no Sign Owner' tl d e entattve
e<wning sq It �s ❑no �•
❑Other(specify) sq It ❑yes ❑no
Property Owne
Internal Review
P!dWing&Community Development Department Historical Commission
Approval
Building Inspector
W2ano..
`# 4
d
erOLIE
T A
If; o tPAN}
COMPANY u
we
,df
Commonwealth of Massachusetts I
City of Salem
120 Washington St,3rd Floor Salem,MA 01970(978)746-9695 x5641
" Return card to Building Division for Certificate of Occupancy - -
FEE PAID:
: o.$0 B-15_18, PERMIT TO BUILD
FEE PAID: $0.00
'DATE ISSUED: 11/2/2016
This certifies that RAI PROPERTIES, LLC
has permission to erect, alter, or demolish a building , _105-LIS2 ESSEX.STREET Map/Lot: 350282-801
as follows: Signs SIGNPERMIT'AS APPROVED FOR: 'JOLIE TEA COMPANY
N_
t V
Contractor Name: MICHAEL E. CLAY
DBA: CLAY SIGN
Contractor License No: CS-0371.20 s
11/2/2015
Building OfficiaK Date
r This permit shall be deemed abandoned and invalid unless the work authorized by this permif Is commenced within six months after issuance.The Building Official ,
! may grant one or more extensions not to exceed six months eachupon written request
ii
All work authorized by this permit shall conform to the approved application aad the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any,�building and structures shall be in compliance with the local zoning by-laws and codes.
t t
'I 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. f '
t
_ The Certificate of Occupancy will not be issued until all;applicablesignatures by the Building and Fire Officials,are provided on this permit.
"Persons,eontractin with unregistered contractors do not have acces to the guaranty fund" as set forth in.MGL c.142A
HIC#: 1082889 9! a 9 tr ( )
Restrictions:
Building plans are to be available on site.
All Pemtit Cards are the property of the PROPERTY OWNER.