10 BEDFORD ST - BUILDING JACKET '' i
�10 BEDFORD STREET 366-14 �
�is#: 96so ,_� COMMONWEALTH OF MASSACHUSETTS
Map: 10 ' � ',i'
�io�k: CITY OF SALEM
Lor. � 0149 �
Category: Refurbislunent
PE=�t# 36�-14 ' BUILDING PERMIT
IProject# JS-2014-000824�
Est Cost: $SQ000.00
Fee Charged: $355.00
Ba�ance Due: $.00 PERMISSIONIS HEREBY GRANTED TO:
Const�Class: � Contractor: License: Expires:
;Use Group: ,,.. Andrew Ambrose .
Lot Size(sq. ft.). 10000.0692 �j
•-�—�-jOwner: Michael Becker
IZonmg: ; R1 e �, .,
��Jnits Gamed�" � - �,� .;.�, �AppliClint: Michael Becker '
� tiits Lost �" '" �' �" " � �AT: 10 BEDFORD S'1'REET �� - y
Dsg Safe#: ` � ' °� -
fSSUED ON: 05-Nov-2o13 AMENDED ON: EXPIRES ON: 04-May-2014
TO PERFORM THE FOLLOWING WORK:
GENERAL REHAB: NEW WALLS,NEW FLOORS, INSULATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plombin� Building
Undergiround: Underground: Underground: Excavalion:
Service: Me[cr: Fmtines:
Rnugh: Rough: Rough: Fuundatiun:
Final: Final: � Final: Rough Frame:
Fireplace/Chimney:
ll.P.W. Fire Health
� � Insulation:
�7eter: Oil:
`ie � � Final:
fio�ise# Smoke:
;t;';:�'. � � Treasury:
WafEr: Alarm: ASS¢5501'
�Sewer: Sprinklers: F°���' �
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
_ Signature:
� FeeType: ReceiptNo: DatePaid: CheckNo: Amounh
BUILDING REC-2014-000830 30-Ochl3 1050 $355.00
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� Che Common�vealth of Nlassachusetts
x � ��� Bo1rd of Duilding Regulations and Standards CITY OF
� Massachusetts Sta[e Building Code, 780 CMR SALEM
a
Building Permit Application To Construct, Repair, Rznovate Or Demolish a �evi.red,Nur?0/l
One-or T�vo-Fnrni(y Dwelling
� This Sectian For 0fficial Use Only :.
[3uildingPermit Number:
Dnte:Applied:
l3uilJing Olticial(Print N,une).� , . � � � :�.
. . . � ��� Si6mture�� - , .. . Date -
SECTIOY(:SITE INFORiV1ATION'
(•� P o�erty.�dress: � � � �
__i���,o����C�''� 1.2 Assessors bl�p,4� Parcel Nwnbers
c♦
I.la Is this an accepted street?yes_ no_ blap Number Parcei Number
1.3 'Loning Information: L4 property 1.19mensions:
"Luning District Propured Ua�—
Lot Mea(sy fl) Frontage(It)
IS Building Setbacks(R)
Front Yard Side Yartis
Re uireJ Rear Yard
9 ProvideJ Reyuired provided
, Requircd Provided
I•6�Vater Supply;(M.G.L c.J0,§54) l.7 Fload Zone►nformation: 1.8 Sewnge Disposal Sysfem:
I'ublic❑ Private❑ Zune: _ Outside Flood Zone?
. Check ifyes❑ Municipnl � On site dispoval system O
SECT[ON2; pROPERTYOWNERSHIP!
2. vner�o eord: —�.._ y . . . �
� � /_�cS��/ d//���!/O/✓ ��/�
�hme(Print) Ciry,St�te,ZIp
Nu.miJ Str�et �
Telephone Lmaii Addras
SECTION 3: DESCRIPTION OF PROPOSED�VORK'(check all that npply)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s)� Alter�tion(s) ❑ Addition ❑
Demolitiun ❑ Accessory Bldg, ❑ Nuntber of Units .
�rief Descr' tion of Proposed\Vurk': — Other ❑ Specify;
SECTIOY.{: ESTIDIATED CONSTRUCT[OY COSTS
Itcm Estimated Costr.
Labur und i��aterials) Officiul Use Only
I. �uilding � I. Building permi[Fee:$ (ndicate how fee is determined:
2. Electrical S �Sf.�ndard�City/TowrtApplicationFee-
3. Plumbing ,� ❑Total Project Cost�(Item 6)x multiplier r
?. Other Fees: S �
4. ��fech:micnl (HVrAC) $ LisC
5. i\�fechanir.d (Fire
Su ressiun) � "CuGil All Pces:.�
G. Tut:�l Project Cost: iZD �{� � Check No._Check:lmount: Cash Amount_
[/U� O P;iid in Full ❑OuGt�nJing O�lance Due:
.- _ � � < � .�.�...�_
�
�
, 3
SECTIO`I 5: CO`lSTRUCT[ON SERVICES � ;
� � �� �
j,l Cunstructimi Sup�sor License( SL) � E� imti� !
�—T—� /� �� /���� Liccnse Number P
���f a ci
Nnmc of CSL Holdcr LiA CSL'Pype(s�e belo�v)�--
c�l- /��,/ �T � � '.'� � Description . .
ir�ti i.ri�Ul!/'�—� —
c
N�.;md Strect ` i!iZ� � Unrutricred �uiWin s u l0 35A00 cu. it.)
� / �y.� T� R ResVicted 1&2 Famil Dwellin
6/� �� �t m�,so�
City/Ca�vn,State,"LIP R� 2ootin Cuverin
. µ�g Nindow anJ SiJin
gp Sulid Fuel Burning App��1nces
. _ _ ��i�,��`` . .. :.:. . ....... _ .. l Insulation .
� `6't/ T p Demalition
Tcle hmie Emml address . .. ._ � � � �
5,2 Re ist d tlome Im vement ContractoF`(ttlC) ' �� irulion D:�te
/ , ��. �/V C — kllC Regislralion Number P
. ����C:i,�i�;��ry N:un������r°�Nui rn� 9�� . . . .
J Email udJress
�_ `����-
No.�n�et/ //'� . . .
` Tele hone . . '-.
Cit /Town,State,ZIP
SECT[ON 6:WORKERS'COMPEIVSATION[NSURANCE AFF[DAVIT(M.G C.c. 152.§Z?C( :
Workers Compensation Insurance affidavit must be completed and submitted with this app��cation. Failure to provide
this aftidavit will result in the denial of the Is'suance of the building permit.
Signed Atlidavit Attached? Yes ..........
No...........❑
SECTION 7n:OWNER AUTHORIZATION:T0 BE COhIPLETED W k(EN:
O�VNER'S AGENTOR COIVTRACTOR APPLIES FOR DU(LDING PERNIl1''
c-. / .�. /�. _ _�`/' ��
l,as O�mer of the subject property,hereby authorize �� ^
tg act on nty behalf,in all matrers reiat��vork a'ehor�ed by this building permd appl�cat�n.� /3 /�
�� /r7 S — Date
�"�.:��� i !'� / �_�—y
Print Owner's Nmne(Eleuromc SignawreJ
SECTION 7b:O�VNER�OR AUTHORIZED AGENT DECLA[LITION
6y entering my
name below, 1 hereby�attest under the pains and penalties of perjury that all of the informntiun
contained in this app��cation is tme and accurnte to the best of my knowledge and understandmg.
� L� �<l>P�r� �z�3-.�3
Dum
Print Owner's ur Autlwrized r\genPs N.une(L'Iccvomc Signauire)
�ares:
I, An Owner�vho obtains a building permit to do his/her own wurk,or an`ol'I'�t`hava ac ess to'�the arbitrationtractor
(not registered in die Home Improvemen[Contrxtor(NIC)Program),
pwsvam i�s.������:tylnfar�m:�t an on he Constru tiOn Supervisor Li efnse c.�n be t undFat wP���»��i?5��n��t
� Z, \Vhen substmitial work is pl.�nned,provide the into(n,do�'n���(�ge tinished bnsemenVattics,dccks or porch)
Potal tloor area(sq• ft.) Habitable room cawit
Gross Iiving nrea(sq. ft.)�--- �ii�»ber of bedrooms
Number of tireplaces Vumber uf half/bnths
Number uf bathrooms �umber of decks!porches
'fype oFhcating system�-- Bnclosed___.----Open
"fypc of coolin�systein
}. "1'otal Projzct Square Fuolage"�nay be substiurted ti�r"Cotal Project CosP•
;;"`eY CI"I'Y OE S:1LE�,I, l��-1SS.�CHL'S.ETI'S
, �t�r
BtiICDNG DEP.�ftT\(E.�iT
� 4 � �J'��� 1?O\X/.�SHL�]GTON S'IREET, 3�D�.00R
��� 'I�z,. (978) 745-9595
1 � F.�.�c(978) 740-98�6
Kl\BERT F.Y DRISCOLI.
�L�1YOR TrtohUs Sr.PiE.exs
DIRECTOR OF Pl'BLIC PROPEATY/BCII.D[�IG CO�[JIISSIONER �
Workers' Cmnpensation (nsurance Aftiduvit: Duilders/Contractors/Electricians/Plumhers
a i ilicant Informatinn Ptcase Print Le i61 j
RUCTION
,V,unc u3�s��,�,,.o�����a��;,,ti�i��i����i�,�n: 845 WnRURN STR€€T -
IMIMINGTON, MA 01887
,�dd��,s: 9T8 6�•#96w
City/State/Z.ip: Phone !t:
' A,r-c,y�ouan�em�iloyer?�Checkthe�appsuprixteDox: 'iypeofproJcct�(requtre�)i ' .
I.��am a cmployer with 4. Q I arn a gcncral contractor nnd I 6 .
employees(full anJ/or pa�.• . have hircd thc sub-contracmrs ❑Ncw cunswction
Z.� 1 am��sole propricror or p:uiner- lis�ud on ihe auached�hect. � �•�emadtlin�
.hip anJ have no cmpioyccs These sub-contracrors have 8. ❑ Demolition
working for mc in any eapacity, worl<ers'comp. insur�nca 9. � puilding adJitiun
(No worken comp. insurance 5. ❑ Wa are a carpnration mid iu �
rcquircJ.]
o(ticcrs have exercised th¢ir �0.❑ Electrieal repairs or additions
3.0 I am a homcuwncr doing all work righ[of cxeinplion per MGL l 1.0 Ptumbing rcpuirs or udditions
mystlE(\o workcrs'cump. c. 152,§I(4).and wc havc no 12.❑ Raof rcpuirs
insurdnct reyuired.)� � empluyees. �l�`o workers' . �g,0 O(her
. �cump. insurance n:yuircd:J .
•Any upplic:mi tlu�dmckabox HI muxi alsu fill uw tha xciiun 6clowshowing iheir wodai cumpenraiun pulicy inliirmaliun. .' . ..
�I Lwnenw��w�s whu wbmi�this�ffld�vii india�ing ihry arc dainW all work and ihen hire uu�tide coNmctma mm1 mihmil a new a?;Javil indialing xuch
�(:.�nim.iun�hulch�ski6i�buamwtanach.slana�4liiibmlxherlshuwin�Ilumm�cohhexubKonlnetonanJihcirwohcro'mmp.pulicyinfu'ma�ian. � � �
!um un entp(uyer 1Gut is provlding�vorkers'rontptusadua insuruncr jor my e�npluyers. !3e(oiu!s flie po(Icy mid fab a�!!p �
injonuurinn. �j
Inwrance(:ompanyVame:�i��.�_�.y(iS �'
I'aliry i}ur Srif-i�ur. Lic. d: �t/�3_Z��.3 �/.3 Enpiration Dnte�3 �T � �
Jub 5iie A�dress: �D �v��/"�S� Ciry/State/Zip'C��f"H '
,�ttach a copy uf Ihe�vorieers'compensatlon pulicy decluutlan page(shawing the policy number and exp(rotlon date). �
F'�iluro w secure coveraga as requireJ unJer Sce�ion 25A of�1GL c. 152 can Iead to the nnposieion ofcriminnl penalties of a �
rinc up�o S 1,500.00 unJ/or one-year imprisnnmcnt,as wcll as civiPpcnaltics in thu fortn uf n STOP WORK ORDER anJ n linc I
nf up eo S�.i0.00�Jay against iha viulame 13e advised�hat�c��py of this ztatement inay be forwardcd to ihc Ol'licu of �
Invrsiigu�ions of Aia nIA for insurancc u>vcngc vcritication. . .. . . - '
/do hrreby crrtijy«iider�hr pulns miJ �anallirs ojprrjury dm�dm i��junnudua providaJ�Guvu is�rur mtd corrrcG '
,�,��,���,��__�� ��-���� �,,t-�� /3
PFnnc�t: ���6 �v� -
OfJiciu!use only. Dn�i�i�!rv�ile in Nii.r urru,'W be cuurp(eled by city arlown nJJiciut � - .
�, . , .,., . .
_. . . � ..., . �q . . . • .
City nr'P�i�vn: _..__.. . � Permit/I.lcense p .
--'--._—. ...---__. .. - .�
._. . . . ... .._.._— ,
Issuing Autlwrily(circic unc): ` .. � .
I. 6oa�d uf Ilealih-2. I7uilding Depardnent .i.Ci�y(fnwu Clerk J. Elecfrieal L�spcctur 5. Plumbing Inspeuor
b.Othcr _.._--
Conlacf Pcnnn: . _. . .__ Phane M: �
�
LL` ^ +M2`�vF7, ur�a�s"' � a � c � i �
a .������ �� k� ka�s .�+ �� , � �y� ryn'�`'"�x �-;�r '�` "�* i �53Y �����h`tl i'&t` �'1.hi `r .yMR �+ '
Z �! 14 t�JY4�;41 ✓4� x�� �.. ���».i ^f Ix��E t���.��.� ,.. ��}�`, .�°' P� a n,;,aa ' `�'�, r '"'�k`� . . � � '.,8°�j' i1 " �
�, �'ar,� 5a M �'yp�„y}sXt ��� i�t 'c,.Y Fi r ^x��C'�+ �v �d'�'p� �4"�"` `� r �.� � 4���i '� �i � � ¢ �.
� a . txa�' � n,� L :�3`�. iYi •�yS`� dR w '�,r x i A a a ���� ki ;w, t
���,� ��� �. $�+� � �`ty�, $� � ,ry'��ry 1 4 ,�. s" � +�� f � ��Ro t' f ���'�'� ����� ��"� � �i
� ...�h �'.i�` :,f•.e.. N �r�"#��� �`rr(�-m ?�' ����' b ti"x s�:���1. :�� �y�� r 0r. �y��. t �3 . A k`4 �
5 � �r� �� s��� q' ,,g' �j "P Q'� :{y'1 � � ��1 �
� ��������.�}���r�'�� '".�a ��.��a"'f� "Y.+� r ' 75�',��� ���y �yiq �,x �, �g �� .� viM ^�'�".
� a.� a T �.�7}+9.y b� 5v r{ � e °3' . °�L �'
t. T � �`�' fi �'�,fa�' �.� �4 s��.'� f"y �y��.4+t�r��" .�9�'f 4+ �. x '� �ry.�y� � 4
S'� � .:xL° .�'�c '� i'v �., a "r -r 4i j .,
t gS�, �
+�. t7x�,k4+"'�t-'}�i��.0 � �.-ar-�u}N'`R,�Yik���t-��"LF���;r �`i, ' J,, a ��7i � t�'��a �4 i¢ ix
•- •. � . � - , � . :F - � 5 N� ,� �.��y}' y� l� Xyl�y��}+I,2�;g�:
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. �
� � P,Iassachuse`�ts - ��eoartment of r'ubiic Sai=_?y
8oard of Buildin:� Regulations ar:d Star.dards . .
l.�n,�ru<ti•�n �up.�r`i.��r .
Licensa:CS-005387 :;�^K
�c � i: ��.
JOHN L SII.VE�IO ���.,
845 WOBIIRDf ST ,":%%•�;" . �
WII.MIlVGT9PIMA.'01887 =
! _
� J•'�^- �l�iS1 '' =::ai;at!or�
C,�r;rr,�s>��r,r• 04108/2014
� ���i,e �p fi d�CiG��zc�u�eG� �
����� Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Repistration: 106478
Type: Private Corporation
- ��cpiratiOn: 7l23/2014 . Tr# 226131
SILVERIO CONSTRUCTION CO., INC.
John Silverio
845 WORBURN STREET #5
WILMINGTON, MA 01887 �
� Upda[e Address and return card.Mark reason for change.
� Address � Renewal � Employment � Lost Card
SCA t wr 20M-05/n �
845 Wobum Street m Wilmington, Massachusetts 01887
978-694-4064 • 781-944-3219 � Fax: 978-694-4067 ■ www.silverioconstruction.com
�
- - -
.�
_�
December 13, 2013
Regarding: 10 Bedford Street,Salem MA
To Whom it May Concern,
I,Justin Silverio, trustee of 10 Bedford Realty Trust and owner of 10 Bedford Street in Salem, am
requesting that the building permit at said property be transferred to Silverio Construction.
If you have any questions, please contact me at 781-205-9850.
Thank you,
Justin Silverio
_ . . _ __.__.. �
� ' �.�o o�s -rt, ��c�- � y ,o.
� "fhe Conunomvealth oFMassachusetts � Q �
�'�� Board of Duilding Regulations and Standards CITY OF
i
bt,� N(assachusetts State Building Code, 780 CMR SALEM
Building Permit Appfication To Construct, Repair, Renovate Or Demolish a Revised,t/urlpll
One-or Tivo-Famrly D�ve!ling
This Section For O�cial Use Only :
13uilding Permit Number:
Date.Applied: �_ � :_ �
VE��i(�L.. �U .
Duddmg OQic�al(Pnnt N:une—�—'� � ' � Cj�'(�z.•�.y� �
� � ature•�f � .
SECI'ION L•SITE INFORi�(ATIOiY' Date
I.t PropertyAddress:
�' �,y��,e �C� 1.2 Assessors blap g p�rccl Yumbere
I.I a Is this an accepted street?yes no_ Map Number ,. �
1.3 'loning Inform;�fion; ��rcel Number
1.4 Property Dimensions:
Zuning District Proposed U��—'
Lot Area(sy ft) frontuge(It) �
�•5 I3uilding Setbncks(ft)
Front Y;vd S.�e Y�S
Reyuind Provided Rear Yard
Reyuired provided Re uired
9 Provided
1.6{Vnter Supply;(M.C.L a J0,§54) 1.7 Flood Zone Infarmntion: L8 Sewnge Disposnl System:
Public❑ Private❑ Zune: _ putside Flood Zone? �
. . Check ifyes❑ Municipnl p On site disposal system ❑
SECT[OM2: PROPERTYOWNERSHIP�
2 1 Orvner�of Reca � � � � � � �
��i.v� � �c���2 2 G�`:
ifame(Pnnt) SL"`--iA..s �'o�" ) f g U �
l� � ��� � Qry Stute,ZIP
No. mtJ Stn,ct
� 7�/'3��.�r��P C��n ,a �a.{{z
. Telephone Emml AdJresg ��
SECTION 3: DESCR(PTION OF PROPOSED WORK'(check all thnt app�y)
New Construction❑ Existing Building❑ OwnerOccupied ❑ Repairs(s) ❑ Alterati n(s) � Addition ❑
Demolitiun ❑ Accessory Bldg.❑ Nwnber of Units
� �rief Description of Proposed Work': — Other ❑ Specil'y;
�/ �
�
------__
SECTION a; ESTIi�IATED CONSTRUCTfON COSTS
Itcm Estimated Costs:
Labur aud blaterials Official Use.Only
�. [3uilding ,� �V�^ I. Building Permit Fee:$ Indicate how fee is de[ermined:
? �lectrical � ❑SL�ndard City/To�vn App�ication Fee�
3. Plumbing ,� ❑Total Project Cost�((tem 6)x multiplier r
Z. Ofher Fees: ,$ �
4. ��Icchanical (FIVAC) � Lish
S. i\lechanic:il (Pire
Su ressiunl � Tutal All Fees:,� -
C. Tuf:�l Project Cosh S Check No. Check Antount Cash r\mounh
�UU U ^ ❑Paid in Full ❑OutstanJing p�l:tnce Due:
'_ . _. j
SECT�ON 5: CONS'CRUCTION SERVICES y
j,l Cunstruction Supervisor Liccnse(CSL) ___.---- ;
---�-- Bs iretion Date
License Numbcr P 9
�
Name ot CSL Elolder List CSL'1'ype(sce below)_�— ,�
. ��YPe - :._��'� � -..- Descriplion . � �
N�.:md Street � Unr��tnctel Ouildin s u to 35,OU0 cu.il.) �
�t 2estrtcled t&2 Pamil Dwellin
y( Mnson
('�tyil'uwn,Smte,ZIP R� Rootin Cuverin
�yg Window an1 Sidin
SF Sulid Fuel Duming Appli�nces
� Insul�lion .
---�-- EinaiLiddress U D�molition
Tele hune
$,2 Registered Home fmprovement Contractor(HlC) FIIC Regist r Gspirut no1 D et
fI1C Cumpmiy Nnme a HIC Registrunt A4une
C•mail address
No.and Street -_
'Cele hona , , . �. � . � : '�. �
Cit /To�vn,State,ZIP
SECTION 6:�VORKERS'COhiPENSAT[ON INSURANCE AFF[DAVIT(M.C.L.c. C52.§ 25C( , .
Workers Compensation Insurance aftidavit mast be completed��5°ermitt��V�th this applicatioa Failure to provide
this aftidavit will result in the denial of the Is§uance of the buildin p
Signed Affidavit Attached? Yes ..........❑
No...........❑
SECTION 7a:O�YNE[i AUTHORI7.ATIQN:TO BE COMPLETED W NEN.
OW NER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT`
f,as O�vner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Dare
Print Owner's Nmne(Electronic Signamre)
SECTION 7ti:O�VNER� OR AUTtIORIZED AGENT DEC[.�1RATION
6y enterin�my name below 5��ue andtaccurn eeto hhe best of my kno�ledge and nderstandi se informntion
cuntame
Date
Print Owuer's o uthorited AgenPs Numa(Electronic Signature)
�o�res:
I (not registered inbhe Home Imp ovementtCo�tractor(NIC)Progrnm)nvillni�t�have ace,ess to'�the arbitmt on tr���or
program or�uaranty fund under hI.G.L.c. Id2A.Other important information on the H[C Progrnm can be founJ at
w�v�v.ma______ss."o�-'��°form�tion un the Cons'tmction Supervisor License can be Fo�md at w���+' �>>'_ �',_____i'_�b"�'���5
� 2. Nhen substa��tial work is planned,provide the info(n cfio�'n����f��e, tinished basemenVatlics,decks or porch)
Total tloor nrea(sy. ft•) Habitable room count
Gross living area(sq. tt.)�--- �iiinber of bedrooms
Number of fircplaces �umber uPhalt%baths
1 ,lumber uf badiroums �wnber of decks/porches
TYPe uf heating system___--.— flucloscd___._____..—Open
Type uf couling systent
}. ""Ibtal Project Sipmre Fuotage"m�y be subslituted fur"futal Project CosP,
I
1
`,���� � ��. CITY OP S��L,EI,t, ti�:1SS:ICHUSETTS
i � � � ,: �:. �CILDL\G DEP.�ft"['JLE�iZ'
�-,�� ` l?O 1(J:ISHCVGTON STRE&T, 3'°F'L002
�,` �h
�'"<� �"=' �L (978} 7d5-9595
F.�.r(978) 7-}a9845
Ki1tHERLEY D[ZiSCOLL
ti�AYO;t TF[OSL�S ST.PiE.QttS
DIRECTOEt UE PI;BLiC PROPERTY�HC'IID4�JG C0�0f155IO�EZ
_ . . w
�,'onstructiun Debris Disposal Aftidavit
(required for all dcmolition and renuvation work)
In accordance �vith the sixth edition of tlie 5tate Building Coda, 730 CD.1R section l t 1.5
Debris, vid die pravisions uf i�tCL c 40, S Sa;
Building Permit k is issued with the condition that the debris resulting from
this work shal! be disposcd of in x properly licensed waste disposul Facility as dc6ncd by ��IGL c
l ! (, S I SOA.
"I'hc dcbris wi11 be transportcd 6y:
y r
y - �c�..,�,�� � 1.�
(namc of hauler)
"Che debris �vill bc disposed of in :
�c"'i2��v-,/'�
(name of Yacility)
---��/ �'` L�
(aJdress of t?�aility)
i
signa ofpermitapplicaut
---�-2-�i�3
i�i���.,�i.,.,.
_--_-- _ ___ .
_ _. _ . __ __-------- _-, �
� `°,'� �r C�TY OF SALEM, MASSAC�NSETTS
,� �
�' '}, y�!i BUILDING DEPARTIviENf
t � f�
V`'� �o_ ,�,f ` � 120 WASHINGTON STREET,3"D FLOOR
J� c�� 'I�L. (978) 745-9595
FAx(973) 740-9846
KIMBERLEY DRISCOLL
MAYpR ZYiOMAS ST.PIERRE
DIRECI'OR OF PLJBLIC PROPERTY/BUILDING COMIvIISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date � ?' �'�' �' ��
Job location � !�VuV� S e` � � �I � � I
Home Owner Address T-
Present Mailing Address !�t� ��^-�� � �dl � ��-�S�o{� �.,e- o( �0�
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 euilding 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 WSPECTO I
� '"`°' CIZ'Y OF S:1I.E�f, 1�'L-1SS.ICHL'5ETI'S
;: ,
' BtiIIDNG DEP.�RT\(&�iT
,3 $����� l?0 C�/ASHL�IGTOV$"IRLET, 3AD FLOOR .
�,�� Tx1.. (978)7t5-9595
F.�r(978) 7�10-9846
K7��gFRi F.Y DRiSCOLL
�YAYOR THOhtAS ST.PIERR& .
D(RECI'OR OF PCBUC PROPEATY/HCII.DI\G CO\L�IISSIOV ER
�Vorkers' Compensation Insurance AtTidrvit: Duildcrs/Contractor9/Electricians/Plum6ers
:\ � ilicnnt Infnrmatinn ptcase Print Le ibl
V,IIt7C (Business.Or�anizatiun,'Individual): ���2 w'�'e �
Address l6 � c..,l�< <.. I`� '
Ciry/Statc/7.ip: � S�� v �� Phonelt: 7�'�3 �g"-� `t /
� Are you an employer7 Check the rpprupriate box: . 'Pype of prnf ect(requlred):
I.�I om a cmployer wi[h � 4. 0 I am a gencrai contcacior and I 6. ❑New cunewceion
�mployees(full and/orpan-time).' have hired the sub-conlracWrs
2.0 I oiu a sole propneror ur p.urtnur- lisiud on the attachcd.rhect.� �• ❑ a�modeling �
� .hip�nd have no employccs These sub-contreccors have 8. ❑ Demolition
�wrking ti�r mc in uny capacity. worl<ers'comp. insuranca 9, � puilding addition
(\'o workcn•' comp. insurance 5. ❑ Wt are a comoration and iU ,
requircJ.] . �
oificcrs have exurciscd thcir 10.� Elecrrical rcpairs oc addieions
3.❑ I mn a homcuwner doing all work righe oi ezempiion per MGL I LQ Plum6ing repuirs or udditions
myxlE [\o workcrs'cump. c. 152, gl(4),and wc have no �Z,Q 2oof rcpuirs .
insuranet reyuired.) � ¢mpluyeea.[A'o workers' . �3.0 Olher �
coinp.inxurancereyuircd:J .
•Any upplicml llut clucka hoz pl mwt aiw 61I uw Iha xclian bclow thowing Iheir wotkrn'compensaiiun puliry inliirm�liun.
�Ilomcowm.�n.vho.ubmit this affleL�vi�inJicming ihq�rc doink ail work and then hirc uWside cantmeton mmt euhmil a new a(f:davil indicating ruch
�(\�mmaun�hui ch�ck thi�6ua musl auach.d un a�Lliiiu�wi.he�!shuwiny ilm mm�.o(the mbKamnAon anJ iheir wohen'mmp.pulicy infurmmian. �
' 1 um urt eurp(oyer tHut is provlJinx�vorkers'caniprnsada�i�isurance jor my eurp/uyees. lie(aiv!s flie poflcy uxd Jub sile
i��jormution.
Invurancc Cnmpany Vame: _."".___
Puliry N ur Sclf-ii�v. Lic. d: __._ Enpiration Dme: �
� Jub Siit Address: City/State/Zip:
,\ttach v copy uf the worlcers'compensatlou puliey declarutlon page(shawing�he pollcy number and explratlon dn[e). �
Failure w xccuro cover�ge as mquireJ under Sec�iort 25A of MG[,c. 152 can Icad to the imposition af criminal penalties of a
tinc up�o SI,500.00 und/or one-year imprisonmen4�s wcll as civil penalties in th� fortn uf u STOP GVURK ORDER anJ u fine
of up co S'_50.00 a Jay�gainst d�e violacor. 13e aJvi,cil ehat a cupy uf this statemcnt may b�:fonvardcd to ihe 011ice of
lirvcstigwions�ii'd�e nIA for insuranct covtrigc verilic�liun. ,. . ... ..
/do lrzreb crrujy mr � e puln mltirs aJper%ttry Ihut!/�e iufurntu(lui�pr�viJed u�ove is Iru/r unJ rrect
>'�,,,i i U itc� /Z Z' (� �
I� 1 C i�: �/� �� �V ✓
OJ)iciu(�ae only.�Do nnf rvrirt in diix ureu, to be conipfeled by riry or rown nJJIe1uL
I City or'fuwn: _.._.. . .-- . Pcrmit/IJccnsc p •
------- ..._-- . .
_..._ . _..._.--
Issuing Aul6urily(circic unc):
I. �SO:If(I U(IIl`JI(Il Z. QIIIIlIIf16 UL`�)JI'1111L'llf .I.CIIY(�Urill CIClI( A. Electrieal lnspecfor 5. Plunibing Inspectur
�. OI�IL`f �
Cunlacf Pcrson: _ __ ____ Phonc 6:
�
�.
• ti �"
ZONING DISTRICT: R2
�, OF yAp_
� ,�,�
� NAL�WII�AH '��"i
� RpD w
No. 29422
N/F �FS � ��
STEVEN ASHLEY ��I CERTIFY THAT THE DWELLING IS � ,�,��j�'�
65 TREMONT ST. LOCATED AS SHOWN."
�+�``� PARCEL ID: 16-0308-0
��-C�--s �`���
RALPH W. REID P.LS.
N/F :
MICHAEL ZINDELL � � 3s•
� � � o NOiE: hIIS PLAN WAS PREPARED
& / 88• � FROM A TAPE SURVEY.
MICHAEL LAWRENCE LOT 33 \ \ ^ � ' ^ " �
12 GROVE ST. � 2 �
PARCEL ID: 16-0312-0 'rj� 423f S. F. � i
N� . a � �� GRAPHIC SCALE
� 1 1/2 STORY g� /� � o to zo �o eo
� � �33� ALUMINUM SIDEO ��J
� �
�
�
�
ly � / � ( IN F'EET )
� � � 1 inch = 20. ft
PROPOSED DECK \�`� 0
2�.3� x ,2. � �S SALEM , MASSACHUSETTS
,22 � �w PROPOSED DECK Pl�i�J PREPARED FOR:
- �`' NORTH VENTURES , INC .
8 GROVE STREET
� GROVE STREET � PARCEL ID: 16-0310-0
� , REID LAND SURVEYORS
� DEED REFERENCE: � 365 CHATHAM STREET � R/
BOOK 12720 PAGE 40 f LYNN, MASSACHUSETfS /� �
� �oT covERaGE: � PHONE �781 -592-2660
� EXISIING = 18.9% � R13-119
� PROPOSED = 21.8� LTS DATE: DECEMBER 16, 2013 SCALE: 1 "=20'
�' � -
� � '
�