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11 BRISTOL STREET - BUILDING JACKET - , _ - - � -- r ���.,r � � I �� g)jq ©Ir c, DEPT BOARDOFASSESSORS eft: 93 WASHINGTON STREET,CITY HALL,SALEM,MASSACHUSETTS 01970 (508)745-9595 Ext.2600`6 ('7 (508) 45 74918 FAX �� I Rpt:r IVcD � V CITY OF SAIEPfl ;AAS December 7, 1990 Mrs. Josephine R. Fusco City Clerk City of Salem Salem, MA 01970 Dear Mrs. Fusco: Please be advised that the single family home currently as- signed the official street address of 13 Bristol Street (Assessors' Parcel 1132-0241) , and also currently using 12} Clifton Avenue as a mailing address, has had its official street and mailing address changed to 11 Bristol Street, effective upon receipt. aly/ yours, Caron Chief Assessor PMC:mjg cc: Postmaster Joseph J. Leccese Chief Joseph F. Sullivan, Fire Department Margaret R. Hagerty, Principal Clerk, Water Dept. vW'illiam H. Munroe, Inspector of Buildings Engineering Dept. , City of Salem Mr. Richard M. Ives 4L1tt'1616 6T-BEfiL{-� APPROVED BY T*IE ASPZCTDB PRWR TP APES BEING GRANTED CITY OF SALEM � No. ,3y` '� � Data Dis Locat the Historic District?rty led In Yes No_ Uildion ing o Is Property Located in the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, epair/Replace Other: PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name ry Address & Phone // IS�� ,�' (977 y'V 0� ' Architect's Name Address & Phone ) Mechanics Name as Address & Phone / 3 C What Is the purpose of building? Material of bulling? It a dwelling, for how many families? Will building cordons to law? Asbestos? Estimated cost V?r city License• N A State-I-Joense x A �� _ Harae Iaprovettent Lie. a ignature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE �-- rS Ova � ca MAIL PERMIT TO: L r. No. 6 APPLICATION FOR PERM TO LOCATI PERMIT GRANTED F AP ROVFD ECTOR OF BUILDINGS a t The Commonwealth of Massachusetts f� F ° Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR DEC 8 ejsiqgfar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only (1 Building Permit Number: Date pplied: Building Official(Print Name) - Signature Date' SECTION 1: SITE INFORMATION L^— 1.1 Property,A,Ild% I 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 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: Public❑ Private❑ Zone: Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Ownett qf,R &* :5QI ` 1 6//�144� � Irtu 11 Name(Print) City,State,ZZ115 'Tr No.and Street� �� ele �1 r Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(cheek 911 that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) el Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other Specify: Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 11 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) i LicenseLicens umbeer Expi do e Name of CSL Holder List CSL Type(see below) No.and Stree� Type Description /�y� �, U Unrestricted(Buildings u to 35,000 cu.ft.) tiIL��,� R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding - �� � I Solid Fuel Burning Appliances I Insulation Tele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Regis" [ration Number E i Dale HIC Company Name or HIC RegtSfrant lame No. xSllStreet Email address Ci Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be com leted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc 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.. I,as Owner of the subject property,hereby authorize ( mgL74 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) ate SECTION 7b:OWNER[OR AUTHORIZED AGENT DECLARATION By en ring my name below,I hereby attest under the pains and penalties of perjury that all of the information conta d i thi application is true and accurate to the best of my knowledge and understanding. Print wner's or Authorized Agent's Name(Electronic Signature) Date NOTES: " L 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. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 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 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" ILA -(Q 3,S tos'5 The Commonwealth of Massachusetts q), Board of Building Regulations and Standards CITY OF Massachusetts State Buildin Code, 780 R SALEM g CM RE'CE1,VE© v l0_ $Revised Mar 2011 Building Permit Application To Construct,Repair, a One- or Two-Family Dwellin This Section For Official'Use Building Permit Number: D e Applied: Building Official(Print Name) Sigmture �Dafe l•^� SECTION 1: SITE INFORMATION S, 1.1 Proper Address: 1.2 Assessors Map&Parcel Numbers ( 4 ''� R�� c� t 5 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 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: Public❑ Private ❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recor f�(� `. JCy-�'en'1 - 1 ' .6- - Name(Printer City,State,ZIP t11Q =) /44201 In ri f-o, 789g9l0 W . Wnj No. and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIW(check all that apply) New Construction ❑ Existing Building 1T Owner-Occupied Cl Repairs(s) Q Alteration(s) Or Addition 1 ` Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: ,r P- Brief Description of Proposed Work 2: ,� C mph cr er t I %a-e o .� �ll eo(�S+-e!�,--�cGr r R��r/rv� Pr%t0 -r-ns=ra�irX�I= 1 r-h SECTIO 4:ESTIMATED CONSTRUCTION C TS Item Estimated Costs: Official Use Only GU{MPC/ (Labor and Materials 1. Building $ — 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ /1 a 9o _ ❑Paid in Full ❑ Outstanding Balance Due: SAD y orzl�sH((z� C( �vtra( Lt✓D t'z.I 1 (� SECTION5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) i00�,�2 / a7 /p a to Y)t 5 �&-ktl S License Number E ua[ion a[e Name of CSI,,Holder / O �jriCs t �- List CSL Type(see below) No and Street Type Description U Unrestricted(Buildings u 000 cu.ft. R 1&2 Family amil Dwelling ity/rown,state,ZIP Masonry Roofing Covering !�,q /,, �r�r�// 1/�f /� S Solid Window and Siding /O -0/O« `/2 ll h Q� /e,S� r�a1h I Insulation Burning Appliances Telephone Wail address D Demolition 5.2j�Registered Hot e)lmprovement Con actor(H�IC)1 1W n ! j 3 "y �I�� '` v C HIC Registrittion Number E pirauon Date HIC omp Name or MC Regi am ."\� -A&t .'-0 pres16 C,P/`cam, No.and S ee �J mail address `� S NO3 !a7 Z City/Town, State,ZIP 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 .........A No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all tters relative to work authorized by this building permit application. 5kA e L— A5� lz i S P ' er's Name(Electronic Signature) Datof SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I 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. _ 106AJAA I,S 1�ka)s lz Print Owner's or Authorized Agent's Name(Electronic Signature) D NOTES: 1. 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. 142A. Other important information on the HIC Program can be found at www.mass. ova Information on the Construction Supervisor License can be found at mn5m mass.gov/d s 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq. ft.) 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 3. "Total Project Square Footage" maybe substituted for"Total Project Cost"