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86 BROADWAY - BUILDING JACKET 86 BROADWAY 1( I I du � No. 153L HASTINGS. MN LOS ANGELES•CHICAGO-LOGAN.ON McGREGOR,T%-LOCUST GROVE.GA U.S.A. CITY OF SALEM �� +� ' tr�� PUBLIC PROPERTY DEPARTMENT FIM111i111.F.1'DRISCOLL N1APgR 120 WASHIN6 rou 5nt[t[-I-0 $A l Nf,it IASSACHCBl Tis 0197(! 978745-9595 ♦ PnX,978-740-9846 COPY STOP WORK ORDER Property Location 86 Broadway February 20, 2008 Anna & William Correa 86 Broadway Salem, MA 01970 Dear Mr. &Mrs. Correa; The above listed property has been posted with a Stop Work Order due to being in violation of the following State Codes and/or City Ordinances. 780 CMR Massachusetts State Building Code, Section 118.1, regarding violations of the construction code, states that it is unlawful to add, alter, or construct any structure without the proper permit to do so. No further work may be done until such time as the order is lifted. Any person who shall continue any work in or about the building or structure after having been served with a Stop Work Order, except such work as that person is directed to perform to remove a violation or unsafe condition, shall be liable to a fine of not more than $1000, or by imprisonment for not more than one year, or both for each violation; with each day constituting a separate violation. If you have any questions regarding this letter, please contact the Building Inspectors Office at (978) 745-9595 ext. 5643. Sincerely, oseph E. Barbea , Jr. Assistant Building Inspector CC: file, Mayor's Office, Fire Prevention, Police Dept., Health Dept., Electrical Dept., Plumbing Insp., Councilor Veno a CITY OF SALEM PUBLIC PROI.IERTY DEPARTMENT KI [WKLG1'Mus,:"H. MAa Ok I Zp R4�51IM(..f0.`I C'flii°.I'"f� $ALP. i,ALtiS,ACI Il S'1-I-I?01970 'rij.:978745-9595 1 FAX:978 REQUIRED INSPECTION PROPERTY ADDRESS 86 Broadway C04F February 20, 2008 Anna& William Correa 86 Broadway Salem, MA 01970 Dear Anna & William; The above referenced property has come to the attention of this department for the following reason(s): A report has been made to this office that there is an illegal apartment unit being created in the basement. For this reason an inspection must be conducted by our inspection team to assure compliance with the code and city ordinance. Under the provisions of 780 CMR, Section 115.6,the State Building Code, access to this property must be granted for the purposes of this inspection. Please call this office upon receipt of this letter to schedule this required inspection. If this property has rental units, these tenants must be notified in advance of this inspection, so that access to these spaces may also be accomplished. This inspection must be completed on or before March 4, 2008; failure to respond to this notification will be construed as non-compliance, and as such an Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property. If you have any further questions regarding this letter, please call this office at (978) 745- 9595, extension 5643. Sincerely, 1 seph E. Barbey r. Assistant Building Inspector( Local Inspector CC: file, Health Dept., Fire Prevention, Mayor's Office, Councilor Veno g Jan.29,2008 Gregory Revill 4 Smith St. Salem,Ma 01970 Mr. Joseph Barbeau Building Inspector City of Salem 120 Washington St Salem,MA 01970 Dear.Mr.Barbeau: As the owner-to-be at 50 Balcomb St,a 3-family dwelling in Salem,I will have obtained the property via foreclosure,and understand from our discussion the following:the basement rooms were left by prior ownership in a condition that does not satisfy the requirements of the City for a non-occupable space.The electric stove receptacle and the kitchen sink plumbing have been left operable,despite the Building Department's request that the prior owner remove them. The purpose of this letter is to certify my intention to take those steps,i.e. full removal of the stove receptacle and kitchen sink plumbing, in order to render conditions that satisfy the City's requirements for a non-occupable space.These actions will be performed within 90 days of the change of ownership at 50 Balcomb St (now forecast for Feb 4)and will be done,with the City's required permitting,by licensed electrical and plumbing contractors. I can be reached by cell phone at 978407-7948 with any questions pertaining to this matter. Thank you for your time and consideration. �.�epp�MIMM Sincer l', al`" �N Fr T!t(gyy� Grego evill = ' Witnessed � � CITY OF SALEM PUBLIC PROPERTY DEPARTMENT 1)A.978-745-9595 978-i45-9595 + F,kx:978-740-98 10 STOP WORK ORDER Property Location 86 Broadway Febi-uiry ZO, 2008 pv Anna& William Correa 86 Broadway --— Salem, MA 01970 Dear Mr. &Mrs. Correa; The above listed property has been posted with a Stop Work Order due to being in violation of the following State Codes and/or City Ordinances. 780 CMR Massachusetts State Building Code, Section 118.1, regarding violations of the construction code, states that it is unlawful to add, after, or construct ally structure without the proper permit to do so. No further work may be done until such time as the order is lifted. Any person who shall continue any work in or about the building or structure after having been served with a Stop Work Order, except such work as that person is directed to perform to remove a violation or unsafe condition, shall be liable to a fine of not more than $1000, or by imprisonment for not more than one year, or both for each violation; with each day constituting a separate violation. If you have any questions regarding this letter, please contact the Building Inspectors Office at(978) 745-9595 ext. 5643. Sincerely, /osepti E. Barbea Jr. ( A'sistant Building Inspector CC: file, Mayor's Office, Fire Prevention, Police Dept., Health Dept., Electrical Dept., Plumbing Insp., Councilor Veno CITY OF SALEM Ijt�. �sl PUBLIC PROPERTY �'`��, DEPARTMENT KINfM.RLEY DRISCOLL MAYOIL 120 WA$1'IINC,PCON$'CRPE'f + Se1LGbl,AMASS;AC HUSISI"IS 01970 Crt.:978-745-9595 ♦ IAX:978-740-9846 REQUIRED INSPECTION PROPERTY ADDRESS 86 BROADWAY December 4, 2008 William and Ana Correa 86 Broadway Salem, Ma. 01970 Dear Property Owner; The above referenced property has come to the attention of this department for the following reason(s): A report has been made to this office that there is an illegal apartment located in the basemen of your building. For this reason an inspection must be conducted by oar inspection team to assure compliance with the code and city ordinance. Under the provisions of 780 CMR, Section 115.6, the State Building Code, access to this property must be granted for the purposes of this inspection. Please call this office upon receipt of this letter to schedule this required inspection. If this property has rental units, these tenants must be notified in advance of this inspection, so that access to these spaces may also be accomplished. This inspection must be completed on or before December 18, 2008; failure to respond to this notification will be construed as non- compliance, and as such an Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property. If you have any further questions regarding this letter, please call this office at (978) 745- 9595, extension 5644. Sincerel , Thomas E. McGrath AIA. Assistant Building Inspector/Local Inspector CC< ile Health Dept., Fire Prevention, Mayor's Office a CITY OF SALEM PUBLIC PROPERTY DEPARTMENT tii autr:ei.i=.iuiziyz n.i. RU ACCS>i uM rn m Srisr_i,_:r♦ SAi.r.M,.AInccVa irsrrrs 01970 TPJ.:9-18-745-959n ♦ FAX 978--'40-9846 Notice of Violation PROPERTY ADDRESS 86 BROADWAY SALEM, NIA December 23, 2008 Ms. Ana Correa 86 Broadway Salem, Ma. 01970 Dear Ms. Correa As a result of the inspection conducted by this office on December 11, 2008 it has been determined that an illegal dwelling unit exists in the basement of 86 Broadway in violation of the City of Salem Zoning Ordinance and also in violation of the State Building Code 780. The Building permit issued February 25, 2008 for construction of a family room is not valid for the work that has been completed. You are hereby directed to remove the kitchen in its entirety from the basement and cease use of any area of the basement as a sleeping room. You must obtain a building permit for this work and arrange for a licensed plumber and licensed electrician obtain permits and inspections for all plumbing and electric work currently installed in the basement within 30 clays of your receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the filing of complaints at District Court. Sinc el , T mas McGrath FAO Assistant Building Inspector/ Local Inspector CC: file, Health Dept., Fire Prevention, Mayor's Office CITY OF SALEM PUBLIC PROPERTY DEPARTMENT K1MBLI(LLY DRISCOLL MAYOR 120 WASHINGTON Srlu.e'1* SALEM,MASSACI{USP;rl'S 01970 TEL:978-745-9595 ♦ 1-nx:978-740-9846 Notice of Violation PROPERTY ADDRESS 86 BROADWAY SALEM, MA December 23, 2008 Ms. Ana Correa 86 Broadway Salem, Ma. 01970 Dear Ms. Correa As a result of the inspection conducted by this office on December 11, 2008 it has been determined that an illegal dwelling unit exists in the basement of 86 Broadway in violation of the City of Salem Zoning Ordinance and also in violation of the State Building Code 780. The Building permit issued February 25, 2008 for construction of a family room is not valid for the work that has been completed. You are hereby directed to remove the kitchen in its entirety from the basement and cease use of any area of the basement as a sleeping room. You must obtain a building permit for this work and arrange for a licensed plumber and licensed electrician obtain permits and inspections for all plumbing and electric work currently installed in the basement within 30 days of your receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the filing of complaints at District Court. Si cc r T omas McGrath Assistant Building Inspector/Local Inspector C (file, Health Dept., Fire Prevention, Mayor's Office Business Certificate b . Citp of ,OIaggarbugEtt.5 DATE FILED Type: New Expiration Date ❑ Renewal, no change Number 95-304 ❑ Renewal with change In conformity with the provisions of Chapter one hundred and ten, Section five of the Massachusetts General Laws, as amended, the undersigned hereby declare(s) that a business is conducted under the title of: at type of business by the following named person(s): (Include corporate name and title if corporate officer) Full Name Residence Signatures --- - � - ----------------------------------------------------- --- - - ------------- - - - - - - - - - ---- ---- ------- on ,�`- AC kf 4L-?�y? 1915Lthe above named person(s) personally appeared before me and made an oath that the foregoing statement is true. ---------------------------------------------- - - -- ----------------------------------------------------- CITY CLERK - Notary Public (seal) Date Commission Expires Identification Presented State Tax l.D. # S.S. # 033—(0 - 9/ail (if available) In accordance with the provision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5, of Mass. General Laws, business certificates shall be in effect for four (4) years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the town clerk upon discontinuing, retiring, or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars ($300.00) for each month during which such violation„nntinues. APPOINTMENT FOR FINAL INSPECTION MUST BE - MADE AT LEAST ONE WEEK AHEAD ..... ...._... 5t� N D BY p W PiMS ARE APPP,OVED SOLELY FOR MENTIMATION OF TYPE AND LOCATION OFF FIRE PROTECTION DEVICES' ALL FIRE VROTMMOti DEVICES ARE,�,'JWECT TO A.. . FINAL TEST AN O iriSPECTIOFIjOR COMPLETE COMPLt- -ANCE'"IV:'!''"F CIO£ No. -� City of Salem Ward y,.couur4. /� D ;t ^ J4'comrt.�o'•sr APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:I, it, Ill, IV, and IX. ZONING J I. AT(LOCATION) CtL�C DISTRICT n LOCATION //�' (NO.)� (STREET) v 1 OF BETWEEN ` -�'.r/17�k AND BUILDING CROSS STREET) CROSS LTORTET) SUBDIVISION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A-D A. TYPE OF IMPROVEMENT D. PROPOSED USE,FOR"DEMOLITION"USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ® Addition(If residential,enter number o/new 12 ❑ One family 18 ❑ Amusement,recreational housing units added,i/any,in part D, 13) If 19 ❑ Chwch,other religious 13 Two or more family-Enter number 3 ❑ Alteration(See 2 above) of units .................p�...:.........................- 20 ❑ Industrial 21 ❑ Parking garage 4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory- Enter number of units 22 ❑ Service station,repair garage 5 ❑ Wracking(1/multi/amity residential,enter number 23 ❑ Hospital,institutional o/units in building in Part D,13) 15 ❑ Garage 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only26 E] School,library,other educational the 17 I1 Or-Specify —3L 27 ❑ Stores,mercantile 28 B.OWNERSHIP Tanks,towers �¢G4i� :✓nt ❑ 8 ❑ Private(individual,corporation,nonprofit institution,etc.) 29 ❑ Other-Specify 9 ❑ Public(Federal,State,or local government C.COST 0 p p.o (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, d� machine shop,laundry building at hospital,elementary school,secondary school,college, / N - parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ... . ...........C..n......................... $ t,ndus plant of existing building is being changed,enter roposed use. To be installed but not included `' C in the above cost a. Electrical ...................................... b. Plumbing.......................................................................... LILIP c. Heating,air conditioning rr �ff 1 i �n uT a.r.�� e��QR Y-e � o-c � U,r d. Other(elevator,etc.)..................................................... I 11.TOTAL COST OF IMPROVEMENT $ �v III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J& M, all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 ❑ Masonry(wall bearing) 35 ® Gas 40 ❑ Public or private company Will there be central air 31 ®1--I Wood frame 36 ❑ Oil 41 ❑ Private(septic tank eta) conditioning? 32 II Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or private company 46 ❑ Yes 47 ❑ No 43 ❑ Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 49. Number of stories .............................. 49. Total square feet of floor area, Approval r all floors,based on exterior oval from Historical Commission been received dimensions .................................................-...................... for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.It....................................................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed............................................................................ 52. outdoors............................................................................. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed ....................:. .................................. Electric: Gas: Full ........ Sewer: 54. Number of bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial...................................... BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes_ No_ Is property located in the S.R.A.district? Yes_ No Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes,submit documentation/if no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No_ Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation) Massachusetts State Contractor License# Salem License # Home Improvement Contractor # Homeowners Exempt form(if applicable) Yes_ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary,please submit CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings. V. IDENTIFICATION • To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. ' Ll y to 4 a h Ler r D��ys 3/ S 77 J IX` Owner or ((� ''� Lessee �. Yq CL 2. Contractor Builder's License No. 3. Architect or Engineer I hereby rtify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as hi uthorized agent and we agree to conform to all applicable laws of this jurisdiction. Signat of gpplicant Address Application date DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19 Fire Grading Building Permit Fee $ Live Loading Certificate of OccupancyApproved $ occupancy Load Drain Tile $ Plan Review Fee $ TITL NOTES AND Data-(For department use) PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN For Applicant Use Ib �V W 7� I f/ z� IN O N Q APPOINTMENT FOR FINAL Salem Fi,%e Depo,rtmertt INSPECTION MUST BE F,i4e P4even�ion Su4eau i APPOINTMENT FOR FINAL ST ONE WEEK 48 La4ayette Street INSPECTION MUST BE MADE AT LEA Salem, Ma 01970 MADE AT LEAST ONE WEEK AHEAD........-•---- (508) 745-7777 AHEAD.....______ FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In acco4dance with the ptov-4.4ton,6 o4 the Maaaachuzetta She Su.i`2.di.ng Code and the Salem Fine Code, appZi.cation t,6 he4eby made 404 approval o4 ptan�s and the 4,6-6uance o4 a ceAtt4tcate o4 appnovat 4o-% a buttd i,ng pe- mum t by the Satem Fvice Depaatment. (Re4. Section 113. 3, Maa-6. State Stdg. Code) Job Location: Owne4/Occupa.rtt: nt, EZec*iticat Conttacto4: F.i ce Supp4"-6ton Contnacto4: It 1 S.ignatuwce o4 ; Appttcartt: Phone #: c� �� _ �1i7/7 Addn.e.6a o4 �/ // 1 ,/////� C.<ty on. Appt,i,cartt: Town: t_ App4oval date: Ce4tt4.icate o4 apptovae t4 he4ebyig4anted, on app4oved ptana ot aubmlttae o4 p4oject deta.i -6, by the Salem FtAe Depa4tmertt. AZl ptanz ane app4oved aoteZy 404 tdertti4.ication o4 type and location o4 4t to paotec tion devtce 6 and equ.i.pment. AZZ ptan,6 ane .6ubject to app4ova2 o4 any othe4 autho4.i ty having juAt4d4coon. Upon comptefiion, the app.tica.nt o4 Z"ta tet(a) aha t 4equeat an t"pecti,on and/o4 teat o4 the 4.i to p4otection dev.tce6 and equtpmertt. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) New con-6t4uction. 0 P4ope4ty Zoca -Lon ha-6 no compt.Zance w4th the p4ovt-64on,6 o4 Chapte,t 148, Section 26 C/E, M.G. L. , %etative to the .in-6ta2atton o4 apptoved 4.Ae atavrm devtce6. The ownea o4 thZ-6 p4ope%ty .L6 4equ,tted to obtain compliance a6 a condtt. .on o4 obtatn ng a Buhl g Petm<t. P4ope4ty Zocation .u6 .iis compliance w.tth the ptov.i Iona o4 Chapte% 148, Section 26 C/E, M. G. L. ExptAation date: d O3 Stgnatune o4 Ft to 044ticla e Fee due: under 7 , 500 Sq. Ft. - G-3 7 ann 4Z, c� P"'O' - Q^5 _ no Fnnm #R1 (r.'- FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In compliance with the provision of Section 113.5 of the Massachusetts State Building Code, and under guidelines agreed upon by the Salem Bldg. Inspector and the Salem Fire Chief, the applicant for a building permit shall obtain the Certificate of Approval (see reverse side) and stamped _�- plan approval from the Salem Fire Prevention Bureau. Said application and approval is required before a building permit may be _j UJ w issued. The Massachusetts State Building Code requires compliance z3 approval of the Salem Fire Department, with reference to provisions of U. m w i Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts 0: � p General Laws, and 527 Code of Massachusetts Regulations. U Nzn ; The applicant shall submit this application with three (3) sets of plans, p drawn in sufficient clarity, to obtain stamped approval of the Salem Fire � 8 Department. This applies for all new construction, substantial Zo w w alterations, change of use and/or occupancy, -and any other approvals as U) a required by the Massachusetts General Laws, and the Salem Fire Code. Exception: Plans will not be required for structural work when the proposed work to be performed under the building permit will not, in the opinion of the Building Inspector, require a plan to show the nature and character of the work to 'be performed. Notice: Plans are normally required' for fire suppression systems,- fire alarm systems, tank installations, and Fire Code _..__ requirements. Under the provisions of Article 22 of the Massachusetts 'State Building Code, certain proposed projects may not require submission of plans or complete compliance with new construction requirements. In these cases, provisions of Article 22, Appendix Ti and Tables applicable shall apply. This section shall not, however, supersede the provisions outlined in the Salem Fire Prevention Regulations, Chapter 148, MGL, or 527 Code of Massachusetts Regulations. All permits for fire code use and/or occupancy shall apply for the entire structure; fire alarm and/or smoke detector installation shall apply to the entire structure based upon current requirements as per Laws"and/or Codes, but the existing structure may comply with regulations applicable for existing structures. Notice: Sub-contractors may also be required to file individual applications for a Fire Department Certificate of Approval for the area of their work. Such sub-contractors -shall file an Application to Install with the Fire prevention Bureau prior to commencing any work for those areas applicable. s ,t FOR EN E Form 81X (10/90) ENT FOR FINAL pPPO�j,ON 0 OrAs`NEEK INSPE I p USONE WEEKLEAS] MADE At ST _.i AHEAD. ...... AH fAD...:..._.. of alem' c�5$�Xr li e f �� Public PropertU Pepartlncut A ell M., pb`Y rl� ltiflina epttrtritenf (nne �nlem Oiirrcu 7,13-11213 William H. Munroe Director of Public Property Maurice M. Martineau, Asst Inspector Inspector of Buildings Edgar J. Paquin, Ass't Inspector Zoning Enforcement Officer John L. LeClere, Plumbing/Gas Insp. May 20, 1987 , To Whom it May Concern: Regarding the property�at86 Broadway Street] Salem,MA. Should that property be destroyed it c6uld be rebuilt as is persuant to Section Vlll (D) of the Salem Zoning Ordinances Respectfully, ---.-s,._. ^.------------- 1 I' William H. Munroe Inspector of Buildings JZ1 The Commonwealth of Massachusetts °t Board of Building Regulations and Standards Town of kt, Massachusetts State Building Code, 780 CMR, 7ih edition 40 Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a !tom One- or Two-Family Duelling This Section For Official Use Only \ Building Permit Number: Date Applied: \v`✓) Signature: A 2 - a Building Commissioner/Inspector of Buildings Date SECTION l:SITE INFORMATION .1 lroperty Address W 0. 1.2 Assessors Map& Parcel Numbers n . 0 Y- 0 I.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 R) Frontage(fl) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I,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 ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Re rd: 1< AtnGt Dtre� e(Print) Address for Service: Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied W1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': ?M. KVVC' VA--iEt-Ag&>T rC1TG1-lEI4 2 ot,�r-' W/f-&TTCfZ qp 12 23 0b SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical g ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire ,$ Su ression Total All Fees: $ v Check No. Check Amount: Cash Amount: /\ 6. Total Project Cost: $ ,700 0 Paid in Full 13 Outstanding Balance Due: P SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) "T T. License Number Expiration Date Ngme of CSL-HQlder List CSL Type(see below) T Description Address U Unrestricted(up to 35,000 Cu. Ft.) R Restricted 1&2 Family Dwelling Signature M Mason Only RC Residential Roofing Covering Telephone WS Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signamre Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 I , 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 I ,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 Si ned under the pains and penalties of perjury 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. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I 10.116 and I I O.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.) 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 }. "Total Project Square Footage" may be substituted for"Total Project Cost" ` CITY OF SALEM r' PUBLIC PROPRERTY DEPAR"I'MENT I I f: '/-8-'i i.7;Vi • I'\X: 778--4}- ,.i L. Construction Debris Disposal Affidavit (re(Iuired lur all demolition and renovation work) In accordance %�ith the sixth edition of the State Building Code, 780 Ch1R section 1 1 L5 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 he disposed of in a properly licensed waste disposal facility as defined by MGL c l 11, S 150A. The debris will hbeetransported by: I he debris will be disposed of in (name of facility) (address of facility) e signature of permit applicant dater! CITY OF S UEM PUBLIC PROPERTY DEPARTMENT Vegas 13OWM NMMsmm"•SAL814Nwsuow=nso1rM TxL 9'L74}9S"•Felt 976-74&9" HOMEOWNER LICENSE E)MMPTION Please Print Date I . 21 , oa Job Location Oho ��Zp2Y�Wp,-ell Home Owner Address Home Owner TelephonePresent Mailing Address ,...t 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 who,does not possess a license,provided that the owner acts as supervisor. DEFINMON 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 dwellin& 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 fors 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 understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code . . 14, CITY OF SM.EM PUBLIC PROPERTY DEPARTMENT KJMMAL Y0W5CaL MAVM 130wtioanGTON STIMT•soma MASLAoR=M 01970 T'=-973.735-95"•FAx 97a•746-96N HOMEOWNER LICENSE EXEMPTION Pies"Print Date 02120 ��, Job Location C� T Home Owner Address ' Home Owner Telephone — �a 9 Present Mailing Address 4 OA4g? 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 who.does not possess a license,provided that the owner acts as supervisor. DEFINMON 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 dwellin& 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 understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requi ents. % 7 HOMEOWNERS SIGNATURE c APPROVAL OF BUILDING INSPECTOR See other side for state code �( 1 The Commonwealth of Massachusetts Board of Quilling Regulations and Standards FOR I 'rlj1 Massachusetts State Building Code, 780 CMR, 7°i edition MUNIc'IP:ALIII', y. USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Rc 1SL'd Junu1u_v One- or Tiro-Family Dtrellnt,q 1. 2008 This Section For Official Use Only Building Permit N er. l/ Date Applied: C� Signature: � 2. 2�. o� - Building CommissioilerTlnspeetor of Buildings Date SECTION l: SITE INFORMATION 1.1`P/roperty Address: / q 1.2 :Assessors Map & Parcel Numbers )L4f/Y�/ti/fT L la Is this an accepted street'" t� Mup Number Purccl Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq to Frontage (it) 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 R--- Private ❑ Zone: _ Outside Flood Zone'? Check if yesC9--� Municipal ®On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.�1 Q�wne ',of Record: Name (Print) Address for Service: �J - Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction ❑ Existing Building sW Owner-Occupied 4' Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units 2_ Other ❑ Specity: -14 Brief Description of Proposed Work': 6 7 )✓1t-4 6A rMSEMOUT SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costrn (Labor and MaterOfficial Use Only I. Building $ �� ng Permit Fee: Indicate how fee is determined: ��`� d City/Town : pp ication Fee _. Electrical $ roject Cosr (Item 6) x multiplier x 3. Plumbing 3 ees: $4. Mechanical (HVAC) $5. Mechanical (FireSup ression) ees: $ 6. 'Total Project Cost: Check No. Check Amount: Cash .AmonnL '6 3 2a0+00 ❑ Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) 'I a License Number Expiration Date C� Name ofCSL- Holder List CSL Type (see below) \� Type Description aAddress U Unrestricted ole to 35.000 Cu. Ft.) R Restricted I&'_ Family Dwelling Signature M Masonry Only RC Residential Rooting Covering WS Residential Window and Sidnie Telephone SF Residential Solid Fuel Burning A>>huncc Instull,uum D Residential Demolition X 5.2 Registered Home Improvement Contractor (HIC) Registration Number HIC Company Name or HIC Registrant Name 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 QCif�r�j� as Owner of the subject property hereby L to act on my behalf, in all matters authorize relative to work authorized by this building permit application. 0 Si nature of Owner Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION I, �ly✓J �UL�"V�'(,1 � �Y(�(.l , 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. k y�l Print Name �0 Signature of Owner or Authorized Agent Dale (Signed under the 2ains and penalties of er u ) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contranor (not registered in the Home Improvement Contractor(HIC) Program), will not have access to the urbitratinn program or guaranty fund under M.G.L. c. 142A. Other imporwnt information on the HIC Program and Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 1 IO.RS, respectively.' When substantial work is planned, provide the intornration below: 'v Total floors area(Sq. Ft.) {including garage, finished bnsemenUattics, decks or porch) Gross living area(Sq. Ft.) Habitable om ,ount Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/ porches Open Type of cooling system Enclosed 3. "Total Project Square Footage" may be substituted for "Total Project Cost'