22 COLUMBUS AVE - BUILDING PERMIT APP 3
1y� The Commonwealth oC\lassachusems
Board of Rmldme Regulations and Standards CITY OF
it htasanehu,cus� State Ruilding Cade,790 CMR SALEM"•.�_' xe.ire arnr 2011
�Y--
< i Ruilding Pemri[Application To Cotntnte(-Repair.Renovate Or 7Jemolish a 1
One-or Tiny-Few ilr Dwelling
This Section For Official Use Oaly_
Ruilding Penult Nurnact Oar APphed:
—_ �� lea
{ Build Offidui(Print Kvntvl Sivaatu, Oet<.
SECTION I:SITE INFORMATION
1_1 Pro er[V Address: �v,S AV+aatu6 1} Z Assessors illap S Par ers
2"2 coc,aam
� I.]a is this an nccepled'>trece"res_ no iMap\uo,h" vrcd Numhcr -
1-7 Zoning Information: 1.4 Property Dimensions:
f
e2enine Diwici P¢µa..v flsc I lot Area tsq R! fronracr(til i
1 1.5 Building Setbacks(ft)
From Y.',d aide Yat-ds Rea.-Yard
RAuuad I V^,nded _� R_gw,d._ f . ...Pmeided ' Reau"ev j Pru iRcl 1
j j
. 1.6 Rater Supply:(ki.G.L c.40.y-�4) I 1-7 Flood Zone Information: 1.8 Sewage Disposal Sysrem:
Znnc' 0. ide 1oed ZollO
Public❑ Ymatr❑ r
I — Chrcl r.r}c.❑ M.'cipv❑ Or.ei d n ,:v3ss�em ❑
,
SECTION?: PROPERTYOWNERSRIP"
2 1 Owaer f Reeosd:. .
Tt3n7 k� s f�4 R+ Rp 040A {i l Ad- S/4t—�nn�MA 0 t9 O\mn<(Pn ti tug i-:c:.7_IP
N'.ana s 2Z< G61itNlAuS�G1t1£ bl?57yS9IdS G��� L WA1� LdM
� 1 tt �rima< c,»�J ndam->. j
�. SECTION-?:DESCRIPTION OF PROPOSED WORK'(check all that apply)
I New[onstmctian❑ i F.Xisdn_g 81i1din_g0 '(heYier_OccupieJ ❑ j Rcpairs(s} ❑ >twr.3tinn(sl ❑ ' AddiRmi ❑ �
Demolition ❑ Acce SoN Bide.❑ �Nrmtbet o:Unite_ O:her ❑ Spc :'__
6riel�De uiptirnt oi'Pn pr ced\\'ork': �L i- IZ t5k-4 R (D' R7=unue
ho
'ho 1 (Sbi lYPK s l_ r
LLP Fr _ ` ^ I
SECTION 4:ESTLMATEDCONSTRUCTION COSTS 11
Iicm Estimated Co•u: ( Official Use Onh !
lT alnr an \lat wd>j
1.Raildinp s )(3 to GJ 1 Building P ruin Fee.:S .indicate hnu fee is detcmtinc&
i ?.Clean al �S d ❑Standard Cim?Todni Application Fee
. .V b7Tnai Prnjit Comr(itern F)s rat hipIier i X i
a Plumbing S- a Other Piss 5
4 D1ech n ai (II\?AC) 5 li i
Wdeiai-ai (Fite
Su ae ion) Total All Fees S: - -
ti.'fotal Cost: 5
Check No._Check AAmount: - C ah Ancatau
Project — '
❑Paid in ❑Outtimidinu Balanc 1)uc:
i
SECTION 5: CONSTRUCTION SERVICES {
5.1 Coonssttruction Supenisnr License(CSL) gazq C 2'�{(.tA� 6SGVA►�►tIuGC� Lmxrcee Number Espiruon Dar,
Name fCSLHnitlxv 4 t
f List CSL'C7pe flee beiowj 1
59 AAzuA►SrtckvE.�tR¢Sr EN��eD
no.anti Suaf f°Rc j _Dc,cnptiud �
MH , 01946 U I U, e to rcd l:3uild a I P Y SAUI a 7,T I
R I R,n tad IEe._Fxm 1 17 .ctl ne i
r itvi rrnc2 SmN.ZIP \[ Nlamnry }
RC Ra.t,ag rrure
t \\'indew and Siding
SF Solid wo fA,mim.Applian:-cs Qo5 M��.Go� In..alati,
Tcic rA.nx --- lntml.1tuL> D Dco,cotiun I
5.2 .Reegistered Dom'e,Improvement Contractor(HIC1 1A14" 1Izz II
b ✓k4 0 H—IC R 'vauon NumbL, Espiran,nn Dm_e
HIS'Q:mLwn'Name H C __ilea (1, n $ CJIVI .W I(� 111111'
Or.7a n date 7_IP T I,+hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c 1 2.§25C(6))
\Forgers Cmnpemation inuancealldumt must becompleted and boouedacith this application. Failnreioprovirtr
thi allida,n villa esulr.in the d.nial ofibc,f,staneeuf the building permit.
Si_vned Affidavit Attached Yes ...P No ....__❑
SECTION 7a:OWNER AUTHORIZATION TO DE COMPLETED WHEN
I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1
Las(honer ofthc su6jcn prupem,irercbv authorize tJ�L-RCN A7�I��1��(,��L.=
ro act on mybehalf,in all rooters relative to wade amhbmed be this building permit application.
jr 1 IM5 kGt-�1�L- *- !D a
f41n1,)w'nxr's\am i Si - ! VY� AAG Q VV (/ �yy roc 1�tiTe a Cc17 LLvv
tF--S.CTION 71TOWNER OR AUTHORIZED AGM DECLARATION
By entenr m name below I hereby act si underme pair-and penah;es ai periary that all of the information
contained in this application Is into and accurate to ih best of my knowledge and understanding.
1F30:�ko Oro✓#-'K KS ur.c= IbI 22 �
Print 1
P .t O, r,or Amhonzed A r-ml.N,t tFlecuonic Sig raiurc) Date
NOTES:
1, .An Owner,slm ubt..n,a building pernnt to do his/her own'tvork.or an mw;crr ho hires an unwai,acr-d cuturaetor i
(not registered in the Home Improvement Contractor(HIC)Program).will nm have access to the arbitration
program or guaranty Arad under M.G.L c. 142AA Orher important information on the.HFIC Program zan be found at
1 w InCormatiou on the Construction Supervisor License can be found lit p Anna— v c
R90 n substantial w ark is planned,provi&the mfnmitamn belmv'
Total flo n aura Uq-ft.) Inhcluclum garage,Finisbcd basenicniAmi s dccks or porcbl '
Gross Irving area(sq.fit.) Ilalntabla ream count
Number of 6rcplaos Number of bedrooms i
Nmnbea'of bathrooms Number ofhulftnoh's I
'hpe of h•aumu system Number ofdccks/porches _
Type ofcooling:yscm Gnrmscd Clpcn
I - "Teial Project Square Footage'riaay be substim(cd fn('70tn1 Project Caxi' i -
N20'10'55"E
24.13 1
6
Z
24.00'
Map 44 Lot 153
N/F
Frederick Simpson
o m 20 Columbus Ave.
vm
v�
E W f
LEGEND ♦M `fi
CB CATCH BASIN I {
® DRAIN MANHOLE 3 Heddwa�
® SEWER MANHOLE
® NAIL !N
O IRON PIPE OR ROD `
PROPERTY LINE 'a E 10 MOEMENTE EWER
EASo— WOOD FENCE .hI
'—"-- — UNDERGROUND SEWER LINE
G UNDERGROUND DRAIN LINE j
� s
m
o iv
fro
ipe o I 1
Nail ( N6034'16"E
(Fnd) 28, 2Z90'
i
12.3' )ran Pipe
d—Bent)
Bit. #22
Con c. Dwelling
Dri e
5.5'
Map 44 Lot 151
N/F
Jean Paul Dionne I S63'53'51"E
Iron Rood 26 Columbus Ave. 1 Bit. 62.70'
o
( I 'o, onc.
(Held)
! 6.4, ) Drive
75.00' 50.00' . f
Iron Pipe I Iron Pipe
(Find—Bent) CB ! (Fnd)
826'O609"W
47.00'
COLUMBUS AVENUE
ZONING DISTRICT — R1
REFERENCES. PLOT PLAN
1) Deed Book 5506 Page 407 22 COLUMBUS AVENUE
2) Plan #f73 or 1941 SALEM, MASSACHUSETTS
3) Plan in Deed Bk. 2002 Pg. 87
Prepared By
LeBlanc Survey Associates, Inc.
161 Holten Street
N w Danvers, MA 01923
vetNON ^ , (978) 774-6012
4
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N0. October 12, 2012 Scale: 1"=30'
33e00
HOR. SCALE IN FEET
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