001A DANIELS ST - BUILDING PERMIT APP i
oy
The Commonwealth of Massachusetts
} Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 C'MR, 7°edition OF SALEM
Revised Junuarr
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 21Nrx
One- n u-Family D riling
This Sec ion For Official Use Only
Building Permit Numb D e Applied:
/` t7
Signature: ,.-, 6 l /
Building Commissioner/Ws for of Build nga Date
SECTIO :-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map dr Parcel Numbers
I A, wNt t S T Co
I.la Is this an accepted street?yes i/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Ama(sq 11) Frontage(11)
1.5 Building Setbacks(R)
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:
Zone: _ Outside Flood Zone?Public Private❑ Check if es❑ Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
V- AN S W ers,-DOt- 1 Ar 'DArJ tE1,S S i 72Cti'r f4hjyG_T
Na a,Print) Address for Service:
>C Ge-1 9-` °t -1 8 7 q
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction it Existing Building i Owner-Occupied Repairs(s) ■ Alteration(s) ❑ 1 Addition ❑
Demolition ■ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: 3)n)rL L65 eCr
Brief Description of Proposed Work':
t2EPA 11'Z5 or T SEA W A-t r_,6 MD Rr'—8U t t.0 6k.(ST)rJ G D e-c4c,
dE 50I L IEY1.o5 t DrJ Dn)I, OYL�L W A Lt.- 'r5 E1.F
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: ORlclal Use Only
Labor and Materials
1. Building 5 15 5oc> "- 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical S ❑Total Project Cost(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (lIVAC) S List:
5. Mechanical (Fire S
Su ression Total All Fees: S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S 1 eO0,— ❑Paid in Full ❑Outstanding Balance Due:
4l) v .o �/� e0ty'lC'l
0
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
102163 1L115 2o)Z
CI}(LI ST1" 11 V5% License Number Expiration Date
Name of C'SI.• I Iulder List CSL"!
(50 ._16-a16-1 5T_a*_LT NA(atkT-) >Pelseebelow) LI
T Description
AJJ _-- Unrestricted(up to 35,000 Cu.Ft.
R I Restricted IA2 Family Owellin
Signature M Mason Only '^
6)1 -81 RC Residential Roaring Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D 1 Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) I(�:77 5-31
9E6A7-rA CO rN%1 22 C-rt OIJ r 'J C• Registration Number
I IIC Company Name o
5o J�sar C sraTtNme
-7_7_ZoI )
AJJ /^�
y am- Expiration Date
Signature - Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152. 1 25C(6))
Workers Compensation insurance affidavit must be completed and submitted with this application. Failure to provide I,
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........■ No...........O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. 44t4 S i.scwG 0 r1 as Owner of the subject property hereby
authorize C t�ISTb AC-1 "7CS 1 ea *G�bA TrA 60 NSfi2UCtsar.1 to act on my behalf,in all matters
relativ/eJ to work auth/�o/rizzee'd by this
�building permit application.
Si tore of ner Dote �
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1, Ctt215 1- A-tJ IDS 1 ,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.
CN,'1-1 STr�3n1 TDS1
Prim N
ill ,• /za) o
Signature of owner or Authorized Agent Date
(Signed under the pains and penalties of 'u
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 ag have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115, respectively.
?. 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
J. "Total Project Square Footage"maybe substituted for"Total Project Cost"
UUWyT�Q
CITY OF SALEM
CONSERVATION COMMISSION
�R
June 15, 2010
Christian Tosi
Regatta Construction, Inc.
50 Jersey Street
Marblehead, Massachusetts 01945
Re: Order of Conditions—DEP #64-497
1A Daniels Street Court, Salem,Massachusetts
Dear Mr. Tosi:
Enclosed, please find the Order of Conditions for the above referenced project.
Following the 10-day appeal period, this document and the attached Special Conditions
must be recorded at the Essex County Registry of Deeds (Shetland Park, 45 Congress
Street, Suite 4100, Salem, MA). Once recorded, please return a copy of Page 12 of the
Order, which will indicate to the Commission that the document has been recorded.
If you have any further questions, please feel free to contact me at 978-619-5685.
Sincerely,
VFTaoj�a
oordinator
Interim Conservation Agent
Cc: DEP Northeast Regional Office