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17-19 EMERTON ST - BUILDING JACKET The Commonwealth of Massachusetts IN P..EC� SERVICES Board of Building Regulations and Standards Ulf Massachusetts State Building Code,780 CMR SALEM 1I'RMd24r2A' 39 Building Permit Application To Construct,Repair,Renovate Or Demolish a ^, One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Appli > a�Building Official(Print Name) Signature ate t SECTION 1: SITE INFORMATION 1.1 Proper Address: � 1.2 Assessors Map&Parcel Numbers Lla 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 ❑ Q SECTION 2: PROPERTY OWNERSHIP' 2 A,- p�L��. 1 r^ >l "'A u� 69.E 0/276 + C� r D Name(Print) City,State,ZIP 7 633� No.and SVeet Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) e7Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Desc 'ption of Proposed Work': VKL Ae'P� '5 12�� t,o VIN 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 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: $ Z,_.�0 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ✓l?�d1<2-EN,4N� e Licensese Number cueso y Z ! /.���Lvj/ � umber Ex 'ration Date N�amle of CSL Holder T7 —/ o Zy2 e,/3d� List CSL Type(see below)No.and Street �! KV�i✓ Type Description 6 e �j ,^„� �//� /� U Unrestricted(Buildings u to 35,000 cu.ft. /7 r'VV & 7 ! R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 5�y /Q, / �y ^'�/ �M'I /� /��p� SF Solid Fuel Burning Appliances !%h b 1 I 60W 06YU '�'�t%'(,U/rl U< I Insulation Telephone Email address L D Demolition 5.2 Registered Home Improvement Contractor. ((HIC) J �3 !! zr) 9,6 2GP>Q V.V r 7 A)6 IteA)5r • &iL IN C/ HIC Registrauon Number Expiration Date H C f 7 CN Name,�HI! gi%str?A Name Q n t/ a d tree l 7i7/ Email address lac t I t�Yl� 0 g� �21�5 L /ul 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 .......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,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. Print Owner's Name(Electronic Signature) Date 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. Print OwneAl6r Kutholized ent's Name(Electronic Signature) Date 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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 1 "Total Project Square Footage"may be substituted for"Total Project Cost" MARCHAND & SONS CONSTRUCTION COMPANY, INC. 17 WELLMAN STREET, EEVERLY; MA 01915 Phone: 978-922-0115 Email: marchand8Cverizon.net Home Improvement Contract# 173846 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and contractor. Homeowner's Signatubf Contras oP ignature Date Date ar :; y ::,« a� . '•. r: You may cancel this agreement if it has been signed by a party thereto at a place other than an addres of the seller,'which maybe his main office or branch thereof,provided you notify the seller in writing at his main office or branch,by ordinary . mail posted, b telegram sent or delivery,not later than midnight of the third business day following th'e,signing of the P � Y g Y �'Y. g Y.. B g g agreement. See attached notice of cancellation for an explanation of this nghe . - �i l . l •aY' 4✓T.tYli..e Y�l:, .. . Note: Owners who secure their own permits or deal with unregistered contractors are eecluded from the Quaranry Fund provisions of M.G.L:c. 142A. "K 1 i 4' r t :111.- t Note: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston MA 02108 617-727-8598 ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor-has a dispute -s concerning this contract,the contractor may submit such dispute to a private arbitration"service which has`been`approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the cori"sumer shall be required to submit �topsuch arbitration in M.G.L. c. 142A. Homeowner's Signatur �n�G L /0/'-2 /O/Z 7 /� Date 7—' Date Notice: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE'THIS SECTIO103 !4OT-'SEPARATELY .SIGNED BY THE PARTIES. I r NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN,BUSINESS DAYS FOLLOWING RECEIPT BY'THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,INyFg ,; ;,_;, SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION,IF.YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER AND FAIL TO.DO SO,THEN YOU, REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS.UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OF ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO: MARCHAND& SONS,CONSTRUCTION COMPANY, INC. 17 WELLMAN ST,BEVERLY MA 01915 NOT LATER THAN MIDNIGHT OF Z7 (DATE). , I HEREBY CANCEL THIS TRANSACTION. DATE: BUYER'S SIGNATURE: The Commonwealth of Massachusetts a Board of Building Regulations and Standards RECEIVED CITY OF Massachusetts State Building Code, 780&MRT IONAL SERVK ES SALEM Revised Mar 2011 �(�1 Building Permit Application To Construct, Repair, Renovate Q Demo h \LJ One-or Two-Family Dwelling ` 1015 St 2 4 o This Section For Official Use Only Building Permit Number: Date AvWied. 1 t Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION Property Addr��/ L 1.2 Assessors Map&Parcel Numbers r T L la 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: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system [3 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Tv�r f Ala-1--Ai 61 FFaCg/ SO� ( YI'�,4 ©/�I 7 d Name(Print) City,State,ZIP � � �rnkXro�/ 5 e1 979 744 633# No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) R( Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work : �Tx�ts��z�� 2. y�Hyi, �c�m �-� w���ws L✓ � �C7r� �7`GN C''N7LI/IL� ev SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 3 ZS 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: $ 3 7is ❑Paid in Full ❑ Outstanding Balance Due: S*—IJ O I-0 '-I E M V_ro 0 10-1- � SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Of b Sa4:p �7 DANJM�7_. )WAAGL H_4/VP License Number Expiration Date Name of CSL Holder /. pe�A List CSL Type(see below) No. and Street Type Description �jyJ��� �// U Unrestricted(Buildings u to 35,000 cu. ft.) City/(T/o!w/n; StatYevZl'P"'/ l 7 Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Im rovement Contractor(HIC) —3 �-1A, ��1 e IHA�t/D 4, ells eD.t6T, CO _ C HIC I Registration Number Expiration Date H/7 ompany N VC egef ame NU�6tree .n;1A q�8 C2//� Email address City/Town,/T000wn, Sta ,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 .......... W, 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. Print Owner's Name(Electronic Signature) Date 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. J)AA( )MOL,4A ✓D s Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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.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"may be substituted for"Total Project Cost" + , 1 `O The Commonwealth of Mrssachuscns 1y 710 own of Board of Budding Regulations and StandardsblassachusrUs State Bwlding Code, 780 ChIR, T"cditioeding Dept Budding Permit Application To Construct. Repair. Renovate Or De One- or ricu-Furruly Divelbng This Section For Official Use Only Building Permit Number' Date Applied: t Signature: Building Commissioner/ is Buildialis Date SEC 1 ITE INFORMATION 1.1 Propert Address: 1.2 Assessors Map A Pared Numbers M Number Parcel Number I.I a Is this an aeee led street yeti o Map 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dmrict Proposed Use La Area(sq it) Frontsge(fl) 1.5 Building Setbacks(/t) Front Yard Side Yards Rear Yard Required Rovi equired Provided Required Provided ' 1.6 Water Supply:(M.G.L c.40.154) 1.7 Flood Zone Information: 1.8 Sewnge Disposol System: Zorn: _ Outside Flood Zone? Municipal 0 On site disposal system O Public O Private O Check it vesO SECTION2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ' n A fer Service Name IPnnt) 47 7fS Z3 Signature Telephone SECTION J: DESCRIPTION OF PROPOSED WORK,(cheek aB that apply) New Construction Cl Existing Building Owner-Occupied V1 Repairs(s) O Alleration(s) V1 Addition O Demolition O Accessory Bldg.Cl Number of Units_ Other O Specify: Brief Description of Proposed Work ri! SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Ofllelal Use Oaly Item Labor and Materials 1. Building f 000 1. Building Permit Fee: f Indicate how fee is determine: O Standard Ciry/Town Application Fee 1 Eleancal f O Total Project Cost(Item 6)x multiplier x J Plumbing f 2. Other Fees: f 4. Mechanical (HVAC) f LisC /y(� 1' Mechanical (Fire f Total All Fees: f Su remon Check No. _Check Amount: Cash Amount: is Total Project Cost f �Qd 0 Paid m Full 0 Outsianding Balance Due P SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor ICSL) 04,650 (o ,f 4 L 50 (o 14111 i, 1D.A14 ' MA"Aq0 LiceemeNuumbcr Evp atio Date Nyoe Ut CSL IIpIJer R-P i Livt CSL T � 0 215 [PaResidemial .000Desc tiers Unrestricted u to 33,000 Cu. Ft estricted I&Z FamilyDwelling S igna ato Only esidential Roofing Covering Tel phone sidential Window and Siding L�8 641 608( sidential Solid Fuel Burning fiance Installation �,��e� yy yf Demolition YY'.ut�C.N !6) '277 HI CompanyN egame Qr}11C R strant N Re iteration Number 7. MA �j 7i Eapir Lion Date S' Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. ISL I Mill)) 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. Signal Affidavit Attached? Yes.......... W7 No...........O SECTION 72:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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. Si azure of Owner Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION 1, DWI MA"la,92b ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and beha tW ',i^ d Print �/j'/fb Signihile of0wrilfir,61PAulhortzed Agent Due (Signed under the pains and penalties of r 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 I HIC)Program), will Sg 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 R6 and 110.R3, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including garage, finished basementlattics. decks or porch) Gross living area ISq. FL) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half baths Type of heating vysiern Number o(Jeckv porches Tv pe of cooling aystene Enclosed Open 1 "Tool Prolecl SNuare Footage"may he.uh.tituied for 'Total Prolect Co%1' Commonwealth of Massachusetts , ` City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit No. 8-18-167 BUILD FEE PAID: $1,793.00ERMIT TO DATE ISSUED: 3/9/201 This certifies that VITAS REALTY TRUST has permission to erect, alter, or demolish a building 17 EMERTON STREET Map/Lot: 350468-0 as follows: Other Building Permit RENOVATIONS TO INCLUDE: REPAINTING, REFINISH FLOORS, NEW KITCHENS, NEW BATHS (2 HALF BATHS, 2 FULL BATHS), RENOVATE EXISTING BATHS, ADD CENTRAL A/C, UPDATE ELECTRICAL& PLUMBING Contractor Name: JOHN HARVEY DBA: Contractor License No: CS-093706 u. 3/9/2018 Building Official Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withal six months after issuance.The Building Official ` may grant one or more extensions not to exceed six months each upon written request. All work authorized by this permit shall contorm to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning byA"and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public i�spection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided of this permit. 'j H IC#: "Persons contracting with unregistered contractors do not have access to the guaianty fund"(as set forth in MGL c.1 42A). Restrictions: Building plans are to be available on site.. All Permit Cards are the property of the PROPERTY OWNER. i � . 14 Washington Si,3rd Hoor Salem,MA u(978)745-9595 X&41 Return card to Building Division for Certificate of Occup icy do Structure CITY OF SALEM BUILDING PERMIT y PERMIT TO BE POSTED IN THE E WINDOW Excavation Footing INSPECTION RECORD Foundation Framing P— Mechanical Insulation — _ INSPECTIO : BY DATE Chimney/Smoke Cfiarnber gal. �` tew- C'1 Plumbing/Gas mbing ! 'I q11�ry Electrical 1-oh,bx r,wfzi�jpq I Finai � ,_ Fire Depak ent Prelimirary ! p Final Health Department Preliminary + Final i 1 Certificate Number: B-18-167 Permit Number: B-18-167 Commonwealth of Massachusetts City of Salem This is to Certify that the ................................................................Two Family Building.......................................................... located at Building Type ......................................................................17 EMERTON STREET in the Ci .......Salem ...................................... f .. . ................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Unit 17 THOMAS &HELEN GIFFORD This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ................................Not.Applicable unless sooner suspended or revoked. Expiration Date Issued On: Thursday, April 18, 2019 Certificate Number: B-18-167 Permit Number: B-18-167 Commonwealth of Massachusetts City of Salem This is to Certify that the ..................................................................Two Buildin Family.. s.......................................................... located at Building Type ......................................................................17 EMERTON STREET in the Ci .......Salem ............................................................................................................................... ..h' f Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY AKA Unit 19 THOMAS &HELEN GIFFORD This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Not,Applicable unless sooner suspended or revoked. Expiration Date Issued On: Thursday, April 18, 2019