7 1/2 BURNSIDE STREET - BUILDING JACKET .-7 � ���Nstvvt� ��
" ,, CITY OF SALEM, MASSACHUSETTS
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BUILDINGDEPARTNENT
120 WASHINGTON STREET,3'� FLOOR
TEL. (978) 745-9595
FAx(978) 740-9846
KIIVIl3ERLL^Y DRISCOLL
MAYOR TYIOMA.S ST.PIERRE
DIRFCPOR OF PUBLIC PROPERTY/BUI LDING COMMISSIONER
March 28, 2012
Re. Zoning Determination - 7 '/Burnside Street
Whom it may concern:
According to our records, It has been determined that the building located at 7 1/2 Burnside Street is a
legal, non-conforming two family home located in a R-2 (two family) zone.
This letter is for determining zoning purposes only, and in no way is meant to confine or deny whether
said property is in compliance with all building, plumbing, gas, electric, fire or health codes.
Thomas StPierre
Director of Inspectional Services/Building Commissioner
cc. file
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APPLICATON FOR
PEFOar TO
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LOCATM
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APF 4D
a�croR of au�Lallos
What is the current use of the Building? „,any units?__Z,
Matelot of Building? Lucm If dwelling.how .,
form to law? a S Asbestos?
"a the Building Con
Amwded's Name
Address and Phone
Mechanic's Name
Address and Phone HIC Registration S
Consbudfon SuPe^�'sors license tl
Estimated Cost of project S__�— Perrnit Fee Co ouietlon
Estimated Cost X S?IS1000 Residential
Permit Fee S — Esttrnated cost S111S1000 Commam'M----An AddlWnal$5.00 Is added as an
AdminislratNe Charge.
Make sure that all fields are prop"and legibly written to avoid delays in processing.
The undersigned does hereby apply for.a Building Permit to build to the above stated
Specifications. signed under penally of perjury
Date z
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DEPART14IFr�1T
uwrc�u.ry oe�t
MAYOR
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APPLICATION FOR REPAIR RENOVATrON CONSTRUCTION
DEMO,a MON OR CHAfffil OF p
3TRUCTC��' OR BUILDnvr FOR EXI TIN
1.0 SITE INFORMATION
Locadon Name: 7
_-.- _-- Building;
Property Address:---
7
Property Is located in a:Conservation Area YIN L__Hlatorio Distrlot YM
T
IP INFORMATION
and
70c- 7 �� cllD2
3.0 COMPLETE THIS SECTION FOR WORK IN EXlSIlNp BUILDINGS ONLY
Addition Existing
Renovation
Number of Storie
s Renovated
Change in Use
New
Demolition
Existing
Approximate year of Area per floors
construction or renovation I { fl Renovated
of existing building New
Bdef Description of Proposed Work:
0- /
J
Mail Permit to: — - --- --
The Commonwealth of Massachusetts
Board of Building Regulations and Standards Town of
Massachusetts State Building Code, 780 CMR, 7th edition ,
Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a
Or Tuo-Faoii11vDuvelling
This S ction For Official Use Only
Building Permit Nu TT: Date Applied:
Signature:
Bui t g Cb"mi 'ones ' f Buildings Date '.
SECTION 1:SITE INFORMATION
L1 Property Address: y 1.2 Assessors Map& Parcel Numbers
C.> ^ ojS
1.1a Is this an accepted street''yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensio
".3700
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Requirtd Provided Required Provided
1.6 Water Supply:(M.O.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 yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name{Print) Address for Service:
15/7 - o?33 - /9 7
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building V I Owner-Occupied V I Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units-3, Other ❑ Specify:
Brief Description of Proposed Wark=: W iJ tlY� f ;i2
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofllelal Use Only
Labor and Materials
L Building S A 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical 5 ❑Total Project Cost'(item 6)x multiplier x
3. Plumbing S t,J 0Q 2. Other Fees: S
4. Mechanical (HVAC) S List:
-5.-A {Fire S
Su ression Total All Fees: S
97
6. Total Project Cost: 5 ^ pJ0 ,,o Check No. Check Amount: Cash Amount:
0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) S�91<S/ 3///1 '
• �' lf7�R-�,rr,G License Number Expiration Date
N:)mc of CSL HyldI 6List CSL Type(see below)
- d-r//S - �� A'�b
Ad c s 6/Qty Type Description
�! U Unrestricted(up to 35,000 Cu. Ft.)
Signature R Restricted 1&2 Family Dwelling
.'N Masonry Only
RC Rcsidential Roofin Coverin
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
S. egisteredHriln�e 1mprrovelnenttCContractor(HIC) 13?-7.29
HI Company Name orHIC Regisf[rrant Name Registration Number
7bKr / Ltr. Q
Addre� 8 —�,— .00/
0 4 Expiration Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 Issuanc of the building permit.
Signed Affidavit Attached? Yes .......... No........... [3CTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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1, Fi.l�1 �i-1�� C�✓ as Owner of the subject property hereby
Tauthorize ��' eve �2,lYyl-- to act on my behalf,in all matters
rm
relative to work authorized by this b i ng peit application.
Si narum wn� Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I, ' 0�Al4e'( t4W-e-� ,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.
2
Print Name
Signature of QWher or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
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 I O.R6 and I IO.RS,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks orporch)
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'
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