32 GARDNER ST - BUILDING INSPECTION CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXEMPTION
Please Print r/
Job Location Z
Home Owner Address
Home Owner Telephone — —
Present Mailing Address
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.
DEFINITION 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 dwelling, 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 hetshe 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.
9
HOMEOWNERSSIGNATURE �
APPROVAL OF BUILDING INSPECTOR
See other side for state code
;w I- 3f I w Idoo.It i-,oh nines:nd slao'ho(k f%or registration ialid for individul Ilse only
11CIME IMPROVEMENT CONTRAC(OR bef:,r,t,le expil anon oil(late. If found rettl I it to:
Bo;tj ),Building Regulations and Standards
RegiStration: 136448 One Moncton Place Rin 1301
Expiration: 7127/2008 nos!, M.n.01108
Type: DBA
VASONARY
,S DRISCOLL
-."N AVE v r. I .......
%A Deplov
Not valid without signature
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 61229
Birthdate: 8/31/1965
Expiration: 8/31/2009 Tr# 4454
Restriction: GO
NICHOLAS J DRISCOLL
16 GLENN AVE
SALEM,MA 01970 Commissioner
,. Nicholas J. Driscoll Masonry
16 Glenn Avenue
Salem, Massachusetts 01970
978-985-1549
Date: March 6, 2008
Customer: Twombley Residence
32 Gardner Street
Salem, MA
Work performed at 32 Gardner Street in Salem, Massachusetts. The existing stairs and
landing in front of house are to be demolished and debris removed. New steps and
landing shall be constructed with concrete block and brick on the top of each step. The
landing shall have a ribbon of brick around the perimeter with concrete poured in the
center of the landing. The wrought iron railing supporting the roof shall be re-attached
after work has cured. All work shall be acid washed after appropriate curing.
The owner is responsible for pulling permit which shall be obtained prior to start of
work. Payment shall be required as fellows: 113 at start of work; 113 at midway point;
113 at completion of work.
Total Amount for above-described work: $4,400.00
1 hereby consent and agree to the performance of the above referenced work in
accordance with the terms and conditions outlined
/abbmove. ////��J ✓
Name
Date
Nicholas J. Driscoll Masonry
16 Glenn Avenue
Salem, Massachusetts 01970
978-985-1549
Date: March 6, 2008
Customer: Twombley Residence
32 Gardner Street
Salem, MA
Work performed at 32 Gardner Street in Salem, Massachusetts. The existing stairs and
landing in front of house are to be demolished and debris removed. New steps and
landing shall be constructed with concrete block and brick on the top of each step. The
landing shall have a ribbon of brick around the perimeter with concrete poured in the
center of the landing. The wrought iron railing supporting the roof shall be re-attached
after work has cured. All work shall be acid washed after appropriate curing.
The owner is responsible for pulling permit which shall he obtained prior to start of
work. Payment shall be required as follows: 113 at start of work; 113 at midway point;
113 at completion of work.
Total Amount for above-described work: $4,400.00
1 hereby consent and agree to the performance of the above referenced work in
accordance with the terms and conditions outlined above. v
Name
Date
I
Z The Commonwealth of Massachusetts FOR
Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code. 780 CMR, 71h edition USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Reri.rrrl J,uurn,_r
One- or Tiro-Family Dwelling l• 'l k)3
This,Section For Official Use Only
Building Permit Number: /I I Date Applied:
Signature: � �
Building Co issioner/Inspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Pro=ddr 1.2 Assessors Map & Parcel Numbers
1.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 It) Frontage(tt)
1.5 Building Setbacks(f0
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? Municipal ❑ On site disposal system [3Public❑ Private❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
Na (Wnt)t ecord: s
r
Name(�nnq Address for Service:
7 �,�-/ -2" 3 r"-
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing BuildZONumber
ccupied Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldof Units Other ❑ Specify:
Brief Description of Proposed Work':
Pm
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials)
1. Building 1. Building Permit Fee: cate how fee is determined:
❑Standard City/Town XppTication Fee
2. Electrical $ ❑Total Project Cost(Item 6) x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees: $
Suppression)
Check No. Check Amount: Cash Amount.
6. Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
,� ll�
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of S - H List CSL Type(see below) t
e �,
Addres T Description
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted I&'_' Family Dwelling
Signature M Masonry Only
RC Residential Roofing Covering
!� Telephone WS Residential Window and Siding
SF I 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
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.S 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........... O
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.
Signature of Owner Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
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
(Signed under the pains and penalties ofperjury)
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.115, 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 I
Type of heating system Number of decks/porches Q
Type of cooling system Enclosed Open
3. "Total Project Square Footage" may be substituted for"Total Project Cost"