6 GIFFORD CT - BUILDING INSPECTION Y
1
The Commonwealth of Massachusetts
I Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR,7`s edition ReOvF SALEM
p 1 dj/ Building Permit Application To Construct,Repair,Reno ate Or Demolish a I, 2008
I V� One-or Two-Fcunily Dwelling
I'YO This Section For Official Use my
Building Permit Number: D to Applied//
Signature:
Building Commissioner/Inspector of Bkiifdin& ate
SECTION 1:SI ORMATION
1.1 P.rope��yr Addre" sc /' � � � Assessors Map& Parcel Numbers
CsiLfoRi aAi .�,q[ W
1.1 a 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? Municipal❑ On site disposal system
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owper of Record, `
/Ac?V1 .A/�avesE �, GIPdo.21� G'Q r
Name(Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition Accessory Bldg.❑ Number of Units / Other ❑ Specify:
Brief Description of Proposed Work:
?� a £ Sr 5'fi orc iNTt� ,t ecc a Qom- -
�a Ntltx+n
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ /•s DOO 1. Building Permit Fee:$. Indicate how fee is determined:
2.Electrical $ /, tl0 U ❑Standard City/rownApplication Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ /, OaV 2. Other Fees: $
4.Mechanical (BVAC) $ N 4 List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ /7r 000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
JoEC lA iz I039.27 /D on 3
� .e License Number Expiration ate
Name of CSL-Holdm U
�a rzri / CR.� �gL List CSL Type(see below)
Address tro d T Description
U Unrestricted(up to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwelling
Signature 97$ .Sfq - gg' M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 R �.at Ierovement Contractor(HIC) b y�
HIC Company Nam r HIC Registrant Name Registration/Number
le r i 51�6/
Address p G 20l Z
T79 Sy'� � 8 E pirat nDate
Signature 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. r
Signed Affidavit Attached? Yes ..........❑ 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.
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 of
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
ConstFrtction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1.I0.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
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"
Contractor Agreement
THIS AGREEMENT made the I t/r/' day of 4&5ld 20 It by and between Joel White
Construction
Hereafter called the Contractor and 0411e ns S L hereinafter called the Owner
WITNESSETH that the Contractor and the Owner for the considerations named agree as follows:
Scope of Work
The Contractor shall furnish all materials and perform all of the work on the property at
G Gts,�o2 t� Cry r
Work Performed /
�NC/ssi ,1JoicR W40w O1A11V //-,72- a.+.✓` <• �C
/ //W 4 �/ .Oct tAA✓o%�/� „Lir 7f. O r/' Ae^c SS r�
Contract Price �/
The Owner shall pay the contractor for material and labor to be performed under the sum of � es-4—le 174w)
Progress Payments
Payments of Contract Price shall be made as follows
1
Signed this S d y of At,,I— 20_L�_
Owner-- Contractor V► ''^`//}I��"
Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT 311 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District, as per the requirements set
forth in the Historic District's Act(M.G.L. Ch. 40C)and the Salem Historic Districts Ordinance.
District: McIntire
Address of Property: 6 (.iffnrd ( nnrr
Name of Record Owner: Jacqueline Albanes
Description of Work Proposed:
Enclose.side porch per drawing submitted, all finished and painted to match existing clapboards and trim.
Reuse existing door.
Dated: June 29. 2006 SALEMHISTORICAL COMMISSION
By:
The homeowner has the option not to commence the work(unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals)prior to commencing work.
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CITY OF S.U1 ENl. 2UNSSACHUSETTS
• BUILDING DEPARTMENT
130 WASHNGTON STREET,3'FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KIStBERT RY DRISCOLL
MAYOR THOAL►s ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CONMaSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54; r—
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A. ` .,.
The debris will be{transsported by:
61&VS {
--bW' 1 o.-l/
(name of hauler)
The debris will
�b'e disposed of in :
/
(name of facility)
(address of facility)
signature of permit applicant
date
debrivtrdix
s
-fJammra.W��&a;( y�R4lade�atin'"�
srncss
office Of6
�Consomer Affairs CTOR
HOME IMPROVEMENT CONTRA Tlon
- �166469 Corporation
Registration:,, 2fi12012 .
. Expiration' � -',
JO
'W HI'f E CONSTRUCAION PLC^
x
JOEL WHITE
O CRT �Unders°cre
12 GIFFOR 01970
SgLEM.Mq
Massachusetts- Department of Public Safety
Board of Building Regulations and Standards
,Cons4tuctiorj Supervisor License
License: CS 103927s.!.:,. -Eor.�+;�M"�rta,•••
00 w,
Restricted too ,,q.
JOEL WHITS rt
12 GIFFORD COU,RTi
SALEM, MA 01970
Expiration: 1013112013
('umnris9ionrr':
Tr#: 103927