24 GLENDALE V3 - BUILDING INSPECTION C� NOD
CA` q 1(:)
1 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY� M� Massachusetts State Building Code, 780 CNIR Sir
Revisedd bltkur 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
i One-or Two-Family D+velling
r
l Kq This Section For Official Use Only
,n Building Permit Number: Date Applied:
pt Dowing Otticial(Print Name). Signature Dat
P SECTION 1:SITE INFORMATION'
I 1.1 Property Add er 3 1.2 Assessors Alap&Parcel Numbers
a4k1 L I a Is this an accepted street?yes no Map Number Parcel Number
1.3 'Zoning Information: 1.4 Property Dimensions:
r Zoning District Proposed Use Lot Area(sy R) Frontage(II)
I
'y 1.5 Building Setbacks(R)
} Front Yard Side Yards Rear Yard s
.t Required Provided Required Provided Required Provide
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Jt:: rn
Public❑ Private❑
Zone: _ Outside Flood Zone?
Municipal❑ On site disposal system
Check if es❑
SECTION 2: PROPERTY OWNERSHIP.'
t 2.1 Ownert of Reco��/ ( City,
1 A� � N i
0 t7�5me(Print) �. YY��IILC-yy"� _ Ciry,Stare,ZI
A
t No.and Street Telep Gmail Address
I SECTION 3: DESCRIPTION OF PROPOSED WORW(chec t at apply)
hNew Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) E6 I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Ot ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: offic Only
Labor and Materials)
I. Building S I. Building Permit Fee: Indicate how fee is determined:
❑Standard City/Town Application Fee-
2. Electrical 5
❑Total Project Cost'(item 6)x multiplier x
J. Plumbing 'S P(,ether Fees: S
4.1Icchanical (11VAC) $ List:
7-Mechanical (Fire S
Suppression) "total All Fees:S
Check No._Check Amount: Cash Amount:_
6.Trotal `Project Cost: S 13 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SSE-R7VIICCESS
5.1 Construction Supervisor License CSL) -c /�' Licens umber E.Spt lion to
Name of CSL H Ider list CSL'rype(see below) r�l
i
Type: Description
No. and Sue
U Unrestricted DuilJin a to 35,000 cu. R.)
�7n"t R Restricted !&2 F;unil Dwelling
Cily/I'uwn,State,ZIP M Masonry
RC Roolin Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I 1 Insulation
'fete hone Email address D Demolition
5.2 Registered Hom 1 nprove 1p ntract IC)
HIC Registration Number Es iru on ; e
HIC C or e .
Nu.an Email address
Cit /Town State ZIP Tele hone
SECTION 6:WORKERS'COMPENSATION INSURA. CE 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 Istuance of ttgAmillding permit.
Signed Affidavit Attached? Yes.......... No...........❑
SECTION7a.OWNFA AUTHORIZATION:TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
t9 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:OWNEW OR AUTHORIZED AGENT DECLARATION
By enterin my name bet w,1 he by attest under the pains and penalties of perjury that all of the information
this appiic I is t e an accurate to the best of my knowledge and understanding.
r
)rint 0 s or Author zed Agent's nme(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 nol have access to the arbitration
program or guaranty fund under 1I.G.L,c. I42A.Other important information on the HIC Program can be found at
coww mass eov'oca Information on the Construction Supervisor License can be found at www.mass.<_ov!dnS
2. When substantial work is planned,provide the information below:
'total floor area(sq. ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq. ft.) Habitable room coma
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type orcoolingsystem Enclosed Open_
3. "Total Project Square Footage"may be substituted for,'Total Project Cost'
Url
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Iorn Iraprov� Cni Cuntrae�i Registration
Yye3z: Sup En�'nt Card
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The Commonwealth of Massachusetts Print-Form".';
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Q hone
Are y an employer?Check th appropriate box: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).
have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself o workers comp. right of exemption per MGL
y � ' m
P 12.❑ Roo atrs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13. Other .L�
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers' pensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: 1 Expiration Date:
Job Site Address: ( dVI42 City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb cerd and iW po#ns q4 penalties of
.e!!jug that the in ormation provided above is true and correct
Si nature: Date
Phone#:
Official use only.,Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other.
Contact Person: Phone#:
t CITY OF SALEM, MASSAQHUSETE
BUILDING DEPARTMENT
120WASHINNGTON STREET,3ADFY,OOR
TEL.(978)745-9595
KMERLEYDRISCX)LL FAX(978)740-9846
MAYOR THOMAS STYIERRE
DIRECTOR OFPUBUCPROPERTY/BUILDING O0MffSSI0NER
Construction Debris Disposa/Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Deb ,
with the
and the provisions of MGL c40, 5 54, Building Permit#
condition that the debris resulting from this work shall be disposed of in a p opeis issuel ris
y licensed waste deposit facility as defined by MGL c 111, 5150A.
The debris will be transported by:
(name of hauler)
The debris will be m
disposed of 'p .
(name offaciility()J
(address of facility)
4Siture of applicant
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CLSNT IAC T TERPAS AND REt UIkED NOTICES
Wnl All hnma im .,I�... H F .,..7 - t +_
home lmprmamonfCwvracLnp,unless spedflodlyaAampi from regislialionby the preVlainns of Chaplar i 42A of the general laws,musl he reglstered !F
with dle CommenoraaIDt of Ida esadalsells. tnquirfus almul iagishahun and -
slnlus ShOokl be made to the.direda,Home Improvnmant Connador --
L;eg� Ono A hbuilun Plncs,Rccm 1301,I3"lun,fiA g2108. Qiial,`l and p clre
354 I'lerrlmaek 9treel[Entry C Sullo SBO).Lnwrence IAA of Bog
___ _.______ ___..____ ____-___.... ._____.._._ .__..-... ...---'BB81g0UDGET•Fa£ g7a lggAl26•--:w:Bud et. .�. .._ . . -
. 1 ) vn• S [xEariort.mm I
� Ola � f[ unar,a Run 3 Ihisiners itegvlmlon License or registration valid for imlirldul use on:y
elm ME Ut1PROVEMEHT CONTRACTOR before the explrallan dale. It found return In:
Islralloa: 177704 Type: _ Office of Con Sumer Affairs and Rumness Regtdulinn
plralien 1271?015 MAi g - I01•ark Plaza 'Sullt S170
x
Reslnn,M1tA 02116 .
BUDGET EXTERIORS
LOUIS MILANO 7 6
354 IAERRIIAAC,t(ST ENTRY C
LAWRENCE,IAA g10411 p'ndrisarJary. C Nut uhd vififiioul signnwre -
t Massachusetts-Department of Public Safety
`it Board of Building Regulations and Standards
Gnutruchnn Superrisdr
License CS-097519� -
`vs I:rs err..
LUQOSSVEC -
817 THOMPSOM
Thompson CT 116E7
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J,.�..�.L •1pj"- - Expiration
Commissioner 08/3112016
Hors Aa
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HOME IMPROVEMENT CONTRACT
PLEASE READ THIS
Sold,Furnished and Installed by:
Branch Name:Bruton North&South Date:6-/L/Aaf THD At-Home Services,Inc. t
d/b/a The Home Depot At-Home Services ,
Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545
1 Toll Free 877-903-3768
Federal ID q 75-2698460;ME De q C 02439:RI Cont.Lic#16427
t� / yn' (� CT is#H1C.0565522;MA Homnellmprovement Contractor Reg#126893
Installation Address: 1 L (-.44 , le Sic-tic
/Yt d" 0/1
City State Zip
Purchaser(s):
Work Phone: Home Phone: Cell Phone:
Home Address: (�
(If different from Installation Address) City State Zip
E-mail Address(to receive project communications and Home Depot updates).
❑1 DO NOT Wish to receive any marketing emails from The Home Depot
Proiect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,
and THD At-Homc Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation('Installation")of
all materials described on the below and on the referenced Spec Sheet(s), all of which arc incorporated into this Contract by this
reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, k
"Contract"):
Job#: o.i...a n.m...q Products: Sec Shtels a: Project Amount
[� (/� Roofing Siding Windom Insulation /^ 46 $ 3�n2`ta /
7J 3L,'V3a Gutters/Corers Entry Doors ❑ )IIV c '(
Roofing Siding Windows Insulation ' O'7 $ ' 7 10
-)r 9 C(Guncm/Cmem OEWn Doors 0-
/
Roofing Siding Windows Insulation $
(]Gmtefs/Corers ❑Entry Doors❑ i
Roofing Siding Windows Insulation $ ✓✓✓/
6°h
�Gmters/ QEntry Doors ❑ $ r
Minimum2 Deposit Amou n
l afCoAmountdue upon eMion of this examine. Contract Amount
et. 35 �QQ
Maine Purchasers may am deposit..,ban one-third ofthe Comma Amount.
Customer agrees that,immediately upon completion of the work for each Product.Customer will execute a Completion Certificate
(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this
Contract agrees to be jointly and severally obligated and liable hereunder.
The Home Depot reserves the light to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at
its discretion,if The Flame Depot or its authorized service provider determines that it cannot perform its obligations due to a structural
problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or bemuse
work required to complete thejob was not included in the f
ontract. included as part of this Contract,sets forth the land
Pavmen The Payment Summary q
Contract amount and payments required for the deposits and Anal payments by Product(as applicable).
NOTICE TO CUSTOMER
You are entitled to a completely filled-in copv of the I Contract et the time you siga. S not sign Completion Certificate(note:
There is one Completion Certificate for each listed Product as defined by individua Spec Sheers)before work an that Product
is complete.
rtermin by The It me Depot or Authorized Service Provider through the date of termination,plus any other
In the event of termination of this Contract,Customer agrees to pav The Home Depot the casts of materials,labor,expenses
ME
THHOLD AMOUNTS
and services p pppp
amounts set Forth
THE Agreemen
FROM eTHEdDEPOSITAPAYMENT OR OTHle law THE HO F.RPAYMENTT MAY IS MADE, WITHOUT
OWED TO
LIMITING THE HOMED DEPOT
OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Acce lance and A nhorizatton: Customer agrees and understands that this Agreement is the entire agreement between Customer
ons
relator to sat Prod Customer acknowledn.Thisges gas a dgaagrees that customer t cannot be shas read,ordersands,�volunmrily accepts thesigned
and. la Homc Depot Wit regard to the Products and Installation m,mens and supersedes all prior amended
except
and y a wricnu,either
Ome I,
oral or written, 8
eyrmsst and has eled a copy of this Agreement.
.Sub led ^/�'
kAccepted.by: b„1-� X Date
jry Dole S •sCisultantt,s7SSiignature
awre 6,' , �� Telephone No (DI'y�I�.Date Sales Conwltant License Na. (.,,l,nbul
Customer's i ure
'USTOMER MAY CANCEL THIS
CANCE TROUT PENALTY OR B OBLIGATION
BY DELIVERING WRITTEN THE THIRD BUSINESS
CE TO THE HOME
DEPOT BY MIDNIGHT THIS AGREEMENT. THE
DAY AFTER SIGNING ATTACHED HERETO
STATE SUPPLEMENT FRM TO USE IF ONE IS
IN
SPECIFICALLY
CONTAINS A PRESCRIBED BY LAW
TRACT
CUSTOMER'S STATE. ATED ON TIIF.REVERSE SIDE AND ARE PART OF THIS CON
NOTICE:ADDITION AND CONDITIONS8.8ranh Yeaow-Cosmmx
- 'k, Whl,a-Bfaoeh Flt-1k
Unofficial Property Record Card Page 1 of 1
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 33-0747-803 Account Number
Prior Parcel ID 51 --
Property Owner JACKSON JUDI A Property Location 24 GLENDALE STREET
Property Use Condo
Mailing Address 24 GLENDALE STREET U3 Most Recent Sale Date 312 612 01 0
Legal Reference 29354-420
City SALEM Grantor WEDBERG KYLE,
Mailing State MA Zip 01970 Sale Price 215,000
ParcelZoning RI Land Area 0.253 acres
Current Property Assessment
Card 1 Value Building 211 000 Xtra Features 0 Land Value 0 Total Value 211,000
Value Value
Building Description
Building Style Condo Garden Foundation Type Brick/Stone Flooring Type Hardwood
#of Living Units 1 Frame Type Wood Basement Floor Concrete
Year Built 1915 Roof Structure Gable Heating Type Forced H/W
Building Grade Average(+) Roof Cover Slate Heating Fuel Oil
Building Condition Good Siding Clapboard Air Conditioning 0%
Finished Area(SF)1023 Interior Walls Plaster #of Bsmt Garages 0
Number Rooms 4 #of Bedrooms 2 #of Full Baths 1
#of 314 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.253 acres of land mainly classified as Condo with a(n)Condo Garden style building,built about 1916,having
Clapboard exterior and Slate roof cover,with 1 unit(s),4 room(s),2 bedroom(s),1 bath(s),0 half bath(s). j
Property Images
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Disclaimer:This information is believed to be correct but is subject to change and is not warranteed.
http://salem.patriotproperties.com/RecordCard.asp 3/24/2015