14 GLOVER ST - BUILDING INSPECTION (2) EI`ry-OFS-.AL
PUBLIC PROPERTY
DEPARTMENT `a
KWAFALEY DRISCOLL
MAYOR 120 WASNINGNM 3`BEEr•SALE 'y MUSACHLSE,13 01970
14i 978-745-959S. FAx:9711-740.9U6 �7
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
01970
Property Is located in a;Conservation Area Y/N o Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land L _
LTejephone:
6117d
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Existing
Addition
Renovation Number of Stories Renovated Z
Change in Use -New
Demolition Existing /� uv
Approximate year of ��z� Area per floor (sf) Renovated
construction or renovation
of existing building New _7 G
Brief Description of Proposed Work:
p �' 6w�'�cJiny 0IV C�
6y
--- Mail Permit to:
What is the current use of the Building?
Material of Building? �iJ°a a If dwelling. how many units? 3
Will the Building Conform to Law? Asbestos? /too
Architect's Name
Address and Phone _
Mechanic's Name �_`� ✓
Address and Phone /�r� e � ��/n 27,* ?361 7,(7�
Construction Supervisors license# rfO6.97" HIC Registration# LrP6 K
Estimated Cost of Project$ 14 0 o U Permit Fee Calculation
Permit Fee$ /��' Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly 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 penalty of perjury Xl
Date II z7 '4
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
xnuaeRSEv eRncott
MAYM 12o WA9C40 WSTRW a SAIEK MASSACHUSEM 0197o
Tat:971.745-9S95 a FAX:M740.%%
Workers' Compensation Insurance Affidavit. Builders/Contractorsmectrieiansq%mhes
Applicant Information Been Print Legality
Name(BusineWorpniauowin"eud): SGGLCl/�Z/� �YlS�JCC ✓�j�
Address: �3 ��3e s]'
City/Statemp:_ f4l m 0/9 7U phone# �7, F3 C /�79
Are you an employer?Cheek the appropriate boss
1. I am a employer with� 4. 0 I am a;costal contractor and 1 Type of project(regatrsd):
employees 0611 and/or part-time).• have hired the m contrac cca 6. ❑New construction
2.0 I am a sole proprietor at partner- listed on the attached sheet,t 7. J0 Remodeling
ship and have no employees These sub-conuactota have 8. (]Demolition
workingfor me in any capacity. workers,
workers'comp innrrance 5. 0 We are A cocorporation and its tag addition
required.] ofi9cas have exercised their 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all worn right of exemption per MGL 11.0 Plumbing repair or additions
myself.(No workers'comp. c. 152,J1(4),and we have no
insurance required.]t employees.(No works=, 12.❑Roof repairs
comp insurance requited] 13.0 Other
*Any apptiom t�checb bas 01 mint also fill out the=erica below rhoviy thou rak4
Acmeowma who ntbmu this dockvu "Yam doter ad wok and smi sin ow"conaugug i ram submit a saw of kkvk tContraaaa abut cbeek tb4 bin soma anachad w adMonal+beat ahowiaa the soma of the mbeona'wow and dwk worker'camRpomwtslhrmmka,
foal an employer that b providbtg workers'comrpensedon insaroneejar my eZployeea Below b the poBey aedJob sbs
Tnjoraratlow. L
Insurance Company Name: b'+��Ct�i�re/J S t� /E9 017A/ bjf(o
Policy#or Self-ins.Lie.#: 7�r�SJiy / Expiration Date:_ d 7110 7 e �
Job Sits Address_ 17/ (7/CG7't2/� S Ci /S O/�7(�
ry tateJZip: L
Attach a copy of the workers'compensation policy declaration page(showingshe policy camber and capitation dab).
Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the
fine up to S 1,500.0o atWor one-
ear' imposition of criminal penalties ofa
y unprWrimcm.as well as civil penalties in the form of a STOP WORK ORDER and a Roe
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,
l do hereby ce r and penalties ojperJnry that the Injo►nration provided above b true and tarred
1617 9
OJJlelad ass only. Do not write in this area,to be comtpfeted by chy o►town oJ)PelaL
City or Town: Permli/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Powo Clerk 4. Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#•
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their emploYas•
pursuant to this statut%an employee is defined as"...every Person in the service of another under any Contract of hir%
express or implied.oral or written"
association.corporation�°�legal entity,or any two Or mote '
An eat Oyer is defined as"an individual,partaas6tp+ ves of a deceased emPloYa,or the
Of the ce ping engaged in ajO1nt snt"Pris%and including legal rap�ntati however the
receiver or trusted of an individual.partnership.association at other °� tity.employing employees.resides therein.or the occupant of the
owner of a dwelling haw bavbsg not more than three apartmentsand
emsurretta or�work on such dwelling barge
dwelling boom of atsothor who employs Pasty to do wintenaace. "
or on the Smunds of building appurtenant Ito shall not because of such employment be deemed to be an empbyer
MGL to chapter 152.125C(6)also states that"every state or local tlwsinf agency shag withboid the isstunae or
operate a bushes or to aasdrud buildings hs the eomwnwes"for say
renewal of a tlaw or permit ideaee oI ampllance with the insnraw cov
erage regedred.
applicant bra Met b set produced acceptable ev"Neither the commonwealth nor any of its political subdivisions shall
Additionally.MGL chapter 132.$25C(n states with the insurance
of he work until acceptable evidence of compliance
inter into any conned for the have
bien pre to the contracting authority"
raquiremena of this chapter have been presented
Applicants
Please fill out tho wodcaa' compensation affidavit completely.by dwcinng the boxes that apply to your aimed=and.if
necessary.saPPIY sub.eonnaetods)nama(s).addras(as)and Phone numbe (s)along withwith no employeess)of
other►ban the
Limited Liability Companies(LLC)or Limited Liability Painsuranca.�an�LLC or LLP does have
to carry workers compensation insurance.
nuembas or partners,are not required that this affidavit may be submitted to the Department°f industrial
CMployea's policy is required.
Be advised
coverage. Abe b•stun to rig•and date the dMILVIL The affidavit
should
Accidents for confirmation lveragn for the permit or licew is being regwte4 not the
Deparmcd Of
be returned to the city or town that the ape any qu" the law a if you are required to obtain a workers'
compensation Policy.pass thei
can the�Depsrtmmt the number listed below. self-insured companies should enterme ngerding r
self inaaaw Hcomm number on die
City or Town Ofltelab
please be sure that the affidavit is complete and printed legibly. The Department has provided a space ere the bottom
of the affidavit for you to fill out in the event the Office of Investgatiom has to contact you regarding the appppl c
of
affidavit
sum to fin in the pamitlliccan number which will be used as a reference number. In addition,
an applicant
��permiittlic applications in any given year,need only submit one affidavit indicating current
that must submit under"Job site Addrw"the applicant should write"all locations in----(City or
policy information(if nxeesary) or marked by the city a town may be provided to the
town). A copy of the affidavit that has be officially stamped r fisture permits or licenses. A now afudavu must be filled out each
applicant as proof that a valid affidavit Is Onfile f a license a permit not related to any business a commercial venture
year.Where a boom owner a ci=oa is obtaining u NOT requited to complete this affidavit
(i.e. a dog license or Permit to burn laves etc.)said petaon
ns would like to thank you in advance for your cooperation and should you have any gaesaons,
The Office of Jnvestigstio give
us a call.
please do not hesitate to
The Deparnnent's addresk telephone and fax number.
The Comm mm9th of Mmachuscd
Mpuument of Industrial Accidents
Ofaa of IavesdBadons
600 washing"street
Boston.MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax M 617-727-7749
Revised 5-26.05 Wwwmmgov/dit
CrrY OF SALEM
' PUBLIC PROPERTY
:t
DEPARTMENT
MAVCS tsovnu�m�aanstmr•ti.��.�os�anaotAte
Cons&ucdon Debris Disposal Affidavit
(required 8or sd dsmwwoa ad rasovs"wade)
is at:oordame with the sixth WWoa of dw Shot Sdidins Code.780 CMR seettaa 111.5
Dam*ad the provisions dUCL a 40.8 Sit
SuOdinti pawk M is Ismail with the eoadidos that the dd*U rawideti foot
chill want sW be disposed O is s peopmlY Um"waste dispoed&d tit as defined by M4 L a
1 i 1.S 1lOJ1.
The debris will be b'tespoeted bar
The debris will be disposed o[in:
Al
(sam..rnGut»
11/z7j
dam
MORTGAGE INSPECTION
BAY STATE SURVEYING ASSOCIATES
234 CABOT ST., BEVERLY MA
LOCATION.: S.4LEM r MA, NOTES:
-----------
SCALE : I = Z<> FT. DATE _ ___��?y_�5S ___ _ _ •This is a Mortgage Inspection survey and not an
instrument survey,therefore this plot plan is for
REFERENCE t $K''_ q $�__ `'Cj'_27 ________ mortgage inspection purposes only.
ES�EX_ _ Sc?. OI$1_ •This survey is based on survey marks of others.
--- ---- -- -- - -- -- ----- ---- - - -- -- - --- ---- • Bushes,shrubs, fences and tree lines do not
necessarily indicate property lines.
4LL N1 ��V� /Ytq�27"
To _S. C�� .In my professional opinion the building(s)are not located
The location of the building(s) as shown,either complied with the in the special flood hazard zone, as defined by H-U.D.
local zoning set backs at the time of construction or is exempt •Whenever an offset is 1't or less, an instrument survey
from violation enforcement action under Mass. G.L.Title VII is recommended to determine prop. lines.
Chapter 40A Section 7. •Offsets shown are approximate by tape survey.
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��Fs� /STCA'"ry��
avolrA CITY OF SALEM, MASSACHUSETTS
BOARD OF APPEAL Lf 1 .� � f "/+�1-�• lj�
120 WASHINGTON STREET. 3RO FLOOR CLE,;6i'S OFFICE
SALEM. MASSACHUSETTS O 1970
TELEPHONE: 978.745.9595
p� FAX: 978-740-9846
�Edb OCTI b P I. 31
KIMBERLEY DRISCOLL
MAYOR
October 16, 2006
Decision
Petition of Brian Brinkers requesting Variances from side yard setback and
number of stories requirements for the property located at
14 Glover Street, R-2 District
City of Salem Zoning Board of Appeals
A public hearing on the above petition was opened on September 20, 2006 pursuant to
Mass General Law Ch. 40A, See. 11, the following Zoning Board members present: Nina
Cohen, Annie Hams, Beth Debski,Richard Dionne, Bonnie Belair.
The petitioner Brian Brinkers is requesting variances pursuant to section 9-5 to allow for
reconstruction and expansion of a deck for the property located at 14 Glover Street,
Salem, in the Two-Family Residential (R-2)zoning district.
The petitioner is requesting a variance from the ten(10)foot minimum side yard setback
requirement of the City of Salem Zoning Ordinance (Sec 6-4,Table 1) to approximately „
six (6)feet and from the required two and one-half(2 6h) stories to three (3)stories for
the expansion and reconstruction of a twenty-three(23)foot by nine(9) foot three-story
deck.
The Board of Appeals, after careful consideration of the evidence presented at the public
hearing, and after thorough review of the Petition submitted, makes the following
findings of fact:
1. The property at 14 Glover Street is within the R-2 zoning district.
2. The Petitioner presented a petition in favor of the proposed addition signed by
three (3)of his neighbors.
3. Ward five City Councilor Matthew Veno spoke in favor of the petition.
4. There were no members of the public wishing to speak in favor or opposed to
the proposed project.
On the basis of the above findings of fact, including all evidence presented at the public
hearing, including, but not limited to, the Petition the Zoning Board of Appeals concludes
as follows:
1. The petitioner's request for a variance from the side yard setback requirement
of ten(10) feet to six (6) feet and from the required two and one-half(2 Ih)
stories to three(3) stories for the expansion and reconstruction of a twenty-
three(23) foot by nine(9) foot three-story deck does not constitute a
substantial detriment to the public good.
2. The requested relief does not nullify or substantially derogate from the intent
or purpose of the zoning ordinance.
3. A literal enforcement of the zoning ordinance would create a substantial
hardship to the petitioner.
4. In permitting such change, the Board of Appeals requires certain appropriate
conditions and safeguards as noted below.
In consideration of the above,the Salem Board of Appeals voted,five (5)in favor
(Cohen,Debski,Dionne, Harris,Belair)and none (0)opposed, to grant the request for a
variance, subject to the following terms,conditions,and safeguards:
1. Petitioner shall comply with all city and state statutes,ordinances,codes and
regulations.
2. All construction shall be done as per the plans and dimensions submitted to
and approved by the Building Commissioner.
3. All requirements of the Salem Fire Department relative to smoke and fire
safety shall be strictly adhered to.
4. Petitioner shall obtain a building permit prior to beginning any construction.
5. Exterior finishes of the new construction shall be in harmony with the existing
structure.
6. A Certificate of Inspection is to be obtained.
7. Petitioner is to obtain approval from any City Board or Commission having
jurisdiction including, but not limited to, the Planning Board.
8. Unless this Decision expressly provides otherwise, any zoning relief granted
doe not empower or authorize the Petitioner to demolish or reconstruct the
structure(s) located on the subject property to an extent of more than fifty
percent(50%)of its floor area of more than fifty percent(50%)of its
replacement cost at the time of destruction. If the structure is demolished by
any means to an extent of more than fifty percent(50%) of its replacement
cost or more than fifty percent (50%) of its floor area at the time of
destruction, it shall not be reconstructed except in conformity with the
provisions of the Ordinance.
tJE.k.O ti9`e�..� /A 4--
Richard Dionne
Salem Zoning Board of Appeals
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY
CLERK
Appeal from this decision,if any,shall be trade pursuant to Section 17 of the Massachusetts General Laws
Chapter 40A,and shall be filed within 20 days of filing of this decision in the office of the City Clerk.
Pursuant to the Massachusetts General Laws Chapter 40A,Section 11,the Variance or Special Permit
granted herein shall not take effect until a copy of the decision bearing the certificate of the City clerk that
20 days have elapsed and no appeal has been filed,or that,if such appeal has been filed,that it has been
dismissed or denied and is recorded in the South Essex Registry of Deeds and indexed under the name of
the owner of record or is recorded and noted on the owner's Certificate of Title.
Nov 27 2006 8136RN YRNKEE PINE CORP 9789487828 P• 1
09/20/2006 11:15 9786635862 MCLLIESTER PAGE 02
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