21 1/2 GOODELL ST - BUILDING INSPECTION 'w
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� The Cummomvealth of M�ssachusetts
—' Doard uFBuilding Regulatiuns�nd StandarJs CITY
,h OF SALF:M
�� Massachusrtts Slate BuiWing Code, 780 CMR, 7 rJition
^ 1 Revisrd Junuur��
� J l3uiWing Permit Application To Cunswct, Repair, Renovate Or Demulish a L 100x
� '"" One-or TwwFumilv Dwrlling
� This Section For Official Use Onl
\P Building Pertnil Nu ber: Date Applied:
� Signaturr. `�'�'�" ' �� �f�,l �� ,.
AuilJing Cummissionrd I spectw uf BuilJiryyr Date
SECTION 1:SITE INFORMATION
1.1 P�operty Addre�a: 1.2 A»e»on Map& Parcel Numben
213 C�DBELI_ 5� S19LrM -
1.1 a Is this an accepted slreet?yes '� no Map Number Pareel Number
t3 Zoning Informatlon: I.J Property Dlmeosions:
Luning District ProposeJ Use Lo�Area(sy Il) Frontage(tl)
1.5 Building Setbacks(R) -
Front Yard SiJe Yards Rear Yard
Required ProviJed RequireJ Provided Requircd ProvideJ
1.6 Water Supply:(nt.G.L c.ao,§54) 1.7 Flood Zooe Informatioo: 1.8 Sewage Dbpoaal System:
Zune: Outside Flood ZoneT Munici el O On site dis sel s stem O
Public❑ Priva�e❑ Check if es0 P � Y
SECTION 2: PROPERTY OWNERSHIP�
2.1 Owner of Record:
EF2A-Ini UMRNfI _�Z GDoDtCL 5'F. SA�.EO''�
� Nume(Prim) Addreu for Service:�
99�- 33.5 - ro 98
Signaturc Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(c6eck all that appiy)
New Construction O Existing Building Owner-Occupied '� Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolilion O Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': k I T GM N R E M D D C L
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: pmclal Use Only
Labor and Materials
I. E3uilding S ID� OOJ.00 �• �uilding Permit fee:S Indicate how tee is Jetermined:
❑Standard CitylTown Application Fee
?.�Electrical S 4, 000,0� ❑Total Project Cost�(Item 6)x multiplier x
). Piumbing 5 l�000.pp 2. Other Fees: S
�{. Mechanical (FIVAC) S List:
5. Mechanical (Fire S Tutal All Fees: S '�
Su rcssion �I
Check No. Check Amount: Cash nmount:
6.Toml Project Cost S 15�000.00 ❑Paid in Full ❑Outstanding Balance Due:
3�s � �l O I
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tiECTtOIV 3: CONSTRUCTION SERVICES
S,� Llcensed Consiructlon Supervisor(CSL) gg 3 I 8 �i II 2012
M� CN AL SZ��L�G]S�I I.iccnu Number F:spimti n Uatr
N:une uf C81.• I IulJer I.ist CSL Type lsae below) LL
�15� f�Kf3l)RY S� � Nf1MILTf7N �, oexri tion
4JJrcss p (' ,
M „f1X. �a 1 _uSIM� U Unrestric�eJ u w I5,000 Cu.Ft.
A.V R Res�ricted 182 Famil Dwellin
tiignu�luArc M Mawn Onl
?p� Z� �-2 6 ��O � RC ResiJemial Routin Coverin
Tdrphone WS ResiJrn�ial WinJowanJSidin
SF Residenlial Sulid Fuel Bumin A liance Installutiun
� D Residemiul Demolition
5.2 Regbtered Home lm rovement C nt ctor(HIC) (6 ooO�
PIONARCN M�GNqC �2�DLO�,�Skf
I IIC Com y Name ur k1IC Regisvant N:une Regisira�ion Number
q��,�o ��K��6tr St. NAMi�rnN MR 6/17/aoio
MJC�n o�.� ��,�Ola nn� 7RI"A I'.�—a G� I G rpira�on Date
tiignoturc Tclephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. iS2.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted wilh this application. Failure to provide
this a�davit will result in the denial of the Issuance of the building permit.
Signed A�davit AttachedT Yes ..........❑ No...........0
ECTION 7r:OWNER AUTHORIZATION TO BE COMPLETED WHEN
WNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�, ' , as Owner of the subject property hereby
thorize to act on my behalf,in all matters
relative to work authorized by this building permit application. .
. i mreofOwner Date ,
SECTION 7b:OWNER�OR AUTHORIZED AGENT DECLARATION
1, Mi r�.n h �F����IU ,as Owner or Authorized Agent hereby declare
that the statements and infortnati on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
MICNAL SZ�DIAWSK-\
r���i N�,� �
�1��n�. �r�1�N�.n: 06 02 � ,20 f�
�� tiigna�urc of Owner or Amhariz Agent Date
Si ned unJer�he ains and naltie�of r'u
NOTES:
1. An Owner who obtains u building permit lo do his/her own work,or on owner who hires an unregistercd contrrclor
(not registered in�he Home Improvement Convaclor(HIC)Program), will no have access to the arbitration
progrrm or guaranry fund under M.G.L.c. Id2A.Other important infortnalion on the HIC Program and
Canstruction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 IO.R6 and I IO.RS,respectively.
2. When substantial worlc is planneJ,provide�he information below:
Total floors aren(Sq. F�.) (including garage, finished bazement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number uf bathroums Number of half'/ba�hs
Type uf heating system Number of decks/porches
Type of couling system Enclosed npen
3. "Tw�l Pmjne�Syuare Fuo�age"may be subs�iwteJ for"Total Projecl Cost" �
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CI'I'y UF SALEM
.�� PUBLIC PROPRERTY
�" " DEPARTMENT
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\I .0�M I_C�l'AJNV..��V 51'�!l'4�.�I INf.y7/•'JY�IIM I�..1'I '
rn,.,n.ras�,. n �°
C.�ns��ru�tlon"Dmbi i�nD�Proa u �w'f1d,vit
In accu►d:uxc wi�h �h�si�cl�eJition of tha State Duildin�Code. 730 CMR uctiun I I t.3
Dabri�.:u�J the provi�iuro ul'MGL e 30. S 34;
Ouilding 1'ermi� N _ . _ i� i�ucd wi�h tht eondition that tha dcbris multin�{ from
ihis wurk xhall he disposcJ ot in •r proPerlY 4c�+�s�'d wmte di�posa� faeility �s daflned by MGL c
l t L 5 131)A.
The debris will be tranepuK� by: ,
.� �IoNASLCh _ ',
pume u!houlerl i
1'he dcbria will be disposed uYin :
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GENERAL DEMOLITION NOTES
1.DEMOLITION IS NOT NECESSARILY LIMITED TO WHAT IS SHOWN ON DR4WINGS. THE
INTENT IS TO INDICATE THE GENERAL SCOPE OF DEMOLITION REQUIRED TO COMPLETE
THE WORK IN ACCORDANCE WITH THE CONTRACT DRAWINGS.
' • 2.REMOVE FLOOR FINISHES WHERE NOTED. CLEAN ELEMENTS THAT WOULD PREVENT AN �
ACCEPTABLE SURFACE fOR FLOOR FINISHES.
3.PATCH ANDI OR REPLACE ANY SURFACE THAT IS DAMAGED DURING THE DEMOLITION
PHASE,OR DAMAGED WALLS.
4.PROVICE TEMPORARY BARRICADES TO MAINTAIN SECURIN OF THE SPACE DURING THE P i o n A rc h `�
DEMOLITPJN PHASE OF THIS PROJECTAS REQUIRED.
5.PROVIOE STRICT CONTROL OF JOB CLEANING AND PREVENT DUSTAND DEBRIS FROM
EMANATINGFROA7DEMOLITION/CONSTRUCTIONAREA. KEEPAREACLEAN. 45❑ AseuRv STREET
• • 6.IF ANY QUESTIONS ARISE AS TO THE REMOVAL OF ANY MATERIAL, CLARIFY THE POINlT IN HAM I LTO N, n�n ❑ 1 9 B 2
� QUESTIOPJ WITH THE OWNER BEFORE PROCEEDING. P i o Na R c ri,c a nn
. . 7.AT COMPLETION OF DEMOLITION WORK,THE CONSTRUCTION AREAS)SHALL BE LEFT IM `�'��• 6 0 9. 1 6 1 1
. "BROOM CLEAN"CONDITION. ALL DEBRIS AND MISCELLANEOUS MATERIAL SHALL BE
REMOVED. , �
8.ALL DEBRIS REMOVAL SHALL BE PERFORMED IN ACCORDANCE WITH OWNER'S
RE�UIREPdENTS AND PROCEDURES.
9.DEMOLITION SHALL NOT DISTURB EXISTING OWNER AND SHALL BE DONE IN
ACCORDANCE WITH GWNER'S LIMITATIONS.
. �
i — . . .
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DEMOLITION LEGEND
D1 DEMOLITION KEYNOTE
RGOM NAME ROOM NUMBER -
• • ��� CONSTRUCTION TO REMAIN
C- — � CONSTRUCTION TO BE DEMOLISHED
/ �
/ I I DOOR/FR4ME TO BE REMOVED. 'R"INDICATES
% DOOR/FRAME TO BE SAVED FOR RE-USE.
I R�
EXISTiNG DOOR TO
/ REMAIN
i LIMIT OF WORK �
vA��� LIMITOFWORK
I
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� I � ; 42 A.F.F ; �• 42"A.F F .
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ana
' ' REMOVEEXISTINGBASEBOARD) ' ;_. _ _; : ._____ � - �- -- : .__ ________ ________ __ __ esidence
�, ALL AROUND THE ROOM. � " � REMOVE EXISTING OUTLET
, �, � : , `•, 21 1/2 Goodell Street
� I '-- ---- -- - �-- -. :� -- � ' ------------ - � ----- --- - -• -- Salem, MA 01970
I PLACEEXISTING EXISTINGOUTLETTOREMAIN. I ' ;�
� POWEROUTLET42" REPLACEEXISTINGPLATE. `__,. ____
A.F.F. REMOVE�JCISTING RANGE
ANDDIS�SE ���'2� I ��I =
/� REMOVE EXISTING LOWER AND UPPER CABINETS �' ~
1; � � � � o �
EXISTING KITCHEN REMOVEAND DISPOSE I I ��
� EXISTING OAK FLOOR'TO REMAIN I EXISTING REFRIDGERATOR "' Z
�; REM04E AND DISPOSE EXISTING � � o � " '
z
,'; � NITCHEN SINK.REUSE DISPOSER. I I � � � Project Number: 0108.000 i
' ' MOVE PLUMBING AS NECESSARY. W
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EXISTING DEN ;��� �--- ; - - - - , ;-- -- I I �� o
I ; ; �---- -�-------- � � � �
REMOVE EXISTING --�
I� � �; RE�,RN.�o�A�TME i i � ¢ � PERMIT SET
I � ' NEW REiURN IN THE
I �� I �, 42'AF.F 42"A.F.F 42'A.F.F ' NEW ISLAND CABINETS. �J i
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� `" --� ---'------- �-------'-�---------- -------------'------ - I I
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r-- ----- ---•-- - -- ---- --- -- - -- - -- - - -- -- -- ---- - - - I
, \� � ; REMOVEALLOUTLETSANCSWITCHESATISLAND ; � j Date: MarCh 15, 2��� 1
� -----------------------------------= W4DENWXISTING � �
', � ---- ----------- --------- - ---
g�_Q. OPENING I I
DOUPLIXPOWEROUTLETTOREMAIN I ,� ,� REMOVEEXISTING I I NO. DESCRIPTION DATE
�I � , ' REMOVE EXISTING ISLAND HEADER
. � • ° AND TRIM i I
I REMOVE AND DISPOSE I i I
' DCISlING VINYL FLOOR TILE.
I I I I A DTREPLACED �ORKED + i
DOUPLEX POWER OUTLET TO REMAIN � � — SWITCH TO REMAW �
; � SWITCH LOCATION TO REMAIN.REWORK WIRES. DOUPLEX POWER OUTLET TO I I
I EXISTING BELL TO BE RELOCATED BE REMOVED I
I 42"A.F.F $ $
- $2 '� ,
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UP � DN
I , ;., , ' tfl ( — SWITCH TO REMAIN
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CHECK WORKABILITY OF THE SWITCH r = -
- i
. ADJUST IF NECESSARY.
, BURNER SWITCH TO REMAIN •
I NOTE: ALL RECESSED LIGHTS �TO BE REMOVED
' WITH THEIR WIRES WITHIN THE LIMIT OF WORK.
1 DEMOLITION PLAN
DEMOLITION
o,.a ,�2��= ,�-o�� PLAN
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OO 2010 PIOfNARCH
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