412 JEFFERSON AVE - BUILDING INSPECTION (2) The Commonwealth ot'Massachuscits
CITY
Board of Building Regulations and Standards OF SALEM
Massachusetts State Building Code, 730 CMR, 7,n edition
Kavisrd Juneiurp
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 2008
One-or Tivo-Family Dwelling
This Section For Official Use Only
Q� Building Permit Number Date Applied:
w0_ Signature: r*,,
IluilJing Commissioner/ dings Date
SECTION 1: SITE INFORMATION
1.1 Property�(dress: 1.2 Assessors Map At Parcel Numbers
41 � 64M A.,� SA h
I Aa 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 11) Frontage Ill)
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:
Zone: _ Outside Flood Zone? Municipal On site disposal system ❑
Public Private❑ al Check if es❑ P P Y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
Soler Mt Mt 11 A. Bec 912
Name(Print) _T Address for Service:
eg 9 ,78.7411 .. is01
Sign re U Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) -
New Construction❑ Existing Building❑ Owner-Occupied)W Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition 13 1 Accessory Bldg. ❑ Number of Units_ Other,� Specity�brtve Ca,rovr,,) PonI
Brief Description of Proposed Work-:
y L 1 ati. l S r 1�owz uv,
W yYlrN tnA Os6Y VvzCe_55 fery t;�, 'r1 CA aC
S AVY\e— J IAA I- is Lk V A,ra
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
I. Building S 1. Building Permit Fee:S Indicate how tee is determined:
Ors ❑Standard City/Town Application Fee
2. Electrical S p ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S-cnzAry / C1 21" ,\
4. Mechanical (IiVAC) S Lisc O/ (�' /�'�
5. Mechanical (Fire S
Suppression) Total All Fees:S
Check No. Check Amount: Cash Amount:_
6.Total Project Cost: S 13 Paid in Full 13 Outstanding Balance Due:
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Numher Expiration Date
Name uf'CSt.- I[older
List C'SL Type(see below)
AddressFs, Descri tion
ll Unrestricted a to 35,000 Cu.F1.)
It Restricted 1102 Family Dwelling
Signature M wlasun ()'!'IRC Residential Routing Coverin
at
telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
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.
Signed Affidavit Attached? Yes .......... ❑ No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S A T OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property hereby
au ze to act on my behalf, in all matters
rely ve 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. I42A. Other important information on the FIIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and I IO.RS,respectively.
2. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage,finished basement/attics, decks or porch)
Grass living area(Sq. Ft.) Ilabitable 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 fix"Total Project Cost"
f'� Y
C,I Y OF SALEN'I
PUBLIC PROPERTY
DEPARTMENT
KIMBI/It I.)%% DRKCi fl1,
I_U\C'.\aiLu,nN,-r¢ritr . S.\i.i u,i.>�:v: .\�anm:1-1S019-11
♦ 1:\s:7-8--.W.98I6
Swimming pools, Spas & Hot Tubs
Frequently Asked Questions
Definitions:
Pool any structure intended for swimming or bathing
containing water 24"deep or more
Spas & are considered pools if water is 24" deep or more
Hot Tubs
Can I put a pool in my yard?
Pools are allowed in side and rear yards if located at least 5' from
Side and rear lot lines.
Do I need a permit?
Yes; a permit is required from the Building Department and when the
the permit is issued, a licensed electrician must obtain a permit
from the city Electrical Department if there is any electrical work.
What information do I need to file a permit?
A certified plot plan drawn at 1"=30' scale or larger showing
the pool, the house, fencing and gate dimensions showing distances from
the property lines. For above ground pools, a mortgage plot plan
will suffice.
What else is required?
Pools are required to be enclosed by a fence at least 48" high with a self-
latching gate at least 36" wide. Rail fences are not sufficient to meet this
requirement. Salem City ordinance require the fence even if the above-
ground pool has a barrier mounted on the top of the pool.
For more information
Refer to Massachusetts Building Code appendix M. See link on our
Department website
<V.a
7S0 G\-IR: STATE BOARD OF BUILDING REGUL.-"rJONS AND STANDARDS
APPENDICES
7811 CNIR 1211-M
S\VININIING POOLS, SPAS AND IIOT TCIiS
780CMR 1-''0\I101 GENEItki. S1V1\IMING POOL, OUTDOOR. Anv
120.\I I111.1 Ga•neral. The pruvisiun.i of'SO CMR s,,muning pool which is nut an indoor pool.
120M ,hall control the design and constriction of
swinuning pools, :pas and hot tubs. 7811 CNIR 120AII03 SIVIMNILNG P(X)LS
.Vole 1: Public and serni-publie outdoor in. 120.\1103.1 In-ground Pools. In-ground pools
ground s winning pool enclosures slmllconfiarm shall he designed and constructed in conformance
to the requirements of3l.G.L. c. 140, ,¢206. withANSUNSPI-5 as listed in 780CMR 120.\1107.
:Vote 2: Also see 521 CUR 19.00:Recreational
Facilities. 120 A1103.2 :Above-ground and On-growtd
Pools. Above-ground and on-gruund pools shall be
:Vote 3: a(s•o.ree/(15 C';SIRf30.00(1 mid J15.!/00 designed and constructed in conformance with
as such regulates swiaanirtg pool re•gttiremenb'. ANST/NSPf4 its listed in 7S0 CMR I_'QM I07.
:Vote 1: Installation of electrical wiring and
electrical devices shall be in accordance with 7,40 CMR 120AII04 SPAS AND HOt 'PUBS
527CMR 12.00. ,Massachusetts Electrical Code. 120:MI04 1 Permanently Installed Spas and Hot
Note 5. Installation of gas-fired pool heaters Tubs. Permanently installed spas and hot tubs shall
shall be in accordance with 248 CMR (the be designed and constmcted in conformance with
Massachusetts Fuel Gas and Plumbing Code). ANSUNSPI-3 as listed in 780 CNIR 120.M 107.
780 CNIR 120AI102 DEfINMONS 120.M104.2 Portable Spas and Hot Pubs.
120.M102.1 General.For the purposes of 780 CMR Portable spas and hot tubs shall be designed and
120.M, the terns used shall be defined as follows constructed in conformance with ANSUNSPI-6 as
2 and as set forth in 780 CMR 52.00. listed in 780 CMR 120.M 107.
ABOVE-GROUND/ON-GROUND POOL. See 780 CMR 120JVU05 BARRIER
"Swimming Pool." REQUIREMENTS
BARRIER. A fence, wall, building wall or 120.M105.1 Application. The provisions of
combination there-of which completely surrounds 780 CMR 120.M shall control the design of barriers
the swimming pool and obstructs access to the for residential swimming pools, spas and hot tubs.
swimming pool These design controls are intended to provide
HOT TUB. See"Swimming Pool." protection against potential drowning and
near-drowning by restricting access to swinmung
IN-GROUND POOL. See••Swimming Pool." pools,spas and hot tubs.
RESIDENTIAL. That which is situated on the 120.1MI05.20utdoor Swimming fool. An outdoor
premises of adetuched one-or two-family dwelling swimming pool, including an in-ground,
or a one-family town-house not more than three aboveground oron-ground pool,hot tub or spa shall
stories in height• be provided with a barrier which shall comply with
SPA, NONPORTABLE. See"Swimming Pool." the following:
1. The to of the barrier shall be at least 48
SPA, PORTABLE. A nonpermanent stntcture inches (1219 mot) above grade measured on the
intended for recreational bathing, in which all side of the barrier which faces away from the
controls, water-heating and water-circulating swimming pool. The maximum vertical clearance
equipment:u'c an integral pan of the product. between grade and the bottom of the barrier shall
SWININIING POOL. Any stntcture intended for be two inches(51 mm) measured on the side of
swimming or recreational hathing that contains the harrier which faces away from the swimming
water over 24 inches(610 nim)deep. This includes pool. Where thump of the pool stmcture is above
in-ground,aboveground and on-ground swimming grade, such as an aboveground pool, the barrier
pools, hot tubs and spas. maybe aground level,such as the pool structure•
or mounted on top of the pool stmcture. Where
SWlbl>IING POOL, INDOOR. A swimming the barrier is mounted ontopof the pool stntcture,
pool which is totally contained within a structure and the maximum vertical clearance between the top
surrounded on all four sides by walls of said of the pool structure and the bottom of the barrier -
structure. shall be four inches(102 nun).
12/28/07 (Effective I/l/08) 780 CMR -Seventh Edition 1025
780 CSIR: 5'r.4 rE BO.\RD OP BUILDING REGUI.:\7lON'S AND SI'.\ND:\RDS
'r11F JIASSACIIUSE7TS STATE BUILDING CODE l
2. Opc•nut gs in the barrier shall not.l low passage _opened. The alarm Amll sound conhnuuusly 7
otit four-inch-di,nneter(102 rim)sphere. furantinimwn of j nJsimmrciuelv,dtrr '
;. Solid barriers which Ju not hate openings, rite door is opened and be capable of being
such as a masonsann'or Mane A all,shall nut common heard thnnghaut the house during normal
indentations or prUtNsluns except for normal hUtLse—hold activities. Nie aLu"rn shall
construction tolerances;utdlooled masonryjouns. autom:¢ical!y reset under all :onditiOns. 'Fite
4. %'here the barrier is composed of horizontal a! m system shall be equipped with a manual
and te•rticai members and the distance between me:u"ans, such as touchpad .or switch, to
the tuns of the horizontal members is less than 45 temporarily deactivate the alarm for a single
inchc.c (1143 tnnh). ;he horizontal members shall
be loc.ned on the s.vintming Pool aide of the "penmg. Su'h seconddcaclivatian shall last for not
1 inure than � seconds. The ;leach v:nion
fence. Spacing bemcen vertical members shalt
east 54 inches
nut exceed 1.75 inches(44 'Mn)m width. Where ts1372 nun))above the shall he located
holdat l of4he door: or
There are decorative cutouts within critical 9 3. Other means of protection, such as
members, spacing within the Cutouts Shallno( .elf-,:losing doors with self-latching dcv ices,
exceed 1.75 inches(44 min) in width. which are approved by the governing body,
5. Where the barrier is composed of horizontal shall he acceptable so long as the degree of
and vertical members and the distance between protection afforded is not less than the
the tops of the horizontal members is 45 inches protection afforded by780CMR 1201A105.2.,
(1143 mm) or inure, spacing between vertical Item 9.1 or 9.2.
members shall not exceed four inches(102 film). 10. Where an aboveground pool structure is used
Where there are decorative cutouts within vertical as a barrier or where the barrier is mounted on top
members, spacing within the cutouts shall not of the pool structure,and the means of access is a
exceed 1.75 inches(44 mm) in width. ladder or steps,then:
6. Maximum mesh size for chain link fences 10.1. The ladder or steps shall be capable of
shall be a 2.25-inch (57 tam) square unless the being secured, locked or removed to prevent
fence is provided with slats fastened at the top or access,or
the bottom which reduce the openings to not more 10.2. The ladder or steps shall be surrounded
than 1.75 inches(44 mm). by a barrier which meets the requirements of
7. Where the barrier is composed of dimensional 780 CMR 120.M105.2., Items I through 9.
members, such as a lattice fence, the maximum When the ladder or steps are secured,locked or
openingfommd by the dimensional members shall removed, any opening created shall not allow
not be more than 1.75 inches(44 tam), the pass 120.Me of a four-inch-diameter(102
8. Access gates shall comply with the mm)sphere.
requirements of 780 CMR 120.M 105.2, Items 1
through 7,and shall he equipped to accommodate Note t/rat jor private, above ground pools:
a locking device. Pedestrian access gates shall 1• The pool wall of an outdoor, above.
open outward away from the pool and shall be ground pool(with pool walls extending at
self-closing and have a self-latching device. least 48 inches above grade at all points
Gates other than pedestrian access gates shall along the Pool),a substitutes for,with e
have a self-latching device. Where the release other barrier around the pool with the
exception of
mechanism of the self-latching device is located the ladder area of the pool.
less me than 54 inches 1372 n 2, A retractable, lockable ladder, that
( can)from the bottom of cannutbe removed(without
al
the gate, the release mechanism and openings t a smallools child),
knnwlydge available to a small cleilJ),shall comply with the following: whi
8.1. 'rhe rcleaae mechanism shall be located ch retracts, by hinge or sliding
can thepool side of the gate at least three inches mechanism,to 48inches or more oho re the -
finished grade level and has Provision fin,(7G net)below the top of[he gate,and securing in the retracted crude with a
8.2. The gate and barrier shall have no locking device, shall be considered tat
opening greater than 0.5 inch(12.7 ern)within acceptable alternative to the applicable
18 inches(457 tam)of the release mechanism. required enclosure (fence or filter gate
9. Where a wall of a dwelling serves as part of harrier)of the 780 C':11R 421 (0 Edition
'he barrier one of the following conditions shall lluilding Code), or 780 CSIR 120.d1 (74
Ile met: Edition Building Code for One.and Two.
9.1. The pool shall be equipped with it Family Dwellings),
Powered safety cover in compliance with J. The retractable ladder locking/release
ASTM p1346; or device ,lost be located at least 54 iochres
9.2. All doors with direct access to the pool abovethefrnishedgrade levelin immediate
through that wall shall he equipped with an viciaily of the retractable ladder or such
alarm which produces an audiblewarning locking/release oechanism shallbrloeated
when (he door and its screen, if present, are on the pool side of the ladder forcing
1026 780 CMR -Seventh Edition 12/28/07 (Effective 1/1/08)
730 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS
APPENDICES
•, ••reach around")and locaredat least three 120AII 16.4 Dual Drain Separation. Sin1le or
inches below the top of the ladder and the multiple pump Oicu'ation systems shall he pros:deJ i
.ladder shall not have an opening greater w:th a nunimum of avo saction tulle;; of dte
that ri inch Mithin IS inches of the approved type. :\ minimum .`Wrizomal or %cnical
lurking/release mechanism, distance of ;hrce feet shall separate such oulicts.
F_•.rcrpriun:fbh(ic andsrmi•public outdoor -These suction ocltleIS .hall he piped so that water is
in-gnnmdsM iuuning pool rnchn'nres'Mall dr:nvn through :hem s:ntuaa;ieousIv though a
nmfornr to the requirements of.11.6.1_ c. raeuum refiel:..prulecled lire to the pump or pumps.
140, ¢206. 120.N1106.5 fool Cleaner Fillings. \"here
120.M105.3 Indoor Swimming Pool. All walls providttl,vacuum or prrssurc cleaner fiuurg(s)shail
suaounding an indoor swinuning p001 shall comply he located in an uccessilile posiliou(s) it least six
milh 7S0 C•\IR I_ ) M 105 2, Item 9. inches and not greater than nveh•e ineheS below the
fill Eli InuIll upe rational �s axr IV vel or as an
120.M 105.4 Prohibited Locations. Barriers shall attachment to the Ainunerfs).
I,e located so as to prohibit permanent structures,
equipment or sinular objects from being used to 780CDIR 120NII(7ABBREVIX11ONS
climb the barriers.
1211.M107.I General.
120.M105.5 Barrier Exceptions. Spas or hot tubs ANSI—American National Standards Institute
with a safety cover which complies with ASTM F I I West 42nd Street,New York, NY 10036
1346, as listed in 780 CMR 120.M107, shall be ASTM—American Society for 'resting and
exempt from the provisions of 780 CIvIR 120.M. Materials
1916 Race Street,Philadelphia, PA 19103
780 CMR 120.M106 EN IRAPMENT NSPI—National Spa and Pool Institute
PROTEC17ON FOR SNV rMNHNG POOL 2111 Eisenhower Avenue, Alexandria, VA
AND SPA SUCITON OUTLETS 22314
120.M106.1 General. Suction outlets shall be
designed to produce circulation throughout the pool 780 CMR 120.M108 STANDARDS
or spa. Single outlet systems, such as automatic '120•M108.1 General.
vacuum cleaner systems, or other such multiple . ANSI/NSPI
suction outlets whether isolated by valves or ANSI/NSPI-3-99 Standard for Permanently
otherwise shall be protected against user entrapment. Installed Residential Spas AG 104.1
Note: Also refer to 105 CVR 430.000 and ANSUNSPI-4-99 Standard for Above-ground/
435.000. On-ground Residential Swimming Pools AG 103.2
l2O.Mt06.2 Suction Fittings. All Pool and Spa ANSVNSPI-5-99 Standard for Residential In-
Suction outlets shall be provided with a cover that ground Swimming Pools AG103.1
conforms with ANSI/ASME AI 12.19.8M,or a 121 ANSUNSP[-6-99 Standard for Residential
121 drain grate or larger, or an approved channel Portable Spas AG 104.2
drain system. ANS"ASME A 1 12.19.8M-1987 Suction Fittings
Exception: Surface skimmers for Use in Swinuning Pools, Wading Pools,Spas,
Hut Tubs and Whirlpool Bathing Appliances
120.MI(16.3 Atmospheric Vacuum Relief System AG106.2,
Required. All pool and spa single or multiple outlet ASTM
circulation systems shall be equipped with ASTM F 1346-91 (1996) Performance
atmospheric vacuum relief should grate covers Specification for Safety Covers and Labeling
located therein become missing or broken. Such Requirements for All Covers for Swimming
vacuum relief systems shall include at least one Pools, Spas and Hut Tubs AG 105.2, AG 105.5
.Ipproved or engineered method of t he t}pe specified :1SME
herein,as follows: ASME Al 12.19.17 Manufacturecs S:dety Vacuum
1. Safety vacuum release system conforming to Release Systems (SVRS) for Residential and
ASME A 112,19 17, or Commercial Swimming Pool, Spa, I lot Tub and
2. An approved gravity drainage system. Wading Pool AG106.3
12/28/07 (Effective 111/08) 780 CMR - Seventh Edition 1027
L
b
CITY OF siu.Eat
PUBLIC PROPERTY
DEPARTMENT
w.s�oa ax L
MAvoe I30 WASO .ROM ftuW•&MAK MAMACM UM o»'0
rM 9-1045 9s"•F.At 9'8.7+o964
HOMEOWNER LICENSE EXEMPTION
Plow"I
Dar.�1 g 2.0 l 1
job Locados A ( 2 Te,4r5ga Av-e
Home Owner Address 412 -,r� erss , Ai—
Home Owner Telephone 6. i 5 o
Pteamt Mauling Address 4 1 2 Tz rs do Are .
The current exemption of"HomeowneW was extended to include owner-occupied
dwellings of two Units or leas and to allow such homeowners to engage an individual for
hire who.does not possess a licens%provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons) who owns a parcel of land on which hdsbe resides or intends to resider 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 O®cial,on a forth acceptable to the Building
Official, that he/she 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 hetshe understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATL
APPROVAL OF BUILDING INSPECTOR
See other side for state code
41
City,ofSalem, MA slot , 5/5/2011
Parcel Map q I Z Tes6►-1 Ave- ,
47 qiz �e�
310090
lr
A ICE
m�
`7 ,
it
3 _0088 , 3
15 � i-A 31_0087
�ce-
/ N 31_0086
A
0 28
31_0089 feet,
1_ooas
Property Information ❑ Surrounding Towns
Property ID ❑ Town Boundary
Location 17 Ocean
— Streams
MAP FOR REFERENCE ONLY 13 water Bodies
NOT A LEGAL DOCUMENT ❑ Parcels
— Easement
0 Buildings
Because of diRerent update schedules,current property O Selection Parcels
assessment;may not reflect recent changes to property
boundaries.Check with the Boats of Assessors to m m nfe
boundaries used at time of assessment.