20 LEE ST - BUILDING INSPECTION 4L-AM INUS 13E fil£� APPROVED BY T44E
.WSPJcJDB Pla" TD.A.PERTT BEING GRANTED
CITY OF SALEM
No.3-3 l-66 Date
Is Property Located in Location of
the Historic District? Yes No)�, Building —nob' [ �e S�_
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications::
Owner's Name 1� Vj ycl 4. Datr r r �rn�I oviQ .
Address & Phone c�c) �,Qe-
Architect's Name
Address & Phone j )
Mechanics Name s
Address & Phone ( )
What Is the purpose of building? P,-OA Id MnII
Material of building? tk) If a dwelling,for how 1many families?
will building, forrm�to law? YL9 Asbestos? Nam-' 7
Estimated cost I City Licenser N P' State ucense S 0 yj 93 C
Hama Improvement v a
Signature of Applicant
SIGNED UNDER THE ENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: ,v�C0 l� r44 govr-,04
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No.:�3 (p
APPLICATION FOR
PERMIT TO
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LOCATION
ao Lie. S�ee�
PERMIT GRANTED
AP ROVFD
INSPECTO OF UILDINGS
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\ Board of Building Regulations and Standards License or registration valid for individul use Only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: _109171 Board of Building Regulations and Standards
�E ipiratiort' 9/3I2006 One Ashburton Place But1301
- Boston,Ms.02108
Type: Private Corporation
DANCO BUILDERS INC.,
Daniel Tremblay
2 Margin Ter �-
Peabody,MA 01960 Administrator Not Aid without signal e
e,�": _ ✓rte /UOmOJrO9N�/e.6�[2 o� dradeQd "�Y
BOARD OF BUILDING REGULATIONS
License CONSTRUCTION SUPERVISOR
Numb&.13S O43536
Bir a�P,.ft_*1960
006 Tr.no: 5200.0
DANIEL E THE i LAY
2 MARGIN TER o/
PEABODY, MA 01960._:
Commissioner
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PLOT PLAN
20 LEE STREET SALEM , MA.,
DATE: 7-20-05
SCALE: 1" = 20'
1 HEREBY CERTIFY THAT THE STRUCTURE IS LOCATED ON THE
GROUND AS SHOWN BY AN INSTRUMENT SURVEY.
BAY STATE SURVEYING ASSOCIATES INC., �, '
100 CUMMINGS CENTER, SUITE 316J
BEVERLY, MA., 01915
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+ CITY OF SALEM, MASSACHUSETTS C ICTL ERK SAL l'f, h1
BOARD OF APPEAL S or~�fcE �
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970 AUG,1 G
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 1085 Z]
MAYOR FAX: 978-740-9846 J A II: 37
DECISION OF THE PETITION OF KENDRA MALIONEK REQUESTING A VARIANCE
FOR THE PROPERTY LOCATED AT 20 LEE STREET R-A
A hearing on this petition was held on August 17, 2005 with the following Board
Members present: Nina Cohen, Chairman, Edward Moriarty, Nicholas Halides and Robin
Stein.. Notice of the hearing was sent to abutters and others and notices of the hearing
were properly published in the Salem Evening News in accordance with Massachusetts
General Laws Chapter 40A.
The petitioner is requesting a Variance from side yard setback to construct a 28 x 20
two- story addition for the property located at 20 Lee Street located in a R-1 zone.
The Variancers, which have been requested, maybe granted upon a finding by this
Board that:
a. Special conditions and circumstances exist which especially affect the land, building
or structure involved and which ate not generally affecting other lands, buildings and
structure involve.
b. Literal enforcement of the provisions of the Zoning Ordinance would involve
substantial hardship, financial or otherwise, to the petitioners.
c. Desirable relief may be granted without substantial detriment to the public good and
without nullifying or substantially derogating from the intent of the district of the
purpose of the Ordinance.
The Board of Apgeal, after careful consideration of the evidence presented at the
hearing, and after reviewing the plans, makes the following findings of fact:
1. Petitioner, Kendra Malionek appeared and represented herself at the hearing.
2. Plans were presented showing the two-story addition.
3. Councillor Bencal appeared and spoke in favor of the petition. Several neighbors
spoke in support of this petition.
4. It was noted that the home is presently not displaying a street numbers Petitioner
stated that she would immediately place the numbers on the home.
5. There was no opposition to this petition.
i
DECISION OF THE PETITION OF KENDRA MALIONEK REQUESTING A
VARIANCE FOR THE PROPERTY LCOATED AT 20 LEE STREET R-1
pagetwo
On the basis of the above findings of fact, and on, the evidence presented at the
hearing, the Zoning Board of Appeal concludes as follows
1. Special conditions exist which especially affect the subject property but not the
District.
2. Literal enforcement of the provisions of the Zoning Ordinance would involve
substantial hardship to the petitioner.
3. Desirable relief can be granted without substantial detriment to the public good
and without nullifying or substantially derogating from the intent of the district or
the purpose of the Ordinance.
Therefore, the Zoning Board of Appeal voted 4 in favor and 0 in opposition to grant the
Variances requested, subject to the following conditions;
1. Petitioner shall comply with all city and state statues, ordinances, codes and
regulations.
2. All requirements of the Salem Fire Department shall be strictly adhered to.
3. All construction shall be done as per the plans and dimensions submitted and
approved by the Building Commissioner.
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. Petitioner shall obtain a Certificate of Occupancy.
r"
7. Unless this decision expressly provides otherwise any zoning relief granted does not
authorize petitioner to demolish or deconstruct any structure (a) on the property to an
extent greater than 50% of the structure as measured by floor area or replacement
cost. If a structure on the property is demolished by any means to an extent of more
than fifty percent of the replacement const or more than fifty percent of its floor area
at the time of destruction, it shall not be reconstructed except in conformity with the
provisions of the Ordinance.
Wei
Variance Granted Nicholas Helides SCrx�
August 17, 2005 Board of Appeal J
f
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND
THE CIITY CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of the
Massachusetts General Laws Chapter 40A, and shall be filed within 20 day
date of filing of this decision in the office of the City Clerk. Pursuant to
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 is has been dismissed or denied 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 Tiitle.-
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Letaibly
Name g3usiness"pnization/tndividual): a4n Lei Ktylac,v 1✓tC
Address: t-Ral ,� mew yQet
city/state/zip:. o 01. � Phone
�eab �ti � �
you an employer?Check the appropriate boa: Type of project(required):'
e
1 I am a employer with t b 4. ❑I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).• have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. # �• Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' cow. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required•] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'.cornpenzation policy information:
t Homeowners who submit this affidavit indicatiag they are doing all work and then hire outside contractors must submit a new affidavit indicating_suck
tContractors that check this box must attached an additional sheet slowing the name of the sub-contractors and there workers'comp.policy information
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to segue coverage as required tinder 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby term(&under the Vains and penalties of perjury that the information provided above is true and correct.
Si afore: Dater Z D S—
k Phone#: C4)Si) �2�- Sol:1
Off kia/use only. Do not write in this area,to be completed by city or town offxial,
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#:
Information and Instructions `
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold-the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure-to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permivlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston, MA.02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26.05 www.mass.gov/dia
Mar-09-05 11 :49A Dan Hurley Insurance
978) 777-3306 P.01
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Danvers HN 01923-3620
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CERTIFICATE MOLDER CANCELLATION
RBI DOOL 04011L0 ANVOF iMf ABOVI pEECReEO roLMxIi BEGUCallO BIPORI THE LFleAIIOM
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SENSE NO OBLIGATION OR LMMLIrY OF ANY RNO UPON THE INW 94L ITS AOENTt OR
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