112 LORING AVE - BUILDING INSPECTION (3) ith� '�'Nfa" hus'etts`
II A The Commonwealth 0 SSac
Department of Public Safety
,Massachusetts State Building Code(780 CNIR)
.;,Buildi
ng,Piermit Application foram Building other than a One-or Two-Family Dwellin&
(This Section For Official Use Only)
Building Permit Number Date Applied: Building Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not avails le)
Z12 AVF—�-
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of NIA State Code used— If New Construction check here 0 or check all that apply in the two rows below
Existing Buildingx Repair 0 1 Alteration x i Addition 0 1 Demolition 0 (Please fill out and submit Appendix 1)
Change of Use 0 Change of Occupancy 0 1 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes El No 0
Is an independent Structural Engineering Peer Review required? Yes 13 No 13
Brief Description of Proposed Work:
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVA 1`10
.N,ADDITIONOR
CHANGE IN USE 61W(tUPANCY z
Check here if an Existing Building Investigation and Evaluation is enclosed,(See 780 CNIR 34) 0
Existing Use Group(s): . I Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
I Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq,ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 Cl A-4 0 A-5 0 1 B: Business 0 E: Educational 0
F: Factory F-I 0 F2 0 H: High Flazard H-1 0 H-20. H-3 0 H-4 0 14-513
L. Institutional 1-1 0 1-2 0 1-3 0 14 0 M: Mercantile 0 LR: Residential R-10 , R-20 R-313 R-40
S: Storage S-1 0 S-20 U: Utility 11 Special Use 0 and please describe below:
Special Use
SECTION 6:CONSTRUCTION TYPE(Check as app icable)
IA 0 IB E3 IIA 13 11B 0 1 IIIA E3 11113r0 I IV 0 1 VA 0 VB 0
SECTION 7.,SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0
required 0 or trench or specifv.
Private 0 or indentilv Zone:-- or on site system 0 permit is enclosed 0
Railroad right-of-way: 111 ....to Air Navigation: .... .Not Applicable 0 Is Structure 11 their review completed?
or Consent to Build enclosed 13 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code:-- Use Group(s):. I N pe of Constructiom.--- Occupant Load per Floor
Does the building contain an Sprinkler SN.,teni?:---Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner a
Name(Print) No.and Street City/Town Zip
PX{etty Owner Contact Information:
'I'itle Telephone No.(business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building ermit a lication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Cunstmction Control then check here 0 and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Cy Name
/ e 4 A? 0, lr,"//, GS 0 )9S)o7
XNA me of Person Responsible for Con: uction License No. and Type of A plicable
Street Address L City/Town State Zip
_ 76k('If( zr 5. b
Telephone No. (business) Telephone No. cell e-nail address
SECTION11: N-1, (ONIMNSAHO.x1 INFU_1,%N(T:AI'tr11),Ab'If M.G.L.c.152.§ 25C6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes 0 No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6)_$
1. Building $ Building Permit Fee-Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)_$
3. Plumbing $
4. Mechanical (HVA $ Note: Minimum fee=$ (contact municipality)
S. Vlechai cal Otl [ S Enclose check payable to 2�
6.Total ost $ �� (contact municipality)and write check Amber here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By ntering my naa e below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
I plication is and accurate to the best of nay knowledge and understanding.
Please print and sign name Tith, Telephone No. Date
Street Address CiIV/Town
Municipal Inspector to fill out this section upon application approval:
i enie Dale
1'a CITY OF SALEM
lr PUBLIC PROPRERTY
DEPARTMENT
i wr:Mf I y',Mh4 111
ISC WA%ttl.\a1 I%^jj.1gf)• • i.au\t,M.%u.u.u, itIf,J197:
I'w. 778•713-9393 of I:%x 97111J4C•7346
Workers' Compensation Insurance :UOdavit•. Hui(den/Contractors/E fee trielans/P(umbers
\ 1 tlicant Inrurmalion
Plc• s Print Le 'hl
ViI1TIQ t141ranN'%LI)IaamVJtlnNlndwidYY11:
Cily,sclm%ip! Mone i/:
I .\re)ou an ewployer:'Check the appropriate bus:
I.❑ 1 ant a cm lu ur with 4. D�a
project(required):
P Y ❑ I ram a general contractor and
enipluycex(full Jnd/urPort-time).• have hired the suh•cunerauu,sew cul>.struetiun
2.❑ 1:uis a solo prnprictttr or partner- listed on the anuched sheet : einodelin`
ship and have no unployeva These sub-contractors have
Linysuclt
Ibr me m any capacity. %workers'comp• insurance. emalirion
ers'sump• insurance S. ❑ We are a cal rati uilding addition
po ran and ib
MI'leen have uidreined their ectrical repairs or additionscowncr doing all work right of exemption 'r haQL n pa tbmY ruPoirs or additinnoo workers'comp. c. IS], I(4),and we hove no yuirrd. t cIn lu •• ol'npairs1 P yu.s. (No workers'comp. insurancerequind.J ter
%iq.pphcum mw chcka lw el m u afw fill ucti the mcaun hcluw rhuwiog ihVo wakwi cunrroawdat rydicy rnnemWiW1,
'l lummrwnon who sti mit this atodavit imlicartng dray Age doing all wurk and thpl hin wtside cuser'C. IM11M%that ckvk this how muse Jtta.hod am addiliuwl.,hM glowing tha ,am*of the nlbcemractuA and Ainif wurkore' a p.Im ll o,,piton "wk.
carp.imdtcy mnwmariva
/tun mt avnployer 1h04177rvv/d/nx rvorArrs'rurnpenrnl/an Lrtumnea/w tray atop/opera. Be/aw/r rMpu//ay u„r/�ub.yi1�
iulunnuftSr4
I nsurancc C ompany.Naine:
Villicy At or Sulf-ins. Lic.rr: ---'--
Expira ion Dare:
tub Situ-lddress:
cily,Slateizip:
.\each a copy of flit workers'cumpcniatlole policy duclarallon page(showing the Polley nuntbur and e.cplratlua date).
Failure to sccuro cowruge as required uwler section:Sr\ul'NIGL c. 132 eau lead to the imposition o1'criminal penalties of a
floe up m 11 St10JA and/or une-year imprixonincnt, a.4 %cell ax civil(4cnalUcs in the Turin of a STOP WORK ORDER and a rint
Of till to i250.00 a Jay,tguinbi the vialemr. Ile advi.4cd that a copy ufihi%s,wemuu may be l'urwirded to the 01lice of
Iil1'i.%IlgJllUf's art the I)L\ for u+surance crncngc %criticJnen.
/du hereby certify nnJer rbe p,rinr and prmr/lire u//rer/nry,hur r/q ia/Lrmnllon pruri'led ubuvt is true and correra
-----------------
tJ/j&•iu/rase un/y. Od nor o•rire in Moir urrw, to be cuutpleird by city ur ro,rrr o//Iciuj
f'ify or 1'n+r n: PCrinityllAvn4e st I
1%%ain \uthoril
a • Y (circle noe):
I 1. 11trd of IlcalUl 1. Ilnddinq Ucparnucal 1. lu Clerk 4. L•'Icclrical Inspector 5, bin"
In%pcclor
L. t)Ibvr
l'nn.lel 1'cnau: . I
- I'huuv Y: .
[nformation and Instructions '
srs to provide workeri compensauon tier heir culployees.
\ r
ass.101U5elts lae "...every pneral Laws Chapter
l�2 re4W(CY all Cn-_every
pc l ion In the service of another kinder ally contract of hire.
1'Itrsu:ult to[III*.litult,an emplorea is defined as '.
kpress or implied. Ural or written."
or other
egal
\n c,npluper 1%dctincd as"an mdividual. ind nvlutlitlg the legal corporer ation
Jfla deceased employer.or the
ry.of ally two or Jre
,,I ihu taregulnll engaged In a joint enterprise.iu-into in vm to ees, Hawevcr the
acetvcr Jr trualce ul'.an individual, pnsmenhip,assoetatioo or Jher legal entity,a th Y g ' D >
owner of a dwelling{house having not morce than three ap°ranents and who resides thettin or tha occupant of the
.hvclling Iwuse of another who a appurtenant thereto shrions to all uo nbewuse of suichuemployment be deemed to gseCtion or tepud work on such dwelling coda yer
or tan he grounds or building shad withhold the Issuance or
mGL chapter 132. 425C(6)also stares that"a"14 state or local licensing agency
renewal of a license tar per to operate a business Of to eosslruet buildings IN the commverage re for any
acts
applicant Nhe has not prowilb the insurance CO'
du1, §25C 7)states vNeiitcs Of iher he commonwealth alth not any of its poll calgwith t e iti ,•shah
Additionally, SIGL chupter l3_, fo I
corer into any contract ter the perfomnanee of public work until acceptable evidence ufcunlplimnca with the ulsumnca
requirements of this chapter have been Presented to the contracting authority
AVVllc°its checking that apply
to our situation and,if
Plc:use full out the workers' compensation affidavit completely, nber(s)along with h their cartificute(s)of
necessary,supply sub'contrrctoc(s)n;una(s),address( )' phoneno employees
insurance. Limited Liability Companies(LLCworketeite n pensatioed Liability nainsurance.(If an)LLC or LLP does have
than the
members or Partners- are not required to carry
members O a policy is required. Ba advised that this affidavit may be so tiodr:d to the Department r of Industrial
i
be Department of
.% ridentz for to conhe firmation
town that ch ce cOv%:ftion for the Pann t orolic`nse is being requested,not he Departm shoo
Should you have any questions regarding the low tar Self-insured companies you utt required to obtain
should enter their
industrial Accidents.
compensation policy,please call the Depament at the number listed below.
lf•insurance license number on the° ro [gate line.
city or'rown Omel°Is
Please he sure that he affidavit is complete and printed Icgrbty. The Department has provided it space at the bottom
of the affidavit for you to fill out in the event the 0ITtca of Investigationst.
has to contact you regarding the applican
r.
nit
I'I:use bosuro to fill in the parmiNieansa lumber ns in anch y
been year,
needreference
sub nit one affidavit indicating current
Yg Y Y
lllat must submit multiple pennio'and u under app ' rovidcd to iha
policy information(if III*neces;affid vi�hu has been oftls ally stamped or mark'edibys tile city oratown may bepin Icily or
each
townl.",\ copy
applicant as proof that a valid affidavit is on file For future permits or licenses. A new a to;my business
nwst m lerci out venture
t no
e`r.'t dug
'gR a home r owe of citizen is to burn leaves ate.) d per. is OTtrequired too complete this affidavit. nlercial venturo
en.jo
1 het)I lice,it Investigations would like to thank you in adv:tnca for your cooperation and should you huee any yuesuons,
plcabe du not hesitate to give Us a call.
she Uapunmau's address, telephone aThfax
Commonwealth of Massachusetts
Department of Industrial Accidents
Me of[avesuzatlons
600 Washington Street
Boston, MA 02111
sal. N 617-727.4900 ext 406 or 1-977-MASSAFE
Fax M 617-727.7749
www.mass.gov/din
i
CITY OF Sm Emli NLkSSACHUSETTS
BuLDLNG DEPARTMENT
120 WAsHLYGTON$TREfiT, J� ItOOR
` TEL (978)745-9595
PAX(978) 740-9846
Kl\BERLEY DRISCOLL
MAYOR I Ho-%w ST.PIjtRs
DIRECTOR OP ruouc PROPERTY/HCILDING co%WISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit Al is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
t 11, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
signature of permit applicant
date
IcAnvdJ,R
CITY OF SALEM, MASSACHUSETTS
"� Qe BOARD OF APPEAL
`O 120 WASHINGTON STREET, 3RD FLOOR
• SALEM, MASSACHUSETTS 01970
TELEPHONE: 978-745-9595
rue � FAX 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
May 4, 2011
Decision
City of Salem Zoning Board of Appeals
Petition of CHARLIE RICKER requesting a Variance from number of stories and a
Special Permit to extend a nonconforming structure in order to construct a third floor
porch on the property located at 112 LORING AVE (R-1).
A public hearing on the above Petition was opened on April20, 2011, pursuant to Mass
General Law Ch. 40A § 11. The hearing was closed on that date with the following Zoning
Board of Appeals members present: Rebecca Curran, Elizabeth Debski, Richard Dionne,
Annie Harris,Jamie Metsch, and Jimmy Tsitsinos (alternate).
Petitioner seeks a Special Permit pursuant to Section 3.3.5 and Variances pursuant to Section
4.1.1 of the City of Salem Zoning Ordinances.
Statements of fact
1. Ina petition date-stamped March 30, 2011, the petitioner requested a Special Permit
and Variances to add a third-story porch and porch rail system to the three-family
house located at 112 Loring Avenue.
2. The petitioner represented himself at the hearing.
3. At the hearing, the abutter at 6 Sumner Road spoke in opposition to the project,
expressing concern that adding the third-floor porch would impinge upon her
privacy. The petitioner, abutter and Board members discussed various options for
landscaping and screening, and the petitioner agreed to work with the abutter to
come to a mutually agreeable solution.
The Board of Appeal, after careful consideration of the evidence presented at the public
hearing, and after thorough review of the plans and petition subnritted, makes the following
findings:
1. Desirable relief maybe granted without substantial detriment to the public good and
with
out nullifymg or substantially derogating from the intent or purpose of the
zoning ordinance.
2. In permitting such change, the Board of Appeals requires certain appropriate
conditions and safeguards as noted below.
i
i 2
On the basis of the above findings of fact and all evidence presented at.the public hearing
including, but not limited to, the Plans, Documents and testimony, the Zonmg Board of
Appeals concludes:
I. A Special Permit under Sec. 3.3.5 of the Salem Zoning Ordinance is granted.
2. A Variance from number of stories is granted.
In consideration of the above, the Salem Board of Appeals voted, five (5) in favor(Debski,
Hams, Curran, Dionne and Metch in favor) and none (0) opposed, to grant petitioner's
request for a Special Permit and 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
does 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 or 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 (500%) of its floor area at the time of
destruction, it shall not be reconstructed except in conformity with the
provisions of the Ordinance.
9. Landscaping and screening will be agreed upon with neighbors.
Ke ecca Curran, Chair
Salem Board of Appeals
r
3
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD
AND THE CITY 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 days of filing of this decision in the
office of the Gty 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 has been filed with the Essex South Registry
of Deeds.