9 LUSSIER ST - BUILDING INSPECTION 1� --- I he Commonwealth Nlasslrhusclls
Board of Building Regulations and Standards Cl IN OF
' Massachusetts State Building Code. 7SO(AIR ti,\Lh,\I
� ., N.•rl.,eJ.lhu _'rill
Building Permit Application 'ro C'onsiruct. Repair. Renovate Or Demolish a
\ Orte-or Two-konnlr Dwellokv
This Section For Olfiiciul Use Onl
Building Permit Number. D c Applied: /
Building 011icial(Print Man,) Signature Uale
SECTION I: SITE INFORMATION
1.1 Property Addr 1.2 Assessors.Map S Parcel Numbers
_11—I,uSSt-cam
I.la Is this an accepted street? es no Map Numher Purcel Number
I.J Zoning Informs ton: 1.4 Property Dimensions:
/.oning District Proposed t sa Lot Area(sy 11) Frontage 11l)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Imvided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c. 40•§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ zone: _ Outside Flood Zone?
Check if 'cs❑ Municipal❑ On site disposal s)stem ❑
SECTION2: PROPERTY OWNERSHIP'
2. wnegtof ord.
LOral..c I�eo ida G� L� �. c i/�4 of q 70
Mune 1 Pnnt) City.State,ZIP
P I %W Sal— 97j-_325.1155
No.and Street Telephone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction AL-1 Existing Building❑ I Owner-Occupied ❑ Repairsls) ❑ Alteration(s) ❑ Addition ❑
Demolition Accessory Bldg. ❑ Numberof Units_ Other ❑ Speciiy:
Brief Description of Proposed Work': F v A? t
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
ll.ahur and Materials) Ofllclal Use Only
1. Building S I. Building permit Fee: S Indicate how fee is determined:
2. Electrical S ❑Standard CiryrTuwn Application Fee
❑Total Project Cast'i Item 6)x multi her _.__x 1
I I'lunihing S :. Other Foes: S_ p •H/r/J7
J. \Icchamical ill\.\('t S List:-_ ..___ __�/. —1�� .
5. \Iceh.mical hire S _ fff----///--_114...!!!
ti�t+rcssionl Total .\II Fccs: S ___
n Total Project Cost S �/ Chcd Vo. _ _('hech Amount: C.uh \mount:
V ❑Paid in Full ❑Outstanding Bal;uoe Due:
SECTION 5: CONS I'R I ION SERVICF-S
r4.1 ('onstruct. S i,or License(CS1,11
lull u -Sl 0,16 -. -,.-
I it Nolocr I \piroiioll Mile
Naitic ol'(S] It cr I Ist('St. 1'.PC Ilev
Dvicription
1141)alid Sircet
It lActril M21
%I , asoll
RC Koofill Co%erin
\%k s willdow.uld sidillit
Solid I:ucI Hurning
SF ima Appliances
I Insulation
D 11clilotilion
I c1cpholle
11.2 R Improvement tillstered flume Improverilell Contractor(111C) ..25-14—
Itegi,tration N1lloMr Date
11) Ico ra
tn
r III(_ lic ,
M ii—stranit NaNj
I oill 1) ; 1 9 1) t 5 � - I A*
�addms
No. mid St t me
I State Zip
Ity/Town.�Slnte—zlp 'ftle hone
SECTION 4:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 2SC(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 ..........jr- No...........
SECTION lull I j :Is: OWNER AUTHORIZATION TO BE C01111PLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNII�T
/
1. as Owner of the subject property,hereby authorize 1
to act on my behalf,in all matters relative to work authorized by this building permit apprication.
Date
Print owner's Nal ,t:lcclrulllc.1111inuturg)
SECTION 7b:OWNER(OR AUT JORIZED AGENT DECLARATION
By entering my name below. I hereby attest under the pains and penalties of perjury that all of the information
contain in this application is and accurate to the best or my knowledge and understanding.
'on application
ulhl to
Prim
NOTES:
I. 77%iier—,,hu,)bta5ls a building permit to o e contractor
Tn 3 i do work,or owner who hires an unregistered
Contractor(H IC) Program).will nu have have access to the arbitration
I not registered in the Hume n the HIC Program can be found at
under
Contr
program or guaranty fund der M.G.L.c. 142.N.other important information o
i Information on the Construction Supervisor License can be found at oO% 1111,
\\'hen subslamial work is planned, providt the-rinaficin below:
iicludiiigg;trage. riiiisliedbasi:iiictitattio.d"kSk)( ptir�iiI
Total floor area(sq 111 ii ilobitable room count
Gil It%ilig Afea I scl 11 1 .... . .. \tuiiher ofbcdr000is
\lllillrvr of lircillut:S ... Number of ImIt'hathi
Numberoi bathrounis \unlherolparches
F\lie ot'heating S)ilctll 01wn
pe"I'll;oollill; 't,iteill
cd Itir Ilroj"t 015C
lotal Proil Stitl3re 1:001,1cc"111�1% "c
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Date: 418-@ Revleed= I Dana B9' AJ
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MIDDLESEX CUSTOM CARPENTRY INC,
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SECTION A
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MIDDLESEX CUSTOM CARPENTRY INC,
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II
70 Washington Street
_ Suite 306
Hverhill, MA
1832
��� Tel: (978) 914 06527
eEngiLne Surveying Fax: (978) 914 - 6528
FILE NO. 2012-05-09A, www.ashkarsurveying.com
SITE PLAN
F�jH OF MSS
( Showing an existing dwelling and garage ) oz� gcyG
( Zoning : R-2 ) U� mi
FnsincAx
9
Date: June 20, 2012 F
Prepared For: Lorraine Beauregard
Surveyed By: Michel G. EI-Ashkar, PLS
Location: 9 - 11 LUSSIER STREET, SALEM, MA
References {Deed Book: 12435 & Page: 15
{Plan: See Assessor's Map #32 (Lot# 187 )
Recorded at the Essex County South District Registry of Deeds.
Scale: 1" = 20 ft:
LOT # 178
N 03°17'58' W n
EXISTING t 50.00 4.9'
RET. WALL
LOT # 187 EXISTING
5,250 S.F. N GARAGE
Jz 12.5 4.7'
w
a L _ — — —
cu DECK cu
0 6.8' 21 o 0
LOT # 186 j 0 25.5' uq �f ASSESSOR'S
C) MAP # 32
°D o } 0ID LOT # 188
r/) < Z
j D9 11 I >
C9
Z
H
6.6' I x
DECK r'-I
i
50.00' 61 _+
SIDEWALK _ S 03°17158' E_ J
E.O.P.
� I
III
LUSSIER STREET ( SO' - WIDE )
I
E.O.P.
Existing Dwelling Area: 1,410 S.F.
Existing Garage Area: 270 S.F.
Existing Total Building Coverage: 32.00 %
This Site Plan was prepared based upon the results of a field instrument survey.,
i
i
70 Washington Street
_ Suite 306
Haverhill, MA(?
1832
����� Tel: (978) 914 06527
Engineering 8 Surveying Fax: (978) 914 - 6528
FILE NO. 2012-05-09B, www.ashkarsurveying.com
SITE PLAN
(Showing a proposed garage adjacent to an existing dwelling) ���y�11AOFna9&
( Zoning : R-2 ) ggo MCHEL N�
$ EL-ASHKAR H
Date:
No.39686
June 20, 2012 9
Prepared For: Lorraine Beauregard q
Surveyed By: Michel G. El-Ashkar, PLS
Location: 9 - 11 LUSSIER STREET, SALEM, MA
References {Deed Book: 12435 & Page: 15
(Plan: See Assessor's Map #32 (Lot# 187)
Recorded at the Essex County South District Registry of Deeds.
Scale: 1" = 20 ft.
LOT # 178
N 03017'58' W n
EXISTING 50.00 5.2'
RET. WALL
LOT#187 n PROPOSED
GARAGE
�I 5,250 S.F. N
5 28.8' 116.0' 5.2'
I \
w
L — — — — — t a
rd I, C) 6.8' DECK p O
LOT # 186 ! 0 25.5' I ci � f ASSESSOR'S
o I % MAP # 32
Z LOT # 188
a
3
U? DWELLING I LLI
>
a / 9 - 17
it � C7
F
s.s' I X
DECK W
I I
I
50.00' p
- SIDEWALK' — S 03'17'58'—E—
`- — —
E.O.P.
1
4
II
LUSSIER STREET ( .50' - WIDE )
i
- - — — — — — — — — — — — — — — — — E— -
�I Existing Dwelling Area: 1,410 S.F.
l Proposed Garage Area: 344 S.F.
II
Proposed Total Building Coverage: 33.40
II This Site Plan was prepared based upon the results of a field instrument survey.,
1