16 MARCH ST - BUILDING INSPECTION . , � ,
,� The Commomvealtli of Massachusetts CITY OF
, �. °�< Board of Buildii�g Regulations and Standards SALEM
n��l\ ��� . � Ntassachusetts State Building Code, 730 CNIR �
ZevisedMnr D!l
I Buildiug Permit Application To Construct, Repair, Renovate Or Demolish a �
One-or Twa-Family Dwelfing
Chis Section For Official Use 0nly `.":�, `,`
Building Permit Number: . 'Date Appliedi : j .'f
) ,.:
c:.Lxk+Lt._ T�y ['�cres:;S �• ,
�ng0fficial(PnntName) . . , ��S�gna[ure;:�.��� ��t-''1' ���� - Dnte �
SECTION 1:SITE INFORi�[ATION -
L 1 Property Ad ress: 1.2 Assessors Map.4c Parcel�Yumbers
° f/ f�i-1Pr.� ��
L la [s this an accepted street?yes no Nfap Number Parcel Number
. 13 Zoning[nformation: 1.4 Property Dimensions;
Zo�ing District Proposed Use Lot Area(sq Frontage(ft)
1.5 F3uilding Setbacks (ft)
� Front Yard Side Yazds Reaz Yard
Required Provided Required Provided Required Provided �
L6 Water Supply: (�I.G.L c. 40,§54) 1.7 Fload Zone Information: L8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Ffood Zone? Nfunicipal❑ On site disposal system ❑
Check if yes❑
SECTION2:, PROPERTYOWNERSHIPL `
21 Owner�of Record:
7'-���{� �-, l�m , /�'Jf� �l��l�
Nama(Print) r Ciry,State,ZIP
�.le J�l A � S-l� �21��6� �a�3 ��hno � �'A,ry�
No.and S«eet � Telephone � Email Address
SECT[ON 3: DESCRIPTIOPI OF PROPO5ED WORK'(check.all th5t apply}
New Construction ❑ Existing Building ❑ Owneo-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Dzmolition ❑ Accessory E3Idg. ❑ NumbzrofUnits Other ❑ Specify:
�3eigf Descript�of Propose Wor�
�tP�YLJlI��s-C ��� �< n C'�--, ('-� s
SECTION 4: EST[NLaTED CONSTRUCTION COSTS
[tem Estimated Costs: Offieial Use Only,.,
Labor and Materials
I. Buifding � 1. Building Permif.Fee. $ Indic5te how fee is determined:
�. Electrical � ❑ Standard City/'Coivn Application Fee
❑Total P�o�ect Cost',(Item b)x i¢ultiplier x
3. Plumbir�g 5 2 Other Fees: � �{�
L \dechanical (EIVs\C) 'S List: �/����
�. �4zeh:mical (Firt $
Suppression) "Cutal All Fees: .S
Check No. Check Amoimt: Cash :\mounti
G. 'I'nY:il Prnject Cost `S �(�ya� ❑ Paid in P'ttll ❑ Outstaiidinv h3.tLince Due:_
-- ----------- ------� - - - - � ----_---
�
�l�'�0� � P��, ,-� �����/ /o %Z�/�,��.
. �
srcT[o�v s: co:vs rauc r[ov sEav�c�s �
�.l Construction Supervisur Liceiue(CSL)
Licensz Number � Gepiration Date
N�lme of CSL F[oldcr �
List CSL Typz(saz below)
No. and Svzet TYpe . �' . � Description : .
U Unres[ric[ed 6uildin s u to J�,000 cu. [t.)
R Rastrictcd I.Pi?Fantit Dwellin .
CitylPo�vn, Stare, LIP bf blasonr �I
RC Ruotin Cuvcrin ',
WS �VinAownndJidin� ��
SF Solid Fucl E3uming Appliancts '�.
I Insulatiun �'..
� �fcle hone Email.�ddress D Demolition
5.2 Registered Home [mprovement Contractor(fi[C)
� FIIC Registration Number Eapiration Date
FIIC Company Namt or hI1C Registrmit Name -
No.and Street Email adAress
', Ci /Town, State, 'L[P Tele hone
SECTION 6: WORKERS' CObIPEYSA'CIOIY INSURANCE AFFIDAV[T(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 [ssuance of the building permit.
, Signed Affidavit Attached? Yes .......... ❑ No ........... ❑
SECTIOY 7a: OWNER AUTHORIZATIOIV TO BE CObIPLETED WHEN
OWNER'S AGEYT OR CONTRACTOR APPLIES FOR BUILDIIYG PERIVI[T
f, as Owner of the subjzct properry, hereby authorize
ro act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's N.une(Elactronic Signature) Da[e
SF,CT[OY 7b: OWNER� OR AUTF[ORIZED AGEN"t DECLAR.4T[OlY
By entering my name below, [ hereby attest under the pains and penalties of perjury that all of the informatiun
contained in this application is true and accurate to the best of my knowledge and understanding. �
_� �� -—
Print Ow �r'' r Authoritcd:\gent's Namz(Glecu'unic Signaturt) n;�tz
YOTES:
I, ;1n Owner whu obtains a building pennit to do his/her u�vn work, or an owner who I�ires an unregistered contractor
(nut registered in the Home lmprovzment Contractur(H[C) Program), will �ent have access to the airbitration
program or gunranty hmd under�LG.L. c. 14'2.�. Other important infonnution on the H[C Pragram can be found at �
�o�v�v.m;us.soviuca Information on thz Construction Supervisor License can be found at uw�v.mas,.ao�dL
�. 1,Vhen substatltial work is planned, provida the information below:
Tohil tloor area(sq. ft.) _(including gat:igz, tinishzd baszmendattics, decks or purch)
Gross living ;u'ea(sq. ft.) H�bitablt rvum count
Numb�r of tlreplaces.- Numbzr ot bedrooms _ ----
Number uf bathrooms �Iumber of hulBb:�ths
fypeuFheatingsyslcin _ _ NwnberoF�ldcks/purdtes- — —
I'}�pe oFcooling sy,tcm _--- Encloscd--- ----Opcn.- —
. „ ,
). � �uCal Project lyuarn Puotug� w�y be sulxtituted t��r..l�ot,�l Pru�ect(_o;t" �
�; —
; .,
t
C `
�
.,.�ivr � �11 1 �L' Jcu.L:iYj� LVS.��JS�7C11lJTJL'�S
YY
� � BI;U.D4IGDEP.�R'I'JtENT
�. t�
�`��. 1"�O 1X/.♦SHCVGTON STREET. 3"D�OOR
� "I�L (978) 7�5-9595
Kt\tliERL.EY D[uSCOLL F.�.Y(978) 740-9846
1�L�YOR Tt-cosr.+s Sr.Pisxxs
� DI.4ECTOR OF PI:BCIC PROPEATY/BCILDING COtL�[(SSIOVER
Coristruction Debris Disposal Affidavit
(required for all demolitiun and renuvation work)
In accurdance with the sixth edit(on of tlie State Building Coda, 730 CMR sectio� l l t.S
Debris, and the provisions of biGL c 40, S 54;
Suilding Permit Ik is issued with the condition that the debris resulting from
this work shall be disposcd of in a properly licensed wuste disposal facility ay dc;fined by NIGL c
l 1 l, S I SOA.
1'he de ris wi11 be transportcd by:
� r��i�J�e�� ������ �
"Che debris will be disposed of in :
_"`."'�—
�� (nama of f�cility)�-�-
� (aJdressoFfacility--�)�—
sign�tu� p«�mit applicant
datc
dcbns.tlFJ.H: .
r .,
;' CITY OF S.�I.E.�I
. PUBLIC PROPERTY
,. DEp�►xx�tticF.ivr
y,v...ar wunaa
wro ��o vsw�w�a snasr�su,a�V..o�oasam mf�s
� TtL f'f71i7sf!�Y.u.f7L7+69w �
H01�lEOW�lEA LICE.�(SB EXE.I4PTIOV
` Pkw hf�t
� �.a .'/1-
, 1��. �� c�%-n.h S�r� f—
��.��
xom.avn.r ze�aphoe.
PeessU Mailio/Ad�er
Th�euerat exempdoa o["Homeownan"w�atadad oo uociud�ow�nar-0eeupied
dweUln�o[two Unib a tw aod w allow�h homao.voers w m�s�m indlvidual for
fwt who doa oot po�a Item�providad that �ow�nar act�a�aupaevtaor.
DEFIIYI'lTON OP H011�OWNEA
Penoo(�) w6o owau �pued otLod oe whie6 bd�resida a�iate+d�w raid�.on .
whie6 than i� or ii intaaded to b�, a oa�or taro A�mity dwroWn�. atta�hed or dataehed
.+tru�tura �eeeswry to �uch uw aad/ar farm�tnreture�. A perwo who conitrueb mon
chao on�hom� ia a Nvo year period ahaU not b�eonsidaed s homeownar 3ueh
"homeownd'�haU �ubmit w r1u 8uitdini OQfeial, on s Corru xcrytabl�w th�Huildint
OEtfcial, tlut hd�lu b�resporuibl� for all�ueh work perfortned uader th�Buildln`
Pamit
Th�unda�i�ted "homeownd'�+suma responaibility for compliane�witb th�Stat�
Buildin Cod�and otha licabl�b Iaws md ro ationr.
f �PP Y` iW
77�e undeni�od "hamaownd'cerdfta thal hd�h�undmtand� the City of Salem
0uildin� Oryartment minimwn inipation procedura �nd requiremrnu and that hdshe
.viit comply wi�h �aid procadura uid requiremrnt�.
H0�IEOWYER9 SiGYATL'RE
.�PPROVAL Of 9UfLDL�fG L�iSPECTOR
Sce otha side far shfe cod� C— ---��-� � ---- _ .
.______--------_� _._�
; -� , . �ev 13 ;I
�h /
I / �
�L � ��
\
UI' � � \
I \
�
��,8�� X19'-g��
up �NCI.O`�n f'OI:CN up o
� �
� � o
� � �
— �
� � N
N
N
C �
� �
17�M0 �XI511NG pOpCN ANn �6UII.n 1"0 COn�
npIV�WAY
z
0
<
i o
z
� �
. � �
� o
� �
� n
�� S1 N
�3EC:
� � 3,20.2013
�JCd�C
�X15�ING � 1 �5� � �00� �AYOU1' �SV�
brawn 13 :
u���
- I/4"=I'-0" 5h��t �
Of �
r . . -------- - ---- - ��; - �- _ _
r
.
I /
I � � �
��
�
UI' � �
I \
0
� �
� � � � �
I �XI511NG pOpCN p00� I - �
I I � � N
I I
I I �
� �
I I o �
L — — — — — — — — — — — — — — — — — — — — — — — — — — J
�X15�'ING S�CON� � � 00� �AYOU�'
�,���.,�,o��
0
�
�
_ o
� _
� �
� �
� o
� �
� n
L S1 N
nd�C:
3,20.2013
(7Ld�E
Az SM,m
�fdW11� :
G.Er�arcxado
(7hCEt 2
Of �
. --- --- -- -��, r� - --
G,A17� 6�AM WIlN
, �OOfINGS AT 601"TOM
;t
3 511:ING�p STAIpS
8- I/4" pI5�p5
II" Tf�DJ�S
U
0
��,8�� X19'-8�� z �o
Up �NCI.05�n pOpCN ~ Up � � �
�
� � �
N
L �
� L
�
� �
8- I/4" p15�1:5
II" 1"�A1�5
2x8 N�AI7�p WITN Z" pI.Y,
n�IVEWAY
0
<
>
__ o
� �
� �
U O
� v
O fl
� N
V CILG:
3.zo.2a3
Scal e,
��,
nrawn 6 ;
��0�05� b � 1 �5�' �� 00� ��YOU�' GE��
5heet 3
I/4��_��,��� �f �
. . �ev, 6
, 36" CI.�AP. SpAN
.,
3 511:ING�� STAI�S
8- I/4" p15�p5
II" 1"�HJ�S ',
� �
� � o
�S1 N �
v � �
p��� � � �
� a �
' N
N
� �
�
0 �
��O�OS� b S�CONb � � 00� �AYOU�' �
__ o
_
�,���_,�,o�� � �
V O
� �
O fl
SL N
I��1�:E�
b,20.2013
Scale,
r�s�.,,
17rawn 6 :
G.e,�.�
Sheet a
Of �
. , — --- - —p v, 6 -- —
, Z��xio�� Arra�H�n ro
EXI511NG WALI. WITN 5/g"
2"XIO" ATTACN�n TO�XI511NG WALI. WI1N I.AG 60�T5 @ �VEf?Y 51"UI
5/8" I.AL, 601.T5 @ �V��:Y 5TU7
2" 10" p5 @ 16" o
2 'XIO' �I.O pJOST@ 0� � � � o
J015T NANG�pS c „ J015T NANG��S @ � � �
�ACN ENt7 I 0' ' 2-2"XIO" pING N ENn 0� � �
� ��
�V�f'Y J015T � � � � � �V�pY J015T � '° �
N
� �
�
� �
12"nIA, X 4' n��p
AT1"ACN �IpST FI.00p pWG ��AM� CONC, �0011NG5
TO 6X6 pOST
�
��0�05� b � 1 �51' � � 00� ��MING ��0�05�b �00� � �MING �
�; _
� �
� �
U O '
I/�II_li,oll I/�Il�li,oll � �
O fl
� N
V aLG:
3,ZD,Z��3
SCaICI
As Shown
Irawn 6q;
G.e��
5heet 5
Of �
, ti , �ev, 13
I/ 2" GYP, 130AP.n .
�-13 6A1"1" INSUI.ATION lil
i
I/ 2" pI.YW00b SN�AfNING
7YVEK
I/2"�IGIn INSLI ,
VINYL 51171NG �,
2X4130ftOM pLA1� II�
3/4" pI.YW00n I
22"XIO" pING WALI. �I.A51-IWG ANn nplp �nG�
6X6 pOST
�
0
� � o
� � �
— � .
w
� \D N
�
N
_. �
� L
pU66�p p00� o �
6X6 p05T A1"TACN�17 TO �1"G,
ANI7 FIpST�I.00p �pAMING _ FI.ASNWG
ANCNOp 1301.T pI.ATE p00� M�M6.AN� 2- 2"X4" 1"Op pI.A1�5
6X6 TO CONCI1�T�
1 5/8" p�YW00t7 SN�ATNWG
— 2"XIO" �7Ep5 @ I6"O,C, p-13�3ATT INSUI„
I I I I I-1I I I I I I I I I I I I I1=1I1- 3/�}�� 5112A}'PWG I/ 2" pI.YW00b SN�ATNWG
I I I I 111=111 I 11=111 111=111—I I
I I I I I I I-1 I I I I I . I I I I I I I I 1-1 I 1- �
IZ"171A X �t' 17��p �0011NG I I I—I I1=1I I I � I1=1I I I I1=1 I I—I I �
I�III III � � III III III-111- I/2" GYY{'� 60A�n TW�K - �
I III —III I ' 11=111 III—III—II G � �
I I I I I_I I I I I I I 111=111= �
II III 111=11 11=111 III—III—II I/Z"pIG1171N5U � �
III 111=111 III ` III III 111=111= o �
I II II1=1II I I1=1II II1=1II-1I � �
II I II I II I II I I I I II I II I II -' I II I II I II I II I II I II I II I II� VINYL SInING
III III—III III ' • III 111=111=111= n�'
I I1=1II-1II I � `I1=1II II1=1I1=1I 3.�o2oi3
IIIII III—III III . ,' III III 111=111=
I I I I1=1I I I • I1-1I I I I I—I I1=1I 5�1�;
IIII 111=111 III ` : III III 111=111=
I I I I I 1=1 I I I '.� I 1=1 I I I I 1=1 I 1=1 I `�s''°�'"
I I II I I I—I I I I I I . := ' • I I I I I I I—I I I—I I 1=
1=1 I 1=1 I 1=1 I 1=1 i—' " 1=1 I 1=1 I 1=1 I 1=1 I nrawn I3y:
-iii_iii—iii—iii—iii—iii—iii—iii—iii—iii—i i i-
W� � S�C�ION b��"AI � G���
5heet 6
3/�t��_��,���
Of �
� t � �EV� Cjl�
n00p 1 Nl�SNOI.b
22"X8" N�A17�p
8-I/4" 51�p t0 pI,A
i �
��
pI.AT�OpM I/2" pI.YW00n � � ��
�
j � � �
N
I N
I � �
b00� 5� � b��'�I � W! NbOW �Nb �00� N�/�b�� b��'/�I �
3/�f��_��,��� 3/�I��_��,���
0
>
0
� �
�
'�i o
� v
o �
� N
n�:
3.20.2013
Scal e:
��
Ylrawn 13y,
u,e�.�
Sheet �
Of �