41 CAVENDISH CIRCLE - BUILDING JACKET 41 CAVEPIDISH CIRCLE y
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QND1 -- BUILDING
3 CITY OF SALEM
SALEM, MASSACHUSETTS 01970
PERMIT
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DATE NOVEMBER 2.: '19 99 PERMIT NO. 83ii "1.9139
APPLICANT FAFARD DEV CORP ADDRESS 2.30 ELI*OT S'TRIEE"F 1.56I
(NO.) (STREET) (CONTR'S LICENSE)
CITY AFHL.AIND STATE PIA DECODE 111.1-721 TEL.NO. 508-881-1.600
MBER OF
PERMITTO NEW BUILDING NU
STORY TWO DR MORE FElh1T!_Y DWELLING
UNITS 4
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT(LOCATION) 0041 CAVENDT&4 C1: RC1_E U184D DOTING R.y
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION M(-1P IAT LOT 'I_y iIDSI BLOCK 868 SIZE 1 S.. 79 ACRE,
BUILDING IS TO BE FT.WIDE BV FT.LONG BV FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: BI.JTLfi /I I IN"iT ("ONIDfIMTN'f IINI AS !:--97R FI nW S! DG 18 L.11\11_f n III 'T'R 1 L nn ti STYLE,
AREA OR Call for Pe frit to OCCUPY PERMIT
@@
VOLUME ESTIMATED COST 1.1711171. ;i`i I�VI FEE y� 11710�,. K
Ir'c ',``
(CUBIC/SQUARE FEET)
OWNER FGiP4:iRTR.r- , D. r..
BUILDING DEPT.
ADDRESS P:)1A G"i "(IYF R'TRFF-'T BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS
ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE
REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HASBEEN MADE. WHERE A PERMITS ARE REQUIRED FOR
1.FOUNDATIONS OR FOOTINGS. ELECTRICAL,PLUMBING AND
2.PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS.
MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE,
3.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS ,p PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
R" �W
/V/ -
2 - t rl 0 2 /o- 2 3 '7
o V/!i
BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT.'INSPECTING APPROVALS
OTHER CITY ENGINEER 2
//_/Ui RMV/
Y
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. AS NOTED ABOVE. OR WRITTEN NOTIFICATION.
„g `° CERTIFICATE OF OCCUPANCY
CITY OF SALEM Issued` aI Per
N: ��
I 9 q�
SALEM, MASSACHUSETTS 01970 City of Salem Building-0ept.
DATE NL ?.._!W_ E N 19 PERMIT NO. � _ ;�_ _
....T c-FR _.... _
APPLICANT I=f::r'_i i i?�i L)1=S f".(..;G-: ADDRESS �_':)( V't V t :.t`1="i .L t:
(NO) (STREET) (CONTR'S LICENSE)
CITY R.S5i-li_.f fqD STATE ^_}� ZIP CODE 01 7E 1 TEL.NO. Q-.`_tt 8 11"_�.�,00
NUMBER OF
PERMIT TO NE:WF! 1-ii IST"'• (_) STORY T W Q I'4v IM QI-.I= FAIY"�"Y DWELLING UNITS 4
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
ZONING
AT(LOCATION) TTS ' c!SL; Pt'lT c_.I _".i. rqi*LE i.-{.'l Q DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION I°It"= 7 LOT !7!0061. BLOCK
1L1SIZE i 5. `''CRE
BUILDING IS TO BE FT.WIDE BY FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS n I.. r. I T . -n. ) 1 h' "1' i i..
AREA OR @@ PERMIT
VOLUME ESTIMATED COST.P 1 !==I; . `k 17120 FEE
(CUBIC/SOUARE FEET)
OWNER P�':-'Ff:-R5 E. G' D. I-' BUILDING DEPT.
ADDRESS "_,c)fl ct .t.,;... c:'".,F.ti...- BY
The Commonwealth of Massachusetts
tr Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
,
[ (ThusSecton' -For off'ie-i"f s,'
e Only)
goilding Permit bMo Applied-" 'Building Offina] -
SECTION 1-.'LOCATION-(Please indicate Block,#indLot'O;f6r,lo'catiiinstoiwiiieh'asfreefa(!&e
Bldg 184 41 Cavendish Salem 01970 Green Dolphin
No.and Street City/Town Zip Code Name of Building(if applicable)
Edition of MA State Code used— If New Construction check here El or check all that apply in thMvo ro.As below
Existing Budding El Repair 1:1 1 Alteration IN I Addition 0 1 Demolition 0 (Please fill out and sub,�Zt ApA,e dix 1)
---f::o
Change of Use El Change of Occupancy 0 Other 0 Specify: C) =1 rr
Are building plans and/or construction documents being supplied as part of this permit application? Yes G Noyfflli
Is an Independent Structural Engineering Peer Review required? Yes 0 No-
Brief Description of Proposed Work: Remove and replace roofing shingles 0
C43
cn M
SECTION 3:COMPLETE-THISSECTION IF EXISTING BUILDING UNDERGOING RENOVATION;ADDITION,OR,','
401a , I I 0
.,-4tAAINGEMUStOROCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): mesidentiai -------T Proposed Use Group(s): Residential
FCTION�4:BUILDING HEIGHT AND
AREA.
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'aplj
A: Assembly A-1 0 A-2 El Nightclub 0 A-3 0 A-4 El A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 El F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H40 H-5 0
1: Institutional 1-10 1-2 0 1-3 El 14 0 M: Mercantile 0 R: Residential R-10 R-2 EX R-3 0 R-4 1:1
S: Storage S-1 EJ S-20 U: utility 0 Special Use 11 and please describe below:
Special Use
SECTION-6.-CONSTRUCTION TYPE(Check'as.applica"ble)'
A
Lk 13 IB 0 IIA 0 IIB [3 IIIA ❑ IIIB 13 IV 0 IVAD VB 13
- o gECtIPN7:SITE fNFbRMA'tION(r'efei-t 7lb,CMAIjj.4jf6r details on each item)`,_
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public 0 Check if outside Flood Zone El Indicate municipal 0 A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone:— or on site system El required El or trench or specify:—
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable D Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed Cl Yes 0 or No 0 Yes 0 No El
SECTION 9.tONTENTPFCERTIFICATE OF OCCUPANCY,
Edition of Code: Use Group(s):— Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?:—Special Stipulations:
7777-7-7777777
,; d SECTION 9:;PROPERTY OWNER AUTHORIZATION P
Name and Address of Property Owner
Green Dolphin Salem 01970
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Charles Minasalli 25 Spaulding Rd Ste 17-2 Fremont NH 03044
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 permit application.
TION10:,CONSTRUCTIOIICONTROL(PleaseliMbut Appendix 2) )
" If buildin fs les`s than 35,000 cu.ft�of enclosed^s ace and or not ender Cmstiuchori Control then aheak here l and ski Sechon 101 `
16:1 Re 'steed Arofesabnal Res`-bnsible for Construction Conirohz "��f- - ' i;,� x�,TM,- "'
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10:2 GenerahContractor'
KTM Properties LLC
Company Name
Charles Minasallli 160139 HIC Exp. 6/25/16
Name of Person Responsible for Construction License No. and Type if Applicable
25 Spaulding Rd Ste 17-2 Fremont NH 03044
Street Address City/Town State Zip
603 895 0400 603.231 1677 tara@ktmproperties.com
Telephone No. business Telephone No. cell e-mail address
SEC1•.'ION E L41 OR FIL4'CCiMPFNSAI'It)N.1NSLf A CE AFT-(6AVIT M.G.L.c.152, r25C 6
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 15 No ❑
' SECTION 1 CONSTRJCTION C�O5TS AND PERMIT SEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6)=$ U00.00
1. Building $ 5,000.00 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ - appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ - Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ 5,000.00 (contact municipality)and write check number here
SECTION 13:SIG]VATi7RE OF,BUILDING PERMTI"APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true an�ccurateZotbest of my knowledge and understanding.
President 603-895-0400 8/18/15
Please print and sign na Uharles PRmasalI Title Telephone No. Date
25 Spaulding Rd St 7-2 Fremont NH 03044
Street Address City/Town tate Zip n
Mummpal Inspectoro fill out this Section aeon apphcation approval
.a Name