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13 WARREN ST - BPA 16-1292 . . _ C-l� c�. � o o � I `�I�� o ' � � . . :rs � - �/� 1 r ';:s� ` rt��: � The Commomvealth of�lassachusetts � CITY OF a� Board of Duilding Regulations anJ Standards � �� (v ��'� Massachusetts State Building Code, 780 CMR 181b OCT 28 �v��J�lar 20// �� Building Permit Appiication To ConsWcG Repair, Renovate Or Demolish a I NOne-or Tivo-Fnrnily D�ve!ling � � This Section For Official Use Onl . � E3uildingFermitNumber. Date.Applied: � I� [3uilJinb OtTicial(Print Name) � Si�n�ture � Date U SECTIOY 1:SITE INFORd1AT10�F.' i.l roperty AJdress: !.Z Assesson binp 3o Pnrcel Numbero I i3 Fv�RR�N 't. I.la Is this nn accepted street?yes no M1lup Nwnber Parcel Numbcr I.J 'Loning InformaHon: I.d Property Dlmensions: "Luning Dislrict Proposed Use Lot Area(sy tt) Frontage(It) LS BuildingSetbucks(R) _ Front Yard SiJe Ya'ds Rear Yard Reyuin� Providnl Reyuired ProviJed Rcquired ProviJed 1.6 Water Supply:(M.G.L c.40,§SJ) 1.7 Flood Zone Informntlon: t.8 Sewage Disposnl System: 2une: _ Oulside Flood Zone7 Munici o�O On site Jisposal system ❑ � Public O Privute O Check if es0 P SECT[ONZ: PROPERTYOWNERSHTP�' 2,1 wner ofRecord: c���.-�y� �a �I� Y�n� Gui�- m AR��r-� � me(Print) City.Smta,ZIP ]�s WRR(�EN �• " 7- 52- O t4A,n Qu.i�,max�in�amui .ww� No.and Street Telephone E il Addnrtsg SECT[ON 3: DESCRIPTION OF PROPOSED 1VORK'(check nll that apply) New Conshuction� Esisting Building E� O�vner-Occupied ❑ Repairs(s) ❑ Altenlion(s) C� Addition ❑ Demolitiun l� Attzssory Bldg.❑ Number of Units� Other ❑ Spocify: E3rieFDescriptionofProposedWork': FU�� N(luSE REKlOV�AT'lON !N✓J[ wiNG• 5 t D!N E �1 0.'n F�IT Q�� NP`JN� • G�Iz.E ��r,ONe A�e �� A ATHao � o �1��cRRE �ca� ��Vi u iRU �A1rXAG 3' oN SECTION�: ESTIbIATED CONSTRUCTION COSTS Estimated Costs: Offlcirl Qse Only Itcm Labur and hlaterials) i 1, 6uildin� � '� �ZO.�� �• Building Permit Fbe:S Indicare how fee is determineJ: ❑StanJard CitylTown Application Fee 2. Electrical � �( �Dl�,� ❑Total Project Cosl�(hem 6)x multiplier s 3. Plwnbing �S ��J�j�(j�,{TQ ?. OtherFees: S F.�I�-�h;mical (HV;1C) S ��),�j�0. UO Lisk 5. ��fechanicnl (Firz ,� N�� futal Ail Fcas:3 Su «ssiun) � Check No. Chzck Amounh Cash Amount: G. ' ol:d Prnject Cust: '�2 �Q�000• Ot9 ❑p;iiJ in Full ❑OwstanJin; Oalnnce Due: �f��l E ���1 S I nl LC-a . r�6'_S��S�YZ \ � V� � � Ma���t? tt ; S i � � ��� ' 1 SECTION 5: CONSTRUCTIUY SERV►CES � 5.1 Cunstruction.5upervisur License(CSL) ��C rr�?��g 04 �� 201$ ' M �CF�AG 5zy�[.01�5K� LicrnscNumber Expimtio Date � Nmna uf CSL Nulder List CSL'fype(see below) � �I�D /�`.��iV2Y S� TyP� Description Na;md Strect - � - U Unmsiricted Ouildin u �to 33,000 cu. Il. .`j-A LETh 1�h(� ��970 R Restricted I&2 F:unil Dwellin City/fo�m.State,ZIP bl MaSon � RC Rootin Cuvcrin WS Nindo�v and$iJin - ' SF Solid Fuel Buming Appliances �R! - R��`a616�ion�,vc3�•��G�'��� ���'•'Am 1 Insulation Tele hunt - Emnil�iddress � D Demolilion � 5.2 RegisteredHomelmprovementContractor(NIC) 16Q��R �j � Z�� j7�p/��G{ LLC HICRegisUationNumber EspirunonD:ite � f IIC Cump:my Name ur HIC Registrant N;ime . u� �}s�,�Qy � �on�rcl�, mi �I.. Nu.mid Street Emuil aJJrese Nr�R�«rnN /�H Ui9R2 `7�1- 9�3-�6/6 Ci /1'u�vn State ZIP Tele hone SECT[ON 6��VORKER$'COhIPE1VSATION IIVSURAIYCE AFFIDAVIT(M.C.L c.152.§ 25C(�), Workers Compensation Insuronce affidavit must be completed and submitted with this application. Fnilure to provide this aftiduvit will result in the denial of the Is�uance of the building permit. Signed AfTidnvit Attached7 Yes ....V..❑ No...........O SECTION7u:OWNER.�UTHORI2ATIONTOBECOMPLETEOWHEN:. ' O�VNER'S AGENT OR CONTRACI'OR APPUE9 FORBUIGDING.PERlV11T I,as O�mer of the subject property,hereby authorize MICM R L .�—��L,OWSk I - t9 act on my behalf,in nll matrers relative to work authorized by this building permit application. �..ra. Gu;(m�+ "'�/�`�' �` �' � PrinlO� �cr's Nmne(Elecuonic Signamre) Date SECTION 76:OWNER�OR AUTF[ORIZED ACENT DEC[.ARATION Dy entering my nnme below,I hereby attest under the pnins and pennities oFperjury that�II of the information cuntained in this application is true and ac urare to the best of my knowledge nnd understanding. D�� � �.u,`I �.., � � - /�:P� l� � I�'rint )wk ncr s ur Authorized Agent's Nume(E•lu Uumc Sig�uture) Dute NOTES: I. An Owner who obtains a builJing permit ro do his/her own�vork,or an owner who hires an unregistered contractor (not registered in the Home Improvzment Cuntractor(HIC) Prognm),will nof have access lo the arbitmtion program or auaranty funJ under hI.G.L.c. 14?A.Other important information on the H(C Prognm can be fo�md at �v�v�v mas;co�+'oc�i Infommtion on the Construction Supervisor License c:ui be founJ at�c���e.mass.�!ov'Jns � 2. 1Vhen substantial�vork is planned,proviJa the inFormation below: futal Fluor area(sq. R.) (includiny garage,tinished b�semenbattics,decks or porch) Gross living area(sy. ftJ Habilable room comu Nnmbcr uf tirepl�cns �umber of beJrooms Numbcr uF bathruums Number of halt%batlis Typt uF hcating systun �umber o(Jeck�/porches fype uf cuolin;system LucloseJ Open J. "I'utal Project Syu:tce Fuota��'may be substituted 1'or"fut:d Praject Cost'• , � The Commonwealth ofMassachusetts Department of Industrial Accidents ' , I Congress Streey Suite 100 Boston, MA 02114-2017 f www mass.gov/dia Workers'Compensation lnsurance A�davit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le¢iblv Business/OrganizationName: i�i �JAIPrR CH �[-C, Address: �J MRiN 5�� �Flr-�n City/State/Zip: rol�FItL� MR 014��i Phone#: q78- �2� � 1646 Ar�ec�yIou an employer?Check[he appropriate box: Business Type(required): 1.u I am a employer with r employees(full and/ 5. ❑Retail orpart-time).* 6. �RestauranUBar/EatingEstablishment 2.❑ I am a sole proprie[or or partnership and have no 7. �Office and/or Sales(incl.real estate,au[o,e[c.) employees working for me in any capacity. [No workers'comp. insurance required] 8� ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemp[ion per c. 152,§1(4),and we have 10.❑ Manufacturing ' no employees. (No workers'comp.insurance required]* 11.❑ Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.❑Other •Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy infortna[ion. r'If�he corporate otYcers have exempted themselves,but the wrporation has other employees,a workers'compensation policy is required and such an organization should check box N I. . /am an entp/oyer that is providing workers'compensatiott insurance for my employees. Be(ow is the policy informa6on. Insurance Company Name: - Insurer's Address: City/State/Zip: Policy#or Self-ins.Lic.# Expira[ion Date: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). FaiWre to secure coverage as required under 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 s[atement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby cer6fy,under the pains and pena/Nes of perjury that the iiijorniqNon provided a6ove is true and correct. Si nature: � Date: � Phone#: ��`��� d �, Officia[use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmeds O�ce 6.Other Contact Person: Phone#: www.mass.gov/dia Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for[heir employees. ' Pursuant to this statute,an emp(oyee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An eniployer 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[rustee 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[o do maintenance,cons[ruction or repair work on such dwelling house or on the grounds or building appurtenan[[here[o shall not because of such employmen[be deemed to be an employer." MGL chap[er 152, §25C(6)also states[ha["every etate or local licensiug agency shall withhold the issaance or� renewal of a license or permit to operate a business or to cons[ruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of comp►iance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither[he commonweal[h nor any of its political subdivisions shall en[er in[o any contract for[he performance of public work until acceptable evidence of compliance wi[h the insurance requirements of this chapter have been presented to[he contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your si[ua[ion and,if necessary,supply your insurance company's name,address and phone number along with a certificate 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[hat this affidavit may be submitted[o the Department of Indus[rial Accidents for confirmation of insurance coverage. Also be sure to sign and date[he aftidavit. The affidavit should be returned to the city or town that the applica[ion for the permit or license is being requested,no[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[he number listed below. Self-insured companies should en[er[heir self-insurance license number on[he appropriate line. City or Town O�cials 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 permidlicense number which will be used as a reference numbec In addition,an applicant that must submit multiple permiUlicense applications in any given year,need only submit one affidavit indica[ing current policy information(if necessary). 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 Iicenses. 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 burn leaves etc.)said person is NOT required to comple[e this affidavit. The DepartmenPs address,[elephone and fa�c number: The Commonwealth oFMassachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 TeL # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Fonn Revised 02-23-I S , (�oFS� MAs.saa�csE� . 8��� � : uo W�+ays�r,3�1�00� � ]�t.�7�5-9S9S. • SII�ERIEYD�R6S�L Pex 7�498�6 �� 7�nr�stS7'.P� D�c�ra�arr►su1c�/s[u�ar�o�ix� Construction Deb�is Disposa/A davit � (required for�all demolition and,.renovation work) �n ao�wdanoe+�th tne aixtn edition ot rne s�e sulldrr,g code, 7�aNl� se�►lus oeb�, and the provtsbns of MGL o40,S 54; BLIIdir�g Permit�I is issued w�h the oonditfon that the debris rewlGing from thls worlc shalf be d&posed of Jn a PropedY Ik�e►ised � was�Ge depo�lt fadliry as defined by M(;L c 111,S iSQA. � The debris will be trans�rted 6y: � _ . mF�KS .�1�P�vsFt-� � , (name ofhauler) ' The debris will be disposed of in: m�,{5 b,5��s�� � (name of facility) �vt-��t� � mr� oig�5 (addreu of factli#y) � � p . , - G4�1� �57.U,��n��!;�,,) Signature of applicant _ �rl�f ,��I� : Date ' • , o ' '� .�,y. � - s . '��aa�� Salem HistoYical Commission 120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving X❑ Reconstruction ❑ Alteration ❑ Demolition ❑ Painring ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire District Address of Property: 13 Warren Street Name of Record Owner: Ryan Guilmartin Description of Work Proposed: Renovate house per drawings by PionArch design construction dated July 25, 2016 with the following provisions: ■ Cornerboards to match existing or be S%"flat boards; ■ Watertable to match existing or be 8"-10"flat boards; ■ Repoint chimney with a historic-type mortar mix, such as a S parts sand, 3 parts lime, and 1 part cement. Color to match the existing mortar; and ■ Balusters and railing on back porch to match side porch. Dated: Sentember 8, 2016 SALEM HISTORICAL COMMISSION gY: �•CA-S�c.� � ��.-�I' / ��� U The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless othenvise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessazy permits or approvals)prior to commencing work. I , . T3- l �_ �2q2 � Pionnr�h ``� design .construction . . . .. . . . . .. . . . . . . . . . � � . . . . . . . � . � � � . . �� . . �. . �. � - �� � . . . . .� . � . � .�. . . . � � . . . . .. � � . � . . . � � . . . �. .. � � �35 MAIN: ST, �SLJITE 178C, . � . . . . . . . . . .. . : � . � � . � . .. . .. . . . . . . . ,. . . . . . . . . . . . .. . . . . . : � . . � � . TOPSFIELD;:�MA� O1 983 � . . . .. . . ..� . . . .. � � . �. . . . . . . . . .. . . . . . . . , .� � : � . .. � . : . .. . � � � .. � �.. . � . . � . . . . � �. .� � � � . . . . .� . .. . . . � � PIONARCH.COM � � � . . . .. . . . . .. . � .. . .. �. � . . �. � � _ .. � .. . . . �.� . ..� � . � . �. : .. . : . � . . : . . . . . . , . � � . . . . .. . . . . � . . � . . � . � .. . .. � . . . . .: 978. 887. �2900 � . 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