23 WARREN ST - BUILDING INSPECTION (3) r
The Commonwealth of Massachusetts
/1 L Board of Building Regulations and Standards Tom
Massachusetts State Building Code, 780 CMR, 7ih edition Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a tItLomwbYOA
\ One- or T - dmi r Melling
is Section Fat OfTici 1 Use Only
Building Permit N mbeerr:� _ Date pplied: q
rgnature be��""' V) 0
Budding Commissioner/Ins for,of Bu Id' Date
SE :SITE INFORMATION
1.1 Pro erty Address: S f_r + 1.2 Assesso Map& Parcel Numbers
7_th \/wit.te �eti ✓�I ::5 �l�t� a -Ci
s Map Number
I.1 a Is this an accepted street'?ye no Parcel Number
1.3 Zoning Information: 1.4 Pge1rty Dimensions:
Zoning District Proposed Use Lot Area(sq� ' Frontage(tt)
1.5 Building Setbacks(ft)
From Yard Side Yards Rear Yard
Fmgnatuft
Provided Required Provided Required Provided
ly:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
vate❑ Check if es❑ Municipal'�/On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
ofecor : .5,r � �/ T�1� , V �- V✓ C r]_
k J �C.C�t Address for Service:
Telephone
`{ a}�
SEC N 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building Owner-Occupied�J Repairs(s) ff, Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
§rief Description Proposed Work':
P�V1'
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofl9clal Use Only
Labor and Materials
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) S List:
5 .Mechanical (Fire S
ression Total All Fees: S
Su
Check No. _Check Amount: Cash Amount:
6. Total Project Cost: SDOrd-O ❑ Paid in Full O Outstanding Balance Due:
+(S'DOr VV
L �
r
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 4(52.7? D
Nd / a] its License Number Eap au n Dote
N4mc of CSL- 11 V /��n List CSL Type(sec below)Ll _11__-
a �^—'"""--7-" T• Description
Address
U Unrestricted u to 35,000 Cu. Ft.)
R Restricted 1&2 FamilyDwelling
Si nature e, Mason—
RC Rcs dcmial Rooln Coverin
Teephone WS Residential Window and Siding
SF Residential Solid Fuel l3umin A fiance Installation
D Residential Demolition
5. istered!'Hoyermp;ny� �yntractor(HIC) ` ['7X/
C Co a e o WC Re istrant a Re ration Number
Addre 2� 9,7/=de `
i7—ai�S Eapira ion Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 Issuance of the building permit.
Signed Affidavit Attached? Yes ..........V No........... O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S ACAAT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 (�U�kS �Pivv15 as Owner of the subject property hereby
authorize A ds/1/L nto act on my behalf, in all matters
ref e o worMauth' ni this building ermi ppli
Si nature o7 Owner Date
S ION 7b:OWNERr OAIrTH ED AGENT DECLARATION
—tzl ,as Owner or Authorized Agent hereby declare
that the statements and in formationon the foregoing appli ti are true and accurate to the Pest of my knowledge and
behalf.
Knit Na*,
' v 1 �l �
d
Signatur o Owner rAuthon ed gent 0Date
Si ned under the pains and pe at es of r u
NOTES:
rl An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will nPl have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and IIO.RS,respectively.
When substantial work is planned, provide the information below:
l floors area(Sq. Ft.) (including garage, finished basemenUattics,decks or porch)
ss living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfibaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage" may he substituted for 'Total Project Cost"
CITY OF S.0 E.`I, ,L-1SSACHUSETTS
BL'ILDLNG DEPARTMENT
120 WASHIINGTON STREET, )era FLOOR
'a 'IDS_ (978) 745-9595
F.tx(978) 740-9846
jU,,(BFRiEY DRISCOLL -
�ertYOA THob,us ST.PIERRR
DIRECTOI OF PLBLIC PROPERTY/BLIIDLNG CO\L%BSSiONER
Workers' Compensation Insurance AlTidavit: guilders/Contractors/Electricians/Plumbers
applicant Information0 ++ '' Please Print Legibly
Nagle (ousim� rrWizatiomInndzvtdual)': 77/0,d -S /V0� S'j
Address: t17 7S A lilyJ `/ p�city/State/zip ffl ,f/�/¢ �hhone 7V 77/ —gd4�_g
Are you as employer'Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. 0 lam a general contractor and 1 6. ❑New construction
employees(full and/or part-time)." have hired the&&cotuncton y 4C5 1 Remodeling
2-�1 am a sole proprietor or partner- listed on the attached sheet :
,hip and have no employees These sub-contractors have it. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9. 0 Building addition
]No workers'comp. insurance 5. 0 We are a corporation and its
required.]
ot7cen have exercised their 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work right of exemption per MOL I I.0 Plumbing repairs"additions
myself.(No workers'comp. C. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.)t employees. [No workers' 13.0 Other
comp. insurance required.]
.Any applicant ihta checks tan Of mina JIw fill rttt the secaion brow showing their workni compensation policy infutmadon
'I h meuwrws who submit this affidavit indicating they are doing all work and then hire outside conosmon riser suhmil a paw aMdsvii inditatlrtg suck
:r,miracton that cheek This box min atachod an addntional ahimn ahowins the name of the mb•to uwaate and their wurknn'mmp.policy intamuwm.
l am an employer that b providing workers'compensadan inirrrance for my employees, Below/s/he pwIcy and Job site
information.
Insurance Company Name:
Policy M or Self-ins. Lie.M Expiration Date:
Job Site Address: City/State/Zip:
,mach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of,%1GL c. 152 can lead to the imposition of criminal penalties of
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties is the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. ale advised that a copy of this statement maybe forwarded to the Office of
Invcsitgationn ot'dte DiA for insurance covcrago veriiieation.
l do hereby certify under ns ar penalties of perjury that the information provided^above is true and ta-r�rec�t ^
G,11,t u ' Dote:
7
Phone A
iOfcial use only. Donor write in tblr area,to be carnpleted by city or town official
City or Tuwn: _-, Permit/f.Icense q
Issuing Aulhorily (circle one): -- - -- - -_ —
I. hoard of llealth 2. Building Department 3. City/rown Clerk 4. Electrical inspector 5. Plumbing Inspector
6. Other
Cunlact Person: __ __ -_. __ Phone p:
Massachusetts- Department fit'Puhlic. Safetc
Board of Building Regulations and Siandertls
Construction Supervisor License
License: CS 45277
Restricted to: 00
THOMAS G NONIS
68 HIGH ST
WINCHESTER, MA 01890
Expiration: 8/9/2010
( nrr Tr#: 1820
,P� �e �iom�noouaea!!/ o ,/l�aaw.cluaella
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: -
Registration: 157261 Board of Building Regulations and Standards
Expiration:_;9118/2009 Tr# 259451 One Ashburton Place 1301
Boston,Ma.0210
-•-Type: Individual
THOMAS G. NONIS
THOMAS NONIS
68 HIGH ST
WINCHESTER, MA 01890 Administrator Not valid without signature
Massachusetts- Department of Public Saletc
9 Board of Building Regulations and Siandarils
Construction Supervisor License
License: CS 45277
Restricted to: 00
THOMAS G NONIS
68 HIGH ST
WINCHESTER, MA 01890 1 ac
Expiration: 8/9/2010
� pp p ('nnmis.iner Tr#: 1820
✓!t¢ lOomNftOn/Ilea�� oy../l�aa�oc%aoelt .
Board of Building Regulatiobs and Standards License or registration valid for individul use only
qp� - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 157261 Board of Building Regulations and Standards
One Ashburton Place 1301
Expiration: g/18/2009 Tr# 259451 Boston,Ma.0210
- Type: Individual
THOMAS G.NONIS
THOMAS NONIS
68 HIGH ST
WINCHESTER,MA 01890- Administrator Not valid without signature
CITY OF SALEM
13 j,
PUBLIC PROPRERTY
DEPART.WENT
I11 'I'9.'4 '8 '4 i4,
Construction Debris Disposal .affidavit
(rcyuired f6r all demolition and rcoovalion work)
In accordance %�ith the sixth edition of the State Building Code, 780 CMR section 11 1.5
Dcbris, and the provisions of''vIGL c 40, S 54;
Building Permit M is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
I 11, S I50A.
The debris will be transported by: _
ZhIbW45 I /UO/U-s
Inamc of haultr)
I he debris will be disposed of in
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(ualna ul I`alny)
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Salem Historical Commission
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970
P78)745-9595 EXT 311 FAX (978)740-0404
CERTIFICATE OF NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑�` Construction ❑ Moving
Yv' Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other Work
as described below does not involve an exterior architectural feature or involves a feature covered by the
exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic
Districts Ordinance.
District: Nicholas Lewis
Address of Property: 23 Warren Street
Name of Record Owner: Nicholas Lewis
Description of Work Proposed:
Rebuild rear stairs and repaint. All work to replicate existing. No changes in color, material, design, location
or outward appearance. Non-applicable due to being in kind maintenance/replacement.
Dated: October 9, 2008 SALEM HISTORI C MISSION
By:
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 otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of'
Buildings (or any other necessary permits or approvals)prior to commencing work.