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0047 WASHINGTON SQUARE NORTH - BPA-10-02 The Commonwealth of Massachusetts Board of Building Regulations and Standards Town of ,�� Massachusetts State Building Code, 780 CMR, 7'"edition Building Building Permit Application To Construct, Repair, Renovate Or Demolish a Or o-Funtih Dwellin 8 This Sect on For Official Use Only Building Permit Nu ber: Date Applied: �. Signature: Buildi ommission A r/Ins r uildings Date r ECTION 1:SITE INFORMATION _L�Property Address: 1.2Assessors Map d Parcel Numbers14hF n � 1�� �� (A I.I a Is this an accepted street?yes � no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(tl) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I,c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public O Private ❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP' I 2.1T-0 woerf ) Record* d r 4 7 4r,� 4%4z Nartx�(Print) " Addzzre��ss for Service: r' Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ Alteration(s) j3� Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': _ O "6 ' e P� lT -ram SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Officlal Use Only Labor and Materials I. Building s 3 I. Building Permit Fee: S= Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical s f9G�C� ❑Total Project Cost'(Item 6)x multiplier x J. Plumbing S YO 2. Other Fees: 5 2 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees: S n, Check No. _Check Amount: Cash Amount: 6. Total Project Cost: SQv ❑ paid in Full ❑Outstanding Balance Due: 3(o '1 LJ-2� r SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) v q 1 „ �) S"VI VLtI.,.dl Z` Ltccnsc Numhe Expirjfion Date N4me of CS - Hpldcf% List CSL Type Iscc below) JSs 4 J f+k/ita T Description t 'R' 3 f4 Unrestricted(up to 15,000 Cu. Ft.) -/6 R Restricted Ik2 FamilyDwelling gnattire M Masonry Only RC Residential Rooting Covering Telephone WS Residential Window and Siding f j� SF Residential Solid Fuel Burning Appliance Installation (,,�, I YC D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration 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 .......... OX No........... ❑ SECTION 7n: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER' GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �/O I, as Owner of the subject property hereby -authorize 1 e'Y-�r11''�'Z to act on my behalf,in all matters relative to wo�zed by this uilding permit application. Si nature of Owner Date SECTION 7b:OWNE/R�t OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behal 1 4s Prim' IG ( '- - Si a e o(Owner or Authoriiedqcgent Date S ned under the airs and rallies of perjury ru NOTES: [I. :Anwner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor egistered in the Home Improvement Contractor(HIC)Program),will W have access to the arbitration am or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and ruction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and i IO.RS, respectively. When substantial work is planned,provide the information below: al floors area(Sq. Ft.) (including garage, finished basement/attics, decks or porch) ross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open J. "Total Project Square Footage" may he substituted for 'Total Project Cost" - �nnua Salem Historical Commission 120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 (978)745-9595 EXT. 311 FAX(978) 740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction Alteration ❑ Demolition ❑ Painting ❑ 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: Washington Square Address of Property- 47 Washington Square North r TT, Name of Record Owner: Barbara A. Swartz Description of Work Proposed: Replace existing "replacement' windows with new Pella Architect Series Wood Double Hung Windows with ILT's, 718"muntin. Where there is a wood choice, it should be cedar. Spacers between the glass to be bronze. Install new same Pella 6 over 6 window to the right of the rear door in addition, 20" shorter from the bottom than those in front (head heights to match), with shutters to match, matching window box, new vent below to be of minimal profile painted to match body color of building. Replace rear door to replicate existing and to replace the transom above to be adjusted so window glass lines up with glass in door. Replace wood shakes on rear with cedar clapboard, 4" to weather to match rest of house. Dated: —Ma 22, 2009 SALEM HISTORICAL COMMISSION By-qL 4 The homeowner has.the option not to commence the work (unless it relates fo 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. CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT Construction Debris Disposal Affidavit ociluired for all demolition and renovation work) In accordance wtIt the sixth edition of the State Building Code, 780 CNIR section 11 L5 Dcbris, and the provisions of MGL c 40, S 54; Building Permit It is issued with the condition that the debris resulting front this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c 111. S 150A. The debris will be transported by: �.D(p t s D ItS (4, 4 (name of hauler)I I he debris will be disposed of in : I ndinr of I]alny) 1• ddres. of lacilily) "vvilurcofp:nnit 71,17711 ,IJIC CITY OF S.1LEii. 2%LxSSACHL;SETTS BUILDONG DEPARTMENT • 120 WASHIINGTON STREET, 3so FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KI,IgEgI EY DRISCOL L THONIAS ST.PMAM �(AY DR DIRECTOR OF PCBLIC PROPERTY/BCILDLNG COMMSIONER Workers' Compensation Insurance AMdavit: Builders/Contractors/Electricians/Plumbers Alifilicant Information A , Please Print Le2ibly NaITIetBasi�Organi:uiomInyv,au:J): �1. Address: 'Z-Z .S City/Statc/Zip: be2,140 A M Phone Are you as employer?Cheek the Appropriate bo . Type of project(required): 1.El am a employer with 4. 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).• have hired the subcontractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet y ❑ Remodeling ship and have no employees These subcontractors have V. 0 Demolition workingfor me in an capacity. workers' comp.insurance. Y P tY• 9. C] building addition [No workers'comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL 1 1.0 Plumbing repairs or additions myself.[No workers'comp. c. 152.§44),and we have no 12.0 Roof repairs insurance required.) t cmploycea. LNo workers' 13,C]Other comp. insurance required.] -Any applicant ihat fiat hoer el moil also rill wl the section bet"showing their workers'compensottun puticy infurmadoo. '1 hereavinci s who submit this affidavit indicating they are doing all work and then hue outride eentlee are must suhmh a new amilavil indicating Mick {'.enrac r,that check this box mud anached an atldiratrW shwa showing dte amen of the sub. aatrncton and their wurken'comp.policy information. I um an employer that lr providing rilrers'rompensadon Insaronce for my employers Below/s the policy and Job site information. ti Insurance Company Name: Policy N ur Self-ins. Lie.N: �/✓C1/ Expiration Date ' tr✓ Job Site Address: y 7 W4,k&II�PA ` � —��/U(�/ f ttl City/State/Zip: / (* Attach a copy or the workers'comp•ttTi' a tba policy declaratba page(showing the policy number and expiration date). Failure 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 S 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. 1)e advised that a copy of this statement may be rurwarded to the Off'tce of Invesugatiunx ul the DIA for insurance coverage verification. /do hereby c e if rder the pains alweltaltlr 0 PerJury that the information provided above is irmr L and Carrec ci . riere' Wig! _ —"- 02 iOflciul use only. Da not wrire in this urea, to be cumpleted by city or town oJJic at City or rusvn: 1%suing Aulhorily (circle one): I. Board of Ileallh 2. Building Department J.city/town Clerk t. Electrical Inspector 5. Plumbing Inspector 6. Other C alacl Person: _, ., _ __, ___ Phone ill: Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)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 I� Reconstruction ❑ Alteration 4 b 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: Washington on Square Address of Property: 47 Washington Souare-North Name of Record Owner: Barbara A. Swartz Description of Work Proposed: Repaint house in existing colors; repair and/or re-attach gutters as needed to replicate existing; replace fascia board to replicate existing, repair/replace shutters to replicate existing. No changes in color, material, design, location or outward appearance. Non-applicable due to begin in kind maintenance/replacement. Dated: May 5, 2009 SALEM HISTORI COMMISSION By: The homeowner has the.option not'to"commence the work(unless if 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.