006B HALSEY WAY - B-11-420
The Commonwealth of Massachusetts
CITY
i Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 7'"edition
OF
Bruised mrnudJanua`r ry
Building Permit Application To Construct, Repair, Renovate Or Demolish a l• =003
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
lSignature: 4-1t,
Building Commissioned lnepectorof Buildings Date
SECTION 1: SITE INFORMATION
I.I Property Address:1.2 Assessors Map& Parcel Numbers tJ
L l 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 11) Frontage(11)
I.S Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
a
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public Private O Check if es
Municipal On site disposal system
SECTION 2: PROPERTY OWNERSHIP'
2-L Owner'of Record:
Name(Print) Address a Semc
9-7d'-
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Existing Building O Owner-Occupied Repairs(s) V1 Alteration(s) Addition O
Demolition Accessory Bldg.O Number of Units_ I Other Specify:
Brief Description of Proposed Work':
r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item
Estimated Costs:Ofllelal Use Only
Labor and Materials
I. Building S 1. Building Permit Fee:S Indicate how fee is determined:
Electrical S Standard City/Town Application Fee
Total Project Cost (Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S
Suppression) Total All Fees:S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S D 0 paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervlsor(CSL)
ADResidential
Z
5;,9/ P L I LA -_ ber Hx 'ration U e
Name of C'SL• I Io1Jer pe(see below)
V1Tr ?n1T/Ct/t Ikscri ion
AJ rfss nrestricted u to 15,000 Cu.Fl.
Lt) a' estricted IB2 Famil Uwellin
S' atur Only
z--esidential Roolin Coverinit
felepltone sidential Window and Siding
sidential Solid Fuel Bumin Appliance Installation
C sidential Demolition
5.2 Registered Home Improvement Contractor HIC))
EA T/46. f7 C-A) Q r f74 Q.y
I ilemCu any Name orHICK'Registrant Niffe Registration Number
jws4 7 YSU S tv' Lien Date
Signat Telephone
SECTION 6: W KERS'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 .......... 0 No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
J 1,
p y
tX41jF4i/)/ r
as Owner of the subject property hereby
authorize er d .
i 9A T 7 to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signaturc of Owner P Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and
behalh
Prin am
Signatum ol'Owner or Au orized Agent Dat
Si under thevainsdnd penalties of 'u
NOTES:
I. 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 Wl have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.115,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) including garage, finished basement/anics,decks or porch)
Gross 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
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
American Properties Team, Inc.
04
TO: Paula Griffin—6B Halsey
FROM: Jennifer Pappas, Property Manager
RE:Window Replacement
DATE: June 8, 2010
Please be advised that the Board of Trustees for Pickman Park has approved replacement
windows for the above referenced unit. This approval is contingent upon them matching the
existing windows and that they fit in the existing opening. They must be the same in appearance
from the exterior. The Board will not allow windows with grids, crank outs, etc.
We also require that permits be pulled in advance (regardless of what your contractor may tell
you), and then a copy of the final approved permit once completed must be sent to APT for the
unit file as well. We also recommend that owners obtain a certificate of insurance from the
licensed contractor.
You will need to bring a copy of this letter to the Salem Building Department in order to receive
your permit.
Should you have any questions or require additional information, please feel free to call me
directly at (781)932-9229.
cc: Unit File
500 WEST CUMMINGS PARK•SUITE 6050• WOBURN -MA .01801.781-932-9229 -FAX 781-935-4289
CITY OF SALEM
i PUBLIC PROPRERTY
DEPARTMENT
I'.11: MI r 1 'MI i I
I:C p.\yu\L.,w)(/kl•f •j.\I1]I.
I ..•M ItI: 'r71.74.4-4 /O •1'\'J:'17/•7JS'/,yJ6
Construction Debris Disposal A171davitrequiredforalldemolition :ux1 renovatiun work)
ith the sixth of the Slate Building Code, 780 CMR scctiun 111.5
In ;Jtcurd:uxc w
Debris, and the provisions of MGL t 40,
is issued
S ssu ndi
building Permit IY d
ed with the condition that the debris resulting from
This work shall be disposed of in a properly licensk waste disposal facility as daflned by MGL e
I 11. S 150A.
The debris will be transported by:
IlOnJO of haulsr)
1'lle debris will be disposed or in
LL PTf ,SEIIIVIeES.
mum u1 raxunf/
CT Il 0 7- 1
I;,,I lms ul Ix 111Iy1
J
I oaulre of Ilernl, applieam
Jats
CITY OF S.U.E.tiI, 1%VwSaXCHL;SETTS
3L MDLNG DFV.%W.11124T
120 WASHINGTON STRESS. )"HOOK
iM. (978)74}9S9!
FAX(978) 14498"
K1*1DE.ALXV DRI3COLL T1+oHASST-I'MMi
JAY01L Dijiln=l of PC eLlc PtOPERTT/K ILDNG CO%04lS3lCL%ER
Workers' CompeassllOO Insurance AflldariC Ouildfls/COAlraitOrl/Elwtr(tlsnslPlvmben
innllcant Information Plesse hiss/ LesM
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Address. 2,57
Cily/State/Zipe Plwtlf N
Are yeti Be ewpbyw?Cbeck the appropriate bear ryw orPreleel(raPslrodl:
i. I am o cmployor witdl 4. Q I am a reform crosra m ass 1 tie New co odors ias
tnPk (fw a dAw pars,dow).s have hkod tip atYsseraeams
listed Choaeadtod shaft: T. Q Remodeling
t.Lids a eve no
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tubing far ma W any capaeiry. erasion'.amps(nsaaaat 9. Q tlri Win f addkiee
1 No workers'coop` ittsu.arres S. Wa ate•ceeperwlas arts in
10.Electrical regain v addition.
hq l oiflkws haw oawelud thofr
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mysolt(Yw working'carry. c. 13K/1(4).mW we have no I2.Q Reef repoin
insaratrea rogttiredl q 3We werhow 13.0 Odratrcomp.instaatlesregWmd.l
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T..drrrw Orr cb W&,W w rt*YtlrtW And.bwlq I"new of ft et rret oom re tint, where'trr's,Itiyl!wig
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ir MrweUilM
Insurance Company Name:
ealicy 0 or Sell'-ins, Lie.M: EnplMion Date:
lob Site Address CityiJlasatZipe
clack a copy of Ibs weriers'co gpeaWas pesky dtelerstlaf PoP(tkawhtg tb Polley"Mbw sod oapdratloe drift)6
tiaun to stxttdcoverage as?.neared under lecdow 3JA of NaL a. 132 can food to Ike impoeklar ofariminal ponelde ofs
fine up to S 1,500.00 amYor on4l-year impriswunortt as well ao civil penalties is the fans of a STOP WORK ORDER and a Atte
ol'up to S_J0.00 a day ayaints the violator. Ise athnsal that a wpy of this ststenteel maybe furwarded to the Witter Cr(
Imc.h Barium dl•the n1A for instrance cov.rapt vvint .here
Jo hereby cefw*Yw/ a psi w Pon Id, /per/w7 rAw rM iele/M/IM MMII YMw is true rued rwrres
nQltidYrr wr/j6 Oe met,.pint he ihir dreg/i 6L rrwp/rrd bj rids er/ItM,.//It•ird
Ciry or fu,vn:
I.t uing.W hsrtly Icircie noel:
I Guard ut ilvalth 1. Htnlding O.•partm.ne i. Citf/rower clerk t. Electrical lntpector S. Plumbing inspector
6. Other
l .if act Pcr,on: Phone 0: