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92 FEDERAL STREET - BUILDING JACKET 9� �-��► s ONDIT4,gO CITY OF SALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT co 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01 970 TELEPHONE: 978-745-9595 EXT. 380 �inrwe W� FAX: 978-740-9846 KIMBERLEY DRISCOLL MAYOR May 22, 2014 To Whom it May Concern RE: 92 Federal Street Salem, Ma. 01970 According to our records, it has been determined that the property located at 92 Federal Street is a legal grandfathered seven(7) family dwelling. This is to determine use only and in no way meant to confirm or deny whether said property is in compliance will all building, plumbing, gas, electrical, fire or health codes. Sincerely, Thomas St. Pierre Zoning Enforcement Officer X11 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 ❑ Reconstruction ❑ Alteration ❑ Demolition ;K 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: McIntire Y Address of Property: 92 Federal Street Name of Record Owner: Susan Quirk_ Patricia McIntire Debra Canomzi Description of Work Propckd: Repaint entire body of h,ou e in California Historic Color 'Portsmouth Blue'-same color as original 1985 approved Cabot #0577 Federal Blue. Trim to remain white as existing. ( rJi Dated: October 19 2(06 SALEM HISTORI COMMISSION ! By: 9WT The homeowner hasthe option not to commencehe work(unless it relates to resolving an outstanding violation). All work commenced must be complet` thin one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be surto obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals)wr to commencing work. ,f'CoxM4 , Salem Historical Commission CITY HALL. SALEM. MASS. 01970 \pf�1MM6� CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed construction [ ] ; reconstruction [ ]; demolition [ ] ; moving [ ] ; alteration [X] ; painting [ ]; sign or other appurtenant fixture [ ] work as described below in the . . . McIntire Historic District. (NAME OF HISTORIC DISTRICT) Address of Property: 92 Federal Street Name of Record Owner: Richard Quirk DESCRIPTION OF WORK PROPOSED: Replacement of two sets of side stairs as completed with the exception of the rails as installed. Approval of rail design to be delegated to Commissioners John Carr and Hank Cook. Conditional that stairs be painted. will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (Mass. General Law Ch. 40C) and the Salem Historical Commission. Please be sure to obtain the appropriate permits from the Inspector of Buildings prior to commencing work. Dated: January 7, 1993 SALEM HISTORICAL COMMISSION By_ 64� l _ iairman Salem Historical Commission 120 WASHINGTON STREET, SALEM,MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction ❑ Alteration ❑ Demolition O 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: McIntire Address of Property: 92 Federal Street Name of Record Owner: Lapozzi Quirk & McIntire Description of Work Proposed: Repaint left side of building in existing color (Portsmouth Blue). All work will be in-kind. Dated: ,June 5, 2013 SALEM HISTORICAL COMMISSION 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. Tito of %lan, MassacllusJetts Pnh11C t1ravertV i9partnment +Nnildfng Repnrrinent (Put Salem preen 568-745-9595 Ext. 380 William H. Munroe Director of Public Property Inspector of Buildings Zoning Enforcement Officer 10/28/92 Lr . Richard A . Quirk 60 Webb ._ _ . Salem Ma . Re : 92 Federal Street Dear Sir: On October 27 1992 a site visit was made at the above mentioned address . Upon inspection it was noted that construction was proceeding without the benefit of a building,; permit . Flease be advised that a stop work order has been issued . You are in violation of the Massachusetts State Building Code section 113 . 0 ( no permit on record) . Contact this office within seven ( 7 ) clays of receipt of this notice . Failure to do so shall result, in further legal action . (/S'�)incerrJelyyy David J . Harris Assistant Building Inspector cc : Ward Councillor 12 (�0�44 ;� 6�' - ln9/- 7di' November .4, 1977 Mr. Robert F. McLaughlin Re.- -92 Federal Street 2 Osborne Street - Peabody, Ma. 01960 Derr Sir; in response to a complaint; this department inspected .the 'garage3 h at 92 .Federal Street rear on November 3, .'197T. the inspection revealed the ,garages to be in ,a haaard8gs- condition and a,danger x . - to the public safety and welfare. You are ordered to contact this office immediatly:upon receipt. of .this .order with plana for repair or demolition of the garages. , A permit :will be required:;prior to starting_work-*, Jery truly yours,. " J 1 ' John B. Powers , : r Supt. o£ Public;-Pro-o and r = Inspector of Buildings TBP/b :;#945286 rr r H 0 SENDER: Complete items 1,2,and i. Add your address in the 'REIIJRN TO" space on 3 reverse. 1. The following service is requested (check one). 3 Show to whom and date delivered............ 150 7 Show to whom,date,& address of delivery.. 350 a RESTRICTED DELIVERY. t Show to whom and date delivered------------- 65{ RESTRICTED DELIVERY. Show to whom, date, and address of delivery 850 a 2. ARTICLE ADDRESSED TO: Mr. Robert F. McLaughlin a 2 Osborne Street z Peabo.(Jy, Ma. 01960 a m m 3. ARTICLE DESCRIPTION: REGISTERED NO. CERTIFIED NO. I INSURED NO. m 426A in (Always obtain slgneturp of W sane m) r as I have eived the article desc ' d6ove4 M M0 SI AT RE ❑ Add esse ut oriz agent Z iT H C 4. a DATE F DELIVERY STMARK m 0 e S. ADDRESS (Complete only if requested) O m a M =1 6. UNABLE TO DELIVER BECAUSE: CLERK'S p INITIALS 3 > r jy GGP:19�263-a56 4\; M Nl � M UNITE >ST6,, gg p OSTAL SERVICE- QPFfl3 A�....$USI�'ESS •y "� II SE DER'INSTRUCTIONS ✓" O AVOID FOR PRIVATE b USE TO FO PAYMENT Print your nems,a P Code in the space below. OF POSTAGE, $360 • Complete items 1, and S on the reverse, 4 ti • Moisten gummed ends and attach to front of adidfl if apaee Permits. Otherwise M.to back at article. • Endorse article "Return Receipt Requested" adja cent to number. fr, RETURN J �e T8 v , ty o_f Sajem Buildinr!• Inspector (Name of Sender) One Salem Green (Street or P.O. BOX) ___�.'11f31Re to (City, State, and ZIP Code) j„7 �.r �aAF; Brt� ia i i a BUILI)JuG DEPT A'yrr yt..'r+ v rr I MAR 2 140 PN$76 q I � RECEIVED — __ CITY OF SALEM,MASS" ;rte +., • !• r SALEM TIRE DEPARTMENT d Fire Prevention Bureau RE �OMMENDATION �� . —. nate.._9. .1'.1..b.. .. ...... ._ —' Name ..,l;at>ert F nncz Larrniii Petaui32ir_ 7 _ 19 Address- ..- .. . 2� jOsborn �t Peabody 1,11,911Stil 92 N'edern.l, : t `, ilem bass As a result of an inspection this date of the premises owned and/or occupied by you, the following recom- mendations are submitted 'which should receive serious consideration. These recommendations are made in t the interest of fire prevention and to correct conditions that are or may become dangerous as a fire hazard or are in violation of law. Smokenipe leading to chimney IS single janket and is up arsinst wooden oar..... . nn extra cold days when fiarnace is r ann3ng f or Ionger.'p� r'i ods 5 _ ... this could lo lead ta seraous, fire This condo}on will Have bc to e orrected i nmeciiatl .. .. r .. . .,. 3 0312217b Reinspection date:. ... .. . .. . . ... . .... . ... i 'cp „ cr�,z2L2a�c...... .... y «rr CC Beaildi.n,(, Tnnpec dor. BUILDING INSPECTOR y ' rm y I�IH CITY OF SALEM P 268 6 91 707 L£�, jti BUILDING DEPARTMENT e U Q F 3 CITY HALL ANNEX OCT 28'82 f � ONE SALEM GREEN 2 .29 — . t SALEM, MASSACHUSETTS 01970 ~A.1A a.e.m¢ G45197; J r c` Ip dF p, Sf�zirk 60 b S�t� Istr f�'otm�;9 fie' ,e{ Retas' V�9' 1992 1 SENDER: I a150 9hQ4eCeVB he t • Complete items 1 and/or 2 for additional services. . O It 1l • Complete items 3,and as&is. following ssi a (fiof aextra a Print your name and address on the reverse of this form so that we can fee): - return this card to you. ---- - • Attach this form to the front of the mailpiece,or on the hack if space 1. ❑ Addressee's Address n• does not permit. W - Write"Return Receipt Requested"on the mailpiece below the article number. 2. El Restricted Delivery W'yl • The Return Receipt Fee will provide you the signature of the person deliverer, I ut m to and the date of delivery. Consult postmaster for fee. K p� m 3. Article Addressed to: 4a. Article Number / n z Cb. Service Type tr=-« ❑ eiste ❑ Insured Ili a Certifiedd El COD } ❑ Ex Mail ❑ Retum Receipt for r Merchandise 7. Date of Delivery m E T 5. Signature (Addressee) 8. Addressee's Address(Only if requested and fee is paid) 6. Signature (Agent) i PS Form 3811, November 1990 cu.s.GPo:1991-2e7-0ea DOMESTIC RETURN RECEIPT The Commonwealth of Massachusetts yi i Board of Building Regulations and Standards I t)It y � 1Il'Nll'll'.\I.I II' Massachusetts State Building Code, 780 CMR, 7"' edition til. Building Permit Application To Construct. Repair. Renovate Or Demolish a Kr ri wd,homaii One-or T /-Fran' e Dvrlling is Sect n For tficial Use Only Building Permit Number: ate Applied: Bm Id ing ununi sSioner/ Inspe or B I in Date SECT[ N I: SITE INFORMATION 1.1 pert" A dress: 1.2 Assessors Map & Parcel Numbers 1.la Is this an accepted sweet? yes_ no_ Map Number P:urel Numhei 1.3 Zoning Information: 1.4 Property Dimensions: 1 7 -ling Dis!rirt Proposed Use ' ct:\:ca(SO It) Fnnl:agc Ilil l.5 Building Setbacks (fill Front Yard Side Yards Rear Yard I Required Provided Required PnwideJ Required PnrvidrJ l 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? n m y %IUMci al ❑ O Site disposals ste Public ❑ Private❑ Check if yes❑ ❑ p I SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Record: Name(Print; Address for Service: Signature Telephone SECTION 3: DESCRIPTIO OF PROPOSED WORKZ(check all that apply) jNew Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) Alterations) ❑ AJditiun ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Spccil'y: Brief Description of Proposed Work.- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor:md Materials) 1. Building $ U(j I. Building Permit Fee: $ Indicate how tee is determined: ❑Standard City/Town Application Fee 3. Electrical $ ❑Total Project Cost} (Item 6) x multiplier x 3. Plumbing $ -. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: C ash AmuunL b. Total Project Cast: 'S 0 Paid in Full 0 Outstanding Balance Due:____ SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSI_) ,/ icense Numher '4 Name otCSl_- Ilolder List CSI_Type(see hclow) \JJrcss f• c Descri hoop L Unrestricted(up to 35000 Cu- Fl.i R Restricted I:c'_ Family Dwelling Signature M %Iasonry Only RC _ Residential Rooline Co%enn_ Telephone N'S RrsiJrnliul \1'induc: .ulj Sidi n�_ SF _ Rrs1drnti:1 Sol J Fuel Burning \ 1h:me. In.LJCw1-u� D Re>idenual Dcnwli ton 5.2 Registered Home Improvement Contractor(HIC) IiIC Conip iy me -L I'C/Registrant Name Registration Number .�Jdress 2,� G�U Expiration Date Signature Te on SECTION 6: WORKERS' COMPENSATIO INSURANCE AFFIDAVIT(M.G.L. c. 152. § 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 .......... ❑ No _......... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize __to act uu my behalf, in all matters relative to work uthorized by this building permit application. SiHnature of O per —_ —__ -- 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 true and accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the 2ains and penalties of perjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contr:tc(ol (nut registered in the Home Improvement Contractor (HIC) Program), will not have access to them baration 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 C•MR Regulations I l0.R6 and 1 10.125, respectively. '. When substantial work is planned, provide the information below: Total flours area (Sq. Ft.) (including garage, finished basemendattws, decks or porchi Gross living area iSq. Ft.) Habitable room count _ Number of fireplaces Number of bedrooms _ Number of bathrooms Number of halt/baths 'fvpe of heating system Number of decks/ porches Type of cooling system Enclosed Open 3. -Total Project Square Foolage- may be substituted for "Total Project Cost- CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT Construction Debris Disposal Affidavit (required lirr all demolition and icnuvation work) In accurdaiicc-ii ith thc" i:tth edition of the State-Building Code, 780 CNIR section 1 1 1.5 Dcbris, and the provisions of 11GL c 40, S 54; Building Permit # is issued with the condition that the debris resulting front this work shall be disposed of in a pruperly licensed waste disposal facility as defined by MGL c l 11, S 150A. The debris will be transported by: 1 name of hauler) _ I he de/b�riiss�willll be disposed of in (namr of lacihty) ,ia;uamrc+ p.nnit applicant - v ' PUBLIC PROPERTY U d DEPARTMENT AINIBUL.EY DRISCOLL MAYOR -+C� 1?O WASHINGTON STREET#SALLW MASSAcHL;sLj-m 01970 14L 978-745-9595 0 FAX:978.740.98" APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION, DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: 6 Build ng: Property Address: 7a 6-70ef�,, / �-�- Property is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: 0-46 Z — Address: Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use 3 New Demolition Existing Approximate year of L:er floor (sq Renovated construction or renovation of existing building New Brief Description of Proposed Work: f RjW �v ReA, L Tyr Aida.=-1 s Mail Permit to: What is the current use of the Buildin ? ��h Material of Building? /_V V)r If dwelling, how many units?- Will-the Building Conform to Law? Q,!5-5- Asbestos? A Architect's Name Address and Phone Mechanic's Name 2 Address and Phone Construction Supervisors Li ense# HI egisVation# Estimated Cost of Project$ U , d Fee rL Calculation Permit Fee $ Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to bull to the above stated specifications. Signed under penalty of perjury ate �slO N 7 F_ z e a C7 b o t . I. CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STREET ♦SALEM,MASSACHUSETCS 01970 TEL.978-745.9595 • FAx:978-740-9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvOicant Information Please Print Legibly Name (Business/Organization/Individual): ___ - D � Address: < City/State/Zip: k_ Phone #: / /y� a ,�� �J O 13. Are you an employer?Check the appropriate box: Type of project(required): to am a employer with AM 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its uired.] officers have exercised their 10.❑ Electrical repairs or additions 34ZI am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑R f repairs insurance required.]t employees. [No workers' J comp.insurance required.] 13. Other // *Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they an:doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractor and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Sel€ins.Lic.#: Expiration Date: 2 Q Job Site Address: 9v City/State/Zip: /4__,�,j Attach 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 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 statement may be forwarded to the Office of Investigations of the DIA o insurance coverage verification. I do hereby certify and r t e ains and penalties of perjury that the information provided a ove is true and correct Si natu D Date: Phone#: 7dX4,2 � 7 Official use only. D not write in this area, to be completed by city or town ofciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person- Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their dmployWs. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer 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 trustee 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 to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of suchemployment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state,or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their certificate(s)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 that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not 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 the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line City or Town Officials 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."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 licenses. 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents OfSce of Investigations 600 Washington Street Boston,MA 021 It Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia CITY OF SALEM PUBLIC PROPERTY DEPARTMENT anm `+uusc otl lm wwswHczcu+SnFsr•Sn�'6.L`ss""'csEns 01970 MAroa 141:978-745-9595•FAX.978'740'9846 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code,'780 CMR section 111.5 Debris,and the provisions of MGL a 40.3 Athe debris resulting fim Building Pemtit N is issued with the condi ty defined by MGL c this work shall be dispos ed of in a proparly licensed waste disp° sd as 111,S 150A. The debris will be transported by: F�¢ r864409 (Dam 00AWN) The debris Will be disposed of in: (name of facility) (address of facility) ----------------- si of permit applieam � � 6L . o 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 -/ 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: McIntir Address of Property: 99 Federal St Name of Record Owner: Susan Quirk, Patricia McIntire & Debra Canomzi Description of Work Proposed: Repair/replacement of window sills and other rotted wood as necessary to replicate existing (i.e. cornerboards, fascia,front door overhang, etc.) No changes in color, material, design or outward appearance. Non- applicable due to being in kind maintenance/replacement. Dated: May 9. 2006 SALE M HIST CAL 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. is tt►e anred use at the zw What I UD L — V dwe .hoW mm raw d suamrw? SWrq Asbedw? Will the tlu av corm to Law? MctmUds Marne medwdes Nam AddfQG6 and Phone ZJ HIC - L y- .� s cad a S v PsnNt FM Q ftd&n Parma Fees E•dn+a�Cost X$7/:1000 Resider" — E sWnstsd Cod X:'t1/:1006 Comrnarels�----- An AddWonal ai.00 I•added as an Adminiatradve dwgo. Make surd that as fields are propey and Isobly writ6an to avoid delays N DrocessI^a The uwslgn does hereby apply for a BuUdkV Panne to to the above stated s glptlone sWod under Panaay Of PWPAV to � v I 3 v \ - Q I iii - CI'I'Y�OF PUBLIC PROPERTY DEPARTMENT �l �..rsa.arossa�u (J 1�W y�0 guys sm,R 01970 APPLICATION FOR T8! R>ipAi>: n xOVA'ITON CONDUCTION DEMOLITUOM CHMGZ OF USE FOR ANY FJ9MMQ 1.0 UM INFORMATION C z `L" . Location N --- _ _ Property names - s� 5 / -- - F%Waly Is WSW In e;Cersoerva/on Are@ YM MldOfb DlsMlot YM �.0 OWNERSHIP INFORMATION 11 Owner of Land Name: Address: Jr ✓ ��� /1 . 6 I y i S TNephone: 1)3 SA COMPLETE THIS SECTION FOR WORK IN E>�p BUILDINGS ONLY Addition Existing Renovation Number of Stones Renovated Change in Use New DernoGtion Existing Approximate year of Area per now(sQ Renovated construction or renovation of existing building New add Deseripdon of Proposed Work: q J ti five r-e 14 �e C /�.. 4,-c�f ,-� (c��n Lis —- ---Mail Permit to - C.: it CITY OF SALEM PUBLIC PROPRERTY o DEPARTMENT :.tstnratF.r otttscuu a4.srlst l2C Vlwsw.w:rau SfttlaT•SA t eu.IIfASAC.7 n xt7-n 0t970 rtsL 97111445.9595 •FAX:97F740.911ee Worken' Compensation Insurance Affidavit: BuilderwCoatractors/Electrictans/Plumben Applicant Information /I / Please Print Legibly Name t0uvncsslOraanirationilmkuA vial): yV J. c..Q-vim 37 7 .J Addreas: � v / C City/State/zip: l _' !'hone N: 7 2 Y7 2 ` 12 9 —2 Are you as c0pteyer'Cheek the appropriate be= Ir pe of project(requlred): 1.❑ 1 am a employer with 4. 0 1 am a general contractor and 1 ❑New construction (ruit and/or pan.tinte).• have hired the sub-contractors 2 11 am a sole proprietor or partner. listed on the attached sheet t I. ❑ Remodeling ship and have no employees Them orb-eonpaetoo have ❑ Demolition working for me in any capacity. workers'comp, insurance. ❑ Building addition (n workers'comp. insurance 5. 0 We are a corporation and its Electripl gwrcd.) oRtcen have exercised thew ❑ repairs or additions 3. 1 am a homeowner doing all wont right of exemption per MOL 11.0 Plumbing repairs or additions myself. (No workers'comp. c. 152,¢t(4),and we have no 12.0 Ruofnpaire insurance required.) t employees.LI\o workers' 13.0 Other comp. insurance required.] 'All)vphcaw the clucks bee sl mute also rill as tbs stxtim IfLttpr alawiaa their tvtpktsa'etmtpnswiat pWi�y ipsamteipq, '11w witem who submit dus affidavit indicatkta ONY ads data A work ape dice him awsids casings"marl at4mid a u w anldavil kkiiaine sod. -C'untrasttws that check on tors mew Spaded an addidansl duet 40wity dw naps of t he and than waken'cap.policy inhnnanue I ace an employer that Is providing workers'compensaton livarancrfa'tny amplrtyeer. Below 1r the polity and job s1H inform"da s. Insurantx Company Name: Policy 4 or Sclr--ins. Lie.0: Fr ir•tt- -- p r on lYrte. Job Site Atklress: CityrStatu2ip: Attach it copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to scum coverage as re u red under Section 25A of.IG an 9 L c. 152 c le ad to the imposition of criminal penalties of a fine up as S 1.500.00 and/or one-year imprisonmcnc.as w•cR as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a dry against the violator. Ile advised that a copy of this slawan;nt may be rorwarded to the Office of lureangauudts of the DIA for insurance covert.-u veriftcalion. l do hereby certify antler the pains td pena/nri of perfary that the in/armallon provided above' true and correct �iavantro' -- s� Uate• 'Q/ � 6/� Plun:c a: t)/Jlde/au only. Be soot write in thin area,to 60 completed by city of to=Pfumbing City or Town: PcrmiNl IssuingAuihorily (circle one):L Itoard of Health I. suildinc Department 3. Civrown Clerk 4. El6. Other Cutttacl Person: , 1'hon Information and Instructions Massachusetts General Laws chapter 152 requites all employers;to p ov s�etwovicrkers another under any' compensation for their C of hi ycm Pursuant to this statute.an ampfsryee is defined as`...every person e%press or implies,oral or written." as omaneW a wporanna or other legal entny,or any two or mote .ka employer u deemed d"an individual.paemer*htp. the le r rcserutatives of a deceased employer.or the of the foregoing engaged in a joiat coserprise,and including t� eP emploYaa entployeea. However the association or other legal entity. receives of dwells f m se having pernaarsh o mad who resides thutrei4 er the occupant f the owner f a dwelling house having not more than three apartments dwelling house of another who employs Persons to do maimensoce.construction or repair work on such dwelling house or on the groun ds or building appuaenam thereto shall no because of such employment be deemed to be an employer." MGL chapter I52.425CM also states that"every state or local licensing agency stag withheld the issusion or renewal of license or permit to oparoperatetoa basiatwn er eoastraet�in the commonweakh for say ���coverage required." appgeasa wbe has stet prmdeced acceptable evidence Of compiling" Additionally-MGL chapter Sped ce of "Neither untii°�epc�le evidence fconplian a with the i th off any of its political stnsurancel enter into any contract authority." requirements of this chapter have been presented to the contracting Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation aid.if necessary.supply subconersctou(s)name(s),addre*cs)and Phone number(s)along with their certiecate(s)f insurance Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partnerk are not required to carry workers'compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also W su or sign license d date the affldaviL The is being requested, not the De affidavit should of be returned to the city or town that the application for the rdpermit kw or if You are required to obtain a workers' ladustriah Accidents. Should you have any questionsregarding at the number fisted below. Self-insured companies should enter then compensation policy.please call the Department self-insurance license number on the appropr4ta lam• City or Town Officials 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 Offtec of Investigations has to contact you regarding the applicant. ,'lease be sure to till in the permittlicense number which will be used as reference number. In addition,an applicant ng that must submit multiple Permit/licerue applications is any given yeatn d id write submit one affidavit locamtioas m seating cat h or policy information(if necessary)and under"Job Site Address"the applicant town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant ss proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or pennit not related to any business or,commercial venture t i.e.a dos license or permit to burn leaves ere.)said person is NOT required to complete this affidavit. IN;Otlice of Inveuisations would Cue to thank you in:advance for your cooperation and should you have any questions. please do not hesitate to give us•a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Oaks of Iavestiptleas 6N waahingtoa Stater Boston$ MA 02111 Tel. 11617-727-4900 ext 406 or 1-977-MASSAFE Fax 0 617-727-7749 Revised i-26-05 www.mass.gov/dia i- - CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT ..v3:■t of•'u.+•t 1 %Wc V•&AAo N.A%-AL U:u.k Cts::ar t's:v7Na3✓t9M•fut:97W+O�teN Construction Debris Disposat Affidavit (required for all demolition and renovation watr) to acconlance with the sixth edition of the Stun Building Coda 7SO C111R section 111.5 Debris,utd the provisions of M1GL c 40.S S* gWlditg ponnit A _ is issued with the audition that the debris resulting ham this wort shall be disposed of in a property licensed waste disposal facility as defined by%1GL c 111. S 156A. The debris will be transported by: V 1e 2 JA - In"W out ttauldd rhedcbds will be disposed of in : / (� 1 o.rnr of factLty) a � r $2S c-K-L4Gz I GEIVEt ILA , pE, 11#t1AL SERVIC g� The Commonwealth of M cjl1altSA 0 01 r Department of Public Sa IIVVVfff Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1: LOCATION(Please indicate Block.#and Lot#for locations for which a street address is not available) ev '/�7 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Reparr.Erl Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy . ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Descri lion of oposed Work. !O'/ UG0elG•G SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR- CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed a 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 applicable) A: Assembly A-1 ❑c.A-2❑ Nightclub Cl A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 Cl L• Institutional I-1 ❑ I-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2 Cl 11-3❑ R4❑ S: Storage S-1❑ S-2❑ Uo Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION.TYPE(Check as applicable) IA Ill IIA ❑ IIB ❑ IIIA ❑ 1116 ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public❑ Check if outside Flood Zane❑ Indicate municipal❑Fp trench will In be Licensed Disposal Site❑ quired❑or trench or specify: Private❑ or indentify Zone: or on site system❑ mut is.enclosed❑ ` Railroad right-of-way: Hazards to Air Navigation: 11A 1 fistoric Umann si n K .ie,1 r nass: Not Applicable❑ Is Structure within airport approach area? _ Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No-Cl--- SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: c_,-c�rz. (-P l 2-0 trO7 J 1 A....ECTION 9: PROPERTY OWNER AUTHORIZATION Nmnc and Address�t) v � l - ^�frt� L/-mayN me(P ��,tr�',�o.(iirv'Street City/Town Zip Prope,rV Owner Contact lnformatio}CV0 7 � �/,� /'I /u / Title Telephone N . one No. (cell) e-mail address if applicable,the property owner hereby authorizes 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 ap2lication. SECTION 10:CONSTRUCTION CONTROL(Please fill out.Appendix 2) if buildingis less than 35,000 cu.ft.of enclosed s ace anti/or not under Construction Control then check here❑and skip Section 10.1 10.1 Rggistered Professional Responsible for Construction Control 96 4 --? - Name( egtstrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2Ge eral ontractor - Company Name Name of Person Res on ble for Construction License No. and Type iE Ap hcable evedA Str t Address City/Townt State Zi Telephone No.(business) Telephone No. cell e-mail address SECTION 11:tVQItKF.IS'COA11'ENSA I10N INSUKANC..li AI'F'IDAVIJ M.G.L.c.152.§25C 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❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ � 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ 3. Plumbing $ 4. 1'vlechanical (HVAC) $ Note: \iinimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable able to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I hereby attest mrder the pains and penalties of perjury that all of the information contained in this application is true and ac rate to the best of my knowledge and understanding. Plea e r nat� `, Ti[ Telephone No. Date o Street Address City/Tow State Zip Municipal Inspector to fill out this section upon application approval• '� - i^'�'' b , Name Date ii CITY OF S:V—E1,f, ctiL1SS:ICHUSETTS BCILOLNG DUARTMENT 120 WASHLNGTON STREET 3w FLOOR TEL (973) 745-9595 KISL➢ERLEY DRISCOLL FAA(978) 74&9843 NLAYott I'-tosc�Sr Pi�ans DrucToa OFPLOLIC PROPER7y/8t:ILDC(G CMLVISSIONER Construction Debris Disposal Aftldavit (required for all demolition and renovation work) In accordance with the sixth edition of tite State Building Code, 730 C&fR se Debris, and the provisions of iMGL c 40, S 54; ction l l I,S Building Permit hi is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by b9CL a 111, S 150A. "1'11c debris will be transported by: y y (nunu w hau r) 2 [hedchriswillbodisp ofin : nam o(tacday) (.1111CIS Ottacirity) siguaru�ru I;rrmit apprieant f CITY OF SOU EM, %L1SSACHUSEITS t BUILDING DEP.i RTMEINT 120 WASHNGTON STREET, 3u'FLOOR TEL_ (978) I45-9595 Rux(978) 740-9846 K1MBERIEY DRISCOLL AAYOR THoMAs ST.PIF_aBs DIRECTOR OF PUBLIC PROPERTY/BL•tLDING CO\fMISS[ONER Workers' Compensation Insurance Affidavit: Builders/Contractor.9/Electrlcians/Plumherg Applicant Informatinn Please Print 1 etaihly Nome (Rosiness.Organiration,'Individual j: Address: City/State/Zip: Phone lk Are you un employer!Check the appropriate box: 'Type of project(required): 1.0 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New eonsuuction oniployees(full and/or part-time).• have hired the sub-contractors 2.0 I atn a sole proprietor or purtner- listed on the attached sheet. [ 7. ❑ Remodeling ship and vc no employees These sub-contractors have 3. Q Demolition war • g $or me in any capacity. workers'comp. insurance. 9. Q Building addition (t workers comp. insurance 5. Q We are a corporation mid its equired.] officers have exercised their 10.❑ Electrical repairs or additions 3.V 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself.(No workers' sump. C. 152, §1(4),and we have no 12.E] Roof repairs insurance required.] t employees. (No workers' (;,(� Other cuntp. insurance required] •Any opplwwn nut chucks bus 11 must also fill our the s"tiun below showing their workers'compensation policy i 111imation. 'I b,mcawm"uAo uhniit this arfldnvit indicting they on doing all wank and then hire ovelida contmcion must mthmit a new a0?davit Indimring ruck <lnumctun that chwk this box most anachui un addniurwl Aut showing the n®nu of the sub<omncton and their worken'cump.pulIcy information. 1 ant an empluyer that is providing)porkers'conrpeissatlon insurance for my employees. Beloly is ther policy mid job,rite information. Insurance Company Name:____. Policy ii or Self-ins. Lie.d: ,_.._ Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers, compensation policy declaration page(showing the pulley number and expiration data). h'ailuru to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S I,500.00 und/ur one-year imprisonment,as well as civil penalties in the form urn STOP WORK ORDER and a line of up to S25oAo a day against the violamr. Ile advised that a copy of this statement may be forwarded to the 011ice of Inec,tigotiuns oftlta D for insurance coverage verification. /do hereby certify it or doe pains aad penuldes a perjury/hut the inforaadun provided abu/vf/i.crytrue nd c'orre,L Official use only. Do out write in ibis area, to be cumpleled by city up town official City nt Town: _ I'ermit/1.icensc 4 i I>s uing,luthurity (circle one): -- --- _-- I. hoard of Health E. Building Ilepartmcut .1.C'i(ylrnwn Clerk -1. Electrical foiliMor 5. Plumbing Inspector 6. 0tltcr ( auCtd Psrum: _____ Phnnc R: f eC/,'IIP1B Salem Historical 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 O Reconstruction 21 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: Derby Street Address of Property 115 Derby Street/ 54R Turner Street (Hooper-Hathaway House) Name of Record Owner: House of the Seven Gables Settlement Association Description of Work Proposed: Replace the existing asphalt shingles with wood shingles, as detailed in the application dated 5122114. Repair and replacement in-kind to the gutters, downspouts, roof sheds, rakes, and clapboards, as detailed in the application dated.5122114. Dated: June 19, 2014 SALEM HISTORICAL COMMISSION By: l� G( ✓��'�'� ' �lliC The homeowner has the option not to commence the work (unless tC relates to resolving an outstanding violation). Alt 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. 2c)-6-- 1 `A C l< 2 u S The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF q Massachusetts State Building Code, 780 CMR SALE,NI Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date ppliedt" Building Official(Print Name) Signature Date SEC "ION 1:SITE INFORMATION 1.1 Pr9perty re : 1.2 Assessors Map& Parcel Numbers I.la Is this an accepted street?yes no Nlap Number Parcel Number 1.3 Zoning Information: - 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Waater/Sy{ply:(M.G.L e.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Di osal System: Public�' Private❑ Zone: _ Outside Flood Zone? Municipal` On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 ert of Record: z/ 0/ 'sme Pri C.. CitY,S to ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check alphatapply) New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief escripti i of Proposed work': €"' Z ,Tl SECTION 4: ESTLNIATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee: 2. Electrical $ ❑Total Project.Cose(Item 6)x multiplier. x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (HVAC) S List:. - - - 5. Mechanical (Fire $ Su ression) Total All Fees:S Check No. Check Amount: Cash Amount: 6. 'Fatal Project Cost: $ ❑ Paid in Full ❑Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES. 5.1 Cm tr ction Supervisor License(CSL) ��vjjL/ License Number E. imtio ate Nam tSIL.f - {{{"' S List CSL"type(see below) No.and Street / TYpe Description.. Unrestricted(Buildings LIP to 35,000 cu. It.) Cis Q/ R Restricted 1&2 Family Dwelling City/town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation 'ele hone — Ernarl address�C —t D Demolition 5.2 RegisteredFlyme Improvement Contractor(HIC) --IC(,/L/ 7 _LA7�/�UL Z1 HIC egtstration Number E, iratio ate I IIC Comp ame or HIC gists Nome No.ai Sir e Ci /T vn, late, or Telephone / SECTION 6:W RKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§'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 lsAuanceqMe building permit. Signed Affidavit Attached? Yes .......... 9VI, No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN. OWNER'S AGENT OR CONTRACTOR PP IES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Z-'w -tg act on my behalf,in a matters relative to work authorized by this building per it application. Print Owner's Name(E clronic Signature) D e SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 not have access to the arbitration program or guaranty fund under ibLG.L.c. I42A.Other important information on the HIC Program can be found at www.mass.,ov;'oca Information on the Construction Supervisor License can be found at vvvvw.nmss.,>ov/d i(s 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage, finished basement/attics,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" 2 �� '�,�„�a,�!�eal�/0. adjuelumemi +y flfiice of Consumrr !lairs g Easrdes>Regnr.ition l fJiE IMPnOVEMEN i CONTP?r i'tZy' { eyi t a i n �151467 �`" " TYF 1 PlrahonLI ��Otn"` rIA VIG 133 f3RIDG� EEVEPLYMA 01915 y, a .• o- o- Unde�rsecretary Massachusetts -Department of Public Safety lW Board of Building Regulations and standards Construction Supervisor I& 2 Family License: CSFA_102846 VICTORJCAPOZZI ir'? 138 BRIDGE STREET-,, y c _ BEVERLY MA 01915+�, 1 Expiration - J��" 09/20/2014 Commissioner i ,< `'" CITY OF SM.EE.M, 'LkSSACHUSETrS BumDu`IG DE21RnIENT P• 120 WASHIDIGTON STREET, 3w FLOOR b TEL. (978) 745-9595 FA.Y(978) 740-9846 (O%{BERLEY DRISCOLL ;�$f1YOR T7-[OnL{S ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BCILDNG COMMISSIONER Construction Debris IDisposaI Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c I11, S I50A. The debris will be transported by: (name ofMauler) The debris will be disposed of in (na e of facility) (address of facility) - ' signatur of permit applicant date deb.i>aa'.d,x �! CITY OF Si1I.E��I, NL1SSACHUSETTS 13=LNG DEPART\IE24T aa) 3 l?O WASHQVGTON STREET, 3""FLOOR T EL (979) 745-9595 Fla(978)740-9846 KIJIBERLEY DRISCOLL T HOMU ST.P[ERRB MAYOR DIRECTOR OF PUBLIC PROPERTY/BI:lIJ7IING COSMISS[ONEA Workers' Compensation Insurance V idavit- Builders/Contractors/Electrlclans/Plumbers A t slicant Information Please Print Legibly Name tnusiii,+yorgani�ia�ndivida ul): Address: /^ Zip:City/State/ t4x Phone hl: i Are y ua employer?Check the app opr)ata lies: 'type of project(required): 1. I am a employer with� 4. 0 I am a genral contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the subcontractors 2.0 lam a solo proprietor or partner- listed on the attached sheet t 7, ❑Remodeling ship and have no employees These subcontractors have S. ❑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.) officers have exercised their !0.❑Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'cump. c. 152,§1(41,and we have no 12.❑Roof repairs insurance required.)t employees.[No workers' 13.0 Other cump:insurance required.I •Any appikunt char clsmks box API must ahso rill uul the adios below showing their workers'mmpaswlan pelby information, r I f m,suwnms who submit this snidavit indicating they am doing all work and thus himoulsida canrmctors mutt submit a new amdavil tndic ang such. !Conim,aon that ch�vk this has must aoachod an additfuwl sheer showing the time of the su0.Nmrwwrs and their workers'ramp,pulley infortnatian. lain an employer!liar is pruvldittg workers'compensation huuranee for my employees Below/s the pollcy and fob rile loforaratlano < Insurance Company?tamer--C_ AJ e� taolicy 4 or Sclf-ins. Lic. 4: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverago as required under Section 21A of NIGL c. 152 can lead to the imposition ofcriminal penalties of a tine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the farm of STOP WORK ORDER and a tine of up to SM.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of I itvestigutimtt of the DIA for insurance coverage verification. /du hereby certify rurddr a puhu and penalties of perjury that rite hrfurinallon provided above i true airycorrect. 3ata: z / 3 P u 4: Ojjiciul use only. Oa not write in 64 arms,to be conrpleled by city or town aff/clat I city ne'ruwn: _.__ Permitfl.lcema.q ___ Issuing Aut Kurily(cirelo one): 1. hoard of IIeanh 2. 13uild(nq Depurtnteat 3.Cityi raw Clerk I. Etectrlcal Inspector 5. Plumbing Inspector i 6.0ther I Cunlacl Person: I'hnna 4: i 2— �S - `� c Aga s $ �o°= The Commonwealth of Massachusetts �I) / Department of Public Safety / Massachusetts Slate Building Code(780 CMR) Building Permit Application for any Building other than aOne-or Two Family w ling (This Section For Official Use Only) Building Permit Nmnber: Date Applied: Building Official: SECTION 1: CATIO (Please Ind' to Iock#and Lot#for locations for which a street address is not available) eve a NJ and Street City/Town Zip Code - Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of NIA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Dcnwlition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: r\re building plans and/or construction docuusnts being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here ifan Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 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 a licable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ If: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-.4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Ndercantile❑ R. Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-I ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as a -licable) IA ❑ 111 ❑ IIA ❑ IIB ❑ IIIA ❑ Ilia IV VA VB ❑ SECTION 7:SITE INFORNIATION(refer to 780 CNIR 111.0 for details on each item) Water Suppl Flood Zone Information: Sewage Disposal: Trench Permit. Debris Removal: Public Check if outside Flood Zone❑ Indicate numicipa A trench will not be Licensed Dispu al Site, Private❑ ,.or indentify Lune: or on site system❑ required ❑or Trench or specify: r permit is enclosed Railroad right-of-way; Hazards to Air Navigation: \I,\I I t n i',niuni 4i n I cfin� I r r,.a; Nut Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION&CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code Use Gruup(s): Type of Construction: Occupant Load per Floor:. Docs the building contain an Sprinkler System?: Special Stipulations:_ f i SECTION 9: PROPERTY OWNER AUTHORIZATION Nn and r\ddress of P operty Owner Na me( rint) No.and Street City/Town Zip Pr u r Owner C ntact Information' < Title elephone No.(business) Telephone No. (cell) e-mail address If applicable,�\+e-p.roop�erty owner hereby authorizes Name �— Street Address City/Town State Zip to act on the property owners behalf, in all matters relative to work authorized by this building ermit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buit ling is less than 35,000 nu,ft.of enclosed s ace and or not under Construction Control then check here O and skip Section 10a 10.1 Re f'tered Professional Responsible for Construction Control �,r / wAcd Name t o e-mail address -/ Registrltio er t ow❑ — _ State - ciplfne Espiratiun Date 0 kill. z 10.2 enera( on fracta Company Name Name of Person R•sponsible for Coo truction License No. and Type if Applicable �}} Diu 30 /6, >/ c t Address City/Tout u A 4 Sta Zip Telephone Nu. business Telephone No, cell e-mail address SECTION 11:10'OI:RICILS'CUNU-1-VS;\fION INStJ I::\VCE:\PPII tAVI'I' M.G.L.c.152. 25C6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents Hurst 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❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor p0 Item 6 and Materials) Total Construction Cost(from Rent )=$ ­7 i. Building $ -5 Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=S 3. Plumbing $ contact municipality) Note: Minimum fee=S ( P� Y) L Mechanical (FIVAC) $ S. Mechanical Other S Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECT 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is t ue. ud accurate to the best of my knowledge aml understanding. Please print and sign nante �_ 'Fill¢ Telephone No. Dote Street Address c City/Tj)kv Stole Zip \lunicipal Inspector to fill out this section upon application approval: / Name Date t �! CITY OF Sit zmE NLxSS.ICHL'SETTS BT.ILOLNG DEPARTMENT 120 WASFILIiGTON STREET,3n°FLOOR �.x T EL (978) 745-9595 F.tux(978)740 9846 !Q\IDFRt EY DRISCOII THOStASST.PIERRB .MAYOR DIRECTOR OF Pl:OLIC PRO PERTY/BI:IIDLNG CON L\I(SS ION'EA Workers' Compensation Insurance AtTidavit: Builders/Contractors/Electricians/Plumbers Ap olicant Information Please Print Ler_ibiv �Ia1nC(Uusiiasy 9Ur�aaniratiantlndividual): "'/ter � �� ZJ Address: City/Statc/Zip: PhoneM: / 7F- Ar!,YIPdan employer'!Check the ap ropriate box: Type of project(required): 1.4j,amacmployerwith 4• ❑ I am a general contractor and t 6. ❑Now construction employees(full and/or part-time)P have hired the sub-contractan L❑ lain a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub•contmctors have V. ❑Demolition workingfor me in an capacity. workers'camp.insurance. 9.y p ry• ❑DuiIding addition [No workers'comp.insurance S.'❑ We are a corporation and its royuircdJ officers have exercised their ME]Electrical repairs or additions 3.❑ l am a homeowner doing ail work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers' 13.0 Other comp:insurance requircd.j. •Anyapplicurd thatchecksbox/l mustalsofill out the sucliue belowshowing their"it=,compensuian poiiry ini nnaeon 'I htmnuwft"who submit this affidavit indicating they am doing sll work and thm We outside contmctora mass sohmll a new affidavit indicting such. :Cammmurs that check this box must aachod an additional shet showing the name of the subs nlraetom and their workers'romp.policy inrermaaon. fain an employer that h providing workers'c onepensadon lnsuraneejor my employees Below far dte polfcy and Job safe Insurance Company Nmne: ��f/�"//✓/� /Ej— Policy 4 or Se1F•im.Lic. 0: Expirutien Date: Job Site Address: City/State/Zip. ,Utach 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 NIGL c. 152 can lead to the imposition of criminal penalties of a tine up to SI,500.00 amUor one-year imprisonment,as well as civil penalties in the fors of a STOP WORK ORDER and aline of up to 525o.00 a day against the violator. Ile advised that a copy of thisstatcment may be forwordcd to the Ofticts of InvestigutiuttsofilioDIA Air insuran Jcovcragevcriticaliun Ida irereby certify fordo'die puG uJ penaliea ojperfary that the it forrnatlorr provided abov it 1r surd c•orree4 atJ' 1i /3 / E 9 7d"- 3- �4 PhonOJJicial use wdy. Do not wtire in Mir arre,to be completed by city or rows afliel"t City nr'1'otvn: __._ Pcrmit/f.Iccnse.Y _ ____ Issuing,whorily(circle one): 1. uoard of lleallh t. BuildingDepartment ICity/Town Clerk 1. Electrical Inspectur i. Plumbing Inspector l 6.Other i Gtnlact Person: Phone Ih ' 1 i CITY OF S.kLEtiI, 1%Lkss.kCHUSETTS • BuiLDL\G DEPAR"i.m&NT • 120 WASHINGTON STREET, 3" FLOOR \ a� TEL (978) 745-9595 FAX(978) 740-9846 KIN(BERLHY DRISCOLL THORtAS SY.PtERR& MAYOR DIRECTOR OF PUBLIC PROPERTY/BL'ILDCvG COJL�tISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in (name�-v-=of facilit ) address of facility) i signature permit applicant date Jcbnsa i,.d,x gONO T �� s1 Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving 21 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: McIntire Address of Property: 97 Federal Street Name of Record Owner:rapozzi, Quirk, and McIntire Description of Work Proposed: Rebuilt the existing rear balconies. The balconies are not visible from Federal Street. Non-applicability due to lack of visibility from the public way. Dated: September 12, 2013 SALEM HISTORICAL COMMISSION 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. The Commonwealth of f SBVLU IMCES ® Department of Public Safety Massachusetts State Building MeC JR)� 1 Building Permit Application for any Building oth a P amily Dwelling (This Section For Official Use Only) -Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 92 Federal Street Salem-MA 01970 N/A No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑ or check all that apply in the two rows below Existing Building❑ Repair®: Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: Transition Walls Roof/Siding Repair around dorma. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 1 )00sgft Total Area(sq.ft.)and Total Height(ft.) E00S ft 32 ft SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business-❑ -� ucational ❑ F: Factor F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2® R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑ and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply:1 Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public® Check if outside Flood Zone El Indicate municipal® A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required ❑ or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: TNIA F-Gstnt'iC ConnnissionReview Prcxess:Not Applicable® Is Structure within airport approach areaIs their review completed? or Consent to Build enclosed❑ Yes ❑ or No ❑ Yes ❑ No Ed SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: Mf>I (<G-0 `m N- M -T - 3[l5 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Steven A.Sass Sr�U� 16 Ida Road Marblehead-MA 01945 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Home Owner 781-608-1951 781-608-1951 steven.sassl@gmail.com Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes 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. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor National Management Team,Inc. Company Name George Vasiliades Unrestricted CSL- 090IgZ Name of Person Responsible for Construction License No. and Type if Applicable 388 Essex Street Salem MA 01970 Street Address City/Town State Zip 617-943-8686 617-943-8686 Thiago@n tionaconstructionl.com Telephone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C 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❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)=$3,000.00 1.Building $3,000.00 Building Permit Fee=Total Construction Cost$3000x0.011 2.Electrical $ (Insert here appropriate municipal factor)=$33.00 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$N/A(contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $3,000.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT 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 and ac4 ate o the best of my knowledge and understanding. GeorgeVasiliades�,,, Construction Supervisor 617-943-8686 02/11/2016 Please print and5ign name Title Telephone No. Date 5 Pitcairn Way Ipswich MA 01938 Street Address City/Town State Zip - / Municipal Inspector to fill out this section upon application approval: ""A -�' "G¢L.-+) `I � Name Date fA- Historical Commission SC/ WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 , (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereb,�� mom Historical Commission has determined that the proposed: ❑ Cck0a, Gla��b`µ ❑ Moving ❑ 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: McIntire District Address of Property: 92 Federal Street Name of Record Owner: Steve Sass Description of Work Proposed: Repair roof(strip existing asphalt shingle at transition walls) and install new flashing and GAF 3-tab Marquis WeatherMax asphalt shingle in Charcoal gray. Dated: March 7, 2016 SALEM HISTORICAL COMMISSION 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. Once completed,please submit a photograph(s) of the final result (maximum offour- i.e. one photograph of each affected fafade). 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.