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135 FEDERAL STREET - BUILDING JACKET 135 FEDERAL STREET Chit of vitmlem. Aussar4usetts Public Propertg Mepartment Nuilbing Bepartment (One t3alcm Qirccn 500-745-9595 Fxt. 390 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer October 25 , 1996 Robert LeDoux City Solicitor Salem, Mass . 01970 RE : 135 Federal Street Dear Mr. LeDoux: I am asking that you might render a decision concerning the above mentioned property. I have been asked if said property could be expanded from a single ( 1 ) family dwelling to a two ( 2 ) family dwelling. The property is located in an R-2 district has all the required density regulations except for one (minimum depth of front yard) . It is my belief that the owner would require a Variance from minimum depth of front yard in order to expand the use from a single ( 1 ) family to a two ( 2 ) family dwelling. I would appreciate your legal opinion on whether I am interpreting the non-conforming structure correctly or incorrectly. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Zoning Enforcement Officer LET: scm CHC of *ttlem, 'Tttssadjusetts 3 9 Pattra of DECISION -ON THE PETITION OF RICHARD & VICTORIA STEVENS REQUESTING A SPECIAL PERMIT FOR THE PROPERTY LOCATED AT 135 FEDERAL STREET (R-2) A hearing on this petition was held November 13,1996 with the following Board Members present: Gary Barrett, Chairman, Nina Cohen, Albert Hill,Richard Dionne and Paul Valaskatgi. Notice of the hearing was sent to abutters and others and notices of the hearing were properly published in the Salem Evening News in accordance with Massachusetts General Laws Chapter 40A. Petitioner is requesting a Special Permit to change a single family dwelling to a two family from minimum depth of front yard for the property located at 135 Federal Street, Salem. The provision of the Salem Zoning Ordinance which is applicable to this request for a Special Permit is Section 5-3(j ) , which provides as follows: Notwithstanding anything to the contrary appearing in this Ordinance, the Board of Appeal may, in accordance with the procedure and conditions set forth in Sections 8-6 and 9-4, grant Special Permits for alterations and reconstruction of nonconforming structures, and for changes, enlargement, extension or expansion of nonconforming lots, land, structures, and uses, provided, however, that such change, extension, enlargement or expansion shall not be substantially more detrimental than the existing nonconforming use to the neighborhood. In more general terms, this Board is, when reviewing Special Permit requests, guided by the rule that a Special Permit request may be granted upon a finding by the Board that the grant of the Special Permit will promote the public health, safety, convenience and welfare of the City's inhabitants. The Board of Appeal, after careful consideration of the evidence presented at the hearing and after viewing the plans, makes the following finding of fact: 1. The petitioner was represented by Attorney Jeffrey Stelman. 2. Councillor Regina Flynn of Ward 2 spoke in favor of the petition. 3. A petition was submitted with 11 signatures in favor of the petition. 4. Steven M. Glovsky, 131 Federal Street appeared and spoke in favor. _v t f� DECISION OF THE PETITION OF RICHARD AND VICTORIA STEVENS REQUESTING A SPECIAL PERMIT FOR THE PROPERTY LOCATED AT 135 FEDERAL STREET (R-2) page two 5. There was no opposition to this petition. On the basis of the above findings of fact, and on the evidence presented, the Board of Appeal concludes as follows: 1. The Special Permit requested can be granted without substantial -- - - detrimenf fo the-public or without nullifying substantiaYly -- derogating from the intent of the district or the purpose of the ordinance. 2. The granting of the Special Permit requested will promote the public health, safety, convenience and welfare of the City's inhabitants and may be granted in harmony with the neighborhood. Therefore, the Zoning Board of Appeal voted unanimously, 5-0 to grant the Special Permit requested, subject to the following conditions: 1. All construction shall comply with all city and state statutes, ordinances, codes and regulations. 2. All requirements of the Salem Fire Department relative to smoke and fire safety shall be strictly adhered to. 3. All construction shall be done as per the plans submitted and approved by the Building Inspector. 4. A building permit is to be obtained prior to beginning any construction. 5. A Certificate of Occupancy is to be obtained. 6. Limit parking to two (2) spaces to the second unit. 7. Second unit is to be no larger than approximately 425 square feet on two floors. 8. Petitioner shall obtain proper street numbering form the City of Salem Assessors office and shall display said number so as to be visible form the street. SPECIAL PERMIT GRANTED November 13, 1996 Richard Dionne Member, Board of Appeal W.� Pri Tq ,�•a_ sk+ ,Y�• .{ m.�%..� c" ✓+..+Fs ...' #°-. rpy t K�^^>.�d" ... - ''xY` DECISION OF THE PETITION OF RICHARD & VICTORIA STEVENS REQUESTING A SPECIAL PERMIT FOR THE PROPERTY LOCATED AT 135 FEDERAL STREET page three A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from this decision, if any, shall be made pursuant to Section 17 of MGL Chapter 40A and -shall be filed within 20-days after the date of filing of this decision in the office of the City Clerk. Pursuant to MGL Chapter 40A, Section 11, the Variance or Special Permit granted herein shall not take effect until a copy of the decision, bearing the certification of the City Clerk that 20 days have elapsed and no appeal has been filed, or that, if such appeal has been filed, that it has been dismissed or denied is recorded in the South Essex Registry or Deeds and indexed under the name of the owner of record or is recorded and noted on the owner's Certificate of Title. Board of Appeal 'w AI CITY OF SALEM - MASSACHUSETTS ROBERTA. LEDOUX Legal Department JOHN D. KEENAN City Solicitor 93 Washington Street Assistant City Solicitor 508-741-2111 Salem, Massachusetts 01970 506-745-7710 October 31, 1996 Mr. Leo Tremblay Zoning Enforcement One Salem Green Salem, Massachusetts 01970 RE: 135 Federal Street Dear Mr. Tremblay: You asked for an opinion in connection with 135 Federal Street and whether or not this could be expanded from a one to a two family dwelling. The building is located in a R2 zone. My opinion follows. There is no question that the property retains its non-conforming status by reason of inadequate front yard. As I understand the proposal that is being made, there will be no exterior changes made to the building and, in fact, the building will remain as it is at this time. The issue that has arisen deals with whether the house, which is currently a one family, can be converted into a two family with or without the need of zoning relief. Inasmuch as the use is being changed from a single to a two family use, which is an allowed use within the zone, the only question that arises is whether or not it would be necessary to seek some form of zoning relief to effectuate this change. The two cases that appear to be controlling on this matter are: Goldhirsch vs McNear 32 Mass APP. Court cd 455, 590 NE 2nd 709 (1992) and Rockwood vs Snow in Corp. 409 Mass 361, 566 NE 2nd 610 (1991). These cases stand for the proposition that a pre-existing, non-conforming use of structure may be extended or altered provided that the permit granting authority, designated by the municipal zoning laws, finds the change, extension or alteration is not substantially more detrimental to the Mr. Leo Tremblay Page Two October 31, 1996 neighborhood than the existing non-conforming use. This is a limited standard of review and in effect there is a two-pronged analysis by the Board of Appeals. The first prong would be whether or not the non-conformity existing at the structure will be enlarged. In this instance I think the answer to question number 1 is "No" and the Board would then be in a position to answer a finding. The second prong would be whether it is more detrimental to the neighborhood than the existing non-conforming use. This prong would only be reached if the answer to the first question " No." I would be happy to speak with you in connection with the same. Very truly yours, 17ROBERT A. LEDOUX City Solicitor cc: Deborah Burkinshaw RAL/leh Ctu of #slrm, Massar4usrtts 0*'kww�wail Public Propertq i9epartment Nuilding Department (ane Onlem Qireen 500.745-9595 Ext. 388 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer October 25 , 1996 Robert LeDoux City Solicitor Salem, Mass . 01970 RE : 135 Federal Street Dear Mr. LeDoux: I am asking that you might render a decision concerning the above mentioned property. I have been asked if said property could be expanded from a single ( 1 ) family dwelling to a two ( 2 ) family dwelling. The property is located in an R-2 district has all the required density regulations except for one (minimum depth of front yard) . It is my belief that the owner would require a Variance from minimum depth of front yard in order to expand the use from a single ( 1 ) family to a two ( 2 ) family dwelling. I would appreciate your legal opinion on whether I am interpreting the non-conforming structure correctly or incorrectly. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Zoning Enforcement Officer LET: scm Y f r V 1\ CITY OF SALEM - MASSACHUSETTS ROBERTA. LEDOUX Legal Department JOHN D. KEENAN City Solicitor 93 Washington Street Assistant City Solicitor 508-741-2111 Salem, Massachusetts 01970 508-745-7710 October 31, 1996 Mr. Leo Tremblay Zoning Enforcement One Salem Green Salem, Massachusetts 01970 RE: 135 Federal Street Dear Mr. Tremblay: You asked for an opinion in connection with 135 Federal Street and whether or not this could be expanded from a one to a two family dwelling. The building is located in a R2 zone. My opinion follows. There is no question that the property retains its non-conforming status by reason of inadequate front yard. As I understand the proposal that is being made, there will be no exterior changes made to the building and, in fact, the building will remain as it is at this time. The issue that has arisen deals with whether the house, which is currently a one family, can be converted into a two family with or without the need of zoning relief. Inasmuch as the use is being changed from a single to a two family use, which is an allowed use within the zone, the only question that arises is whether or not it would be necessary to seek some form of zoning relief to effectuate this change. The two cases that appear to be controlling on this matter are: Goldhirsch vs McNear 32 Mass APP. Court cd 455,590 NE 2nd 709 (1992) and Rockwood vs Snow in Coro. 409 Mass 361, 566 NE 2nd 610 (1991). These cases stand for the proposition that a pre-existing, non-conforming use of structure may be extended or altered provided that the permit granting authority, designated by the municipal zoning laws, finds the change, extension or alteration is not substantially more detrimental to the Mr. Leo Tremblay Page Two October 31, 1996 neighborhood than the existing non-conforming use. This is a limited standard of review and in effect there is a two-pronged analysis by the Board of Appeals. The first prong would be whether or not the non-conformity existing at the structure will be enlarged. In this instance I think the answer to question number 1 is "No" and the Board would then be in a position to answer a finding. The second prong would be whether it is more detrimental to the neighborhood than the existing non-conforming use. This prong would only be reached if the answer to the first question " No." I would be happy to speak with you in connection with the same. Very truly yours, ROBERT A. LEDOUX — City Solicitor cc: Deborah Burkinshaw RAL/leh � 0 CITY OF SALEM - MASSACHUSETTS ROBERTA. LEDOUX Legal Department JOHN D. KEENAN City Solicitor 93 Washington Street Assistant City Solicitor 508-741-2111 Salem, Massachusetts 01970 508-745-7710 October 31, 1996 Mr. Leo Tremblay Zoning Enforcement One Salem Green Salem, Massachusetts 01970 RE: 135 Federal Street Dear Mr. Tremblay: You asked for an opinion in connection with 135 Federal Street and whether or not this could be expanded from a one to a two family dwelling. The building is located in a R2 zone. My opinion follows. There is no question that the property retains its non-conforming status by reason of inadequate front yard. As I understand the proposal that is being made, there will be no exterior changes made to the building and, in fact, the building will remain as it is at this time. The issue that has arisen deals with whether the house, which is currently a one family, can be converted into a two family with or without the need of zoning relief. Inasmuch as the use is being changed from a single to a two family use, which is an allowed use within the zone, the only question that arises is whether or not it would be necessary to seek some form of zoning relief to effectuate this change. The two cases that appear to be controlling on this matter are: Goldhirsch vs McNear 32 Mass APP. Court cd 455, 590 NE 2nd 709 (1992) and Rockwood vs Snow in Corp. 409 Mass 361, 566 NE 2nd 610 (1991). These cases stand for the proposition that a pre-existing, non-conforming use of structure may be extended or altered provided that the permit granting authority, designated by the municipal zoning laws, funds the change, extension or alteration is not substantially more detrimental to the Mr. Leo Tremblay Page Two October 31, 1996 neighborhood than the existing non-conforming use. This is a limited standard of review and in effect there is a two-pronged analysis by the Board of Appeals. The first prong would be whether or not the non-conformity existing at the structure will be enlarged. In this instance I think the answer to question number I is "No" and the Board would then be in a position to answer a finding. The second prong would be whether it is more detrimental to the neighborhood than the existing non-conforming use. This prong would only be reached if the answer to the first question " No." I would be happy to speak with you in connection with the same. Verytrulyyours, \\ ROBERT A. LEDOUX City Solicitor cc: Deborah Burkinshaw RAL/leh The Commonwealth of Massachusetts 1 Board of Building Regulations and Standards CITY (V Massachusetts State Building Code, 780 CMR,7`h edition OF SALEM Revised January Building Permit Application To Constmct, epair,Renovate Or Demolish a I, 2008 One-or Two-Fam'y Dwelling This Sectio4or Official Use Only Building Permit Nu ber: Date Applied: wtqU Signature: Building ominmioned Ins r of Buildings Date SECTION 1:SITE INFORMATION 1.1 Properly Add 1.2 Assessors Map&Parcel Numbers I.la Is this an accepted street?yeses/no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 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 E� Private❑ Check if yes❑ Municipal E1`15n site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' /N -r7 print) •J'(yl Address for Service: Si ure Telephone SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) - New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ErfAddition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units Other ❑ Specify: BriefDescription of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3:Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.total Project Cost: $ yG ❑Paid in Full ❑Outstanding Balance Due: ob � �� lex� - SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) fn J/- h7 )YI'rc -4 License Number Expiration Date Name of CSL-Holder List CSL Type(see below) Addre� T Description �� rZ, U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential 1�wfing Covering Telephone WS Residential Window and Siding V2 SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Rfe,stered Home Impro meat on for(HIC) / MC Company Name or HIC Registrant Name Registration Number Address yJ9 /d Expiration ate Signs vee — Telephone SECTION 6:WORKERS'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 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 1, f�t t,�Y� [� ,—QH y�cS 1�-- as Owner of the subject property hereby authorize (j v�t✓< ys to act on my behalf,in all matters relatty ork authorized by this building permit application. �+ ( ' Si of Owner Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION I, I 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 pains and penalties of NOTES: 1. 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 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 I10.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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" ACORD09/23/2010010 � CERTIFICATE OF LIABILITY INSURANCE 9/2M/ ) PRODUCER (976) 922_6600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sterling Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 306 Cabot Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 493 Beverly, MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Commerce Insurance Co. COM Universal Builders INSURERS' Steve Murray 6 Peter Prioux DB INSURER C: P.O. BOX 719 INSURERD: ,BeverlyMA 01915— INSURER E. COVERAGES . THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSIRD TYPE OF INSURANCE POLICYNUMBER DATE(MM/DD/YY) DATE(MM/DDNY) LIMITS A GENERAL LIABILITY WP4862 01/19/2010 01/19/2011 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RED 100,000 PREMISES Ea occunanw $ CLAIMS MADE �X OCCUR / / / / MED EXP(Any oneperson) $ 5,000 PERSONAL S ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 POLICYE JEC LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS - (Per person) $ HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Par accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ (1 Is WORKERS COMPENSATION AND / - / / / TORV LIAMITS OT EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1$ OFFICER/MEMBER EXCLUDED? - E.L.DISEASE-FA EMPLOYEEI S If yes,describe under SPECIAL PROVISIONS W. E.L.DISEASE.POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION — FAX ) — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO D L IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Dikson Residence INSU R, S REP T S. 135 Federal St. R DF. v Salem MA 01970- ACORD 25(2001/08) ©ACORD CORPORATION 1988 �TM-INS025(moe).D5 ELECTRONIC LASER FORMS,INC.-(800)3 0545 Page 1 of 2 ACO-RD,N' CERTIFICATE OF LIABILITY INSURANCE 09/23/2o 0 PRODUCER 978.927,2600 FAX 978.927.8938 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leslie S. Ray Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 129 Dodge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beverly, MA 01915 INSURERS AFFORDING COVERAGE NAIC# INSURED Steve Murray INSURERA: Granite State DBA: U. Builders INSURERS 10 Hood Farm Road INSURER C: Ipswich, MA 01938 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ALDD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPDATE IMMIQ NY' DATE WIRATDlyION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LABILITY DAMAGE TO RENTED $ CLAIMS MADE ElOCCUR MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JEC LOC AUTOMOBILE LABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY'. AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCOOS-09-1830 10/15/2009 10/15/2010 WC STATu- OTH- EMPLOYERS'UABIUTY E.L.EACHACCIDENT $ 100,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EW.PLOYEEj $ 100,00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Dickson residence BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LABILITY 135 Federal Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Salem, MA 01970 AUTHORIZED REPRESENTATIVE Richard Jones/DONNA ACORD 25(2001108) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108) CITY OF SALEM PUBLIC PROPRERTY DEPA RTMENT ARTMENT =•.,� I'y:)klRaa 1. U"are 12C WA I ON 513ELT • 5,s u(s1, M.%vSA(.1 It it I Is 0197-, fI:1.:WS-715-9595 a 1'.tx. 978-74C-9846 It'vbrkers' Compensation Insurance Afriduvit: Builders/Contractors/Electricians/Plumbers %policant Information jhly t� Please Print Let �lnlTv lOuuiwsyl�r;tani,atinNlndivutuutl:f't-tNY-H GI%•OG,/ t3m,- yl� Address: GvtGt r7r Sr City'Statci7.ip: 8r!/r,`5V P" Phone N: 97t-49Si^/ Are seen an employer! Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and 1 1.El 1 ;un a employer with h. El New construction employees(full and/ur part-time).• have hired the sub-contractors 02" .❑ 1 am a sole proprietor or partner. listed on the attached sheet. �• L6 �emodeline , ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. ,`workers' comp. insurance. 9. Q Building addition l No workers'comp. insurance 5. E We are a corporation and its 10.Q Electrical repairs or additions required.) officers have exercised their . . 3.ElI am a homeowner doing all work right of exemption per hIGL 11.0 Plumbing repairs or additions myself. (No workers'comp, C. 152, j 1(4),and we have no 12.❑ Roof repairs insurance required.) t employees. (No workers' 13.0 Other comp. insurance required. -.way:ytphc oa that chucks box hl must also lilt out the scctimt Wow showing their w•orkias'cumpentatiws policy inhurtulioa ' I loma,wmrs who udsmil this anldavil indicating they are doing all work gut then his outside caturmiors must.uhnnit a new amdavie indicating ouch. -C'ontrwtun that check this box mtnm mwhW in additional..shcal showing the nmr.o of the subcontractors and their wurkon'comp.rmiicy information. l am ua euydoyer that Is providfalf workers'c ompenwifinn insurance jeer eery eurployeLm Belory is the pulfay and job site hil/artaution. Insurance Cumpauy V:une: S� .rr/j r-z ��{-ry5 u�-GK.- ._. __.._---.------ Policy is or Self-ins. Lic. ti: ____ ... .._ Ewpiranon Date: / 9 62c>ler Job Site Address: l A,f �^tn�L fi 7— _ C'ilyistate/Zip: , Attach at cupy of the workers' cwmpcaration policy declaration page (showing;the policy number and expiration date). Failure to secure coverage as required under Section 25A ul'SIGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or one-year intprisoumcnt, as well as civil penaltics in the form of a STOP WORK ORDER and a fine of up to S250.00 it day against the violator. ilc advised that a copy of this statement may be furwarded to the Office of Invcsugannns ul'Ihe DIA for ioctuarcc covcragu,erilication. /do herc•hy certify under the pains and pens/tics of prrjury that the inforinaNen provided above is Irue and correct. Official use oa/y. Do roar ivrire is this area,to be completed by city or fawn ojJiciul. Cilv or fawn: - Permit/Licensc V.- Issuing, Coal .Wthurily (circle one): - I. Board of health 2. Iluilding, Department .1. Citsi Ibwn Clerk 4. Llectrical Inspector 5• Plumbing lnspector G. Other Act l'crsou: __ _. Phone 4: Information and Instructions \I:mssaclmusetts General Laws chapter Ij2 requires a I I employers to provide workers' coinpensat ion for their cinployces. Pursuant to this wattle. an empluree is defiled as"...every person in the service of another under any contract of hire, e,,press or implied" oral or written." An emmployer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more ,,r the t0re6oing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of:um 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, cunstruction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." .%IGL chapter 152, a25C(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. NIGL chapter 152, §25CM 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 cumlpliance 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-contractor(s) namc(s),address(es)and phone number(s) along with their eertiftcate(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 time number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officlais Please he 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. Pizase be sure to till in the pennittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple pernio'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(hat 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 i.e. it dug license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. I he t)I Ille of lnves(igatnons would like to thank you in advance for your cooperation and should you have:my questions, please do not hesitate to give us a call. -The Dcpartincnt's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Ofilce of Investigations 600 Washington Street Boston, MA 02111 Tel. li 617-727-4900 ext 406 or 1-877-MASSAFE Fax N 617-727-7749 www.mass.gov/tile CITY OF SALEM 9i PUBLIC PROPRERTY ' +. .'r DEPARTMENT r'I'%W! MIt.5 •Itlx. '•I I. \I 11 qc 1 to WA.,111M.;ON SI1W:T ♦SAi I'\I, `1AS.iAI.!It it I'iS 'f rl: 978-74 9i9$ ♦ FAX:978J449846 Construction Debris Disposal Affidavit (required fur all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris,.and.(lie provisions.of.MGL c 40,S_54;_.—. Building Permit # . __ 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 l 11, S 150A. The debris will be transported by: 0. 12L Utame of hauler) The debris will be disposed of in (name of faci ity) (address of facility) signature of permit applicant . date dchri:al'I'uue CO T ^J �1 ` 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 ';3< Alteration . ❑ Demolition ■ Painting zzntm� g ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property- 135 Federal Street Name of Record Owner: Brenton and Betsy Dickson Description of Work Proposed: received 814110 with solid lower panels, keeping existing Enclose existing screen porch per Option 1 drawings ecez p p g g porch dimensions and existing exterior trim and columns. Windows to be Pella Architect Series wood windows with 718" muntins (bronze spacers if available). All to be painted white to match existing. Install 2 copper skylights per drawings set 4 %' back on the porch roof Existing porch handrail to be relocated to edge of existing deck Dated: August 5, 2010 SALEM HIS RICAL COMMISSION By: � The homeowner has the option not to commence the work (unless it relates to resolving an outs tandi 2g 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. p a w• F ft. tvPD$Nn oft 01"Y op- gLEM (F'uBLlC LISF2AR'Y � m q o`er ti p F 0 n7 ;.�y+� FGJ� 37p Sc�.FT. h LAND oP d ai4%+kit h {CIKP IS VVHEA-ri-AND . • fe Ler. d !'t+�� ' Oa ` +-�,'.-`• ✓ToE= /OP. oo CIO D Z A Z s Ho4,$le� RR+ry6ro�v .,• ...:-;sue NED o 0 VJ m >S BCDEGHB= a � � eSAM - 3 '7'�Q SQ. ft• � � I LAND p F n W IN) a E'X►RY �C ` �. IJOO SGL.Fr � vJ n O in ABHI= 6457 sq. ft � /%�. _ Po/Icy � � WALcoT-1- a � 0 V _.__. rtxcsr�Ny p. v � v k h� xrceOf 4 4f € $ Z ti 0 U�2 r : Y 9 House PIo.131 �o fl QQ \� A A - 62,1E — - - F�Erec� T— 'p -re c m 170.70 ___' y-4 .V N FE�ER.yL.. STREET � � a o • rd -I-, ) -L4r�� en _ On_ LAND of MRS . JENN1ECd M, MtitERTcsit A..� ., 0 �t� ,��CT•+`.� a �CA L_E � I IvC H �' 4-t? FT. U Q� o J: -IJ . 4010 i Q •ro _-� Al I �d AN �,, ell Ix I x/ im � I i / 1 N /00 / I I / i i P � H PLAf4 Revisions : Dickson Residence 135 Federal Street Salem,MA Q G f t a q 4 < •InrtierioreDes a gn Scale:. � 2t � —O File Nme, . 1v Siemasko + Verbridge •U dacape Atchilecwrc Date:. 8 31 f0 1 Plot Date:. .Decorating �7 126 Uodge St. Beverly,MA 01915 svdesi n.com t 978.927.3745 f 978.927.6365 Dmwn b y 9 PRoPoSeb tofPeje- "TO B1 c Sr-Y"44f'( BY 14W EWj"APP 5r-YLtgbt7 - N r_ 0 .Nn ee§ ikl6Tlhly 6HAU-ow PITGH P�wF 'Tuft! Ta kW-tA) / Q F m F z a ds LauSTfNy WOOD ec"I- NS To R61 CAIOL4 i a / "O J PAINTED pT k-r STOCK 7RJhT 4 O HOW W6Torl Pe-".A AAXHI7t,:6r 13 _N W \ e CA6ot?CNY ji/NpoGj3 � 7YP.� •n = 3 6fl-fv%-IE7ab bfvlbEb ucflwml 41o0bxTERloR � -_ / tZ�-+OCHE-C� �Jc15Tfa•!cr �R-�J-1 �? �$X�p a LE _ _:`-- -IfEG7\ 7+TooD Rd.1L ! GvbTof•T $ H 5ot_T7�[✓aOD P,brl-EELS W I � \ V 1 f How TMJM IA-"lcr-, "to mA-rai N r E�cl6TlN�� ALf4Et W/til&A) W/NbOWS C�A N A v1 N SLwJv• — Jrc. aq ..♦q.�d:5 8N /V1 V 6 CD H. ` ►��' �7J1Jk7 yMl- rrfH O N o a. U /n a h,; Or �11 '1� ZfO !-k^-70i .J.. a" a a 1 +rA1-+dal 01, 911var cl..*bn! TJ Li N G J � R � wPr Q� e - 3 a � a y wV � 1 l9�NrJS �'�FLJ'Yi_ K1/c i/J?�d l.J oLsnJ �H N o ` d 5►�'3�1/r-low laoor, 3�,�s,� r ro o � Z � _ h'�azl oL tnohardd sJ�us+� o Hprl, r of wm d�d H'71Jd NJ vrW4$, 3Hllgi.V V. I allbl��1S oJ�o1.9J{/ � -a-Ode eV a4*vd r44 I r' r u�J �itSTI!-0 r9 W/NpOCJ NW 51�41ypW 1'iTGM gvfsft,r- C10of 'EIE NPuj Tp ij To l-M•'1�t1 LJL- LI eft aeral�s rGxis=/N S Exan zt :111E -IFIF i NSW R4/NZ,� Woo,t� [ot-uMN To 1' "TraH jclStlll� �k7 spa porzc fl N /RoH /1�1`R[JpRlL To M"T Cook - f4."F+Fk- Ta D 9;);ArII. 6"Oe $X/8T/H5 /+1aOb STaMK. To plg-: !/-1 J/ I —4* I �N 1 : Dickson Residence 135 Federal Slreel,Salem,MA SI1--Yr-- t44TF-y Revisions Y P'wipm nua '•Archimcmrc Scale:.V7-�.I : File Name: . 61 tntefiM�eY1g11 Siemasko + Verbridge •; .ca.Areaitee,are Date:. Plot Date:, �S 126 Dade St. Beverly,MA 01915 svdeaign,com t 978.927.3745 f 976.927.6365 DmWn b A s� r - - _ QI e�l O LP 5" 411 o.c. .0 Al 71 F7 iu+r�Wcr rb�.�.rrrs � , �y i• tvu. suti� �rF�T�-yT�(LS Revisions Dickson Residence 135 Federal Street,Salem,MA s ^ .Ase"itectare •Interior Design Scale:. �./ JWJ2 File Name: . Siemasko + Verbridge .laadacape Areh tee'we Date:. s r co Plot Date:. .Decoracng d 126 Dodge St. Beverly,MA 01915 evdcsign.com t 978.927.3745 f 978.927.6365 Drawn b 1 q;`f2 ct � 333 The Commonwealth of Massachusetts NSPECTf NAl 1 RV� OF Board of Building Regulations and Standar SALEM VA Massachusetts State Building Cade, 780 CNIR 4t''', ppppyy 4t.04.�dr 2011 Building Permit Application To Construct, Repair, Renovate(0E1e115B(isP a3 One-or Tivo-Family Dwelling This Section For Official Use Only Building Permit Number: DateApplied:I I ' { {. i Building ORicial(Print Narne). Signature Date SECTION t:SITE INFORNIATIOW 1.1 Property Address: 1.1 Assessors 611p& Parcel Numbers I.la 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) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(hl.G.l.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: — Outside Flood Zone? Municipal O On site disposal system ❑ Check if yesO SECTION: PROPERTY OWNERSHIP, 2.1 Ot nerl of Record: d l �1me(Prin City,State,ZIP 47g-? -u No and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Pr t Ppoked Work-: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building $ F.gtj,r— I. Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S P Other Fees: S t. Mechanical (NVAC) S List: 5.Mechanical (Fire S "Coral All Fees:S i Suppression) Check No._Check Amount: Cash Amount:_ 6. Total Project Cost: S - p ❑Paid in Full ❑Outstanding Balance Due: LO O K I IJ CG F'prL J E1C.GfAL f7TP91TI N C T'0"O R-�-oL� TL-`✓S 1 G - 1911 $' 3 ( 70- 2-11 (0 C,f�'�f:-o Lt)Izo 514 C. Lrr- 1 O ST r-1 L, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor Li ease(CSL) s•-OAT'� �5 �rr l W& ""pD License Number E.epiratio Uate 7 St° 5 " e)ae.A•P���1i� S Name of CSL holder List CSL'rype(see below) lip rylle Description No. and Street s U Unrestricted [iuildin s up to 35,000 cu. It.) (�I �y/yl?Z, W,&ti 019 n Restricted )&2Fnmil Dwelling City/Town,State, hl Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel[fuming Appliances b — — Insulation Tee hone Email address D Demolition 5.2 Regis red If me Ira rovement Contract ( C) e ei HIC Registration Number E. rati n Date Mc cull :my Name IIIC gtstranl Name A P d � I ass l e' N99.•.yid Str t Email address City/Town,State ZIP Tele hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.C.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 IsAuance of the building permit. Signed Affidavit Attached? Yes ..........❑ No....... ..'d SECTION 7a:OWNER AUTHORIZAT N,T D}VHEN. ' OWN EWS AGENT Olt CONTRACTO . APPL S FOR BUILDIN 0ERDIIT' I,as Owner of the subject property,hereby authorize t9 aac�cctJt on my behalf,inn all matters relative to work authorize b t ' ing p I application. d PL 11 r sw. Pr1n Dwne 's Namn(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 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 accurate to the best of my knowledge and understanding. -mow bf��sft , Print Dwncr 'or Authorized Agent's Name(Electronic Signature) ate NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who(tires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program),will nut have access to the arbitration program or guaranty fund under I.G.L.c. 1 d2A.Other important information on the HIC Program can be found at www.mass.auvow Information on the Construction Supervisor License can be found at ivivw.ma,s.aov!das . 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. it.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/batlis Type of heating system Number of decks/porches Type orcooling system Enclosed Open_ 1, "total Project Square Footage"may be substituted for"Fut.d Project Cost" 301 - I 2qq ( Zq3 The Commonwealth of Massachusetts } Board of Building Regulations and Standards CITY OF dl !: Massachusetts State Building Code,730 CR SALEM M ReviseJ.tlar 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: D p ' d: Building Oft iul(Print Na - Da e SECTION 1:SITE INFORMATION 1.1 P Irr�ertysl dress _ { 1.2 Assessors Niap 3r Parcel Numbers 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Tuning District Proposed Use Lot Area(sq It) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Y;ud Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP'' vnerl of a ord: �hit (Print) City,State,ZIP 979- 04- 6 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building' Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description o Prgpos dtWork': \ S G �v SECTION a: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labur and Nlaterials I. Building S i pQ0,— I. Building Permit Fee:S Indicate how fee is determined: �. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x J. Plumbing S 2. Other Fees: S 4. Mechanical (FIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No._Check Amount: Cash Amount: 6. Total Project Cost: S C� I bo2t� 0 Paid in Full 0 Outstanding Balance Due: l SECTION 5: CONSTRUCTION SERVICES 5.1 nst�tion S rcrvisgr Lkccuse(CSL) License Number Expir tion ate Name of CSL Holder �� List CSL Type(see below) No.and Scree "fy 8 Description - [s IQ�� U Unrestricted(Buildings u to 35,000 cu. 11.) ��Q..t (lL ) Restricted 1&2 Family Dwelling Citylrown,State,ZIP bl Masonry RC Rooting Covering WS Window and Siding Solid Fuel Burning Appliances I IInsulation Telephone Email address D Demolition 5.2 Register d Hne Improvement Contra r C EC� /SU' HIC Registration Numberxpiratont e HIC Cum my Name or I C Re -strunt Name \PSS 1 � 16 L JQ� No.and Stre t Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'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 Is§uance 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 W/� b Te"Se V t ct on my behalf,in all matters relay, o work authorized by this buildi g permit application. Print Owner's Name(Electronic Signatur - ate S N 7b:OWNERI OR AUTHORIZED AGENT DECLARATION By entering in 1me belot , I hereby attest under the pains and penalties of perjury that all of the information contained in Iris applicat n is true and accurate to the best of my knowledge and understanding. Print 0sy 6er's or r rorize Agee :une(Electronic Signature) Date / NOTES: I. n 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 bLG.L.c. 142A.Other important information on the HIC Program can be found at www.mass.i>ovocal Information on the Construction Supervisor License can be found at www.mass.gov'dns 27When 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 Footagc"may be substituted for"rot:d Project Cost" �ONDIT 6 I �Clnnug 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 ❑ Reconstruction C 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: McIntire - Address of Property-1 zs Fcderal ctreet Name of Record Owner: Barton & Elisabeth Dickson Description of Work Proposed: Replace two (2) existing 2'x4'skylights with two (2) 4'x4'skylights. Position of the skylights will be as shown in drawings dated 6120113. The curbing will be dark bronze colored aluminum. Dated: July 18, 2013 SALEM HISTORICAL COMMISSION 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.