11 CHURCH ST, APT 403 - BUILDING INSPECTION 25
f "Che Commonwealth of Massachusetts CITY OF
Board of Building Regulations and StandartECEIVED SALEM
/ Massachusetts State Building Code,yI/�,�i�II(pp(F L SEftViC S
�( I pt'�YL Revise)blur 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a , 3
N one-or Two-Family DivellingNOV —
This Section For Official Use Only
( t Building Permit Number. Date Ap lied:
UJ
Building 0t7icial(Print Ntune). Signature•:
SECTION L•SITE INFORMATION'
n4f�lC i
1.1 P og ty� dress: 1.2 Assessors Map Sr Parcel Numbers
6 1.1a Is this an accepted street?yes"_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
"Luning District Proposed Use Lot Area(sq It) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Nater Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal O On site disposal system ❑
Public❑ Private❑ Check if yes13
SECTION 2: PROPERTY OWNERSHIP)`
C .2.1 Ow ert of Record:
ePnnl Cily,"It 1—
No.
and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) O Altemtion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specily:
Brief escription of Proposed Work=:
— caw A_
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Itcul Labor and Materials
I• Building Permit Fire:$ Indicate how fee is determined:
Building $
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(item 6)x multiplier x
3. Plumbing $ P Qther Fees: .S V
4.Mcchmiical (HVAC) S List: lJ
5. \lcchanical (Fire S Total All Fees:S
oppression
Check Na_Check Amount; Cash Amount:
6." utal Project Cost: ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES 1
5.1 Cuust(r�uct1fnn Supervisor License(CSL) O ) 3
/ �o /6
" + f�SSS License Number Expiration ate
-
N uncc,of CISL�fIoIder List CSL'rype(see below)._
` (� U Type Description
No. ;ad Street - __
rr U UnreslrideJ� Duildin s u to 35,000 cu. Il.
I n A In�'\ I' 't f' y 1 I R Restricted 1&2 F:unil Dwellin
Ci�o+v State,ZIP M Misonry
RC Roolitrat Covering
WS Window and Siding
r} SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / 61)k/7 Z (&
L (V\ )1 3�-�-/ HIC Registration umb r xpimt on Date
II C Company N e or fiC R i trent Name
�hyj t/ta+J l�� � S Cr. °L , rr .
N mad Street �A enq ,,U Email JJress
Ci own State ZIP `��� Telephone
SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§ 2SC(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 ..........6�—' No...........❑
SECTION 7a:OWNER AUTHORIZATION:TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject pro erty,hereby authorize ` y 'x ^ a-'
t9 act o n behalf,in I m ers relative to work authorized by this building permit application.
/C/S�r S '
Print Own r' NarneAlecIrfn c 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.
Print Owner's or Authorized A nt's Nanae(Electronic Signaturo Date
OTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who(fires an unregistered contractor
(not registered in the Home improvement Contractor(HIC) Program);will no have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
www.mass. gay �O Information on the Construction Supervisor License can be found at ww�'Jns
a 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. R.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of healing system Number of decks/porches
Type of cooling system Enclosed Open
3. `Total Project Square Footage' may be substinned 1'or„Total Project Cost”
- _ Office of Consumer gffnirs !-
_ NOME IMPROVEMENT &Business Regulation
OVE
e9istration: 701743 CO
Expiration: 6/29/2016 TYPe:
LELANO M. HUSSEY OBA
CONTRACTOR
Leland Hussey
490-500 WASHINGTON ST
LYNN, MA 01907 4
Undersecretary
Massachusetts - 0epartmenf of puoilc Sap
etV
Board of Building Reouta>ions and Sta^da;ds
rcen;e CS-032197
LELAND M HUSSEY - -
490-500 WASHINGTON ST'$
LYNN MA 019()l--
10/16/2015
19()l-- .
=n n'es� anar 10/1612015
- Office of Consumer Affairs&Ousi�
L - --,P 9st Mon OVEo E43 CONTR,gCTOR gulatian
'xi�-,;>Expiration: 6/29/2016 Type:
LELAND M. HUSSEY
DBA
CONTRACTOR
Leland Hussey
490-500 WASHINGTON ST
LYNN, MA 01901 �-
undersecretary
Massachusetts -Depl"eni ^.1 rup lc Sa'ieTY
Board of 9uiid;ng Regulations 3rd Standards
cense CS-032197
LELAND M HUSSEY
490-500 WASHINGTON STY
LYNN MA 01901--
z
190E_;nir.,.r 10/16/2015
The Essex Condominium
Telephone: 978-532-4800 1 Fax: 978-532-6023
c/o Crowninshield Management Corp.
18 Crowninshield Street
Peabody,MA o196o
Jim Garfield
Unit 403, The Essex Condominium
11 Church St.
Salem,MA 01970
Dear Jim,
The Essex Trustees have reviewed your request to replace the windows and/or the outside doors
of your unit. The Trustees have given their consent for you to proceed with your project, but with fT�
the following qualifications:
The Trustees are not in a position to assess the engineering details of your request nor can they be
assured that the final product will be in accord with the plans. Thus you the Owner retain the
responsibility for ensuring that the finished work is in accord with the Essex Condominium
Documents* in that it does not"affect the appearance or structure of the Condominium, or the
integrity of its systems,"that"all materials used and Work performed shall comply with all
OSHA, other federal, state, county,and municipal laws, rules,ordinances, codes and regulations,"
and that the work is carried out by the contractor in the manner specified by the Essex
Condominium Documents* (vis a vis hours,removal of refuse, noise,etc.).
Regarding replacement windows and doors, please be aware that:
• Replacement windows and outside doors must be of a quality equal or greater to the
original windows or doors.
• The appearance from the outside must be identical to that of the original windows and
doors, specifically as to color(white), number and spacing of mullions (grids), and
location of mullions/grids on the outside of the outer pane (not only between the panes).
• Screens must cover only the bottom half of the windows to match those throughout the
rest of the building.
• Flashing must be to Massachusetts code standards.
• Installation shall be done by a reputable contractor with a good work record and
references, and as required by State Building Code,the contractor must obtain a building
permit from the City of Salem. This ensures that the contractor is properly licensed and
insured.
Please contact the Management Company if you have additional questions.
Good luck with your project.
Signed: Z.a. /t u, �csn Date: October 2, 2015
As managing agent for The Essex Condominium
*Exhibit C of the Certificate as to the Rules and Regulations,Book 23224,Pg. 241, South Essex
Registry of Deeds and Sections 5.2 and 5.15 of the Declaration of Trust, Book 101169, Pg. 84.
Both are available in the black bound copies of the Essex Condo Documents available from the
front office.