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0088 1/2 - 0090 FEDERAL STREET - BPA-16-1052 The Commonwealth of Massachusetts iMlV. . Board of Building Regulations and Sta22$at�§.�T Sr Ri��'• CITY OF \ Massachusetts State Building Code, 780 CMR SALEM C /� evised Mar 2011 ((� Building Permit Application To Construct, Repair, Ren ljetttof t,,W A One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: p v� Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION Ll J72,3 0Atj d eK ss:l !_ 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Usd Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§-540 , ,1.7, Flood Zone Information: 1.8 Sewage Disposal System: Public* Private 13 Zone: _ Outside Flood Zone? Municipal Nt On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record:t Ift }��cacJne`� Tc a MR v .n�8 Name int) - r City, _`'d► c rvyrgkstq - -3 373$ Im.kczzo g � .coM No.and Street - Telephone Email Ad ss SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) X I Alteration(s) R Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other 19 Specify: Brief Description of Proposed Work': z tr, v� o� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ Kn Doo 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ 14- 13Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ 000 List: 5. Mechanical (Fire IV$ Suppression) 6 9ft Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ �� ( ❑Paid in Full ❑Outstanding Balance Due: M is t Lr Tb TOps-f t E LI7 K t S i ©1 n - CJ N t=l t✓ �i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) h Delels CS- O°I y y 1'1 8 1 ate �(��o � Q � <t5 License Number Expiration Dale Name of CSL Holler IqR Tail\Ct c<T- „,c `� List CSL Type(see below) No.and Street 1 Type Description Unrestricted(Buildings up to 35,000 cu. ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding _ SF Solid Fuel Burning Appliances X75 ��(' ett tS�ar�a�` .•L� I Insulation Tele hone Email addr� D Demolition 5.2 Rggistered Home Improvement Contractor(HIC) 199-10,13 (� 1�lIJ\n e Gt`Amaif LLC HIC Registration Number Expiration Date HIC Company Name e orC$6 gistran Name and tree Q! Mj No. "Al Email ad ss Ci ho , State,ZIP Telephone �IJJ 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 ..........)d(, No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 'l1 - ` I,as Owner of th697----7 ,hereby authorize V�� o,�J to act on my behelative to work authorized by�uilding permit application. Print Owner's ectronic Signature) I D to SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,l he by est under the pains and penalties of perjury that all of the information contained in this applicatio accurate to the best of my knowledge and understanding. Print Owner's or Authorize t s me(Electronic Signature) Date 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 can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at mm .mass.gov/dRs 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" 1Aassacn is Oeparttriejlt o�1Pu'birc5Metp71 Board.of Building Regulations and Standardsx License:;CS 4944i7 Construction'.Supervisor 0 JOSEPH F DEVELl6 47 B POND ST i b BOXFORD MA 0- ;19 - Expiration: \"` - Commissioner, 0811712017 9/15/2016 IMG 8509.JPG s. e=. Mips://mail.google.com/mail/WOMFnbox/1572e03c4f5a5c767projector=l 1/1 i T/re Commoxwea{th ofHanpabasez4v Depaifiitent ofInAslrWAevdeats I Congress Sbeet;Su&elBO B.mto*Aft 02.114?017 www.massgov/dia WJWorkersCompensation haarsuce Affidavit:BollderMCan tradors/Ekdrtciaas/Plombcm TO BE PILED WITH THE P22UMTENGAUTHORITY. Pill Name(Basinn Eye . Addwss: g VOtlr\� -Ct -e¢4 CityjStat m,. &L� Phone#: '6,D9 Are you ao empbyerriSed WeayprppaNte boot: - of ro ci �. Iamaemployuw (�and4rput-th:ae)•47. nNew consuuc0_m 2 lam gsok pmpteaworpartpereldp have no.eaPkXgee!4°?t°Aax tmmem 8, V)RenodelmB sayeepaelty.(No watare' 9: O Demolitiin' 3.p I am a homeow&ft an we*nwwx.fxo wwkwe comp.msmants"W Md.)r 4. I®ahomeowmerandwrD6ehvmamtreitmamconiaeawo>Icw '10QBuilding'additi . mypopany. ]war eowaefiatauconuacomad haewohall.QBlectricalrepaosoradditi®a Ieopriatesa wLb pp®ploycra. ' .. - . 72.�P1 ,.. - .,. oladditioiis umb�g'iepaae s.Qlamegenval comeaaaad]have hfired Pole sub eamiaa6we h'seed oa d+s abept 13.01toofrepatrs. . 7Leaesab4ama? twhmaooploymmdbavewo*w'cmR-amp=$ 6.0wea,ea cogmrefiocaod ib offieerebm earieisedW�iibfia ofeaeonyt perM(a'I.e. 14.QOtliea'-.. 757,11(4h and.xbaieaoemptoyses:�tfo wodoae'Nomp.:,tosu>mar ).- •Anyat8ietehadatasllmagtakar1x38 coram aebtkababwa6awlofPosj iradnro �mpm pohaY - : t xomeowners who aulalut affdavitirtdio�g tbey anedo,tig woSk iddthra hoe adstde eonbnkas>mtet aoboYfa i aewaffidwamdug Ewa IConvacom that check"hot muosmchwanaddWand sbaddo"wieg the name:ofaKab-cacasamend owe wbedwoi am Pomcaad0a;hm . employees.xPo .aub aA P1.aY 4tlKr,m mw;aamaii.wadzw� pojkyuaowc . Ian+ana4PYeJfrgOridinBrporkera'ioagvnuwM►mrceforaytees A&W iathepulieyagd/o4si(e - injorwution. Insurance Company Name: Policy#or Self-ins.Uc.#: Eapuafion Date-- Job Site Address: city/State/Zip: policy Attach a copy of the workers'Compensation policy deelaratlon page(showing the po fi number and expiration date). Failure to secure coverage as,required under NJGL'c. 152,MA is a eain�a]violation punishable by a fine up to 51,500.00 and/or one-year impaia�y as weD as civil penalties m the foam of a STOP WORK ORDER And a fine ofup to$,250.00a day against the violator.,A copy of this staocir>mt y be forwa dad to the Office oflovesdgatianivi7tbe DIA feu m' sumace coverage verification. I do hereb Aep ' aad penalties vfperjary that the Informadem pmAWM abmw irboe and oorreat Date. — �06J Offmial ase only. Do nor w*e in this area,to be co*Ided by eary or Mown ojWaL City or To": Pernd&lJcmn# Issuing Authority(diets one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofbire, express or implied,oral or writtep." 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 ocaipsN of the dwelling house of another who employs persona to do maintenance,construction or repair work on sucb dwelling house or on the grounds or building appurtenant thereto shall not because of such employment 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 Bre performance of public work until acceptable evidence of compliance with the insmance requirements of this chapter have been presented to the contracting anRhority." 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)mmrie(s),addresses)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ 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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidaviC 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-marmed'companies should enter their self-insurance license number on the appropriate lime. City or Town Officials Please be arae 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/liceme number which will be used as a reference monber. In addition,an applicant that must submit multiple pamit/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 proofthat 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 Department's address,telephone and in number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017. Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia C n Y tF SALEA4 NLASSAt.' ASETP, BULUMDJtPAIMMW 120wA9M MnvSs>seetr,s' ROOJt Tits. 945.95 . FAX( `740-M" BII�ERIEYDRiSI�l MAYQER DnmcmacrpuwcpxaFway/BtiLEmamagSgcM Construction Debris Disposa/Aff idavit (required forail demolition and.renovation workj In acwrdance with the sixth edition of the State Building Cade, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40,S 54; Building Permit R is issued with the condition that the debris resulting from this work shag be disposed of in a properly rkensed waste deposit facgtty as defined by MGL c 111,S 150A. The debris will be transported by. (name of hauler) The debris will be disposed of in: ._ �V (name of facility) (address of facility) N Sim re(of applicant t Date ii .. - ------------ FF SII Back Stairs ` 11•_6•:x T-7" I J f I I i LAUNDRY 14'-5•x 11•-10" I I : I : I I Itl I I I ; I II UTILITY 1. 17'-0"x 13'-6" I ' I { I" I JI II I I .I I I I . I 1 I I I STORAGE z0-a•x 1 s'-0•: ' I 90 FEDERAL BASEMENT LIVING AREA 963 sq ft i k UP BackStair�. _. 1 V-9-1 x 7--1",1 I--=-i Bt1��F9�= I: s KITQW17 6 t. 6 ,..� i _1.. 8? � ,. DINING 16'-11"X 13'7" 6LOS 6"x 6'- J .CLOSET 7 I � I I FAMILY 15'-3"x 19'4" UP um z.m i v 90FEDERAL FIRST FLOOR LIVING AREA 1073 sq k f UP i Back Stair 13'_0"x T-1" o I I V 5 OFFICE HALL 12'-10"x 9' -T x 9'4' 1 C — BATH 12'_6"x 6'_47 I_)AH LOSE �� I I HALL -9"x 15'4 BEDROOM 15'40"x 12'40" CLOSET 11Ta0"x 2'+� '� _ AI � i ronttair �T-6" 20'-3' BEDROOM 15'-1"x 13'-10" UP 90FEDERAL 2ND FLOOR LIVING AREA 1103 sq H v Back Stairs/ I 19'2"x71" II i \ \ I STUDY 16-11"x TA" ' I I ` BATH LOSE 12'-7"x 6'-6'`j v d I \ HALL ` ' I I BEDROOM 3 u'-s"x lo,-2., � i \ I `CLOSET s x 3-A,,, UP— i ` IIS \ \ 5 BEDROOM ` 16'-9"x 15-7" \ i ` d I •� i / 1 \ \ I — \ I 90 FEDERAL 3RD FLOOR LIVING AREA 1110 sq n - ---------------- ---------- LAUNDRY --LAUNDRY '. 17'-3"x 13'-11" I - I I+ I I- I I I I I I I I I I I 'I I : I I I UTILITY 15'_8"x 16'_3" I I I 1 II I I ' I I I I I I I I 1 STORAGE IT-5"x 22'-0^ I - I I - I I - I I < I I ': I ,_-----.--__--------J : , ----------------- 88 1/2 FEDERAL BASEMENT LIVING AREA 972 sq R UP uP-I i UP a " � y 8 88 1/2 FEDERAL ST 1 ST FLOOR LIVING AREA 678 sq R �TH —UP c �0'-6\x TV [airs CLOSET 10'-6"x 8'-3" BEDROOM 13'-1"x 13•-8" 1 e 2 i S ENTRY - ' 8}r 5'-5"x 8'-T UP UP BEDROOM 14'-9"x 16'-7" 88 1/2 FEDERAL ST 2ND FLOOR LIVING AREA B44 sq ft �\ BATH -UP—i I� 13'-5"x 5'-2" B f8 2'— Y3' 0" STUDY 13'-6"x 8'-3" FAMILY 12'-11"x 16'-5" 3 i _ oma/I T, -ENTRY BEDROOM 14'-7"x 22'-8" 88 1/2 FEDERAL ST 3RD FLOOR LIVING AREA 836 sq ft File number: 160628-29 UNREGISTERED LAND Anorne : LIBERTY LAW &TITLE,LLC Deed Book 5674 pa a 236 Lender. Plan Book Pae Lois Owner: ROY&FLORENCE GELIN REGISTERED LAND ReAt. Book Sheet Lof(s): Date: 6/28/2016 Cerfi rcate of Tifle Assessor's Map 26 Blk: Lot 627 Census Tract MORTGAGE INSPECTION PLAN Scale: 1^=40' 88 .112 FEDERAL STREET, SALEM, MA 41..T5. AP26-627 62 ry 6210 S.F. s' LOT 626 LOT 628 3 STY ae0-881 50.07 FEDERAL STREET CERTIFICATION 1 CERTIFY TO THE ABOVE ATTORNEY,RANK,AND THEIR TITLE INSURANCE COMPANY THAT THE MAIN BUILDING,FOUNDATION OR DWELLING WAS IN COMPLIANCE WITH THE LOCAL ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED(WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY)OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS.GENERAL LAW TITLE VII,CHAPTER 40A,SECTION 7. NOTE:BUILDING APPEARS TO SE CLOSE TO PROPERTY LINE. AN EXACT LOCATION WOULD REQUIRE AN INSTRUMENT SURVEY FLOOD DETERMINATION 0 1T 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 ❑ 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 District Address of Property: 88%2 - 90 Federal Street Name of Record Owner: Leo Kraunelis Description of Work Proposed: Remove synthetic siding and restore wood clapboards and trim with the proviso that new watertable and cornerboard trim replicate size of original trim as indicated on the building and that flatboard stock be used for both. Dated: September 8, 2016 SALEM HISTORICAL COMMISSION By. ( C�4A,Lh / p � 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.