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95 FEDERAL ST - BUILDING JACKET CK S -7 Ll I L'"D The Commonwealth of MassacIt��` ¢ Department of Public S ty Massachusetts State Building Co3(s aill)5 A ID 0.8 Building Permit Application for any Building other than a One-or Two-Fantily Dwelling 40 (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) iy40• 0/920 No.and Street I IT City/-rown 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 ❑ I Addition❑ I Demolition ❑ (Please fill out and submit Appendix l) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ NoAl is an Independent Structural Engineerin Peer,Review require/d Yes ❑ No Brief Description of Proposed Work: / {Q ;; /!1' , � V •� ('tnwS✓��c-TiFit'7 — 0�, 1 10CN> —t���7'ctd14 C 9!' �i�/c�S a Fitti322r� i%ta�.✓u�i'�F'.�/e �viru(— 7L�.tre Y-zs�r 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.) Total Area(sq. ft.)and'rotal Height(ft.) SECTION 5: USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Factor F=1. ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 ❑ C Institutional I-1 ❑ I-2❑ 1-3❑ 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 ❑ 11111 IV VA 11 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 Zone❑ 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: %4A I fistocic C:nmmissiyn Rci_i=w Procoss: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes ❑ or No❑ Yes ❑ No ❑ 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: I'l f:�'S 5 I-4 c-� i✓rn 1 % M ��.L - CJ 17--�-6 • c; SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 'Bm?� k:AADALL �5 SEDE tot . s i Sr9L�� ss'Ir� �l 9Jo Name(Print) No. and Street City/Town Zip Property Owner Contact Infamatiotn: W—VY 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 bv this building permit application. SECTION 10: CONSTRUCTION CONTROL(Please fill out Appendix 2) If buildin•is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑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 L ^i- z— 0,,S J 'T5"iz Company Name nn'�� // '' J 1.TCp /C SL iam Name of Person Responsible for Construction License No. and Type if Applicable �y J LI! FA L S 1 �i9 LF1 t7 A —l1L 1 Street Address City/Town State Zip 5 S56- 9 i R064L)E4(F-MZ(P Gal('457 A6E,�Z fele phone No. business Tele hone No. cell e-mail address SECTION 11:SVI. < ' SURANCF..AFFIDAVIT M.G.L.c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the NIA 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 X1 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item - Estimated Costs: (Labor and Materials) Total Construction Cost(from [tem 6) _ 1. Building $ Qo • 09 Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor) =$ 3. Plumbing $ 4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality) 5. Mechanical (Other) $ Enclose check payable to G.Total Cost $ ` t'(�O, Ott (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering any name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this rapplication is true and accurate to best of my knowledge and understanding. 11 7CfJ)1��rrl.L f;�� O fztJHJ.Ei< ��- G 76- Zcl l Please print and sign name o Title Telephone No. ate /lFc!EF'O' ea-1— C �? b Street Address City/Town State Zip (� Municipal Inspector to fill out this section upon application approval: " �'�" ZS /�4 Name Date .�0 T 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 ❑ 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: 95 Federal Street Name of Record Owner: Bob Kendall Description of Work Proposed: Repair and/or replacement of secondfloor porch wood railing system (top and bottom rails, skirt boards, molding trim, deck boards, etc.) to replicate existing. No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind maintenance/replacement. Dated: August 16, 2016 SALEM HIST C MMISSION 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 fa(ade). 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. 1 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM dMar 1 Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a v One-or Two-Family Pwelling Cp This Section For fficial Use Only Building Permit Number: Date Applied: Z Building Official(Print Name) V SignaW Date 94 N ECTION 1: SITE INFORMATION 1.1 ropers Address: f 1.2 Assessors Map&Parcel Numbers / 1.1 a Is this an accepted street?yes no _ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: - - Zoning District Proposed Use Lot Area(sq ft) Frontage(In 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: Public❑ Private❑ - Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recor Name(Print) City,State,ZIP (e1ldl , IaO'. I No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction D Existing Building❑ Owner-Occupied ❑ Repairs(§) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work 2: r a SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ w G on) 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ a ❑Standard City/Town Application Fee w• ❑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: $ 9 6 d" ❑Paid in Full ❑Outstanding Balance Due: 7Cl r'yf COC ,.Tj1/ , SECTION 5: CONSTRUCTION SERVICES q 51 Construction Supervisor License(CSL) 7/5, /.1 GaA ,[J---) C,OMGS License Number Expiration Date Name of CSL Holder /, C7 � List CSL Type(see below) Vl No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Nia—sonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances C-t` k-J 35_- 3S-61 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) �rxe S 3 S/6o o n6fiyC 7 L.� E - �ti rs IBC Registration Number Expiration - �/tion Date HIC Company Name or HIC Registrant Name SS Cen�Y/� t f t (ors 6CdSC0r15V 0 YAI)w-Cd No.,an eel y `S/ - 3l S—J�i Email address eii�t/Town, S tt—Z !S 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 I,as Owner of the subject property,hereby authorize CA f`O} 60Y,, S to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic ature) 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. An Print Owner's orAuthorized Agent's a(Electronic ' nature) 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 M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos 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 halfibaths 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" E e Commonwealth of Massachusetts " OF Boaz of Building Regulations and Standards CITY M Mass chusetts State Building Code,780 CMR SA Revised Mar 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:I Date Ap Building Official(Print Name) - - Signature - Date SECTION 1:SITE INFORMATION 1.1 Pro a ,�itdreF / 1.2 Assessors Map&Parcel Numbers m 1.1 a.Is this an accepted sheet?yes no Map Number Parcel Number C ti 1.3 Zoning Informatio 1.4 Property Dimensions: t g W D Zoning District Prdposed Usi Lot Area(sq ft) Frontage(ft) r- 1.5 Building Setbacks(ft) ; Front Yard Side Yards Rear Yard Required Provided Required Provided Required Proceed N ' 1.6 Water Supply:(M.G1 c.40,§ 4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ ( Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSIIIPr 2.1 Ownerr of Re ord: Jo r1a A 0 cr- 0 /9 -70 Name(Print) City,State,ZIP I / No.and Street Telephone Email Address SECTION3:DESCRIPTION OF PROPOSED WORKz(check all that apply) New Construction❑ Existing B filding❑ Owner-Occupied ❑ Repairs(s) ❑ eration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Specify: Brief Description of Proll,used Wo k2: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item I Estimated Costs: Official Use Only Labo and Materials 1.Building I $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical I $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing ( $ 2. Other Fees: $ 4.Mechanical (RVAC) $ Lisle 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ &SU ❑Paid in Full ❑Outstanding Balance Due: n} r rI SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number N Expiration Date ame of CSL Holder EPIC W.1�81ID Hilton Skeet List CSL Type(see below)_(A- slilemMA01970 Type Description U Unrestricted(Buildings up to 35,000 cu.ft. City/fown,State,ZIP R Restricted 1&2 Parruly Dwelling M Maso RC Room Covenn WS Window and Sidin SF Solid Fuel Burning Appliances T ele hone I Insulation Email address . 0 1 Demolition 5.2 Registered 11ome Improv meut Contractor(HIC) n 1L1�o��1 / WC Company Name AvenueCF17,RhAk,-e HIC Registration Number Expiration Date _ No.and.Street S91CM MA 01970 o ?1f I,/.O t('5 Email address Ci /Town,State,ZIP�1 Tele hone SECTION 6r�ORKE 'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insuran a affidavit must be completed and submitted with this application. Failure to provide this affidavit will resulti in the denial of the Issuan of the building permit. Signed Affidavit Attached? es.......... No...........❑ SE�TION 7 :OWNER AUTHORIZATION TORE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT, [1, s Owner of the subjIct prope ,hereby authorize frYC Calw✓'rct on my behalf,in all matter relative to work authorized by this building permit application. rnnt Owner's N e(Ele on ig a ) l Date SECTION b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name bellow,I hereby attest under the pains and penalties of pepury that all of the information contained in this application is te and accurate to the best of my knowledge and understanding. / Print Owner's or Authorizkd Agent' Name(Electronic Signature) W Date NOTES: 1. An Owner who obtains a bui ding permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in th Home I nprovement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund un er M.G.L.c. 142A.Other important information on the HIC Program can be found at ProgrMss.eov/oca Informa on on the Construction Supervisor License can be found at www.mass Qov/dos 2. When substantial work is plained,provide the information below: Total floor area(sq.ft) I (including garage,finished basementlattics,decks or porch) Gross living area(sq.fLj Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system INumber of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ti The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code„780 CMR MUNICIPALITY USE Building Permit AlpUcafloq To Construct,Repair,Renovate Or Demolish a RoftdMar2011 One-o Two_Family Dwelling z Trds Section For Official Use Only a n BuildingPennitNumber DateAp 'ed m c-� U /1 J Buil ' Official dutg (Print Name) ± Signature � ( afea- 3:1< - SECTION 1:SITE INFORMATION N m 1 Ll Prof Ad ess -P <o '^ S 12 Assessors Map&Parcel Numbers 1— i _ l.laTS this an accepted street?yes no, Map Number PmcelNumber CV �' 1 13 ZoningInformation: 1.4 Prop e'tyl)imensrons _ Zoning District Proposed Use Lot Aces(sq ft) Frontage(it) 1.5 Building Setbacks(ft) Front Yard - Side Yards I. - _Rear Yard _ Required Provided Regorted Provided Requited Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood xon0Information; _.- I.8 Sewage A)sposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?Checkifyes❑ t Muniopal❑ On site disposal system ❑ SECTION2: PROPERTYOWNERSEW 2.1 Ownerc of,Recpr..2,.1 OQ // �G,/CiH't / '✓ �� . Name(Pno� �e de f'Dtl SL City,State,ZT No.and Street Telephone ... - - Ema1 Address SECTION 3:DESCRRWnON OF PROPOSED WORK2,(checir all that apply) New Construction❑ Existing Building❑ I Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ AcoessoryBldg.❑ Number'ofUnits-- Other Specify BriefDescription of -oposed Work.` — SECTION 4M. rrFees. ESTIMATED CONSTRIICTION COSTS Item a . Official Use Only 1_Building Building Pemrit Fee:$ Indicate how fee is determined: - I Electrical tandard City/1 own Application Fee otal Project 6sP(Item 6)x multiplier x 3.Plumbing ther Fees: $ 4.Mechanical (HVAC) 5.Mechanical (Fire Suppression) Total All Fees:$ ' 6.Total Project Cost: $ Check No.le s Check Amount Cash'Amouut- ��U'r ❑Paid in Full . ❑Ouh9anding Balance Due: (2 SA. 3 G SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor Ltceuse(CSL) 1. 7 ! -7-7 Licesse Number Expiration Date Name of CSL Holder List CSL Type(see below) Eric W.Palm No.and street Milton St t ' Type Description ^t U- Unrestricted " -up to35000 ca.tL Calent MA 61970! R Rcs1rieted1&2Faad1 Dwellm City/rowq State,ZIP M Masom -- - - RC Rooting coverhux WS Wmdow and S' dim IF - Insulation olid BammgAppbances Tel one EmaOaddress - - D Demolition 5.2 Registered Rome Improvement Contractor(BIC) laO 3 Z Atlantic WeattleniAlIV4,L,.._ HtCRegistrahoa umber ExpirstionDate HICCompanyNameo,m venue ' No.and Street Seim-MA 0197g Email address Ci /rovm, ZIP t Telephone SECTION 6,WORREns,COMPENSATION INSURANCE AFFiDAv1T(ALG.L r-152.§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure toprovide this affidavitwill result in the denial oftheLssuance building permit. Signed AffidavitAttached? . Yes.....;.... ! No..........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN OWNER'S AGENT OR CONTRACTOR APPIM FOR BURRING PERMIT I as Owner of the subject property,hereby authorize. t�f rG l a lh't to act on my behati;in all matters teMve to work authorized by this bmlding permit application. &Azy Print Owner's Name(ElecbomeSigoatu ) �. _ Date .. . <'SECTION 7b:OWNER!OR AUTHORIZED AGENT DECLARATION I By entermgmy name below,I hereby attest under the pains and penalties of perjury that all ofthe information contained iCilica' is fi n§a rI to the best of my knowledge and understanding. 1?rimt owner's orAutirorized Agents Name(Electronic sigaaaue) Date .I NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unrelostered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty find under Iv G.L.c.1421L Other important information on the.HICProgram can be found at www.mass.eov/oca information on the Construction Supervisor License can be found atwww.mass.gov/dos 2. When substantial work is planned,provide the information below Total floor area(sq.fl.) > (including garage,foushed basement/aMm decks orporch) Gross living area(sq.R) Habitable room count Number offxeplaces Number ofbedrooms -Number-of bathrooms Number-of-haltYbaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost". c (c Z3o (C' ( 3 The Commonwealth of Massachusetts RECEIVED Board of Building Regulations and Standar I ICgS TY OF Massachusetts State Building Code, 780 C( pECTION" SE. ` S EM BevisCd Mar 2011 Building Permit Application To Construct,Repair, Renovaj W Vft(�liAh aA b 2U, One-or Two-Family Dwelling ll �) This Section For Official Use Only Building Permit Number: Date Applied: Budding Official(Print Name) r Signature. Date SECTION 1: SITE INFORMATION 1.1 Pro ty Addss: 1.2 Assessors Map&Parcel Numbers $ Fed re«I s _, L) t Saar, In1¢ 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number _ 1.3 Zoning Informatio°� 1.4 Property Dimensions: I ILo.S {{l Zoning District Proposed Use 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSIRPr, 2.1 Owner of Record: Jo F Sal{., A4 ni44-D Name(Print) City,State,ZIP 45 Ve'A it-a l l'?-411-3Jss No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) : New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) 19 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work?: F-emrwc owl [Ii*tXf. o'f, 4o, ! fOo rJ44C'6 avt,1l 11I >, G-r r il`r., IC ��AI• rY� 4[!�4r1�. SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs I Official Use On Labor and Materials 1.Building $ 41 4 (,I of 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x . ' 3.Plumbing $ V 2. Other Fees: $ : 4. Mechanical (RVAC) $ List: .• O 5. Mechanical (Fire Suppression) $ Total All Fees: $ Check No. Check Amount: Cash Amount. %. 6.Total Project Cost: $ 4 r N ❑Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (,S "0 g y 1 1 S 0 4 °S do ec)Lt4 J �&�11 iVc..v. License Number Ex iration Date Name of CSL Holder List CSL Type(see below) l ( 41 /tiluSsS�h�Sed� s /}t1eKc e No.and Street Type Description f}�1��1 i w. . /I1 h D��(� Unrestricted(Buildings u to 35,000 cu.ft.) R Restricted l&2 FamilyDwelling City/Tto ,State,ZI M Masonry r-r / I (`I A 1 RC WindRoofi Covering 6 i" J�'+fh�� WS Window and Sidin t� (+ SF Solid Fuel Burning Appliances g«,- 4-41 -343Y t qF r rJ,fool' I Insulation Telephone Email addr D Demolition 5. Registered aHome Improvement Contractor(HIC) �3S 4�-- 3S �-U I�` ,t&, ''t V 'OV-f HIC Registration Number Expirlition Date HIC Company Name or HIC Registrant Nay�e r I l c11 Mwlxr..t�4v5.GW-S /F✓1°r+vc t1Fo c C��w�`,�..,. �.. No.Vd S reet Email addr s r A o�-ua c Boa - Ci /T ,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 Issuance of the building permit. Signed Affidavit Attached? Yes ..........E1 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 RO -(,-i OS o t 1,u ,-, to act on my behalf,in all matters relative to work authorized by this building permit application. Jo bee s-gVl4 oaw4�-,&�- N6 0 Lois Print Owner's Name lectronic Signature) Date SECTION 7b OWNER' OR AUTHORIZED AGENT DECLARATION E 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 trues and,accurate to the best of my knowledge and understanding. {�r�- o S.�1VVJ 1A Ap — S II 1 Print Owner's or Authorized Agent's (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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" - � s - (0 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 [9 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: 95 Federal Street Unit 44 Name of Record Owner: Jo Fladges Description of Work Proposed: Remove the three (3) existing skylights and replace them with Velux Solar Powered Fresh Air curb mounted skylights per Ranch Renovation's work description dated 4122115. Dated: June 22 2015 SALEM HISTORICAL COMDMIS'SIION The homeowner has the option not to commence the work(unle s 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 Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code,780 CMR, 7'edition OF SALEM Revised January Building Permit Application To Cons ct, epair,Renovate Or D olish a 1,2008 One-or YWqlFamily elling r m J39j, & i a f n u4xY ,911I"4..�1 ql CcKCnl `BUtltltng°P.erittn Number "��' ` ' ,' °at 4- tore- t Biiildmg Corwtjissioner£Insp e f' urldt{ip 1 ��.{1( pA � n .:h. a� + a/ 1.1 Prope Addrgcs: 1.2 Assessors Map&Parcel Numbers erg, J 1.1a Is this an accepted street9 yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: f Zoning District, Proposed Use Lot Area(sq 11) .Frontage(li) - 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: Public❑ 1 Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ 2.L Owner'o �/5e,•cford: // O r 7. f� Name(Print) Address for Service: 9�fc���4�10 r ��� �ss� igna� Telephone ;" SEGxION D, CRIY I IQ Y f!t)SEll UI �fG,.ect aB that apply} New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify.- Brief Description of Proposed Work: a. SECTION 4:EST �ED COkYSTI�U ION COSTS Estimated Costs: x', EYfjcral-Use Ouly Item r Labor and Materials 1.Building $ 1 WildingPor'fnttFee $ Ind mate`how fee is.determined: 2.Electrical $ °i3 Standard Ctty/Tawn Apphbattan Fee Total� ect Cgs(' x 3.Plumbing2�b? eft 4.Mechanical (HVAC) $ its( E 5.Mechanical (Fire 3 =�— g ; Suppression) $ Tota1,A1)Fees` O d Gheek$Ia Check Atrrount Cash Amount: 6.Total Project Cost: $ O o • ❑pmd�n Futl l7 Outstanding Balance Due: ) } C•. 4 'Stye^.+.S T.C+'+. E 4 yry�Yl� 5 r-MC..Jla sC N1 lt(i{ Ig 5.1-_Licensed Construction Supervisor(CSL) 44 ' , e L ( \ za 6c/ License Number Expiration Date Name of CSL-Holder 1 List CSL Type(see below) y "UU 12eff"twn,. Q Address � , p ° U- Unrestricted(u to 35,000 Cu.Ft. Restricted l&2 Family Dwellin Signature M Maso Onl RC Residential Roofin Coverin Telephone WS- Residential Window and Sidra SF Residential Solid Fuel B ing Appliance Installation. D Residential Demolition 5.2 Re I i ereI H e I provement Contract r /D (a8- S LL Registration Number HIC Copar) Neme or C Re t rt me < 7 -,a Ss7 D Expiration Date Signature ,Y £ / Ate- -T-e eephone J ,SECTION 6 Wt)RKERS'CBA�PE18�AnT1,4�Ipi� IRA�T�.�,',t1FF�AVIT(MG.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 ❑ (?WNER'B AGIt T11"f=COIY PILr1CT(/I�x1PP �QR� �I}V EE ; I & t Z Q fo / as Owner of the subject property hereby authorize ` to act on my behalf,in all matters relative to work authorized by this buildin permit application. Si ature of Owner Dale SECTI©N 76;.U4'1�1Fi>�A� „� � � ��` A., �rNT�ECLARAT�ON'. 1 41 as Owner or Authorized Agent hereby declare that the statements and informatio>fon the foregoing application are true and accurate,to the best of my knowledge and behalf. L � Print Name A ZZ Signature of Owner or Authored AgSUV Date (Signed under the eras and penalties of 'u 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(MC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other importantinformation on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area substantial q.Ft.) (including garage,finished basementlattics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms ths Number of bathrooms Number of decks/half/b porches Number of decks/ Type of heating system Enclosed Open Type of cooling system 3, "Total Project Square Footage"may be substituted for"Total Project Cost"