164 FEDERAL ST - BUILDING INSPECTION The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
T— W Massachusetts State Building Code,780 CMR Revised Mar 2011
D Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
l TUs,Setx3on Fur f)lficial Llse . o
,9 Bail mng Pk nate ap 1:
G!
I— SECTION L_:$1TE RM:4T1O1!1 '�
11 Pro rty.Address: 12 Assessors Map&Parcel Numbers
w
1. a s this an accepted street?yes no
Map N»ber Parcel Number r'v
1.3 Zoning Information: 1.4 Property Dimensions:
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:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system Cl
Public E3 Private❑ Check ifyes❑ . .
SECTION 2:-PgOPERTYOWNERSMP'
2.1 O r'of �vd D
e t) City,State,ZIP
s sir` : 1g1 r-uKZ "�� l t, ,f�d 145_3�� t Coi4,l
No.and Street ' Telephone Email Address
SECTION 3t DESCRIPTION OF PROPOSED WORIf'(check all th9t apply)
New Construction❑ Existing Building 13 Owner-
Demolition
E3 IR ❑ Alteration(s) ❑ Addition 13Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description gf Proposed Worle: 7
( [
SECTION 4:ESTB►?ATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only q
Item (Labor and Materials
1.Building $ 1. Buikling Permit Fee:$ Indicate how fee is determined:
13 Standard City/Tovm Application Fee
2.Electrical $ O Total Project Cost'(liem 6)x multiplier x
3.Plumbing $ 2. Other Fees; S
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
ression
pa LBedc Num. (xmeel:Amount Cash Amount: . .
6.T 1 Project Cost: $'tJ �j I07) p pfd}n poli ❑outstandingBalance IAre:
fY)fa0»�
-
SECTIONS: CONSTRUMOA SER ICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Dau
Name of CSL Holder
List CSL Type(see below)
him
No.and Street TMe
x. ; U I Unrestricted uildia to 35,000 cu.ft.
. R I Restricted Family Dwelling
City/Town,State,ZIP blI Masonry
is
RC I Roofing Covering
ws window end Si
-•- SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
Ci /town State ZIP Telephone
SECTION 6:WORKERS-COMPENSATION VMRANCE AFFIDAVIT(ALGI-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...........❑
_. 7a O"M RUTH RUA TORE COI4IPLETED WREN
ANER'S AGTNT OR CO OR APPIdES... 1104409 PERMIT_
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER!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 an ccurate to the best of my knowledge and understanding.
n O 'l Z4 `141
t Owner's or 4uth4 e(Ela nic Signa ) Date
NOTES:
1. An -ner 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
wlvw.mass.aov,'oca Information on the Construction Supervisor License can be found at ww�•.mass.eov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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"
aQTY OF SALEM, MASSAC HUSE TTS
BUILDING DEPARTMENT
120 WASHINGTON STREET,3n FLOOR
TEL.(978)745-9595
KBaERL.EYDRISI7LL FAX(978)740-9846
MAYOR TrIOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO&WSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date 6 '(�
Job Location w[ ''
Home Owner Address �(OI 1 \` �t� (>, [, ST
Present Mailing Address S k4w
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a,
license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or
is intended to be, a one=or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such "homeowner"shall submit to the Building Official,on a form acceptable
to the Building Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner"certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'S SIGNAT L�7
APPROVAL OF BUILDING INSPECTOR
ChYCFSALE34 MASMACHLBETI
BERaWDSPACMW
1M WA9M=WSU r,3'DAM
BL 745.9995.
BIA�ERIFYIL
FAX 70-MO
MAYOR 9}lrWASSTJUM
DeadcrPURWM WM/BUUaMAM f0M
Construction Debris Disposa/Affidavit
(required for all demolition andrenovation work)
In ao xwcbnw with the sbM edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL 00,S 54; Buihfir,g Permit it is Issued with the
condition that the debris resulting from this work shah be disposed of in a properly lkensed
waste deposit facility as defined by MGL c 111,S 154.
The debris will be transported by.
(name of hauler)
The debris will be disposed of In:
(name of facility)
(address of facility)
Signature of applicant
Date
r
e
Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
CERTIFICATE OF HARDSHIP
It is hereby certified that the Salem Historical Commission had determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction ✓ Alteration
❑ Demolition ❑ Painting
C. Signage ❑ Other work
as described below has been approved under a finding of Hardship, 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: 164 Federal Street
Name of Record Owner: Peter and Donna Bimbo
Description of Work Proposed:
Replace existing 9-light window on west elevation with three, 3-light double glazed wood casement windows per
submittal.
Reason for Issuance of Certificate of Hardship:
o The application affects only the building or structure on which work is to be done and not the historic district in
general.
o The application is approved because it does not cause substantial detriment to the public welfare.
o The application is approved'because if doesitot cause departure from the intent and purposes of the amended Historic
District Act.
Dated: 8/4/16 SALEM HISTORICAL COMMISSION
By: v � �}
The homeowner has the option not to commence the work(unle t 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.