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183 FEDERAL ST - BUILDING INSPECTION
2 5"— U' 122_SoZ The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards hECE VED SALEM Massachusetts State Building Code, 780 CMR Iti SP EC J I G;1'` e se'd 4arS201] uilding e it Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling 1015 NOV 3 P 4: 21 (� This Section For Official e Only Building Permit Number: Date plied: 1 � IJl r Building Official(Print Name) Signature Date I SECTION 1:SITE INFORMATION 1.1 Progerty,Address 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(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'? Public ❑ Private❑ Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 0nrt Vecord: _ / „/ j� �/� A�GI ;,4 fit Co 2 0 . �5.1-cC'- //?y%� _S P'� y 17-0 Name(Pring� �� City, State,ZIP /e- fcvlerp No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) 01 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': 5h V Imo - ov SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 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 $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ y Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ fi" 0 Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /OG G 5—r/ S �. /p TJr v�N License Number Expiration Date/�9 / Name of CSL Hold r / 3 77 LOv r& Sl' List CSL Type(see below) No.and Street /� / �, /// Type Description %.�,. L,e 'n O�L�� U Unrestricted(Buildings u to 35,000 cu.ft.) RX.L l "I ` /'/ O R Restricted 1&2 Family Dwelling City/Town, e,/IF M Masonry RC Roofing Cin WS Window andndSiding SF Solid Fuel Burning Appliances c� 60 S71 / —6 1 Insulation Telephone Email address D Demolition 5.2�jRegii'stere Home Impro(vemen ConyFactor(HIC) l 7�� 9 elcl /y�4-lo J u7 Po �7zq LI ZtiC HIC Registration Number Expiration Date HIC Company 14ame or HIC Registrant Name J 377 Lcvellt- No.and 1pP�_ /'e / 5-7/ 9G Email address Cit /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 Issuance of the building permit. Signed Affidavit Attached? Yes .......... ET' 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 /`C� —P 41%/ to act on my behalf, in all matters relative to work authorized ding permit application. JefcAM* /1)% ///-?° /S— 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 inthis al lication is true and accurate to the best of my knowledge and understanding. �y�� Print Owner's or Authorized Agent's Name(Electronic Signature) 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. 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" � Ofifces: - 377 Lowell Street, Wakefield,MA 01880 Tel: 781-245-4900 MH RYAl000 Fax: 781-245-4999 8n Faw, www.PeterfVanAndSouRoofng.com INC Inc. Submitted To: lob Location: Blacksmith Condo Assoc. Trust c/o Jeff Schmidt Blacksmith Condo Assoc. 183 Federal Street 183 Federal Street Salem, MA 01970 SsIem..MA 01970 PhOneik 617-921-9546 EMIL L.P.SCbnIIdlCNetlmRlmt Proposal date: October 22,2015 Raised date: November 22,2015 We are pleased to hereby submltdiis proposal to furnish materials and labor,completely In accordancewith the below specifications: (Additional charges may apply for any change's not included below in proposal either by request of owner,or if Peter Ryan and Son Roofing finds unforeseen circumstances that will affect the performance,quality or integrity of this job).In the event legal action is taken to enforce any provision of this agreement, the prevailingparty shall be entitled to all its reasonable costs, including reasonable in-house or outside attorney's fees. Not responsible for debris in attic. MURM Strip entire roof to bare wood and re-shingle: $7,000.00 • Strip existing shingles down to bare wood • Check for rotted wood and replace(at time&material) • Nail down any loose wood • Install ice&water shield to first 6-feet,and in all valleys and around any protrusions MIWRpp • Install premium synthetic underlayment(in place ofstandard 301b.felt paper) BEL • Install all new 8"white drip edge on perimeter and step flashing,where needed • Install manufacturer suggested starter course of shingles • Install IKO or GAF Lifetime/architectural shingles in color of your choice • Install ridge vent - • Cap ridge vent properly with manufacturers suggested cap(GAF Timbertex®or IKO Hip&Ridge 12) • Properly flash any protrusions and all new pipe flanges,ifany on roof Install new lead around chimney: MEE of charge Clean gp: • Cover area with tarps to minimize debris and remove debris related to work • NOTE: Please cover any belongings in the attic,as they will get dusty,if applicable IA payment due upon signing: $2,000.00 Total COSL $7,000.00 Total balance due upon completion: $5,000.00 Kindly remit payment to "Peter Ryann. Thank you! RespecdollySubmitted by , Accepted by: Xl� Our craftsmanship is 100%guaranteed a 10-years. A warrantees are through the manufacturer.All warrares II be null&void ifjob is not paid in full. Peter Ryan an oofing,Inc.License#1788711 Thank you for letting us serve you!!! cc: Joe TXae C'arri:to-ra.raar)�ralXla �f�r�ssrrciYrtsarrEts ' F eptirtinertt afIufustrW Ar.videnty (7,�fii*e �xfnvesfigrtflvtts I Co.rspes,+<•.Streei, S##de 100 Briton, MA 02114-2017 arat+rv.tFi[rss,$Gpa�/t�>'t� workers' com.1>'ein:saften Insurm-ce Aff tlu0t: t ilade�,stCatncrt t a^s/Ei rt�'i ians/PIta tdaers JAIRONALBA, �'1 iatce Ibi Name Peter Ryan and Son Roofing,Inc. a Rditress; 883 [rear] L9W611 Street,SUIte 20 Cit lStitt,/Zi .. Wakefield,MA 0188.0 pll:otle #; 817-511-9058 Are you an eastpteyer? Ck�dr tWe ttlmPs'elrrtate twxt Type orlp 'o}eet Lteegaalretl}: 1.® I am a es*uyea:with 4. ® I run a gruea'ol coattractor and I 6. ❑New construction employ«c(full andlot•PwAtime).e' tmvc ILred the stat)-oomra axs listed on tha attached ilreet. 7• ❑R•einodcling 3.(] S am a cola prt;I)ietor m'Partner•. These stnU conhaators have sltiP antlhave noetty)loye:es ThS. ❑ Demolition ernnployees and hove Workers' warl:inlr for nu in any capacity. 9. ❑Hnilditrtx addition [No worker's' comp. in.swance C4Oa%). insnrance.t sxcyuired,J 4. ❑ I0.❑ Bi We aro a ocil)oration and.its ecnicat repairs or ndditians 3.❑ I am a homMM14r doing.all orotic _ offices s;give Ixxcreisexl thou 11.❑ Plumbing ral)a.irs or addition-, t f exeut)tion. per:MOL C. 1 c 1 I Z. Roofr•o ohs myself. {No warkeas' coYisP. l ❑ P inswanee mquiued.J t C. 15'l. §](4),mid ter have tits out;Joyeas. [No wo&ers' 13.❑ Otltra C8.rn17. 1r15{rt'atIlCe 3'Cgll7Ped,J "Airy aypYiW althatcllecka�ox.lt.l fltaaE also Pill orttthe sectlaa lrMow slaowhagtheia w�rltara'cnnapWasatioa paiicy hrtbnuarinn. t Hoalwwntrs wlw satAl t tills afadau.it uttucorlasVey aaedolog all work arad 4te.91 titre outside watraetm most ruUnrit a new a}Mdavit indicming such. tC.ont ctors t1j d Cheek thisbox ino5t ataaQiaorP ail arkUtloaaF Saleei.51iQQ!iYig e1C.Rune O:P Ilte sob_CQahaCton find state wbethe7 or nOtt170te WTUite9 have. emp•loyaes. I1theattb-eolMractorshaveeaixrioyeea.6hfytaaas1yrovidet1yeir workers'*utvW.poaicyaawtber. inrn on an rlapar tkFfra is frf'ovleEittg rvarfcer's`COlril3f rF•€rMiOrd ilV.SLriKiP3FC• E3i'Mrd ei}'rplO,l e$S. Below 13 the p'r7'kji atnflfob site lnfsrrmrettonr, Insurance CattFl)raryh'atne; NSA (I am not required to carry W,r,as I have no employees) Please see the Sub CentfaotoP's W.C..affidavlt att Policy it m•Self-ins,Lic. #: ►SIA ftlAmniotx Data: Joh Site Address:....... ._ _... .... .. C iry%State:ZiP: h.ttacbt n tvPyoa4lre worker s' cdurrpettsset#os Itcy tlecla a.t1o'.ii])age(.sliewl'rtg the Poli• rttaanber and e;clrhrntlou date). Failnco to sectiue coverage as M gatired ttndeV Section 2.5A ofMOL c. 1:g2 t= lead.to aw irr4)osition of ceitisival Penalties of I fiat tip to$1.500.00 aanclror aria=year imprisotuneut. aa. we:l.l'as civil Penalties ira.die form of STOP WORB,ORDER and a ft:ue of tit)to $250,00 a.day agmillst th6 Fltrl-MADr. Be t1dViSC-Cl that a C1013y of this statcunent. lnay I)e fol-wal-dod to dor Office Of In.vestigatirnts of the DEA for insltrance ecrvartigc vet•.i.ftcatiail. 140 lurreby cr rrn er rhv.IraIn-s on4prrrudatO of pvfy.%fry gwt the trrfseattat.l..orx,prrrvNerf u€aove is'Mite anti unrrrn it, r 7 g►11 _#�.. __� _..__...611_-571.9056 official use'vNIN. Ao riot 11wi to in f}riis frreta, to Ix', rcartiyJl tend kV o ffia or tmvtt gffligFa1. City or Tonna P'erwItll:,Icense # Iswing Atuthoi:lty(etrt•:I:e orre)r I Bogrd of I.eaixit, 'b, Bulli-Rug Depa:rtttteakt .1, C.`0/3'vw'st Clerk 4.Elzctri A Inspector 4..Pl'awttlstvug luspector 6 CT•twr f;nistnrkPersoctt; _- P'laette'ftt. The C'aptptattwealtb of Ma•ssnahrsrlts Deparlfwnt of Industrtal•A•ccldents I ;fflce of fnves#gotton-s 1 Congress .Street, Sulte 100 B0,110n,M.,f 02114-2017 wwNti,to assgrry/dta Workers' CampeusalliO t ingtt.ratice APflttnvlt; Bn11del's/C ontructoa�slE1 Ft�se 1?�ttL Legibly A 1 t or aa23 Name(Btwhwu/Organiaation/hsc6vidual):. Lema Construrtton, Inc. Address: 71 Prospect street Cit / talr3/Zi Brockton, MA 02301 Phone M 5OB-232-1194 Are yon an eval)JOyee? C:hreek'the•appropriate boxt Type of project(regUilvd): employer with 9© 4. ❑ I ant ageneral contractor and I 6. ❑New construction mn a w-a yees(full and/or 17art•tltne) * haw hired the sub-contractors Remodeling listed.on the attached sheet, 7. ❑ 2•❑ I alt a sols proptictor or pattnot•- These sub-contractors have 8, [J Demolition ship and have no employees vinployees and leave worker's' g ❑Building addition working for tae in any Muck- comp. insttranee.t [No workers` cott>)1, Insurance 5 We m`e a c01po1atlon.and its 10,[]Electrical repairs of additiOlts reryttireit.] olficershave excrcisal their 11.❑Plumbing repairs or. additions 3.[� 1 nm a homeowner doing,all work - right of exctuption per MOL 1 g,Q Roof repairs myself. [No workers' comp, c, 152, §1(4),and we have no 13,0 Otlter insurance requilod.)t ettpioyus, [No wodus' comp. insurance reryulied.] 'ally appikaatthatchecksbox Nl tnastalso tilt oat the section bdow sltowing'tlir;(i,workers'cotnpwmnon policy information. sCo cto meowreer4 who submit thateheck lids box m nttaclted tlitionaloeet slng navuog the mune lof Me nb-cc11re outside awmcton d ate vAettxr or notal affidavit eadnes have such. emptoyea• ushesul?•eomrmvretraveemptoyea.theymtgatProvidttbeh• workes'contp.poNcynttotber. I Belo,,, Gs rite policy nndJob site am an emplever that lsHrar+ldltrg wrt workers' compesmion lnsurrurcr for m,p ernployaas, tnformadon. _ Insurance CompanyNattte: Insurer A: Northland Insurance, Insurer e: Athelia Protection, Insurer C: Travelers A/R k: 6S60UB-SB86069-2.15 Expiration Date: 03-01-2016 Policy#or Self-ins,Lie. Job Site Address:... ...._... __.. .... ...... .. City/StatdZip: . Attacxt a copy of the Workers, cosavensation policy declaration page(.Showing the ptrlicy nmsnber and exp6:ation date), Pailul a to secure coverage ss retlttit ed ttncier Sevaton 25.A of MOL c. 152 can had to the imposition of criminal pulaUies of a fine up to$1.500,00"&or o11e-Year imprisurullent, its well 115 civil penalties in the form of it STOP WORK 6RDER and a ft of up to$250.00 it clay attaurst the violator. Be advised that a copy'of this stnteructst may be fOtwarded to the,Ofce of Investigations of the DIA frit ulsttrarlce'rovelage veriftesthon, I do hara8p Coro under the paters am rJury Mai the lnrforrttarlon provided above /-s true and aQrrect. ____.' ✓ ____ Date: .___.— ._.�:-.-------��. pltane#; 508-232-1194 offictal•use only. Do not write in this Oren, to br Completed by ci())or town off7Ma1. CSty or Towttr PervOLtcense N hsitlltg Andiwity(circle one)i lector. S. Board o9 Hea1t11 2',Bstllclittg 9ltegat tnrraot 3. City/Iowrt Clerk. 4.Eleetrlcal'Iuspeetor 5. pdnmb'tug Iaisl' 6, Other -------------- Courter Qa so'ul Pttosae#; G,�y�'1 DATE(MMIDDIYYYY) J•`✓•P' CERTIFICATE OF LIABILITY INSURANCE 041Og2015 THIS CERTIFICATE 18 18$UBD A8 A.MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON'THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTANO OR ALTER THE COVERAGE APPORDEO BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPREBENTATIVE OR PRODUCER,AND TH4 CERTIFICATE HOLDER. IMPORTANT: If the certificate la en ADDITIONAL INSURED,trio Pollcytles)must be endorsed, If BUBRCOATI N 18 VEO, subject to the terms and 9ondltlons of the policy,oertaln policies may require an endorsement. A statement on this certificate does not confer rights to lha certificate holder In lieu of such dndorsement e , PROOVCSR ' .. JOyOe M Kellar _ MeesPeylnallrepce Serdpes,LLC 0 e"••'—'" — 878)774 1318 (878)77A•A338 x116 I O,No):( -- ___ _ 27 wo, $,gel,UI11110 I:Llrnere,MA01823 inoatlea: loyce�masspaylneuraneo.Dom . INSURE9191 A/PORDINO COVERAOB NNC P • _. we RER A; Norlhland Insurance___ NOR INsuReo Lame Construction,Ino INSURlR at fvb0119 Proleclian 41380 JeeueLeme NeuReRCi TRAVELERS PIR TRC_ 71 Prospect Street N ne,9R!__.._..__._....... .._. ...... Broollon,MA02301 'INGUAgn P, _..:._...... ... Ne Ra COVERAGES CERTIFICATE NUMBER" REVISION NUMBER: THIS i8 TO CERTIFY THAT TF(E POLICIES OF INSURANCE LISTED SFLOW HAVE REEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATES, NOTWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OROTHERDOCUMEM WITH RESPECT TO WHICH THIS CERTIFICATE MAY DE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE .TERMS, EXCTU810NS AND CONOITlONS OF SUCH POLICIES.LIMITS_SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. — R .TYPO O;INIVURMOR _�PULICY MUtiRER 0 0 y];Y Pic 41Mns 7 q Dex%RALLAaaITT WS236101 01!3112016 01131/2010 eACHOCCLPiReNOe s 2,000,00coMdeRCRLoL LNa@nY 6,00 CLNM6M2OocuR MED¢xP one Breen P@RSONALaADV aUURY 3 2,000,00o@N@RALAocRecATe 300000 08NL AOOR60ATE PUes PER: PRODUCTS•CQSIPMP AOOPOL LOC 0009274 TK012014 20.6B AVFDMOaIIfi LIMIBODILY INJURY(Per PON") i ANY Auto AALyL OYSE0 OBU.EC SOOM1Y INJURY IPer saddenp✓ HREDAlto$ �09�D .�•.� '. It y -- uMa1181. LIPS. OCCUR encnocctPzaeNce 3 excess UAD C'LARAWWADe ADGREOATE 3 3. D 8 O -- C WORxegaDOMPSHOATION 08000B•OB8000&2.16 03!0112016 I 0 0 018 MeeMPL0Y3Rs'UMIUTY It N G.L. ACOIOHM, __ t 500,01 ANY PROPr3ETWWMIIGRExeGumf pACN, r ...__.� OFFICBWMEMSERER:WDED7 LJ NIA E.L.DP3EAS8•@A eMPLOY@E 600,01 I ndelerYlp NH1 500,01 s 8tR wAbe NPP E.L.DieEA62'POLICY WAT i RAfIONS below DESCRIPTION OF OPgRATIeNs I LOCATIQNe F VeHICLOI IM.0 ACORD tet.Addlllvnel Rc merke Schedule.Il mecc epee.1.required) Proof of Insurance - • , T - CERTIFICATE HOLDER _, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Peter Ryan and Son Rooting,Ino THE EXPIRATION DAT% THEREOP, NOTIde L WILL an DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 383(Rear)Lowell Street Suite 20 nunloRlzea aaI aeseamnve WakelvaBeld,MA01880 lU�j - dJ 1886.2010 ACO RD CORPORATION. NI rights reserve, ACORD 26(2010100) The ACORD name and logo are registerod marks or ACORD Poo LICENSURE Peter Ryan and Son Roofing, Inc. MCC 178871 Peter Ryon . 14 rr3�n7Y1•mmexnuv/GI,,/ r(Lr..nd'u�/A Llaoowmroylllrnemwnpd Nrindlwdnl ao only .t . 0111Mdr(:awomA hRoM dllwkAwllRlalallon bnlbra 1110 axplrnNnn tlnlw'rr NnaJ return la OMe1Mzoveme" OONIRAOTOR TjPor ONoenrcananmer Allton and Oudneec lNPdnllun Iatmllanf WltoTt OmdernOon 10I-ark 11111 ,$914 5170 'InOont oaofrolo; _ Ilarmn,MA Ot1'l4 Pare RYAN o6ON'AaOYIN0,IN0, reran RYAN "� . . '• 701 IRNARI LOWP.LlaT.OUNP.t xY'..r. • rh�= Nm vnllJ wit tlynnlnra 91AWIFL0,MA01510 Uedrrnerelery _ Massachusetts Department of Public Safety (l7_J3 Board of Building Regulations and Standards License: CSSL-108054 Construction Supervisor Specialty PETER RYAN 077 LOWELL STFIE . WAKEFIELOMr401 - 'I, P_-jzC;z l.Jl._.- Expiration: ' Commissioner - 0511712015 Construction Supervlso S _ Restricted to: specialty . CSS4RF_Roofing 1 , Failure to possess a current edition Of the Massachusetts . State Building Code is cause/or revocation o/this license. OPS Licensing irt/ony,etion visit: WWW.MASS.Gov/D.Ps .. a J 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 ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage O 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: 183 Federal Street Name of Record Owner: Jeff Schmidt Description of Work Proposed: Reroof with IKO Cambridge Collection shingles in the color Harvard Slate, as has already been completed Dated: January 22, 2016 SALEM HISTORICAL COMMISSION By: IU/�/ The homeowner has the option not to commence the work (unless Velates 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.