55 WARREN ST - BUILDING INSPECTION The Commonwealth of Massachusetts y PEMOHALSERVICES
asa� Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 C S DEC 2 Z P �.y SALEM
,,/� 1 ed Mar 2011
UV Building Permit Application To Construct,Repair,Renovate Or Demolish a
O One-or Two-Family Dwelling
This Section For Official Use Only
i Building Permit Number: Date Applied:
/1 Building Official(Print Name) Signature Da,
—®! SECTION 1: SITE INFORMATION
} 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
55 Warren Street 25 0173
l.la Is this an accepted street?yes,__x noMap P Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: 80'41
Residence 2 _11,3�
Zoning District Pro—pose Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Provided
15' 10' 10'-8", 24'-3 15' 84'-6"
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public M Private❑ Zone: _ Outside Flood Zone? Municipal® On site disposal system ❑
Check if yes®
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Richard Jones, Naomi Cottrell Salem MA 01970
Name(Print) City,State,ZIP
55 Warren Street 978-594-5202 nao 1 @michellecrowley-la.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building M Owner-Occupied W I Repairs(s) ® 1 Alteration(s) M I Addition ❑
Demolition ® 1 Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
IF Description of Proposed Work": emolition of existing vestibule and trellis at front door- roof
and columns to remain In-kind replacement of existing brick landingstairs and cheek wall -
with�ranite veneer cheek walls and solid granite risers Reuse of the existing faoiings is
anticipated. Contractor to provide temporaly shoring of roof and columns.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ 30,000 1. Building Permit Fee: $�_Indicate how fee is detemrined:
❑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 $ Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount:
6,Total Project Cost: $ 30,000 ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-044005 09/06/2017
Fred Anderson License Number Expiration Date
Name of CSL Holder
45 Stagecoach Road List CSL Type(see below)
No.and Street Type Description
Lancaster, MA 01523 U Unrestricted(Buildings u to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
978-422-6500 fred(a)-andlc.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 130911 5/4/2016
Anderson Landscape Construction Inc. HIC Registration Number Expiration Dace
HIC Company Name or HIC Registrant Name
4everl
By Drive fredlaandlc.com
and Street
Sterling, MA 01564 978-422-6500 Email address
Ci /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 .......... ® No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize Anderson Landscape Construction Inc./ Fred Anderson
to act on my behalf,in all matters relative to work authorized by this building permit application.
_ 12/22/15
Print Owner's Name(Electronic 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.
12/22/15
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/dks
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"maybe substituted for"Total Project Cost"
n Massachusetts Department of Public Safety
. . 'Board of Building Regulations and Standards
License: CS-044005
jConstruction Supervisor
- FRED ANDERS(A
45 STAGECOACH
CC LANCASTER M)V 0'1
/n' 0
lzu 12141— - Expiration:
I Commissioner 09/0612017
I�r V/ze rOo4nmwntisea. Regulatiivael�l
r
� - � O11ice of Consumer At7am&Busmesa Regulation
ME IMPROVEMENT CONTRACTOR Type:
egistraUoni.. i p9�11 Private Type:orpoalio'
pi L6
LiCTION-INC. .
ANDERSON LANDSeW - i� !I
4 FRED ANDERSON f
68EVERLYDR.
STERLING,MA 01564 Undersecretary
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual insurance Company
54 Third Avenue,Burlington,Massachusetts 01803-0970
(800)876-2765 NCCI NO 26158
POLICY NO. 1 VWC-100.6018564.2015A
PRIOR NO. I VWC-100.6018564.2014A
ITEM
1. The Insured: Anderson Landscape Construction Inc
DBA:
Mailing address: Po.Box 930 FEIN:'•=062311
Sterling,MA 01564
Legal Entity Type: Corporation
Other workplaces not shown above: See Location
2. Tho policy period is from OtAW015 to 05/15/2016 12:61 a.m.standard time at the Insureds mailing address.
3. A. Workers Compensation insurance:Part One of the policy applies to the Workers.Compensation Law of the
stateslistedhoim MA
S. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed In item 3.A.
The limits of liability under Part Two are: Bodily Injury fly Accident $ 1,000,000 each accident
Bodily injury by Disease S 1,000.000 policy limit
Bodily Injury by Disease $ 1;000.000 each employee
C. Other States insurance: Coverage Replaced by Endorsement W020 03 06 8
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for thispoliccyy will be determined by our Manuals of Rules,Classifications,Rates and Rating Pians.
Alf Informationrequired below Is subject to.verification and change by audit.
Classifications Premium Bass Rates
Code Estimated perslo0 Estimated
No. Total Annual Of Annual
Remuneration Remuneration ProrNum
INTRA 327725
INTER SEE CLASS CODE SCHEDUX
Minimum Premium $575 Total Estimated Annual Premlum $56,898
GOV GOVDeposit Premium $14,915
.
STATE CLASS State AssossmentslSurcharges
MA 1 42 $47.562AO x 5.8000016 $2,759
This policy,including,all endorsements,is hereby countersigned by 05/05/2015
AUVWdZedsIgnature- Date
Servico Office: Siver Insurance Agency Inc
54 Third Avenue PO Box 398
Burlington MA 01803 South Lancaster,MA 01561
WC 000001 A(741)
Includes eopyriahted material or the National COLInell on Compensation Insurance,
used with Its permis;Ion.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.govldia
1F'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERtYIITTING AUTHORITY.
Applicant Information Please Print Le ibly
Name (Business/Orgmr zation/Individual): A/L-1 D TCz cJQ-60C—(
Address: 1iJZJLc I�( Y S i�zJLL�`t /�'C
City/State/Zip: Phone k "do S— 2 3 1
Are you an employer?Check the appropriate box: FMO
project(required):
I.V(I am a employer with employees(full and/or pan-time).* w construction
2.Q I am a sole proprietor or partnership and have no employees working for me in Remodeling
any capacity.[No workers'cornp.insurance required.] g
3.Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required]t molition
4. 1 am a homeowner and will be hiring contractors to conduct all work on m ilding addition❑ $ y property. 1willensure that all contractors either have workers'compensation insurance or are sole ectrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached Sheet.
These sub-contractors have employees and have workers'comp.msumnce.; 13.E]Roof repairs
6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other_
152;§1(4),and we have no employees.[No workers'comp.insurance required.]
.Any applicant that checks box#1 must also fill out the section below showing their workers"compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-'contractors have employees,they must provide their workers'comp.policy number.
I am an employer,that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. AA -
Insurance Company Name_J"tj L A/1 0 l L144 C—
Policy#or Self-ins.Lic.#: i!i.JC- —I - ae,oi 55 slat.] ^ Z O 1,� Expiration Date: 1 Z'71
Job Site Address: �Vt � �2�2e2 // �� City/State/Zip:--,5/\C_We-11� AA,&
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certify un a pains antipenahles of perjury that the information provided above is true and correct.
Signature: ate: I Z- .Z41-10--
Phone#:
417✓-
Phone#: Z-3( —
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.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 of hire,
express or implied,oral or written."
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 occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such 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 the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
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)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)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 may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 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-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure 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 pe-mit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/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 proof that 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 fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-NIASSAFE
Fax #617-727-7749
Revised 02-23-15 www.mass.gov/dia
CITY OF SALEM, MASSACHUSETTS
BUILDING INSPECTOR
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
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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 JK 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_ 55 Warren Street
Name of Record Owner: Richard Jones &Naomi Cottrell
Description of Work Proposed:
Use of granite in lieu of brick for stair and cheek wall material at the front stoop and for the stair at the sidewalk
edge, elimination of the vestibule and trellis structure additions, reduction of the size of the front stoop to be
consistent with the original construction of the house, adding a full light painted wood storm door with
glass/screens at the front door. Work as per exhibits presented.
Dated: December 17, 2015 SALEM HISTORICA ��MMISSION
lGtG%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 thefinal result(maximum offour-i.e. one photograph of
each affected fagade).
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.
C l0
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PROPOSED PLAN BLOW-UP
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�� Scale: 1/4"= 1'-0"
UMichelle Crowley Landscape Architecture, LLC 55 WARREN STREET
281 Summer St, 6th Floor
Boston, MA 02210 Proposed Wall and Stair Renovation
10 617.338-8400 December 22, 2015
www.michellecrowley-la.com
EXISTING TRELLIS TO BE REMOVED
® BRICK CHEEK WALLS TO BE REMOVED,
REUSE EXISTING FOUNDATION
BRICK STEPS(BEYOND)
1_
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EXISTING SIDE ELEVATION
SCALE: 1/8"= 1'-0"
GRANITE VENEER WALLS WITH CAP,
REUSE EXISTING FOUNDATIONS
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GRANITE STEPS(BEYOND)
I I
� PROPOSED SIDE ELEVATION
� SCALE: 1/8"= 1'-0"
® 3"THICH GRANITE CAP
6--l' 1 GRANITE STEPS 7"R, 12"T,TYP.
4'-2„ y
IIFMII
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PROPOSED SECTION L—_J
3
SCALE: 1/8"= 1'-0"
UMichelle Crowley Landscape Architecture, LLC 55 WARREN STREET
281 Summer St, 6th Floor
Boston, MA 02222 10 Proposed Wall and Stair Renovation
10 617.338-8400 December 22,2015
www.michellecrowley-la.com
------------------
------------------
EXISTING VESTIBULE FB ® ® IN
® ®
TO BE REMOVED
BRICK STEPS
BRICK CHEEK WALLS
EXISTING FRONT ELEVATION
SCALE:
LLJ
FE[71
WOOD STORM DOOR
SOLID GRANITE RISERS
GRANITE VENEER WALL WITH CAP
PROPOSED FRONT ELEVATION
SCALE: tl8"= 1'-0"
UMichelle Crowley Landscape Architecture, LLC 55 WARREN STREET
281 Summer St, 6th Floor
Boston, MA 02210 Proposed Wall and Stair Renovation
16 617.338-8400 December 22,2015
www.michellecrowley-la.com
IFIF
GRANITE VENEER WALLS
® WITH GRANITE CAP
GRANITE STEPS(BEYOND)
i4FL--
-1
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PROPOSED SIDE ELEVATION
Scale: 1/4"= 1'-0"
® 3"THICK GRANITE CAP
GRANITE STEPS 7"R, 12"T,TYP.
3'-0"
— 4,-2„
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PROPOSED SECTION
2
Scale: 1/4"= V-0-
Michelle Crowley Landscape Architecture, LLC 55 WARREN STREET
281 Summer St, 6th Floor
Boston, MA 02210 Proposed Wall and Stair Renovation
617.338-8400 December 22,2015
www.michellecrowley-la.com