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0007 BOTTS COURT - BUILDING JACKET C' 7 BOTTS COURT t � ' 1 JUN 21 o 911 '09 CtU of �$ttlPm, C tssstttl�use##��� , �s �Battrb of hopers! Re,c,m.wit' DECISION ON THE PETITION OF PETER AND JEANNE KEMPTHORNE for FOR A SPECIAL PERMIT AT:�7-EOTTS`COURT'(R=2) A hearing on this petition was held June 14, 1989 with the following Board Members present: James Fleming, Chairman; Richard Bencal, Vice Chairman; John Nutting, Secretary, Edward Luzinski and Richard Febonio. Notice of the hearing was sent to abutters and others and notices of the hearing were properly published in the Salem Evening News in accordance with Massachusetts General Laws Chapter 40. Petitioners, owners of the property, are requesting a Special Permit to allow construction of a deck/porch in this R-2 district. The provision of the Salem Zoning Ordinance which is applicable to this request for a Special Permit is Section V B 10, which provides as follows: Notwithstanding anything to the contrary appearing in' this Ordinance, the Board of Appeal may, in accordance with the procedure and conditions set forth in Sectioi VIII F and IX D, grant Special Permits for alterations and reconstruction of non- conforming structures, and for changes, enlargement, extension or expansion of nonconforming lots, land, structures, and uses, provided, however, that such change, extension, expansion or enlargment shall not be substantially more detrimental than the existing nonconforming use to the neighborhood. In more general terms, this Board is, when reviewing Special Permit requests, guided by the rule that a Special Permit request may be granted upon a finding by the Board that the grant of the Special Permit will promote the public health, safety, convenience and welfare of the City's inhabitants. The Board of Appeal, after careful consideration of the evidence presented at hearing and after viewing the plans, makes the following findings of fact: 1 . No support or opposition was presented. 2. The proposed addition would be used as a second means of egress. 3. There is currently a six foot drop from the rear of the house to ground level. On the basis of the above findings of fact, and on the evidence presented, the Board of Appeal concludes as follows: 1 . The relief requested can be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. Therefore, the Zoning Board of Appeal voted unanimously, 5-0, to grant the Special Permit requested, subject to the following conditions: DECISION ON THE PETITION OF PETER AND JEANNE KEMPTHORNE FOR A SPECIAL PERMIT AT 7 BOTTS COURT, SALEM page two 1 . All construction be done as per existing City and State building codes. 2. All construction be done as per the plans submitted and by legal building permit. 3. Petitioner obtain a Certificate of Appropriateness from the Salem Historical Commission. SPECIAL PERMIT GRANTED ��� ichard A. Bencal, Vice Chairman A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal frcm this decision, if any, shall be made pursuant to Section 17 of the Mass. General Laws, Chapter 808, and shall be filed within 20 days after the date of filing of this decision in the office of the City Clerk. Pursuant to Mass. General Laws, Chapter 808, Section 11, the Variance or Special Permit gr-anted herein shall not take effect until a copy of the decision, bearing the certi fication of the City Clerk that 20 days have elapsed and no appeal has been filed, or that, if such an appeal has been filed, that it has been dismissed or denied is recorded in the South Essex Registry of Deeds and indexed under the name of the owner of record or is recorded and noted on the owner's Certificate of Title. Board of Appeal. SUILgIFdG DEi>7 9 RAT PH F69 pfulyn CITY OFMEM� Salem Historical Commission CITY HALL. SALEM. MASS. 01970 744-4580 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed construction (xr ; reconstruction ( ) ; demolition ( ) ; moving ( ) ; alteration ( ) ; painting ( ) ; sign or other appurtenant fixture ( ) work as described below in the . .. McIntire Historic District (NAME OF HISTORIC DISTRICT) Address of Property: 7 Botts Court - Name of Record Owner: Jeanne & Peter Kempthorne DESCRIPTION OF WORK PROPOSED: . Addition of porch to rear of house as shown in plans submitted dated 4/29/89. will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic Districts' Act (Federal Laws, Ch. 40C) and the Salem Historical Commission. Dated: May 18, 1989 SALEM HISTORICAL COMMISSION By ZZ Chairman cc: Building Inspector wi City Clerk \\�Gt�¢wF.�•r Salem H" toy°I co ission CITY HALL. SALEM. MASS. 0I970 744-4580 CERTIFICATE OF'APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed construction ( x) ; reconstruction ( ) ; demolition ( ) ; moving ( ) ; alteration ( ); painting ( ) ; sign or other appurtenant fixture ( ) work as described below in the . .. McIntire Historic District (NAME OF HISTORIC DISTRICT) Address of Property: 7 Botts Court Name of Record Owner: Jonathan S. Horwitz DESCRIPTION OF WORK PROPOSED: To construct a landing and staircase on the rear (east) facade approximately 12' long by 7' ' deep. will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic Districts' Act (Federal Laws, Ch.. 40C) and the Salem Historical Commission. Dated: April 25,1986 SALEM HISTORICAL COMMISSION By. Chairman _ Salem Historical Comm Isslon' ,Li, �l1 CITY HALL. SALEM. MASS. oe�o <crenE SEP 17 1124 RIM 'B5 RECEIVED CITY OF SALEM,MASS. CERTIFICATE OFF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed construction [ ] ; reconstruction [x]; demolition [ ] ; moving [ ]; alteration [ ] ; painting [ ]; sign or other appurtenant fixture [ ] work as described below in the . . . McIntire Historic District. (NAME OF HISTORIC DISTRICT) � A a d r e s s of Property: 7 Batt' s Court _ Name of Record Owner: Jonathan S. Hn „r7 and Patricia D. Kravtin DESCRIPTION OF WORK PROPOSED: Replace roof with Georgia Pacific Sable Black Blend Asphalt; remove rusted metal between flat and sloped roofs and replace with wood and crown molding (to be painted trim color) ; and to install two small skylights on flat of rear of house 38" X 21" (TPS-6 Velux) . Also to remove roof hatch and cover. will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (Federal Laws , Ch. 40C) and the Salem Historical Commission. Dated: September 17, 1985 SALEM HISTORICAL COMMISSION Bye,< -,- Chairman CC: /Building inspector K,LLXCity Clerk Otli Av If Salem. Historical Commission �J '\ CITY HALL. SALEM, MASS. 01970 M1 '`FCUfIhL� CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed construction [ ]; reconstruction [ ]; demolition [ ]; moving [ ]; alteration [ ]; painting [x]; sign or other appurtenant fixture [ ] work as described below in the , . . . McIntire Historic District. (NAME OF HISTORIC DISTRICT) . Address of Property: 7 Botts Court Name of Record Owner: Jonathan S. Hnrwita and Patricia D. Kravtin DESCRIPTION OF WORK PROPOSED: Exterior painting - Window and door trim to be white, shutters to be black and door to be Morristown red. Body of house to remain Plymouth gray. will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (Federal Laws , Ch. 40C) and the Salem Historical Commission. Dated: July 31, 1984 SALEM HISTORICAL COMMISSION By :7 ? Chairman y „ •^1J The Commonwealth of Massachusetts Board of Building Regulations and Standards \� I CITY Massachusetts State Building Code 780 CMR 7 edition OFSA LEM Revised January �\\ Building Permit Application To Construct,Repair,Renovate Or Demolish a 1 2008 111 One or Tw a 'ly Dwelling _­ !rt,. =6=:'°T ' etiofi F Official Use Only . �::^`” �_.. BuldingPernitNumber. .•.....,s J. --- ate Applied wa Signature _: NH: -- P .,.° 9 Building Coaunissioner/Ins et uildi Date - '" ` 114' I 9 !(„.,,:;„SEC 1:SITEINFORMATION :),s 1.1 Propel'tVre ^� 1.2 Assessors Map& Parcel Numbers L la Is th_iiss an accepted street?yes k no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use - Lot Area(sq R) Frontage(ft) 1.5 Building Setbacks(it) Front Yard Side Yards Rear Yazd 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❑ F{°: ,.,) SECTION'2'PROPERTYOWNERSHW,, 4�=u.: In s "... 2.1 QAnerl of Reco d: /r e fe Na 'nt) - Address for Service: Si ure Telephone SECTION 3: DESCRIPTION OF,PROPOSED WO (check all that a`pply), `�r, New Construction❑ Existing Building ly Owner-Occupied Repairs(s) ❑ 1 Alteration(s) qi Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work2: gewaAttm- c 3 SECTION 4:ESTIMATED CONSTRUCTION COSTS I[em Estimated Costs: y a, r •' E 'h":1e �-� serg 4 EM Official Use Only G - Labor and Materials) - 1.Building $ .J 4M A. Building Permit Fee:$ Indicate how fee is determined ❑Standard Crty/Town Application Fee , s , t 2.Electrical $ - - 3 , ❑Total Project Cost.(Item 6)x Imuhipher i x a 3.Plumbing $ 2 er Oth Fees $ 4.Mechanical (HVAC) $ OO List ' s r 5.Mechanical (Fire $ Total All Fes $e '° Suppression) I Check No Check Amount 7 au Cash Amount 6. Total Project Cost: W13 D ® ❑Paid infull .,7.g='❑Outstanding Balance Due sF " SECTION 5!"'CONSTRUCTION SERVICES' 6 ' .F 5..11-p-Lic/e/psed CLo^/nstrruu'ctii/on� Supervisor(CSL) B71, f T // �(�(e. License Number EtxUpiration Date Name of CSL-Holder p List CSL Type(see below) Add o .,.. . _ ... _ U Unrestricted(up to 35,000 Cu.Ft.) R Restricted 1&2 Family Dwelling }�T �+ L M MasonryOnly 6` 77 - RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Regi�ste/r.ed Homg[m"prov rnYenttSontractor(RIC) CO�twrovI`t HIC Co m �n N��t�ee or HIC�Aty is t N e Registration Number y 3*rtvt ref gash Ad s y Expiration Date Sign re - ,,, - Telephone a . . ..... .. : * .,a as 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 aTO BE COMPLETED WHEN i ,"OWNER'--SI'�AGENTOR CONTRACTOR'APPLIES FOR BUILDING PERMIT a RAW as Owner of the subject property hereby authorize ofte to act on my behalf, in all matters relative to work authorized by this building permit application. Si ure of OwnerAr Date T. SECTION 7bOWNERi:OR'AUTHORIZED AGENT DECLARATION ... .. I, ✓ h L4eue ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. /Lt't Print Nam Signature of wrier or AuthorifEd Agent Date _LSigned,u4er the pains and penalties of a 'u Ito 34tx:­ 1 110 g MN NOTES. - _ __AM ATI 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(I-IIC)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 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(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" i CITY OF SM.EN4 l LAxSSACHUSETTS BtiII.DLNG DEPARTMENT ,{�• 120 WASHINGTON STREET, r FLOOR dr TEL (971)745-9595 FAX(978) 740-98" KINIBERLEY DRISCOLL MAYOR TrioASAS Sr.PIERRS DIRECTOR OF Pt:BLIC PROPERTY/BUILDING COMMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Antillicant Information l a Print Legibly Name(tiusineswOrganizationrindiv I): u-Q(/ (`£ Address: 7 / �t City/State/Zip: hone rE: 72�E ( r� C T l Are you an employer?Cheek the appropriate box: Type of project(required): 1.g 7 1 am a eatp to with� 4. ❑ i am a general contractor and I ` (full and/or pan-time). • have hired the sub-contactars 6. ❑New construction employees 2.❑ I am a sole proprietor or panner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have & ❑Demolition working for me in any capacity. workers'comp,insurance. 9. ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL t L EI Plumbing repairs or additions myself.[No workers'comp. c. 152.§1(4),and we have no 12.0 Roof repairs insurance required.]1 employees.[No workers' 13.❑Other comp.insurance required.] 'Any aPpli"11 that checks box NI most also fill out the section tclow stowing their workns'compensation policy infom ation. i I lnnreowrtns who submit this affidavit indicating they am doing all work and that hill:ou sick contractors most submit a now affidavit indicating such :Contractors that check this box most attached an additional sheet showing the name of ao zub•wnire smra and their workers'comp.policy infom aimut. I am an employer that is providing wor rxr co pensadon Insurance for my employees. Below Is the polley and Job site information. e. Insurance Company Name: Policy k orScif-ins. Lic.H: C k-A/ /r� © Expiration Date: �f Job Site Address: CL l Ciry/State/Zip: G 6-t Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i do hereby verd t er the pales a of perjury that the information provided above is t and correct. ' I tr ' '-7 Date- phone I X• 71 �..., OJJlchd use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License q 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 q r CITY OF S.U.EM, AN'L-1ss xcHUSETTS BUILDING DEPARTJI&NT 130 WASHLNGTON STREET, 3" FLOOR TEL (978) 745-9595 FAs(978) 740-9846 KI�>$FRt RY DRISCOLL ;MAYOR THOM AS ST.PtERRE DIRECTOR OF PUBLIC PROPERTY/BUUMING CONMIISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: ( 01,4a I - (name of hauler) The debris will be disposed of in �Ginri��- (name of facility) (adcf ess of facility) Sign ature of permit applicant date JebrivfT.Jn1: $-7 -7 S The Commonwealth of Massachusetts Board of BuildingRegulations and Standards CITY OF + h Massachusetts State Building Code, 780 CMR SALEM Revised 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: Date plied: 17 b Building Official(Print Name) Signature D SECTION 1: SITE INFORMATION 1.1 Property.Address: 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 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 OWNERSHIP' 2.1 O ner'oef Rd -713p � �/:r Name(Pint) City,State,ZIP �y (l7- ?93 No.and tre et Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s)Ji Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work2: r a 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: 2.Electrical $ ❑Standard City/Town Application Fee ❑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: $ /U, /Z ❑Paid in Full ❑Outstanding Balance Due: rn � SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C'S 1' License Number jJ Expiration Date Name of QSL Holder List CSL Type(see below) lJ No.and Street J Type Description /2 U Unrestricted(Buildings up to 35,000 cu.ft. �J R Restricted 1&2 Family Dwelling City/Town,State,ZdP M Mason ry RC Roofing Covering �jj WS Window and Siding SF Solid Fuel Burning Appliances CC41 I Insulation Telephone Email address D Demolition 5.2 Re istered Home Improvement Contractor(HIC) 'gO P/1 AO/e HIC Registration Number Expiration Date HIC Company ame or HIC Regi grant Name No.a d S eet, Email address t /M�r �r�s9y ii3� Ci /Town tate,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 ........e.-e 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 >f to act on my be in all matters relative to work authorized by this building permit application. r Pri t Owner's Name(Electronic Signature) ate 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 and accurate to the best of my knowledge and understanding. Print Owner's or AutlYbrized Agent's Name(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/dam 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" VA- The Commonwealth of ivlassachuiett 'r# ` Wh" Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, JJff� 23 SALEM DI►— A Rewisecl,llur 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a (-` One-or Two-Family Dwelling This Section ForOfcial Use Only Building Permit Number: Date.A1110 d: ( 1 Building Official(Print Name). Signature Dat SECTION 1:SITE INFORMATION: 1.1 Property Addres 1.2 Assessors,Nlap&Parcel Numbers S , _le,,r MIS L l a Is this an accepted street?yes no Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: "Luning District Proposed Use Lot Arca(sq 11) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required L 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? I'ublicJiiC- Private D Check ifyeso Municipal MOn site disposal system C3 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner' f Record: .4gG s ?+ }yTtie 4 C41 NN me(Print)(,41+,-'�vr1Ar /- 1,, I rl City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building Z Owner-Occupied•ff I Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': 'rt n u , -wt y SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: OfQcial Use Only Labor and Materials 1. Building S I. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee D Total Project Costs(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S q.Mechanical (FIVAC) S List: 5. \lechanical (Fire Su ressiun) "['oral All Fees:S Check No. Check Amount Cash Amount: 6. Total Project Cost: S j 50c, ❑Paid in Full ❑Outstanding Balance Due: 4 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name ofCSL Holder List CSL'type(see below) No. u►J Sheet Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/ibwn,State,ZIP ,M Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date I IIC Company Name or HIC Registrant Name No.and Street I Email address Ci /Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G4L c.ISZ.4 2SC(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 Istuance of the building permit. Signed Affidavit Attached? Yes..........❑ No...........0 SECTION 7a:.OWNER AUTHORIZATION.TO BE COMPLETED WHEN., - OWNER'S AGENT OR CONTRACTOR APPLIES`FOR 1BUILDING PERMIT [,as Owner of the subject property,hereby authorize wo'� ie b'y 11J� _ p j L L C- t9 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: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 contait to this, pli ation is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Aggnt's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to Jo his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will aut have access to the arbitration program or guaranty fund under 1W.G.L.c. 142A.Other important information on the HIC Program can be found at w►v%v.msss.gov'oca Information on the Construction Supervisor License can be found at www-ma;s.,ov/tins 2. When substantial work is planned,provide the information below: 'total tloor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.it.) 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 fur"Total Project Cost" r0 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 District Address of Property: 7 Botts Court Name of Record Owner: Alexander Marks and Kimberly Tompkins Description of Work Proposed: Cellulose insulation to be blown into walls of building through temporarily removed exterior boards, which are to be returned to existing condition upon completion of work. There will be no changes to the color, material, design, location or outward appearance of the house. (See attached photograph.) Dated: JanuM 27, 2017 SALEM HISTORICAL COMMISSION By: c-.i, —}- 1���4- / 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 of four-i.e. one photograph of each affected fafade). 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.