005A DEWEY DRIVE - BPA-16-782 JACKET The Commonwealth of Massachusetts""
Board of Building Regulations and S ItF* CITY OF
Massachusetts State Building Code;71Y'�fR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair, ioy a(013AAX
'V One- or Two-Family Dwellinu�t u"
(�O This Section For Official Use Only
Building Permit Number: Date Oplied.
Building Official(Print Name) Signature VDate
1 SECTION 1: SITE INFORMATION
1.1 Prope y�dCeSz 6r 1.2 Assessors Map&Parcel Numbers
� �
1.I a Is this an accepted streeh 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 OwnOwn/q�6r,I of Re
Name(Print) City,State {',
; Iigy
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(cheek,50 that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) RriAlteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units tpther ❑ Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor and Materials
I. Building $ 1. Building Permit Fee: $ dicate 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: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ ❑Paid in Full ❑ Outstanding Balance Due:
Mr"('--En l N Si m 711,t
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License
Liceense(CSL)
I- -t.` License Nu er Ex ion Date
Name of CSL Ho der
C5 /) ,L List CSL Type(see below)
No.an TT��eet �//Y-Ikr/ Type- Description
' )n t _z1 - U Unrestricted(Buildings u to 35,000 cu.ft.
)k% R Restricted 1&2 FamilyDwelling
City/Town,State7IP M Masonry
RC Roofing Covering
WS Window and Siding
�- SF Solid Fuel Burning Appliances
I I Insulation
Telephone Email address D Demolition
5.2 Registered Ho a Im ovemen Con tor(HIC) (�/may Jy�
HIC Re s iotiaC n Number Ex rat n ate
HIC Co N or RW'
No.an t - - Email address
City/Town, State,ZIP Yelephone
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 .......... ❑ ❑
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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Cat
Print Owner's Name(17lectrodic Signature) Date
SECTION 7b: OWNERS 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 a of standing.
Print Owner's or Authorized Agent's Na at
NOTES:
L 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 mLA .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"
American Properties Team, Inc.
TO: 5A Dewey Drive
FRONE Jennifer Pappas,Property Manager
RE: Window/Slider Replacement
DATE: June 28, 2016
Please be advised that the Board of Trustees for Pickman Park has approved replacement
windows and slider for the above referenced unit. This approval is contingent upon them
matching the existing windows/slider and that they fit in the existing opening. Installation of the
windows must be completed from the interior of the unit and they must be the same in
appearance from the exterior. The new windows are not to have grids, crank outs,etc. In
addition,the Board will not allow grids, etc. in the slider unless they are removable. Please note
that you will be responsible for any damage that your contractor might cause(this includes
painting). Should you contractor find any rot or damage during the window/slider installation,
please make sure that it is reported to my office immediately.
We also require that permits be pulled in advance(regardless of what your contractor may tell
you), and then.a copy of the final approved permit once completed must be sent to APT for the
unit file as well. We also recommend that owners obtain a certificate of insurance from the
licensed contractor.
You will need to bring a copy of this letter to the Salem Building Department in order to receive
your permit.
Should you have any questions or require additional information,please feel free to call me
directly at(781)569-2675_
cc: Unit File
500 WEST CUMMINGS PARK-SUITE 6050- W08URN NIA-01801-781,932-9229 FAX 781-935.4289