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6 FEDERAL CT - BUILDING INSPECTION (5) I� The Commonwealth of Massachusetts Il ! W Board of Building Regulations and Standards CITY OF 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 A i : ~ a,)I7 / Building Official(Print Name) gnature Date .1 SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 6 FFDt P�� Coale 2 26- o5o z l.la Is this an accepted street no Map Number Parcel Number 13 Zoning Information:, 1.4 Property Dimensions: -z Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) J 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 Owner[of Record: F6-1&-kAt- Q U-P r K.—Aj Ty "1 R.0 ST— Jo Nn/,q- PERB6,6 •rMA-R 1r—A%QS' SALh"�t, IL4t4 6( 9 7O Name Print ' ( )-TRJ.L$ City,State,ZIP -5'0 Pr A/ -VA--LE AV6r . 7kl-9gy-1579, rc'e4ardsf'm1eP No.and Street &E'A D/WO-, M A O 19-6 7 Telephone Email Address ./ert'oA.r) SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building( Owner-Occupied ❑ 1 Repairs(s))K I Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work2: " 4EP41R OF tV60F 6AI''S Of-- A"SCDe O8 A/• �PA-tR SOF-FtT A-Ab t5h$C1A SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Of Use Only (Labor and Materials 1.Building $ Jr zoo. 00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee !f ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $�✓ 4 Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ J!- ZOO 60 0 Paid in Full 0 Outstanding Balance Due: � 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. City/Town,Stare,ZIP R Restricted 1&2 FamilyDwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) H HIC Company Name or HIC Registrant Name IC Registration Number Expiration Date No.and Street Email address City/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..........13/ 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 (r�Iyl I N l C yT"E2 I G R.S to�act on�my behalf,in all matters relative to work authorized by this building permit application. Print Owner 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 and accurate to the best of my knowledge and understanding. Print Owner's or Authorized 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.eov/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" . lhs R CERTIFICATE OF LIABILITY INSURANCE DAM(MMOD/YYYY) �...� 2i7i2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endomement(s). PRODUCER CONTACT Wally ValdeZ NAME Woodward 6 Higgs Insurance Inc. PHONE Sun. (781)598-3050 FAX .(TSl)596-2423 156 Broad St. lIE . Spite 202 HISURERISI AFFORDING COVERAGE NAACO Lynn MA 01904 INSURERANational Grancie Mutual INSURED INSURER B Gemini Exteriors Inc INSURER C: 54 Kirkland St p2 INSURER D: .SURER E: Lynn MA 01905 INSURER F: COVERAGES CERTIFICATE NUMBER-CL122706457 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSSRR TYPE OF INSURANCE A POLICY EFF POUCYEXP POLICY.NUMBER MM DrrrM (NINLIDE11YYYY1 LIMITS GENERAL LWBIUTY EACH OCCURRENCE_ S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oaunence $ 500,000 A CWMSMADE OCCUR 0272N /4/2011 /4/2012 MED EXP(My one Person) S 10,000 PERSONAL4ADVIWURY $ 1,000;000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY PIFQT RQ LCC $ AUTOMOBLLE LIABILITY COMBINdEMSINGLE LIMIT -I1000 OOO A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED x0272N /4/2011 /4/2012 BODILY INJURY(Per aawem) $ AUTOS AUTOS }( NON�OWNED PROPERTY—DAM-AZE HIRED AUTOS AUTOS Per accident $ Uninsmea motorist Blslit limit $ 100 300 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EKCESS Me CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION WCSTATU- x OTW AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE❑ NIA EL EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Nlanddury in NH) 0272N /4/2011 /4/2012 E.L DISEASE-EA EMPLOYE $ 11000,000 If yes,describe uncer DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 11000,000 A Business Personal Prop 0272N /4/2011 /4/2012 $10000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Aaach ACORD 101,Additional Remarks Schedule,if more apace Is required) Any Person or Organization including Certificate Holder is additional insured if written signed contract, agreement, or permit to such exists prior to loss subject to form indicated above in General Liability section. CERTIFICATE HOLDER CANCELLATION geminiexteriorsinc@gmail.c SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mary Richards ACCORDANCE WITH THE POLICY PROVISIONS. 6 Federal Court Salem, MA 01970 AUTHORIZED REPRESENTATIVE ally Valdez, CIC CISR ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 emimsi nt The ar npn name a.A Innn aro ronieforeH make of Ar nian e' 9hG7P1�g q�N� ' Salem Iffist®rical 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 Address of Property: 6 Federal Court Name of Record Owner: Joanne N. Peabody& Mary F. Richards, Trustees of Federal Court Realty Trust Description of Work Proposed: Reroof south side of barn and repair soffit and fascia to replicate existing. No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind maintenarxeeh•eplacenaent. Dated: January 27, 2012 S I AL COMMISSION 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. 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. �._„ j� .. _ -----rat..---+.: _• r. Office of Consumer Affairs * Busincss Regulation HOME IMPROVEMENT CONTRACTOR Q Registration:: B349 Type: Affil Expirations ' 013 Private Corporat c EII E7 E J F^ ENRI E REYN LYICIN, MA 01901 _ Undersecretary w Y 1 � I Office 6f Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Regl tration: 63496 Type: Expiration:: 13 Private Corp orat c E 14r+1 a I EXTE 10. r 202 BLOSSOM ST",Ei Dry 7 � f' LY 1 1 MA 01901