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6 FEDERAL CT - BUILDING INSPECTION (6) The Commonwealth or Massachusetts Board ul'Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7'"edition OF SALEM r Revisrd Ju.rmvt• Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Sectio For ORcial Use Only Building Permit Nu r`:�_� Date Applied: O� l ,'7 Signature: Ar �"", - //aF/w Building ummissia r/ taro[Buil Date SECTI 1:SITE INFORMATION I.t Props�r Address 1.2 Assessors Map& Parcel Numbers (o F-e era.e C!o-Lr� I.I a Is this an acts ted street?yes no Map Number Parcel Number �� IJ Zoning lofarmatbn: 1.4 Property Dlmensloos: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) I.s Building Setbacks III) From Yard Side Yards Rev 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 O Private O — Cheek if esO Municipal O On site disposal system O SECTION 2: PROPERTY OWNERSHIP' I Owner'of Record: /vanna N. Pbx dcwA tja.rz F. f&CAa JS, �O FR a2 C°�xt� �a QQm Naam"e�(Print) Co -(7%,rS+�g �— Address for Service: Sign Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction O Existing Building O Owner-Occupied O 1 Repairs(s) O Alteration(s) O Addition O Demolition O Accessory Bldg.Cl Number of Units_ I Other O Specify: tier Description of Proposed Work: /Y bu i(d .rOUA4 Z_h fh d fV sCV_L , o(.00n d- k ft,� Q(O SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: OMCISI Use Only Labor and Materials I. Building S 7<0(J I. Building Permit Fee: f Indicate how tee is determined: O Standard City/Town Application Fee 2. Electrical S , O Total Project Cost (Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S f ,\ 4. Mechanical (IIVAC) S List: S. Mechanical (Fire S Suppression) Total All Fees:S Check No. Check Amount: Cash Amount: Qi 6. Total Project Cost: '7'SOD 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES ' 5.1 Licensed Constructlon Supervisor lCSL) 6267g r 28 dL I.iccnse Number Expinluun Dale Name ut'CSI.• I lulder I.ist C. -type(see below) L.( 3 Z C fVt f3f.R--1�sJ R-� r lyercri ion rid �! (Q�'f /� d 016 3 u unmtri.ted(uptoys.000 Cu.Ft. R I Restricted Id2 Farnfly Dwellin Onl S' u i/ / M Masonry al R RC Residential Rooting Covering s cplame I WS I Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installation G7�' .fj• g 9 . 7 21 D Residential Demolition S. RegbferedHomelmprovemesfContnetor(HIC) G.Jc— I IIC Co.mQarty Name ur HIC Registrant Name Registration Number V,K//r t AJJresa3 _ n£lvt'S 4/c.7_r'A 'rO�S�ic/O � Espirntion Dale Signal .� 'rcltpv 2 L SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. ISL 23C(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 .......... O No...........0 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION 1 Q{t C¢Q L-e,C ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and behalf. Print w��Af$/2c /x�S�jd6f O St ature of Owner or Authorized Agent Dale Si under the sins and penalties of 'u 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 ad 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 790 CMR Regulations I IO.R6 and I IO.RS,respectively. �. 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 ). "Total Project Square Footage" maybe substituted for"Total Prnject Cost" ;'�r±e lOmminniearvrs�� n .^��Nsc�euarl«. Board of Bailding Regulatio s:m(1 Standards I HOME IMPROVEMENT CONTRACTOR - �.. Registration: 123610 Expiration: 3/14/2011 Tr# 282213 Type: Private Corporation D.W. Philpot Co.INC - Daniel Philpot _ 32 Pemberton Rd Topsfield,MA 01983 Administrator ubli Department ,\►assuchusetts- Rc uLtt itns :md Stundar(Is 1 Board of Building Construction Supervisor License License: CS 62079 ' Restricted to: 00. „ DANIEL W PHILPOT .. y 32 PEMBERTON RD TOPSFIELD, MAOJ983 Exp,ration: 1/28/2011 oi�� iy fj� Tr#: 10963 4 .;; CITY OF SALEM 5 PUBLIC PROPRERTY DEPARTMENT \I „ I; 1 ': \\ r.III\ •. "Jldl.l r � �.\II \I, \l.\ i 11 .. I .I1 . I11 '1'8 '1;.•/;4S � { \\: 'i Jg.'J:'rih Construction Debris Disposal Affidavit (required lix all demolition and renoVAiUn work) In accordance ith the sixth edition of the State Building Code, 780 CN1R section 1 1 1.5 Dcbiis, and the provisions of MGL c 40, S 54; Building Permit N is issued with the condition that the debris resulting front this work shall he disposed of in a properly licensed waste disposal I'acility as defined by MGL c I 11. S 150A. The debris will be transported by: (home(it hauler) The debris will be disposed of in e7 2Z C-//o (nume ul lanhty)... (address ut Iaci ilv) - r �1411Jtll/ti nt prnnit.q�phcant IlJle I Salem Historical Commission 120 WASHINGTON STREET,SALEM, MASSA1�RUSETTS 01970 (978)745-9595 EXT. 311 LAX (978) ""40-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem historical Commission has determined that the proposed: ❑ Construction ❑ Movin� Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other wIork as described below does not involve an exterior architectural featu{e 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 Nichols Peabody & Mary Foster Richards, co-trustees Federal Court Realty Trnst Description of Work Proposed: Reconstruction of missing steps to South doors (per 1965 photogrt ph). Repair/replace bulkhead to replicate existing. Non-applicable due to being non-visible from the public way. I Repair windows to replicate existing. Repoim brick work to replill ate existing, with mortar to match in color, thickness and texture. No changes in color, material, design or outward appearance. Non-applicable due to being in kind maintenance/repair. j I Dated: August 23, 2010 SALES ORIC C MISSION By: `I I I 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. Ti-uS 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. 09/02/2010 THU 15:54 FAX IN01/001 acoRoa CERTIFICATE OF LIABILITY INSURANCE DATE(MMOD Vn) t✓ 09/02/2010 PRODUCER 978-887-8304 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION UGONE-JOHNSON INSURANCE AGENCY, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 7 GROVE STREET SUITE 201 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER WESTERN WORLD DW PHILPOT&COMPANY,INC. INSURER B FARM FAMILY CASUALTY INSURANCE P.O.BOX 174 INSURER c. LIBERTY MUTUAL INSURANCE TOPSFIELD,MA 01983 INSURER D_ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 TOALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH rOLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDE POLICY EFFECTIVE POLICY EXPIRATION POLICVNUMBER E M V DA V LIMITS i. GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY NPP1183011 07/10/2010 07/10/2011 PREMISES Ea occurrence $ 50,000 CLAIMS MADE Fx-1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1.000,000 GENERAL AGGREGATE $ 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG $ 1.000,000 X POLICY PCOT RO LOC B AUTOMOSILELIABIUTY COMBINED SINGLE LIMIT $ ANY AUTO POLICY#2001 C50063A 12/11/09 12/11/10 1Ee eccldenU ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ 10Q,000 HIRED AUTOS BODILY INJURY NON OWNEDAUTOS (Per accident) a 300,000 PROPERTY DAMAGE $ 100,000 (Per accident) GARAGE LIABILITY AUTO ONLY EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY'. AGG $ E%CESS I UMBRELLA LIABILITY _ EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE g RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- C AND EMPLOYERS'LIABIUW YIN CERTIFICATE WILL ISSUE TORY LIMITS ER ANY PROP RIETCRIPARTNE RIEXECUTIV E E L.EACH ACCIDENT $ OFFICERN EMBER EXCLUDED'/ N� FROM LIBERTY MUTUAL- (ManaetorVinNH) EL.DISEASE-EA EMPLOYEE $ Ives descfibeonder UNDER SEPARATE SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL MOV19ONS LIABILITY POLICY INCLUDES CARPENTRY-RESIDENTIAL PROPERTY NOT EXCEEDING THREE STORIES CERTIFICATE HOLDER CANCELLATION SHOULDANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SALEM DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN BUILDING DEPT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL SALEM, MA 01970 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR FAX#978-740-9846 REPRESENTATIVES. TP AUTHORIZED REPRESENTATIVE Dale Johnson ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and loao are reaistered marks of ACORD