86 FEDERAL ST - BUILDING PERMIT APP 109
The Commonwealth of Massachusetts
CITY OF
SALEM
^ , Board of Building Regulations and Standards
l v Massachusetts State Building Code, 780 CMR Revised Mar N 201 i
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
' o - This Section For Official Use Only
Building Permit Number: Dat Applied: -
Building Official(Print Name) Signature - - Date
(� SECTION 1:SITE INFORMATION
1.1 P;gperf,,A Q.r fi' C } 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 a ✓�
Required Provided Required Provided Required P;vided Cm7
{ om
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal Syste$„ m
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal stem rrrtt m
Check if yes❑ c7�
SECTION 2: PROPERTY OWNERSIIIP'
2.1 err of Reco
01g170 rn
Name(Print) City,State,ZIP �r
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other Specify: /LCW (o
Brief Description o Proposed Work': 0 n tw9
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ (^ O O ,00 I. Building Permit Fee:$ Indicate how fee is determined:.
❑Standard City/TownApplication Fee '
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ -
Suppression) Total All Fees:$ _
O r7J Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 5 0 ❑Paid in Full ❑Outstanding Balance Due:
I L.YN1 o Vr-�t ZAD)
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
\ =Description
Q eue License Number Name of CS olde List CSL Type(see below)No.and Street /� pType
D!d r l n (B 1 U Unrestricted(Buildings u to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
Citf/T64vn,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
L SF Solid Fuel Burning Appliances
974-G97-s'Ss77(tneve-ass eD�ce�+ .nil I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Qvf. Atis Cons+ft.c+zo'zrL ���a��
HIC Registration Number Expiration Date
HICC Name W e t trantName
P qr g
377 G. tt C-1) �ahsoatc d—%+.ncf
No and Street Et—address
n -Sb6ro A o tr7f 75I (641- 11 11
C Own,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 Issuan of the building permit.
Signed Affidavit Attached? Yes ..........d 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 0k r ( A Y ..-1 '�u—S
to act on my beha f,in all matters relative to work authorized by this buddiniperaid application.
Print Owner's Narlie(Electronic Signature) I 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
contai in is a ' a 'on is to the best of my knowledge and understanding.
Print(Tuner's or AlMorized Agent's a(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/dns
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"
�ONDIT
���MINB
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
J9 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: 86 Federal Street
Name of Record Owner: Jonathan& Suzanne Felt
Description of Work Proposed:
Reroof with black 3-tab shingles.
Repair and replace damaged fascia boards, gutters, sills, water tables, and clapboards, as necessary. There
will be no change to the design, materials, color, or outward appearance of these features.
Dated: October 28, 2015 SALEM HISTORICAL COMMISSION
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.