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100 FEDERAL ST - BUILDING JACKET ;aa I At € �itlI�IST EffL£ 4fJO fLROVED BY THE ,IALSA�CT.L?{)(� ,P�,�F»�R TDh PEAlG1�1T BEING GRANTED 1 CITY OF S4 EM No � i ©� I A7°+2' �. rr � Date �cl Ward Zoning District Is Property Located In Location of L the Historic District? Yes_No_ Building 4170 Aald S[ . Is Property Located in the Conservation Area? Yea_No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof_ Install Siding, Construct Deck, Shed, Pool, Repair/Replace, Other: PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name & r- Address & Phone 1Gc� (.6o3) (07 q - 8'(oc:�-/ Architect's Name Address & Phone ( ) Mechanics Name Address & Phone What is the purpose of building? i'r S t Materiel of building? 7 If a dwelling, for how many families? 3 Will building conform to law? Asbestos? Estimated cost Co.30a city Ucense it State Ucense 8 �+ Bowe Improvement 4 Lie. / t3F5'/ - �ldZt ( —" Signat re#' 'p`plicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: 4.00 Kard Sf- �'�c�•� - G/n �a�c� �ck �� I . ..��xariRd��'4a a ?t�'4�,b�w.�,' a$•d,5,;: fiSW�n�k - I •ral4 t}R]i{("v{if , .�Ironsdt+ ,x ia34 ._ f'c�'ki16'deLY ' . - vol r.:% ,., � .✓v1 tA.a t 1 { .ik�.13`°". ' _. . ,t{v 'p :':;..4 + K•r 3,antfr4 a ( (Js pb}S�S.x,i , _ - :';sF xf SF�m:Ajtti'd w.i..' l L, ,r It,!%,.Q,UR .1U'Nf{ l.ladr .,+'6 's lk t{x,, , dd / ( l nf.7Y. �V°�Y k-xi1,`°. .,�1�::� f._,�", 1.6:�¢P �d:.�i i✓'e�.'1;. kill ....OP L LE.`gv w 9 A, iT" '�� +I'�k•�'k$•�u;'.�N.� rv'a .A'xe� .f 54.)u4+.:_$ DJZA= V jkl? W'; PFi J"NAN"l C:°'Fii"K, �f 4 'f4�3 da Ja tf{)1:+: 1 4tJ r .1,,1,¢n,3dya CxS3 Pt,.}� i1Ra ar„�:T�} �a:dl, �,pffl,rLy � frta{! i�N�3a, Y �' rJ�E�1C s, f 7V+a �t�.)4 ,d �yal@7^�• _ a t.�'ET Ifs; {lafi a rxl asca'. n t . 4fcR yn! cc tly .Z o� ,K _.... _ a♦ 0 zo m 100 FEDERAL ST 412-2004 GIs#: 9961 COMMONWEALTH OF MASSACHUSETTS Map: .. 26 " CITY OF SALEM Block: Lot U624 Category: t,.. RE004 EPLACE BUILDING PERMIT Permit# 412-2-2004 Project# JS-2004-0556 Est:Cost: $6,300.00 Fee: $65.00 IConst. Class: PERMISSION IS HEREBY GRANTED TO: Use Group:''f Contractor: License: Lot Size(sq. ft.). SAVORY ROOFING Zoning: R2 Owner: BRIAN RODGER Units Gained: Applicant: BRIAN RODGER Units Lost: 'AT: 100 FEDERAL ST Dig Safe#: ISSUED ON: 27-Oct-2003 AMENDED ON: EXPIRES ON: 27-Nov-2003 TO PERFORM THE FOLLOWING WORK: 412-2004 REROOF.TJS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final: House# Smoke: Treasury: Water: Alarm: Sewer: Sprinklers: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount BUILDING REC-2004-000583 27-Oct-03 1624 $65.00 GeoTMS®2003 Des Lauriers Municipal Solutions,Inc. J IM11ST-BE ffL-EG APPROVED BY TIE .W3P XT-13 .PRWR T-O.A PERMIT.BEING GRANTED CITY OF SAL EM Date LOV s �t �r�snl ' Ward �AfGyy�gg�� Zoning District Is Property Located In Locating of 100 Fr�u� y� the Historic District? Yes 6=No Buildin Is Property Located in I ►',,�K41(/ the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Sidingqkinstruct D Shed, Pool, Repair/Replace, Other: PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications:/� /., /, Owner's Name Iflwf'c-f��� YG�M�(�] ��I�M�Q,.CCI✓1 �/ Address & Phone 10D t'e, '` �6VC(/.L �� (��7 — 7� Architect's Name ' /.L Address & Phone L6- Mechanics Name &&/ If S Address & Phone LL S7 7721A-t-ts fi, gel/, (9761 5yA;>--:27 6a6 What is the purpose of building? L/Y I4YW1 Material of building? ( cac> If a dwelling, for how many families? Will building conform to law? Asbestos? Estimated cost �� .,co City License # State License tt CS © S >3 Home Improvement Lic. 1 42 E5�/ Signature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: I��A��t�yt° L G Wsd L N JT SAS � v �� 10 \A APPLICATION FOR PERMIT TO Oil �Pq✓ � LOCATION //�� l0 D 961e,-5 � �-Al PERMIT GRANTED M& 19 AP FiOV�D INSPECTO OF BUILDINGS i NE Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978) 745-9595 EXT. 311 FAX (978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving X 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: 100 Federal Street Name of Record Owner: Margaret I emelin Description of Work Proposed: Repair/replace roofing as necessary to replicate existing. Remove and reconstruct rear deck to replicate existing. No changes in height, width, color, material, design or outward appearance. Non-applicable due to being in kind repair/replacement. Dated: .Rine 23. 2004 SALEM HISTO CAL C jiVIMISSION 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. Hr The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR R SALEM Building Permit Application To Construct, Repair, Renovate Or Demolish a vised Mar 2011 1 One-or Two-Family Dwelling 'ry This Section For Official Use Only ✓✓✓ Building Permit Number: Date Ap plied: Building Official(Print Name) - - - Signature Date SECTION 1: SITE INFORIVA1601' 1.1 Pr Andress: I 1.2 As sso p&Parcel Numbers 1 Z�p e s \ (�60? / 803 L la Is this an accepted street?yes_ no Map Numbe Parcel Number 1.3 Zoning Information 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(it) 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:^ �i It 4 1 n\(A rrt 0,V\✓�,e C�� tl\LLIC 1 Yi \e✓v� . VVV& U l9 -4-6. Name(Print) City,State,ZIP )OD Lsle,cC, , S� 10o3-q5-3- 3815 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) 2_ New Construction❑ Existing Building lk Owner-Occupied JM Repairs(s) J8 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ IOther 6 Specify: v e" Brief Description of Proposed Work':_ e. �c� tee. Ln )WS 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: ❑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 (Five $ Suppression) Total All Fees:$ �7� Check No. Check Amount: Cash Amount: 6. Total Project C)st: $ o� S ac 0 Paid in Full 0 Outstanding Balance Due' a SECTION 5: CONSTRUCTION SERVICES - 5.1 Construction Supervisor License(CSL) l v � Expiration SQS�InV F - ate License Number Expirationn D Date Name of CS1.Holder 1 u �C 1I co n ` J List CSL Type(see below) No.and Street ` lS\ Type - . Description - -I\ ` (� \ � _ I „tom, I J 3-(- 0 U Unrestricted(Buildings u to 35,000 cu.fr. 1ty V"r`tat P C R Restricted 1&2 FamilyDwelling City/Town,State,ZIP - M Masonry RC Roofingovering. WS Window and Siding O __ ' SF Solid Fuel Burning Appliances S�'Qp 'jS (- �doo tjtjol�S I Insulation Telephone Email address D Demolition 5/.�2 Registered Home Impr(ovemen1t Contractor(HIC) ) �O ( � 'ad3_i IC �., -i t it C('SGh HIC Registration Number Expiration Date HIC Com y Name H Registrant Name 16�A T - Nq,�d Street mail address `�"ar�l�.lntrro , rv�. C� Ij'3a E 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 ..........A 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 TDSe 1 O N K e Z Z-&\ to 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: OWNER' OR AUTHORIZED AGENT DECLARATIONS Yr' By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application isKrue and accurate to the best of my knowledge and understanding. -;- /0- ( 3 Print Owner's or Authorized A ein ame(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/des 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" ��CONCU\IT e! 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 ❑x 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: I00 Federal Street Name of Record Owner: Marianne Cho-micki Description of Work Proposed: Replacement of two (2) 3r1 floor rear windows, as indicated in photograph submitted 4122113. Dated: May 16, 2013 SALEM HISTORICAL COMMISSION By: �l L The homeowner has the option not to commence the wor nless it Hrelates 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. i The Commonwealth of Massachusetts Department of Public Safety ..\lussachusrtts Slate liu ilJing Qalr(7811 C\IR) Building Permit Application for any Building other than a One-or'Lwo-Family Dwelling (this Section For Official Use Only) Buildiol, Permit Numbee DateApplicd: Building Official: ti L'C'I-I(1N 1: LOGCIION(please indicate Block R and Lot p for locations for which a street address is not available) Nu.and Street Cily'/'town Zip Code Nano of Building(if appli(able) SECl'ION 2:PROPOSED WORK Edition of MA Stale Code used If New Construction check hero❑or check all that apply in the two rotes below Existing Building', Repair❑ Alteration Addition❑ 1 Demolition ❑ (Please till out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or camslRICtiun dOCU111 aus being Supplied as part of this permit application? Yes ❑ No _ ------ le an Independent Structural Engineering Pqee�r,�Review required? Yes ❑ No Brief Description of proposed Work:---/416VA& /.h'y1rBhin — -- SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 11) ❑ Existing Use Group(s): Proposed Use Group(s): ._ SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Fhwr(sq, ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-1 ❑ A4❑ A-5❑ 1 B: Business ❑ E: [educational ❑ Po Facto F-1 ❑ F2❑ FI: fli h Hazard H-1 ❑ H-2❑ 11.3 ❑ 1-1-4❑ 11-5❑ 1: Institutional 1-1 ❑ 1.2❑ 1-1 El14❑ A1: Alcrcantile❑ R: Residential R-IWZ, R-2❑ R-1❑ R-a❑ S: Storage S-1 ❑ S'_❑ U: Utility❑ Special Use❑and please describe below: Special Use SECTION 8:CONSTRUCFION 1-YI'E (Check as a able) IA ❑ IH ❑ IIA ❑ 118 ❑ ILIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECFION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details(in each item) Water Supply: Hood Zone Information: Sewage Disposal: French Permit Debris Removal: Public31K, Cheek if outside Flood L_onvA Indicate municipal A (tenth will not bo Litenscd Disposal Sitk rrquirckX,or trench or specifv. I'motc❑ ur indentify Lune: oron site Svstom ❑ permit is cm lased ❑ _ _ ._.. Railroad right-of-`wJ.y: [lizards to Air Navigation: \l \ 1�-1, . , -. . \'nt:\ppbcableT Is ti(nii flue within ,urport a +I+r0.iclr area? Is their rvs'iew eonlpleled.' or Cnroent to Build enelused ❑ 1 es❑ ur..\'tr� Yes❑�C`�❑ SFCT ION 8:CON I FN"r OF CFR I uic,%rie 01:OCCUPANCY Ildiliun+u Code ._.. ... L se Gruupis): - - I\1,v u I Com>I ru.nun: 0,,up,mt lead per I lour I tors lhabuilJinl;rinlain an gprinklrr ticsirin?: �r0 <prciel�lipuhnlians: - SE("IION9: PROPIi R'1'Y OWNERAU I'1 IORIZA1 ION :Ninuc and Addrss of Prolwrt7 Ow tier -- - -- ar,rd f - /vx n_ _Ili l0,0 - Name(Print) No.and Streit City/Town - ---Zip Property Owner Contact Information: 6G�. //��t�� . Y0 [A- y3 b o 1'��l_ytvo a L cep Title —— I elephune No. (business) Telephone No. (cell) e-mail addr s It applicable, the property owner hcrebv authorizes 9�ek av ie -Amwov/-- r --- — Eli Name Street Address City/Town State Zip to art on the property owner's behalf, in all matters relative to work aulhorized by this building termit a plication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) if building is less than 35,00l1 cu.ft.of enclosed s pace and or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control /tile(Ale;pistrant) Telephone No. a-snail Registration Number address Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor �)A� S-4�1 Compa�ny Name r Nan a of Person Responsible for Construction License No. and Type if Applicable �/ /f'1Grli� A a/f -� Street Address City/Town State Zip I'de,hone No. business Telephone No. cell e-mail address SECTION 11:ran o;t.,Is rl lN111 N1:.p ION l,N'a111A.MV AJ 111'AVI I M.G.L.e.152§ 25C 6 A.Workers'Compensation Insurance Affidavit from the M11A Department of Industrial Accidents 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. Is a signed Affidavit submitted with this a lication? Yes O No ❑ SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and %lateri is) Total Construction Cost(from Item 6)=5_ 1. Building S Building Permit Fee a Total Construction Cost x_(Insert here 2. Electrical S appropriate municipal factor)-5 t. Plumbing $ 4. :Mechanical (I-IVAC) 5 Note: Mininmun let =S_—(Contact nnunicip,11ity) 3. ,Mechanical Other S Fndusc check payable to _-- n. total Cost $ (Contact municip,dity)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering tiny 11,111le belOW, I hercbv auh•st under the pain and penalties of perjury that all of the information contained in this application is true and accurate to the best Of me knot led , rand understanding. Please print and sign oa me;ue I"itle It Irphone No. ale icy-A��2 -s - r9 d/y2`�j titrcel Address -_� Ci lc/rows ..Tate Zip i Municipal Inspector to fill out this section upon application approval: . .. ._- 9 RECEIVED ISPECTtON,AI SERV The Commonwe ��"`��// ssachusetts N o� Department���t Puu cS etyA ID 2SM Massachusetts State Budding Code(780 CR) Building Permit Application for any Building other than a One-or Two-Family Dwelling _ (This Section For Official Use Only) ` Building Permit Number: Date Applied: Building Official: �( SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 1D0 Fec4Y�l S� S'ctlsztnn mp O la-I O coca FeclA ia\ Ccnr." No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK. L Edition of MA State Code used_ If New Construction check here❑or check all that apply In the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: S x Cam 'tAAN_ ILI 0.. ` SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) l7 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) - -- A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-S❑ B: Business ❑ E: Educational ❑ F: Facto F-I❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ 1 Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ Ill ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipid❑ A trench will not be P required ❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ ards to Air Navigation: \I I I_t,t ori<_C_unpm_clon Railroad right-of-wa)7: --l-H�Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Fluor: Does the building contain an Sprinkler System?: Special Stipulations: 0'o c&I �- TlAtl_E:� Z� 2�\ SECT{QN 9: PROPERTY OWNER AUTHORIZATION , Name and Address of Property Owner? j'j; r� Mariam Grvo\h�ckl \anI t7� Fec�uo� s So�lsz�nr� Dla� \ Name(Print) -NodySfreet City/Town Zip Property Owner Contact Information: -Title Telephone No. (business) - Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION.10:CONSTRUCTION CONTROL(Please fill out Appendix.2)- - f buadin is Icss than 35,0o0 cu.ft:of enclosed s aceand or not under Construction Control Then check here O and skip Section 10.1 10.1 Re istered Professional Responsible for Construction Control -L 4�8-807 0 7-7 23_ant) Telephone No. a-mail addres `Z�t'y'� Registration Numberp� nta�i City/Town State Zip Disciple Expiration Date 10.2 General Contractor - - - Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11:4YbItKERS'C061YENS,-,IION tNSURANCEAPFIDAVfF M.G.L..c.152:.§25C6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ 3. Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to Z6 _ 6.Total Cos[ Is (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 est o(my knmvlec .and understanding. Please print and sign name Title Telephone No. Date Ioo ft-fi� o\G\S Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: ✓ "t'u7"'� '-'ttiu? 3 Name Dat 100 Federal Street Salem MA 01970 February 22, 2016 To Whom It May Concern, All 3 voting parties of 100 Federal Condo Trust have agreed to the work proposed by A C Castle roofing as evidence by email communication dated from 12/23/15 through today's date. Sincerely, Marianne Chojnicki 100 Federal Street 0 1T Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX (978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage 0 Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 100 Federal Street Name of Record Owner: Marianne Chojnicki, Mitchell Henderson, David Sullivan Description of Work Proposed: Reroof with either three-tab or Slateline asphalt shingle in a dark charcoal or black color. Dated: February 23, 2016 SALEM HISTORICAL COMMISSION By: 8,{y�-�i c a ��,_-� 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. . , - �u i �� r � U