141 FEDERAL ST - BUILDING PERMIT AP The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
/ Massachusetts State Building Code,780 CMR, 7"'edition ReOF S LEM Ja
UC Building Permit Application To Construe Repair Renovate Or Demolish a I, 2008
One or Two-F i Dwelling
1sr`eE. o '. i�.t.�di°ie'C}n7y
I311ding 9nullissionet/
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1.1 Property Addres : 1.2 Assessors Map&Parcel Numbers
Y
1.1 a 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 ff) .. 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❑
2.1 Owner'of Record:
Name(Print) 61d Address for Service:
f>h- 9-3<
Signature Telephone
3 SECTION 3'bF' hyl{flgIRiPO SE ,
YOLK=(cheek ald that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units p - " 'Cnher'`❑ Specify:
Brief Description of Proposed Work':
y—XW ze Ltd (Ud f
CQ�
SECTION 4:ESTtItYIA� p CONST72IJC�IOIV COSTS'
Estimated Costs:
Item Official Use Only
Labor and Materials ,*^_
1.Building $ 1 Biti', mgPwitee $ Indicate how fee is determined:
❑Standard Cii}lTbwn gppheauon Fee
2.Electrical $ -
❑Tot �rbleet�GMost',(Itatp 6�x mulupher; z
3.Plumbing $ 2tx(jtEle ) e rk
4.Mechanical (IIVAC)
5.Mechanical (Fire. $ sz`�. sir t �. x ,
Su ression3 ohfalljl Fees' f
fnhedk$�ohedk Amount Cash Amount:
6.Total Project Cost: $ �j/J p pazdn Futl q Outstanding Balance Due:
5.1 Licensed Construction Supervisor(CSL)
MI P L License Number Expiration Date
Name of CSL-Holder List CSL Type(see below) y
i >OU
Address
_».`�
p - e 4 e
a�A/.CUCrn U Unrestricted u 000 Cu.Ft.)Q " R Restricted 1&2 Family
Dwelling
Signature � M - MasonryOnly
7�'"7 4/•S'a 7p/13 RC Residential Roofing Covering
Telephone - WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Regis r H yue I provement Contra orr !IC) - Id (a c�.S�{
HI—C C ame/or C Reg nt me L. Registration Number
Address 7 -,Z� Q
177�L/�„ , „ ��, 7��C,�, Q'?/3 Expiration Date
Signature / Telephone
SECTION 6 WO1ZI(ERS+GOIIiPN$ATLq] ISUC AFFH)AVIT(M G.L.c.1S2.§ 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 .......... No...........0
SECTIbN 7s OWNED tlHl? A j IfP1, fd#E _., k �11 F
'OWNEWS,AGENT Ok-CONT 'CT ''iO i �ES;FO)LBU11vI3 s EER1yIi2,
1 as Owner of the subject property hereby
authorize 2 c L �F �� to act on my behalf,in all matters
relative to work authorized by this buildin permit application.
Signature of Owner Date
SE GTION 7bOWNLi (1liYJfO. U�AS� 11)CCL�RhTON., '
as Owner or Authorized Agent hereby declare
that the statements and information-on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
L
Print Name
Signature of Owner or Authorized Agent Date -
Si ned under the sins and penalties of Rer'u
S
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 importantinformation on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage,finished basementtattics,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"
ye 2„
3
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 ❑ 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: 141 Federal Street
Name of Record Owner: Mr: & Ms- Steven Gregory
Description of Work Proposed:
Install new roof on tipper level of Mansard roof to replicate existing. No changes in color, material, design,
location or outward appearance. Non-applicable due to being in kind maintenance/replacement; not visible
from the public way.
Dated: September22, 2011 SALEM HIS CAL 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.