164 FEDERAL ST - BUILDING INSPECTION (2) '0
The Commonwealth of Massachusetts
Board of Building Regulations and Standards Town of
Wilbraham
Massachusetts State Building Code, 780 CMR, 7"edition
Building Dept
Building Permit Application To CgrL,4ruct, Repair, Renovate Or Demolish a 413-596-2800
One- vo-F roily Dwelling Ext 118
his a 'on or Official Use Only
Building Permit Numbe Vit h Date Applied:
Signature:
BuildingCommissioner/Inspectlik2LBtuldings Date
SECTION 1:SITE INFORMATION
1.1 Prope ddress: 1.2 Assessors Map& Parcel Numbers
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 R) Frontage(tt)
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:
Publico Private❑ Zone: _ Outside Flood Zone? Municipal'On site disposal system ❑
Check if yesg'
SECTION 2: PROPERTY OWNERSHIP'
2. weer'of RefPrd•
`C�tL d' • ivvby 164 �c.t'�C.f2l1L. SZ
Nam p,P,rint) Address for Service:
Seerv{ice:
Signature " Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition W Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work:
71
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building $ lea.oa 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
�— Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
r.
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of CSL-Holder
Lis[CSL Type(see below)
Address T e Description
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 FamilyDwelling _
Signature M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address —
Expiration Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit munt 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........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property hereby
to act on my behalf,in alt.m:arers- i .
relative to work authorized by this building octr:i:application.
w:ature o;Owner -- -- Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I,� � �L.F� �• { '8 ,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.
Print N r
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
_ NOTES:
I. 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 and .
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total Floors area(Sq. FL) (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"
CITY OF S.U.EM
PUBLIC PROPERTY
DEPARTMENT
VwraM 130ww9ulrc.- S4REST•&UAK MAUAaa'serts01970
TEL 9',}74SAM• Fnx:978-740.9616
HOMEOWNER LICENSE EXE.MMON
i Plea"Print
Date 1 `7 D
Job Location I l„(' &h�.PA'(— S T t �A ,.O m h t,A- Ot S--7 C7
Home Owner Address /a 4 cbE11 AI rk Ill A O 1 j• 20
Horne Owner Telephone — 12_
Present Mailing Address J le Le ttz C, S-r Sean." , nA la 01 lC�
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowner to engage an individual for
hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Pawn(s) who owns a parcel of land on which he/she resides or intends to reside, on
which there is, or is intended to be, a one or two family dwellin& attached or detached,
structures accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
"homeowner'shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned "homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
.APPROVAL OF BUILDING INSPECTOR
Sce other side for state code
CITY OF SALEM
'�jry PUBLIC PROPRERTY
DEPARTMENT
I
Construction Debris Disposal Affidavit
(reyuircd lirr all den101itIUtt and trnovation t\'ork)
In accordance a ith the sixth edition of the State Building Code, 7SO CNIR section I 11 .5
Debris, and the prof isions of MGL c 4,0, S 54;
Building Permit A I is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal lacility as defined by MGL c
I t 1. S 150A.
The debris trill be transported by:
hauler) 2 t�� �a t �
I nantc of hauler)
I he debris will be disposed of'in
(uamr ut tauhty)
2(0S N etAJlouwflnl`:`- _P��tltco. , .
laddrea. of Lrnluyly
aenalwt of p:nntl .ytpl icaut
\n l
datc
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Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978) 745-9595 EXT. 311 FAX (978) 740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
0 Reconstruction ElAlteration
Demolition ❑ Painting
Signage ❑ 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- 164 Federal Street
Name of Record Owner: . . Donna& Peter Bimbo
Description of Work Proposed:
Remove 11 x 12 room on rear of house over patio and repair exposed exterior wall to match rest of house.
Dated: October 2, 2008 SALE ISTO//RII,CAAL COMMISSIONN
By � � /'�v!t . /V *4
The homeowner has the option not to corrunence the wok (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.
P g