182 FEDERAL ST - BUILDING INSPECTION b
b / The Commonwealth of Massachuscns To
.t� Board of Building Regulations and Standards �.Massachusetts State Building Code. 780 CMR. 7i"editionept
Building Permit Application To Construct. Repair. Renovate Or Demolis
One.or firo-Fanidl Duefbng
This Section For Official Use Onl
Building Permit Number Date Applitd: O
Signature:
Building Y issionsr/I m of Buildings Dais—� 7
SECTION 1:SITE INFORMATION
I.I�Property Address: C 1.2 Assessors Mop m Parcel Numbers
1.Is Is this an uce led street''yea no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use La Area(sq B) Frontage(fl)
1.5 Building Setbacks(R)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Provided `
1.6 Water Supply:(M.G.L e.40.174) 1.7 Flood Zone lsformstlon: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal O On site disposal system O
Public D Private O Cheek if
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qwoeri of Record: \%
Name(Print) Address for Service:
Signature Telephone -
SECTION l: DESCRIPTION OF PROPOSED WORK'(check aR that apply)
New Constnution O Existing Building O Owner-Occupied O Repairs(s) O Alteration(a) O Addition CI
Demolition O Accessory Bldg.O Number of Units_ Other O Specify:
Brief Description of Proposed Works: S c W
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: ORlelal Use Only
Item i Lahor and Materials
1. Building S I. Budding Permit Fee: f Indicate how fee is determined:
O Sundard City/Town Application Fee
2 Electrical S O Total Project Costa(Item 6)x multiplier s
J Plumbing S 2. Other Fen: S
J. Mechanical (HVAC) S List:
S Mechanical (Fire S Total All Fees. S
Su ression
Check No. _Check Amount: Cash Amount:
h Total Project Cost S ��� �� 0 Paid in Full ❑Outstanding Balance Due-
SECTION 3: CONSTRUCTION SERVICES e
3.1 Licensed Construction Supervisor(CSL)
License Number 1 Ej_.,pjiioo DIDate
Nyae of CSL Helder M List CSL Type Isle heluw)
A.kkrss W A Tvot Descripnon
U Unrestricted(up to)7.000,000 Cu. Ft.
SiaM1Y!! R I Resin led Ih2 Family Dwelling
%, 1 Masonry Only
RC Residential Rooln Covering
Telephone wS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D I Residential Demolition
5.2 RegbtSred Home Improvement Contractor(HIC) 1��
HIC ampan Name or IC RepsnanrN nf� Registration Nu er
Addict /
Expiration Date
Sigriature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I. e. ISL/ 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this andevit will result in the denial of the Issuance of the building permit.
Signed AIT(davit Attached? Yes.......... O No........... O
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.
Si inure of Owner Date
SECTION 71s:OWNEW OR AUTHORIZED AGENT DECLARATION
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 Nunes/
nu
Signae'/o/nf Owner or Aulhoriied Agent Dole
St tied under the pains and penalties of
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 gg 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.R7, respectively.
2. When substantial work is planned,provide the information below:
Total Ilion area(Sq. Ft.) (including garage, finished porch)
decks or porch)
Gross living area(Sq. Ff.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfbaths
Type of heating system Number of decks/porches
Tspe ufcooling system Enclosed Open
1 -Total Project Square Footage"may he.uh.tituted for 'Total Project Cost"
-s s
CITY OF SALEM
PUBLIC PROPRERTY
4 r� DEPARTMENT
.4,yvi
1\l l:: Niel -K N 011
\I'.\,4t
171:W11-74.+•9595 1'.\Y:978.740498*
Construction Debris Disposal Affidavit
(required lur all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit N _ _ is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
I 11. S 150A.
The debris will be transported by:
(name of Imuler)
The debris will be disposed of in
liaumn
(address of(al'1IIly)
.igna re of pumit applicant
Jatr
CITY OF S.1 X. Nfg A-kSSACHL:SETTS
BUMDLYG DEPARTMENT
1'_0 W. .i z:NGTON STREET, )era FLOOR
TEL (978) 745-959S
FAX(978) 7406984
KI%(Bg]IIEY DRISCO[L
Y D -mmiAs ST.PtElutt
�(
DIRECTOR OF PL RLIC PROPERTY/IILRDLNG COMNBSSIONER
Workers' Compensation Insurance AfRdarit: guilders/ContractoNElectrlclanslPlumbers
Sg)nll(ant Information Please Print Legibly
Nainc 19usinesa.Organiratiomins4vtdual): W , \\ i 01
Address:
City/StatdZip: psZJ LY� Ys Phone N: S-1'G�Sh�
Ire you as employer!Che the appropriate boa: Type of project(requlreQ:
I)EP1 am a employ with 4. Q I am a general contractor and 1
employees(rull and/or Part-time).* have hired the subcontractors 6. ❑New construction
2.Q 1 am a sole proprietor ar partner- listed on the attached sheaf : 7. Q Remodeling
.,hip and have no employees Thee sub-contractors have 3. Q Demolition
working fo►me in any capacity. workers'comp.insurance- 9. Q Building addition
INo workers'comp. insurance S. Q We am a corporation and its 10.❑Electrical repairs or additions
required.) odlcers have exercised their
3.Q I am a homeowner doing all work right of exemption per MGL I I.Q Plumbing repairs or additions
myself.(No Workers'Comp. c. 152.91(4).and we have no 12.0 Roof repairs
insurance required.) t employees.LNo workers' 13.0 Other
comp. insurance required.]
-Any applicant this chncb boa Of MUM alers fin out Iha saxrian 6elose showing their workm'cantprrrs"policy inf amat"
'I howrownue who submit this afildwit indicting Ihry are doing all wait otter than him outside coetna ion most suhmil a now anlsbvil indicwng suck
('.mumion dui chock this box mud anaehd an addiriorw shot showing an nmae of are auhtogmMem and their woakma'temp.plity imfmrouon.
/ono eon employer chat B proridlnr women'rosrpensadow lnrwrorrerjoe troy essp/uyaes QNow br rbe pNlay owd JoI r/br
informal"
t
Insurance Company Name: n Q i +v��
Policy N or Self-ins. Lic. H: � � �a\Y �o Expiration Date:)24
\ _
Job Site Address: City/StanyZip: SAS." A,
Attack a copy of the workers'compensation policy declaration page(showing the policy number and expiration dap).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1.500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a Ron
of up to 5230.00 u day against the violator. Ile adviad that a copy of this statement may be rurwurded to the Office of
Invcahgatiuna ul'dw nlA for insurance coverage veriricalion.
l do hereby aari/y Dole:
pains andpenoldes ojper/ury that the information provided above is true and swrrtts.
Phone d `�0
O/Jlc'ial use unly. Do not write in this area,lobe wpnp/Ned by airy or/ow•n u/jlwax
iCity or ruwn: _ Pcrmit/LDcenre M__.
Issuing.%whorily Icircle une): -
1. Itwrd of Ilruhh I. Ruildlhg Department J. City/town Clerk J. Electrical InspcCto► 5. Plumbing Impector
6. Olher _
L.'ellacl Person: _ ._. _.. Phone N:
Shea Roofing Co.
Salem, MA 01970
(978) 745-7313
March 25,2009
PROPOSAL
SUBMITTED TO: Alex&Ogno
182 Federal Street
Salem ,Ma.
We hereby submit specifications and estimates for.
To remove all existing aluminum siding and roof shingles from all four
sides mansard roof.
To install architectural (30 year windseal) roof shingles, covering all four
sides mansard roof.
To install ice and water shield covering (3) feet up from all roof edges
and all window flashings prior to re-roofing:
To install 15 lb. asphalt saturated felt paper covering all roof boarding
prior to re-roofing.
To install all new metal drip edge along all roof edges, both horizontal
and vertical.
To counter flashing and/or reseal all flashing points on all eleven
mansard windows.
To cleanup and remove all roofing debris from job site.
** To replace rotted wood window sills on mansard roofs wherboecesdary
at a cost of$275.00 per window.
We propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of.
Eight Thousand One lHundred and Eight Five --------------dollars ($8,185.00)
Payment to be made as follows:
Upon completion
All material is guaranteed to be specified. All work to be completedin a workmanlike manner according to
standard practices. Any alteration or deviation from above specifications involving extra costs will be executed
only upon written orders,and will become an extra charge over the estimate_ All agreements contingent upon
strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary Insurance.
Our workers are fully covered.by Workman's Compensation Insurance. -
Acceptance of Proposal—You t rize to do th o s s j cified. -
Authorized Signature:
Signature: _ Cil 1✓. U
Date of Acceptance:
L
1 • A
rP
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
❑ Reconstruction `A Alteration
❑ 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- 1 R? Federal Street
Name of Record Owner: Alexa O no & Peter Pamassa
Description of Work Proposed:
Removal of aluminum siding from mansard and replace with either Sovereign 3-tab asphalt shingles in either
nickel gray or black or with Grandslate asphalt shingles in Bristol Grey.
Option to either leave aluminum siding on sides of dormers or to replace with wood clapboard, with 4"
exposure,painted to match body of house.
Dated: September 18, 2009 SALEM HISTORICAL COM`MIIS�SION
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.