47 SUMMER ST - BUILDING INSPECTION LA
'file Commonwealth of Massachusetts j%S?E1 I" L it of
Board of Building Regulations and Standards CITY$
WMassachusetts State Building Code, 780 CMR � QQEC SIVMH( r Mli
V Building Permit Application To Construct, Repair, Renovate Or De oilsa
One-or Two-Family Dwelling
This Section For Official Use Only
v Building Permit Number. Date plied
Building OlTicint(Print Name). Stgmture . . ate
ti
SECTION 1:SITE INFOR,NIATION`
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
l accepted
es
1.I a Is this an acce ted street?yes ✓ no M1fap Number Parcel Number
1.3 'lolling Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(It)
1.5 Building Setbacks(it)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(11YI.G.I.c.da,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private Cl Zane: _ Outside Flood Zone? Municipal❑ )n site disposal system ❑
Check if es❑
SECTION2: PROPERTYOWNERSHIO
2.1 Ownerl J of Record:PVT t,a�lR�a��l - �G �� v mv- o «-ld
RR me(Print) City,State,ZIP
�1 Sl/`^^vkt" sk R7Tele h neC�U ON�a EmalAdJ� .9
No.and Street P
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner•Occupied ❑ Repairs(s) Cl I Altemtion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': Tukc 'nc,r
J
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item (Labor
Costs: Official Use Only
Labor and I'vt:tterials
I. Building S 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Costa(item 6)x multiplier x
3. Plumbing S 1�4,gther Fees: S
d. Mechanical (tIVAC) S - List:
5. i\leehanical (Fire S Total All Fees:S
Suppression)
Check No. Check Amount: Cash Amount:
6.TuCrl Project Cost: .S L(JCI ❑ paid in Full 13 Oulstanding Balance Due:
F
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) t
("C License Number Expiration Date
i
Nano of CSL Holder List CSL Type(see below)
Type Description
No.and Street
U Unrestricted DuiWin s u to 35,000 cu. It.)
R Restricted 1&2 F:unil tip
Citylrown,State,ZIP M mitsonry
RC Rooting Coverin
WS Window and Siding
SF Solid Fuel[honing Appliances
1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Contp;nny Name or HIC Registrant Name
No. and Street Email address
City/Town,/Town State ZIP Telephone
SECTION 6:WORKERS'CONIPENSAT[ON INSURANCE AFFIDAVIT(M.G.L c. 152.g 2SC(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...........❑
SECTION 7a:OWNER AUTHORIZATION.TO HE COMPLETED WHENi-
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
/� ,1 Ly&l aycl 2—1 157/7-01L{
Print Owner's Nane(Electronic Signature) Dale
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
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 best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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(FIIC) 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 it
www mass sov:'oca Information on the Construction Supervisor License can be found at www.mass.��ov!d,L .
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
rype of cooling system Enclosed Open
1. "Total Project Square Footage"miry be substituted tir"Total Project Cost'
QTY OF SALEM, N A.SSAC IUSETTS
BUILDING DEPARTMENT
120 WASHINGTON STREET,Yo FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMbIISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date IZ— l 5 — I N
Job Location �I 1 S Urn YY1�TL S T
Home Owner Address SQa r�
Present Mailing Address
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(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 dwelling, 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 understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements. -
X HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
QTY OF SALEM, MASSACHUSEM
i1$ BUII.DTNG DEPARTMENT
r — - - - 120 WASHINGTON STREET,3AD FLOOR
TEL. (978)745-9595
KIMBERLEYDRISCOLL FAX(978)740-9846
MAYOR THomAs ST.PIEmE
DIRECTOR OF PUBLIC PROPERTY/BUILDING OOAmssIONER
Construction Debris Disposal Affidavit
(required for 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 c40, 5 54; Building Permit# is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, 5 150A.
The debris will be transported by:
N°fb-5 i �c co"4
(name of hauler)
The debris will be disposed of'in:
rj O A S'['[ (
(name of facility)
(address of facility)
Signature of applicant
12 ! S 701H
D to
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Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
CERTIFICATE OF HARDSHIP
It is hereby certified that the Salem Historical Commission had determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction ❑ Alteration
.)< Demolition ❑ Painting
❑ Signage ❑ Other work
as described below has been approved under a finding of Hardship, 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: 47 Summer Street
Name of Record Owner: Philip Marchand
Description of Work Proposed:
Remove the chimney closest to the street and cover with shingles to match the existing roof.
Option: to leave the chimney in place at a height of 2'above the roof, subject to Building Inspector approval.
The chimney will be capped with black aluminum or similar product.
Reason for Issuance of Certificate of Hardship:
o The application affects only the building or structure on which work is to be done and not the historic
district in general.
o The application is approved because it does not cause substantial detriment to the public welfare.
o The application is approved because it does not cause departure from the intent and purposes of the
amended Historic District Act.
Dated: 12/4/14 SALEM HISTORICAL COMMISSION
By:�/7�1YJ
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.
Fit 1�,�