41 CHESTNUT STREET - HISTORICAL - BUILDING JACKETI 4i CHESTNUT ST.
HISTORICAL
universal,
i
The Commonwealth of Massachusetts FOR
a Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code,790 CMR,Th
Building Permit Application To Construct,Repair,Renovate r DepzdTi'sbia Revised January
{ One-or Two-Family Dwel irsg 1,2008
��i ` This Section For Offi Use y
Building Permit Number: APp
Signature:
Building Co ' sioned Inspecto fBu'din Date
SECTI ITE INFORMATION .
1.1 Prop I Adders f 1 11 Assessorsj"p&rP ,rcgltN;umliers
�(ii V n
1.1 a Is this an accepted street?yes_ no Map Number .. Parcel Number -
13 Zoning Information: 1.4 Property Dimensions:
Zoning Disuiu Proposed Use - -Lot Area(sq ft) Frontage(fl)
1.5 Building Setbacks(ft) - -
Frout Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.OL c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Cbeck ifyes❑
SECTION 2: PROPERTY OW'NERSTUPr
2.1 O ert of Recor t.( t �ItGS M sh
Addrreess for Service:
Y 7�-
Signature — - Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check aB that apply)
New Construction O Existing Build'mg❑ Owner-Occupied ❑ Repairs(s) ❑ Alteraiion(s) ❑ Addition ❑
Demolition ❑ I Accessory Bldg.❑ 1 Number of Units_ I Other ❑ SPecify:
Brief Description of Proposed W ork-l: tA
Ivrti J S-� E G—3!7 -
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only - -
Labor and Materials -
1.Building - $ i-. 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 (Fire $ - Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount
6.Total Project Cost: $ `(y �)— t 0 ❑Paid in Full D Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES - t
SA Licensed Construction Supervisor(CSL)
License Number Expiration
Date
Name of CSL-Holderrule W, .j List CSL Type(see below) "'l
��Iilbo�t3oleet i
Address Salem MA 01970 Type Description .'
U Unrestricted(up to 35,000 Ca-Ft)
Signature R Restricted l?Family Dwellin
M Masonry Only
RC Residential Roofing Covering -
Telephone WS .Residential Window and Siding -
r SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition- - -
5.2 Registered Home Improvement Contractor(HIC) - 'i' )-O ryr
HIC Compan Mc Registration Number _
fit R effemm Ucalue
Address Salem MA 01970 4 ZSj 9q y-g I ' Lion Date
Signature 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 .......... No...........❑ -
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
-OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT -
1, a--t C-vim'✓ e ��T�y as Owner of subject property hereby
authorize n,�, 0 ( ,� - to act on my behalf,in all matters
rela ' to work authorized by this building permit application. - - - -
i
/)X;i/
Si nature of Owner Date
// SECTION 7b: OWNER' 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 Name
Signature of O"er or Authorized Agent Date' -
(Signed under the pains and penalties of perjury) -
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 and - -
Construction Supervisor Licensing(CSL)can be found in 760 CMR Regulations 110,R6 and I10.R5,respectively.
- 2. When substantial work is planned,provide the information below: - - -
Total floors 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 ofhalf/baths
Type of hearing system - Number ofdecks/porches
Type of cooling system Enclosed Open
3" "Total Project Square Footage"may be substituted4or"Total Project Cost"
What is the eurfwt use of the Building?
V-eS
Material of
Build"? -2"'l C AlabeatOe?
L �t dwelr �,how ma• u?
WIN the suNdi to Law? -
p rchileds Name 1 —
Address and Pharos
Mechanids Name
Address and Phone HIC Registration E
Construction Supervisors tense
Es*nagd Coat ed -0 C7 Pemd Fee Caleulslbrr
Permit Fes S Es*nated Cast X:7/51000 Residential
Estlrnatad Cost X$111$1000 C mmercial An Additional$5.00 Is added as an
Administrative charge.
Make sun that an fleids are properly and 1e9bly written to avoid delays In processing.
The undem4pwd does heroby apply for a Building Pw"A to Itd to the above at ted
c
,peclkatwn., signed under penalty of penury
Date
4
PUBLIC PROPERTY
DEPAR'IIMNT
�a.�olEniY�....-r• �J
Wroe 130 WARUNGT w SnWW•3w1M A!►n CHLSV s 01970
APPLICATION FOR IM REPAIR RE1yn_y�nnnr rn*rcTo.rCrION ,
DEMOLITION. OR CHANGE OF USE OR% LEA_lVQ _ dg- ANy �S G
STRUCTURE ORB ING
1.0 317E INFORMATION
t.aaatlon Name: Building:
Property Address:- 41 ._.. �,.✓t 5fr e�� .
Property le kesated In e:Cw*=vatten A=Y -HtetoriB Y
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
t
Name:
Address: SI—
Q
Telephone: ip -fit 8 9 7Z
3A COMPLETE THIS SECTION FOR WORK IN E1NQ BUILDINGS ONLY
Addition nR.n,,vat.
Renovation ✓ Number of Stories
Change in Use
Demolition
Approximate year of Area per floor(sf)
construction or renovation ��
of existing building
Met Description of Proposed
Work:
C/�
"ok r
— Mail Permit to: SQ2
TitV of *tdon, Massar4uoetts
Public Vropertg Department
Nuilbing 'Otpartment
(One t3sletn Green
509-745-9595 ext. 38Q
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
April 12, 1993
TO WHOM IT MAY CONCERN:
RE: 41 Chestnut St. , Salem, Massachusetts
Residential Two Family Dwelling (R-2)
Please be advised that the above referenced property which is zoned
Residential Two Family, is in compliance with the City of Salem Zoning
Ordinance.
If 1 can be of any further assistance please do not hesitate to
contact me.
Sincerely,
Leo E. Tremblay
Zoning Enforcement Officer
Inspector of Buildings
LET:bms
1