17 BECKFORD ST BPA-17-221 WINDOWS M
10014
The Commonwealth of Massachusetts 1l3 ;;* g
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CW
SALEM
MAR 3 Q Q ,Red Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Wy
Building Permit Number: Date Apple
4WVO
VZ4�214
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
\ 1.1 Property ddre • nn 1.2 Assessors Map&Parcel Numbers
/7 �f �c
Lla 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 ft) 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❑
SECTION 2: PROPERTY OWNERSHIPI
24nerl of Re rd:
01ss,� � /� ems►�' �1�-r ve+�s A4
Name(Print) City,State,ZIP
yosr s
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:
C r�rtyT .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
Cl Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) 'Total Al!Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 6
5e � License Number Erpi'a�ilo Uate
Name off CSL fulde� List CSL Type(see below) y
Typb Description
No.and Street U Unrestricted(Buildingsa to 35,000 cu. Il.
G R Restricted 1&2 Family Dwelling
City .vn,State,ZIP v Hasonry
RC Rooting Coverinst
WS Window and Sidin
SF Solid Fuel Burning Appliances
/ YJ 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home ImprovementColttractor(HIC) � S Z I Z'F ay o �-
+ ` G HIC Registration Number —Expifution Date
tilC rompany Name or I'U TKegistrant Name
VA� '/
No.and Street �� _e� _17 Ye-' Email address
4 W11
IA Ci /To+�n State ZIP Telephone
SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.G.c.ISL g 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 Isivance of the building permit.
Signed Affidavit Attached? Yes..........O No...........0
SECTION 7a-.OWNER AUTHORIZATION TO BE COMPLETED,WHEN'
OWNER'S AGENT OR CONTRACTOR APPLIES'FOR BUILDING..PERMIT
I,as Owner of the subject property,hereby authorize 'Je_'1 � -
t9 act on my behalf,in all matters relative to work authorized by this buildin permit application.
Corr,erSfor�e l3eciC{ord SLC
tI�SSonClra 1 G�ern;', rYJan�gPr 3 -�?3 - 17
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW 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:
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 LWJ have access to the arbitration
program or guaranty fund under�LG.L.c. 142A.Other important information on the HIC Program can be found at
ww
w .msss.�v'oca Information on the Construction Supervisor License can be found at+v++w.mass. ov'dus .
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
,dumber of bathrooms Number of half/baths
'type of heating system Number of decks/porches
'fype of cooling system Enclosed Open
1. "Total Project Square Footage"may be substituted for"Total Project Cost"
- 17
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 has determined that the proposed:
❑O Construction ❑ Moving
❑ Reconstruction ❑ Alteration
❑D 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: 17 Beckford Street
Name of Record Owner: Cornerstone Beckford LLC
Description of Work Proposed:
Demolish garage at rear of property due to significant structural deterioration. This decision is based on visual
inspection and correspondence with the Salem Building Commissioner. In its place, applicant is to remove
existing stockade fence and replace with new flat board fence along rear property line to match existing fence
on side yard. New fence to be installed with finished side out and painted white to match existing fence.
NOTE: This Certificate is conditional upon submission of three-quarter view photographs of all elevations of
the garage prior to the issuance of a demolition permit.
Reason for Issuance of the 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: ALL 6, 2017 SALEM HISTORICAL COMMISSION
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.