29 CHESTNUT ST - BUILDING PERMIT APPr
Cr
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
SALEM
Massachusetts State Building Code, 780 CMR Bevised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a s„
One-or Two-Family Dwelling `c
This Section For Official se Only ,�r�
OBuilding Permit Number: Date Applied:
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Building Official(Print Name) Signature a ^�
l SECTION 1: SITE INFORMATION i
1.1 Property Address, 1.2 Assessors Map&Parcel Numbers
54�
LI a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zonipg Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) 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 OWNERSHIP'
2.1 Owner'of Record: /RA
I
M,aUKA
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied M Repairs(s) ❑ 1 Alteration(s) W I Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': /3C /0 x e
1,4 KAgw'iea�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ -w/coo 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 $ Total All Fees: $
Suppression
Check No. Check Amount Cash Amount:
6.Total Project Cost: $ yo coo ❑Paid in Full ❑Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
coo la rya 2 !�
' bkool 1t�GL r License Number Expi tion to
Name of CSL Holder
avi K List CSL Type(see below) seri
No.and Street ,`� ' T e Description
fW Lc�lU Unrestricted(Buildings up to 35,000 cu.ft.
!'r'4T
619�-o 7 R Restricted 1&2 Family Dwellin
City/Town,$tate,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
AP S4'S y f16� TYXt'y Z @ p*4; Iinsulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(RIC) //OV�
Alel// /d ZD
i rr Chu GfJ04A.Af HIC Registration Number E pirati n Date
HIC dompany Ame or HIC Regi t N e
No Str� / nn Ot p�7 / � ,1y�7 mail a ress
.� i Lriry ! / 7 f/
City/Towli,State,ZIP 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`/
I,as Owner of the subject property,hereby authorize o" l��/
to act on my behalf, in all matters relative to work authorized by this building p4ermit application.
Am'11la M` it e as /
Print Owner's Name(Electronic Signature) I Da e
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contain in this application 's tru and accurate to the best of my knowledge and understanding.
q70 I(e
Prin ner's or rized Menrparne(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 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 at
www.mass. ovg_ /oca Information on the Construction Supervisor License can be found at www.mass. og v/dns
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
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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Salem Historical Commission
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction 1] Alteration
❑ Demolition El Painting[1 Other work
Signage
❑ � e g
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 Prope
Name of Record Owner: Maura McGrane
Description of Work Proposed:
Renovations to rear ell and construction of a rear deck based on the application submitted 3/18/16 and
drawings prepared by ASB Architecture dated 3/17/16 with the following changes: retention of the ell's existing
cantilever; retention of the ell's entry door in its current off-center location; and installation of a window in the
center arch on the west elevation. Window to match other new windows on west elevation of ell. Ell to be
painted Benjamin Moore "Mapboard Black" (CW-680)
Dated: April 25 2016 SALEM HISTORICAL COMMISlSIO/Nps
By:
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.
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