5 HARRINGTON COURT - BUILDING JACKET }
� The Commonwealth of Massachusetts
Board of Building Regulations and Standards CTY
ALEM
Massachusetts State Building Code,780 CMR 1��b ��er l A_E *13
d Building Permit Application To Construct,Repair, Renovate Or Demolish a
One- or Two-Family Dwelling
0 This Section For Official Use Only 7 c
Budding Permit Number. Date Applied '
c
Building Official(Print Name) . r ; ' .Signature VJ r. Date "
fi) >t>' "' SECTION 1 SITE INFORMATION:
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers_
_S�.P.Pj Nl4TZJnJ GT ��
1.1 a Is this an accepted street?yes—A— 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?
Check if yes❑ Municipal 11On site disposal system ❑
- a SECTION2:`PROPERTXOWNERSHIP''
2.1 ner of Record: p
/ f3/n?/� ..4
Name(Print) I City,State,ZIP
,5"f/: XVj n/G T J 6�7-
No.and Street Telephone Email Address
-SECTION 3:DESCRIPTJON OF PROPOSED WORKrcheck all that app Iy Jievy
New Construction❑ Existing Building Owner-Occupied Repairs(s) Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify:
Brief Dscription of Pro osed Work':
>'r'` �' `r': ECTION 4:ESTI ATEDC
. ONSTRUCTION COSTS
Estimated Costs: s --� ,...
Ism Labor and Materials Official Use Only., r
sa,
1.Building $ 10006 '1:Building Permit Fee: $°0,U Indicate how fee is determined:'
2.Electrical $
1I'll1 Stan City/Town Applicauon Fee ;= ry ,s -�,
1-1 Total Protect Costs(Item 6)xmultiphei•" x
4
3.Plumbing $ 2.`,`6 er�,Fe''es $
K h
4.Mechanical (HVAC) $ List: >,
5.Mechanical (Fire
Suppression) $ Total All Fees $
CheckNo. �. ""CheckAmount: �.`CashAmount.
6. Total Project Cost: $ —
'�0 �QOQ ❑Paid in Full ❑ Outstanding Balance Due
w,r .SECTION S CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street ; Type` st ! �'. Description:`q'"., `
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Dale
HIC Company Name or HIC Registrant Name
No.and Street Email address
Ci /Town,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 7ai OWNER AUTHORIZATION TO RE COMPLETED WHEN 0
OWNER'S AGENT ORCONTRACTOR--APPLIES FOR BUILDING PERMIT 'µ N
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.
Print Owner's Name(Electronic Signature) Date
•=. SECTION,7bi OWNER"OR AUTHORIZED AGENT DECLARATION
By ente ' g my name below,I hereby attest under the pains and penalties of perjury that all of the information
contai a application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authoriz 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 not have access to the arbitration
program or guaranty fund under M.G.L.a 142A.Other important information on the HIC Program can be found at
www.mass. oov/oca Information on the Construction Supervisor License can be found at www.mass.gou/dps
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 HARDSHIP -REVISED
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: 5 Harrington Court
Name of Record Owner: Pamela A. Lussier
Description of Work Proposed:
Reconstructfront porch per revised sketch (see attached). Decking to be constructed ofAzek in gray. Posts and railings
to be Harvey RDI product in white per attached specifications. Stairs to be in concrete with bluestone treads. The
installation of synthetic materials is approved based on the building's location at the end of a narrow, dead-end street
which has caused significant weather-related damage to porch. While the approval of synthetic materials is a departure
from Design Guidelines, it is allowed on a hardship basis only.
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: 8/25/16 SALEM HISTORICAL COMMISSION
By: c--
The
aThe 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.
Lv
7-777 X
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F, Ao ro
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: 5 Harrington Court
Name of Record Owner: Pamela A. Lussier
Description of Work Proposed:
Reconstruct front porch per attached sketch. Decking to be constructed ofAaek in gray. Posts and railings to be Harvey
RDI product in white per attached specifications. Stairs to be in concrete with bluestone treads. The installation of
synthetic materials is approved based on the building's location at the end of a narrow, dead-end street which has caused
significant weather-related damage to porch. While the approval of synthetic materials is a departure from Design
Guidelines, it is allowed on a hardship basis only.
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: 8/18/16 SALEM HISTORICAL COMMISSION
By: ca 0, "
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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