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BUILDING JACKET (Ci The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY O SALEM Massachusetts State Building Code, 780 CMR / Revised Mar 2011 { Building Permit Application To Construct, Repair,Renovate Or Demolish a � , One-or Two-Family Dwelling 1 This Section For Official Use Only Building Permit Number: ate Ap 'ed: Building Official(Print Name) Si a ; �D J SECTION 1: SITE INFO ATION 1.1 Property Address: L2 Assessors Map& rceI N tubers L to Is this an accepted street?yes_ 9� no Map Number Parcel Number 1.3 Zoning Information: 1.4 Properly Dim sions: 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: Publics Private❑ Zone: _ Outside Flood Zone?Check if yesEff Municipal$On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP -A' No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Buildingl3� Owner-Occupied ❑ Repairs(s) Rl� Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work�: ./e yo,,C3 Aodrman/E /!'r4 ( . SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials Official Use Only 1.Building $ 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 (BVAC) $ List: 64 C)L 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cast: $ 7�_o.a ❑Paid in Full ❑Outstanding Balance Due: J'b SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) z-G License Number Expiration Date Name of CSL Holder List CSL Type(see below) 61 i/ C rrs y Too./ s 7 No.and Street Type Description y U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling Citylfown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances !7 Z�"��{� ft'o7/HRzG• CoM I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1530/3 1r3-23 -fY HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address Corry /Y/4. cY96G/ �!7-ZT7—/Yll3 City/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 ..........A< No...........❑ SECTION 9a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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 Owners me(Electronic Signature) Date SECTION 7b: OWN t'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 uthorize 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(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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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"maybe substituted for"Total Project Cost" CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving © Reconstruction ❑ Alteration ❑ Demolition x❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 19 r2mbridge 4t Name of Record Owner: Karen M. Cady Description of Work Proposed: Replace clapboards as needed on east and south facing sides of house. Repaint in existing color. All work will be in kind. Dated: June 21, 2013 SALEM HISTORICAL COMMISSION 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. >/Ar� fhe Commonwealth of Massachusetts 1 Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7"edition pFSALEM CITY Massac use Revised January Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. =008 One-or Two-Family Dwelling This Section Fo Official Use Only Building Permit Number: Date Applied: Signature: / Building Commissiu /inspec ui dings Date SE TION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers - .. 'i.I a Is this an accepted street?yes no Map Number Parcel Number _ 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use [.or Area(sq ti) Frontage(11) 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: / Zone: _ Outside Flood Zone? Munici al On site disposal system ❑ Public L% Private❑ Check if yes❑ p Y SECTION 2: PROPERTY OWNERSHIP' 2.1 gqwwner'of Record• / l V'r/Lkn1 Cr�O (AM 0¢O&C 5 1 5-4&f --1, Aill- Name(Print) Address for Service: sod -sa3- YSa Signature Telephone _ SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑FE, wner-Occupied ❑ Repairs(s) Alteration(s) ❑ I Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units Other ❑ Specify: Brief D scription of Proposed Work'-: f.� re .5;lffen WIE/hh✓t _f_� A � RSPN4�T QGrF rc/i.tl,«'S SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ GDr 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 S 2. Other Fees: S 4. Mechanical (BVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Su ression Check No. Check Amount: Cash Amount: 6.Total Project Cost: .S ❑Paid in Full ❑Outstanding Balance Due: e � �O an � a /rJccce SECTION 5: CONSTRUCTION SERVICES + 5.1 L'censed Construction Supervisor(CSL) Z ��-�� L — I.icense Number F'xpimtioit Date Name of CSL-I lolder Iai4ci 1 List C'SL'I'ype(see below) :Wdres Ul rQ14,0p� T' Description U unrestricted(up to 35,000 Cu.Ft.) 18 � �•C� R Restricted 1&2 Family Dwelling Signature Mason Only RC Residential RoofinE Covering Telephone WS Residential Window and Siding Si, Residential Solid Fuel Burning Appliance Installation Residential Demolition 5.2 Registered Hume Improvement Contractor(HIC) (/�72(` CNN me � a� �e S Re istrat ion Number IiIC Cum an Name or HIC rgatrant'ame OV166 7 al iY Addres el 2 53I_1 6p`C Fspirat n Date Signature Telephone 1 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 .......... U,-' No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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. Signature of Owner Date SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION 11 ft} PC�16AJ Zf ,as Owner or Authorized Agent hereby declare that the sta ements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. o / Print Nam Signature-otlOwner or Author'wd 61gent Date / Si ned under the pains and penalties ofperjury) 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(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 780 CMR Regulations 110.116 and 1 I O.RS, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. FL) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Ilabitable 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' i coxar 3 Salem Historical Commission 120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑, Construction ❑ Moving Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage q Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 18 Cambridge Street Name of Record Owner: Karen M. Cady Description of Work Proposed: Replacement of'main hip roof, mansard.side roofs, 8 window dormer and bay window roofs to match existing (3 tab asphalt, charcoal grey). Dated: March 10, 2011 SALEM AL I ION 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. J