13 BECKFORD ST - BPA-13-341 GAS FP & LIVING ROOM RENO The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
p\1\1 Building Permit Application To Construct,Repair,Renovate Or Demol'
vl One-or Two-Family Dwelling
lrUU1t This Section For Official Use Only
Building Permit Number.: Date: plied:
Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION'
1.1 Property Addr 1.2 Assessors Ma &Parcel Numbers
ST Sct.ler ,MA 15o,5y - �q Z6-
Lla Is this an accepted street9 yeses_ no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
R ?. l2eslr�e.Aut, q ) 35
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
I2 7- 1 Ll0
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public�l Private❑ Zone: _ Outside Flood Zone? Municipal On site disposal system ❑
Check if yes
SECTION 2a PROPERTY OWNERSIIIPr"
2.1 Ownerr of Record:.. ..
HLIN e,l -Scu(ern tAA om--7-y
Name(Print) City,State,ZIP M wil I%G PASO/I t 3
13 13u: t✓Sot-a ST 9 Tg-7'40 -Siiz U coc.usr. neT
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check'all that apply)
New Construction❑ 1 Existing Building Owner-Occupied i1 Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work : Z'nefew.11 c tro n C;Pws. rr i re_,Olrt ueJ i
r6MOvnI nF lower CP:'L.:c1 -i n< hnU Cer li rty� 4-T' cy ow +yl
T_
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs' Official Use Only ;
abor and Materials
1.Building $ Cr 000 -.1. Building Pemtit Fee.$ Indicate how fee is determined��
2 Electrical $ ❑Standard City/Town Application Fee
2 O O ❑Total Protect Costa(Item 6)x mitltrpher x
3.Plumbing ( aLS) $ 5-0 2. Other Fees $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ression -Total All Fees.$
Check No. Check Amount.:: Cash Amount::
6.Total Project Cost: $ S -�-00 ❑Paid in Full O Outstanding Balance Due
';,.. 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 ' " t 'x.Descnp ion
U Unrestricted(Buildings up to 35,000 cu.ft.)ry
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 Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
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 .:.I...... ❑ No:..._.....❑
OWNER S AGENT OR CONTRACTOR
TO BE COMPLETED WHEN S '
r#r. ''' R APPLIES FOR.BUILDING PERMIT a ,
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 Owner's Name(Electronic Signature) .. Date - -
; —,,, = 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
contained in this application is true and accurate to the best of my knowledge and understanding..
M d T/6/ZdrZ
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
wNOTES
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.masg.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.) L/$O (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) a S`oly Habitable room count (/
Number of fireplaces % Number of bedrooms ;3
Number of bathrooms .3 Number of half/baths /
Type of heating system gLXS 6 0r l+-r'-t�l er Number of decks/porches D
Type of cooling system Enclosed ' Open '
3. "Total Project Square Footage"maybe substituted for"Total Project.Cost"
Salem sto cal 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 ' Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
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 Property 14 Rerkford Street
Name of Record Owner: Michael and Karen:Williamson ..-
Description of Work Proposed:
Installation of gas fired fireplace vent with termination cap DirectVent Pro sconce 446DVA-HSC on south
fagade (left side) between first and second window, 2'above the top of the first floor windows, approximately
13'6"from the front edge of the house per sketch submitted.
Dated: July 19, 2012 SALEM FNSTORICAL COMMISSION
By:
The homeowner has the option not to commence the work(unless i relates tore solving 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.