28 BECKFORD ST - BPA-15-1223 REPLACE 5 WINDOWS i,.
REC I vF
y The Commonwealth Of Massachusetts'` NP,� SE�VICCy�YOF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CNW5, NOV S P j2tet{sWLNar 1011
Building Permit as
To Construct, Repair, Renovate Or Demolish a
M one-or Two-Family Dwelling
rN 1 This Section ForOfficial Use Only
F\ I3uildingPermitNumber. ate. p lied:
lV ti'
-DuilJing 011icial(Print Nti:ne). Duane : ' - ate
' ( SECTION 1:SITE INFOILMATION
Property Address: ST 1.2 Assessors AInp Sr Parcel Numbers
t 2f3 61=Sx R�I�D
1.1 a Is this an accepted street9 yes_ no M1lap Nwnber " " Parcel Number
1.3 Zoning Information: IA Property Dimensions.
Zoning District ::..,.• - Proposed Use Lot Area(sq R) Frontage(R) -
1.5 Building Setbacks(it)
;From.Yoard Side Yards Rear Yard
Requiredvided Required Provided. Required' " Provided
1.6 Water c.J0,§5J) 1.7 Flood Zone Information: 1.8 Sewage Disposal Systern:Zone: _ Outside Flood Zone? Municipol D On site disposol system DPublic D Checkif esDSECTION2r PROPERTYO%VNERS2.1 Ownersof Recrd:
17t1tne(Prinq \//City,State,ZIP 21
No.anJ Street V" ` elep one z Email AddressSECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply),
New Construction D Eiiisting Building❑ Cnvner-Occupied D 1 Repairs(s) D I Alteration(s) ❑ 1 Addition D
Demolition . D Accessory Bldg.D 1 Number of Units1 Other D Specify:
Brief Description of Proposed Work': __ r NJ 00 t
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials :
I Building $ I. Building Permit Fee:S Indicate how fee is determined:
❑Standard Cilyfrown Application Fee
2.Electrical - S ❑Total Project Cost'(Item 6)x multiplier x -
3. Plumbing S 211 Qther Fees: S
d.Mechanical (l-lVAC) S List:
5.Mechanical (Fire $ 'rotal All Fees:S -
Su ression)
Check No. Check Amount:-Cash Amount:
6. 'rotal Project Cast: S z Oo0 ❑Paid in Full ❑Outstanding Balance Otte:
SECTION 5: CONSTRUCTION SERVICES
r
5.1 Cottstructimt Supervisor Liccnse(CSL)
License Number Expiration Dale
Nome ofCSL Holder List CSL'rype(see below)
Type' Description
Nu.and Street
U Unrestricted(Buildings tip-to 35,000 cu. It.
R Restricted 1&2 Family Dwelling
city/Town,State,ZIP M Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
IIIC Company Name or HIC Registrant Name
No.and Street Email address
Cit !Town State ZIP Telephone
SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.I51.§ 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..........13 No...........O
SECTION lap OWNER AUTHORIZATION TO BE.COMPLETEO)VHEN:
OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nano(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
cont ' in this application is tr a and occur -the best of my knowledge and understanding.
veer s or to ionzc Age k s ame(Electronic Signature) D' e
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 Lid have access to the arbitration
program or guaranty fund under M.G.L.c. 1 d2A.Other important nformation on-the HIC-Program can be to`untt at
www m;lss.eov'oca Information on the Construction Supervisor License can be round at www.mass.eov;dns .
2. When substantial work is planned,provide the information below:
'rota) tloor area(sq. ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. 11.) 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. "rotas Project Square Footage"may be substituted a "Total Project Cost"
CO P
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: 28 Beckford Street
Name of Record Owner: Rich & Jane Stauffer
Description of Work Proposed:
Replace 5 windows, in-kind with J.B. Door &Sash windows.
Dated: July 29, 2015 SALEM HISTORICAL COMMISSION
B
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.