19 BROAD ST - BUILDING INSPECTION (2) w� \
The Commonwealth of Massachusetts
1k\, ) Board of Building Regulations and Standards CITY OF
\ Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 20!1
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Offici Use Only
Building Permit Number: Date &plied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address• 1.2 Assessors Map&Parcel Numbers
IG 3rr��
_ I.l a Is this an accepted street?yes no Map Number Parcel Number
13 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? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP`
2.1 Owner'of Record:
Lr rjao�cc(� \ddoy C'1.S .-
Name(Pr�p \ y City,State,Zffi
No.and Street Telephone Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(c all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other CB_Specify: f00t
Brief Description of Proposed Work : %fir' 9 r 00 wP101 S
SECTION 4:ESTIMATED CONSTRUCTION COSTS III
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ �� 1. 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 $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire Suppression)
$ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
T. SECTIONS:°CONSTRUCTION SERVICES= R._
5.1 Construction Supervisor License(CSL)
2123 5/24/19
Glenn R Battistelli License Number Expiration Date
Name of CSL Holder
Lis[CSL Type(see below) U
11 Broadwa -R/P.O. Box 496 ,Type !' tA T® Descnption m�; =-
No.and Street
U Unrestricted(Buildings up to 35,000 cu.ft.
Beverly MA 01915 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
�- (978) 927-8956 I Insulation
_ Telephone Signature D Demolition
5.2 Registered Home Improvement Contractor(HIC)
172456 7/3/14
Glenn Battistelli LLC HIC Regis nNumber Expiration Date
HIC Company Name or HIC Registrant Name
281 Dodge St
No.and Street Signature
Beverly MA 01915 (978) 927-8956
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 .......... ❑ No........... ❑
i SECTION.7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN s .r
ra'M OWNER'S AGENT.OR CONTRACTOR APPLIES FOR BUILDING PERMIT nk..
I,as Owner of the subject property,hereby authorize Glenn Battistelli
to act on my behalf, in all matters relativ awork aW, WO71 by this building permit application.
X r o o
Print O er's Name(Signature) Date
SECTION:7b OWNER',ORAUTHORIZED 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.
Glenn Battistelli / 11A4,h
Print Owner's or Authorized Agent's Name(Signature) Date
"i. . ..._...?._ __.. NOTES. e111W.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. og v/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"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 NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑O Reconstruction ❑ Alteration
❑ Demolition ❑ 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 Broad Street
Name of Record Owner: Georgia Mon ouris
Description of Work Proposed:
Replace roof and flashing, rotted clapboards. All work visible from the public way will be repaired in-kind and
painted to match the existing.
Repair/replace fence. All work will be in-kind and fence will be painted to match the existing.
Dated: July 11, 2013 SALEM F ISTORICAL 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.