30 BROAD ST - BPA-12-757 SHED Vie C'om monweal(h of Mossachuscus
Board of Buildin g Regulations and Standards CITY OF
s b b
Massachusetts State Building Cute, 7SB C'MR SALE,M
2011
Building Permit Application 'ro Construct, Repair. Renovate Or Den a
One- or ricu-Fwnih' Dtvd iuv+
This Section Fur OI'ft''al Use Only
Building Permit Number: Da a Applicd: Z.
Iluilding 0111cial(Print Miami Signature V Dute
SECTION 1:SITE INFOR51ATION
LIL }�1 Property Addre' 1.2 Assessurs Alrp di Parcel Numbers
.la Is this an acce ted street?),es no blap Numher Parcel Numher
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c. 40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Rrblic O Prieate O Zone: _ Outside Flood Zone? Munieipd❑ D I Bite disposal s)stem O
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owne 'o �/ttecord:
r �lce= .2 �,, (2oSS SA( AAA
Nano(Print) City.State,ZIP
3o u7& 7& 7
Nu.and Street relephone Ftnail Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building Owner-Occupied Cl Repairs(s) ❑ Alteration(s) ❑ Addition O
Demolition ❑ Accessory Bldg.1 Number of Units_ Other O Spccity:
Brief Description of Propo ed Work': Q✓nov 2 2 i j ✓ bl c
blid 5 c. —t cA .e <
SECTION a: ESTIMATED CONSTRUCTION COSTS
lent Estimated Costs:
I labor and.Materials) 0mclal Use Only
I. Building S 2 000 a. 11. Building Permit Fee: f Indicate how tee is Jetenmined:
lilrctrical S ❑Standard CityrTuwn Application Fee
❑Total Project(gust'(Item O v multiplier
!. I'IuniM°g S ?. Other Fees: S
J. \Icch,ulicul III\.\(') S List:
�. \Icdtaniccd IF,rc ota
\u++rc�shlnl r \it Fees: S
('11V ANo. ('heck :\mount: Ca
uh \nnuunt:
n Totall'nnjcRCuss: S z UpU �a
( ❑ Pail in Full O Outv;mJing Ilal;mce Due:
SECTION S: CONSI-RUCTIONSERVI( FS
5.1 ('onstructiotiSuljer%isur License((St.I
Wise -i cr� \pirattoii Dale
tol-h-
%;miv of L'S1. I lolder I Ist C G. I)IV 1.ec 116m)
----- -- PC Dvsvriplion
No and Street t I llnrestrictaJ Iltuldit, 3 L10 14)35.00( ot
It Re,irioed l&2 Famill! D--llino
Ot%/klml.Slalv-/11' %1 Mason
RC Rmilin Co%vrin
AS Window md Sidin
SF solid Fuel liurning Appliances
I histilutiOn
D Donolition
I cicphoilc Email;Idjrvsg
5.2 Registered Home Improvement Cuumictor(HIC)
111C Ilegistration NurnhLr 1:\Piraliojl Ditc
I 11C Compaq Mime or I Ill: liciiii.strunt Name
No. mid Street limail address
City/Town.State.ZIP rdephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. J 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...........0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner or the subject property,hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print 0micir's Narne(Electronic Sianulurv) 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 trt qd accurate to the best or my knowledge and understanding.
L
lCVirkinic Signature)
NOTES:
FI. In 0 ,who a building permit to do his.her own work,clan owner who hires an unregistered vuntractur
— OwnerOwner, lot registered i n the Home iiiiproveiiiciitContr.icturIHIC) Programi.will!Up have access to the arbitration
program or guaranty fund under NI.G.L. v. 142A. Other important information on the HIC program can be found at
'u"'
'r,"ra"'or 6
Information on the Construction Supervisor License can be round at
2 When substantial pork is planned.pro%ide the hilbrmition below:
)r area(,q I
rotas flour area(iq. 11.1 1 including garage. finished basement Ittics,decks or pordi)
Ill.") "o Habitable room couill
Crosilkingarealicl- t)
Ntjmheroflirvplaces \uniher ofbedroom
Nuinhcrof hathrounis
Number ol'Jecks, parches
%itelll Flwlo,ed
foi.fl Project Square Footage- ma.% lie itibstitutcd flor-1',,(A Project CoA-
�v
fl c
9�
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 ❑ 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: 30 Broad Street
Name of Record Owner: William Ross
Description of Work Proposed:
Remove existing shed attached to the garage and reconstruct new shed in same location. Siding to be wood
clapboards. Conditional that it is not visible from the public way.
Non-applicable due to being non-visible,from the public way.
Dated: March 20, 2012 SAL I 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.