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30 BROAD ST - BPA-12-928 The Commonwealth of Massachusetts A Board I of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR ar42011 Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised JOne-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) 1, Signa Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.I a Is this an accepted street?yes no Map Number Parcel Number -- '13'ZoningInformation: IA 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?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'gf Record: // Ltlr�lfGwl BOSS 5e?k/ r �l� �(nt ? Name(Print) City,State,ZIP ` 30 e �p- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s)y I Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': l� w SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 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 (IfVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ 6.Total Project Cost: $ Y©o_60 Check No. Check Amount: Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 104ZJ��kN-__y ? � License Number ! A Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings u to 35,000 cu.ft. ` City/Cown,State,ZIP R Restricted 1&2 FamilyDwelling M Masonry RC Roofing Covering _1J WS Window and Siding �JJ 2 ` SF Solid Fuel Burning Appliances Ib 3 I I Insulation Telephone Email address D Demolition 5.2 Registered tHome Improvement Contractor(HIC) /� aW/bY",,R10/ 15� �lUfe� l0{�. HIC RegisttratiionnNumber Expiration Date RIC Compfiny Name or IRU Revstrmt Name i n No.and eet mail address s/,t( e(e A4 aG4?;o City/Town,State,ZIP Tel hone 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...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT / I,as Owner of the subject property,hereby authorize U`P �� t' / U/y to act on m behalf,in all matters relative to work authorized by this building permit plication. 1� � /a Print Owner's Name 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. Print Owner's or Au 'zed ent's Name(Electronic Signature) Date 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 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.niass.gov/dpss 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" • v��ON01T4�Q! � �1 b 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 St Name of Record Owner: William Rosa Description of Work Proposed: Replace back porch steps to replicate existing. No changes in color, material, design, location or outward appearance. Non-applicable dale to being in kind maintenance/replacement. Dated: April 26, 2012 SALEM O 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.