27 CHESTNUT ST - BUILDING INSPECTION r � -
The Commonwealth of Massachusetts
t1 Board of Building Regulations and Standards CITY
Ji I Massachusetts State Building Code,780 CMR,7ih edition OF SAL
EM Revised Jaaanu
rpy
Building Permit Application To Construct,Repair,Renovate Or Demolish a 1,2008
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit!!m N A J Date Applied: U
Signature: /"
Building Coludirigsiona dings Date
IA
ON 1:SITE INFORMATION
1.1 Prope Address: 1.2 Assessors Map&Parcel Numbers
1 C'.54
Lin 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 Requred Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public❑ Private O — Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name(Print ' Addresssss for Service:
�1'l - l79-' 'NY- 11070
Sigoabue Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) 1k I Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief DeyysVp� ptionof Proposed WorlO:
LCt - CCU.. j G.• f=SNn A-e( ,-r,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item r and Materials Official Use Only
(Labo1.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 (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:
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expvation Date
Name of CSL-Holder List CSL Type(see below)
Address Type Description
U Unrestricted to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwellm
S'pat"re M Masonry Only
RC Residential floofing Coycrim
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential T)®olition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Reostranon Number
Address
Expiration Date
Signatrue Telephone
SECTION 6:WORIMR.S'COMPENSATION INSURANCE AFFIDAVIT(NLG.4 0152•§ 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...........0
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 to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature ofOwaer Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
I, as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of Own or Authorized A ent Date
(SiRned under the pains and Penalties of
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 find under M.G.L.c.142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and I IOR5,respectively.
2. When substantial work is planned,provide the information below
Total floors area(Sq.FL) (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 halflbaths
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"
Salem Historical 'Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978) 745-9595 EXT 311 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: 22 Chestnut Street
Name of Record Owner: Oscar Padien
Description of Work Proposed:
Repair/restore and repaint rear deck to replicate existing. No changes in color, material, design or outward
appearance. Non-applicable due to being in kind maintenance.
r'
Dated: October 13, 2009 SALEM T AL 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.