30 CHESTNUT ST - BUILDING INSPECTION qz
The Commonwealth of Massachusetts R$ EIV�Q�� �WCE$
Board of Building Regulations and Standards INSPECTI AlR
Massachusetts State Building Code, 780 CMR SALEM
c Revised Mar 2Q(l
Building Permit Application To Construct, Repair, Renovate Or DertielahAP11 3 A 4 1
One-or Two-Family,0welling
This Section For Official Use Only
Building Permit Number: IDate A plied:
S h) /
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
3, Ches f-
1.la Is this an accepted street?yes no, Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(&)
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: LS Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
•SAAe- r'lto two eo6y,� ' ot,f 2
Name(Print) City,StatLlP
,TY I�I .I, r' S �' q7d'• 7y`1• JIJo /U/9
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repmrs(s) ❑ Altemoon(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work z: (?� Ie„ , 7 —
b M'dh �G�'1.a„45G c..+"(t. d/Gt-+�oC2ri� C✓—Tyl
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SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. 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: $ I al•I�p — ❑ Paid in Full ❑Outstanding Balance Due:
T1 R ( S 1C
e s � C(
SECTION 5: CONSTRUCTION SERVICES
5.1 Con'str"uction,Supervisor License(CSL)
01 CAS oSk'�-d—s 'I d� r
License Number Expiration Date
.Name.of CSL odder
r
.r �•i ;i'� iiIri List CSL'rype(see below) C.)
No.and Street Type Description
Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted 1&2 Family Dwelling
Cityaown,State, P M Mason
ry
RC RoofingCoverin
WS Window and Siding
/ SF Solid Fuel Burning Appliances
S15 Sit 7G6� �,,. �� (J>M• (iM l Insulation
Telephone Email dress D Demolition
5.2 Registered name ImprovementContractor(HI )
�7 / 11 S 8 a� t�_�,_,r
n
AS e, 2o3r. SQI✓• y ;5 c- HIC Registration Number Expiration Date
HIC ompan Nun r HIC Registrant Name
J£ 2 �I�rH r% c�a b FRS n,,f. , CP
No.and Street 'mail addres.
?0M- ✓ ZI otS6 �j73 S3L j6G ?
Cit /To , State, P 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 .......... 0" 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's None(Electronic Signature) Date
SECTION 7b: OWNEW 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 a plication is true and accurate to the best of my knowledge and understanding.
Print Owner's or Ythorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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.mass.eov/dos
T. 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�,6coiuniT �
RECEIVED
tP INSPECTIONAL SERVICES
a
Salem Historical Commission -� A a ss
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:
❑ Constriction ❑ Moving
IR 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 Chestnut Street
Name of Record Owner: Jane Phillips
Description of Work Proposed:
Remove the existing internal copper gutters along the rear of the house and install new internal copper gutter.
Work includes associated in-kind slate repair.
Dated: May 7, 2014 SALEM HISTORICAL COMMISSION
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.