37 CHESTNUT ST - BUILDING INSPECTION i
The Commonwealth of lNtassachusetts
Department of Public Safety
! y :\tasear h hulls SLllo BLI iIth nf;Code(780 C\Ili)
Building Permit Application for any Building other than a One-or Two-Family Llwelling
1 ►Wn (Phis Section For Official lkc Oil IV)
IBuilding Permit ,Vumbec ...--- -- Date Applied: ---"_-____-- Building Official:
SECTION L• LOCAP ION(Please iodi• to Block #ante�d�'Luut #fur locations for which a street address is not available)
No. ,old Street City /Town /ip Code Name of Ruildin; it u , ,lic.lble ---
SECHON 2:PROPOSED WORK
Fdition of MA Stine Code used ------ If If New Construction diet k here❑or chc all that api,l) in the t,vu runs below _-
hxisling Building; ❑ Repair❑ :\Iteration ❑ :\JJi1 ❑ Ucnndition (Phase fill out and submit Appendix 1)
Chanl;e of Use ❑ Change of Occupancy ❑ Other ❑ Specify:_..... ;,No
Are building plans and/or construction titWunu•nts being supplied as part of thispermitapplication? Yes ❑ oIsan Independent Structural Enginecrin% Peer Review mquirct ? Yes ❑
Brief Desscriptit ,t proposed lVu r�r:"_ ..[Yhvi _
SECTION 3:COMPLETE"THIS SEcrION IF EXISTING BUILDING UNDERGOING RENOVATION,AUDt'NON,OR
CHANGE IN USE OR OCCUPANCY -
Chvck here if an Existing Building Investigation and Evaluation is enclosed (See 780 C,\IR S4) ❑
Exislinguse Group(s): —_,_-- _ Proposed Use
SECTION 4:BUILDING IIEIGHT AND AREA
Existing proposed
No.of Floors/Stories(include basement Icecls)h Area Per Flour(sit. it.)
Total :\rca (sy. ft.)and Total Height(it.) -
SEC FION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-'_❑ Nightclub ❑ A-1 ❑ A-1 o A-5❑ V B: Business a E: Educational Cl
F: Facto F-1 ❑ 1:2❑ 1 If: High Hazed If-1 ❑ H-2❑ 11 3 li-a❑ FI-S❑
I: Institutional 1-1 ❑ I-2❑ 1-1 O 1-4❑ M: Mercantilt❑ R: Residential II-I R-2❑ R-3❑ R-4 ❑
S: Stose 5-1 ❑ S'_❑ U: Utility❑ Special Use a and please describe below:
Specialcial Use
SECTION 6:CONSTRUCrION INVE (Check as a licable)
IA M Ill ❑ II,\ a fill ❑ ill,\ ❑ flllf a IV a ..\ — %'B ❑
SECTION 7: SITE INF( RMA HON(refer to 780 C\IR 111.0 for details on each item)
Water Suppl Flood Lune information: Sewage Disposal: Trench Permit Debris I(C.."I":
Public Check it outside hood /-one❑ Imitate mulliclpal ❑ A trench will not bu Luvllwd Disposal Site
Prie.uc Cl nr indcnllIN Lone: or on vile st clan ❑ naluinvl ❑or Ironch or pee if% -
permit is en,loved ❑
Itmiroad right-of-way: hazards to Air Navigation:
..\'ot \pphol blr❑ Is Slim hue,ulhin .orpert ipproat It env IS thou rrc it ,omplelrJ! .
or C on,ont to Budd rn,I...rJ ❑ 1 rc ❑ or.No C3 1 rs Cl \'o ❑ '\
SF('I ION ,4:CONII:NI'OF C FI(1'FVI(':\1 1;OP 0( ill'.\N('Y
I dilwn,d (oJr- l,r l;nnlggsl. I\pool C•.n,lrtr.t,,,n: Ltr,up.mt load per l lour —
IAo, the buildinl;,,vl,00.m tiprmklr r tit,trm.` �pcct.d ;lipul.oion,-
3. J
SIVIION4: I'l(OI'lilt'IYUWNIiRAUT110121ZAI1UN__-
unc and \,Ian's,of I roperly Oauier ��--�--
V,mie (Print) No. and titrccl
City own Zip
Properly Owner Contact Information: -
Title Telephone No. (business) Telephone No. (cull) --_ a-mail address _—_—
it applicable, the property owner herebv authori/es
-..--- Name ---- -----Street Address -- -City/l'uwn State ---Yip it,art on tht, ,ro,ert owner's behalf, in all matters relative to work authorized by this building icrniit a ,+lic,itioll.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If buitililIg is less th,ua.li.diM)cu.it.of enclosed s,ace and or not under Constirmt on CnNral then check here❑and.ski,Section I0.1
I().1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. c-mail address -Registration Number
Street Address Cily/Town State Zip Discipline Expiration Date
10.2 General Contractor .
atileal Is 90-Y6 7
Name
�of PPerrssonn Responsible for Construction License No. and Type if Applicable
d `U
Street pAd✓dree.iss City/Town State Zip
Tole ,hone No. business Tcic+hone No. cell a-mail address
SECCION11: luvaS.rl<:, lkA IN"but)N-I.N"I11"\. 11%111( A�a'i( M.G.L.e. 152. 25C6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a si tied Affidavit submitted with this a lication? Yes❑ No O
SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs: (Labor
Item and Materials) Total Construction Cost(from Item 6) '.5----
I. Building S = 11COb Building Permit Fee'Total Construction Cost x _(Insert here
2. Electrical $ ,)ppropriate municipal factor) '$
1. Plumbing, $
I. Merhanic,ll (HvAC) $ Note: \lininnun fee'$__(io Ittit nuui'eipality)
3. Mechanic,! Other) $ Enclose checkit)
payable t Jf/yF
it. fol,l Cost t0-0lcJ (contact nuuiicipality)and ie rite check mint!" x• e _�.!-___
SECTION 13:SIGNA PURE OF BUILDING PERMIT APPLICANT -
liv entering tin name bopnv, I herebv,utvst under the p,iins,md penalties of perjury that all tit the infonnelion willaincd iu this
.application is true and accurate to the best of my kuoa+lvdgc anal utidcrstuading.
qp
I lease print and .it;n name Rifle Tr l+hon No )etc
C il\'; 11ncn ?lac /ip
\lunicipal Inspector to fill out this sect tun upon application approval:
.Name
geprrllive 1Y�
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
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 will be appropriate to the preservation of said Historic District, as per the requirements set
forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance.
District: McIntire
Address of Property- 37 Chestnut Street
Name of Record Owner: Daniel Randal and Phillip Gillespie
Description of Work Proposed:
Addition of3'x 12' buy with brickfoundation, wood windows, copper roofand wood trim, paint white trim
color, located on West elevation of the existing wood frame extension at the rear of the house. Dentil detail to
match existing on eave of main house.
Replacement of existing wood frame mudroom/sunroom and covered porch with wood frame
rnudroom/conservatory with wood windows, wood trim details, painted white to match and copper roof,
extending rear jagade by 2.5,feet. Removal of existing wood stair on East side and wood deck on South side.
Dated: March 8, 2012 SALEM ST02,CA//L GO N
By:
The homeowner has the option not to commence the work (unless relates to resolving an outstand' g
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 n
Buildings (or any other necessary permits or approvals) prior to commencing work.