40 CHESTNUT ST - BUILDING PERMIT APP (002) L�Z GK 5 S`-I ►l-'1�
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State ButMitg Code,780 CMR SALEM
Revised Mar 2011 -
Building Permit Application To Construct,Repair,Renovate Or Demolish a y�
One-or Two-Family Dwelling
This Section For Official U Only t /.
Building PermitNmnber: Date App ed: i✓ � F
1-
Building Official(Print Name) - Signature Dalcoo �L
SECTION 1:SITE INFORMATION /
. _.1.1_.Property-Address: - L2 Assessors-Map-&Parcel�Nnmbers tT, (!!
HD C-AeS fn.✓l- sl-reef
L 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 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTi3ON.2:..PROPERTY OWNERSHIP_'
2.1 Owner'of Record:
Sef� �2G�2 Salewr � �� O J
Name(Print) City,State,ZIP
t/o C✓1nS{nuf S�. el7 - 5-13-9,0 6etilePeJvny4nce.
No.and Street Telephone Email Address
-SECTION3:-DESCRIPTION OF=PROPOSED WORK'-(check-all-thatapply)-
New Construction❑T—Existing Building fE". Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ -
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of P oposed Work': (cs_e ,5�,iffPl ��-,ti.. L'/ S.' 757-
Cell( fJ. .JS 1'e� r 7? sej�a,wJn 1Pt (eSlom i Slnr;c
!c-s..2 W.'7-G. ato f,✓ en.o oh�✓�P.� la�/ ®e.ir+.L+.�
SECTION•4t ESTIMATED CONSTRUCTION COSTS:
Item Estimated Costs: Official Use Only
3nd.Materials)
1.Building $ a 6 To 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost?(Item 6)x multiolier x
_.3.Plumbing . ..$ 2..,Othei-Tees: S ,
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire - $
Su ression Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ b ❑Paid in Full ❑ Outstanding Balance Due-
4 C.(a Lt p lz0 2 ( U
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
P lo�g3 1�
,_�dY�eµi t /� License Number Expiration Dale
Name of CSL Holder - List CSL T
30� e P2 Type(see below) l/
No.and Street !i Type Description
$�n� o�.(p l) U Unrestricted(Buildings up to 35,000 cu.ft.)
t R Restricted 1&2 FamilyDwelling
Citylrown,State,ZIP M Masonry
RC Roofm Covetirt
WS Window and Siding
SF Solid Fuel Burning Appliances
J$1 63 CS ,2� ✓t a J yMCS�nryr i u2? I Insulation
Telephone Email address Gv D Demolition
5.2�R/,e�gistered Hom�e/Improvement Contractor(HIC)
HIC Compan Name or HIC Registrant Name HIC Registrapption Number Expiration Dale
PO. (3oV $�jcN 6fensrurCH2�/YwIfN<SeIfYF
No.and Street Email address n.o/'e,
St(e0,, M� O/y i/ 9}S S��'o9'1v ca,n
city/Town, State,ZIP Telephone
SECTIONb WORKERS'£OMPENSATIONINSURANCE'AFFIDAVIT(M.GL-c..152'§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit wt7l result in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes .-._.....X No...........
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S.AGENT.OR.CONTRACTOR.APPLIES_FOR BUILDING PERMFI'
see C:mrf ecF
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 Name(Electronic Signature) Date
SECTION7b:QWNW 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 Authori gent'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 MG.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.sov/dps
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"
r
o �
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 ❑x Painting
❑ Signage ❑O 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: 40 Chestnut Street
Name of Record Owner: Jeff Beale
Description of Work Proposed:
Replace the existing shutters. The shutters shall match the existing in all respects and be painted to match the
existing units. The existing shutters are mounted backwards, the replacements should be mountedproperly.
Repaint the lintels and sills, caulk the windows, repair and repaint the front entrance. There will be no changes
to the design, color, or material.
Dated: August 28, 2014 SALEM HISTORICAL 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.