343 ESSEX ST - BUILDING PERMIT APP (002) H The Commonwealth of Massachusetts
° Board of Building Regulations and Standards INSPEi U AMICE
Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permjt Application To Construct,Repair,Renovate Or DemoNt4aM —5 A es 38
One-or Two-Family Dwelling
This Section For Official Use Onl
Building Permit Number: Date Applied:
J/
Building Official(Print Name) Signature VDate
SECTION 1:SITE INFORMATION
1.1 Properpyt Address: 1.2 Assessors Map&Parcel Numbers
L I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Dist—net 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'of Record:
lade'l A(Print) N— c Q �r� �j 0 t��V VI (� Cal g ?O
Name(Pnn[) City,State,ZIP 1
5SPC
No.and S etr t � '7'elep� Y— o J Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOR W(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) A I Altera[ion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed k': e - h- N
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 S 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
f�-- TD c)
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) o 9
r 1 C �-Q I License Number &—ppmItioonn f51,at�,
Name of CSL Hol
✓ovList CSL Type(see below) ��`
a l.�e AsPe
No.and Street Type Description
U Unrestricted( ail s u 35,000 cur.ft.)R Restricted 1&2 Family Dwelling
C)ty/fbwn,State,ZIP M Masonry
RC Roofing Covering
Window and Siding
_ -7 SF Solid Fuel Burning Appliances
o I Insulation
el hon Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Inc Co Name Regi t N'me HIC Registration Number Expir ate
mp oo���II[[C
d Streetl Email address
/ tit e1Ml�c��t � 4' 7&475 ?41-6
Lawn,State, IP 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 ..........Ot' No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
— 1
I,as Owner of the subject properly,hereby authorize C f t C— � -P_.t� \
to act on my behalf,in all matters relative to work authorized by this building permit application.
l--[-�\-Lo r —tU C-.Q— 1-L`� \ Ed 571
11.
Nat Owner's Name(Electronic Signature) -_J — 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 A orize A_g,- 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
)nnL.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
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" ��f�
f
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
El 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: 343 Essex Street
Name of Record Owner: Lawrence Frei
Description of Work Proposed:
Replacement of existing 3-tab black shingle roof with new 3-tab black shingle roof.
S
Non-applicability clue to work being in-kind replacement.
Dated: April 28, 2014 SALEMHpIST/ORICAL COMMISSION
By: A lI
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 1S 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.