31 FLINT ST - BUILDING INSPECTION (2) The Coll'lnumvCalth of MaSSaChll,CtlS
Guard of Building Regulations and Standards CI I'Y OF
Massachusetts State Building Code, 780 CNIR SALLM
'ti"• Building Permit Application To Construct, Repair. Renovate Or Demolish a HC ri.red.1 Gu'2011
One-or TourFuulili'Du eUinp
This Section For Official Use Onl
Building Permit Number: Datte/Applic
f`��
Bolding 011icial(Print N;une)
Signature Dale
SECTION I:SITE INFORNIATI N
LI Pro pert Addres : �� 1.2 Assessors 61 p& Parcel Numbers
r i)�
1.la Is this an accepted street?yes t/ no Map Nunlher Parcel Nmnfkr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Fr,,poscd U,e Lon Area(, 111 4 Frontage(tl)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Re uircd
4 Provided
1,6 Water Supply:( . l.c.40.§54) 1.7 Flood Zone Information: 1.9 Sewage Disposal System:
Public❑ Private❑ Zone: — Outside Flood Zone?
Check if cs❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
7td) n'n eeecord: 1 / Sj� �(
N;Inle(Pnnl) T- ""C W ! --�.�GI 7
SState,1..IP
No.and Street 1 9 /o '
Telephone Entail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Spwil'y:
Brie Description of Proposed Work-:
e✓"0 Z c/'Y/ 46 "12' P e, r
LG
SECTION a: ESTIMATED CONSTRUCTION COSTS
Rent Estit a ed Costs:
Labor and.Materials) OfRcia) Use Only
I. Building S I. Building Permit Fee:E Indicate how fee is determined:
'. Electrical S ❑Standard Ciry/Town Application Fee
❑Total Project Cast"(Item 6)x multiplier
1. Plumhing g � _x -- _
_. Other Fees: $ �J(/p�{j/^J�/
List:_.___.5. 11eehandiliaal ll (Fire
Su„res,iwll S Total :\II Fees:
Total Project Cast: S ('heck No. _--('heck Amount: - -- — ('ash Amount: -/Z ❑Paid in Full ❑Outstanding Balance Due:
3200 ner�av�/
300,b 6r eS7 r �j Erce q�il�ira �P Q� ��hGJgQ�7 �/�/Jj
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(C'SL)
License Number -- --' P.\piruion Date
N;une oll'SI. Ilulder
List CSI.T�pe lice beta\vl
----- ----------- ----------- 'I')pe Description
No. and Street
U I htrestrictcd(Building uii ul 35,000 at. Il.l
R Restricted M2 I:aulil- Mwilin
Citri town,States LIP M Masonry
MD
R(wlin Covering
-. R'indow:mdSiding
Solid Fact Burning Appliances
btsulatiun
l'cle hone I'mail address Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC Registration NwnKr Expiration Date
I IIC Compan) Name or I IIC Registrant Name
No.and Street Email address
Ci /Town. State,ZIP relc hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.4 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 .......... (3 No........... O
SECTION 7s: 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 mattA relative to work authorized by this building permit application.
Alnm
�FC t rs Nwne(Electronic Signature) 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 Owners or Authoriicd Agent's Name 01ccrunic 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
(nut registered in the Hume Improvement Contractor(HIC) Program),will 1 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
q.l Information on the Construction Supervisor License can be found at\\ „\.nets:'0\ Jp,
2. Wien substantial work is planned, provide the information below:
Total fluor area Iny. tl.) _ (including garage, finished basement attics.decks or porch)
(irons living area Iny. it.l Habitable room count _ -
\unlberof fireplaces. _ Number of bedrooms
\'umber of bathrooms Number of half bunts
1.\lie of heating s)stenl _ Number ofdecks, porches
f\pe of O'0llllg system _ l7nclosed _. .. _ _-01'ell -
1. "Total Projcct Square Footage-nt:q he submituted t'or '1'olal Project Cost-
\9��rMINE tX1���
Salem Historical Commission
120 WAS HINGTON STREET, SALEM, MASSAC H USETTS 01970
(973)619-5635 FAX(973)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction Alteration
❑ Demolition I 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: 31 Flint Street
Name of Record Owner: Suzanne & Jonathan Felt
Description of Work Proposed:
Removal of sideword painted cedar shingles on entire house and restore/repairhreplace clapboardv, matertable
and trim as needed to replicate what is underneath.
Paint colors.
Body— Fieldstone
Trim—Sensible Rlhite
Shutters & dour remain Black
Dated: July 21, 2011 SALEM H TORICAL C MISSION
j ✓
By:
i
The homeowner has the option not to commence the work (unless it re tes 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.
I �
CITY OF S,V-&Nf, AASSACHL'SETTS
OLMDLNG DEP-M-N E,NT
120 WAISHLNGTON STAEBT, !iO FtoOA
M (978) 745.9599
KIN®EML.EY DUSCOLL FAX(974) 740.9846
MAYOR h+0.%W ST.PmR"
DIRECTOA OP pLaLIC PII0PEA7Y/BCBALNG CO-NUSSIONER
Construction Debris Disposal Aftldavit
(required for all demolition and renovation work)
In accordance with Debris, and the provisio the sixth edition of the State Building Code, 780 CMR section 111.5
ns of MGL a 40, S 54;
Building Permit p is issued with the condition that the debris resulting from
11 work shall be disposed of in a proper
1
l 1, S I SOA. ly licensed waste disposal facility as defined by MGL c
The debris
/will be transported by:
Iflor1'sr (I/.
(name hauler)
The debris wi II be disposed of in
(name of facility)
Oddrem of facilily)
`''"VitX
°1tl re ofpermrt applicant
- /2 -�
date
nrw it
CITY OF SM-E.M
PUBLIC PROPERTY
DEPARTMENT
�u.a..tsr o.emu
VAvo� Ib'IA" .r7 "sluff•11"KN A040wts9mot1'e
r a.9W45.93"•FAX 975.71p764
HOMEOWNER LI LN
HO�tEO C SB EXE.NP1'I0r
Pleew lirbt
Date `/ —
Job Location �1 o 7c S
Home Owner Address e
Home Owner Telephone 17 e • 7 9tS-. 7 7S
Ptaoer Mailing Address "m e
The current exemption of"Homeowner'was extended to include owner-occupied
dwellings of two Units or less and to allows such homeowners to engage an individual for
hire who.does uat possess a license provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons)who owns a panel of land on which he/she raids or intends to raider on
which there is, or is intended to bee a one or two family dweging,attached or detached
structures accessory to such use and/or farm structures. A person who constructs more .
than one home in a two year period shall not be considered a homeowner. Such
,lomeowner"shell submit to the Building Official,on a form acceptable to the Building
Official, that he/shs be responsible for all such wort performed under the Building
Permit.
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations,
The undersigned "homeowner"certifies that he/she undentands the City of Salem
Building Department minimum inspection procedures and reqyjrrments and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING DiSPE OR
See other side for state coda