31 FLINT ST - BUILDING INSPECTION (3) Fhe ('ommlmwealth of \IeSsachusttts
�\ 11 IJId Ill 13lllldllil RCgLIIal1Uns .Ilid SIandaIds l
Nit Nlr it, \1 11 )
\l,J.SachUSCltStitt
\ S 11ullding Code. 7SO('%IK, 7"' edition)
r e.
Fluilding 1'ermit Application To Con>tmct. Repair. Renu,att (h I)rn)Illi,h a Il " •/ / i'"„"
l'hu .-•cuoit For Otticwl Use Only ----- -
Ihuldmu Pennn Numh• _ _ -- — Date .\ppheJ:
ll
ll_nalurr: -
HwIJwF muw..0 My In 1I1n of Ilmldmp, D.ne
SEC"IFON I: SITE: INFORNLN f1ON
j 1 1 'rn 1,.\JJm I 1.2 \ssessurs %lap & Parcel Numbers
Nl.i \u niher_-- —_-- I'.u.el Xunihri
I I d I, ;hu ,ut accepted street" se,—__ no P -
I..', toning Information: 11,41 Propcir-y flan r >:r ns:
ir LUllnl D"tiicl Pro )sed t,e Lot �\re.r I,t, ill h.... .qx it
1.5 Building Setbacks (ft)
Fru�nt Yard tilde Yards Rear Y:ud
Ro�—I provided— Rcy cared PruvJed ReyuurJ� Pu�I IJrJ
I
1.6 Water Supply: (N1.G-L c. Jo. §5-t) 1.7 Flood Zone Information: L8 Sewage Disposal System:
Zone: _ Outside Flood Zone:' Nlunlei aI ❑ On ,uc Jis w,�l .�,Icm ❑
Public ❑ Prn ale❑ Check rt ves❑ __ P s1
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner]of Record: .---
X �--CCN^^ame l Pr,n1tl C Addres> lin Service 7
Signature - Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New C'I Instruction ❑ Existing BuildingX Ow net Rep❑irs(s) ❑ :\Ileraul m(,) ❑ 1 \JJiunn ❑
Demolinon ❑ I Accessory Bldg. ❑ I Numbi ther ❑ Specify _ —I
9ncf Description of Proposed Work-:_
=— 1] _ Vwt �is P-00t + 2 E p—LOR4 �N i tybt I
SECTION a: ESTIMATED CONSTRUCTION COSTS
Lem Esomared Cols: Official Use Only
I iLabor and Materials)
IiwlJulg S I I. Bwlding Peanut Fee: S--y L InJlcale how fee I, drlemmmcJ:
--- — ❑ Standard Clty/fown application Fee
i 2. Electrical N ❑Total Project Cost' i hem 6) s mulnplier .__ s
i. Plumbing S '_ Other Fees: S
1. %lechanical iH\':\CI
i. Mechanical Flrc S ,
Su t,re.auiu � f,•lal :\111=ce,: )__�Z--
Check NAW+3 C heck \miiunt Ca,h \Iw,unl
b Fatal Project Cost j l �t T\1 ❑ Paid in Full 0 uut,t.utdu,g 11,11ame I)ue
SECTION 5: CONSTRIL CHON SFR% ICES
.1 I.icensed ('oiistructioiiStiper%iS4)ri('Si1
"."11C M l SI. I IA&I
SI I'Itv cc
Lic I,( J
1 000 Ft
I \_%,;!j, 7, d
F
5.2 Registered Home Itinpro,tvnient Contractor I IIIC)
III( Ct'itipall, N'llic of HIC R"I%llajlt ssaille
liKnatwc I,-le phone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(67)
Workers Compensation Insurance attidavit must be completed and submitted with this appli,at,-)n 1:.111 Lire tI- III,,,ide
this athdaN it will result in the denial of the Issuance of the building permit.
Signed Altidav it Attached? Yes .... .. - 0 No ., 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. as Owner tit the ],hj,:,i property hereby,
I dialit",ze to act ''I! Ins 111 ,ill III'mets
;c!,we io ,,tork authorized by this building permit application.
Siunature of Owner Date
SECTION 7b: OWNEWOR AUTHORIZED AGENT DECLARATION
_ as Owner orAuthoit/ed
that the state ments and information on the toregoi m: application aie true and accurate, to the best (it my k no k%icd ge and
behalf.
Print .Narne
S,Lin,tur,ol Ownero, AuthowclAgent Date
I Signed under the pain.,and penalties tit perjury) NOTES:
I. An Owner \kho obtains j building permit to do his/her own work, oranok%ner who hires An Liniep,iciedl 11-1111ALk'I
in,,( registered in the Iforne lmprosernent Contractor (111C) Prot,rarm, will not hj\e acce,,.N to the '11f,111,111n
program or guaranty fund under M.G.L. c. 14"A Other important informalion ,m the HIC Progimn ,ind
Cons(lu'li'm Supervisor Licensing WSI,i can be found in 780 CNIR Regulations I M R0 and I I0 R5. IC1IIeL(oCI\
When uhs(arntal work is planned, pio\ide the information below'.
1,,tjl rt,ors area 4 Sq. H.i tintluding __garage. tini,hed ha,eincnt/am s, decks or pt:i,h,
Gnt" Itt,m"Area fsq. Fr i Kihilahle n,om couni
'sumberct nicillaces-_ Number of hedro,mi,
N'1111hel id hathl"t In's NL111117,er Or h.11: Altll
he.ttmiz Number Or 11CLk" ji,�t,hc,
I.%lie of \,iern
Pr11j"I Square Ft,,ajt,,:' may he 'Llb,lituled for F, I'd Pooled C, 'r
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
MAVM 13DWA"MMONSTAGET9sAUMK 'MM0r97o
TVi 9 WUS-9595 9 FAX.975.744900
HOMEOWNER LICENSE EXEIMPTION
Please Print
Date ( � 6
Job Location 3l FL-1 to T 5T,
Home Owner Address
Home Owner Telephone
Present Mailing Address 3 Fl.t ntT
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on
which them is, or is intended to be,a one or two family dwelling, 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
"homeowner"shall submit to the Building Official,on a form acceptable to the Building
Official, that he/she be responsible for all such work 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 understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and r ' ments.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING EPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\I C', \C.�;ni��,:,w Sr?mrr # SAI rat. \1,\.;%; :c i , .Ii
I I.[, L)78-'45-');')5 # I�%\: 'i78.74_-9846
Construction Debris Disposal Affidavit
(retluired litr all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CN1R section I 11.5
Dcbris, and the provisions of v1GL c 40, S 54;
Building Permit ft _ is issued with the condition that the debris resulting from
this work shall be disposed of in a pruperly licensed waste disposal Facility as defined by MGL c
111. S 150A.
The debris will be transported by:
(name of hauler)
I lie debris will be disposed of in
(nume of facility)
p:ddres,of facility)
ignature of permit applicant
( % 0 e
date
J
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978) 745-9595 EXT. 311 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 31 Flint Street
Name of Record Owner. Jonathan & Suzanne Felt
Description of Work Proposed:
Replacement of green asphalt roof shingles with black, 3-tab asphalt shingles.
Dated: August 19, 2008 SALEM IC OMMISSION
By:
The homeowner has the option not to'comm ence the work (unless it relates to re olving 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.