0038 FLINT STREET - BPA-10-456 The Commonwealth of MajjAn'dilrds
ets Town of
t� Board of Building Regulationsards
Nassachusens State Building Code, R, 7'"edition Building Dept
1 ` Building Permit Application To Construct Renovate Or Demolish a
^I One- w Ttru•funult D
\w�^ This Section For OftOnly
Building Permit Number � Date Signature: 41BuildingCommissioner/ Inspector of Buildings SECTION 1:SITE INTION
1.1 Property rev) t „ 1 Y1 1.2 Assessors Map& Parcel Numbers
f n Pl Number
1.1 a Is this an acc led street? o M W Numbs arce
yea
IJ Zoning Information: 1.! PrepeAy Dlmeaalone:
Zoning District Proposed Use Lot Area(sq R) Frontage 1(1)
16 Building Setbacks(It)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided '
1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.11 Sawage Disposal System:
Zone: _ Outside Flood Zone? Municipal O On sits disposal system O
Public O Private O Check if veso
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owneri f Record: '
hPrt ���Vt�Gc�2
Name(Print ` A for Service:
y'ZZ- 7V0 -
Signature relephoir
SECTION): DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
New Construction O Existing Building Owner-Occupied Repairs(s) Alteration(a) Addition O
Demolition O Accessory Bldg. O Number of Units_ Other O Specifry:
Brief Description of Proposed Work
SECTION!: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Ofllcial Use Only
Item Labor and Materials
I. Building f I. Building Permit Fee: f Indicate how fee is determined:
O Standard City/Town Application Fee
2 Electrical f O Total Project Cosa(Item 6)a multiplier ay�—
) Plumbing f 2. Other Fees: f /
a. Mechanical IHVAC) f List: 7
S NechamcaI (fire S Total All Fees: f
Su remon
� Check No. _Check Amount: _Cash Amount:_
is Total Project Cost f 0 Pad in Full 0 Outstanding Balance Due:
SECTION !: CONSTRUCTION SERVICES
!.I Licensed Construction Supervisor(CSL)
License Number Etpiraoon Dare
N,yet tit CSL Ilglder Lia CSL Type(*cc twluw)
Address [RDResideniial
Description
nrestricted u to 11.000 Cu. Ft.
estricted IA2 FamilyDwellin
sit"lure Masonry Only
sidential Roofin Covering
Telephone sidential Window and Siding
sidential Solid Fuel BurningA Nance Installation
Demolition
S.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Dale
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I. e. IS2.I ISC(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..........O No........... O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. . as Owner of the subject property hereby
aulhorize to act on my behalf.in all matters
relative to work authorized by this building permit application.
Si awe of Owner Data
SECTION 71y:OWNERI OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and information on 1 e orego' application arc we and accurate. to the best of my knowledge and
behalf. Sh e- ( .-S-LA !/1/ZJ,/-e-I
Print Name
Signature of Owner or Authorized Agent Dale
Sistried under the pains and penalties of
NOTES:
I. An Owner who oblains 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 go have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I 10 R6 and 110.R!.respectively.
2. When substantial work is planned.provide the information below-
Total Goon area(Sq. Ff.) (including garage. finished basement/attics.decks or porch)
Gross living area tSq. FL) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half baths
Type of heating system Number of deckv porches
Ts pc of cooling system Enclo%cd ._Open
1 Total Project Square Foolage"may he.uh%muted for 'Total Project Cost"
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
❑ Reconstruction ❑ Moving
❑ Demolition ❑ Alteration
❑ Signage ❑ Painting
❑ 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:
Address of Property.:_
Name of Record Owner: Sheri Rosenzweig
Description of Work Proposed:
Paint colors:
Gable shingles, body clapboards—Muted Mulberry
Trim — Tudor Ice
Doors—Asher Benjamin
Foundation— Unpainted
Replace two side (kitchen) windows with 4 over I windows. Replace two front windows with I over I.;Windows to be wood true divided light, single glaze with energy panels.
Dated: _Aucust�
SA
STORICAL CO7/77
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.
I-I IIS 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.commencrn g work.