6 HAMILTON ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
i �> Board of Building Regulations and Standards CfCY OF
Oj Massachusetts State Building Code, 730 CNIR RevisedSALfcrrI201/
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family Divelling
'Mis Sact ort ForOfficial Us of
Building Permit Numberr, Data:Ap edi
Building Official(Print Nama) Signature.. 7��
to'_"
SECTION [:SITE I�NFORNIATION.
X LL Property Address: 1.2 Assessor Map g Par el Numbers
HapW11 {�h St . Sa�°6N /AA A
1.1a 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.O.L c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public❑ Private❑' Zone: _ Outside Flood Zone?Check if yesO MunicipalQ On site disposal system ❑
SEGTIOPtZS PROP.ERTIf-OWIVERSHIF! .
2.1 Ownert of Record:
Z3ey1 Wi-(�lheC 3alewt, mA ol9 76
Name SPrint) City,State,ZIP
/Iattn (bn Sf 761 W16/`111 6ewwi4ne%r " gvvta;1,c6vv:
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED.WORW'(check ali that appiy)
New Construction❑ Existing Building❑ Owner-Occupied Q Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition Q Accessory Bldg. Cl I Number of Units I Other ❑ Specify:
Brief Description of Proposed%rkt: 6 ' x R ' ejjeA to sfa Il A h'�
SECTION 4: ESTINWTED CONSTRUCTION COSTS-
Item Estimated Costs: OfRcial Usta Onl
Labor and Materials Y'
1. Building 5 I. Building Permit Fee:S' Indicate how fee is determined:
�. faectrieat Q Standard.Citylfown Application Fe&.
❑'fotat Project Cost t(Item Q x multiplier x
3. Plumbing S 2. Other Fees: S
1. ,M-Chanical (IIVAC) S List:
?. :Mcehanic.it (fire S
SnP ttcssirnt) — Total All Fces:.S_
Check No. Cltcck Autount: __C;ish :\mount
----
n 1'ural Prnicct t'u;C S �5 0 f ❑ P.tid in Fill OOutst:mdim, Ilnl:mcc I)ua: _---. _-
SFCfION5: CONS'MUCIIONSEIMCES
5.1 Construction Supervisor License(CSI.) -
License Number Expiration Date
Name of CSL I(older List CSL'rype(see below)
Type Description
No. and Street U Unrestricted(Buildings up to 35,000 cu. tl.
R Restricted M2 Famil Dvvell"l
Citylrown,State,ZIP 1%1I %clasonr
RC Rootin Coventl
WS Window and Sitting
SF Solid Fuel Iluming Appliances
I Insulation
D Demolition
1'ele hung Email addrcs9
5.2 Registered Home Improvement Contractor(IILC)
HIC Registration Number Expiration Date
I IIC Company Name or IIIC Registrant Name
No
Email address
.and Street
Ci /Town State ZIP Tale hone
SECTION 6: IVORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. 1 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 .......... ❑ No ❑
SECTION 7 - OWNER AUTHORIZATION TO BE CO1141 ED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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)
Dille
SECTION 7h: OWNEW 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.
2Y1 (n/J 2( 6I27Date
,013
I`rint Owntr's or Authorized Agent's Hanle(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do hisiher own work,or an owner who hires an unregistered contractor
(nut registered in the Hotne 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
www m:u±.cuv%ore Information on the Construction Supervisor License can be found at www.mass. n�w_�IL
2. 1V11en sib,tantial work is planned,provide tho information below:
futal Iloorarea Oki ttJ _( cluding garage, tinislted b:lscmenV:utics,decks or porch)
f labitable rows count _
tiro;; living:uea(sq. It _ Number of bedromni --_--
Number of tiraplaec;,..---------- Nuuther of hal0aths -- -- _.
Nunlbcrofbath oums _ ------_---.— - -- ——
I"pe of ho,tling iYstull Nunther of dxks,'porihes
-.. ----
---Enclose t pen
..f,v,llI'r,q.rt �'.plu'a Foot,eSC', ul.ryhC ;Ilh,tinrt. lt; r " I„ellI'r,ijtalira' -,_- _ .
CITY OF S. -04
PUBLIC PROPERTY
DEPART►tiLENT
u .7Wf1r eu+•.r�
wane t]0 WMWMG **UW•
r u
HO►KEOWNER LICLNSR E.XE.W j0j-j
P1011ss Print
Due 2 /2al3
lob I oeados 6 9AW r /{e r\ Sf Sg l e m MA
Home Owner Address & 11A mi l+-ar7 G1, l e w M a Q1 of 7Q
Home Owen Telophnne 791 8
Presstt 14faillag Addtea G_f laYu /fo n 4-. tT 76
TU current exemption o!"Iiomeowna a wag extended to include owner-occupied
dwellings o[two Unite or lea and to allow reach homeowners to engage m individual for
hire wbo don not posaese a licenses provided that the owe acts as aapaevisar.
DEFINITION OF HOINBOW AM
Person(s) *be owns a parcel of WW an which hdahe reslda or intends to readdt% on
which them is, or Is intended to be; a one or two litmily dwelling, attached or detached
ntrumm accessory to such sag and/or tarn sWx u va, A person who constructs mors
than one home in a two year period shall not be considered a homeowner. Such
"homeowner"jW submit to the Building Oalcial,on a tone acceptable to the Building
0lllci4 that hdshe be responsible for all such work performed under the Building
Permit
The undersigned "homeow"ce assumes responsibility forcomplianes with the State
Building Coda and other applicable bylaws and regulation&
The undenigned "homeowner"cent Iles that haute undentands the City of Salem
Building Department minimum inspeeriae procedures and requirements .and that he/she
Nill comply with maid Procedures and requirements.
HOMEOWNERS SIGMA TL'RB
�PPROV,�L OF 911lLDIYG MPECTOR
See other side fat state coda
v��CONUIT� .
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978) 619-5685 FAX(978)740-0404
Buiiuii,gs (or any other necessary permits or approvals) prior to commencing work.
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑x Construction ❑ Moving
❑ Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
as descri, below will be appropriate to the preservation of said Historic District, as per the requirements set
forth uj Iiia:r3istoric District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance.
Distri is McIntire
Address of Property: 6 Hamilton Street
Name of Record Owner: Ben &Mariorie Wittner
Description of Work Proposed:
Install a shed in the backyard. The shed will be:
8 X6
6'high to bottom of roof
4" overhang
Bl lck shingles
tt; wood construction
" M ed will be stained and trimmed to match the house paint colors
LoL:, �n of shed as submitted in the application dated 5130113.
Dated: June 27, 2013 SALEM HISTORICAL COMMISSION
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.
BUILDING
NOT A B THIS IS U G 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.