1 HARRINGTON CT - BUILDING INSPECTION The Commonwealth of Massachusetts CITY
Board of Building Regulations and Standards OF SALEM
Massa
chusetts State Building Code, 730 CMR. 7ih edition Re isedJunuury
Building Permit Application-ro Construct, Repair, Renovate Or mulish a l• =uo'v
One-or Tuve-Family DmellinK
This Sect' F Official Use Onl
Building Permit Numb Date p
Signature: /
Building Commissionerl'Ins •torof Buil i Data
SECTION 1: ITE INFORMATION
I.1 Property ddr.ss: 1.2 Assessors Map& Parcel Numbers
Ma Number Parcel Number
.I
Ia Is this an accepted street'?yes_ no
P
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(11)
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.Ja,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if es❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
—tet a t,4 !D � `'/A'yll
Name(Print) Address tor Serve �?
® ps�yz� G 2 - (� 3. J
Signature 'telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 13 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑, 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other Specify:l�t—�Al�r
BriefDescriptionof Proposed Work': PCSFs � t
rc--uCl� 2 1cJ'9- L C� g
Per—
SECTION J: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: OMcial Use Only
Item Labor and Materials
I. Building $ I. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
J. Mechanical (BVAC) S List:
5. Mechanical (Fire S Total All Fees: S
Su ression
Check No. Chick Amount: Cash Amount:
_
6.Total Project Cost: S ` 6-0 Check
Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
r.Licensedruction Supervisor(CSL) r�-511? UQ6 S !I.icense Number P pir List CSL I*\pe UCe below)r Description
/�.... __ s� Il 1'nrestricted u to 35.000 Cu.R.)
`-"�� R Restricted 1&2 FamilyDwelling
wre N1I Masonry Only
RC' nti
Resideal Routing Coverin
I cicphone WS ResiJrmiai Window and Siding _
SF Residential Solid Fuel Burning Appliance Installation
U 1 Residential Demolition
;.2 Registered HAm=lt� vramenntroctor(HIC)
I IIC'Cu pan Nam or IiIEE==1C Ilj�yistttrrrmt Name Registration(Number
dd �— C7"j 9?f' 7 ��0� 22�261
Gspim)on Date
Signature 'relephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 25C(6))
Workers Compensation Insurance affidavit must be co pleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuanc t the building permit.
Signed Affidavit Attached? Yes .......... a No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
11 , 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.
Signature of Owner Date
.ySECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
/Zr (/ltlt5s—�i� ,as Owner or Authorized Agent hereby declare
that the statements and nf'ormation on the foregoi g application are true and accurate,to the best of my knowledge and
behal
&4570ehec2L k,
Prim
23 IOC
Signature of Owner of Authorized Agent bat
(Signed under the pains and penalties of du
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 flame Improvement Contractor(HIC)Program), will nu have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I IO.RS, respectively.
2. When substantial work is planned•provide the information heiow:
Total hours area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Ilabitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfibaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may he substituted lift"Total Project Cost"
I�
�ONDIT
i
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
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: 1 Harrinaon Court
Name of Record Owner: Donald Harlow Powell
Description of Work Proposed:
Patch in existing wood shingle siding and stain to match existing. Repoint brick foundation. Repair or replace
existing basement windows in kind(wood, true divided light, single glaze, clear glass). Repair or replace
window molding and window sills to replicate existing. Repaint trim white and basement windows black.
No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind
maintenance/replacement.
Dated: March 14, 2011 SALEMISSION
By: C
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 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.
b /Fp
F-
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)619-5685 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: 1 Harrington Court
Name of Record Owner: Donald Harlow Powell
Description of Work Proposed:
Remove existing roof shingles and replace with 35 year, 3 tab asphalt shingles in charcoal gray. Repair 1 "x
8"pine fascia boards as needed to replicate existing. Install cobra ridge vent. Install chimneyflashing.
Dated: March 14, 2011 SALE ISSION
By:
The homeowner has the option not to commence the work (unlessrelates 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.