229 NORTH ST - BUILDING INSPECTION } The Commonwealth of Massachusetts
RECEIVED
Board of Building Regulations and Stan��j��DEETtONAL SEW 1ICE1kITY OF
E ( Massachusetts State Building Code,780 CNlft SrVLEM
"ed Mar 2011
Building Permit Application To Construct, Repair, Renovae ��1r I11sh�
One-or Two-Funnily/hvelling NO 2T41 ;D
This Section For Official Us Only
Building Permit Number: Date Ap ied:
Building Offcial('Print Name) Signature Date
f� ,1q SECTION 1:SITE INFORMATION
IlerlytVUJ`Yhs �� 1.2 Assessors Map& Parcel Numbers
I.la Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: --- IA Property Dimensions:
Zoning District Proposed Use Lot Area(sq Ili Frontage(Il)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Rcyuircd Provided Required I Provided Required Provided
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
- Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system El
SECTION 2: PROPERTY OWNERSIIIPu
2.h4t e ofRc ord'
Na''n�llliall(Print) jj--�� City,Statc,ZIP
rY^— ct/o- S� �(,&
o.and.ncet Telephone Email 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 Othbaf Specify:_
Brief Desc__r'II rtt77ion of P o Q d Work': 1--P rs+J SIX,t..� ._
b. �tWd ' ork2: J
SECTION 4: ES ruNixrED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1. Building $ SZU 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ Nadu_ ❑Standard Cityrrown Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ „�Uad — 2. Other Fees:
4. Mechanical (I IVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: S
6. Total Pro ect Cost l $ l l/� Check No. _Check Amount:_—Cash Amount:
: (� l l ❑ Paid in Full ❑Outstanding Balance Due:
Z 6DEV3 ST
stn,i i 4 -t ( L�
I,
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor.License(CSL)
09-5"301 `1 113 ,)1
License Number Expualfon Datc
Nnnc of(�ISfL H Ider
List CSL Type(see below)
No.and Street Type Description
U Unrestricted (Buildings u to 35,000 cu. R.
R Restricted 1&2 Farnily Dwelling
Ulyffown,State,ZIP
M Masonry
_ RC Roofine Covering
WS Window and Siding
SF Solid Fuel BumingAppliances
I Instdation
Telephone Email address D Demolition
5.2 Registered Ho me Improvement Contractor(IIIQ / i_/�g— / 3j /
I lIC Registration Number Expiration Dale
T� jomp ur ame or lUgistr�rigNa
No.and Street
I nI 8 -�3V . ' :Q Email address
City/Town,State,ZIP � Tele hand)5
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 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 .......... 0 No........... ❑
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 authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Y d1� ") gfCAA
Print Owner's Name(F,lec(ronic Signature) Date
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest tinder 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 Owner's or Authorized Agent's Name(Electronic Signature) pate
NOTES:
I. 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 Home 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.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.vov/dps
2. When substantial work is planned,provide the information below:
Total Boor area(sq. ft.) (including garage, finished basemenUattics,decks or porch)
Gross living area(sq. ff.) Habitable room count_
Number of fireplaces _ Number of bedrooms _
Number of bathrooms _ Number of half/baths
"Type of heating system Number ofdecks/porches
Pype ofcooling system_ Enclosed _Open _
3. `Total Project Square Footage"may be substituted for"Total Project Cost'
-- I
CITY OF SM EM, i%L1SSACHL'SETTS
j / ~
BUILDING DEP.4R'fME.\T
120 WASHCVGTON STREET, 31' FLOOR
TEL (978) 745-9595
FAx(9 7 8) 740-9846
Kl\iB Ri F.Y DRISCOLL
y',A-kYOR THoNw ST.PIEMH
DIRECTOR OF PUBLIC PROPERTY/BUR.DING COMMISSIONER
Workers' Compensation insurance Affidavit: Builders/Contractor,4/Electricians/Plumbers
A a tlicant lnformatinn Please Print Le ihi
Nainl' (nusinuss.Urganirationrinuividu,J l: G � ( � - t `'
Address:
City/State/Zip: a Phone f :
Are pain employer:'Check the appropriate box: 'Type of project(required):
I. 1 am a employer with 4, ❑ I am a general contractor and t
employees(full and/or part-time).' have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet, ; 7. emodeling
' .hip and have no cmploycex These sub-contractors have 8. ❑ Demolition
working For me in any capacity. workers'camp. insurance. 9, Building addition
)No workers' comp. insurance 5. ❑ We are a corporation and its
required.) officers have exercised their 10.❑ Electrical repairs or additions 3.0 1 ant a homeowner doing all work right of exemption per MGL 1 I.[] Plumbing repuirs or additions
myself.(No workers' comp. C. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.) r employees. [No workers' 13.C] Other
comp. insurance required.)
•Any upl lit o tlwl elweks bux 11 moat.rlsu NI caul IN section bclowshewing their wurkau'eumpensatiun pulicy inlurmaliun.
' L+mmrwnen who whmit this sindnvit indicating they are doing call work and then hire uuuidrr cuntmctars m101 Submit a now aOFdavit indicating such,
('notrwtun that cheek this bux mtal anaehal can additiunal Am showing the n:une of the subavmnetun and their workers'camp.pulley inrolmmion,
I alit can eurplayer that is providing workers'cumpeasarlon insurance for my employees. Befoly fs the policy and Job rile
lrtfonrrarian. � _
I n.wr;mce Company
Policy 4 or Self-ins, Lie. d: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation pulley declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of&fGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S1.500,00 and/or one-year imprisnmmcni,as well as civil penalties in the torn of a STOP WORK ORDER and a lint:
or up to S250.00 a day against the violator. Ile advised that a copy of this statement may be furwardcd to the Office of
luve•.aig;ttiun.c ol'the DIA For insurance coverage vchficaliun.
1 du hart enmity a er drr p07(r )uJ penalties of periury that the L jormuduff rovided a cave ix rue and correct.
\ p 7 -a
- cn note' "-�7 Datd• �
Phone 1
Official use Surly. Oo nar write in this area,tube cumpletad by city ur lown a/Jiriut
i
City or Towns: _ .____ Permirli.lccmc ts
fssuing Aulhurity (circle one): - --- ---
I. 0oarddaf Ilealih 1. Buildinq DepasUucot I.CilyMivo Clark 4. Nlectrical Inspector 5. Phtmbing (nsp.cror
b. Other
t
t C'unlact I'erson: _ ---_-- Phone B:
--------------
CITY OF S,Uzm, A-ks&: CHUSETTS
i.l� i`>" tll'[LDL�IGDEP.IR TIGYT
120 C(/.1SHLNGTOV STREET jw FLOOa
TEL (973) 745-9595
Kl MMIU EY D[tISCOLL FAA(973) 740-9344
,1,LAYO;a
I`-ta�c�Sr.Pt�vig
DIRECCOR OF PUOLIC PROPERTY/aL•UpLNG C0SL%11SSfON ER
Construction Debris Disposal fkt-f7(lavit
(required for all demolition and renovation work)
In accordance with the si.edl edition of the State Building Coda, 730 Cj,(R section 111.5
Debris, and die provisions of tMGL c 40, S 54;
Building Permit this work shall is issued with the condition disposed of in a properly that the debris resulting from
S 150A. be licensed waste disposal facility as defined b9GL c
"I'he debris will be transported by:
Oam, orltat,t,l)
fhe tlebri3 will be disposed ot,in
(.iJatest of r.iality)
sign�turr u(permil.t�
{pfi�•aut
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Super�isor
License: CS-095321
DANIELDBEA "`
10 FORT AVENUE
SALEM MA 01970
>nN" Expiration
Commissioner 07/13I2016
Q\ Office of Consumer Affairs&Business Regulation •'
ME IMPROVEMENT CONTRACTOR -
-_ egistratlon. A(61*86 T
xpiration 19 3l 0/2Q75 - DBA
BEAUVAIS BUILDERS° �
DANIEL BEAUVAISI~',�' -
2 N/ESTVIEW CIRCLEz
PEABODY,MA 0 �
Undersecretary
ce: Any work needed to be done that is not mentioned in this estimate will be an additional cost.
111 carpentry work will be done at a cost plus basis, @$95.00 an hr for me and one laborer,plus the cost of
material.
Any additional work needed will be discussed and agreed upon prior to the start of any such work.
(Such as an AC unit/
Respectfully s e anie uvais,owner of Beauvais Builders
Daniel Be uvais---------------- -------- - Homeowner------------- --- ----------------------
Unrestricted builders license#CS-095321 EXP 7/13/2014. HIC license#16488 XXP 11/30/2015.