34 CROWDIS STREET - BUILDING JACKET The Commonwealth of Massachusetts
60 Board of Building Regulations and Standards CITY OF
N Massachusetts State Building Code, 780 CMR 5��01 0: 50
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
I This Section For Official Us Only
Building Permit Number: Date Applied: _
Building Official(Print Name) Signature
I�— SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
34 CROWDIS ST SALEM,MA 01970 14 0076
1.1 a Is this an accepted street?yes_ no_ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R1 ONF FAM
Zoning District Proposed Use Lot Area(sq R) Frontage(ft)
1.5 Building Setbacks(ft)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.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 C3
SECTION 2: PROPERTY OWNERSHW
2.1 Owner'of Record:
MFRILFF nFSANTIS SALEM. MA 01970
Name(Print) City,State,ZIP
34 CROWDIS STREET 978-430-3774
No.and Street Telephone Email Address ,
;SEQ `:MYION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building I� Owner-Occupied lteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Nnmber of Units_ Other &Specify:Replacement
Brief Description of Proposed World:
REPLACE 4 WINDOW - NO STRUCTURAL CHANGE
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials OfficialUse Only
1.Building $ 6,633.00 1 i Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees; $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 6,633.00 ❑Paid in Full ❑Outstanding Balance Due:
{h caapi C' 'II2c\ It.) Sl?
SECTIONS:.CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-06-16
Jamie Moira License Number Expiration Date
Name of CSL Holder U
86 Gardiner St List CSL Type(see below)
No.and Street Type Description
Lynn, MA 01905 U Unrestricted uildi s u to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2214 I 1 Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-17
Renewal by Andersen HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
30 Forbes Rd
No.and Street 508-351-2214 Email address
Northborough, MA 01532
Ci /Town,State,2EP Telephone
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 .......... No...........❑
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Jamie Morin
to act on my behalf,in all matters relative to work authorized by this building permit application.
SEE CONTRACT / i?
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby der the pains and penalties of perjury that all of the information
contained in this application is true d an to to the best of my knowledge and understanding.
JAIME MORIN g r t ( I&
Print Owner's or Authorized Agent's lecmmlr Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered cmttractor
(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.eov/dna
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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un
Up I OR30
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101 HIGH STREET, PO BOX 40, NORWICH, CT 06360 FOUNDED 1840
INSURANCE COMPANIES
(860)887-3553 — TOLL FREE 1-800-962-0800/1-800-243-4080 — FAX(860)886-8270/(660)887-2898
www.nlcinsLirance.com
October 11, 2016
Inspector of Buildings
120 Washington St., 3rd Floor
Salem, MA 01970
RE: Insured: Robert P Desantis
Property Address: 34 Crowdis Street
Company Policy Number: H5183317
Date of Loss: 10/07/16
Claim Number: C62951
Claim has been made involving loss, damage, or destruction of the above
captioned property, which may either exceed $1,000.00 or cause Massachusetts
General Laws, Chapter 143, Section 6, to be applicable. If any notice under
Massachusetts General Laws, Chapter 139, Sec 3B is appropriate, please direct
it to the attention of the writer and include reference to the captioned insured,
location, policy number, date of loss, and claim number.
On this date, copies of this notice have been sent by first class mail to the
municipal officials named above at the address shown.
Sincerely,
Linda M. Fahey
Sr. Property Adjuster
BUTTERWORTH & O'TOOLE, INC.
P.O.80X 8294
SALEM, MA 01971-8294
ADJUSTER&APPRAISERS - -
FOR INSURANCE COMPANIES ONLY
TELEPHONE (978)741-5731 - FAX (978)740-9109
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS . GEN. LAWS, CH. 139 , SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City Hall City Hall
ADDRESSES
Salem, MA 01970 Salem, MA 01970
RE: Insured: Robert P. DeSantis
Address : 34 Crowdis Street
Salem, MA 01970
Policy No. :HO 9705412
Loss of : 4/18/00
File or Claim No. : 08-0715
Claim has been made involving loss, damage or destruction of
the above captioned property, which may either exceed $1, 000 . 00 or
cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable.
If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is
appropriate, please direct it to the attention of the writer and
include a' reference to the captioned insured, location, policy
number, date of .loss and claim or file number.
If no reply is received from your office within ten days, we
will assume you have no liens of any type against this property
and we will recommend to the insuring company that this claim is
paid.
Edward Welch
Adjuster