9 DALTON PARKWAY - BUILDING JACKET k" ,w\ .
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The Commonwealth of Massachusetts Town of
Board of Building Regulations and Standards
v
Massachusetts State Building Code, 780 CMR, 7"edition Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fandly Dwelling
(1 This Section For Official Use Only
Building Permit Num r: Date Applied: — `k — c7
Signature:
Bwl mg ommissioner/Inspector of Buildings Date
SECTION 1: SITE INFORMATION
I.1 Pro1,eerty'Addresr. 1.2 Assessors Map& Parcel Numbers
1.[a 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 R) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.U.I.C.41),§34) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Public❑ Private❑ Check it es❑
SECTION 2: PROPERTY OWNERSHIP'
2.l�wner'o(Recordn , '���� 9 `� '��� �
((FH-I to GI 0. bb�v�t
Name(Pri ) Address for Service:
9 7 F-- h'S3- 0 SG �{
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building Owner-Occupied 0- Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': /4 L a
SECTION 4: ESTIMATED CONSTRUCTION COSTS I
Estimated Costs: Official Use Only
Item Labor and Materials
G r o o U 1. Building Permit Fee: S Indicate how fee is determined:
I. Building S
_ ❑ Standard City/Town Application Fee
2. Electrical S // f DO ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S `y sat? 2. Other Fees: S Ali
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S Total All Fees: S
Su ression
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S �' (/ fy 0 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
v � G S ?9 �/ 7 S-/G - 2a� 9
r, o CC O 7.;-/LtL) 2—Z, I License Number Expiration Date
N.4 of CSL- HQlder
o" List CSL Type(see below)
AJ ress / if T Description
a S G�V l U Unrestricted u to 35.000 Cu. Ft.)
Signature R Restricted I&2 FamilyDwellin
Go -3 9 3 0 7o a (o M Mason Only
RC I Residential Roofing Covering
Telephone WS Residential Window and Siding
SF I Residential Solid Fuel Burning Appliance Installation
D I Residential Demolition
5.2 egirtered Homgyn�Prov=nt Contractor(HIC) �� 7 9
HIC Company Name or HIC Re,Kistrant Name Registration Number
s7
` ,,
Ad /D�—X 7�.2 6 O
7V G Z/O 3 333 x pirauoA Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 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.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1, ! N a-L�o >L as Owner or Authorized Agent hereby declare
that the state tots and information on the foregoing application are true and accurate, to the best of my knowledge and
behal _
l�c,_ _r F— 1
Prin
i 3 —/ `t — e5
Signature of Owfiff or Authorized Agent Date
(Signed under Ae pains and penalties of (u
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 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 and
Constriction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.1115, respectively.
2. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable 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 be substituted for"Total Project Cost"
1':7 C_r�
• A The Commonwealth of Massachusetts
°�y Board of Building Regulations and Standads CITY OF
4j Massachusetts State Building Code/R ()v*ate
SALEM
Revised:Liar 2011
Building Permit Application To nstruct, RepairOr Demolish aOne-o w Family Dwell
is Sectlop For Offs ' I Use Only
Building Permit Nymber. a Applied: ,$——/ 7—
Building Official(Print N- Signature Date
�IKION 1:SITE INFORMATION
LI Property A/dfd ress: 1.2 Assessors Map& Parcel Numbers
�f .Lk.laa.. /�!L'Wp../
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 It) Frontage(It)
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.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes[] Municipal ElOn site disposal s}'stem ❑
• SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
A, ae/a !1 t'crley ,Sa/e� MA o ! 9 7 0
Nat (Print) City,State,ZIP '
9 AL(/o,. Arkwa t/ (92s)Fs 3-0 �6`f a.vela@s%4mayarfner -.Cm
No.and Street 'relephone '� Em Add ess
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) 9 Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work'': My/,LCC e x!S i
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1. Building $ / ,j o 0, 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ g 0 0 0 pP
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 0 D 0.' 2. Other Fees: $
4.Mechanical (HVAC) $ nl/fl List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount
• 6.Total Project Cos[: $ zs o0 0, ❑Paid in Full /0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90j�/ �� •
(J2 S. License Number Expiration Date
Name of CSL Hold
30o MA 14re e f List CSL Type(see below) (�
No. and Street Type Description
_ / A o/ C� D 11 U Unrestricted(Buildings2 Fmi u el ing cu.tt.)
P, hA�t� b R Restricted l&2 Family Dwelling
Cityn'own,Stale,ZIP M Masonry
RC Rooting Covering
WS Window and Siding
�68 �/� SF Solid Fuel Burning Appliances
0 /eL�CCGarq,f/an < Coin 1 Insulation
Telc hone `� Email,ddress D Demolition
5.2 Registered `ered Home Impr eent/CCoontractor(HIC) /e3o �5' 1 0/Z6 /Z
I)e 4 -% - Ka m"-,— e. HICC Registration Number Expiration Date '
HIC Company'NLme or IIIC egistran Name
Sou Arn �y G1,gs�o
No.and Su et � A p�( /p Q n � eo N+
I AlP�. 4..-r M" - 0/10 7 07s�Y -7/7 / Ema' ddress
t /Town, State,ZIP 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 ..........X 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 (S-61,r ls-A)/` CO nl pet/7 r e S L-L—C
to act on my behalf,in all matters relative to work authorized b this building permit application.
.C;-- / 7—
Print Own s Name(Electronic ignature)I Date
SECTION 7b: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 rue and ecurate tot a best of my knowledge and understanding.
S- / 7—//
Print Owner' or Authorized Agent's ame(Electro is Signature) Date
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
ww.v.mass. ov%oea Information on the Construction Supervisor License can be found at www.nctssj,ov%dns
2. When substantial work is planned, provide the information below:
Total floor area(sq. ft.) (including garage, finished basement/attics,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" •
' � I
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Li�o :
Permit Listing Report
by District
Printed On:Fri My 22,2015
',
SQL Statement Street No.like"9"AND Street like"DALTON PARKWAY"
District Address(Work Location) District Zoning Owner Work Category Est Cost Proposed Use And Detail
Permit Type Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Description Fees Paid Check#
9 DALTON PARKWAY R2 MILLARD ANGELA C.M. REMODEL $11,600.00 Residential
Building 614-09 Expired Mar-19-2009 ROCCO TFRRIZZI(603)930-7026 REMODEL BATHROOM AND LAUNDRY ROOM
$89.00 105
9 DALTON PARKWAY R2 COLLEEN DONAHUE 434 $4,000.00 Residential Single Family Home
(0009 DALTON PARKWAY Residentia6additions,altera
) tions,conv.
Building 64-2003 Expired Jul-25-2002 TIMOTHY J.BOUCHER(7)812-3357(83) 64-2003 REMOVE PARTIAL WALL,FRAME OUT,
PUT IN CABINET ISLAND. FRO
$29.00 514
9 DALTON PARKWAY R2 MILLARD ANGELA C.M. REPAIR/REPLACE $25,000.00 Residential Other
Building 809-11 Expired May-25-2011 Craigston Companies LLC(978)468-7179 REPLACE EXISTING KITCHEN jbh
$180.00 1465
9 DALTON PARKWAY R2 ROUSSEAU JACQUELINE $0.00
(0009 DALTON PARKWAY
Gas G417-2001 Expired Jun-29-2001 Holden Oil Inc. 1st Door- I range
$20.00 01
9 DALTON PARKWAY R2 MILLARD ANGELA C.M. PLUMBING Residential Other
Plumbing 11-363-09 Expired Apr-01-2009 DeChristofore Plumbing/Francis (1)WATER CLOSETS/(1)LAVATORIES/(1)SHOWER
DeChristofore(781)438-9339 STALU(1)LAUNDRY TRAY/(1)WASHING MACHINE
CONN./(1)HOT WATER TANK jhb
$40.00 2378
9 DALTON PARKWAY R2 MILLARD ANGELA C.M. PLUMBING $0.00 Residential Other
Plumbing p447-11 Expired Jul-27-2011 merton pekrul 1 kitchen sink, I disposer
$20.00 x
District O TOTALS: ESTIMATED COST: $40,600.00 NUMBER OF PERMITS: 6
FEES INVOICED: $378.00 FEES PAID: $378.00
BALANCE: $.00
GeoTMSV 2015 Des Lauriers Municipal Solutions,Inc. Page I of 2
Permit Listing Report
by District
�`')istrict Address(Work Location) District Zoning Owner Work Category Est Cost Proposed Use And Detail
Permit Type Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Description Fees Paid Check ft
GRAND TOTALS: ESTIMATED COST: $40,600.00 NUMBER OF PERMITS: 6
FEES INVOICED: $378.00 FEES PAID: $378.00
BALANCE: $.00
GeoTMSO 2015 Des Lauriers Municipal Solutions,Inc. Page 2 of