22 OSGOOD STREET - TBA 17-92 WINDOWS/DOORS GI` Ct (o O z-D l So
The Commonwealth of Massachusetts ,
0 Board of Building Regulations and Standards
Massachusetts State Building Code,780 CMR lfl Ff 8 ,, SALEM 11
Building Permit Application To
pp � Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
r This Section For Official Use
Building Permit Number: ;
(� Building Otliieaai(Pant Name)
aI
SECTION 1:STTE DiFORMATION
1.1 Property Address: 1.2 Asaarors Map 8t Parcel Numbers
22 Osgood St. 36-0286-0
1.1 a Is this an accepted street'?yes X no Map Number Pwmi Number
1.3 Zoaiag IInfornmation: 1.4 Property Dimensions:
R2
Zoning District Proposed Use Lot Area(sq R) Frontage(g)
1.5 Boilding Setbacks(*)
Frit Yard Side Yards Rear Yard
Required Provided Required Provided Required Pievided
1.6 Weber Sum:(M.G.L a 40,§54) 1.7 Food Zone Ltformtlon: 1.8 Sewage Disposal Sydesn:
Public 0 private 0 Zone: — �Flood Zone? Municipal Cl On site disposal system 0
SECTION 2: PROPERTY OWNERS
2.1 Ower'of Record:
David Mendes Salem, MA 01970
Name(Print) City,state,ZEP
22 Osgood St. 781-248-5349 davefire51@gmail.com
No.and Street Telephone Emu?Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(deck an that apply) 4.
New Construe ion 0 Existing Building Owner-Occupied 12f I Repairs(s) C3-
Demolition
Demolition 0 Accessory Bldg.0 Number of Units 12 Other 9 Specify:_Replacement windows a J doors
Brief Description of Proposed Work-2: replacement of 12 windows and 2 doors
SECTION 4:ESTBUTED CONSTRUCTION COSTS
Item Estimated Casts:
and Materials 2mi se Only
1.Building S 24,155.00 1 Build iog Permit Fee.S L 0 6 Indicate how See is determined;
2.Electrical S 0 Standard City/Town Apphcadon Fee
0 Total Projed Costa(item 6)x multiplier x
3.Plumbing S 2. 011ier Fees- S
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
S $ Total All Foes.S
Chock.No.. Chedr Amount: Cash Amow t:
6.Total Project Cost: $ 24,155.00 0 Paid in Full 13
Outgmdiag Balance Due:
2 t M czo t rJ sA s;:�=-
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10/06/18
Jamie Moim License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
30 Forbes Road
No.and Street Imm
Northborough, MA 01532 U Unrestricted to 35 000 cu.R.
R Restricted 1Bt2 Family DymIling
Citytrown,State,ZIP M Masonry
RC Roof inx Covering
WS Window and Siding
SFSolid Fuel Burning Applianoea
508-351-2244 RBABostonPermitting@andersencorp.com I InSuLfftion
Telephone Bmail address D Demolition
5.2 Registered Home Improvement Contractor(SIC) 170810 12/23/17
Renewal by Andersen
HIC Compatry Name err HIC Registrant Name HIC Registration Number Expiration Date
30 Forbes Road RBABostonPermittin9[a)_andersencorp.com
No.and Street Email address
Northborough, MA 01532 508-351-2244
Pity/Town,State,ZIP Te
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT i(M.G.L.c.15L i 25C(6))
Warners Compensation Insurance affidavit must be completed and submitted with this applicabion. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........If No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUM)ING PERMIT
I,as Owner of the subject property,hereby authorize Jamie Morin
to act on my behaii;in all matters relative to work eu dioriaed by this building permit applicatiom
see attached contract 02/02/17
Print Owner's Now(Electronic Signature) Date
SECTION 7b:OWNERI OR AUTHOR12ZD AGENT DECLARATION
By muting my name below,I hereby attest under the pains penalties of peajury that all of the information
contained in this application is true and accurate a best of y knowledge and understanding.
Jaime Morin 02/02/17
Print Owner's or Autborized Agent's Name r ) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or on owner who hires an unngister+ed contractor
(not registered in the Home Improvement Contractor(HIC)Program,),will not have access to the arbitration
program or guaranty fiord wider M.G.L.c. 142A.Other important information on the HIC Program can be found at
wwwJWN.gov/oca Information on the Construction Supervisor License can be found at wvwv .& vo /dam
2. When smbstantial work is planned,provide the information below:
Total floor area(sq.8.) (including garage,finished basement/attics,decks or porch)
Gross)ri►mg area(sq.f},) Habitable room count _- _-- - -
Number of fireplaces Numaber of bedrooms
Number of bathrooms Number of haWbaths
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"