448 LAFAYETTE STREET #2, REPLACE DOOR 4Bn MAR 30 ED 48
The Commonwealth of Massachusetts LU
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
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1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
448 Lafayette Street.#2 31-0213-802
1.1 a Is this an accepted Met?yes x nc Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R1
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 BuNing Setbacks(B)
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 0 Private 0 Zone:��_pL Outsik Flood Zone? Municipal D On site disposal system 0
Chec2.1 Owner'of Record:
Andrea Delorie Salem, MA 01970
Now(Print) City,Starve,ZIP
448 Lafayette Street,#2 617-957-0362 amdelorie@gmail.com
No.and Street Telephone Emwl Address
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l� �Ns DESCRIPT)FON;OF FWR_OP�SSD WORKSc6cckall
New Construction 17 Existing Building® Ownea'-Occupied ® Repairs(s) 0 Alteaation(s) ® I Addition 0
Demolition D Accessory Bldg.O Number of Units Other ® Specify: Replacement
Brief Description of ProposedWori?: Rep[acement of1door
Itemaabor and Materials) ad—
l'�
1.Building $ 3708.00 0 =
2.Electrical S �n
D Total"Pttijoct'Cost3(lbim xis
3.Plumbing $ 2. 01hei Fees: S
4.Mechanical (HVAC) $ List:
5'Mica! dire S Total All Fees:S
S 'on
Check No. Chock Amount: Cash Amount:
6.Total Project Cost: $ 3708.00 D Paid in Full Ou andin8 Balance Due: •
to MAl L46O 10 SrNS67
SON 5H -COi�lS'i'RUC�'I0�1�R`j[CES
5.1 Construction Supervisor License(CSL) 90125 10-06-18
Jamie Morin License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
30 Forbes Road
No.and Street -- •
Northborough, MA 01532 U Unrestricted to 35,000 cu.R
R Restricted 1dt2 Family Dwelling
Cityfrown,State,21P M MWKWY
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Bruning Appliances
508-351-2241 rbabostobpermittin4(cDandersencorp.com 1 Insulation
Telephone Email address D Demolition
5.2 Registered Rome 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 rbabostonpermitting@andersencorp.com
Nortthhboorrough, MA 01532 508-351-2241 Email address
City/To%ii,State,ZIP T
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Workers Compensation Insruance 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..........M No...........O
ON"Ie "SON.
I,as Owner of the subject property,hereby wAorize Jamie Morin
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached contract 3/28/17
Print Owner's Name(Electronic Signature) Date
SECTION 76,OWNER'UR' UTHO AGl&NT jDEq*&I'ION,
By entering my name below,I hereby attest WAF the pains and penalties of perjury that all of the information
contained in this application is to the best of my knowledge and imdeus�g.
Jaime Morin 3/28/17
Print owner's or Audmi7,ed s ecironic Signature) Date
loom
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an urmgis-tared wriftactor
(not registered in the Home Improvement Contractor(HIC)Program),will"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
Imnya ss.2oVIM Information on the Construction Suparvum Ligase can be found at www mass.gov/dos
2. When substantial work is plarm4 pfovide the information below:
Total floor area(sq.ft.) (including garage,finished base nentlattics,decks or porch)
(ice ling area(sq,I) Habitable room count
Number of fireplaces Number 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"