0015 ORLEANS AVENUE BPA-17-132 ry The Commonwealth of Massachusetts { CITY OF
Board of Building Regulations and Standard u; t ,yA L ` SALEM
%V Massachusetts State Building Code, 780 CMR
Revised Mar 2011
N Building Permit Application To Construct,Repair,Renov&�JCHeeptglis$o j
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Ap .
_- Lt�M l�Yti /()
1 Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
15 Orleans Ave
1.1 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 11) Frontage(8)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required I 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? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Josephine and Tom Gallo Salem MA 01970
Name(Print) City,State,ZIP
15 Orleans Ave 978-979-7554 tog.pbs@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 13Addition 11Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:Insulation
Brief Description of Proposed Work2:Install 3 door sweeps and weatherstrip, air seal 8 hours, 114 lin ft damming
Install 1 - 8" roof vent, thermal barrier to attic hatch, 2 -12" mushroom vents, vent bath fan to roof Rapper
Insulate enclosed attic floor w/blown in cellulose to R22, insulate open attic floor w/blown in cellulose
to R49
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 3,636.64 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (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: $3 636.64 ❑Paid in Full ❑Outstanding Balance Due:
C4,), Ll P I U ,
10. 50 LMO rf
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CSSL 100454 6/13/17
Glenn Alexander License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
25 Bond Street I
No.and Street Type Description
Reading MA 01867 U Unrestricted(Buildings u to 35,000 cu.ft.
g R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
781.397.9909 gja06139gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 188085 1/29/19
Alexander Insulation LLC HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
25 Bond St gja0613@gmail.com
No.and Street Email address
Reading MA 01867 781.397.9909
Ci /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 .......... ® No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Glenn Alexander
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' 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 true and accurate to the best of my knowledge and understanding.
Print Owner's Auth ri ed Agent Aam (Elcctronic Signature) Da e
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 can be found at
www.mass.,ov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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"