8 ALMEDA ST - BPA-16-894 INSULATION The Commonwealth of NIrsS� " ` }
Department of Public Safety
Massachusetts State Building Cq �(7k
Building Permit Application for any Building other E an a n r#W@�"ly Dwelling
J- (This Section For Official Use Only)
r.:5— Building Permit Number: Date Applied: Building Official:
6>0 SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
1 8 Almeda St Salem 01970
No.and Street City/Town Zip Code Name of Building(if applicable)
( SECTION 2:PROPOSED WORK
Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ 1 Other M Specify: Insulation
Are building plans and/or construction documents being supplied as part of this permit application? Yes M No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work: Basement insulation, door sweeos &weatherstrips, air sealing, duct insulation
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ 1 H: Hi h Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑
1: Institutional I-1 ❑ 1-2❑ I-3 ❑ 1-4❑ M. Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 13 IB ❑ IIA 13 IIB 13 IIIA C3 IIIB ❑ IVO 1 VA 13 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
Oar (P-d- � )
7(30 - CP� F02-fJupSa V'3 4r5-\ ZjE60 — Lo LU P O .
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SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Ewa Kantorosinski 8 Almeda St Salem 01970
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Ewa-Owner 978 -729 - 7150
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Jose Santos 8 Almeda St Salem MA 01970
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building ern-it application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and or not under Construction Control then check here❑and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
American Building Technologies 781- 598 - 7125 jobs@abtinsulation.com 163106
Name(Registrant) Telephone No. e-mail address Registration Number
2 Neptune Rd Ste 439 Boston MA 02128 5/11/2017
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
American Building Technologies
Company Name
Jose Santos CS-101378 Tyne U
Name of Person Responsible for Construction License No. and Type if Applicable
37 W Milton St Apt 1 Hyde Park MA 02136
Street Address City/Town State zip
_781-598- 7125 Jobs0abtinsulation.com
Telephone No. business Telephone No. celle-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C(6)
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes M No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ 1,177.25 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact m�umciip[�ty)\/l)
5.Mechanical Other $ Enclose check payable to
6.Total Cost
$ 1,177.25 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 a rat the best my knowledge and understanding.
lose Santos Owner-ABT 781 - 598 - 7125 8/12/16
Please print and sign n me Title Telephone No. Date
263 Western Ave Lynn MA 01904
Street Address City/Town �J State Zip /�
Municipal Inspector to fill out this section upon application approval: eft r ' t� 1
Name Date