4 AMANDA WAY - BPA-15-1289 REPLACE PATIO DOOR 1
The Commonwealth of Massachusetts RECEI'VED
4 Department of Public Safety IMPECIIG�:P,l QHETTICE
9 Massachusetts State Building Code(780 CMR)
�^ Building Permit Application for any Building other than a One-or T F 'y e 'n
(This.Section For Official Use Only).
`V Building Permit Number. Date.Applied: Building Official:
SECTION 1:LOCATION(Please indicate B ek,#a'nd Lot lhf locations for which a street address is not available)
jNm"p rA I fa
No.and Street City/Town Name of Building(if applicable)
. - SECTION 2-PROPOSED WORK-..
Edition of MA State Code used If New Construction check here 13 or check all that apply in the two rows below
` Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
}`— Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work: _
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) C
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 a licable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: Hi h Hazard H-1❑ H-2 13, H-3 13H-4❑ H-5 E3I: Institutional I-1❑ I-2 Cl I-3 13 14❑ M. Mercantile❑ R: Residentiat R-1❑ R-2❑ R-3 13R-0 E3
S: Storage S-1 ❑ S-2 O U. Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6.CONSTRUCTION TYPE(Check as applicable)
IA 13 IBC IIA 0. fill [3 IIIA ❑ 1III1113 1 IV ❑ 1 VA 13 VB 13
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: Nig\Ilistoric Comnucsion
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ 1 Ycs❑ 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:
SECTION 9' PROPERTY OWNER AUTHORIZATION
Name and Address of Proerty Op/wrier l f /� t
�rt/t
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes (' , ^ �( / �—
l C �r!4 i�11- 1"'�
Name Street Add tess City/Town State Zip
to act on the property owner's behalf,in ail matters relati-k. to work authorized by this building permit application.
SECTION 10:CONSTRUCITON CONTROL(Please fill out Append 2).
(If buddingis less than 35,001)cu.ft.of enclosed space and/or or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control -
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town - State Zip Discipline Expiration Date
10.2 General Contractor
Cony Name ,/ 0�-�Zc ^
l
Name of Person Responsible f\Construction Lic�wse�Nao_and Type if Applicable
Street Address (� City/Town tate Zip
Telephone No. business Tele hone No. celle-mail address
SECTION 11:WORKF,'RS'COMPENSA'T'ION INSURANCE AFFIDAVV' M.G.L.c.151§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 O No O
SECTION I2--.CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ Building Permit Fee=Total Construction Cost x—(Insert here
2.Electrical $ appropriate municipal factor)=$
3. Plumbing $
d.Mechanical (HVAC) $ Note:Minimum fee=$ (contact mum.cipalit )
5. Mechanical (Other) $ CZq Enclose check payable to l
6.Total Cost $ (contact municipals )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
a..eh tion is true and accurate t e b t my kn wledge and understanding.
Please prin)aud_sign name Titl Telephone No.�Dete
treet Address City/Town Stat '.
Municipal Inspector to fill out this section upon application approval:
Name Date
III
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) t�
License Expiration Date
Nameof CSL Type .Description
U Unrestricted(up to 35,000 Cu.Ft.)
Address R Restricted 1&2 Family Dwelling
M Masonry Only
Signature RC Residential Roofing Covering
WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance
Telephone D Residential Demolition
5.2 Home Improvement Contractor Registration (HIC)
Registration Expiration Date
HIC Company Name or HIC Registrant Name
Address
Signature
Telephone
SECTION 6i WORKER'S COMPENSATION INSURANCE"AFFIDAVIT:(M.G.L.c.151,§ 25C(6)) '
Worker's Compensation Insurance affidavit must be completed and submitted with this application.
Failure to provide an insurance affidavit may result in the denial of a 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 relevant to work authorized by
this building permit application.
Signature of Owner Date
SECTION 7b: OWNER OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent,hereby declare that the statements
and information on the foregoing application are true and accurate,to the best of my knowledge and belief.
Signature of Owner or Authorized Agent (Signed under the pains and penalties of perjury) Date
SECTION 8: DEBRIS DISPOSAL
All dumpsters of six(6)cubic yards or more are required to have a permit from the Marblehead Fire department: call 781-639-3428.
I, In accordance with the provisions of 780 CMR and MGL c40,§54 a condition of issuance of this building permit is that debris
resulting from any work performed shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL e111,§
150x.
DEBRIS DISPOSAL LOCATION
SIGNATURE OF APPLICANT
NOTE
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 Flome 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 Construction Supervisor Licensing(CSL)can be found in 780 CMR
Regulations.
Sanctuary Condominium Trust
c%Crowninshield Management Corp.
18 Crowninshield Street
Peabody, MA 01960
(978)532-4800
November 2, 2015
Ms. Elaine Skolnick
4 Aurora Lane
Salem, MA 01970
RE: Replacement Sliders— Sanctuary Condominiums
Dear Ms. Skolnick:
Thank you for your inquiry regarding slider replacements at your unit. Please be advised
that the Board of Trustees for the Sanctuary Condominiums does not object to the
replacement of these sliders providing that they match in appearance. They must fit the
existing opening, no grids, no French doors, glass size and moldings must all remain the
same. etc.
We also require the permits be pulled in advance, and that a copy of the final approved
permit once completed is also submitted to our office. We also require that you hire only
a licensed contractor, with adequate insurance.
You will most likely need to show a copy of this letter to the Building Department in
order to obtain your permit.
Should you have any questions or require additional information, please feel free to call
me directly at(978)532-4800 ext#232.
Sincerely,
Jill Fama
Jill Fama, CMCA
Regional Property Manager
Crowninshield Management Corp.
Managing Agent for the Sanctuary Condominiums
cc: File
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