23 BEACH AVE UNIT 1 - BPA-16-1048 REPLACE DOORS The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
C� Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
0 One-or Two-Family Dwelling
u..
This Section For Official Use Only o 4-V
1 Biuldutg Pemttt Nttmbe; Date Applied;' y
Building Of6cral(Print Name) , -- S;gnaMe. . _ _ 8
_ SECTION 1:SITE INFORMATION
1.1 Property Address: 1S Assessors Map&Parcel Numbers tV
23 BEACH AVE # 1 SALE-M�MA 01970 45 45-0079-801
1.1a Is this an accepted street?yes— no Map Number Parcel Number 6 .,
13 Zoning Information: 1.4 Property Dimensions:
CONDO
Zoning District Proposed Use Lot Area(sq ft) Frontage(it)
1.5 Building Setbacks(ft)
Prom 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: _ Outside Flood Zone? Municipal O On site disposal system O
Check if yes0
SECTION 2: PROPERTY OWNERSIHP1
2.1 Owner'of Record:
EDWARD FITCH SALEM MA 01970
Name(Prim) - City,State,ZIl'
23 BEACH AVENUE #1 978-594-4822
No.and Street - Telephone Email Address
$F1fx1ION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction 0 Existing Building Owner-Occupied Vf I Repairs(s) lif I Aheration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units_ Other specify:Replacement
Brief Description of Proposed WorV:
RFPl A DOOR - NO STRUCTURAL CHANGE
SECTION,4:ESTIMATED GONSTRUCT'lONCOSTSt
item Estimated Costs:and Materials) r Odic ,use Only
1.Building S 8,035.00 1 t Building Permit Fee:$ indicate how fee is determined:
2.Electrical $ O Standard City/Town Application Fee
'D Total Project Coats(Item 6)x multiplier x
3.Plumbing $ 2- Odter Fees: $
4.Mechanical (HVAC) S List:
5.Mechanical (Fire
S ion) $ Total All Fees:$
Ch
Check No. eck Am-mintCash Amount:
6. Total Project Cost: $ 8,035.00 0 Paid m Full 00
utstandmg Balance Due:
SECTIONS: .CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-06-16
Jamie Morin License Number b7cpirationDate
Name of CSL Holder U
86 Gardiner St List CSL Type(see below)
No.and Street Type_ _ Description
Lynn, MA 01905 U Unrestricted(Buildings u to 35.000 cu.ft.
R Restricted 1&2 Family Dwelling
Cityrrown,State,ZIP M Masomy
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2214 I 1 Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-17
Renewal b Andersen
y HIC Registration Number Expiration Date
BIC Company Name or HIC Registrant Name
30 Forbes Rd
No.and Street 508-351-2214 Email address
Northborough, MA 01532
C' /Town S ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GJI a 15L§ 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..........ir No...........❑
SECTION 7a:OWNER AUTHORIZATION TO HE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR WELDING PERMIT
I,as Owner of the subject property,hereby authorize Jamie Morin
to act on my behalf,in all matters relative to work authorized by this building permit application.
SEE CONTRACT 9- 7— a.
Print Owner's Name(Electronic Signature) Date
SECTION'7b:OWNFW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I herebv attest under the pains and penalties of perjury that all of the information
contained in this application is a to to the best of my knowledge and understanding.
JAIME MORIN 1- 7-1(_
Print Owner's or Authorized A t' ame(Electronic Signature) Dau
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hives 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.Otter important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mess.eov/dos
2. When substantial work is plamted,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlaltics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Nrrmber 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"maybe substituted for"Total Project Cost"