48 DEARBORN ST - BUILDING INSPECTION Cs Z� �133g g cr. 96 0-7 o-73
The Commonwealth of Massachusetts
�— Board of Building Regulations and StandardsCITY F
Massachusetts State Building Code,780 CMR t?evi SALE 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Faunily Dwelling
This Section For Official Use
Building Permit Number: Hate Applied:
Building Of ew(Print Name) Signature Date
SECTION is SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
48 Dearborn St
Lin is this an accepted street?yeses no Map Number Parcel Number
1.3 Zoning Information: 1.4 Properly Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks($)
From Yard Side Yards Rear Yard
Required Provided Requbed Provided Required Provided
1.6 Water Sappy:(M.G.L a 40,§54) 1.7 Flood Zone Iaformation: 1.8 Sewage Disposal System:
Public O Private 0 Zone: _ Outside Flood Zone? Municipal O On site d
Check if esOdisposalsystem O
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: Salem MA 01970
Antonio Silva & Maria Silva
Name(Print) City,State,ZIP
48 Dearborn Street 978-745-0072
No.and Sweet Telephone Email Address
;SAt MON 3:DESCRIPTION OF PROPOSED WORKS(deck all that apply)
New Construction 13 Existing Building 4 1 owner-Occupied if I Repairs(s) if I Alteration(s) 0 1 Addition 0
Demolition 0 Accessory Bldg.O 1 Number of Units_ I Other ff Specify:Replacement
Brief Description of Proposed Work?: Ra In nrin9 2 dnnrs, 11 windows - no structural change
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item EstimateVials Official Use Only,
1.Building $ 1; Building Permit Fee:$ Indicate how See is determined:
2.Electrical $ 0 Standard City/Town Application Fee
O Total Project Costs(Item 6)x multiplier x
3.Plumbing $ 2. Ofhei Fees: $
4.Mechanical (HVAC) $ Lrst:
5.Mechanical (Fire $
S on Total All Fees:$
6.Total Project Cost: $ 45,546 Check No. Chock Amount: Cash Amount:
0 Paid m Full 13 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-0 6-
Ij
Jamie Moirn License Number Expiration Date
Name of CSL Holder U
List CSL Type(see below)
86 Gardiner St
No.and Street IYpe Description
Lynn, MA 01905 U Unrestricted m 35,000 cu.ft
y R Restricted lt2Family Dwelling
Citynown,State,ZIP M Masonry
RC Roofim Covering
WS Window and Sidimt
SF Solid Fuel Burning Appliances
508-351-2214 1 I 1 Insulation
Te hone Email address D I Demolition
51 Registered Home Improvement Contractor(HIC) 170810 12-23-17
Renewal by Andersen HIC Registration Number Expiration Dau
IBC CompwW Name or HIC Registrent Name
30 Forbes Rd
Nortthorrough, MA 01532 508-351-2214 Email address
hbo
Citynoyni,Stow,27P Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(hLG1-c- In 12SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Faihm to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........9 No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUHIIING PERMIT
I,as Owner of the subject property,hereby authorize Jamie Morin
to act on my bdmA in all matters relative to work authorized by this building permit application.
SEE CONTRACT 10/7/16
Print Owner's Name(Electronic Signature) Dam
SECTION 7b:OWNE)e 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.
JAIME MORIN 10/7/16
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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(FAC)Program,),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other importent information on the HIC Program can be foumd at
www.mass.aov/ocs Information on the Construction Supervisor License can be found st www.masa.aov/du>s
2. When substantial work is planned,provide the information below:
Total floor area(sq.It) (including garage,finished basememt/attics,decks or porch)
Gross living area(sq.ti.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of haWbatha
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"