The URL can be used to link to this page

89 MOFFATT RD - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 20/1 Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling O This Section For Official Use Only Building Permit Number: Dat Applied: (� 1t G &b-(k-- Building Official(Print Name) Signature Date 1 SECTION 1:SITE INFORMATION (n 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 89 Moffatt Road ' Lla Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front 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 lk Private❑ Zone: _ Outside Flood Zone? Municipal IR On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner]of Record: Diane Murphy Salem MA Name(Print) City,State,ZIP 89 Moffatt Road 617-312-1008 dlrrurphy29@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) IR Addition D Demolition ❑ Accessory Bldg.❑ Number of Units . Other ❑ Specify: Brief Description of Proposed Work : Remove non-load bearing interior partition wall,install new kitchen floor,new countertops and construct new cabinets to match exisitng. Install new door to exiatng rear 3 season porch SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 18,000 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 2,500 ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 3,000 2. Other Fees: $ 4.Mechanical (HVAC) $ 2,500 List: 5.Mechanical (Fire Su ession $ - '-- Total All Fees:$ 6.Total Project Cost: $ 26,000 Check No. Check Amount: Cash Amount: \ '� ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ll 5.1 Construction Supervisor License(CSL) CS88561 8/2/16 Paul Macero License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 42 Stark Ave No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. Wakefield MA 01880 R Restricted I&2FamiIy Dwelling Citylfown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 781.258-1013 paul@thehomecrafters.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172397 6/21/16 Home Crafters,Inc HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 42 Strak Ave paul @thehomecrafters.00m No.and Street Email address Wakefield MA 01880 781.258.1013 Cit /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 ..........IR 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 Paul Macero/Home Crafters, Inc to act on my behalf,in all matters relative to work authorized by this building permit application. Diane Murphy 12/14/15 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW 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. Paul Macero 12/14/15 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(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.eov/om Information on the Construction Supervisor License can be found at www.mass. og v/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decksror 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" CITY OF SM.&M, iMASSACHUSETTS BUILDING DEPARTM&NT • 120 WASHINGTON STREET,San FLOOR TEL (978)745-9595 FA.Y(978)740-9846 KINfBERLHY DRISCOLL THOMAS ST.PIFRR6 MAYOR DIRECTOR OF PUBLIC PROPERTY/BUI DLNG COWNUSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lei 1 Name(BusiivssQtganizalion/Individual): MG �i✓(/�i-Zr`J 10 r/ Y7 Cj Address: I Z s—)-n ' ✓ax` City/State/Zip: �✓� r/t� /'1`0 Phone#: V—2i7y/o13 Are you an employer?Check the appropriate box: Type of project(required): 1_❑ I am a employer with 4. Q 1 am a general contractor and 1 6. []New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sok proprietor or partner- listed on the attached sheet.t 7• 10,11ternodeling ship and have no employees These sub-contractors have 8. Iff Demolition workingfor me in an capacity. workers'comp. insurance. Y Pae tY• 9. ❑ Building addition [No workerx comp. insurance 5. We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3,111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] •Any applicant that checks brae el must also fill out the section below.stowing their woukaa'compenution policy infoonnion. f I hvneuwnus who submit this affidavit indicating they mwads and doing ail waand then hire outside curs=es must submita new,affidavit indicating such. :Contra eon that cheek this box most anachcd an additional shati showing the mame of Me reb•eontmclms and the'v werkrn'aegp,policy infunuatim lam aur employer that is providing workers'competrsadon insurance jar my employees. Below is the policy acrd fob site information. Insurance Company Name:. //e�-- WC tG h Policy#or Seif-ins.Lic.#: ZZ l) b — 610 176 ( Expiration Date: Job Site Address: e/ /1-1U f--/'STT Ciry/StawtZip: �/916i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcsligaliva+or the DIA for insurance rnvcra•c verification. I no hereby cerdjy a the pain and pea hies of perfury that the information provided above i II//trrt mrd correct. Signattire• // Date, /Z Z7�r Phone#: �7/�-Z�—�0 Oficial use only. Do nat write in this urea,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Details Page 1 of 1 triasxro.;!force Striz Agcn:i=s ..,,_� ensee Details _ nformati ull ame: P L D MACERO Gender: v,Lner Name: hdress: - ddress 2: Address WAKEFIELD State: MA (Zipcode: 01880 o nt : Urjted.9tates License o: S- 8 561 License Type' Construction Supervisor Profession: Building Licenses Date of Last Renewal: 6/23/2014 Issue Date: Expiration Date: 8/2/2016 License Status: Active Today's Date: 12/18/2015 Secondary License: „ Doing Business As: atus Chan e: Lic se Renewal.nn --+ �o Pnereguisite Information No Discipline Information ocumen um - Close Window „�.. ©2011 Commonwealth of Massachusetts Site Policies Contact„Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=27750... 12/18/2015