70 WEATHERLY DR NO 405 & 407 - BUILDING INSPECTION r
2� b° c>�
The Commonwealth of Massachusetts CITY OF
e� Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date ) %p led:
Building Official(Print Name) Signature VDa0'
SECTION 1: SITE INFORMATION
1 Propperty Address: \ 1.2 Assessors Map&Parcel Numbers
1.1 a 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 a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP' 7
Owner' ecor-r r( IJ ILCp � I �L. �7J� `7
Name(Pring� City, State,ZIP
IQg0 Y(,tQ"10(463a-aS rnhn �0 G 4
No.and Street li Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other X Specify: to/
tof Description of Proposed Work': '
i L n n
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building $ 39( 0(-
1. Building Permit Fee: $ 126 Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ ❑ Paid in Full ❑Outstanding Balance Due:
mAt t eV R/2� l N 5I4s�
1 pa° � �'
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) (�
epl A � u
1 1 tm 9 r tti� License Number Expir ion to
Name of CSL Holder
� List CSL Type(see below)
()Cap �� �I as!4
No.and Street Type Description
nlU Unrestricted(Buildings u cu.ft.
( Mon R Restricted I&2 Family Dwelling
Citywn,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
rig l • J 1�' 1 I J�l r.•lillyvr•�, I Insulation
Telephone Email address D Demolition
5.2 Re istered Home Improvement Contractor(pPn / /�a�te�`6" U )1Ili-��� � & �) `-'"° HIC Registration Number Ex
9C�Lpa ��m�e� r HIC ICIRegist at Name
o. and Street Email address
4nr\ ►N`y\ () lr=l 17>v ( �C� 1`
City/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 .......... 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 Z D - .12,P—bbo --r [7l VQ C9>
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) I D e
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.
� 3
rin Owner's or ApKorifd g ame(Electronic Signature) ate
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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial w��Qprk is fanned,provide the information below:
Total floor area(sq. ft.) (including(including garage,finished basement/attics,decks or 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"maybe substituted for"Total Project Cost'
CITY OF SM.E.NI, 1AxSSACHUSETTS
• BtiIIAING DEPkRTNEE2NT
120 WASHINGTON STREET, 3w FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KmB Rr FY DRISCOLL
MAYORT'HOl►(AS ST.PtF1tRE
DTRECTOR Of PUBLIC PROPERTY/BUILD NG COINISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
cn eSk
o (name of facility)
�A)a 'e f1 ME
Tr(address of facility)
�signature of pn it apptic�
date
lchnvll;Jce
f
n%/re`6re"...•.unnrl/f
Offer of Consumer Affairs&lesions Regulation
WONE IMPROVEMENT CONTRACTOR
egistration: 128634 Type:
xpiration: SWG17 DBA
ED BYRNE WINDOW CO
EDWUND BYRNE
756 WESTERN AVE
LYNN,MA 01902 Undersecretary
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
i lihitrUi nih rfi3Tc1"t isur ��"��
License: OS-010870
Nlt� fF tttl
EDMUND J BYRI91i yrs
18 Woodrow TerrIIse 9M! e
Lynn KA 01904 7 [']„
1�--,v�f(0 _""' Expiration
Commissioner 0710914017
I
E.B. Window and Siding Co. Invoice
756 Western Ave
Rt 107 Date Invoice#
Lynn MA 01905 9/1/2016 53282
Bill To
Ronnie Freeman
19990 Sawgrass Lane
Boca Raton,FL 33434
P.O. No. Terms Project
Des ipti Qty Rate Amount
0.00 0.001,
acceptance o1`proposal
authorized signature
All sizes on file ready to order
Subtotal $3,727.50
Sales Tax $232.97
Total $3.960.47
Payments/Credits -$1,100.00
Balance Due $2.860.47
Phone# Fax# E-mail Web Site
781-592-9747 781-592-9746 ebwindow@i)msn.com www.ebwindow.com