B-17-303 - 0010 ANDREW STREET - Building Permit A'
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The Commonwealth of Massachusetts 'z
' Board of Building Regulations and StEu� �� ��� � � P
CITY OF
Massachusetts State Building Code,780 UL=2011
Building Permit Application To Construct,Repair,_Renovate Or Demolish it
One-or 7Wo-Family Dwelling-
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. . 5EC°IION4 SITE'INFORMATION� �
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
10 Andrew Street, 2A 35-0531-803 -
l.la I s this m accepted street?-yes X no Map Number Parcel Number
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13 Zoning Information: 1.4 Property Dimensions:
R2 condo
Zoning District Proposed Use Lot Area_(sq ft) Frontege(ft)
1.5 Building Setbacks(R), -
Front Yard :'Side Yards: Rear Yard
Rrequmed Provided Required =Provided Required Provided
1.6 Water Supply:(M.Gl c 40;§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?` -
Public 0 Privat 0 — Check if Municipal 17 On site disposal system. 0
_'° 777 7, _ 77 7 011 _ .�Y N2 PRO R ,:.zOWNERSHIPI <,.,�x .7 L1
M (Nwner'of Record: - {
R. Ryan Rafferty and Daniel Dault Salem,'MA '01970
Name(Print) City,State,ZIP
10 Andrew Street, 2A 857-265-6355 rrraffety@yahoo.com
No.and Street Telephone Rmail Address
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"�-: � ON3=DEscRIPTIONOFPROPOSED'Vf►O,RK'`(�kallffiat-p�13'), :,; � ii
New Const►uction 0 Existing.3uildino� 0 Owner-Occupied.® Repsirs(s)-O Alterations) M Addition 0
Demolition 0 Accessory 13ldg.13: 14umbei of Units Other ® Specify:_Replacement
Brief Description of Proposed Woke: `Replacement of 14 windows
" SECTION 4eriESTIMA
!1C'ONSTRUCTIONCOSTS
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- Estimated Costs:. p --
item � : � 'OII1Cl9llUse Onlyt , V V
aabor and-Materials cif �.
1.Buil ' $ F1Buldmg1Pe m t,Fee r$ k Indicate howkfee is detennimed
24682.00 ❑,S`taad dfeity- Appliis�tton F `# - s
2.Electrical $ '"* _VIA ��1
0TotnlPt oloi Costa(1t�6)x multzpher x �
3.Plumbing $ 12 Otlei}Fees$ € "" 47
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4.Mechanical WAC) $ I.iet t !
5.Mechanical (FYre
S ion $ Total All Fees $
t
Ghack No x :Cbecic Amrnmt Cash Amount '
6.Tkal Project Cost: $ 24682.00 O Paid m Full' p 0utst d ng DUE,,
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5.1 Construction Supervisor License(CSL)`' 90125
10-06-18
Jamie Morin LicenaeNumber Expiration Deft
Name of CSL Holder
List CSL Type(see below) U
30 Forbes Road .r a .
No.and Street Iype� tt°n
-_
Northborough, MA 01532 U Unrestricted(Buildings to 35,000 cu.R
= : R_ Restricted 1dt2 Family Dwelling
Cityfrown,State,ZIP M MaSonry
`RC RJDOftR COVCring
- 'WS Window and Siding
'SF. Solid Fuel Burning Appliances'
508-351-2241 rbabostobpermitting(cDandersencorp.com ` I Insulation
Tel `bone Email address D Demolition
5.2 Registered Home Impravement Contractor(HIC) 170810 12-23-17
Renewal by Andersen MC Registration
gistration Number Expiration Date
HIC Company Name or MC Registrant Name
30 Forbes Rd rbabostonpermitting@andersencorp.com'
Nortthhboorroouugh, MA01532 508-351-2244 Email
C' ITown,S ZIP Tel one
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SECTIONA WORKERS'COMPENSAT101C,INSURANCE AFFIDAVIT(M;G.L.c.1152:;�25C(!�) ,
Workers Compenwation 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 permits
SipW Affidavit Attached? Yes
"` �SE,C�'1TON 7a:�OWNERtAU+Z'HOTION�TO BE�COMPL~ETED WHEhT�,,��, x���*`"
. ,.�_ �' "'�-kU�,_, � 'S�AGENTOB� I�RA"�G°TQR�APPL'IEi4'I�RtBUII:bING,;PERIVIIT' �_ y
I,as Owner of the subject property,hereby authorize Jamie Morin {
to ai-t on my behalf;in all matters relative to work authorized by this building permit application.
See attached contract 4/18/17 i
Pont Owner's Name(Electronic Signature) Date
...:.
� ' � '�3ECTION�7li�OWNER'�ORAUTHORIZEDAGENTaD ��TIONV'rv'� 'M=�`�'_r . ��
13 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 nay knowledge,anduiuWstand ng. -
Jaime Morin 4/18/17 f
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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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 Contactor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the EIIC Program can be found at
wwwJIM. �+foca Information on the Construction Supervisor License can be found at www.mass.gnv dos
2. When substantial work is phumed,provide the information below:
Totid floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Nui nber of fireplaces Number of bedrooms
Number of bathrooms - Number of half/baths
Type of heating system Number of decks/parches
_ Type$of cooling system - Enclosed Open
43. ;"Total Project Square Footage"maybe substituted for"Total Project Cast"