B-17-345 - 0018 APPLEBY ROAD - Building Permit The Commonwealth of Massachusetts 'k
Board of Building Regulations and Standards
�� 3' fi � CITY OF
` Massachusetts State Building Code,780 CMR
1011 APR ,2 ,I ARvis 2011 i
Building Permit Application To Construct,Repair,Renovate Or Demolish a
�c One-or.Two-Family Dwelling,
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�5 AEC'WNI I.SITE Il0ORMAT�
i 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
18 Appleby Rd. 04-0028-000
1.1a is this an accepted street?eyes X ,no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R1
Zoning District Proposed Use Lot Area"(sq ft) Frontage(ft)
1.5 Briiklivag Setbacks(fl),
Front Yard 'Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Witter Supply:(M.G.L c:40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public 0 Private 0 Check if yesl7. Muruicw 0 On site disposal system 0
:w '_ SF.C'ITON 2:PROPEItxTY_O� _ t � a
2.1 Oinerr of Record:
Peter and Phyllis Meaney Salem,MA 01970
Name(Print) City,State,ZIP
18 Appleby Rd. 978-744-0992 meaneyppcomcastnet
No.and Street "" Teleph= Email Address
_ '! �'�4N:3 ��DE3CRIP `ION OFrPROPOSED WOR,�Ks`{check all-;that app,�l�ya)���'{
New Construction D Existin ,Building-® Owner-Ocx ,pied® Repairs(s) 0 Atteaation(s} ® Addition 0
Demolition 0 Aocesso?3'Hldg.0 Number of Units ___ Other 0 Specify: Replacement
Brief Description of Proposed Wor'k2:—Replacement of 6 windows
t
-=-� °� �", ��` SEC°TIONy4:EST RATF�D>C'ONSTRUCTIONCOSTSt ,�' JT' �� '
— �` t.�; ram : r
Item Awls k Official Uae Oalyt>:: 1 1,ON", m
1.Building $ 1 pBuildrirg Parmu�t'Fee t$� lndtcate`'how fee isd6larmmed"
dmg 10978.00 ter- •- * " - „ ,
O rStandari own Apphcshon'Fee t " t.
2.Electrical $ ", � � . .' ^"t 'A
�O,Tota1 Pr+olect Costa(ltem 6_j�x'mulriPh�
3.Plumbing $ 2' OQier Few.$ �� �
jf
4.Mechanical WAQ $ tmz
5.Mechanical (Fire al - _
$ Total All Fees' $ r . ,.t,
Suppression) Check No �# -Ch&k'AriroinrY -C sh'Air
6.Total Project Cost: $ 10978.00 d`- 'Batce'Du l
.Ot ' mg.,� �-.
3ECI`IONS:=4. a NSTRUCTIONSERYi� trES �.
15.1 Construction Supervisor License'(CSL) 90125
10-06-18
Jamie Morin License Number Expiration Date
Name of CSL Holder
30 Forbes Road List CSL Type(see below) U
No.and StrectLr-.�TOVIN
Northborough, MA 01532 U Unrestricted to 35,000 cu.ft.
_R Restricted 1dt2 Family Dwelling
City/Town,State,ZIP M Masonry
_ RC Roofing Covering
VS S Window and Si '
"SF Solid Fuel Burning Appliances
508-351-2214 rbabostobpermitting(apandersencom.com I Insulation
Telephone `Email address D Demolition
5.2 Rigistered Home Improvement'Contractor(HIC) 170810 12-23-17
Renewal by Andersen _._ MC Registration Number Expiration Date.;
HIC Company Name or HIC Registrant Name
30 Forbes Rd rbabostonpermitting@andersencorp.com
Northboorroouugh, MA01532 508-351-2214 Email address
City/Town,StrAr,ZIP_ .- _ Tel hone
SECVR
TiON�6 �WOItKERS''COMPENSATION IlITSURANCErAFFIDAVIT(M 152 2SC(�)
a(:
Workers Coon 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 perinrt,,
Signed Affidavit Attached? 'Yes..........M No...........E3
g -'SEC�TION37a OWNER A ffHp TION TOE BERCOMPLETED WHEN
`r 'OWNER SANG x�NTR7 =R.AP ;LI' E8'=FOR*BII:�iNG PERMITS '-
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 Wilding permit application. #
See attached contract 4/25/2017
Print Owner's Name(Electronic SWiaturre) Date
SECTION7b� 'O�i►NER'OR.AUTIIORIZEDAGFT DE � a�M�TIUN„' _ :;
m name below,I hereby attest under the arcs and ties of ury,that;all ofthe information
By entering Y P P�� perjury i
contained in this application is true and accurate to the best of my knowledge and.understanding.
�T
Jaime Morin 4/25/2017
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
ST
T- TRUTH
1. An Owner who obtains a building permit to do his/ler own work,or an ownea who hires.an ustered contactor
(not registered in the Home Improvement Contractor(MC)Program),will not have access to the arbitration
program or guaranty fimd under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass MLoca Information on the Construction Supmw License can be formal at www.mass.govldos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq.I) Habitable room count
Number of fireplaces Number of bedrooms
Numiber of bathrooms --< Number of halVbaths
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"