B-19-464 - 0038 BALCOMB STREET - Building Permit 'r The Commonwealth of Massachusetts APR 3 4! OF
Board of Building Regulations and Standards SALEM
1 Massachusetts State Building Code,780 CMR Revised Mar 2011
75- Building Permit Application To Construct,Repair,Renovate Or Demolish a
j One-or Two-Family Dwelling
This Section For Official Use Only
t7 Building Permit Number: Date Applied:
61EaA. s'••6-��
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
38 Balcomb St,Salem Ma 01970
L l a Is this an accepted Street?yes 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❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Jared Hill Salem Ma 01970
Name(Print) City,State,ZIP
38 Balcomb St
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) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units I Other ❑ Specify:Insulation
Brief Description of Proposed Work z:R-18-20 restricted-slopes/floored fill w/cellulose;
R-30 restricted-slopes/floored fill w/cellulose; R-49 unrestricted-settled cellulose;
Perimeter 1" R-max or equivalent foam board; Fixed Sweep triple flanqe;Weatherstrip s/Q-Ion
SECTION 4:ESTIMATED•CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $10,827.21 1. Building Permit Fee:-$-. Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $10,827.21 ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 101378 11/27/2019
Jose A santos License Number Expiration Date
Name of CSL Holder
37 W Milton St, Apt 1 List CSL Type(see below)
No.and Street Type Description
Hyde Park MA 02136 U Unrestricted(Buildings up to 35,000
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
781-598-7125 info@abtinsulation.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 163106 05/10/2019
American Building Technologies H
HIC Company Name or HIC Registrant Name IC Registration Number Expiration Date
263 Western Ave info@abtinsulation.com
No.and Street Email address
Lynn Ma 01904 781-598-7125
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
I,as Owner of the subject property,hereby authorize 37 W Milton St, Apt 1
to act on my behalf,in all matters relat' to wor authorized by this building permit application.
TA,��� N 1 LL 4/30/2019
Print Owner's Name(Elec a e) Date
SECTION 79:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest u the ins and penalties of perjury that all of the information
contained in this application is true an ac u ate t e b st of my knowledge and understanding.
-e 0 4/30/2019
Print Owner's or Authorized Agent's a Ele oni gnature) 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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (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 halfibaths
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"