B-17-986 - 0025 1/2 BARR STREET - Building Permit The Commonwealth of Massachusetts
Board of Building Regulations and Standards OF
Massachusetts State Building Code,780 CMR Y 0 T —=t* 45,
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or 71ao-Family Dwelling
_.
. _ This Section For,OfEciil Use Only -
Burl -mg Eermtt Number' Date App i
1 Building Official(Print Ni*) '� — 3ignanue _ ._,._ .Die
SECTION 1:SITE INFORMATION`
' 1.1 Property Address 1.2 Assessors Map&Parcel Numbers '
25 1/2 Barr St. 26 0275-0
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R2
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 0 Zone: _ Outside Flood Zone? .Municipal 0 On site disposal system 0
Check if es0
SECTION 2: PROPERTY'OWNERSHI '
2.1 Owner'of Record:
David and Natalie Mahady Salem, MA 01970
Name(Print) City,State,ZIP
25 1/2 Barr St. 617-543-2489 chefdave37@hotmail.com
No.and Street = Telephone Email Address
' EC' hl)N 3c DESCRIPTION,OF PROPOSED WORK=(check all that aPPlY) =P
New Construction❑ Existing Building'M Owner-Occupied 0 Repairs(s) 0 Alteration(s) M Addition O
Demolition 0 Accessory`Bldg.O Number of Units I Other ® Specify:_Replacement
Brief Description of Proposed Work Replacement of 1 Entry Door
. SEC'1"ION 4:ESTIMATED C'ON'STRUCTION3COSTS.:� - h
Estimated Costs:
Item and Materials OD Witse,Only
1.Building $ 6545 1:,Building Permit Feed'$ Indicate how fee is determined`
2.Electrical $ 0 Standard C /Town Aep.�p,�#cation Fee T
0 Total Project Costs(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees $
4.Mechanical WAC) $ List:
S.Mechanical (Fire N
S ion $ Total All Few!,-$
Check No.�Check Amount: Cash Amount:' t
b.Total Project Cost: $ 6545 0 Paid in Full' O Outstanding Balance Due:
10 M
i
SECTIONi& CONSTRUCTION SERVICES`
5.1 Construction Supervisor License(CSL)
90125 10-06-18
Jamie Morin License Number Expiration Date
Name of CSL Holder List CSL Type(see below) U
30 Forbes Road _
No.and Sheet IYPe Descxrption - {
Northborough, MA 01532 U Unrestricted uildin s up to 35 000 cu.R
R Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masonry
RC Roofing Covermg
'
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2277 rbabostobpermittinp andersencgM.com I Insulation
Telephone Email address D Demolition
5.2 Registered Rome 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
No.and Sheet Email address
Northborough, MA 01532 508-351-2277
City/Town,State,ZIP Tele p hone
SECTION:WORKERS'COMPENSATION INSURANCE AFFIDAVIT_,(mG 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 79c OWNER AUTHORIZATION TO'BE COMPLETED WHEN'
OWNER'S AGENT.,OR CONTRACTOR APPLIES FORXBUiLDING PERMIT '
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 building permit application.
See attached contract 10/3/17 {
Print Owner's Name(Electronic Signature) Date
SECTION 7b:UWNERr OR AUTHORIZED:AGENT,DECLARATION;
By entering my name below,I hereby a under the pains and penalties of perjury that all of the information
contained in this application is true and to to the best of my knowledge and understanding.
Jaime Morin Vyly, - 10/3/17
Print Owner's or Authorized Agent's Nam lectronic ignature) 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.gov/oca Information on the Construction Supervisor License can be found at www mQN. v/dns
'2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/aWcs,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces 9 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 Cast"