B-19-481 - 0016 BARSTOW STREET - Building Permit 35` C,�� �ld3
IM6 Co'tnm�of Massachusetts'
Board of Building Regulations and Standards CITY OF
E Massachusetts State Building Code,780 CM RAY —1 p Al SALEM
Revised Aqr 2011 i
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Se tim For Official Use:
Building Pernnit Numbef: Matr Applied: _
s _
Building OfFic;ial(Print Name) Signature Date
SECTION 1:SITE INFORMATION;
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
16 Barstow St. 26 305-0
I 1•la Is this an accepted street?=yee X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot A+ea(sq ft) Frontage(ft)
1.5 Building Setbacks(flt)
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 Informations 1.8 Sewage Disposal System:
Zone: •Outside Flood Zone?
Public 0 Private O ", .Check if esO Municipal E3 On site disposal system 0
SECTION 2. PROPERTYOWNERSHIP'r
7.1 Owner'of Record:
Pat Caron Salem,MA 01970
Name(Prim) City.State,ZE?
16 Barstow St. 978-744-1080 caronpat3@gmail.com
No.and Street --- - Telephone Email Address
3:DESCRIPTION.OF PROPOSEDWORK=(c>mcl;all tbrtt a1ply)
New Construction❑ Existictg Building I--
Owner-Occupied ®- Repairs(s) 0 Alteration(s) ® Addition O
Demolition 13 Accessory Bldg.q Number of Units Other M Specify:_Replacement
Brief Description of sed Wor : -_ -
� _$e,placement of 1 window
i
SECTION 4:ESTIMATED CONSTRUCTIONICOSTS
Estimated Costs.. ` . �,. _ - _,
Item (Labor and Materials) Officlal[Jse Only
1.Building $ 4 644 1; Building Permit Fee:$ flee
Indicate how e is detetmime d
2.Electrical $ LiStandard Cky/TowkApplication Fee
0 Total P%lect Costa(item 6)x multiplier x
3.Plumbing $ 2- Othei Fees,. $
4.Mechanical MAC) $ List,
S.Mechanical (Fire
S ion $ I Total All Fe W.$
Check.No. Check Amouat Cash Amourrt:
6.Total Project Cost: 4,644 0 Paid m Full { El Outstanding Balance Due:
rJI ' �rAi tJ Est
SECTION'S: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSQ'
90125 10-06-20
Jamie Morin License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
30 Forbes Road
No.and Strcet ;Type Description
Northborough, MA 01532 U Unrestricted(Buildings up to 35 9W cu.ft
R Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masomy
RC Roofing Covering
- WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2277 rbabostobpermittin_g )andersencorp.com I Insulation
Telephone 'Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-22-19
Renewal by Andersen HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name -
30 Forbes Rd rbabostonpermifting@andersencorp.com p g@andersencorp.com
No.and Street Email address
Northborough, MA 01532 508-351-2277
City/Town,Statei ZIP_ _ Tole' e
SECTION 5:WORKERS'COMPENSATION INSURANCE AFFIDAVIT,(M.G L.e.152.§'',2SC(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 penirik-
Signed Affidavit Attached? Yes..........M No...........p _
SECTION 7a:OWNER AUTHORMATION.TO'BE COMPLETED WHEN h
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L 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 5/6/2019
Print Owner's Name(Electronic Signature) K Date
SECTION 7b OWNER'OR AUTHORIZED AGENT DECLARATIONL,
By Bering 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,"i
1
Jaime Morin 5/6/2019 f
Print Owner's or Authorized Agent's Name(Electronic Signature) Date `
NOTES:
1. An Owner who obtains a building permit to do his1her own work,or an owner who hires-an unregistered contractor
(not registered in the Home Improvement Contractor(WQ Programs),will not have access to the arbitration
program or guaranty fiord under M.G.L.c. 142A.Other important information on the HIC Program can be found at,
wwwmu=.wy/ocs Information on the Construction Supervisor License can be found at www.mass.01 ./des
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft) (including garage,finished baseme&Jattics,decks or porch)
Gross living area(sq.1) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms ._. . . Number of halflbaths
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" `