B-17-1073 - 0073-0075 BARSTOW STREET - Building Permit The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR 1 OCT 32 SSAI EM
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
;This Section"For Official Use Onl r ,r
i Building Permit Number: - `Date Ap ted:
41
.Building Official(Print Name)* Signature
o ,
rr SECTION 1:`SITE INFORMATION -
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
73-75 Barstow St 26-0226-0
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R2 Two Family
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 2:4R6PERTY OWN)ERSHIP,�
2.1 Owner'of Record:
Joseph Day Billerica Ma,01821
Name(Print) City,State,ZIP
900 Middlesex Turnpike,Building 6 (978)969-2184 joseph.day@us.tel.com
No.and Street Telephone Email Address
x "SECTION«3:DESCRIPTION OF PROPOSED WORKZ check all khat a- l
( hP y), ,
New Construction❑ Existing Building® Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units 2 Other E Specify: Insulation
Brief Description of Proposed Workz: Blown in cellulose to exterior walls and attic floor,Seal and insulate sill/mudsill
in basement,install door sweeps and weather stripping,Insulate steampipe,Air sealing in attic and basement,Install
clothes dryer vents including exhaust ducts and vent kit/bath fan' SECTION 4.ESTIMATED CONSTRUCTION COSTS
Estimated Costs: ,
Item (Labor and Materials - 6inaal Usep Only �.4
m.� ,...
1.Building $ 12,211.03 1 Building Permit Fee:$.,y Indicate how fee is determined.,
❑Standard City/Town Applicatton,Fee'� r
2.Electrical $ �
D Total Project Cosi3(Item 6)x multphei _�� x� •_- � `
3.Plumbing $ 2 Other Fees $
t
4.Mechanical (HVAC) $ Ltst
77,
5.Mechanical (Fire « 1
Suppression) $ Totai All Fees
6.Total Project Cost: $
12,211.03 Check No Check Amount Cash Ainount � �.
❑Paid m Full ❑Outstanding Balance Due:_.
(/�C �C
w` SECTION 5 'CONSTRUCTION SERVICES '
5.1 Construction Supervisor License(CSL) CS-052576 10/3/2019
James Fortin License Number Expiration Date
Name of CSL Holder U
50 Rundlett Way List CSL Type(see below)
scn Uon.
No.and Street Type �";� „r De p ��.
Middleton,MA 01949 U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
978-998-4684 phil@air-tightweatherization.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 165640 3/15/2018
Air-Tight Weatherization,LLC James Fortin HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
50 Rundlett Way phil@air-tightweatherization.com
No.and Street Email address
Middleton,MA 01949 978-998-4684
City/Town,State,ZIP Telephone
°SECTIONz6 WORKERS!COMPENSAT[OMINSURANCE AFFIDAVIT(M.G.L.c:152. 25C(6))- TV �;
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 ..........EX No...........❑
'SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENTwOR CONTRACTOR APPLIES'FOR'7BUILDINGxPERMTT
I,as Owner of the subject property,hereby authorize James Fortin
to act on my behalf,in all matters relative to work authorized by this building permit application.
Joseph 6ay(Oct 27,2 Oct 27, 2017 7) � _
Print Owner's Name(Electronic Signature) Date
;= SECTION 7b:,OWNER'OR AUTHORIZED AGENT DECLARATION
By 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 my knowledge and understanding.
James Fortin "'�' 10/27/2017
Print Owner's or Authorized Agent's Name(Electronic Signature) 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.mass.gov/dgs
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 half/baths
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"