B-19-386 - 0120 BAY VIEW AVENUE - Building Permit -'Elie Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
=� Massachusetts State Building Code,780 CMR
SALEM
Revised Mar 2011 1
Building Permit Application To Construct,Repair`,Renovate Or Demolish a
. `One-or, Two-F.mnilyDwelling.
-
Bwlding Pit}Number"x DateAppli6d. y _
V Buildiag fftc[al'(Pntnt Na e) ,� # Sigt at�ae•,, 77"
.r. `SECl'ION is SITE INFORMATION;' _ --
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
120 Bay View Ave 44 0120-
1.1 a Is this an accepted street?-yes X no- - Map Number Parcel Number
1.3 Zoning Information: 1A.'Property Dimensions:
R1 #
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) W
Front Yard Side Yards„ Rear Yard
Required Provided lteguired Provided Required Provided
1.6 Water Supply:(M.G.L c..'4o §54) 1.7 Flood Zone-Information:- 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public 0 Private 0 — Municipal 13 On she disposal system 0
Check if es[1
SECTION 2 PROPERTY OWNERSHIPi -
2.1 Owner'of Record:
Mike Phelan 1 PA • G KA r F 1 tJ Salem,°MA 01970
Name(Print) - City,State,ZIP'
12 Bay View Ave 978.873.0868 mpptalk@yahoo.com
;•
No.and Strut ---- `` - Telephone Email Address
DESCRIPTION OF PROPOSED�VORK (cleck;all that aPplY)
� .
New Construction 0 Existing Building Owner-Occupied.;® Regairs(s) 13 Alteration(s) M Addition C]
Demolition C3 1 Accessory'Bldg.d Number 6f Units Other M Specify: Replacement
Brief Description of Proposed Wont?: Replacement of 2 windows and 2 doors
SEtC'I'IONA ESTIMATED COI�T$TRUCTIONCOSTS �
Item Estimated Costs:, 0 ;
and Materials t $liUse my
r
1.Building $ 42,494 i l Buildt,J P`_Feex$ Indicate how`fee-is determined:"`
17 Standard,,Ctty/Town Application Fee
2.Electrical $ t : - t
t7 Total Project Costa(Item 6)x multiplier ' x _ t
3.Plumbing $' i2 Other Fees,
a ;
= ,
4.Mechanical gWAC) $. List:` z r
5.Mechanical (Fire $ Total All Fees $ ---------------
Suppression)
F
Check No. 1, -Check Amount: �-:Cash Amount
6.Total Project Cost: $' ; -
12,494 ,0 Paid'iri Full Ei Outstanding`Balogcelhte: t
-
L111 J$ vn ca t U_E50 t N 510,-%E
S`ECTI0Ni5 NSTRUCTION S KRVI ESQ $`-
UCTTI..-...x'wae-
5.1 Construction Supervisor.Lleense(CSL)'
90125 10-06-20
Jamie Morin License Number Expiration Date
Name of CSL Holder
30 Forbes Road List CSL Type(see belo_w) U
Deon;No.and Street .
U Unrestricted uildin s u to 35,000`ci fft
Northborough, MA 01532 - R Restricted l&2 Family Dwelling
City/Town,State,ZIP
M' Masonry
RC Roofing Covering
- - WS Window and Siding,
SF Solid Fuel Burning Appliances
508-351-2277 rbabostobpermitting cDandersencgm.com "..Ie Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor 170810 12-22-19
Renewal by Andersen
-- HIC Registration Number Expiration Date
HIC Company Now or HIC Registrant Nam_g
• 30 Forbes Rd rbaboston ermittin_ p g@andersencorp.com
No.and Street Email address'
Northborough, MA 01532 508-351-2277
City/Town,S ZIP a - Tel hone
{SECTION 6 119 S'COMPENSATION°INSURANCE AFFIDAVI?(M.G.L 15 §
Workers Compensation Insurance affidavit must be completed and submittal with thus application: Failure to provide
this affidavit will result in the:denial,ofthelssuance of the'building permit.
Signed Affidavit Attached? --Yes' .® No...........❑'
S�ECTI0N'7a V'OWWNNER AUTHORMATIaX TO HE OIVIPLETED WHEN ' K �
r OWNER'S AGENTOR C'ONiTRACTQR�APPLIES_l�(1R'��BUII,DiNG i'ERNIII .. r
Y _
I,as Owner of the subject property,hereby authoriie Jamie Morin
to act on my behalf,in all matters_ relative to work authorized by,this,building permit application.
See attached contract 4/11/2019
Print Owner's Name(Electronic Signature) Date
° '� � � � SECTION':7b O,WNER''�OR`AUTHORIZEDtAGENT�DECLARATIQNi Y. _ ,
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information 1
contained in this application is true and accurate to the best of my knowledge and understanding:'
Jaime Morin w, 4/11/2019
Print Owner's or Authorized Agent's Name(Electronic Signature), = Date
— - �-` �. .of •' r'.-� ,"� . .r„e.,.:
_� 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 fiord under M.G.L.c.I42A.Other important information on the HIC Program can be found at,
www.mass.rv/oca Information on the Construction Supervisor License can be found at wwwaW. v/dos
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.I) Habitable room count
Number of fireplaces Number of bedrooms "-
Number of bathrooms - Number of half/baths.
Type of heating system Number of decks/porches k
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"