B-19-397 - 0077 BAYVIEW AVENUE - Building Permit The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised mil'20P
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family S Dwellin '
d Thts Section For Official Use Only F` C
Buildtng;Permtt Number:`•� �:- -�'�. Date Applied r � _ v . �.,,,1 �_
��. -Btii1""din `Official` lint Naive x, ~" 'S�`'afore Dam
SECTION,.1 SITE INFORMATION,�
1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers
7 �io.11y'�C�nR Pckf�
1.1 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 rPROPERTY OWNERSHIP' } ' x'
2.1 Owner'of Record:
77 PAUU�QjjV NO UQ'-f(St cS0,A-V0r WT�- 0'PI-7C
Name(Print)' City,State,ZIP
-77 bDQkl #A) 0,,(P cl- 9'-74 5-oa-4 I
No.and Street Telephone Email Address
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SECTIQN 3 DESCRIPTION OF,PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work2: 5�1. 0-n d St-alk 4( 16 V S o<S o-k
roG�-in (u 5 s : r oft' add On t-
o a coo
SECTION 4 ESTIMATED CONSTRUCTION COSTSAlk
r �` x.�
2 Estimated Costs:
Item OffieialjUse Onl
Labor and Materials ,.... «..c �y�
1.Building $ ZU'p_ 1 Bu ldmg-Pemnt Fee $ ^s Indicate how fee IS determined
❑Standard City/To yn Application Fee
2.Electrical $ :
❑Total Project Costa(Item 6)z multiplier x
3.Plumbing $ 2 Otlier Fees $r G Shy! Z ;
4.Mechanical (HVAC) $ List
h r r
5.Mechanical (Fire
Su ression $ Total:`All Fees
CheckNo Check Amount Cash Amount
6.Total Project Cost: $ ay °?, tg 0 ❑Paid m Full. ❑Outstanding Balance Due. ;.
`�`l� Mo tub TD PA
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) D�' �7 �D 19
.} 1�—Z License Number Expiration Dat
a
Name of CSL Hold List CSL Type(see below)
l5 i Type Description
o.and •treet U Unrestricted(Buildings up to 35,000 cu.ft.
tState,
R Restricted 1&2 Famil DwellinCity/ToZ M' Masonry-
RC RoofingCovering
WS Window and Siding
Construction Supervisor Sign a or(Electronic Signature} $F Solid Fuel Burning Appliances
_ a I Insulation
Telephone Email address D Demolition
5:2 Re istered Home Improvement Contrnctor(HIC)
S
HIC Registra n ber E iratio Date
HIC Co pony Name or HICelgtstrant Name'
—A9t, , -fir
No. tr eeet HIC egistrant' Signature
Ci /Town, to e,ZIP
Telephone
ity/
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§,25C(6))
Workers Compensation Insurance affidavit must be.com' I ted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance_o e building permit.
Signed Affidavit Attached? Yes.......... No:.....:....❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR.APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize a to act on
zed b this build erm application.
my behalf,in all matters relative to work authorized y g P .
Devint's See CcaL ►
Owner's Signature or(Electronic Signature) D e
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- i
Ownet s or Au orize gents Name or(Electr is 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. 12A.Other important information on the HIC Program can be found at www.mass.eov/oca
Information on the Construction Supervisor License can be found at www.mass. og 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.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"
BUILDING • PLANNING • HEALTH • ELECTRICAL • GAS • PLUMBING MAINTENANCE
Certificate No: �:4�t>.�62�
c,,e
- THE COMMONWEALTH OF MASSACI.111SETTS
EXECUTIVE OFFICF OF LABOR AND I4IORKFORC[DEVELOPMENT i
F
ri DEPARTMENT OF LABOR STANDARDS
19,S.'TANWORD STREET BOST6N.MASSACHUSETTS 02114
LEAD-SAFE RENOVATION CONTRACTOR LICENSE
A &A SERVICES.INC.
i 115 NORTH STREET
SALEM MA 01970
LICENSE: LR002749 EXPIRES: Thursday,August 20,2020
IN ACCORDANCE WITH M.G.L.C. 111,§ 1978(b)AND 454 CMR 22.04,THIS I_ICENSI?IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
1 ENGAGING 1N LEAD-SAFE RENOVATION.
i
I
THIS LICENSE IS VALID FOR A PERIOD OF FIVE(5)YEARS.
T141S LICENSE MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE:WTI"H M.G.L.C. I 11.
j § 197B(b)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION ANWOR
MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT
j PERFORM MODERATE RISK DELEADING WORK UNLESS THEY EMPLOY A SUPERVISOR, WI40 HAS
TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,TO OVERSEE THE,WORK.
t
I
i
:
2 WILLIAM D.MCKINNEY,DIRE ;
,Vt&",Va11x"IG � �9 Massachusetts Department of Public Safety
Office ofConsumerAffatri6a„kwwReg„t uoe Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR I License: CS-057733 as
TYPE:Cormarion p
Registration Ealrallop Construction Supervisor :
101609 I MJ2512020 -• '
A&A SERVICES,INC CHRISTOPHER ZORZY
115 NORTH ST
SALEM MA 01970 '
CHRISTOPHER ZORZY
115 NORTH STREET
SALEM,MA 01970 Underswreta
rY /;�
%,�ne!cw %rstA•- Expiration:
Commissioner 65/6/2019
:A&A SERVICES,INC.
'115 NORTH STREET
1SALEM,MA 01970
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