B-17-398 - 0018R BECKETT STREET - Building Permit 3 5 C'<<. 3 8 28
The Commonwealth of Massachusetts
=. ; ' Board of Building Regulations and Standards CITY OF
" `y Massachusetts State Building Code, 780 CYIR SALEtkt
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fancily Dwelling
This Section For Official Use Only
Building Permit Number:. :: .'. :.` .. Applied:
Building Official(Print Name) Signature Da
1 SECTION l: SITE INFORTNIATION
r 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
t 1.1a Is this an accepted street?yes no flap Number Parcel dumber
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 Systems
- Zone Outside Flood Zone?
Public❑ Private❑ Check cf yes❑ . . 'Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERS]
2.1 Own rl of Record:
�l M)A- v r �
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTI.ON OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) Addition
Demolition ❑ Accessory Btdg. O Number of Units Other ❑ Specify:
Brief Description of Proposed Work'-: -S a Goa L
SECTION 4: ESTIMATED CONSTRUCTION,COSTS
Item Estimated Casts;, Official Use Onl
Labor and Materials) 3'
1. Building Permit Fee:$ Indicate how fee is determined:
1. Building $ �l g Indi
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier. x
3. Plumbing $ 2. Other Fees: $ -.
4. Mechanical (HVAC) $ List: .
5. Mechanical (Fire $
Suppression) Total All Fees: $
_ Check No. Check Amount: Cash Amount:_
6. Total Project CastT
C f1 5 �' ❑.Paid in Full ❑Outstanding Balance Due:
A►�—ElD 51 t g �o �'� /a
0 •• «-+
SECTION 5c 'CONSTRUCTIONN SERVICES.:
5,1 Construction Supervisor License(CSL)
�� l^r�_' I ►�Vlf> acene�?—���� P-iration Da
te
�C)r L—
Name of CSL nn� G /� T Descri on
[api /Uf � 70 U Unrestricted to 35,000 Cu-Ft)
Ad iW�
Restricted 1&2 Family Dwelling
_ M MasonryOnly
RC Residential RooBng Covering
i
WS Residential Window and Siding _
SF Residential Solid Fuel Burning Appliance
Telephone D Residential Demolition
5.2 Home�Improvement Contractor Registration(HIC) /
�! �.4 �t?P- `�t ,� s Registration Expiration Date -
ffiC CIO y N e or HIC R'�sS
Lant Name
Address
Signature .
7, -
Telephone
SECTION 6:-"rWORICER'S.COMPENSATIONINSURANCE-AFFIDA;YIT(NLG:L.c-152.§25C(6))
Worker's Compensation Insurance affidavit must be completed and submitted with this application.
Failure to provide an insurance affi vit may result in the denial of a building permit
Signed affidavit attached? Yes No 0
SECTION 7a ': "OWNER AUTHORIZATION TO BE"COMPLETED WSEN OWNER'S AGENT:OR
• .
``_ : CONTRACTOR APPLIES:FOR BUILDING PERNIIT
Id as Owner of the subject property,
hereby authorize ��Iq a i CPS to.act on my behalf in all matters relevant to work
authorized by this building permit application.
MAY 08 Z017
Signature of Owner Date
SECTION 7Ii: OWNER OR AUTHORIZED AGENT DECLARATION::
as Owner or Authorized Agent,hereby declare that the statements
T a-
and information fore application are true an_a ccurate,to the best of my knowledge and belief.
Signature of Owner or-Affthodzed Agent (Signed under the pains and penalties of perjury)
SECTION"8: " DEBRIS DISPOSAL
All dumpsters of six(6)cubic yards or more are re aired to have a permit from the Marblehead Fire department:call 781-639-3428.
In accordance with the provisions of 780 CMR Arid MGL c40,§54 a condition of issuance of this building permit is that debris
resulting from any work performed shall be disposed of in a properly licensed soli waste disposal facility as defined by MGL c111,§
150a. �, ,eti. Al- `(C A Spa ��`� 1�1,4 0
t
DEBRIS DISPOSAL LOCATION
SIGNATURE OF APPLICANT
NOTE
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 and Construction Supervisor Licensing(CSL)can be found in 78.0 CMR
Regulations.
Certificate No: A044625
i
THE CONllti10NWEALTH OF MASSACHUSETTS
E'(ECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPNIE 3T
LAHM.t
t}E�Mp__-•�— r_� DEPARTMENT OF LABOR STANDARDS !
19 STANIFORD STREET,BOSTON,NIASSACHUSETTS 02114 �
I
LEAD-SAFE RENOVATION CONTRACTOR LICENSE
I
A&A SERVICES, INC.
115 NORTH STREET
SALEM NH 01970
LICENSE: LR002749 EXPIRES: Thursday,August 20,2020 t/
! b
IN ACCORDANCE WITH M.G.L.C. 11 t, § 197B(b)AND 454 CMR 22.04,THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENGAGING IN LEAD-SAFE RENOVATION.
THIS LICENSE IS VALID FOR A PERIOD OF FIVE(5)YEARS.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L.C. 111,
§ 197B(b)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION AND/OR
MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT
PERFORM MODERATE RISK DELEADING WORK UNLESS"THEY EMPLOY A SUPERVISOR, WHO HAS
TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,TO OVERSEE THE WORK.
s
W1LLANfD.MCKINNEY,DIRECTOR
...__..... —._
= Massachusetts Department of Public Safety
y Board of Building Regulations and Standards
q rr,jinni-,�nrruL//e r`i r�/r�iiun�it.ir 1/i r�=� �
Office of Consumer Affairsairs&Business Keculation License: CS-057733
�C fi F (°HOME IMPROVEMENT CONTRACTOR Construction Supervisor - !
Registration: 10.1609 Type:
p I
Expiration:_ 6/26/201,8 Private Corporation CHRISTOPHER ZORZY I
116 NORTH ST !
A&A SERVICES INC' SALEM MA 01970 s
Christopher Zorzy
115 North Street
1<�
Salem. MA 01970s. � ;tL iKi fl��� Expiration:
Undersecretary .:k.Commissioner 05/26/2019
iA&A SERVICES,INC.
115 NORTH STREET
SALEM, NH 01970