B-19-6 - 0045 BELLEVIEW AVENUE - Building Permit 43�5 cf-, -7
�. The Commonwealth of Lklassachusetts
5i Board of Building Regulations and Standards CITY OF
1!� Massachusetts State Buildino,Code. 730 CLk SALE��i
Revised�Ik7r 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 Date Applied:
CAJ
1 "Building Official(Print Name) Signature .. Date
SECTION l: SITE I tFORi�LATION
1.1 Proe erty Address:. 1.2 Assessors Map&Parcel Numbers
1.1a 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(l)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard..
Required Provided Required Provided Required Pr0#ed
1.6 Water Supply: (M.G.L c.40,§54) 1.7,Flood Zone.Information:' ' ' 1.8 Sewa e:`-Disposal System,,r
Zone Outside Flood Zone?
Public Private-❑ — Municipal❑ On site disposal system ❑ r
Chick if yes❑
SECTION 2: PROPERTY OWNERSHIPI -
2.1 of Record:
�=r'
on P eko otSAAjl, L(V o- '0 'J
Name(Print) City State,ZT'
°7-79- 7y qq7 �-
No.and Street _ Telephone ` Email Address'
SECTION 3 DESCRIPTION.OF PROPOSED WORK (check all that apply)
. , Alteration s New Construction❑ E.�cisttng Building❑ Owner-Occupted IZepairs(s) ❑ (s Addition:
Demolition ❑ Accessory Btdg. 11 ` " Number of Units Other ❑ Specify
Brief Description of Proposed Worlc. me, / ._ 1 S
tkh A AD)C
SECTION 4:,ESTIMATED CONSTRUCTIOIN COSTS.. -
Esti hated Costs:. .
Item Official Use Only
Labor and Materials)
1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
$
❑ Standard City/Town Applic.ation Fee
2. Electrical
❑Total Project Costa(Item.6)x multiplier., x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Su 'ression) $ Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ I ZO G -- p paid in Full ❑Outstanding Balance Due:
13 I i�( Yet.A� � �i O C-�•C ,
SECTIONS: CONSTRUCTION SERVICES.' -
5,1 �C;o(n__struction Supervisor License(CSL)
License. -0S ' Expiration Date
Name of CS 1 n I G�—7 T e, Description '
U Unrestricted to 33,000 0,Ft)
AdL
R=t icted l&2 Family Dwelling
_ M MasonryOnly
RC Residential Roo Covering
i
G J -7 q � wS Residential Window and Siding
�J SF Residential Solid Fuel Burning Appliance
Telephone, ; r. D Residential Demolition ,
5.2 Home Improvement Contractor Registration(MC) ti ` �« c �` e ^�,{
Registiahon "Expiration Date
HIC com y N e or E IC Registrant Name
S; y U�)
Address —. ..... . . ... . . _. -
4
Signature
Telephone
SECTION 6: ;WORKER?S COMPENSATIONIli URANCRAFFIDAVIT(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 Na '
SECTION Via.. "OWNIIi AUTHORIZATION,TO BE C OMPLETED WH1p$OWNER'S AGENT:OR
CONTRACTOR APPLIES:FOR BUMDIIIIG PERNIIT
bin
,as Owner of the subj ect property, �
hereby authorizer— )(�ICE lli C to act on my behalf in all matters relevant to work
authorized by this building permit application.
,aavz
Signature of Owner Date
SECTION?1i: OWNER OR AUTHORIZED.AGENT DECLARATION ';
as Owner or Authorized Agent,hereby declare that the statements
and information tod..d�
re application are true an_d curate,to the best of my knowledge and belief.
_.
is a?
Signat re of Owner or Aent (signed under the pains and penalties of perjury) Dare -
SECTION'8;_ DEBRIS DISPOSAL
All dumpsters of six(6)cubic yards or-more are required to have a permit from the Marblehead Fire department:call 781-639-3428.
In accordance with the provisions of 780 CMR and MGL e40,§54 a condition of issuance of this building permit is that debris
resulting from.any work performed shall be disposed of in a roperly licensed solid waste disposal facility as defined by MGL c111,§
150a. Gl � �f PC-A)66,A Jq,
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 PC)Program)will not have access to the arbitration program or guaranty fund under M.G.L.
c. 142A,Other important information on the EEC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR
Regulations.
Certificate No: A0 44625
=�--. THE COMMONWE:A1,71i OF MASSACHUSETTS
EXF..CUTIVE OFFICE'OF LABOR AND WORKFORCE DEVELOPMENT !
DEPARTMENT OF LABOR STANDARDS
19 S'IANIFORD STREET,BmTON,MASSACHUSETTS 02114
LEAD-SAFE RENOVATION CONTRACTOR LICENSE
A &A SERVICES.INC.
i l l5 NORTH STREET
SALEM MA 01970
LICENSE. LR002749 EXPIRES: Thursday August 20 2020V/
IN ACCORDANCE WITH M.G.L.C. 111. § 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
i ENGAGING IN LEAD-SAFE RENOVATION.
i
I
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. I 11.
j § 197B(b)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION AND./Olt
MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT
j PERFORM MODERATE RISK DELEADING WORK UNLESS THEY EMPLOY A SUPERVISOR,WHO IiAS
TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,1.0 OVERSEE THE WORK.
1
V`44pw
��
-r
' WILLIAM D.McKINNEY,DIREC R I
t Massachusetts Department of Public Safety
umer Affairs
r�Business ! Board of Building Regulations and Standards
Office of Consumer Afralrc 6 t3ush►eas Regulation i
HOME IMPROVEMENT CONTRACTOR f License: CS-057733
TYPE:Corooratiai
RRegistrauan Expiration f Construction Supervisor
1011M 9 06/25/2020
A&A SERVICES,INC CHRISTOPHER ZORZY
115 NORTH ST1'`'.'
SALEM MA 01970
CHRISTOPHER ZORZYC ,
115 NORTH STREET
SALEM,MA 01970 Underwretary
/ ZC, ��,�.� Ex iration:
-Commissioner 06/2612019
!A&A SERVICES,INC.
115 NORTH STREET
!SALEM,MA 01970
jF