B-19-375 - 0056 BELLEVIEW AVENUE - Building Permit 5 Des,
The Commonwealth of Massachusetts .,jmv
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Board of Building Regulations and Standardsg��OF„,;
Massachusetts State Building Code,780 CMR SALEM
Iffl Ap Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolis7� 1 A
One-or Two-Family Dwelling
M This Section For Official4Use Only r
Building Permit Number: Date Applied
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Building 0fficial(Prinf'Naiiie) ;Signature "' Date
SECTION;1 SITE INFORMATION
1.1 Property Address. 1.2 Assessors Map&Parcel Numbers
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1.1 a Is this an accepted street?yes W 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?Check if yes❑ Municipal❑ On site disposal system ❑
2.1 Owners of Recgd•
Name(Print) City,State,ZIP
_510 btfle'V'm 0)7&--7`f5-'V_Z8_
No.and Street Telephone Email Address
SECTION 3 DESCRIP.TION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Propose Work2: ee'o%fi
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SECTION 4c ESTIMATED CONSTRUCTION COSTS k
Estimated Costs:
Item Official IlJge Only
Labor and Materials _
1.Building $ "7 ��� 1 Buildmg Permit Fee $ . Indicate how fee is determined
2.Electrical $ ❑Standard City/T-dWh Application Fee
Total Protect Costa(Item 6)x multiplier x
3.Plumbing $ �2 `Other Fees: S.µ,
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4.Mechanical (HVAC) $ List
5.Mechanical (Fire s
$ Total All Fees'$
Suppression) 5.
Check No Cleck Amount Cash Amount i
6.Total Project Cost: $-7 �®0
1 ❑.Paid in Full ❑Outstan ing Balanc de Due:
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+' 'i+i�' 's "' ' • SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
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A li _� F b
r' •t !``. �► "'ta`�Z License Number ExpirationDat
Name of CSL Hold List CSL Type(see below)
Type Description
o.and tree[ U Unrestricted(Buildings up to 35 000 cu.ft.
IR Restricted 1&2 Fami] Dwellin
City/Town,State,Z M Masonry
RC Roofin Coverin
WS Window and Siding
Construction Supervisor Sign a or(Electronic Signature) SF Solid Fuel Burning Appliances
_ a( I Insulation
Telephone' Email address D Demolition
5.2 !Registered Home Improvement Contractor(HIC)
HIC Registra n ber E iratio Date
HIC Co pany Name or HIC�2 strant Name
� - _
No. treet71 ` ���1 HIC egistrant' Signature
City/Town, to e,ZIP Telephone
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SECTION.6c WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§.25C(6))
Workers Compensation Insurance affidavit must be comp] 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
I,as Owner of the subject property,hereby authorize to act on
my behalf,in all matters relative to work authorized by this building permh application.
Owner's Signature or(Electronic Signature) Date
SECTION 7b:OWNEW 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.
' 8/2-S-Al/
Owner's or Au orize gent's Name or(Electrdnic 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
gtY uaran 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.inass.eov/dps
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 coolingsystem Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
BUILDING PLANNING • HEALTH • ELECTRICAL GAS PLUMBING MAINTENANCE
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Certificate No: . '.l,J.625
= --� THE COMMONWEALTH OF MASSACHUSETTS
f ria ;h EXF..CUTIVE OFFICE OF LABOR AND NVORI(FORCE DEVELOPINIENT
DEPARTMENT OF LABOR STANDARDS
9 STANIft)RI)STREET BOSTON;JVIASSACHUSETT5 02114
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LEAD-SAFE RENOVATION CONTRACTOR LICENSE
A &A SERVICES,INC.
115 NORTH STREET
SALEM MA 01970
l
LICENSE: LR002749 EXPIRES: Thursday,August 20,2020 V
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
ENGAGING IN LEAD-SAFE RENOVATION.
i
THIS LICENSI 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.
i § 197B(b)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION ANDfOIt
MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT
j PERFORM MODERATE RISK DELEADING WORK UNLESS THEY EMPLOY A SUPERVISOR,WIIO HAS
TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,TO OVERSEE THE WORK.
i
WILLIAM D.MCKINNEY,DIREC i
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'�/k �cr,n„taxueall/rq��l� r ,tiu,I�, Massachusetts Department of Public Safety
Office ofConsurrwArrairs6f3uskwmRegulafron Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR t License; CS-057733
TYPE:Corwration
Registrouor► Expirallon Construction Supervisor :
101609 O(i SR020 1.._..: .,:.
At1J1 SERVICES,INC CHRISTOPHER ZORZY
: <p
115 NORTH ST t'e="
SALEM MA 01970
CHRISTOPHER ZORZY t
115 NORTH STREET { -
SALEM,MA 01970 Undersecretar
y 7
�'/ ;!.cv Expiration:
Commissioner 06*612019
IA&A SERVICES,INC.
115 NORTH STREET i
!SALEM,MA 01970