B-19-404 - 0006 BORDER STREET - Building Permit x.
<al, The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR Z319 APR +� S EM
ReP'i;, ar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
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$-- Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
6 Border Street 10 . 0093-0
1.l a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
RI Residential-One Family
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 ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Francis Hosman Salem,MA 01970
Name(Print) City,State,ZIP
6 Border Street (978)744-5770 billyh423@yahoo.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building® Owner-Occupied ® I Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units 1 Other 13 Specify: Insulation
Brief Description of Proposed Work 2: Air sealing,Install door sweeps and weather stripping,Blown in cellulose to
exterior walls and attic slopes/floor,Install foam board,Seal and insulate sill/mudsill,Vent kit/bath fan,Seal ducts,
and install clothes dryer vent including exhaust duct.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) r,
1.Building $ 7,412.34 1. Building Permit Fee:$ �cA Indicate how fee is determined:
2.Electrical $ 0 ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 0 2. Other Fees: $
4.Mechanical (HVAC) $ 0 List:
5.Mechanical (Fire
Suppression) $ 0 Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 7,412.34 ❑Paid in Full ❑Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-052576 10/3/2019
James E.Fortin License Number Expiration Date
Name of CSL Holder U
50 Rundlett Way List CSL Type(see below)
No.and Street Type Description
Middleton,MA 01949 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofmg Coverin
WS Window and Siding
SF Solid Fuel Burning Appliances
978-880-7088 phil@air-tightweatherization.com I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) 165640 3/14/2020
Air-Tight Weatherization,LLC - James E.Fortin HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
50 Rundlett Way phil@air-tightweatherization.com
No.and Street Email address
Middleton MA 01949 978-880-7088
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........® No...........0
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 James Fortin
to act on my behalf,in all matters relative to work authorized by this building permit application.
Francis HosmanFrand �ar2� Mar 22,2019
Print Owner's Name(Electronic Signature) Date
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.
James Fortin V� -�-
3/22/2019
Print Owner's or Authorized Agent's Name(Electronic 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. 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.mass.eov/dpss
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"maybe substituted for"Total Project Cost"