B-17-348 - 0030 BOSTON STREET - Building Permitr
Contact:Phil Morris (978)880-7088 phil@air-tightweatherization.com$ 2-5 '5�X
The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR) a_
Building Permit Application for any Building other than a One-or Two-FamilylAvell g
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official: tJ
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) t.4,Y
30 Boston St Salem 01970 t
o
No.and Street City/Town Zip Code Name of Building(if appliA%le)
J SECTION 2:PROPOSED WORK t 5.
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building® Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ® Specify: Insulation/Weatherization
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work: Blown in cellulose into attic,duct and pipe insulation installpropa vents air-sealing
install weather stripping and door sweeps.
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION;OR
CHANGE IN USE OR OCCUPANCY -
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5;USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional I-1❑ I-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:.
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑
A trench will not be Licensed Disposal Site
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: NIA Historic Conunvssion Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Jay Goldberg 7 Rantoul St.Suite 110B Beverly,MA 01915
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Owner/Manager 978 239 6087 joldberg@goldbergpropertiesre.com
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
James E Fortin 50 Rundlett Way Middleton MA 01949
Name Street Address City/Town State Zip
to act on the property owners behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Pleasefill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1
10.1 Re "stered Professional Responsible for Construction Control
James E.Fortin 978. 998 -4684 phil@air-tightweatherization.com CS-052576
Name(Registrant) Telephone No. e-mail address Registration Number
50 Rundlett Way Middleton MA 01949 Const Super U 10/03/2017
Street Address City/Town State Zip Discipline Expiration Date
102 General Contractor
Air-Tight Weatherization,LLC
Company Name
James E.Fortin 165640 Home Improvement Contractor
Name of Person Responsible for Construction License No. and Type if Applicable
50 Rundlett Way Middleton MA 01949
Street Address City/Town State Zip
978_664_ 4684 978_978 0690 phil@air-tightweatherization.com
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSUR I ANCE AFFIDAVIT M.G.L.c.152.§25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION.12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ 2,400.00 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ 2,400.00 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 E.Fortin A�a V a Co-Owner Air-Tight Weatherization,LLC 978_998 _4684 4 27 2017
Please print and sign nam Title Telephone No. Date
50 Rundlett Way Middleton MA 01949
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date