B-19-538 - 0137 BRIDGE STREET - Building Permit The Commonwealth of Massachusetts
_(� Board of Building Regulations and Standards CITY OF
W Massachusetts State Building Code,780 CMR SALEM011
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar�'
One-or Two-Family Dwelling
This Section For Official Use Only
( Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION Qc 11,
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1l 137 Bridge St u
l'mil Ma Number Parcel Number l.la Is this an accepted street?yes no P
1.3 Zoning Information: 1.4 Property Dimensions:
rF3
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) v""-
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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes[] Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Peqqy Roos Salem Ma 01970
Name(Print) City,State,ZIP
137 Bridge St
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units I Other ❑ Specify:Insulation
Brief Description of Proposed Work:R-30 restricted-slopes/floored fill w/cellulose;
R-38 unrestricted-settled cellulose; Perimeter 1" R-max or equivalent foam board;
Attic/basement blower door guided sealing with two-part foam; 1"THERMAX or equivalent on door
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $10,457.37 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑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: $10,457.37 ❑Paid in Full ❑Outstanding Balance Due:
1 Z 3 lVl Imo.-L t-'-=:o A D (b7
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 101378 10/18/2019
Jose A Santos License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
Jose A Santos
No.and Street Type Description
Hyde Park MA 02136 U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(781)598-7125 jobs@abtinsulation.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 163106 05/10/2021
American Building Technologies HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
2 Neptune Rd, Suite 439 jobs@abtinsulation.com
No.and Street Email address
Boston, MA 02128 (781)598-7125
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...........❑
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 Jose A Santos
to act on my behalf,in all matters relative to work authorized by this building permit application.
GG z(go < �Q, r'��� 5/21/2019
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 best of my knowledge and understanding.
Q (�f 5/21/2019
Prin Owner's or Authorized Agent's Name(E ctro c store) 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.gov/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 cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"