B-19-532 - 0039 BUENA VISTA AVENUE - Building Permit r
The Commonwealth of MassacliusettsCITY 0
Board of Building Regulations and Standards? i�q..
F � ,�` ALEM
Massachusetts State Building Code,780 CMRb.
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovatd 1X0*
One-or Two-Family Dwelling '
This Section For Official Use Only,
V Building Permit Number: Date Applied:
1 Building fficial(Print NameT Signature Date
SECTION 1:SITE INFORMATION
1 1.1 Pro ert Address: 1.2 Assessors Map&Parcel Numbers
39�ueia Vista Ave Salem MA 01970
1.1 a Is this an accepted street?yes x 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? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2 PROPERTY,OWNERSHIP'
2.1 ,e l9 r° ��i�d:
Salem MA 01970
Name(Print) CiNState,ZIP
39 Buena Vista Ave (781)475-3302 gentz1er328@gmai1.com
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) ❑ 1 Alteration(s) IN Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work-2: insulation work as part of the Mass save program
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 3000 J. Building Permit Fee:"$ "' Indicate how fee`is determined;
❑Standard City/Town Application Fee '
2.Electrical $ 3
❑Total Project Cost_(Item 6)x multiplier 'x "
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
3000 Check No. Check Amount` Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
JIZD Mal i N —CXA-SC $7 per$1000; minimum $25
SECTION Si`CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-096385 10/8/2018
Romain Strecker License Number Expiration Date
Name of CSL Holder y
-j List CSL Type(see below) U
10 Churchill Place
Place
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
Lynn, MA 0 1902 R Restricted 1&2 Family Dwelling
Z
Pity/Town,
State,ZIP. � M Masonry
'RC Roofin Coverin
WS Window and Sidin
SF Solid Fuel Burning Appliances
781-309-7540 x 3 ops@neeeco.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC). 185222 5/11/2020
Neeeco, LLC - HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name "
10 Churchill Place ops@neeeco.com
No.and Street Email address
Lynn, MA 01902 781-309-7540 x 3
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 Neeeco, LLC
` to act on my behalf,in all matters relative to work authorized by this building permit application.
5/17/19
(signed contract attached)
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNERI 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.
Print Owner's or Authorized Agent's Name(Electronic Signature) Roma in Strecker Date
5/17/19
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
vrww.mass.gov/oca v�Information on the Construction Supervisor License can be found at www.mass.g2v/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"maybe substituted for"Total Project Cost"