B-17-539 - 0041 UPHAM STREET - Building Permit `The Commoitvvealth of Massachusetts -
Board of Building Regulations and Standards � � + 3 CITY OF
, '
Massachusetts State BuildingCode 786 CMR -1
,a--� ltevlsedMar 2011
V Building Permit Application To Construct;Repai ,'Renovate Or Demolish a
One-or Two-Family Dwellm .
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�SECMN4:SlC1'E INFORMATIONS
1, 11 Properly Address: 1.2 Assessors Map&Parcel Numbers
41 Upham St. _ 27-0268-801
1.1 a Is this an accepted MwVyesL X no Map.Number Parcel Number
1.3 Zoning Information: 1A_Property Dimensions:
Zoning District Proposed Use Lot Area.(s4:R) Frontage(ft)
1.5 Building Setbacks($),
Front Yard _ Side Yards.`.. Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L'c:40,§54), 17 Flood Zone Information: 1.8 Sewage"Disposal System: `
Zone: _ Outside Flood Zone?
Public O Private 13 Mrmici�l O On site disposal system 0
_Check if es0
. .. � .4,_.. . _ -
21 Owner'of-Record: _ --
Judy Kauffman Salem; MA 01970
Nance(Print) City,state,23P
41 Upham St 978-317-8723 judykauffman@gmail.com
�. -
No.and Street -' - -� — Telephone F.mar7 Address
µ'l1� N 3 DEStCRIPTIONOF PRPOSED,�VORIC'(check apple� ;, ' 'r
New Construction O Existing Building,Rl Owner-Occupied:® Repsics(s) l] Alteration(s) M Addition O
Demolition 13 Accessory Bldg!b Number of.Units Other ® Specify:_Replacement
Brief Description ofPropood—Wo V.—keolacement of 5 windows
{ ,. 5F.G"I'ION_A-ESTIMATED�NSTRUGTIO�NICOS �_
Estimated Costs:
itemand Materials) 1 _ ilt } Oi�ei>otMlie Daly'
UAbor 1,Building $ 14332 1 B—:Wdmg"`Permit Fee $ l diCate`'}mw fee isiletermimed
�' i x- ,
t]St ndatd itylTown Application Fee
2.Electrical $ �; �}.
n a
f]Tor Prolog Costs=(lte�fi}"xmul4iier .R
3.Plumbing $ 2 Other Fees, $ 0
4.Mechanical (HVAC)
5.Mechanical (Fire Total All Foes:$
S an _ ��.._
Check No. Check Amoum Cash Amourit'`
6.Total Project Cost: $ l .u.,jy .. e ,r ;
14332 O Paid m Full ,:,. ��"Odmg BalanceDue.'`�_ 7i
C2r�t
(pl2Z 1V)r-\) i N SAs�
..rs,. _ gECTION'5.;: UCTION SERYIC`ES4; _'' '
5.1 Construction Supervisor License(CSL)
90125 10-06-18
Jamie Morin License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
30 Forbes Road
w
No.imd Sheet ;Iype ' r ` , , Desalptrez ;i 'c
Northborough, MA 01532 U Unrestrictod uil to 35,000 cti.f
- - R Restricted 1&2 Family Dwelling
Cityf town,State,ZIP `:M Maw
`RC Roofine Covering
VS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2277 rbabostobpermitting(a)andersencoM.com " `I Insulation
Telephone Email address _ D Demolition
5.2•Registered Rome Improvement Contractor(HIC) 170810 12-23-17
Renewal by Andersen HIC Registration Number Expiration Date;'.
HIC Company Name or HIC Registrant Name
30 Forbes Rd rbabostonpermitting@andersencorp.com,
Nortthhboorrouugh, MA 01532 508-351-2277 Email address
City/Town,City/Town,State,ZIP. _
,� -,.:�-�stx .�' .. _ - - ice- •"�-e.a; sw,. „ ��*"... w r � : +e�^ ' - r.
SECT'IONC6 WORKERS'COMPENSATION'INSU3L4NCE4AFFIDAYI (M G1;.L c 1152.�ZSC(�)'`M
Workers _ submitted
with
this
_ppl on. Faihire to videthis t
Compensation
wwrl'1 wit�denial of the..I�ce of the buildm aril vmth ttus application.
'I
Signed Affidavit Attached? Yes..........M No............Cl
`SECTION 7a�i'0WNERrA 1= ORIZATION,1— KICOMPLETED
�;�:F. ,, u.r:� =,:OWNER,$AGRNTOR.CON�TRIICTQR APPLIES_FOR-BUII.DING PF.RMIT�.�s _ I". _t
I,as Owner of the subject property, ' orize Jamie Morin
to act on my behalf,in all matters relati to work authorized by this building permit application.
See attached contract 6/12/17 i
Print Owner's Name(Elechonic Signature) _ Date }'
4
�, ,, �..�;,���;.��; SECTION'7b 'O,WNERr,"OR�tAUTHOIVZ�D�AGFNT DE j TION _ µ- '"�""�•t
m name below,I beret under the pains and tees of that, of.the information "
BY. g Y Y P P�i P�J�Y
contained in this application is true and to the best of my knowledge and understanding
I
Jaime Morin 6/12/17
Print Owner's or Authorized Agent's N ectronic gn_attme)
Date
. g Y. � •NpOTES._ 71,
1. ' An Owner who obtains a building permit to do his/her own4ork,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will Mot have access to the arbitration
program or guaranty fimd under M.G.L.C. 142A.Other important information on the HIC Program can be found at
www.massBpyJoca Information on the Construction Supervisor License can be found at www.mass.g vo /dM
f .2. ' when substantial work is planned,provide the,information below:
Total floor area(sq.R.) (including gauge,finished basementlattics,decks or porch)
Gross living area(sq.I) Habitable room count
Number of fireplaces _ .___, Number of bedrooms
Number of bathrooms -- - — 4' Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
r3. "Total Project Square Footage"may be substituted for"Total Project Cost"