B-17-357 - 0065 VALIANT WAY - Building PermitI rF,
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Thd Coniimid-nweal&of Massachusetts
Board of Building Regulations and Standards CITY OF
SALEM
b Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
Otte-or:Two-FmnilyDwelling.
Btuldmg;Pe�nntt Number,,. "*° ray tDateTAp � mot- ,a . g
a.1 gntldingr0 ;(PrmtName) ., .1... - S �'w �Dati #
L!.I., "" • " 4SECTION 1:SIT1C'INFORMATION
1.1 Property Address: 1.2 Assessors Ma &Parcel Numbers y
I�My P ev V:
65 Valiant Way 21-0041-865 '' '
1.1 a is this an accepted street?yes Number Parcel Number X no Map .s�
13 Zoning Information: T1.4-Property Dimensions:
Zoning Distinct Proposed Use Lot Area(sg fl) Frontage(8)
1.5 Building Setbacks(it) _ -
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required vided
1.6 Water Supply:(M.G.I;c.-40,§54) 1.7 Flood Zone Information: 1A Sewage Disposal Syst m:
Zone: _ Outside Flood Zone?
Public t7 Private O Check if yesU Munk ❑ On site disposo system D
ON2: PROPF3LTrY,�,W11TE�RSAIPta- . of
_
2.1 Owner'of Record:
Tony-Pikus Salem, MA 01970
Name(Print) City,State,Z1P'
65 Valiant Way 508-527-1207 tpikuscom@gmail.com
No.and Sbvet - " Telephone Email Address
° �ON 3 DE9CRIP,TION OFzPRPOSED`6VORK (check pp,ly,) *1
New Con�tion❑ Existing Building® Owner-Occupied<®- Repafi*s) ❑ Alteration(s) M Addition O
Demolition 0 AccessoryBldg.d Number ofUnits Other M Specify: Replacement
Brief Description of ProposedW6W: Replacement of 3 windows
t
Ott _ t�J,
Item Estimated Costs: Ofllelal Use O E and Materials
1 •$Buildmg Permit'Fee � �� Indicate law fee4is' ed
1.Buildmg $ 5596.00 a *-„w {� .. . i
gSt dard .Crif Aptifibid Fee
t �
2.Electrical $ [3=TOtaIAPt+o1 CII
ast3;(lt� xmnthpher
3.Plumbing
4.Mechanical WAC) $ ` � .aim,
5.Mechanical (Fire r 1 try '
Suppraiion $ (total All Feiril$ �z �_� X t - �{
Check N0. _ Check Ainoimt k Cash Amount. -
6.Total Project Cost: $ 5596.00 1'aid�`m Full- tr;:� }r Bal ncceDi e=r - N
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5.1 Conduction Supervisor License(CSL)-
• 90125 10-06-18
Jamie:Morin License Number Expiraiion Daft
Name of CSL Holder
List CSL Type(see below) U
30 Forbes Road ,.
No.and Sheet I e
Northborough, MA 01532 U Unrestricted(Buildinits up to 35,000 cu.f
R Restricted l&2 Family Dwelling
Cih'tT�_ n,StatU6 Z M Masonry
'RC Rool Covering
- a 'WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2277 rbabostobpermitting(cDandersencoM.com I' Insulation
Telephone Email address _ - D I Demolition
5.2 Registered Rome Improvement Contractor(HIC) 170810' 12-23-17
Renewal by Andersen MC Registration Number Expiration Date t'
MC Company Name or MC Registrant Name '
30 Forbes Rd rbabostonpermitting@andersencorp.com',
No.and Street Email address
Northborough, MA 01532 508-351-2277
C' /Town,S 23P. Tel one
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ON 6:WORKERS'COMPEAISATION INSURANCT°AFFIDAV (M,U c.152.V
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
SECION°7a�'OWNERA ORiZATION TOtBE COMPLETED WHEN
., — ,
OWNEIII'$AGENT OAS _NTRAA*AllI:IES'>FOR+BUILDING,PERIIIIT µ
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I,as Owner of the subject property,hereby authorize Jamie Morin !
to act on my behalf,in all matters relative to work authorized by this building permit application.,
See attached contract 4/28/2017 !
Print Owner's Name(Electronic Signature) Date
` SECTION7bO�VNEROAA ORIZEDAGI,.NT DECZAIZATION � �.
4� n� a <.� ..��.
I
Su
By aging my name below,I hereby under the pains and penalties of perjury that all,of the information j
contained in this application is true kndlaccurate to the best of my knowledge edg and mderstsndinB•'
Jaime Morin 4/28/2017
Print Owner's or Authorized Age's N (Electronic Signature) W Date
Ira-
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an intregistered contractor
(not registered in the Home Improvement Contractor OMQ 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.mess.gov/ft
2. When substantial work is planned,provide the information below:
Total floor area(sq.1) (including garage,finished basemenUattics,decks or pomp)
Goss living area(sq.8.) :Habitable roam 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 Squiare Footage"may be substituted for"Total Project Cosf'