B-17-677 - 0015 VISTA AVENUE - Building Permit q2t
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The Commonwealth"of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,790 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling,
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�,_..�. .-�,. `•_.=�°t �TM°.- ." `� SECTION;I SITC��II�FORIHATION��*R ..-� ��- --- .� -� '� '.:
11 Property Address: 1.2 Assessors Map&Parcel Numbers
15 Vista Ave. 09 0050-0 a �`
1 4
M a is this an accepted street?yes X no Map Number Parcel Number
'
1.3 Zoning Information: 1.4 Properly Dimensions: r `�g
R1 .:
Zoning District Proposed Use- Lot Area ft Ft+on (ft)
I '
11.5 Building Setbacks(ft), 4 v
Front Yard Side Yards Rear Yard .n .
Required Provided Required Provided Required Provide
-4
11.6 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 es0 Municipal 0 On site disposal system O
2.1 Owner'of Renard:
James Assimakopoulos Salem, MA 01970
Name(Print) City,State,ZIP
15 Vista Ave. 978-744-0519 grkangel78@hotmail.com
No.and Street - Telephone Email Address
'I �i!UN 3 DEStCRIPTION OF PROPOSED�f!ORK�(c>teck.allzthat a V
�.
New Construction 13 Existing Building M Owner-Occupied.M Repaus(s) 0 Alteration(s) ® Addition 13
Accessory Bldg.q Number of Units Other M Specify:_Replacement
Demolition 1] A
Brief Desmiption of Proposed Worita: Replacement of 7 windows
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_.�..�.-^.r----�*-'— .�.. �• ...„ties --�.rA: _ �-,.-_-..-`.,--...:
item Estimated'Costs:
j ( HCCitUBe QIIlY1 )` * s,,
and Materials . _r
1,Building $ 1;�Bi aft Pe mrt',Fee�$� gdicate+how feedisad nidnedN'
13,742 p'St ndand`CityPq§WnAffilation F
ost�
2.Electrical $ t -.'0
= O Tatal�Prolod �(Iteni�x'mulhpher � x, � '•p
ti 3.Plumbing
g L Other Fees: $ f g*„4w, � ,
4.Mechanical (HVAC) $ # k.
5.Mechanical (Fire
Total AllpupEME
lOII 4 t� ro
Check:No Check Amount ^Cash Amount
6.Total Project Cost: $ 13,742 ��1'aid'in Full jo,'Qut�admg�BalanoeDu: 1.
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SECTIO1�iS U f �pNSER�Yi_CES i 1" -�:..
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) lJ
30 Forbes Road .
�,1 7� 7
No.and Street ' -I'ype,�' _ DescaipttonM „a:
iVorthborough, MA 01532 U UwesWcted uil to 35,000 cu.R
R Restricted 1&2 Family Dwelling
City/Town,Ste,ZIP M Masonry
RC Roofing Corycrmg
_ VS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2277 rbabostobpermittinp(cDandersencorp.com I Insulation
Telephone Email address D Demolition
5.2 Registered Rome Improvement Contractor(HIC) 170810 12-23-17
Renewal by Andersen MC Registration Number Expiration Date r'.
HIC Company Name or MC Registrant Name
30 Forbes Rd rbabostonpermitting@andersencorp.com.
Nortthhboorroouugh, MA 01532 508-351-2277 Email address
/Town,state,ZIP. _ Tel one
SECTIOQ 6RKERS'COMPENSATIONINSUIZAI�TCE`AFFIDAVIT Ge,152 25C(�)
Workers Compensation Insurance affidavit must be completed acid 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..........M No...........❑
" SECTIONr7a I0VM A y ORTZATIO E COMP, WHEN -u
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i -OWNER'$A ENTOR�, %_LV�TRII, _s RAppI,IEg'FOReBUiI.DiNG PERM-
as €
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 7/19/17
Print Owners Name(Electronic Signature) �* Date
B m name below,I hereby attest der the arcs and y tre��of ury that,al l of the.nformation
y y y pains i�� � �
contained in this application is true and to the best of m knowledge and`understanding. R.
Jaime Morin 7/19/17
Print Owner's or Authorized Agent's Name(Elolronic Signature) Date
Fa ti
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 Conftctor(WQ Program),will rot have access to the arbitration
program or guaranty fiord under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www mass gowoca Information on the Construction Supervisor License can be found at www.mass.g vo ft
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.1) 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"