0002A & 0002B ATLANTIC STREET - BPA-16-1446 r
The Commonwealth of Massachusetts ( ` �i
n Board of Building Regulations and Standards ;1 ?� "Yg
\d� Massachusetts State Building Code, 780 CMR SALEM
e�*eq 011
Building Permit Application To Construct,Repair,Renovate Or Depoli0a
y� One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date p iedc
tt1 Building Official(Print Name) Signature
�y SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
2A & 2B Atlantic Ave
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
�Ll 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"1/ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
/2.1� �Owner'of Record: t� �rrS Y
1-a5_�0.Gr4 1uvltw�nbk; nedcpmrnl� Parham
Name' i City,State,ZIP
(�In� � �tituS• �y�yL�t+ :t.Le�
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOR]e(check all that apply)
New Construction Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work2: Onstrucuon O new sq esel entla Duplex
See attached plans for detail.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official U Only
Labor and Materials Use n
y
1.Building $ 1. Building Permit Fee:$ Indicate howfee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier ` x
3.Plumbing $ 2. Other Fees:-$
4.Mechanical (BVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 3(a0 1 O UO 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5:,CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 104428 5/12/2018
Adam Brien License Number Expiration Date
Name of CSL Holder U
List CSL Type(see below)
417 Waverley RD
No.and Street Type Description
North Anodver MA 01845 U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted l&2 FamilyDwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
978-479-1526 adambrico@gmail.com I insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 168512 2/28/2019
BriCo Building and Remodeling LLC HIC Registration Number Expiration Date
H1410 p _any Name;HIC Registrant Name
Waverley Rd adambrico@gmail.com
No.and Street Email address
No Annoyer OIA45 978-479-1526
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 ..........V No...........❑
SECTION 7ai ,OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
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Prifit Owner's Name(Ele onic ature) ate
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 to the best of my knowledge and understanding.
Maw $Prep 4/1/17
Print Owner's or Authorized Agent's Name(Electronic Signature) 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 hnprovement 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. og v/oca Information on the Construction Supervisor License can be found at mmunass.Kov/dtts
2. When substantial work is planned,provide the information below:Duplex, combined figures below
Total floor area(sq. ft.) 5,040 (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) 3360 Habitable room count 8
Number of fireplaces 0 Number of bedrooms
Number of bathrooms 4 Number of half/baths 2
Type of heating system Forced Air Number of decks/porches
Type of cooling system Forced Air Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"