13 BOSTON ST - BPA-15-137 INSULATION The Commonwealth of Masi�$$ NpL SER
' Board of Building Regulationstkn ndards FOR
Massachusetts State Building Code,780 A Cj: 0'4 ' MCI JISPEAI ITY
Building Permit Application To Construct,Repa enovate Or Demolish a Revised Mar 2011
One or Two-Family Dwelling
^ Thus Section For Official Use Only
U J Building Permit Number: Date Applied:,
n, 1 Building Official(Print Name)j S�ghatnre Dat
Ltl�l SECTIONT SITE INFORMATION
I1.1 Property Address. 1.2 Assessors Map&Parcel Numbers
13 Boston St
1.1 a Is this an accepted street?yes no Map Number Parcel Number _
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq it) 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 Owner'of Record:
John Chamulsos Salem MA 01970
Name(Print) Ciro.State,71P
13 Boston St 978 532 8874
No.and Street Telephone Email Address
SECTION 3 DESCRIPTION OF PROPOSED WORK''(check,ell th. at.a. pply). .
.
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other 6 Specify: Insulation
Brief Description of Proposed Work': Insulate walls R13 door sweeps air sealing in basement
SECTION 4 ESTIMATED CONSTRUCTION COSTS
Estimated Costs
Item (Labor and Materials Official Use Only
1.Building $ 4478.66 I Building Permit Fee:$ Indicate how fee is determined.-.1:
❑Standard, City/Town Application Fee
2.Electrical $
❑ i
tot Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. OtherFees: $
4.Mechanical (HVAC) $ List; .
5.Mechanical (Fire $
Suppression) Total All Fees $
Check No. Check Amount:. Cash Amount,
6.Total Project Cost: $ 4478.66 ❑paid nFull ❑Outstanding Balance Due
C4�0_t__� L.m o r, 1 3 5l IS
v
SECPION.5e-CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 101378 11/27/2015
Jose Santos License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) Unrestricted
2 Neptune RD#439 Boston MA 02128 Type Deseipuon
Nc.and Street
... nri
Boston, MA 02128 U Unrestricted(Buildingu to 35,000 cu.flJ
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
781 7106637 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 163106 5/11/2015
Jose Santos- American Building Technologies HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
2 Neptune Rd #439 Boston MA 02128 jose@abtinsulation.com
No.and Street Email address
Boston MA 02128 6172338704
Ci /Town,State,ZIP Tel e hone
SECTION 6c WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G L c:152 § 25C(6)j
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 .......... 12 No...........❑
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S•AGENT pR CONTRACTORAPPLIES:FQRBUILDING PERMIT
I, as Owner of the subject property,hereby authorize Jose Santos-American Building Technologies
to act on my behalf,in all matters relative to work authorized by this building permit application.
John Chamulsos 2/25/15
Print Owner's Name(Electronic Signature) Date
S.E.& ON 7b:OWNER'.OR AUTIIORIZED 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.
Jose Santos
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES
I. 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
www.mass.p,ov/oca Information on the Construction Supervisor License can be found at www.mass.eovidns
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"