28 HIGHLAND AVE - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
MUNICIPALITY
Massachusetts State Building Code, 780 CMR
USE
i 1 Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One or Two Family Dwelling
W This Section For Official Use Only
-n,
tE- adding Official(Print Name) ,-_ - ;St aturFVF
Date ;''
ialit AaSECTION 1: SITE INEO ON r , F: Aux„y
1.1 Prope Address: Ale- 1.2 Assessors Map&Parcel Numbers
�ga �/sNc..�i�D
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 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
m `� _g_ SECTION 2:cPROPERTY;,OWNERSHIPi , n .;.. ,. m t _.......:a R
�.� . _.
2.1 Owner'gfRe f��ft\q�vi Clke e-\� WUSS SA-, O\QJ -70
Name(Print) p City,State,
7x 1_\Igh6Ar-\ flvt_ 9 7$ -11K 01\C7 :2/'e
No.and Strebl Telephone Signature
q v., ,"�,SECTION 3:DESCRIPTION OF PROPOSED WORK?(check all that apply)
New Construction ❑ FExisting Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ®-Specify: ft�.
Brief Description` oof Proposed Work': t� 5 Ot vrt r 6 '` \ e a r in s QSS n S
oomwe"7, tay ok\\ new &C - h v S In F011 �tvrrm C
" _11 mSECTION 4 ESTIMATED CONSTRUCTION COSTS.
_w
_..
Estimated Costs: w� z
Items ,z Official Use On "
Labor and Materials)
1.Building $ )Ls 1 Building Permit Fee $A n L Indicate how fee is determined:
❑Statdard City/Town Application Fee ' ;
2.EIeCtI1Ca1 $ 3 'a rr'•.• a °� ram: �.
❑,Total Project Cost (Item 6)x multiplier r x
3.Plumbing $ 2 Other Fees u$�' F ,t OffliP"%
4.Mechanical (HVAC) $ List x --- "'
5.Mechanical (Fire
Suppression) $ GT661 All Fees $"" §13 �dn '��''�"�'„
Check ashtAmount
6.Total Project Cost: $ ZS i 49"C) ❑Paid m Full ❑Outstanding Balance Due
ZP
, SECTION S:gCONSTRUCTION SERVICES_=
5.1 Construction Supervisor License(CSL)
2123 5/24/12
Glenn Battistelli License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
P.O.Box 496
No.and Street °,Type a
n ,.._ . _...... _. _.
U Unrestricted ((Buildings up to 35,000 cu. ft.
Beverly,MA 01915 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(978)927-8956 I Insulation
Telephone Si nature D Demolition
5.2 Registered Home Improvement Contractor(HIC)
ft* ation
7/13/1
Glenn Battistelli Construction HIum e, Ex 'o to
HIC Company Name or HIC Registrant Name
P.O.Box 496
No.and Street / Sig to
Beverly.MA 01915 (978)927-8956 1
City/Town, State,ZIP Telephone
it
` SECTION 6 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c'I52.
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 .......... ❑ No ........... ❑
-x x SECTIONla:OWNER AUTHORIZATION TO BE COMPLETED WHEN�J
- _ OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Glenn Battistelli to
act on my behalf, in all matters relative to work authorized by this building permit application.
X wyf-1A clkxI Wss c �a 3 \ 2C1 '1/
Print O er's Name(Signature) Date
' = SECTION;7bo 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 applicationdacc a to h bes m knowledge and understanding.
Glenn Battistelli . �kz u� I 3 1 /2171 1/
Print Owner's or Authorized Agent's Name(Signature) 413ate
Lr rami 6 0NOTES. .._rt 207M:� F ..
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 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 www.mass.gov/dps
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"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street, 74h Floor
Boston, Mass. 02111
`Worker's Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
"Applicantiut'ormztitioD: �
name: Glenn Battistelli
address: P.O. Box 496
city' Beverly state: MA ` p zip: 01915 phone# (978) 927-8956
work site location(full address): Sr,)era,t M I
❑ I am a homeowner performing all work myy—self. Project Type: ❑ New Construction ❑ Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition
x❑ I am as employer providing�7(workers'compensation for my employees working on this job.
company
name: Glenn'iBattistelli,�c.ompanyWlll i 6
s _ oT
rvz
address:€P.o. Boxs496 si:i'cri'� "; i € taro: o_a., �A6Iri- 1
KWUMA
city:r'8everly u a', IM, sphone# (978) 927-8956xEl" m ; .
rim g ,. _
insurance co.zT avelers Ind mni I ,� _ 1 n}p licy ty 8 4258 P098 11 ._
..m_ .....: . ....r............ ... ....:. . _� .._.,....._...._ . .... .._. ._ ......_:.
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the
following workers'compensation policies:
3 djeI t
, .I,..._.4�'aikw�.
com an Dame.:-. .._.:,:,�.
: xd t�€l�j"AIL ,. s€ Ph �i p u ,n", s, :i y€i €, I. i=- t ,, ,=3 ' AI.4il �4 s'vi F s :� i�` ;
address !,...i..n,9 Sr„ iI141, .� �.. s i�_z .... ..r_:aw,i,, d ,),l fi ° y,.. �k1 '
°,;i C r"�`€( a<€ s hR g, I � I E-e• i t �N rig " 'v"S 1Hn
erty., tu,:u,_ s....n _„s.a �r ai.:.:�.. e 6_� one
I,i t�..� rf E 3ltrEt) d+' ( r .mv
`''�"° ..<:. # 'I"a : �x{ Uat�. -'� '.E ..,
Y : ,. '. m. .
EN
611011 �
O
'comoanvname:'. '' �' .!. t , `, — ..... z 3
address. t'° k -... i .'-F *s, r. ` ..{ ...
city:.g a i I -# . a�:' n�€„y r N` ne# ' � �'s i l p� a"
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to
$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day
against me. I uunnderstand that a copy of this statement may be fo varded to the Office of Investigations of the DIA for coverage verification.
I do hereby cehr on a [he pains a en [eS1tGl 'uryAnformandon provided above is true and correct
Signature Date
Print name Glenn Battistelli Phone# (978) 927-8956
omcial use only do not write m this area to be completed by city or town official
city or town: permiNicenseN Q Building Department
O Licensing Board
Qcheck if immediate response is required Q setectmen's Office
Q Health Department
contact person: phone 9: ❑ Other
(r ised Sept.200J)
�lasachusett. - Department nl Public ``aft•t�
Board of Buildin-, Rc,ulations and stanch.( .
Construction Supervisor License
License: CS 2123
Restricted to: 00
GLENN R BATTISTELLI
11 BROADWAY-R/PO BOX 496
BEVERLY, MA 01915
Expiration: 5/24/2012
( mmi..i„ner Tr#: 27684
Office of Consumer Affairs and usiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Repistration: 104352
_ .. Type: DBA
Expiration: 7/13/2012 Tr# 298688
GLENN BATTISTELLI CONSTRUCTION-
Glenn Battistelli
PO BOX 496
Beverly, MA 01915
Update Address and return card.Mark reason for change.
❑ Address ❑ Renewal M Employment ❑ Lost Card
DPS-CAI 0 50M-04/04-G10121e
. Consumer Affairs& °� Regulation License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation S y
; -HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration: 104352 Type: g
Ex iration: 7/13/2012 DBA 10 Park Plaza-Suite 5170
p Boston,MA 02116
GL�N BATTISTELLI CONSTRUCTION
Glenn Battistelli - n
11 BROAD WAY REAR./P.O.BOX
Beverly, MA 01915 -
Undersecretary � Not valid without signature
GLENN BATTISTELLI P.O. BOX 496
BEVERLY, MASSACHUSETTS 01915
/AINTING—R,QQFING—SIDING—INSULATION—CARPENTRY (978)922-6338 (978) 927-8956
- I/we,the ovAer(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials and
labor and to install the improvements on said premises accord)9g�to he following specifications:
Owner's Name:�:,A'.�/.... ... /. ..�✓.'...�'+...�.Job Address...... .:?.... � GGr~"••• /�... ............ . ..................................TSetal.t.e... /,�....�.7.........................
1. Secure Building Permit with the Town of ^-
2.All necessary electrical work will be done by a licensed Electrician.
3.All work is to be continuous. �� Ac �
4.A clean job site will be reasonably maintained at all times. 2l 7i?.✓ �Ji i qh 1
5.All necessary strapping is included
6. Secure loose wood to obtain an even surface.
7.Allow proper space as to allow for expansion and contraction. e /"e-T ?� " O ak �✓
8. Galvanized nails to be used to apply siding.
9 Contractor has all necessary Public Liability and Workmen's Compensation Y
:f lnstall..W-4�11. .; �� ®fin ..: f '
..... ... .. "-ct..:... f........... - .�r�C ...W.................G...........
...................G!........ ✓7-' .''.'y........ ..........................�"'................ ... ......''Y''= .......- ..........�..:"....... ........
......... .. ..... .J........................ �G'� .�r. ...^.... .s` �.....'......:.....CXti...(.f......... e.l..............................................
......................+.... ........,....... .................................................................. ...................... . ..
✓J.. ....e�.. ..... .......:.................... � �-
1,
.................
................... . ......... ............................. ...................................................................... ......... ......... .........................
In consideration of the labor and materials supplied by the Contractor,the Owner(s)agree(s)to pay to the Contractor the sum of
..............................................................................................................................................................Dollars......................................................................
Payable....................................................................................................................................................................................................................................
The contractor shall be liable for any defect of material or labor only if it fails to repair same within thirty days after receipt of written notice,but not
otherwise and in no event shall the contractor be liable beyond the cost to it of the labor and material required.
The.00ntractor.shall be paid by the owner(s),all cost,attorney fees and expenses,in addition to the amount unpaid,that shall be incurred in enforcing
the terms and conditions of this contract and/or any lien in connection therewith. -
Owner agrees that in event of cancellation of this contract before work is started,but after expiration of recession period,owner shall pay to contractor
on demand all costs incurred by the contractor plus twenty-five percent of the face amount of the contract.
No work to be done on this property other than that specified herein without additional charge.All parties by their signatures hereto covenant and agree
with each other that there are no representations or promises of work of any nature other than what appears within the four comers of this instrument.
Receipt of a copy of this contract is hereby acknowledged.Company agrees to furnish guarantee upon request at completion of contract.
INSURANCE COVERAGE
This contract is subject to strikes,accidents,or other delays beyond our control.
Glenn Battistelll Co_.hereby agrees to perform all work In a workmanlike manner.Workmanship is guaranteed to be of the highest quality.
RECESSION NOTICE:You may cancel this agreement if it has been consummated by a parry thereto at a place other than
the address of the seller which may be his main office or branch thereof, by written notice directed to the seller at his main
or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third day following the
signing of this agreement. See the attached notice of cancellation fob"an explanation of this ri t. , //
1N WITNESS WHE the part ave her kJrt95tFeir names this day of � C 4 20l Z�
.... .......................... - .. .......... ............................................
Representative
Accepted:
Signed..... l.. ...............................................................................
- OWNER
By....................................................................................................................Signed............................................................................................................
OWNER
Unofficial Property Record Card Page 1 of I
` Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 25-0024.0 Account Number
Prior ParcellD 22--
Property owner WASS MARY ELLEN Property Location 28 HIGHLAND AVENUE
Property Use One Family
Mailing Address 28 HIGHLAND AVENUE Most Recent Sale Date 11111968
Legal Reference 6708-346
City SALEM Grantor
Mailing State MA Zip 01970 Sale Price 18,500
ParcelZoning R3 Land Area 0.041 acres
Current Property Assessment
Xtra Features
Card 1 Value Building Value 151,100 Value 0 Land Value 69,000 Total Value 220,100
Building Description
Building Style Old Style Foundation Type Cone.Block Flooring Type Hardwood
#of Living Units 1 Frame Type Wood Basement Floor Concrete
Year Built 1890 Roof Structure Gable Heating Type Forced H/W
Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil
Building Condition Good Siding Wood Shingle Air Conditioning 0%
Finished Area(SF)1312 Interior Walls Plaster #of Bsmt Garages 0
Number Rooms 6 #of Bedrooms 3 #of Full Baths 1
#of 314 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.041 acres of land mainly classified as One Family with a(n)Old Style style building,built about 1890,having Wood
Shingle exterior and Asphalt Shgl roof cover,with 1 unit(s),6 room(s),3 bedroom(s),1 bath(s),0 half bath(s).
Property Images
Disclaimer:This information is believed to be correct but is subject to change and is not warranteed.
http://salem.patriotproperties.com/RecordCard.asp 3/19/2012