The URL can be used to link to this page

23 LEE ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR S Revised Mar Marar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two-Family Dwelling sir This Section For Official Use Only c m 1 Building Permit Number: Date Applied: A Building Official(Print Name) Signature Date ri SECTION 1: SITE INFORMATION �� 1.1 Prope Address: 1.2 Assessors Map&Parcel Numbers w L l 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❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Ow4errt�of,R�[e�ord• RAI IV i)s! \�N) 450 t /x1Fa 01G-1d Name(Print) City, State,ZIP L-&4k- St q,N g1ALJk-LA 1< No.and Street Telephone Signature SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other 9-.Specify:CA Brief Description of Proposed Work2: Sk t e rc�rt ar� sx!,OVXt Shr n4!s SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ C1 �� 1. Building Permit Fee: $ 7© Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ 3 ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ C'i ,C1 Q ❑Paid in Full ❑ Outstanding Balance Due: MA% L- T-o to -o PAA-tt_op 511-1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 2123 5/24/16 Glenn R Battistelli License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 11 Broadway-R/P.O. Box 496 Type Description No. and Street U Unrestricted Buildin s 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 1 Insulation Telephone Signature D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172456 7/3/16 Glenn Battistelli LLC HIC Regi tion Number Expiration Date HIC Company Name or HIC Registrant Name 281 Dodge St No.and Street Signature Beverly, MA 01915 (978) 927-8956 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 .......... ❑ No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN 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. 0r XRn6 A DA lh o1 Print Owner's Name(Si ature) Date SECTION 7b: OWNEW 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. Glenn Battistelli gElul-w\ lo Print Owner's or Authorized Agent's Name(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.gov/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" Wer's The Commonwealth ofMassachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street, 7th Floor Boston, Mass. 02111 Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors Applicant information: Please PRINT legibly time: Glenn Battistelli LLC address: P.O. Box 496 city: Beverly state: MA zip: 01915 phone# (978) 927-8956 work site location(full address): . s L-Z-O— S� fy \ oyznb I am a homeowner performing all work myself. Project Type: 0 New Construction Remodel I am a sole proprietor and have no one working in any capacity. Building Addition x❑ I am as employer providing workers' compensation for my employees working on this job. I companyname: Glenn Battistelli Construction LLC t address: P.O. Box 496 ' city: Beverly phone# (978) 927-8956 t insurance co. Travelers Indemnity policy# UB 4258 P048-14 ❑ 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: company name: address: I city: phone# insurance co. policy# company name: t address: city: phone# insurance co. policy# Attach additional.sheet'P necessary 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 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cefrijy urs }the p�oirss�aJn�d p�e�rspallies�ojperjury that the information provided above is true and coned�-y Signature — -L srC�"'�� Date J l(f 1 U( Print time Glenn Battistelli Phone# (978) 927-8956 official use only do not write in this area to be completed by city or town official city or town: permit/license# Q Building Department QLicensing Board Ocheck if immediate response is required O selectmen's Office OHealth Department contact person: phone#: O Other (revised Sept.2003) S ` GLENN BAITISTELLI, LLC PAINTING-ROOFING-SIDING-CARPENTRY-VINYL REPLACEMENT WINDOWS KITCHENS-BATHROOMS-PORCHES-DORMERS-ADDITIONS-MASONRY' ' ' P.O. BOX 496 BEVERLY, MASSACHUSETTS 01915 (978) 922-6338 (978) 777-4499 DIRECT LINE (978) 927-8956 FAX (978)921-9202 CELL(617) 962-1235 gbattis298@aol.com ESTABLISHED 1974 GLENN BATTIj TELLI CO., hereby agrees to perform the following services for: IJ at :2 -T jP a /Z/w Home Phone C><n-1'k a -Z�> Business Phone Sealer applied to all vent pipes and chimneys. �1-2 f s 6/ All Flashing will be inspected. Roofing Nails will be inches. Grounds will be cleaned of all roofing materials. All workmen are covered with Public Liability and Worker's Compensation. All work will be continuous and will be performed in a workman like manner. Roofing Shingles are self Sealing. t While installing the new roof, we will protect your home and plantings from debris. Roofing Shingles to be delivered -7/ Install new fiberglass paper to roof boards when stripping of shingles is required. All shingles will be secured with eight nails. State and local building codes, along with manufacturers specifications will be adhered to at all times. Colorof Roof is to be _11-1 D ; eP All woS)c is priced as specific. The possible occurrence of rotted roof boards or poor flashing will warrant an additional cost of I/ xq�/44 la The homeowner is responsible for covering their articles within the attic. Work is to be commenced on Payment is to be delivered �l>Ou /moo 4ei Gz �i �� ter/®/��,Gv✓ Apply inch aluminum drip edge to the following areas: e P Z—) 1-6—Year Workmanship Guarantee. 3 D Year Material Guarantee Roofing shingles to be Agreed by Homeowner { ' Agreed by Contractor Ref. Page Date 3 Day Cancellation Notice Required