21 LINDEN AVE - BUILDING INSPECTION �l] e o
'd4/-70 -
The Commonwealth of Massachusetts
I y Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
.,: s � �- ._This Section For Official Use Only` r "
Building Permit Number: = " 1Date`AppI'ed. -YV '
' =Building Official(Print Name) �, = a ..,;.ems_ '> `=?' Si atuYe '� ate
.ry}' -- - -a SECTION 1:.SITE INFORMATION u*=. - -
'rs+l*n'N
LI Property Ad ess: 1.2 Assessors Map& Parcel Numbers
L l a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Z'oning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yazd 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❑
SECTION2 PROPERTY.OWNERSHIP1
2.1 Owner'of Record:
I.. K,IQSfKdn
Name(Print) City,State,ZIP
' 4 LJrAe_r.A.rt` -744 090�)
No.and Street Telephone igna e
';M`=SECTION 3 DESCRIPTION OF PROPOSED wW z(check alt that apply)-s- ,_ :_ w
.
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of ProposedWork2: FN. Ve' Pt 0. t 11
9 .Y
SECTION 4t ESTIMATED CONSTRUCTION COSTS .m..
Estimated Costs:
Item f s ,Official Use Only b� 6
(Labor and Materials -r _. _.' _
1.Building $ —� 1 Building Permit Fee: $ " Indicate how fee is determined:
❑Standard City/Town Application_Fee ` -
2. Electrical $ r.
❑Total Project Cost s
(Item 6)x multiplier x
3.Plumbing $
2."Other Fees: $ r
List.
4.Mechanical (HVAC) $
w .
5.Mechanical (Fire
Suppression) $ Total All Fees. $' -
6. Total Project Cost: $ p r\ Check No A Check Amount ash
Amount
1 �V ❑Paid in Full ❑ Outstanding Balance Due
MA,i(,�P"V-J LT 772)
SECTION5: CONSTRUCTION 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 _ _ Description_ „
U I 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
Tel hone Sign to D Demolition
5.2 Registered Home Improvement Contractor(HIC)
104352 7/13/12
Glenn Battistelli Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
P.O.Box 496
No.and Street `� Signature
Beverly,MA 01915 (978)927-8956
City/Town, State,ZIP Telephone
g'k 3�SECTION 6 WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M .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........... ❑
ap— ;;, - SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN A
_..
T R'AOWNER'S AGENT OR CONTRACTOPOLIES FOR BUILDING PERMITJN lllla R ..
I,as Owner of the subject property, hereby authorize Glenn Battistelli to
act o y behalf, in all matters lative work authorized by this building permit application.
�Irftm[ wner's Nam (Signal re) —� Date
SECTION 76 OWNER' OR AUTHORIZED'AGENT DECLARATION .`; ' 4
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 an=d�I c or/ate to the best of my knowledge and understanding.
Glenn Battistelli ��Ln\' 7kf'1 7 I _L
Print Owner's or Authorized Agent's Name( ignature) 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 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/dns
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, 2' Floor
Boston,Mass. 02111
Worker's Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicanfinformation
name: Glenn Battistelli
address: P.O. Box 496
city: Beverly state: MA zip: 01915 phone# (978) 927-8956
work site location(full address)'
❑ I am a homeowner performing all work myself. Project Type: D New Construction Remodel
1-1 I am a sole proprietor and have no one working in any capacity. El Building Addition
e a
x❑ I am as employer providing workers compensation for my employees working on this job
„company name:,d'G1enn'Battas ell .,0ompany,:v .. n ,:. a, ,yrt� �' :>tia r-, ` 41,_ ._,,;,
"� i� � x '
address--,P.O.rBax_496 t.:F t .,. ,.. ,i ...�_ru ,.�...,ti �3;,.„: L...gsl, -_.®:.4 ,3_„ '+a. ..a t ' m = _.
'citynBeverly7'= ' Flay" t ;=phone# (978) 927=8956 1 '".
dtk't .._. rate,.-„ 'O 3� ° Ig p W iL,n '1 'krli#i, � �;_.�. "' v
�insnrance cUdi
o:2'iavelers tTndemnityat !i. .. t �t. t' pohey# UB 4258
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❑ 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
come v name•11� �:1�v*:ir,� ' a � _ �� .§r__..:e'� MOM tr
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company name• �. -'m.i,l-
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Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Hne 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.
1 do hereby certify under the pains and penahies ofperjury that the information provided above is true and correct
Signature M Date f IAy(I
Print name Glenn Ba tistefli Phone# (978) 927-8956
official use only do not write in this area to be completed by city or town official
city or Iowa: permitnicense q Q Building Department
QLicensing Board
Qcheck if immediate response is required Q selectmen's Office
O Hralth Department
contact person: phone 0: 0 Other
(revised Sept.2003)
Nlassaehusetth - Department ul Public .SafctN
Bnard of Buildin_ Kc_ulatinn> and Standards -
Construction Supervisor License
License: C6 2123
Restricted to: 00
GLENN R BATTISTELLI
11 BROADWAY-R/PO BOX 496
BEVERLY, MA 01915
Expiration: 5/24/2012
( anmiasiaier Tr#: 27684 -
� - 9Xe
Office of Consumer Affairs and usmess Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 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 Employment Lost Card
DPS-CA1 0 50M-04/04-G101216
"O"L"LO""•� ` rr�"��"4d "'de�4 License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation
= ,HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
y Registration: 104352 Type: Office of Consumer Affairs and Business Regulation
Expiration: 7/t3/2012 DBA 10 Park Plaza-Suite 5170
Boston,MA02116
GLENN BATTISTELLIcCONSTRUCTION
Glenn Battislelli
11 BROAD WAY REAR /P.O BOX
re'verly, MA 01915 - Under //S wowNoott valid without signaturet
GLENN BATTISTELLI
PAINTING-ROOFING-SIDING-CARPENTRY-VINYL REPLACEMENT WINDOWS
IOTCHENS-BATHROOMS-PORCHES-DORMERS-ADDITIONS
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
ESTABUSHED >974
GLENN BATTISTELLI CO., hereby agrees to perform the following services for:
at
Home Phone: —Business Phone
Sealer applied to all vent pipes and chimneys.
All Flashing will be inspected.
c �
Roofing Nails will be / / inches.
Grounds will be cleaned of all roofing materials..
All workmen are covered with Public.Liability and Workmen's Compensation.
All work will be continuous and will be performed in a workman like manner.
Chalk lines will be used to line-up the shingles.
Roofing Shingles are self Sealing.
While installing the new roof, we will protect your.home and plantings from debris.
Roofing Shingles to be delivered ' e_�A4 -Y° v e `'L"i �?
Install new fiberglass paper to roof boards when stripping of shingles is required.
All shingles will be secured with four nails.
State and local building codes, along with manufacturers specifications will be adhered to at all times.
Color of Roof to be
AII work ' priggd ass cific. The possible occurrence of rotted roof boards or poor flashing will warrant an additional cost
Of
The homeowner is responsible for covering their articles within the attic.
Work is to be commenced on
Payment is to be delivered
Apply inch aluminum drip edge to the following areas:
_,dS7_ Year Workmanship Guarantee. Year Material Guarantee *'
Roofing shingles to been 2D
i
eed by Hom owner r Agreed by Contractor
Ref. Page Date 3 Day Cancellation Notice Required
CITY OFSALEM, Akss.1Cf-iusETTS
SLMDNG DEp.UiTTtE\T
I 20 WAiHNGTON Smu, }'O IZOOII
TtL (978) 745-9595
KIAMERF Y DAMOLL FAX(978) 740.984
MAYOR TNOaW ST.P1FAU
DIRELTOR OF PLBLIC P1t0PERTY/8LA.DNG CO. L\IISSION ER
Construction Debris Disposal Atlldavit
(required for all demolition and re
novation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section I l I.S
Debris, and the provisions of MOL a 40, S 34;
Building Permit p is issued with the condition that the dcbris resulting from
(his work shall be disposed of in a properly licensed waste disposal facility as defincd by MGL c
l 11, S I SOA.
The debris will be transported by:
(name or hauler)
The debris will be disposed of in:
T in �c d
(name or •d;ly) '�—
'7lac
(jddre»of faadjty)
r
vMnamre of permit applicant
la(a