22 LORING AVE - BUILDING INSPECTION (2) 17 GIL 30
i The Commonwealth of Massachusetts
Board of Building Regulations and Standards 1h SPEC# SERVICES
Massachusetts State Building Code,780 CMR Revised Mar 2011
T Building Permit Application To Construct,Repair, Renovate Or Demolish a 1615 APR -9 A 3: 13
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date lied:
f /) Building Official(Print Name) Signature Date
1 SECTION 1:SITE INFORMATION
1 I�P opesty Qpyss; �/� 1.2 Assessors Map&Parcel Numbers
I.t a Is this^aCn accepted street?y les—V 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 f!( Private Cl Zone: _ Outside Flood Zone?
Check ifyes❑ Municipal MrOn site disposal system ❑
Q� f� ,nfSE,,ICTION 2: PROPERTY OWNERSHIP'
Name(Print) City,State,ZIP
2 2 Lqkz( ,- *4�-
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction Q( Existing Building 9 Owner-Occupied 1Y I Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition 6d Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief DDes�fPro o� sed Wor Z:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $�Wl e04Z9D 2. Other Fees: $
4.Mechanical (IIVAC) $ jf`tg6 �9� List:
5.Mechanical (Fire
Suppression) $ �G��Z� Total All Fees:$
1 Check No. Check Amount: Cash Amount:
6.Total Project Cost: $- / v v V ❑Paid in Full 7 ❑Outstanding Balance Due:
PtcK v� 1141'M1t�- �LA KI
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /j C �Q -n
License NumberExpiration Date `
Name of CSL Holder /s
List CSL Type(see below) ram[
No.and Street Type Description
U Unrestricted Buildin s up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Maso
my
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
EW"IM0 X 16;f- r�Zo29
Ea� a $�s�ant Name HIC Registration Number Expiration Date
l�L7
�C�177�"(/� o��lepl-V leal GV Email address
-City/Town,State,Zip Telephone t7 T
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..........b-' 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
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 applic tion is true and accurate to the best of my knowledge and understanding.
ALI-, �
Print Own 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 Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
www.mass. ov/oca Information on the Construction Supervisor License can be found at www.mass,gov/d/d s
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basementlattics,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"
I
1 A Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction
L License: ' r CS-093436
JERONIMO ALMIDA
15 WAITE CT S " D�e
MALDENMA ITfI4RI
�,,�,,,, �,,d{�� " "``• Expiration
Commissioner 1110 512 01 5
1
I
Rice of Consumer Affairs&Business Regulation License or registration valid for individul use only
VIE
before the ex ration date. if tounJ return to:
OME IMPROVEMENT CONTRACTORegistra6on; 147028 Typa; Once of C sumer Affairs and Business Regulation
xplretion: 67/2015 Private Corporatior• B ton,ork Plaza-Suite 5170
I Boston,MA 02116
r MATTOS CO,INC.
JERONIMO DE ALMEIDA
15 WAITE COURT
MALDEN•MA 02148 �—
Undersecretary J' \ot valid without s gnature
I
15 Waite Court-Maiden,MA 02148-Phone:781.489.9010•Fax:781.723.0050•www.mattosco.com
Date: 04/0812015
To whom it may concern:
Please be advised that Shendel Bakal of Mattos Construction, Incorporated has my consent to
process the paperwork for the permit indicated below:
JOB NAME AND LOCATION: Home Remodeling—22 Loring Ave. Salem
oeonlmoAlmeid�a
President
Mattos Co.Inc
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