Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
39 MARCH ST - BUILDING INSPECTION
, � w t� The Commonwealth of Massachusetts r Board of Building Regulations and Standards CITY Massachusetts State Building Code,780 CMR,7'h edition Ois SALEM Revised January "nI Building Permit Application To Construct,Repair, Renovate Or Demolish a 1, 2008 One-or TWo-Family Dwelling This SectiojpFo`F—Olficial Use Only Building Permit Number to Applied: .Signature: ' Building Commissioner/Inspector £Build` Date SE :SITE INFORMATION 1.1 ProVddre;s" s� / 1.2 Assessors Map&Parcel Numbers 1.I 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 to- PROPERTY OWNERSHIP' 2.1 O er'of Record: A. Name i t) Address for Service: // O f "7�7 �i__ % l �� - S gnature T phone SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) - New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition- ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Pro posed Work : �jS l Aoi<Z c)dr` ALP SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:- ❑Standard City/Town Application Fee ❑ . 2.Electrical $ - a e - Total Project Cost (Item x multiplier xr 3.Plumbing $ 2. Other Fees: $ �^ 1 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression Total All Fees:$ l 9 yS18 Check No. Check Amount: Cash Amount: 6.Total Project Cost $ 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction upervisor(CSL) vYN �V h L;�� License Number Expiration Date dame of CSL-t older +y List CSL Type(see below) Address T - - . Description U Unrestricted u to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling t lure M MasonryOnly "obot� RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5 2 Registered Home Improvement Contractor C) a,T' uVt . )I kOw NtaC17 Sa 1�Company a*e o RIC Pegistrant Name Registration Number ddress g G Expiration Date Si lure 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 7 to act on my behalf,in all matters relative towork a horized by this build permit application. Signature or Owner —'^"' Date ��— SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. -Print Sign of Owner or Authorized ihf- (Signed under the pains and penalties of 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS,respectively. 2. When substantial work is planned,provide the information below: Total floors 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" 641 Office of Consumer Affairs and usiness Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - _ Registration: 165640 - Type: LLC Expiration: 3115/2012 Tr# 294587 AIR-TIGHT LLC. WEATHERAZATION JAMES FORTIN 10 PINE KNOLL DR. _ BEVERLY, MA 01915 Update Address and return card.Mark reason for change. ❑ Address ❑ Renewal ❑ Employment Lost Card OPS-CAI b 5aM-09NCC101216 ,,.� ✓r{e-Cnos>rm a�✓f//omoduiaedn - -- Office ofCossumer Affairs d Busiaess Regulation License or registration valid for individul use only - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 165640 10 Park Plaza-Suite 5170 VIP Expraton 3/1512012 Tr# 294587 - Boston,MA 02116 Type: -LLC AIR-TIGHT LLC WEATHERAZATION - JAMES FORTIN 10 PINE KNOLL DR BEVERLY,MA 01915'':��"- Undersecretary Not valid without signature h,u itl, .01•pa t. dpt,tl'. 7 1! Board(If B tilding RegUlad0fis and Standards Ccnseruc-ic.13 ;p,a visor Le'. -;e - License: CS 52576 . Restricted to: 00 JAMES E FORTIN 10 PINEKNOLL DR r _ BEVERLY, MA 01915 E::,iratl n: 10/3/2011 ('onmlixci"na1' Tr--: 200 04/06/2011 03: 28 9789692161 AIR TIGHT WEATHERAZN PAGE 01/01 �YJATE(MMOD" acorn11�1141 ,> r � B111111I`� THIS GERTIIFICATE DOES NOT AFFIRMATIVELY OCATE ISR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFI ORMATION ONLY AND CUN�I:Kb NV ORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATEccyyHOLDER. subject to the terms and eo dNlons of the lder Is an policy,ceNAL Aain polices may n the noyuhe an endorsement endorsed.talementt onththlsON IS WAIVED, ceH711cate does not confer rl hts to the cerBOcate holder in lieu of such endorsements• COMPANIES AFFORDING COVERAGE PRODUCER PAYCHEX INSURANCE AGENCY,INC- mY GUARD INSURANCE GROUP P 150 SAWGRASS DRIVE coNPARY ROCHESTER,NY 44620 B INSURED r.O CnNr AIR-TIGHT WEATHERIZATION LLC _ 9 Story Ave BEVERLY,MA 01915 c DANY r ,YlVi51tr�144444444444WlJiA6r k'r1 r'r,; r„x,(* Ct�AG�S a' eERTIiFICJitINUWft ;T.__. .__� ',,' r ,: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ 0 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE IMNIODM) DATE)MMODIYIT TA GENERAL LIABILITY GENERAL AGGREGATE $ COMMERGAI,GENERAL LIABILITY PRODUCTS-COMPIOP AGG $ I:LAI SMADE CNCCUR PERSONAL&ADV INJURY f OWNER'S&CONTRACTORS PROT EACH OCCURRENCE $ FRRE DAMAGE(AnY am:MG) f MED EXP An ells rnon $ AUTOMOBILE LIABILT' COMBINED SINGLE UL1n $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pc Person) -�HIRED AUTOS BODILYINJURY $ NON•OWNED AUTOS (Pv aeaden0 PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY•EA ACCIDENT Y ANY AUTO OTHER THAN nUTO ONLY: EACH ACCIOF.NT 5 AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM nGTiREOATE $ OTHER THAN VMRRSLLA FORM $ WORKER'S COMPENSATION AND X �IAJM oivF EMPLOYERS'UABILm AIWC234202 03/15/11 03/15/12 EL BncH ACCIDENT f 1,000,000.00 TFT mDPNETOR, OINCL EL DISEASE-POUCV LIMIT f 1,000,000.00 PARTNERS CmnNE d MR5Am:'1 a]EXCL ELDISFASE-EAEMPLOYEE f 1'000,090.00 OTHER DESCRIPTION OF OPERATON9/LDDATIDN$iVEHICLES(AKOM ACORD 101,AddIUMA Rm - SeMdule,It M—aP,ce h,equire0) EIIFI�IC�l1E"14 LIDER:.' CYNII rE�17�1FIOA1Wit:, r 1" .:" MOYNIHAN LUMBER LD ANY OF THE A9aVE CANCELLED DESCRIBED POlIC1E5 BE BEFORE THE EXPIRATION BZ RIVER ST DATE THEREOF,NOTICE MU BE DITUVERM IN ACCORDANCE WAY"THE POLICY BEVERYLY,MA D191S ' PRMS)ONS,RUT FAH_URE TO MAIL SUCH NOTICE SHAD IMPOSE NO OBLIGATION OR UARKJTY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR RETNtESENTATIVES- AUTHORIZED REPRESENTATIVE t The Commonwealth ofltfassachruetts Department of Industrial Accidents O,©'ice of InvesfigadOffs 600.Washington Street Boston,MA 02111 www.massgov/din Workers' Compensation Insurance Affidavit: Builders/ContractorslC+1 Please Print Le ibt Apolicaat Informa 'on Name(Businesslorganization/Individual): — Address: City/State/Zip. \ e'—v e-t-\ Phone#i:Are you an employer?Check the ap rate box: Type of project(required): 1.ERI am a employer with 4. 1 am a general contractor and I 6. �]New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet.t �• Remodeling 2. I itm a sole proprietor or partner- Demolition ship and have no employees The esub-contractors have 8. Q working for me ht any capacity workers'comp.insurance. 9, []Building addition [No workers'comp_insurance 5• ❑ We ore a corporation and its ME]Electrical repairs or additions required.] officers have exercised their airs or additions right of exemption per MOL i 1.❑Plumbing rep 3.[� I ys a homeowner doing all work c. 152,§1(4),and we have,no 12.❑Roof repairs myself. e required.] comp• employees.(No workers' insurance required.) comp,insurance required.] 13.®Otheryy0c,r,1c� f Ova *Any applicant tMt ebecke bux Nl mau also Ell out the section below showing their workwe wmPeosation policy lnrormetion, t Homeownm who sulnnit this affidavit indicstingthey see doing all work and then hate outside Con tretsars myetsabmit anew effidevi+indie i�n such. tcontmemrs that check this box mast attacbed an additional sheetshowmg the came of the sub•wmmetws and theh'workers'comp.pn1 ry I am an employer that isproviding workers'compemadon insurance for my employees: Below is thepolley and jab site information. f Insurance Company Name: �� Policy#or Self-ins.Lie.#: \t ;C. to fi�— Expiration L 1 ej -1 Job site Address: City/Stato/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and eirpiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under Ike pains and penaties ofperjuryThat the information provided above is true and correctt, i Phon e#: FOffldal use only. Do nor write in this area,to be completed by city nr town officialr Town: Permit/License#gAuthority(circle one):rd of Health 2.Betiding Department 3.CityPfown Clerk 4.L+leetrieal Inspector 5.Plumbing Inspector er ot Person- Phone P. Ti-SALES... ` WATER and WASTE WATER SUPPLIES 36 Hudson Road(Route 27) Sudbury,MA 01776 (800)225-4616 PAX(978)443-7600 Bruce Kueffner CELL(203)258-2296 Systems Manager bkueffner@tisates.com - - - - - FORD i Brass&Horns Benches&Couplings Tapping Sleeves&Uni-Flange NEPTUNE Meters&Readers AMERICAN AVK Valves&Hydrants SMITH-BLAIR Couplings&Clamps LMI Chemical Pumps PIPE&TUBING CARUS CHEMICALS Corrosion Control CLA-VAL Automatic Control Valves TOOLS&EQUIPMENT SUBSITELOCATORS__ PRESBY SEWER PIPE STREAMLIGHT LIGHTS