0027A MARION ROAD - BPA-14-558 \
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The Commonwealth of assac use s
Department of P Ve
r y° Massachusetts State Build a�iJ'(7 MR', 1:'4b '
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Onl )
Budding Permit Number. Date Applied: 1 Building Official:
SECTION 1:LOCATION(Plea e i icate Block 1t and Lot N for locations for which a street address is not available)
------------------------------
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used_ If New Construction check here O or check all that aPPY �I the two rows below
m
Existing Building Repair❑ Alteration ❑ Addition❑ Demolition ❑ Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other Spectfy' Lid p4
Are building plans and/orconstruction documents being supplied as part of this permit application? Yes ❑ No
Is an Independent Structural Engineering Peer Review required?
Brief Description f Purpose 1 Work: Yes ❑ N LR
C ILCe
SECTION 3:COMPLETE THIS SECTION�IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR '
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Gruup(s): Proposed Use 1: :(s):
SEL 11014 4:BUILDING HEIGHT AND AREA
Existing Proposed -
No,of Floors/Stories(include basement levels)&Area Per Floor(sq.It.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as a licable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-1❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F. Facto F-I ❑ F2❑ If: High Hazard H-1❑ H-2❑ H-3 ❑ FF ❑ H-5❑
1: Institutional I-1❑ I-2❑ 1-3❑ I-4❑ bL• Mercantile Cl it: Residential R-113 R-2❑ R•3❑ R4❑
S: Storage -li-t❑ S-2❑ IU: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as a licable) -
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indentfy Zone: or on site system❑ required ❑or trench or specify:
permit is enclosed❑
Railroad ri ht-of-wa : _., __._ _ _
PP Is Structure`Yell❑air No p roach area? Is their
view completed?i'rt�'•1M1.
Y ttaLa[d5 to A1[Navigation: \I!\I lbfl nl 1. plU11i,511n k %w"
Not Applicable❑ P PP
or Consent to Build enclosed❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code Use Group(s): Type of Construction: Occupant Load per Floor:
Does the Building contain an Sprinkler System?:__ Special Stipulations:
5TU:�, -T t 3(::� o fH S
'Tv H •d ,
r
SECTION 9: PROPERTY OWNER AUTHORIZATION
Nat •vtdAdd ess of Property,Owner 4e. /� ,,/p ^
Name(Print) No.and Street City/Town Zip
Property Owner Contact Informations 9j2 011k
Title Telephone No.(business) Telephone No. (cell) a-mad address
If ap livable, th pertx owner hereby iu!bvxLzes
JR+�� Qnzlil lam leo ul
Name Street Address City/Tmv State Zip
to act on the proper ownei s behalf,in all matters relative to work authorized by this bu dd ing permit a pplication. "
SECTION 10.CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.It.of enclosed space and/or not tinder Construction Control then check here O and skip Section 10.1
10.1 RegisteredPrqfessional Responsible for Construction Control
tz�� q�b3le 4(S JIMc� r -167 Ysy
N:me.(Rugistrant) .L Telepli No. a-mail.t I ess Registration Number
1 rrr�a .1 57 �jeJLtI� A b(�/ of .�i7
Street Address City/town State Zip Discipline Expiration Date
10.2 General Contractor
ir�lAllno- home a.tl �ebw,,,j LAC
Name
T
Name of Person Responsible for Construction Licenses a No.and Type if Applicable
St crcr et Address City/T wn State Zip
_• �7l-�3 yy.� / .hr{faI15 4vtleccr,��F�lu •�
Telephone No. business Telephone No. cel e-mail address
SECTION 11:WORKEKS'COMPI NSA VION INSMANCE AHADAVI r M.G.L.c.152.§25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the)ssuance of the building permit.
Is a signed Affidavit submitted with this application? Yes Cf No 13
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) - Total Construction Cost(from item 6)_$
L Budding -S ji'876, ot Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ appropriate municipal factor)_$
3. Plumbing 5,
1. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
S. Mechanical Other $ Enclose check payable to
6.Total Cost S 9--7 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I he •by att um the pains and penalties of perjury that all of the information contained in this
application is true and accurate the •st of m nowledge and understandin .
PI-ase prixu uiysi a nai a Title Telephone No. Date
e , _ � - 1 -
Street Address City own State Zip
f If
M1lunicipal Inspector to fill out this section upon application approval:
jq
Name Date
MLIGHTHOUSE
Home & Design
Bill Lynch
27a Marion rd
Salem ma
Job Description:
Replace existing windows with high performance triple pane vinyl replacement windows.
Remove existing sliding door and replace with new high performance triple pane sliding door(custom
size 6'6"x6"10" c;ean up and removal of all debris.
Materials:$5,051.22
• 6 double hung sash lover 126%:x 24
• 4 double hung sash 1 over 126'/:x 20
• 1 double hung sash 1 over 130'/:x 18
• 1 double hung sash 1 over 128 x 46
• 1 double hung sash 1 over 137%:x 34
• 1 double hung sash 1 over 128 x 38
• 1 sliding door 6"0"x 6'8" $1,401.22 energy star rated
• Interior trim for sliding door installation
• Exterior composite trim for sliding door installation
• misc supplies ex... caulking, insulation,fasteners etc....
• Clean up and removal of all debris
Labor: $4,825.00
• Removal of existing sash and replace with new replacement sash
Removal of sliding door and installation of new door
• Prep and paint all trim associated with replacement sash and sliding door
Total labor and materials:$9,876.22
X X
lames Clar is Bill Lynch
Contractor Homeowner