65 MASON ST - BUILDING INSPECTION (2) a t
I� The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
'> .This'SechonFoi:Offri IUse'O
Butlding Official(Print Name) ^ , �.;Signatu e , Date
SECTION.1: SITE'TNFO ION"
1.1 Property Address: / 1.2 Assessors ap arcel Numbers
l.la 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:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ElPublic❑ Private❑ Check if yes❑
SECTION 2: P�tOPERTY OWNERSEIIk'
2.1 Owner'of Record:
iZ- ICh/iKJ S/f CIS f`1 A(-e,* d'!9 7 0
ame(Print) City, State,ZIP
s )r 3o,ri sT 8 20 Z -�3B`1 Y
No. and Street Telephone Email Address
SECTION 3z DESCRIPTION OF PROPOSED WOW,(check all thaka f ply)'-
New Construction ❑ Existing Buildi
ng❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 AI ation(s) ❑ Addition ❑ i
Demolition ❑ Accessory Bldg. ❑ Number of Units Other pecify: D ,
Brief Description of Proposed WoLk': 4-1 r
012
O —
SECTION 4: ESTIMATED.CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building 1 Building Permit Fee $ Indicate how fee is determined:
❑ Stand'ard'City%Town Application Fee;
2. Electrical $ ❑Total-Project Cost (Item 6)x multiplier x
3. Plumbing $ $
4. Mechanical (HVAC) $
List t ' a
5. Mechanical (Fire $ Total All Fees
Suppression)
CheckNo Ch�ck'Amount Cash Amount
6. Total Project Cost: $ ZQ o d ❑ Paid n,Full ❑.O 1staruling Balance Due
r
SECTION 5: COrNSTRUCTION SERVICES,
5.1 Construction Supervisor License(CSL) G5 /d /9 ro� �� D Z 20(2
(i�f1L-t S� t'0 c/WL� -5'� License Number F p" atiou ate
Lo ,
SL Hold f List CSL Type(see below) L<
ye ptionU Unrestricted Buildin s u to 35,000 cu. ft.° �!y Restricted I&2 FamilyDwelling
City/Town,Sta e,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / c(Lf9 V6 !
� ��� ������� CO HIC Registration Number xpir on Date
HIC C6rn of Name or HIC Registrant Name
o. an Str et &e3 Email address
City/Town, State, ZIP Telephone
SECTION 6: WORKERS`COMPENSATION INSURANCE AFFIDAYIT(M.GL. 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 Issuanc the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a'. OWNER AUTHORIZATION TO BE COMPLETED-WHEN
OWNER'S AGENT ORCONTRACTOR APPLIES FOR BUILDING PER, ,
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
FSECTION`7b: OWNER'.OR AUTHORIZED AGENT,DECLARATION
7�
ing my name below, I hereby attest under the pains and penalties of perjury that all of the information
d in this application is true and accurate to the best of my knowledge and understanding.
t� rah iz . em .w 32 2-er's or uthorized Agen['s Name(Electronic Signature) ate
NOTES;wner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration
ram or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
.mass�=ov%oca Information on the Construction Supervisor License can be found at4vwvv.mass <_>ov�dus substantial work is planned, provide the information below:
or 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 halffbaths
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"
e
CITY OF S.0 EtiI, IASSACHUSETTS
BUMDNG DEPARTMENT
• 130\YUSHLNGTON STREET, 3° FLOOR
Tat- (978) 745-9595
FAx(978) 740-9846
KINLgFRt F.Y DRISCOLL
T
MAYOR HObtAs ST.PIERRB
DIRECTOR OF PLBLIC PROPERTY/BI;ILDL\G CO\LNIISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
in accordance with the sixth edition of the State Building Code, 780 CMR section I 1 L5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
Gd�STD tirg,✓ ,���-t.1�
(name of hauler)
The debris will be disposed of in :
Pew"Sa D y tA14 --
(name of facility)
(address of facility) -
signature of permit applicant
�a -,7 i z
tt:
dcbdsal7 J.x:
, r
i `c CITY OF SM1 EAv1, i%LAIS&AkCHtiSETTS
BuILDDvG E DEPART .NT
d. 120 WASHIINGTON STREET, 3a'FLOOR
TEL (978) 745-9595
F.S.Y(978) 740-9846
KLN fBERt EY DRISCOLT
'M
MAYORt. oatAs Sr.PtFaRa
DIRECTOR OF PU13LIC PROPERTY/BCILDLNG CONL\l3SSIONER
Workers' Compensation Tnsurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
NaI31C(OusinessQrganizatiotufndividual):�rFF.�fS �iEf�- /� �rnr�.-�L�-- ��
f
Address: 2� SAY ST
City/State/Zip: 64o P7cZ Phone : �7c4 t��6 r O /O
Arexallan employer?Check the appropriate box: Type of project(required):
1.0 1 am a employer with �5 4. ❑ 1 am a general contractor and 1
6. ❑New construction
employees(full and/or pact-timt).• have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. 0 Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
workingfor me in an capacity. workers'comp. insurance.
Y a tY 4. ❑ Building addition
(No workers'comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their !0.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plum eporrs or additions
myself.(No workers'comp. c. 152, §1(4),and we have no 12• aof repairs
insurance required.)t employees. LAro workers' 13.0 Other
comp. insurance required.]
•Any apPlicam IIIat dlucks box xl must also fill oun hc section below showing their wakes'compensation policy information.
I fotneowocrs who submit this affidavit indicating They ate doing all work and then hire outside contractors most submit a new amdavil indicating such
;Contractors that check Ibis box most aaachod an additional shoat showing the name of the rab contractoim and i heir workers,romp.policy inium,,,tio,
l urn an employer that Is providing workers'compensation insurance far my employees. Below is the policy and Job sits
htformatiox
Insurance Company Name: !!/lS/L�
Policy u or Self-hu. Lie. 4:_ /1,6 5-6 17 106 df 2-—l 2 Expiration Date: l -,d
Job Site Address: &S Gr�o/5�dotJ SIB"— Citwstatcaip_sl:o '¢-e
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152can lead to the imposition of criminal penalties of a
fine up to S 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 S250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of
Investigutions of d IA for insurance coverage verification.
1 tls lie reb •erti ider die pains cold penalties of perjury that the information provided above is true and co recta
Emir re: � Date: 1,57A —
Official use only. no not write in this aret4 to be completed by city or town offlcial
City or Town: Permit[License
Issuing Authority(circle one):
I. Board of health 2. Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other .---,� _---_-
Contact Person: Phone 4:
COYNE & SONS
GENERAL CONTRACTING CO.
P.O. BOX 605 SALEM , MASS. 01970
978-532-0300 / 978-740-0101
MASS LIC # 128253/144946/CS101965
W W W.COYNEANDSONSCONTRACTING COM
RAPID ROOFING IS A DIVISION OF COYNE&SONS CONTRACTING COMPANY
ARCHITECTURAL ROOFING ESTIMATE
TO. 9/18/2012
PETER CASTRICHINI
65 MASON STREET.
SALEM, MASS. 01970
978-204-3874 CELL
978-535-7141 FAX
JOB SITE ADDRESS.
SAME
RE; ROOF ESTIMATE#2012-073
COMPLETE STRIP OF 25 YR. 3-TAB ROOFING SHINGLES ON THE COMPLETE
LEFT SIDE ROOF OF THE PROPERTY. 10 SQ.
INSTALLATION OF 30 YR ARCHITECTURAL ASPHALT ROOFING SHINGLES -
AND CAP ON ENTIRE LEFT SIDE MAIN ROOF OF THE PROPERTY..
INSTALLATION OF NEW RUBBER ROOFS ON THE TOP FLAT ROOFS AREAS
LOCATED ON THE RIGHT SIDE OF THE BUILDING.. 10 SQ
WE AGREE TO.
1. COMPLETELY STRIP THE ENTIRE LEFT SIDE ROOF OF THE PROPERTY,
OF ALL THE EXISTING LAYERS OF SHINGLES ON THE ROOF OF
THE BUILDING AT THE PRESENT TIME.
2. REMOVE ANY ROTTED ROOF DECKING BOARDS OR SHEATHING ON
THE ROOFS OF THE BUILDING, AND INSTALL UP TO 100 FT.OF EITHIER
ROOF BOARDS OR SHEATHING- FREE OF CHARGE (ONLY IF ROTTED
AREAS ARE PRESENT).
{
3. INSTALL NEW WATER& ICE SHIELD ON THE FIRST THREE FEET OF ALL
THE LEFT SIDE ROOF OF THE PROPERTY.
4. INSTALL NEW 15 LB. ASPHALT FELT ROOFING PAPER ON THE
ENTIRE LEFT SIDE ROOF OF THE PROPERTY..
5. INSTALL NEW 8 INCH WHITE ALUMINUM DRIP EDGE ON THE
ENTIRE LEFT SIDE ROOF OF THE PROPERTY.
6. INSTALL ALL NEW VENT PIPE BOOTS ON THE MAIN ROOF OF THE
BUILDING AS NEEDED.
7. INSTALL NEW ALUMINUM STEP FLASHING ON ALL AREAS OF THE
COMPLETE JOB AS NEEDED.
8. INSTALL NEW 30 YR.. ARCHITECTURAL ASPHALT ROOFING SHINGLES
AND CAP ON THE ENTIRE LEFT SIDE SHINGLE ROOF OF THE PROPERTY.
9. INSTALLATION OF A NEW RUBBER ROOF ON THE EXISTING FLAT
ROOF AREAS LOCATED ON THE TOP RIGHT SIDE OF THE BUILDING
10. USE ALL NEW RUBBER ROOFING MATERIALS , INSULATION BOARD,
SCREWS & PLATES,INDUSTRIAL HIGH STRENGTH GLUES, SEAM
TAPES, COVER TAPES,NEW ROOF DRAINS, VENT PIPE-FLANGES,
TERMINATION BAR, SEALANTS, WHITE ALUMINUM 3 INCH METAL
DRIP EDGE, ALSO ANY ROOF & WALL FLASHINGS AS NEEDED.
NOTE. SOME ITEMS ABOVE MAY NOT APPLY TO THIS SPECIFIC JOB.
11. WE AGREE TO REMOVE ALL ROOFING DEBRIS FROM THE PROPERTY
AND OBTAIN ALL BUILDING PERMITS AS REQUIRED BY LAW.
12. NOTE.. ALL NEW ROOF INSTALLATIONS HAVE A LIFETIME WARRANTY.
13. NOTE.. REPLACEMENT OF THE OLD EXISTING SKYLIGHT ON THE LEFT
SIDE OF THE BUILDING, WILL INVOLVE AN EXTRA COSTS
ABOVE THIS ESTIMATE, FOR THE COSTS OF MATERIALS &
LABOR TO INSTALL A NEW SKYLIGHT..
TOTAL COST OF JOB..................................$ 7,000.00
WE HEREBY PROPOSE TO FURNISH ALL MATERIALS AND LABOR-COMPLETE IN
ACCORDANCE WITH THE ABOVE SPECIFICATIONS FOR THE SUM OF....
$ SEVEN THOUSAND DOLLARS-$ 7,000.00
WITH PAYMENTS TO BE MADE AS FOLLOWS....................
$ 3,500.00 DOLLARS DOWN/ $ 3,500.00 TO BE PAID IN FULL UPON THE
COMPLETION OF THE WORK....
RESPECTFULLY SUBMITTED BY.
COYNE & SONS CONTRACTING COMPANY
ROBOX 605.. SALEM ,MASS. 01970
978-532-0300/ 978-740-0101/ 978-223-7740/ 978-532-0344 FAX
OWNER.. C14RISTOPBER R. COYNE SR.
NOTE-THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN-21 DAYS.
ANY ALTERATION OR DEVIATION FROM THE ABOVE SPECIFICATIONS
INVOLVING EXTRA COSTS,WILL BE EXECUTED ONLY UPON WRITTEN ORDER,
AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.
ALL AGREEMENTS ARE CONTINGENT UPON STRIKES,ACCIDENTS,OR
DELAYS BEYOND OUR CONTROL.
NOTE.1,AGREE THAT COYNE&SONS CONTRACTING COMPANY,OR ANY PARTIES HEREIN..ARE NOT LIABLE IN
ANY WAY,AND CANNOT BE HELD LIABLE IN ANY WAY IN THE EVENT OF A ACT OF GOD OR NATURE..
WHICH INCLUDES STORM DAMAGE,WIND DAMAGE,WATER DAMAGE,FIRE DAMAGE,LIGHTNING DAMAGE,
HURRICANES,ECT.
WHILE WORKING ON ANY PROPERTY OR ANY PROJECT IN THE EVENT OF ANY SUCH DAMAGE SHOULD HAPPEN,
AS STATED ABOVE.
NOTE;ROOFING...
WE CANNOT ACCEPT ANY RESPONSIBILITY FOR ANY DAMAGES.OR DEBRIS FALLING INTO ATTIC AREAS,
CUSTOMERS SHOULD COVER VALUABLES,UREA I'CARE WILL BE USED TO PROTECT THE EXTERIOR STRUCTURE
BY COVERING THE EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENT ANY DAMAGES
DURING THE STRIPPING OF THE ROOF,HOWEVER SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR
CONTROL,
HOMEOWNERS MUST MOVE ANY VALUABLES AWAY FROM THE BUILDING,PRIOR TO THE STRIPPING OF THE
ROOF
NOTE; IF MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE IN THE ESTIMATE,THE
OWNER OF THE PROPERTY WILL BE IMMEDIATELY NOTIFIED,THE OWNER ACCEPTS ALL RESPONSIBILITY,AND
(AGREES)THAT,ANY EXTRA CHARGES WILL BE ADDED FOR THE LABOR AND THE REMOVAL OF THE EXTRA
DEBRIS,OVER AND ABOVE THE PRICE OF THE ESTIMATE....
NOTE.IF FINAL PAYMENT HAS NOT BEEN RECEIVED OR PAID IN FULL AT THE TIME OF
THE COMPLETION OF THE WORK, AS OUTLINED IN THE CONTRACT,AND RESULTS IN ANY
TYPE OF COURT ACTION.. THE OWNER OF THE PROPERTY OR CONTRACTOR OF SAID JOB.
OTHER THAN COYNE&SONS COMPANY... AGREES TO PAY ALL COURT FEES,ANY
ATTORNEY FEES,AND INTEREST OF 12%COMPOUNDED EACH MONTH.,ON THE FINAL
BALANCE OWED TO COYNE&SONS CONTRACTING CO.
ACCEPTANCE OF PROPOSAL
THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS
ARE SATISFACTORY AND ARE HEREBY ACCEPTED.
YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.
PAYMENTS WILL BE MADE AS OUTLINED ABOVE..
DATE OF ACCEPTANCE
SIGNATURE
SIGNATURE
SIGNATURE
PLEAS MAKE ALL CHECKS PAYABLE TO
CHRISTOPHER R. COYNE SR THANK YOU!!
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