0005 MESSERVY STREET - BUILDING INSPECTION APPLICATION FOR
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LOCATION
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PERMT GRANTED
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INSPECTOR OF BIALOPM
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SWPWCIIQB PlWl V A"J WT SAM 0RANTkD
CITY OF SALEM
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Permit to: BU LDNG PERWT APPUJCATION F01%
Oft whW wr apply) Roof Reroof, InshN Ski ft C 18VW DUK Shed, pool.
lispak/I'isplaa, OUler
PLEASE M L OUr LEOBILY a COYPI.ETLLY TO AVOID DELAYS N PMXUSM
TO THE INSPECTOR OF BUILDING& '.
herby applies for a pwmk to bund a000r ft to #0 t kw hg
Owners Names Co �e U 4
Address a phone A l i e-rs-L c vtj
Ardlksat's Name
Address a Phone c
Lft&wlp Name hL 4 rd Alf O P -r So A/
Address a Phone
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tN W THE PiNALTY'
oEacwPnoN OF WORK TO eE DONE P�iRY
MAIL PEAMIT TO:
H.A.Johnson & Son's Inc ESTIMATE
Maintenance Free
Vinyl, Decking, Railing & Fencing
11 X Rabbit Rd.
Salisbury Me. 01952
978-499.8904
E-mail: dec mva.ne_t
W W W.decksa nddocks.com
To:Joe &June Collella Date:August 112005
5 Messervy Estimated By.
Salem Mass. 01970 Start Date:TBD
Location: 3 Messervy, Salem
Phone: 978-745-1060
Terms: 10%deposit 40%at start of job,40%when framing is completed and 10%upon completion.
JOB DESCRIPTION
Remove and replace existing rails leading up to rear porch and on rear porch,with L.B.white
vinyl railing 3250 series fluted and white vinyl post wraps with caps. Also replace existing
treads and risers with a maroon colored composite decking and same color risers.This does
not include replacement of any existing framing or stringers. Also for installation of white
patio room walls and roof on rear porch where it is existing now. Shed roof to be shingled in
color close as possible to existing. No interior finish in underside of roof. Walls will be
finished look inside and out Also install 4 replacement sliding windows in front porch and
close up below. Outer side to be enclosed in white vinyl siding. Permit cost Is not included in
this estimate.
INSTALLED PRICE
MA SALES TAX
TOTAL INSTALLED PRICE $24,040.00
This price is for completing the job as described above. It is based on our evaluation and
does not include material price increases or additional labor and materials which may be
—required.should unforeseen-problems arise after the work has started.
[If Accepted_p1epe Sign and return o copy: ,
DateU06 �. . NameP,u•
T00/Te0101 u919e0 BuT.r0013 p00a M8 S9V 919 T XU 99:C0 III SOOL/LT/90
Imparrnrem q mausma eectaensa
offl"W 1�atvrst'emsits
600 Waskinafoa SftW
Bosfow,BLt 02111
wrosstarangewdle
Workers'Compenaadon Insurance Afmavft: BuMeialContractors/Electridam/Plumbers
AauBeaut Information Please Eft 11 mtr.r.,
Name /J
Address: H �a Res bbi R�
City/Stat&7* Phow 0: _T9 9 r—%o q
Are you an mptaPerT Cleek the appropriate boss �prol� �):
1.�am a employer with - 4. ❑ I am a pmerg cm*aclor and I TYPO
es4loyeas(14B alwar past-tim le have liked the xdRoamdm Q ❑New comsaoctiom
2.❑ I am a sole psopiieror or pwt w- lined on the saached sliest t 7. 0 Remoddiag
sbip and have m employees 'These sdRouftelon have B. 0 Demolition
workhrS ibr mein any cap* . workers'cong.iaauaase. 9, Building addifiDII
(No wodmt comp.insuranceS. ❑ We are a empondu acid id
10.0 Mmuicai mpah or additions
3.❑ I boumw ei doing all work rigla ofoteremptim per MGL 11.0 Pbrmbisg rgWm or additions
mywx No winters'comp. a 15Z 41(41 and we have no 120 Roofrepaus
i t«n�•l t awby«a• Dim woks, 13.0 Rene
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;Any appHrmr wotabaft boar N UMN WN 0 ao On soeuow below*mbg adr ww�Lq'
fstogy ..eo.6uat..rea. ::atmfta.ra.abs.o. .a>om>m.�ua' &=wsajdxvftb&catftW.wX
tCOUNWI .69 dkeek dieb=nmW eroecW m edd dmW:bent ofaa mb,msu.osom sod ark wodm-oaoa poft mFumutim
I tAar bproms tewrAera'eorapewsadoa buwsmwjor ary earpley"I Rdow b dkr
vdb awJJob star
insurance CompmyName: !Y 2 Pe �6 y f>✓f IW yzs
Policy#or Sehrins.Lie.0 C U 2 0 5 Expiration Date: &LLI L /• O4'
Job Site Address: Citylsmcgip: t-10-17 /'�'4
Attach a copy of the workers'tompens on podey declaration page(shoring the poucy number and esplruioa date}
Paihue CO segue caverape at required under Section 25A of MGL c. 152 can lad to the impositbn ofcrimmal penalties of a
tine up to$1.500.00 md/or oapyear imprisonment,as well as civil penalties in the dnm of a STOP WORK OR
of up to$00.00 a day agaimt the violator. Be advised that a copy of this>tatemmt may be forwarded and a Sna
tD the O DE DER s a Invcsdpdms of the DU for fi m m"covaags vaidcW
IlalFaayc. salr.Abe pr mmdpanaNaNpvjwy&WAU11af«wadoanrovuN 6bw And
s«riea
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Phone C/
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opid mar oaf. Do am wdm to rAb area,to be cow,pfdd 61 ci&or sswu oa&d
Cky or Towns PermWUC Ne 0
Inniy Autkorky(ehrek one):
I.Board of Hakk 2.Budding Department 3.Cky/Powu Clerk 4.Ehxtrkai Inspector S.Plumbing Impe¢tor A Other
Comes Person Phone 0:
Massachusetts General ter 152 requires al a4loY r�to FI. worker contract of W*#
�""�� " ID'tbe 8etVtet of another under any
pursuantt0"statute. artea isdefSnedas •••eVQYpenon
cwm or imPued'mat or v 'Wca twono"hied AS"SID IDdmdnal.Partuasbrp. 'corporation Q Other tantY'Or OW two
a tbie
A exWjaydr
fo��is d la a7oat�¢�'Od Mc� *A�TWU anstiva�a deCCased a&emp H
apopatten a user aodko c raids tt►aein em , � ��Ate
receiver a trustee of and &M&MWff a the aaop�
owner of a dael{mg _w6o��pers.to do mamteaata.constmd W or reps*werlt oa s�dwe>
dwellingthereto Stan not hecnat of sadh empboymatbe darned b be a emploYWr*
or on the! orbur7dmi
MGL�132,125CM also data""every daft W load���wltlih�the l�alee 0r
a badaas err to contract bt� OW h the eomnsonweatlb for AW
renewd d Abe err P to°perate evldeaea d a'vNb tht lanraata to�erup ro9�red' shA
„pplit"Who has net prod"A "Neither Ate °0f a of its pCOMM l wbdfvSsioa
Add dossft-MGL j.W table evtdenee of oempliaace wit!die insarantt
mnnad to the pa&=uaw ofpobdc we*me so .
cam into any of this chapow bavebeen restated 0 as contraothtg
Appks§" affidavit oomplerdy,by charms the bona that appty to year litoation if
Please till out the�a00�tj tea)and phone augO s)along wig s)necessoy o employees OdMff than A.e
,bwasom.�muo�ed L abr'ti4Y CeMMPM not TCW _(LI rwrten iomrattoe if LLC a L12 does nave
otemben or ea,Lucy y�aqui M& Be advised that this at33davit mry be abmitsed to the Deparement�of �abeald
emploAccid e aff of iawuaoce coverage: Also be are to dp AM date the dlldavk. of
be rtauaed n AK city or town mat the application for the permit iiyoaare being mpested,b the D
epotolew lndu wW Acc;deow Should you hove any q�' °g . law to obtain s workers'
at Ste somber hated bekrvr. �imtced s>tanld eats tbeh
ampeasationposcy,please call the Depsstso�)goer
self-inauraaa tioense 6.*a on as
Cky or Tower Oflldeb at bottom
Please be sort that a aft b oomPlea and printed legally. The Department bat provided a las
ban.to contact you rtsardio'��alrPticamc
of the aMmAt tar you m ffi out in the event dte t�et wImr a used Zee in addi"an appiicaat
please be sore to 5n in the paw�a which will be used a.s refereece •
le pertoWkem ticatiaa in any giver year,need only submit one affidavit indicating aurent
that
�1tt�cy a�a�usy under"]ob Site Address"the aPPhcant should write"ari bcauons m (city a
town}"A e)PY of the sett do has bees o�cctallY stamped�malted by
u�tw�davrtwa�mos�t��t�
that a valid af8dsvit is ea Me for bow permits of comosefcisl vesture
a�Where as biome owner 41 cithm is obtaining a license a p '�10 so any business o lele afiidavit.
(i.a a dog liceate or petemst to bars lava ere.)said Perin is NOT regoued comp
le"
Office of lovatigSbow would late so Stile you in advance far Your i10°and should you bsve anY 4utsdOM
please do not besitste to give to a ca0.
fbe pep�m Des address,telephone and f3a miner.
The Commonwealth of Massachnsdta
Deparmcnt of Industrial Accidents
Office of Investigatttws
600 Washington Street
gostaia,MA 02111
TeL p 617-727-4900 ext 406 of 1-977-MASSAFE
Fax#617-727-7749
Revised 5-26-05 wwa.masa.gov/die
CITY OF SALKA9 MASSACHUSETTS
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SAIt11.MA 61/70
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