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17 MOUNT VERNON ST - BUILDING INSPECTION c 3G (4p $ i Lf 'l The Commonwealth of Massachusetts INSPECTIONAL SEftV !� Board of Building Regulations and Standards C�"YY�F Massachusetts State Building Code, 780 CMR SALEM 2015 MAY -4 Aer2ipolor2011 Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Tivo-Family Dwelling I This Section For Official Use Only Building Permit Number: Date Applied: �D Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers L l 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 to 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? Public Private❑ Check if yes❑ Municipal PrIon site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: rj RVAI) �J `�i- ��m /VYt 01q 70 Name ) City,State,ZIP I7 At. �- K 1-;MJs No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) KI Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': Qtrmer�c\ G'Y�_{� SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ / I,16a .00 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0o 79 ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: [��J 5. Mechanical (Fire $ Suppression) Total All Fees: $ (j+ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $�Gj 'rV, ❑Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) skAf Sr ©r`iyer License Number Expiration Date Name o?CSLHolder Y1-law List CSL Type(see below)_ J _ No.and Street t Type Description SG&� �� p�� U Unrestricted(Buildings u to 35,000 cu.ft.) _(( R Restricted 1&2 Family Dwelling Cityffown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding pp —1 I SF Solid Fuel Burning Appliances -V't' t�3•94-0,� s�t'!lItMQ.SIY!/L,�u;��.CD1'4 I Insulation Telephone T-- mail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /n/zltt IT. a n¢�(' sS-{c r1 C J . �rl✓L•r HIC Registration Number Expiration Date HIC Cohip iy Name or IIC Registrant Name No d Street Email address /n. ('f A 0Kilo •1qH31Q(621 city/Town,State,ZIP 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 ..........0 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 S+ ,, -n6I/{r to act on my behalf, in all matters relative to work authorized by this building permit application. N141� ILflf�IziitJ� Prin 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 application is true and accurate to the best of my knowledge and understanding. Yn P int wner's or Authorized Agent's Name(Electronic Signature) Date NOTES: L 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 can be found at www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.sov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basemenUattics,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" L443 EVEBUILT NSTRUCTION II� 1 RI VER:PROPRIETOR - 6u . @STE V EBUILT.COM zo88A 01970 IWWW.STEVEBUILT.COM CITY OF S.UX1NI, NNLkss kcHL'SETTS • BuILDLNIG DEPAR-nIENT 120 WASHINGTON STREET,S'n FLOOR TEL (979) 745-959S FA.r(978)740-9846 ICI\(BEP1EY DRISCOLL .r1AYOR THosw ST.PtERRB DIRECTOR OF PUBLIC PROPERTY/BUILDING CO%massIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'blv Name(Business,Organixatiordindividual): %12/n IF Address: A AlAr/ S-1— City/State/Zip: .SAk; 11) d/GI 6 Phone Are you an employer?Cheek the appropriate box: Type of project(requiref: LEI❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction ,oMployees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet.t 7 modeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. q, ❑ Building addition [No workers'comp.insurance 5. ElWe are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL t L❑Plumbing repairs or additions myself.[No workers'comp. C. 152,§I(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' 13 [1 Other comp. insurance required.] Any applicant that checks box#1 must also GII out the wctim below showing their waken'compensation policy information. 'I lnmeownen,who submit this affidavit indicating they am doing all work and then him outside contmctma most submit a new affidavit indicating such 'Contmcton that cheek this box must anachrd an additional shoes showing the name of the sub ontmeton and their workers'comp,policy infomutim. l um an employer that Lr providing workers'compensation insurance for my employees. Below!s the policy and Job S,to information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: Ciry/State/Zip: Attack 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. 152 can 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. 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 certyy�under the pains and penalties of perjury that the information provided above is true and correcit mtum J Date: hats #: " OJfcial use only. Do not write in(his urea,to be completed by city or Iowa official City or Town: Permit/Llcense# Issuing,%ulhority(circle one): 1. Board of Ilealth 2.Building Department 3.Cilylfown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6,Other Contact Person: Phone ill: g� �l�-ny ����� a STEVEBUILT CONSTRUCTION Construction Contract Homeowner Information Name: Ryan Robbins Street Address: 17 Mt. Vernon St. City/Town State Zip Code Salem MA 01970 Contractor Information Company Name: STEVEBUILT Contractor/Owner Name: Stephen J. Driver Business Street Address: 4 henry St. City/Town State Zip Code Salem MA 01970 Y WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor agrees to do the following work for homeowner: Bathroom Remodel (See attached drawings and proposal). Materials Expected to be used: (See attached proposal) Work Scheduled To Begin: April 29, 2015 Expected Date of Completion: June 5, 2015 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to provide the work, furnish the material and labor specified above for the sum of$ 20,727.00 Payments will be made according to the following SCHEDULE: $5,181.75 upon signing the contract. $10,363.50 by 06/6/2015 or upon completion of $5181.75 upon completion of the contract. In order to meet the completion schedule, the following material/equipment must be special ordered before the contracted work begins: (1) Anderson 200 series double hung windows 2 Homeowner's Signature Contractor's Signature Ate ( y►; 7,0/ 50�- iV-- Date Date You may cancel this agreement if it has been signed by a party thereto at a place other than at the address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. REQUIRED PERMITS The following building permits are required: Building, Plumbing and Gas, Electrical. It is the obligation of the contractor to secure such permits as the homeowner's agent and any costs which contractor will incur in doing so are included in the price for this job as set forth above. Please note that homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL C. 142A. Is an EXPRESS WARRANTY being provided by the contractor? No Yes X The following warranty will be provided by the contractor under this contract: STEVEBUILT warrants all labor and materials (excluding owner supplied) installed at the above mentioned jobsite address for a period of(2) TWO years. (see attached letter of warranty). 3 1 � Please note that all home improvement contractors and subcontractor shall be registered and any inquiries about a contractor or subcontractor relating to registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1310, Boston, MA 02108, 617-727-8598. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided for in MGL C. 142A. Contractor: �— Homeowner- Date: Date: NOTICE: the signatures of the parties above apply only to the agreement of the parties to alternative dispute settlement initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not separately signed by the parties. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity. A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity. In instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require the signatures of both parties. OTHER CONTRACTUAL DOCUMENTS This contract includes as contract documents the following additional enumerated documents: • Construction proposal • Letter of warranty • Bathroom drawings 4 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED A DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE OR SEND A TELEGRAM TO (Name of Seller), AT (Address of Seller's Place of Business)NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: 5 4'-24° 39"VANITY / HEATED / 12"X24"TILE TOWEL O_ RACK i / GLASS SHOWER _ ENCLOSURE <t X 1}" I� - •MOS CTILE I 0 60"ALCOVE 00 PLAN �� - RIG HTIHASOAKNG TUB, ND DRAIN BATHROOM N SCALE: I'=1 1-0't t.E CNORAIN.CHROMEOR6[ wUCEI z - MT. VERNON STREET RESIDENCE 5'-0" SALEM, MA NOVEMBER 28, 2014 6" STEVEBUILT CONSTRUCTION SALEM, MA 9'-11, 2'-6" 3'-10„ 1'-9 " / 6"X24"TILES / / 24"GRAB BAR THERMOSTATIC / - I CONTROLS �'STONE / TUB FILLER— CAP �\ O 00 s I nil ELEVATION C N N 6"X24"NICHE I cD \\ ON KNEE WALL, N BATHROOM w BACK OF NICHE \ °STONE CAP SCALE: 2'=1'-0" TILED WITH MOSAIC ___ Al"t MT. VERNON STREET RESIDENCE 5'-0" 3'-7" SALEM, MA 6^ NOVEMBER 28, 2014 STEVEBUILT CONSTRUCTION SALEM, MA 7'-10" 8, 7,—2„ HOOKS SCHLUTER �t SCHLUTER EDGE CORNERS IN SS FINISH a IN SS FINISH I I I aI SUBWAY TILE TOWEL BAR— T.P.HOLDER ELEVATION B --- BATHROOM �� AIco 2'=1 '-0" Y i ' m SCALE: � I MT. VERNON STREET RESIDENCE SALEM, MA 2'-6„ NOVEMBER 28, 2014 STEVEBUILT CONSTRUCTION SALEM, MA APPROX. 62"X 36" i. FLOATING MIRROR WITH LED LIGHTS INSTALLED BEHIND IT, SCHLUTER EDGE HIDDEN CONTROL? IN SS FINISH I II 2k8" 00 L---------I SUBWAY TILE I\ IQ °o O -1 x 00 - ELEVATION A BATHROOM SCALE: 2"=1 '-0" - 1'-3" MT. VERNON STREET RESIDENCE SALEM, MA NOVEMBER 28, 2014 STEVEBUILT CONSTRUCTION SALEM, MA Y SHOWER---- SCHLUTER EDGE HEAD ./ IN SS FINISH 7'x8"—^ SUBWAY TILE �\ `-'' HYDRONIC HEATED y HOOKS— TOWEL RACK n 8'z10"NICHE, 0 SCHLUTER EDGE MOSAIC TILE Q IN SS FINISH INSIDE BACK - OF NICHE, t SC I EDGES c0 THERMOSTATIC — VALVE WITH - 00 ELEVATION D DIVERTER FOR o L—U I RAIN SHO SHOWER BATHROOM - SCALE: 2 MT. VERNON STREET RESIDENCE ---- SALEM, MA 2,_11„ NOVEMBER 28, 2014 STEVEBUILT CONSTRUCTION SALEM, MA STEVEBUILT CONSTRUCTION Stephen Driver PO Box 2088 Salem MA 01970 781.443.2621 Stephen@STEVEBUIT.com Letter of Warranty: 17 Mt.Vernon St—Bathroom Remodel To Whom It May Concern: STEVEBUILT warrants all labor performed and material installed (contractor supplied) at the above mentioned job site, in accordance with the contract, drawings, specifications, alterations and additions thereto, for a period of(2)two years from date of contract completion. This warranty does not include normal wear and tear, and/or product abuse. Under this warranty, STEVEBUILT will be provided the opportunity to have to assess any damage identified to be caused by STEVEBUIT employees and/or material installed by STEVEBUILT. If said damage is judged to be the fault of STEVEBUILT workmanship and/or material,STEVEBUILT will at no cost to the Owner repair or replace defective material. Sincerely, Stephen Driver QTY OF SALEM, MASSAai JSE TTS IS 1 ji BUILDING DEPARTMENT 120 WASHINGTON STREET,3AD DOOR 'AL.(978)745-9595 KB BERLEYDRISCOLL FAX(978)740-9846 MAYOR TiHomAs ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUIIAING 0DOWSSIOMR 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 111.5 Debris, and the provisions of MGL c40, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: T)Jry%0'q/C S F L1` (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signature of applicant Date