157 NORTH ST - BUILDING INSPECTION f
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7"edition OF SALL-M
�'X % Nrvi.ced Jamrury
dab
Building Permit Applicaf o Construct, Repair novate Or Demolish a 1. ?008
ne-r Two-Family qx0fing
T is Section OfTcial Use Only
Building Permit Nu b Date Applied: r 'Z
Signature: . 'Z�
13uildm ummissioner/In ectoroF Buildings Date
SECTION I:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I.1 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 lt) Frontage(R)
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 ❑
Public❑ Private❑ Check if yes❑ p P y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow,t�er of Record•
r( 4Gh >° l �ahaY9h / 5 iVorf�l S f
Name(Print) Address for Service:
(/ 7- 717 _ Qy .2
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work'-: F Aga IF er
A. l h flD
G h i /n v
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
I. Building S I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: $
4. Mechanical (FIVAC) S List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Chec Amount: Cash Amount:
6. Total Project Cost: S S 3 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) �y 7 t/ 7 2
Y L V f h S�e qh / e S f-icense Number L Ispimu Date .
Name of CSL-I folder List CSL"Type(see below)
- G e° h ob,' ' .5g1r,b6
I e Description
„ Unrestricted u to R Cu.Restricted I&2 Famililv y Dwelling
Signature M Masonry Only
07 1r 7 7 9- RC Residential Rooting Covering
I el- cphone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Hume Improvement Consractor(HIC) t ,? S 7
r G r s- �G 7`
fIIC Compa N. ne or t IC Registrant Name RRegistration/Number
Address
-ff: ,%4 7 Espt ation Date
Si b" mature ct 'relephone
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
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.
Signature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
1 ,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 Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
NOTES:
I. 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 I0.116 and 110.115,respectively.
2. When substantial work is planned, provide the information below:
Total floors 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"
Lie./Beg./Ins.
Proposal
SEARLES CARPENTRY
Leroy Searles
Danvers, MA 01923-1419
978 777-8032
Proposal Submitted Date: 4/18/11
Name: Rachel Donovan Address: 157 North St Salem,MA 01970
Phone: 617-767-9429
Job Name: Job Location: Phone:
Specifications & Estimates:
1) Strip off old roof shingles on top off main house approximately8 sq.
2) Install new Grace ice& water shield cover hole area.
3) Install new 8" aluminum drip edge.
4) Install new 30 years landmark woods cape Architectural shingles approximately 8 sq.
5) Repair rot board approximately 3'x5'.
6) Tear down one chimney down to roof area and board in this area.
7) Flash around main chimney and cement chimney.
8) Any other rot found will cost.
9) Removal of all debris.
10)�ns O k\ cWq&'4e*_(4 s )
TOTAL MATERUL &LABOR
DUMP$5,300.00
We PROPOSE hereby to furnish material,labor—complete in accordance with above specifications,for the sum of
Five thousand three hundred dollars,[5,300.001 payment to be made as follows;one half to start,and%at halfway
point,and''/<(balance)upon completion. (Any alterations involving extra costs us t be in writing,including extra
charges.)
Leroy Siarles or Agent
ACCEPTANCE OF PROPOSAL;The above prices,specifications and conditions are satisfactory and are hereby
accepted. You ppare authorized to do the work as specified. Payment will be made as outlined above.
Qw-
0h r � 11
Signature Signature
��77yy pConsu
Once of mer Atiairs&B smesa Regulation !
HOME IMPROVEMENT CONTRACTOR Type.
Registration ,.116357
Expiration .617/2012 Ltd Liability COW
1
S ALES CARPENTRY LLC. -_
MELVIN SEARLES _ y
53 CENTRE STREET
DANVERS,MA 01923 Oudersecremry
I
i
>lassachusetn - Department of Public Safety
1 Bo:u'tl of Buildin_ Re-aulatiuns and Standards
Construction Supervisor License
License: CS 58476
MELVIN L SEARLES 5`
PO BOX 60
ESSEX, MA 01929
Expiration: 7I23r2D12
31146
( m...lissi,mer
Tr#:
04/25/2011 13:23 9782018072 BABSON ELWELL DAVIS PAGE 02/02
ACORN CERTIFICATE OF LIABILITY INSURANCE °"'"'aizs� ol""' 2 011'
o
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. If the Certificate holder is an ADDITIONAL INSURED,the Poncy(les)must be endorsed. B SUBROGATION IS WAIVED.subject 10
the terms and Conditions of the policy.certain policies my requin s an endmement. A stet~on this oertlRDete does not Confer dghts t0 the
doN;teRle holdor In Mau of such andorsaRlam(E).
PRODUCER R Laurie Rebey
BABSON-ELWELL 81 DAVIS 978.291.1561 F"$ N,:978.281.9072
44 Blackburn Center AD ;
Gloucester, MA 01930 O1J 00106743
INSURE S AFFORDING COVERAGE NAR:R
INSURED INSURER A; The Travelers
Searles Carpentry LLC INSURER B:
PO BOX GO INSURER C:
Essex, MA 019Z9 INSURER O:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:Rachel Donovan REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 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.
LRAYRR TYPE OF INSURANCE [MR me POLICY NUMBER M ° Y LIMITS
GENERAL WPBWTY EACH OCCURRENCE a
COMMERCIAL GENERAL LIABILITY m w $
CLAIIASAIADE U OCCUR MED EXP(Am ore PMewl, s
PERSONAL A ADV INJURY E
GENERAL AGGREWTE S
GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPMP AGG S -
FOUCY 7 PECO'T LOC S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
(Ea swldenl)
_ ANY AI O
BODILY INJURY(PerPmmn) 3
ALL OWNED AUTOS
BODILY INJURY(Perewldenl) S
SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS IPM eeridem) 5
NON-OYMEOAUTOS S —
8
UMBRELLA une OCCUR I EACHOCCURRENCE E
EXCESS LMB CWIM9+AADE AGGREGATE
DEDUCTIBLE E
RETENTION 6 E
MMERS COMPENSATION XHURS923YI391110310412011 03104120121 X I wORY u. 1 2,
AND EMPLOYBRS•LIMUW YIN
ANY PROPRIETORNARTNERIEXECUTNE E.L EACH ACCIDENT E 100,000
A OFFICERRAEMBER EXCLUDED? NIA ---•
(Mendetnry In NMI E.L DISEASE EAEMPLOYE 1 100,000
X yyeea,deeaMe uMer '-
OEaCRIPTIONOFOPERATI R E,L.DISEASE-POLICY LIMB E SOO OOO
OEBCRIPTION OF OPERATIONS I LOCATION I VEHICLES(Aa¢R ACCORD 191,AddX l MMINts Selmdele,It Inure up"Is reglAMd)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBE[)POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORD E WITH THE POLICY PROVISIONS.
Rachel Donovan " Eon ENTATIVE
1S7 North St
Salem, MA 01970
B88.2009 A R CCORPO TION. All rights reterved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
CITY OF siux.tit
PUBLIC PROPERTY
DEPART NIENT
wry t]o rAswaGnm sruar•W^VnoAoazens osero
M r&resss+s•r.%L r.tzra)w
HOMEOWNER LICENSII EXE.r MON
Ptew Ihiet
Daq !
!ob ! 51 /VGh liLi 5� SQ
Home Owner Address
Hom tow arTsigMons 4LXfis- C17 7 7 7_ gy2 0
Proem Mailing Address i r7 .t/oh-// s f S v Ae A
The current a amptioo of"Homeoweers"was extended to include owner-occupied
dwellings of two Units or teas and to allow such homeowners to engage an individual for
hire who.does not posseae a linens%provided that tho owner acts u supervisor
DEFlNM0N OI►H0hWWNMt
Persona)who owns a parcel of land on which hdshe redden or Intends to roof" an
which then is6 or is intended to bs,a one or two hmily dwelling, attached or detached
structures accessory to such use and/or farm squctures. A person who comwcte more
than one home in a two year period shad not be considered a homeowner. Such
'Imutowme shag submit to the Building Oillcial,on a form aaeptable to the Building
Official. that he/she be responsible for all such work performed under the Building
Permit
The undersigned "homeowner'°assumes rnponsibility for compliance with the State
Building Code arid other applicable bylaws and regulations
The undeniined "homeowner'certifies that he/sht understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF S.kL.&%I, ,L-kss k iusE-rrs
• BL DLYG DEPAlt .M:T
120 WASHLYGTON STRM. 3i0 Rooit
TLL (978) 74S-959S
FAX(978) 740-9846
KI\IHERLEY DRISCOLL
MAYOR Tkows ST.I?It:tts
DIREcrot OF PIBLIC PROPERTY/BUn.DLNG COMMISSIONER
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 c 40, S 54;
Building Permit At is issued with the condition that the dcbris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as dcfincd by MGL c
111, S 150A.
The debris will be transported by:
A -elld Aepad
(name of hauler)
The debris will be disposed of in :
A ? _
(name of facility)
�O r9- T e o'w h
(aA ress of facility)
signature of permit applicant
data
IcAnvlfdw