12 NORTHEND AVE - BUILDING INSPECTION The Commonwealth of Massachusetts
1 Board of Building Regulations and Standards CITY OF
I Massachusetts State Building Code, 780 CMR ,101b NOV �.
s 6/u 1�A7�
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For OffkiO,Use Only
r
Building Permit Number: Date Applied:
- Buiidinb Official(Print Name). Signature Date
It\l\L SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
19 Qn,,4hE0 Ave
1.[a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: IA Property Dimensions:
Zoning District Proposed Use Lot Area(sq t1) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal O On site disposal system ❑
Public❑ Private❑ Check If es❑ P po y
SECT(ON2: PROPERTY OWNERSHIP!`
2.1 Owner/t of Record:
I`erJ I�u-m-u deM �t'YlA i�i7D
17)me(Print) City,State,ZIP T
12 I[crf� ke, C175'-7Yy-2`s"2-
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Altemtion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ Other Q Specify:
Brief Description of Proposed Work-: C p g y 121it /—�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S I. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Costs(item 6)x multiplier x
3. Plumbing S V Qther Fees: S -
q. Mechanical (FIVAC) S List'.
5. Mechanical (Fire S Total All Fees:S
Su ression)
p- Check No._Check Amount: Cash Amount:_
6.Total Project Cost: S Y/ 766 ❑Paid in Full 0 Outstanding Balance Due:
ll f 2g M Rt �E1D TO ei.(Z.
SECTION 5: CONSTRUCTION SERWCES
5.1 Construction Supervisor License(CSL) S� 9
Pe,4 to e �`�a n - License Number Expiration Date
Name of CSL Holder
9p�� List CSL'rype(see below)
/�7 �Ol✓�JI S4 Type Description .
No.Widd Street
/' I 'nit U Unrestricted 0uildin Lip-to 35,000 cu. 11.
1 idd' mmf} �Ir�>�d R Restricted 1&2Famil Dwelling
6Yyrfown,Slate,ZIP h masonry
R Rooting Covering
WS Window and Siding
c�^- SF Solid Fuel Burning Appliances
0 U 7 2(�l 707`� 1 1Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) O f71 _Z r-/
c^^P&-- lhs IT^r HIC Registration Number Expiration Date
F I II 7 TF y a or HIC istmnl N;un
U„�(r
No.aIW Stre�r Email address
1liter >`CtC) YnA b(frk0 $C-72y,70 .
Cit rrown,State ZIP Tele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.¢2$C(6)y.
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Is§uance of the building permit.
Signed Affidavit Attached? Yes ..........@O No...........13
SECTION 72;OWNER AUTHORIZATION:TO BE COMPLETED.WHEN.' -
OWN EIVS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT'
1,as Owner of the subject property,hereby authorize �t'��2.ill r)
t9 act on my behalf,in all matters relati work authorize d by this building permit application.
// Z3 h
PrintOwner's Name� •tmnicSi to Date
SECTION 7b: N1 ERtOR 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 thi�s a lication is true rate to tl a best of my knowledge and understanding.
p2��I`y�" �/�
Print Owner's or Authorized Agent's Name(Elw " nature) Date
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 no have access to the arbitration
program or guaranty rand under II.G.L.c. I42A.Other important information on the HIC Program can be found at
w+vw mass cov'oca Information on the Construction Supervisor License can be found at w�rw.mass.�aov:'dus
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basementlattics,decks or porch)
Gross living area(sq. R.) 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 ofcoolingsystcm Enclosed Open
1. "Total Project Square Footage'may be substituted Tor,,Total Project Cost'
Peter Ryan and Son Roofing,Inc.
LICENSURE
t Peter big Bud Sol
Rednti19
HiC License #: 17E871
Exp. Date: . 05-28-2016
%/e1=r armar�/l�r. fl 'ne7 ru J
f License or registration valid for indivitiul use only
aPJ, office of Consumer Affairs d Business Regulation before the expiration date. if found return to:
n_
fg i ME IMPROVEMENT CONTRACTOR Type OTficu of Consumer Affairs and Business Regulatiau
istration: 176877 10 Park Plaza-Suite 5170
K ay„ irailon: 5128tWil Corporation Boston,MA 02116
PETER RYAN 8 SON ROOFING INC;
PETER RYAN
383(REAR)LOWELL ST SuffE 2 G-' ,".,_ - -'"----
CNAKEFIELD.MA 01880 Gndersecretars - M10 itl t signature
CS License #: 106056
Exp. Date: 05-17-2019
_ Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License:CSSL-106054 t
onstruction Supervisor Specialty
PETER RYAN
377 LOWELL STRE
WAKEFIELD MA 018i .,
l,/A,_- Expiration:
Commissioner 05117i2o15 f
i
P1100F NOD a00 SOD BOD00S,ft Wakdeld,M 1HO80 "TekIM-57i-9056/FM70 204999 d Ema0:8yae800SDOSMMEeO®
Di�i90.6�OYa�Od3OOOODS@OO.e®®C
The Commonwealth of, assaehusetts
Department of Industrial Accidents
i 1 Congress Street,SPtite 100
Boston, MA 0211 4-2 01 7
cvwru.ntassgov/dia
.� Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WTTB THE PERM1717ING AUTHORITY.
Applicant Information Tease Print Legibly
Business/Organization Name: WeatherTite Solutions, c/o Richard Reynolds
Address: 79 Nashua Street
CitY/State/Zip:_ Woburn, MA 01801 Phone#: 781-281-5782
Are you an employer?Check the appropriate box: Business Type(required):
t.❑✓ I am a employer with 4 employees(full and/ 5. [_—]Retail
or part-time).* 6. [-�RestaurafibBar/Eating Establishment
2.0 1 am a sole proprietor or patinership and have no 7_ (J Office and/or Sales(met-real estate,auto,etc.)
employees working forme in any capacity.
[No workers' comp, insurance required] S- ❑Non-urofit
3.® We are a corporation and its officers have exercised 9- ❑Entertainment
their right of exemption per c. t 52, §1(4),and we have lo.❑Manufaeturin.,
no emplovees.[No workers'comp. insurance required]* I L❑Health Care
4.❑ We are a non-profit organization,staPfcd by.voluineers,
with no employees. [No workers' comp. insurance req] t2.0 Other -
=Am applicant that checks box#1 must also fill out the seclum below shumng their worker'compensation policy information.
"Jfthe corporate officers have exempted themselves,but the corporation has other employees,a:,orkers compensation policy is required arld soh an
or,,anivztioo should check box 41.
d am an employer that is providing workers'compensation.insurance far my employees. Below is the policy information.
Tnstu-ance Company Name: Duffy Insurance Agency
Insurer's Address: 317 Broadway l Wyoma Square
City/State/Zip: Lynn, MA 01904-2602
policy#or Scif-ins.Lic.k WC5-31 S-345064-046 _ Expiration Date: March 3, 2017
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. 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 dre form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D1A for insurance coverage verification.
1 zla hereby certifj nder,the�Yzins and per allies ofperjury Pleat file inforznation provided above is lrzee`and correct
Signature: / t/ttlC�__111..(ai�. '. Date:
Phoney:
i Official use only. Do not write in this area,to be completed by city or town official.
i` City or Town: Permit/--License it Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.Cityll'i wo Clerk 4.Licensing Board 5.Selectmen's Office
b.Other 1
Contact Person: Phone#:
- vnvn.m:us.�ov(dia
ADDITIONAL COVERAGES
Ref If Description Coverage Code Form No. Edition Date
DIA Assessment DIA
Limit Limit Limit Deductible Amount Deductible Type Premium
$48.00
Ref# Description Coverage Code Form No. Edition Date
Expense constant EXCNT
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
$250.00
Ref# Description Coverage Code For No. Edition Date
WC &Employer's liability WCEL
Limitl Limit Limit Deductible Amount Deductible Type Premium
500,000 500,000 500,000
Ref# Description Coverage Code Form No. Edition Date
Terrorism TERR
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
$4.00
Ref# Description Coverage Code Form No. Edition Date
Loss constant LCNT
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref# Description Coverage Code Form No. Edition Date
Experience Mod Factor 1 EXP01
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref# Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref# Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref# Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref# Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref# Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
OFADTLCV Copyright 2001,AMS Services,Inc.
offices:
frRedle,
c n 377 Lowell Street,Wakefield, MA 01880 P"QQR
Tel: 781-245-4900
Ron and 0911 Fax: 781-245-4999
lac. www.PeterRyaRANdSonReefing.eom
Submitted To: lob location:
Ken Darcy
12 Northend Avenue 12 Morthend Avenue
Salem, MA 01970 Salem,MA 01970
Phone#: 978-744-2802
Email: N/A
Proposal date: November 22,2016
We are pleased to hereby submit this proposal to furnish materials and labor,completely In accordance with the below specifications:
(Additional charges may applyfor any change's not included below in proposal either by request of owner, or if Peter Ryan and Son Roofing finds
unforeseen circumstances that will affect the performance,quality or integrity of this job). In the event legal action is taken to enforce any provision of
this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorneys fees. Not responsible
for debris in attic.
.,
Strip enure roof to bare wood and re-shingle: $6,700.00
• Strip existing shingles down to bare wood
• Check for rotted wood and replace(at time&material)
• Nail down any loose wood
• Install ice&water shield to first 6-feet,and in all valleys and around any protrusions
�• • Install premium synthetic underlayment(in place ofstandard 30lb.felt paper)
• Install all new 8"white drip edge on perimeter and step flashing,where needed
• Install manufacturer suggested starter course of shingles
• Install Owens Coming®Lifetime/architectural shingles in color of your choice
• Install ridge vent(only if soffit vents are present,per national roofing guidelines)
• Cap ridge vent properly with manufacturers suggested cap(Owens Corning®ProEdge),if applicable
• Properly flash any protrusions and all new pipe flanges,if any on roof
Clean UP:
• Cover area with tarps to minimize debris and remove debris related to work
• NOTE: Please cover any belongings in the attic,as they will get dusty,if applicable
- 1 St payment due upon signing: $2,200.00
Total Cost- $6300.00 Total balance due upon completion: $4,500.00
Kindly remit payment to "Peter Ryan". Thank you!
Respectfully Submitted bY: Accepted bv:
Our craftsmanship is 100%gu anteed a 10-years. A warrantees are through the manufacturer.All w e null&void ifjob is not paid in full.
Peter Ryan and oofing,Inc.License 41788711 Thank you for letting y seyv you!!!
V cc: Peter/Ricky