6 OAK ST - BUILDING INSPECTION 1� I ZZ, The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
ley j Massachusetts State Building Code, 780 CMR, 7"edition OF SALF.M
"'w Revised Januory
Building Permit Application To Construct, Repair, Renovate Or Demolish a 2008
One-or Twu-Family Dwelling
This Section For Official Use Only
Building Permit Nu , r: Date Applied:
Signature:
Ruildi g usroner/ t of Buildings Dale T'
ECTION 1:SITE INFORMATION
1.1 a;
M 7" 1.2 Assessors Map d Parcel Numbers
r
1.1 a Is this an accepted street?yes V no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
From 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 Cl Private❑ Check if es❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2. weer'ofRIcord
0 12 lex ¢44l Cl % �2 ulG � ST
A
Name(Print) Addrc for Service:
Signature - Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied O Repairs(s) ❑ 1 Ahcration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: 0171clal Use Only
Labor and Materials
I. Building S 3,. O� 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical 5
" ❑Total Project Cost (Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S /� �r f /�.
4. Mechanical (IIVAC) s List: .�C�-/Y\ l
5. Mechanical (Fire S
Su ression Total All fees: S
�> Check No. Check Amount: Cash Amount:
6.Total Project Cost: S� V ❑Paid in Full ❑Outstanding Balance Due:
r
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) ��r2=
Numbe li. puatiu I}a c
Name of'CSI.-4 IuiJer /� I.ist CSL Type(see below) t
� rl& e- J / f t3exri Lon
Address— U unrestricted up to 35,000 Cu.Ft.
a /7 D l� R I Restricted IR2 Family Dwelling
Signature JJ M Masonry Only
RC ResiJemiai Rooting Coverin
"elepMme - WS ResiJential Window and Siding
SF ResiJential Solid Fuel Burning Appliance Installation
D I ResiJential Demolition
5.2 R bte Home 1 J
c/cement Contractor(HIC)
l IIC C ana�me r HIC Re ie1randt NGame �� - Registration r
AJJn: �Y�j7 _� 7a6 E,pimliofi Date
Signature Teleepphoric
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 2SC(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 .......... O No...........O
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 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
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.--04 j`r d
Print Name .�
Signature of(honer or Authorized Agent Date
(Sinned under the pains and penalties of 'u
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 UX have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 IO.RS,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) li
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 ProjeL•t Square Footage"may be substituted for"Total Project Cost"
J
' a
CITY OF SALEM
PUBLIC PROPRERTY
,,, DEPARTMENT
r.u: of ri , 01. E 12C V'.rw M\r...w Slott, •S.\lI%.
Construction Debris Disposal Atndavit
(R'quimd fur all dcrnolition wid runovatiun work)
In accun alma with the sixth edition of the Mate Building Code. 730 CMIt section 111.3
Debris. and the provisions of MGL a 40. S s4; fat a.donned by MGL e
is issued with the condition that
t the debris resulting{ m
Building{ Permit N Gcrrtsed wrote disposal
this work shall he disgloscd of in a properly
111. S 150A.
The debris will be transported by:
]
purrme u!emular)
1-11a debris will/be disposed of in
prarrrul xi ply
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Insurance Company Vance:
Policy I or Self•irra.Lis.N Expiration Dale
Job Sin Achhm: /1 1!:� ST City4lakrZipt
miscb a copy d the workers'compeaeWe Polley dnktrattas pap(shswlo@ the POft oumber and espirwho dWI♦
Failure to secure covenp ao required uadw 1Orlim 2SA of SIOL e. 172 can led to the imposition of criminal ponslds are
rune up to S I.JO0.00 anJfar ano-year imprisonment as wall as cavil penalties is the fans of a STOP WORK ORDER and a Roe
Of up to S2JO.00 a Jay ayainsl the violsoor. Ile advilutl those wpy of this statement maybe forwurded to the 001ce of
I n..,u ptiurr of tier nlA for inswanco coverap v%riflratims,
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tswtnt .\utherdy Itircte one►:
I iluuJ u(Iltaltb 1. Fluddlny Mparlmene ►. citltrowa Clerk I. Fletirical In+pector S. Plumbing tntpoctor
6, thher
Phone is.
�_ Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
Regiatratloni:s. 150617 TA 294001
Expiration -.4l12I2012
CODA ROOFING(
DAVID MOORE v
OAK ST
SA EM,MA 01970 Unde
ritcrtisrY
Massachusetts - Department of Public Safct.%'
Board ul' Buildin- Rc_Id: tiuns and Standards
Construction Supervisor Specialty License .
License: CS SL 100552
Restricted to: RF•WS
DAVID MOORE
3 OAK STREET
SALEM, MA 01970
Expiration: 9115/2012
('onmisxi.mcr Tr#: 100562
CoDa Construction PR,O'P'OS,AL, Page 1 of 1
"Exlerior.specadists, that alwgvs have you covered"
3 oak Street No. #6710
Salem, MA 01970
978.335.7065 Date: June 7, 2010
Proposal Submitted to: MA Construction Supervisor License#.100562 HIC#150617
Name Ronaldo Ramos Job Same
Address Oak Street Address
City/St/ZipSalem, MA City/St/Zip
T: 978.998.9533 T:
We hereby submit specifications and estimates for:
ITEM DESCRIPTION
1 Remove existing cedar siding front& rear deck area). Replace with '''K insulation and vinyl siding.
2 All window trim, corner board and rake trim to be covered using aluminum coil stock.
3 Any rotted sheathing to be determined upon inspection and replaced at material cost.
4 Roof area on right side to be stripped and replaced.
CoDa Construction to remove and dispose of all debris in compliance with current legal standards.
Manufacturers Guarantee on all materials
All labor fully guaranteed
We hereby propose to furnish labor and materials-complete in accordance with the above specifications, for the sum of:
$ 3,200.00
With payments to be made as follows: $1600 deposit,$1600 upon completion.
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.
Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control.
This proposal subject to acceptance within 30(thirty)days and is void thereafter at the option of the undersigned.
Customer accepts responsibility for payment(s)of all legal fees,costs,expenses and interest(at the rate of 1'/a%per month, 10%per
year) associated with the collection of overdue balances ninety(90) days or more after invoice for services and material rendered by
CoDa Construction.
Authorized Signature ->Vic �� 6e=�
ACCEPTANCE OF PROPOSAL,
The above prices,specifications and conditions are hereby accepted. You are authorized to do the work as specified. Pa ents will
be made as outlined above.
ACCEPTED: Signature
Date: Signatttre
THANK YOU FOR YOUR CONSIDERII TIOM
Customer Copy ❑ Office Copy Other 0