3 OAK VIEW AVE - BUILDING INSPECTION Lhe Commonwealth of Massachusetts --- - — --- -
:pl'�R Board of building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Reci.reJ.Ilu, _1111
Building Permit Application To Construct, Repair, Renovate Or enw 'sIt a
One-or Two-Funtily Dveflhkg
This Section For Offs ' I Use Only
Building Permit Number: Da Applied:
Building Oflicial(Print Nmne) Signature Dute
SECTION I: SITE INFORMATION
I. Prope/'t�AJJress: �1 1.2 Assessors Map& Parce mbers
I.la Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoninb District Proposed Use Lot Area(sq tl) 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:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP',,
2. Owner'of Record: /
ca ti n e. Neu J 60 M
N;une(Pri t�)/ City.State,
19-WP q& $Y3 Q��Z
No.and Street 'telephone Entail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other L4 Specify:
Brief Description of Proposed Work'':
1,---A G91i
SECTION 4: ESTIMATED CONSTRUCTION COSTS
(tent Estimated Costs:
(Labor and Materials) Official Use Only
I. Building $ I. Building Permit Fee: S Indicate how fee isIdeternimed:
`Electrical ❑Standard City/Town Application Fee
2. S
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
q. Mechanical (HVAC) S List:
5. :\Iechanieal (Fire
Su m mression) 'rotal All Fees: S _
^'1 e O Check No. _(•heck:\mount: Cash
G. Total Project Cost: �60OZ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: C(INSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
j � � �y� _ �/ 22 D
A4n "�r4 n J fL—on ,Zn �,__ License Number I?. piral an Dutc
Name of C'SI. I lulder --
List C'SI-l)pe(see below)
PPo,n�j Ste_ _
No. unJ Strcel 'Type Description
/Y� S U I Unrestricted(Buildings up to 35.000 cu. It.)
R Re,tricted 1&2 Family Dwellin
City 'own. St't— M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
rcic hone Ismail address D Demolition
5.2 Registered
tt S2 `Home Improvement Contractor(HIC) A1127 „/
, i��nG A1. �- r>7 e — IIIC Registration Number sp tiun Date
11111C C ompany Name or III C Registrant Name
L eof6 ?!9 V�
u.unJ Street Email address
SS a jg/Sal y!2 -/
Ci /Town, State, ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.11 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
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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below.
I hereby aft I under the pains and penalties of perjury that all of the information
contained in this application is true and c orate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Nane(Electronic Signature) Date
NOTES:
1. 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 Hume Improvement Contractor(HIC) Program),will riot have access to the arbitration
program or guaranty fund under\I.G.L. c. 1 q2A.Other important information on the HIC Program can be found at
yyy oc;i Information on the Construction Supervisor License can be found at
2. When subsntial work is planned, provide the information below:
Total tloor area ta(sq. ft.) (including garage, finished basement'attics,decks or porch)
Gross living area(sq. ft.l _ _ Habitable room count _
Number of fireplaces _ Number of bedrounts __— —__--_--
Numbernfbathroonts _ _ _ _ __ Number ofhalfbaths
1)pc of heating system _ --------- — _ Number of decks, porches --- -----.-
l)peofcoulingsystem Open
3. "f utal Project Square Footage-mad be substituted for-rutal Project Cost"
CITY OF SALEM
PUBLIC 1)ROPRERTY
DEPARTMENT
.nu'. Yf I Y:fYIN,91
\111t el
I!�\Vn11uA,a u.�SIseY)' • i.hu•w. M.1,,�a,.ln a i L JI'77�
I'll. )7/.;1S•�i)5 • I'1.r vla•;+C•'isM
Workers' Compensation Insurunce 1,1'f(duviC Uullders/Contractors/E(ectricianyplumbers
\ ) tl(t:•an In unnullo
o / ^� `` Pl �� rent a 'Ill
ValTfyllOiulfellil)raanerainfvinJwuluull:�lM a SQ �•+RZ
to i _
Nddress: o1 4s
City.5taro%ip: Lit r,n ✓'lc- <� Phone ilr��I
IArk),so an vniWayer'!Chvcle the aytproprlato boa:
I ;tm a empluyer with ❑4. l')M of pnt)vef(requlrrJ):
enlpl"""(lull and/ur purt•�nro h).• hovel eJ thel.euh-clientroav u nr and l 6. Now cururructiun
2•❑ 1.un a soly prreprichtr or partner• listed on the anachcd sheet r 7• ❑ Remodelin j
ship and have no vmpluycvs These subcontractors have
lvarkinY tier too in any capacity workers'comp• Insurance. g' 0 Nmolition
i No workcrv'sump. insurance 5. ❑ We are a col 9. ❑ DuildinE addition
nyuircJ.) pontinn and its
olRccn 11ave wigmisal their 10.Q Electrical repairs or additions
).�] Ian)a halncowner doing all work righr of vsamption put hfCIL 11.❑IslumbinY repairs or additions
mysclL (n'o workers'sump. C. 152. 31(4),and we hove no
insuranco required.) r .mpluyceY. (No workers' 12.0 Ruoi'rvpuirs
entrap, insurance nyuinvl.J I S• Itlrr n/Pc / t7�,�t
1'I)••pplw'uY Old eheYs e,la al mop:Jw sill wl site,epfen Iwlur
'I Iun41urllara rho w ineut this anldsvkr i Jwruq ItNir rwItems cum awaken
Wkriine Illyy eer Join ell ru ra muet s ft"ifalWiwa
C',.nlnww,n Ihp.M'ce This Ilea mun anxhlM ran.),lit Y • ;afal Ilse hire Iwtsidr e•YYrKMfa d Ih euhria a raw e1RJitrit inJi aftip rwY.
i,rwl..h,rt dturin iM naaM d Itr tua.eefenehfre and Ihea wuAfrre'cvlp.piltcy enrbrmanw
/afn all rutploya rhu4 Lr pros)(//rag rvarArrs'rurnprnrndon htmraace for lay,aap/oprr% Bdo)r/a rhr pu/hy ant//ul.rih
LrlwrarurGrs �,)
Insurance C'untpauy .Vmne:c n Q /�
Policy u or Suir•ins. Lic.M:S_ Ej •� 9 - _--_
q L / Expiation Dave:
Job Sity Addresr: t1O/`L� 7('� ) 9 v e
C1ly'slate/zip: a r CSS
\trash a copy or tlm workers'eunpematlaa pulley declaration pugs(thawing rM policy somber and etplratlua dote). -
Pallufv to sucury euveraye u required under Secliun 25f\ul'SIGL y. 152 eau lead to ill@ imposition oreriminal penalties of
tine I'll let.Sl.5n0.tln untYur uue•yesr impris,nuncnt, is Iccll aY civil we,, in]he 1'unn Jfa 5Tr)p\VC1RK ORDER and s fine
°(tell rat )_'S0.00 a day Idaltbs Ill@ vu)I:ttnf. Ile advlicd that a deity ter lhl\Ns in]h 11 IOay be lowsardeJ to the RDE a
tm:.vuy.imnu ul''hu I)1,\ ;or nl,nctrce alvcra3e lelilicunun.
/Ju her,-by r crr fuller der p.... v wm pennAler u/yn/nry rite(r/u in unaarlra^A ! prvriJaJ buss is rru@ ua✓eorrrra
7 1 J 9 O u.ns rsi 3a�y/
21
IIt)/Ih'IY!fIII do/y. At nor wrier in ritele urru, Its be rump/ryrd by riey up town n//errs[
( iW qr rgtrn;
llvuinq .\ulhfirity (circle nou)t Ycnnif)Lkcme/
I. IL•ivir n(Ilcelth ). Ihuldulq IkIs' nncnl 1. Cilt.•ru❑o Clerk 4. Uvctric.11 Ills)cctur i•
G. l)Iher 1 PIuulDiny lu,ycetor
r•."nl.aci Virtues: -
�_
Information and Instructions .
Jctequi as" .every pci.:on m the service of another under•uty:uNncr of hire.
�Lusaatusetts General Laws:hayrer I52 trywrcs all empdu)ers to provide workers wmpensauun tilt shear cnofhir es.
I'ursu.art W 1111%."lute, an r,n0la1'fd t:f
'press or unplieJ. oral or wntren." g or an two or more
urtnenhip,assacianue,corporation or other legal cntiry, y t.r or the
�n employer a{defined as"an individual.p to in vnr to employer.
However the
t ,ha luregwng engaged m a lent enrerpr,sa, and ioc"ana of otthveslegal entity.empl employing
g ce Pe yens.oy ' '
,ecmver or uusaed ul'.m individual, permenhip,ssaoe
owner of a dwelling house having not ,.ore than Ill ens to de Hain enun a un ttru.tion orhepu r work ue su h dwell t Of n�{house
,hvelhng huuse of anorhar who employ Pe
ur on the grounds ar building appurtenant thereto shall not because of such employment be deemed to be an employer."
shag withhold the Issuance or
mGL chapter 152, 025C(6) also states that"Ovary state or local liaenslog ageoey for
renewal of a license or permit to operate a busimsa or to construct
with theslIn the co storate'►equr any
applicant wbo has not reduced acceptable evidence of comp
>dditionally, �IGL chapter i S_'. 525C1'11 states"Neither the commonwealth not any of iu political subdivisions shad
corer into any IGIL%cl pt the per of public work until acceptable evidence utcuuiptiance with the insurance
requirements of this chapter have been presented o the contracting authority."
�ypllcsnu 1 to our situation and,if
checking the boxes that app Y Y
hone numttcr(s)giant with their ceniflcafe(s)of
Please rill out the worker' compensation atlldavit eompletaly,by with no employees other than the
necessary supply Buts-contractof(s)name(
.a).addr*Li.!)and p
insurance. Limited Liability Companies(LLCworker'tcompaosau partnerships
it's it(If an)LLC or LLP does have
mm�bers or purtnar, are not required to carry w this affidavit snap N submitted to the Departmnrrt of Industrial
advised vIL 71re a111dovit should
yr I1Ja
Be aJ the of
employees.o policy is required. cot of
hcaagetion for the pdnnit or license is being requested, not the Dcpttttm
Accidents for confirmation of insurance coverage for
Also be sure to sign uaJ ate to obtain u workers'
ha icittmed to rile city or town that the app "
Industrwl Aecidents, Should you have any questions regarding the low to .you ass required
compensation policy, pler�call the Department st the nurntxr listed below. Self-insured companies should enter their
self-insurance license number on the a ro riaro lino.
City or'rowe Omelets The De artment has provided u space at the bottom
Plea..c he sure that the afflduvit is complete and printed legibly. P
the applicant,
Of die afiidavit tar you to till out'" the event the OlTice of Investigations has to contact you regarding
given year,need only submit one affidavit indicating current
1'I:asc be durc to till in the ll out'license nwnM:r which will be used as a reference number. In addition,an applicant
punnil
Wet must submit muliipla penniulicatrsa applications in any g Y by rile cis or town tea ba Provided to the
policy information lif necessary)and under"Job Site Address"
the appdicmu should write"ell tucy funs o (ce ur
town)•",\copy of the affidavit that has bean officially stamped elm is ur licenses• A now 4111davit^rust be addled out each
applicant as proof that a valid affidavit is on raid for tlrtwv p to any
d;r. Whelicense nt permi Of t to bum citizen islea o tag)if J license °s Penn"OT y not red o complete th+affidav affidavit.
venture
I h: ,)fticc ill Investigations would ilk*to drunk You in advance fur your:ooperatian and should you hula.toy yumuons,
please du not hesitate to give us a coil.
umber
the U:parnnau's addtes{, tclephuna and Th Cn mrnnonwealth of MatsaehuscrU
Deparvnent of Industrial Accidents
o111IN of IavaNQadons
600 Washington Street
Boston, MA 02111
I el. p 617.727.4900 edit 406 or 1.877-MASSAFE
Fax 0 617-727-7749
d a.us www.mus.gov/dia
i
CITY OF S.�t.E.�I, �LxSSACHLSETTS
BCtLDLNG DEPARTMI NT
120 W-,umLVGTON STRm, 3iO FLOOR
TEL (978) 745-959S
FAX(978) 740-91146
KIJBERLEY DRWOLL
MAYOR THomu ST.Pm x a a
DIRECTOR OF Pt:BLIC PROPERTY/BCILDLYG COMMISStOYER
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 a 40, S 54;
Building Permit p is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transportedby:
Qa .,�
( time of hauler)
The debris will be disposed of in
L4\ n n wknZ- _
( ame of facility)
L r1 +-(/ L
(add less of facility)
signatuvocrmz�t applicant —
a
�eM1n.titf Lw
J
\I _
•eeLlrla, aU4k66 LEpyye.b37) ~ - 'w � -+ _ '.J
1.�er' M.b� U,r1!al
oaf ing Page No, w
v 77 r �s�C -- Pages
WM. TRAHANT JR. CONSTRUCTION, INC.
4TH GENERAT)ON ROOTING
215 Verona Sbeat
LYNN, MASSACNUSETTS 01904
r� (761) 599.1211 • (781)'. wosox 84551 a TAY.(781) 182• 85slzi;aaro -- - H.I. L:G a 161778
rG N DATE
1 r a•D
p f Ap A111E
I cnY,➢TAR erW a1 c00E
a Ja LGGipy
C�
vJa haroCV,ubmi/,aaai0a,nana aM a,en1 -ela,ter, -
fiNhougre I,araey,uaM,a'ac:l.aoana and wartoV,!y
V ntlm roof ..._ .._
_ Q 9wea0 entire roof clean
c eo any bad beards up M !00 lalaer foot
M StriO anhrg ruuf MS
let and water barrier first three feet up roof
- ❑McChanir_aly fasten drjwn ISO I^St _ End water barrier in o11 veil -
airs and along dormers .
..- .. . board Ir1stlladM
O Install 060 Rubber RTORn n�yl- Ib felt oaoer on remainder of roof -
J g on enam roof
_ ❑Install metal flashing around
at 1 eight inch d
ro edge Dedmeter of bu idmg :
I-..-- U Flash chimneys). pipes)and wails)
! ns ridge pint - .._:.
lash Or► -` Oa caulk a0 seams
, s) kAt.�r.C( tF/)1CttdaQ 0 Instal new copper center drab
Sh ch
�Instlll new pipe Ranges ...-
Cl Other,
stal30 year Shingb -
❑Gedn _, .....
instal auttars and downSDarts — _ — up as debris
p Libor and materialg guaranteed I00%for five
C instal trim roll
._. j . _. . _.. - years
I G Instal new fascia boards
.... .
7 inatak Raw rake boards -
J 'nstal aky Ilght(s) 4o I -�
can uo all debris
--
and materials guaranteed 100%for five years (,-781 44 -/647
N shingle roofs are nailed by hand.
�a rrgpoad Hanby to tumibn material ana labor
complete m ee;ordarce WBh above a0ecilications, far the sum of
_---------
--------------
**If rata
YOU ARe'.""ING YOUR BOOP STRIPPED, PLLAse COVER All VAWABLES IN ATTIC.i AS price Il {'
_
WE NAVE N0 CONTROL OVER 0e8Rtl THAT MAY FALL THROUGH ROOF BOARDS."
:' nul,ryl it luarav,ad b q O IWAnd. U .—
"rM` azyaap ra suviler rM:lCee. w ao c,Ta.ya,d +v, rkmwib, --'•,n....d.nr rm�ansm wr rn a °zY aa,r,Wn ar a,raaan tram aac.,swum, Ai03ruoo -
:.'ra clot . Ilad elid NLn avny..Ya1ra, In0 pia sea",, S
Aar e the aftlm,t NI eara,meah turns al atb'ra �
w�V11'M a QQ'Carme a-ch"r,Calry'al,. as a as Yar:ll strikos
sa"k ra, hV WMS.,,'g C4r hoaas`had 1h qV
i
.. r[Bpt27 TltC of,y7 rUP0641_.rna,haw orras, ,aaen.snorx -
'::�w::a4o4 are utl,raC Cry ana wo aaraby NAeptae, vpa.n.rt.wa.A s zoac'^fa.parnk"t anAe nratle➢ ea aulrorrpd t
g o Signature
-
obth"c MJVa
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