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8 OAK VIEW AVE - BUILDING INSPECTION (2) TSALEM �YICES TheCommonwe thwft, sacitils_et[s_t S Board of Building Rg'ulati �nd Standards iNSPECMassachusetts State Buildi(T ORidBuilding Permit Application To ConstruLLccct, Repair, Renovate Or Det&h r _ One-or Two-Family Dwelling This Section For OtTici Use Onl Building Permit Number. Date. pplied: I Building Otticial(Print N,vne).- -.Signature Dale SECTION U SITE INFORrAMATION I. Proper Address: n , j,` ellxeml 1.2 Assessoro Map&Parcel Numbers L I a Is this an accepted street?yes no Map Number Parcel Number 1.3 'Zoning Information: I.J Property Dimensions: Zoning District Proposed Use Lot Area(syit) Frontage(It) - 1.5 Building Setbacks(it)... . Front Yard Side Yard} - - Rear Yard - Reyuin:J 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:' ` Public❑ Private . Zone: _ Outside Flood Zone? Municipal Cl On site disposal system ❑- Check If es❑ SECTION2: PROPERTYOWNERSHIP!' ' 2.1 Ownert f Reco d^ .=c(Print) - City,State,ZIP No.and Street Telephone `t Email Address SECTION 4:DESCRIPTION OF PROPOSEDWORW(check all that apply) New Construction❑ Existing Building❑ Owner.Occupied ❑ Repairs(s) ❑ 1 Alteration(s) 13 1 Addition Cl Demolition ❑ AccessoryBidg.❑ NumberofUnits_ I Other ❑ Specify: Brief Description of Proposed Work-: �'I yKa It Pat SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) - - 1. Building $ ,rj 00 DO 1 1. Building Permit Fee:$ indicate_ how fee is determined: Cl Standard Citygown Application Fee 2.Electrical $ ❑Total Project Cosh(Item 6)x multiplier s 3. Plumbing S 2?Qther Fees: S d.Alechanical (FIVAQ S List- 5.MechanicaI (Fire S total All Fees:S Su ression) Check No. Check Amount: Cash Amount: 6.Totai Project Cust: S s� fl t 0,0 0 Paid in Full 13 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 /Construction Supervisor License (CS-L)) I of P_)_p0-16 I `k,& I �ti-FI `� _l > > License Number Expiration Date Name of CSL Holder List CSL'rype(see below) �,_ TYpw Description .. . No.and Street e- 1.,Y iv� ,/ In ���O t r U ResUnrtricted d 2 Family a el ing j" r �, I JSJ 7 R Restricted I&2 F:unil Dwelling Cityfrown,State,ZIP M Masonry RC Roofin Coverin WS Window and Sidins SF Solid Fuel Burning Appliances "7 L d+( 1 Insulation Telephone Email address I D Demolition �5.2R,egiistered Home Improvement Contractor(HIC) 17 g 1 YS —IL Vv,yt���✓M� 1-�^'T �)_)l HIC Registration Number Expiration Date 1I'Cw Tan Name or HIC Registrant Name p bb V)- Cl-�fJ��ittv?- �`iT (e �7,g �p Nl , ,s.0 n. m A- t?f q 0'1 /1 J-5 L q-)V I Email address City/Town, State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§ 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 Isivance of the building permit Signed Affidavit Attached? Yes .........?ff No...........O SECTION 7a:OWNER AUTHORIZATIONTOBE.COMPLETED.WHEN' " OWNER'S AGENT OR CONTRA I T.O}R�—AP.MES FOR BUILDING•^PERMIT' I,as Owner of the subject property,hereby authorize W.1� lit ✓ ��G7 n�7 t9 act on my behalf,in all matters relative to work authorized by this building permit application. (_ CX)Nnv tz�Y l (-22-1-7 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW 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. W �G1� l f-2�73 Print Owner's or Authorized Agent's Na Me(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 Home.improvement Contractor(HIC)Program),will LLoj have access to the arbitration program or guaranty Fund under M.l7.L.c. I J2A.Other important rifoimafto`n on the HIC-Programcan be-a`mdT www mass eov:'oca information on the Construction Supervisor License can be found at www.mas� 2. When substantial work is planned,provide the information below: 'total fluor area(sq. ft.) N (including garage, finished basement/altics,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 'rypeofcoolingsystem Enclosed Open 7. "Total Project Square Footage"may be substituted for"'rued Project Cost" - Page No. - of - Pages ZaofinsProposal . WM. TRAHANT JR. CONSTRUCTION; INC. 4TH GENERATION ROOFING 215 Verona Street LYNN, MASSACHUSETTS 01904 CSL #101220 (78,1)b99-1211 (781) 844-4551 • FAX: (781) 581-0855 H.I. LIC. #141778 PROPOSAL SUBMITTED TO _ PHONE Y-7 C1 �l DAT� FCtc I .. y/} .'STREET a - . d ti. Vi CITY,STATE and ZIP CODE .. .. -. .. .. -° JOB'LOCATIQM`^, Ste,IC n. We hereby submit specifications and estimates for: " We hereby submit specifications and estimates for: -SHINGLE - SHINGLE ROOF FLAT/RUBBER ROOF -_— '--- Rau f` ----_— "'-_�-------.--. _-,----. _---_-- --_-„- .'---'— ._------_- Strip entire roof Bayw ads , ❑ Reshingle ❑ Sweep entire roof clean Replace any garclrc up to 100 linear feet Wtnp entire roof — - ©r� Ins a I Ice and water barrier first three feet up roof Cel- echanically fastefTdown ISO board insulation nstall is and water barrier in all valleys and along dormers Install 060 Rubber Roofing on entire roof nsta f�lnstall r on remainder of roof ll metal flashing around perimeter of 6' Idfng — La�tall eight inch drip edge, hlte ❑ Black ❑ MIII lash chimney(s), pipe(s) and walls) ❑ Install ridge vent If�dge caulk all seams FI h or re-flash chimney(s) Install new copper center dram !nstall new pipe-flanges ❑ Other: Install lifetime shingle Color 61 q CA4 A can up all debris r- - -- ---- -- --- - - - ---- -- — fl-Install gutters and downspouts abor and materials guaranteed 100%for five years CO Install trim toll ----.—Plm— e-Eall with-an — -- — — -- 1 V ttti7 ti 9Y I --- Install new fascia boards ❑Install new rake boards — QQ qq ❑ Install sky light(s) Other - 1eanup all debris P<abor and materials guaranteed"100%for five years II shingle roofs are nailed by hand: We Propose hereby;.to furnish material and labor — complete in accordance with above specifications, for the sum of: Total Price($ ` 1`•: " ,5'Op ° a ® " CIF YOU ARE HAVING YOUR ROOF-STRIPPED, -PLEASE COVER ALL VALUABLES IN ATTIC, AS Cad( -WE HAVE NO CONTROL. OVER DEBRISTHAT- MAY FALL THROUGH ROOF BOARDS." - 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 specBiGa- -Authorized tions involving extra costs will be executed only upon written order's,and will become --- extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner 4to5 carry fire,tornado, and other necessary - - insurance.Our workers are fully covered by Workman's Compensation Insurance. a�tl E tFIICCE 1T#` rapasal The above prices, specifications Q conditions are satisfaccry and are hereby accepted.You are authorized to- Signature ` do the work as specified.Payment will be made as outlinedabove. - - Ddte�of Acceptance:. , T 0 1S Signature {¢bna!nail yellow copy to:above address. G \ The Commonwealth ofMgssaehusetts Depaent oflndusbialAecidents 1 Congress Sleet,Smite 100 Boston,MA 02114--2017 www.ma=gov/dia Workers'Compensation Insurance Affidavit:Builders/Comiractors/Eledricians/Plumbem. TO BE Fnyb WITH TEE PERNETTINC AUTHORIIY. Avylleant Information T p 1r Please t Name(Bussinws/Ouganintion/Individual): ter' t/�-X�-M- L9 �'Y1t .3h tvajr Atliftess: Citylstate/Zip:- L�oN/ l - fl-1{9 Ot io Phone#: Are you an employes?la the apprepriaoe box: 1,0 I am a employer with 1.l7 employees(fiill and/mpMt-time). 7. Q New construction 2.01 am a sole Iroprictor orpartnerahip and have no.eml)loyees wofk'ig forme in 8: 0 Remodeling -Y Capacity.[No workers'comp-counteractm p*ad) . 3.01 am a homeow doing all work myacK..[No workers'comp.insurance required.]t 9. 0 Demolition . 10 E]Bpildmg addition. 4.01 am a homeowner and will be hiring contractors re c�rct ell work on my properly. 1 colt cons a that all contractors eithwhm workers'compearotion+ram+An»or are sole 11.0 Electrical repairs or additions proprietors with an employees. 12.DP1mnb10$repairs or additions - 5.0m 1a a general colo lm uctor and Ihaveed the sub-contractors;listed on dw attached dreoL lbese subcontractor have employee;and haveworlors'romp.insa. f o.❑Roof nn ox1p,^ar m;m 6.0 We are a corporation and its ol6cesbave exercised dtcvright of exemption perMGL C. 14.0 Other 15Z§1(4),and we bait an employees.(No workers'Eomp:insurance required) `Any a�iicaot that cheeksboa#1 most slag 6g our thesection below showmg their wcekerss'eompea porey intro on. . t Nomrowms wbo subigit uric affidavit indicating they nredoint;an work and ibm u hire outside co�aetaos must sit a view a%davitiodicating suck tContracters that check this box must athwhed an additional street showirrg the nare of 0e sub-coutnatom and slate whcdwor nor those eandes have employees. If dw sebcomncfma have employees.they mustpwvidd= workess'.comp.policymrsdas .. lam an employer that is providing workers'compomadon insurance for my eetp ces. Bdow is tliepolicy aidjob site Insurance Company Name: 6J r5-(�} �l ®�p� C�- Policy#or Self-ins.Lie.#: U (j D\E-: Expiration Dee: © I" Oq 1 k Job Site Address: C/ D y= w(I • r" SYT Citymateaip:Jr fyl �1 f} Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a ciuninal violation punishable by a fine up to$1,500.00 and/or one-year impnsomnent,as well as civil penalties in the form of a STOP WORK ORDER and afire of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations.of the DIA for insurance coverage verification. I do hereby certiffy under thepains and penalties ofperjury that the information provided above isis true and correct. hi�latnre: Ir(/..,:.�i.a Yf p t- Date: Phone#: �6/-S lP ly�t:1�y- ):24( Official use only. Do not write in this area,to be cbeipleted by dry or town ofJieia City or Town: Permit/Mcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OTY DF SALEg mASSAC-JSE m BMD1WDEPAR7MWr 120 WA9MYMMS7REET,3'VAOOA YkL(978)745.9593. R11vJ8ERIEYDRiSQ7LL FAX(978)740.9846 MAYOR 7)MMASSTYMtRE DntEcrcat of PuBijc RmRTr/Buwmo Oj,= Construction Debris DispOSW 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 coo,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: 'TAA44/�5t (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signature of ap icant Date