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6 OBER ST - BUILDING INSPECTION (2)
1'Ile ('Un1111UI1N'e;llth of Massachusetts /1 1: ', Board of Building Regulations and Standards CI FY OF Massachusetts State Building Code, 7SO 0011 SALLM Building Permit Application To Construct, Repair. Renovate Or utlish a One-or Tnv-Pirnuh Du ellit{fir This Section For OtTciul Use Onl Building Permit Number: —_ D to Applied: Building Official(Print N;une) Signature (Date/ ! SECTION I: SITE INFORMATION L I Pr, operty C2RF-Kss: 5 1.2 Assessors Slap sir Parcel Numbers 1.1 a is th-is an acre led street?yes no M1lap Number Purcel-Number 1.3 Zoning Information: 1.6 Property Dimensions: Zoning District Propuscd Use Lot Area IN It) - Frontage 00 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.1.c.40.§sq) 1.7 Flood Zone Informatlon: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ CheOutsck Flood"Lune? Municipal❑ On site disposal s stun ❑ Check if cs❑ P W!' >� ' SECTION2: PROPERTY OWNERSHIP' 2.1 Owner,of Record: T N;unMR6Krint) 1,4 C-6 tar0e. 16Pe S / 7 SWk Z ! No.and Street -relephone &nail Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check"apply)New Construction❑ Existing Building❑ Owner-Occupied ❑ Repaisls) ❑Demolition ❑ Accessory Bldg. ❑ Number of Units Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS tMO Estimated Costs: Official Use Only Labor and Materials) y ng S 7s �� I. Building permit Fee: S Indicate how fee is determined: ral S O Standard CityrTown Application Fee❑Tutnl Project Cost!(Ilens 6)x multiplier .x°g S ?. Uther Fees: S ical III\'.\(') S LisC _ —ical I Firc S -----nl Tutnl .\II F'ccs: S ('heck Nu. ('heck Amount: _ l'.Ish \lntunc n. Total Project Cosh S 7,S o � ❑P;IiJ in Full ❑UulsLmJing Bal:mcc Doc: SECTION S: C'ONS'1'RUC'rION SERVICES ' 5.1 C`onstructimt Supervisor License(C'SL) I iculsc Number --- - - F,pirniou Mite N:une ot'l'SL IInIJer I sit(.'SI. I)pe bee beta„\.__-_ I•y fx Description U 14ucs1ncleJ(Buildings up to iS.t)tlq n1. ItI _ R NnIrldcd 1&2 Fmml y Decllin l'ir,i fa„n,Stale,L11' ..— ___.. . . ,I Masonry KC' Kadin Cb,erin A S Window and Siding SF Solid Fuel Burning Appliances I Insulation ` 1'cic hone Email address D- Demolition 5.2 Registered Home Improvement Contractor(HIC) f IIIC•Registration Number Fwirotion Date !� IIIC Compan) Name or IIIC•liegistrunt Name No. and Street Email address Ci !Town,State,ZIP 'relc one 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 ..........0 No...........0 SECTION 7s: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 O%wcr s Name(Electronic Signature) Dale 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. Print 0%%ncr'eorAuthorind.\gcnt's Name(Illecuonic Signaturu) Dme VOTES: I. .\n 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 rro have access to the arbitration program or guaranty fund under M.G.L. c. 112A. Other important information on the HIC Program can be found at ,,,,a nl.n. �;o, ,,, I information on the Construction Supervisor License can be found at n1.1.; „w, -It', 2. \\'lien substmuial ,vork is planned,proside the information below: rota) floor area(sy. ft.) . I including garage. finished bascnlenCattics,decks or porch I Gross lisingarea(sq. it,I ___-. _ Habitable room count _-- --- - -� Number of bedrooms - Nunlbcrol'lircplaces -. .. _. . . Number o1'hathroonis Number of halt'hpths I\peo 'heatingsysteal . . _ . . Nunlhcrol'decks, porches Open I l\pe,�1 CdU hilg it jlelil 1'ncloscd i 1. "loial Project Square b,huage" 111as be sobstitwed Ibr"I'oud Project Cost" Office of Consumer Affairs and Ausiness Regulation 10 Park Plaza - Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Reillstration: 1W733 Type: Prorate Corporation 'p Expsztcn: 64212012 TrS 29840 A. B. CARNES. INC. ft samf Carnes 30 Arrowhead Farm Rd. Smdord, MA 01921 Update Address and return card Mark reason for change E] Address f] Memewd Rempioywout Lot Card -M/04p101216 Massachusetts_Deparbrient of Public safety Hoard of Building Regulations and Standards Canr.tructiun Supcn iwr License CS.=139 ` I 'r.:' 8 Pit1iYFS 5E t. GROVFG MA�aist_i+ i {�d n1 Corrardssionx Expiration 1 0111412p't€ ' UKANIIC DIMIC 1N,UKRNtd 6UPWANT OU/ODUb-UU WC 002-50--24OU 13102 --__ _ _----------------------- 013-66-0311-10 PIUNJXLYANIA A 8 CARNES INC CHART 1 S BOXFORD,,MA 019211-0000 A Chartis company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 17S Water Street Now York, NV 10030 I.DN MA Utff, AHMED INSURANCE AGENCY INC WORKERS COMPENSATION AND EMPLOYERS PO BOX 449 LI"ILITY POLICY INFORMATION PAGE SALEM, MA 01970-0449 CORPORATION Rf�N NAL�cNUMBE 02480 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY P9aOD i2GOt Alt standard Nam et the inaired's nalfinaaddRca JIM 03/31/11 To 03/31/12 mm 3 A. Workers Compensation lnsuranar Part One of am policy applies to the Workers Compensation taw of the states listed here: MA S. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in Kum &A. The limits of our liability under Part Two are: Bodily Injury by Accident S 1 ,000,000 each accident Bodily injury by Disease $ 1-000.000 policy limit Bodily Injury W Disease S 1-000-000 each employee C. Other Stelae Insurance: Part Three of the policy applies to the states, H any. listed here_ SEE ENDORSEMENT - WC200306A D. This policy includes these endorsements and schedules: SEE EXTENSION OF REM 3.13. OF THE INFORMATION PAGE - WC99W12 11113114 The premium for this policy w81 be decenninod by Our NMruals of Rules, Clatn:tftmtions, Rates and Rating Plans. All Information required below Is subject to trertieetion and change by e1u9t premium stag Rate per Estimated casdtieations Cede Numbs, IT��TWO Remunendian atre OF Rg Premium OAneua! 3 Yen d/orr Mnuat ❑3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $232 MUMOE COPATANT IE%CE"W111M APPLICABLE SYSTATE) MA NOMKM PFtEm t S SOO MA TOTAL EsiBtATED AteaM PMW" S 3 861 a indicated beim inbdm adjustments A premium taeit is,made: ❑ Simi-Mnkwiy ❑ Ous" ❑ umra,h DEPOSIT PrIMW t 03/17/11 ASSIGNED RISK 66 t% ram mrm Date Iatuateg OIBee Authorltsd Representaffm WC CIO 00 01 A 3OW (Rasa OVOa) CITY OF SAL.E,N(, NWS.wH(.'SETTS ©LILOLNG OEP.IRTt&1iT 120 W.tsjjLYGTON SrXgxT, jw FZOOR NL (973) 743-9393 KDOEFU V ORMOLL FVt(97i1) 7-;&9g46 .tiL1Y0R 7110.W�ST.PMUX DIREGTOtl or PLSLIC PROP9Arf/aL•mpNC COJM133101VEA Construction Debris Disposal Atfidavit (required for all demolition and renovation work) In accordance with the sixth edition orthe State Building Code, 790 CMR section I I I.1 Debris, and the provisions of MOL c 40, S 34; Building permit p this work shall be disposed of in a is issued with the condition that the debris resulting from 1 11, S 1 JOA. properly licensed waste disposal facility as defined by,yGL c The debris will be transported by: In ul hauler) The debris will be disposed of in : ( ma of facility) 0. IJJdrt» of 19cih�y) name ofpermit 19p11cmt C[-I-Y OF S, LEM, NWSACHUSETTS a BOLDING DEPML %WNT �,s9 '�� °�• 120 WASHNGTON STREET, 3aa FLOOR =aaea ` TEL (978) 745-9595 F.kx(978) 7.10.9846 .�-1.-%IBER EY DRISCOLL x �,L�YO.Z T1iOStAS ST.P1EAR8 DIRECTCR OF PUBLIC PRO PERTY/BUnDING CONNISSIONER Workers' Compensation Insurance AlTidavit: Builders/ContractorWElectric(ans/Plumbers 1pplleant Infnrm•rtion PleAm Print Leoibiy Minis Inusiiwa.Ur�,tnijrCa�tia�n,l�m/l'ividu.d):_�/7 '9 l.//T/`—w�J Address: City/StatcjZip: PhoneH: �� Are you an cmptev dXAeck-the appropriate boa: Type of project(required): I. am a s employer with 4. ❑ I am a gcnaial contractor and I S. ❑Now construction citlployees(full and/or part-time).• have hired the sub- contractors 2.❑ I am a sole proprietor or partner- listed on the altached sheet. t 7. ❑Remodeling .,hip and have no employees These sulrcontroctors have 8. ❑ Demolition working for me in any capacity. workers'camp,insurance. 9• ❑ Building addition (No workers'.comp, insurance 5. ❑ We are a corporation and its required.) officers have exercised their ME] Electrical repairs or additions ).❑ 1 am a homeowner doing all work right of exemption per MCC 1 I.❑ Plumbing repairs or additions myseif.(Na workers'comp, c. 152. §1(4),and we have no 12.❑ Roof repairs insurance required.) t employees(No workers' I7.0 Other sump. insurance required.) •,\uy appliaam dW ahaike boa rI mw1 alau nil out thv feutiue buWw showing chair ratan'<ompenudun puiiay inllrrmallon, 'I hvneu%m"who,uhnia this atrldavit indiwina they am doing all work and then him will"contractors mtnl nrhmil an"anldavie indiarine awh. :r-"-tractors that cha<4 this box mwr auachad an additiurwl.hwl.huwing the none or the tubwunimi m and their werken•comp.policy inramieon. fain an eatplayer that lr providing Ivorkors'rompeasodon insurance jar my employees Bela w/s the policy and job site in`oratudom - Insurance Company Name: >,�'f Policy4 or Sclf•ins. Lie. 4: 02 21} G �_3J_ Z Expiration Date: !ubSiteAddress: h roJ S '� Cilyislatrizip: �r� \Itach a copy of the workers'compenmtloe policy declaration page(showing the policy number and expiration data). Failuru to iccuru coverage js required under Section 25A uf, WL e. 152 can lead to the imposition of criminai penalties of a tine op to 11,500.00 and/ur one-year imprisonment.as I as civil penalties in the torn of a STOP WORK ORDER and a line Of up to 5230.00 a day against the violator. Ile adv' d that a copy of this..statement may be furwardcd tathe 011ica of Invciligmiuns of the DIA for insurance cevcra cririciliun. /do/rerrby c•rrti ,unJer d� nu uuJ pe uh/er ,j'prrjury phut ere in�unrrutlmr proviJrJ�b�w�e��i v��true unJ comet =i••r t t Dater --L Claw d ��f 13A7 O//iciul tree rndy. Da nor write 911114 area, rat be cumpleted by city ur town tilitavi City or lbws: ._ . _. Pcrmitii.lecose 4 la\uiag Authority (circle ono): I. Ilo:ard of licallh '. Building Doporimeut I. it town Clerk 4. Electrical Inspector i. Plumbing Inspector b, Otbar C11111.14I Perum:....__ _. 1'hnnc d• Proposal AB CARNES,INC. Page 1 of 1 30 Arrowhead farm Rd Boxford,Ma.01921 978-887-1431 or 781-599-9197 Mass,Builders License No.000230 Contractors Registration.No 100733 Proposal Submifted To: MARK&JULIE CARR Date February 29,2012 6OBERST ProlectName SAME SALEM,MA 01970 Address 978-744-2302 We propels,to furnish material and labor-in accordance with the specifications below: Seventy Five Hundred Dollars($7,500.00) Payment to be made as follows:$300.00 Deposit Balance Upon Completion No116e:All home imprmmaroot mnbacbrs and subconeatlers Moped in home Authorized l — Mpmrememeantrading,unless spedficsly exempt from mgiebation by prmeions Signature of Chapter 142A atme General Lava must be regrAmd web are CommwweatN Note:This proppsal may be withdrawn by us d not accepted with n of Massachusetts. Inguines about regianson arts stews should be made 0 the days. Masa.guvmlwroes websile. ROOF PROPOSAL N STRIP ROOF OF ALL LAYERS OF ASPHALT SHINGLES,COVER ROOF DECK WITH 15 POUND FELT PAPER COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP P M GE. N INSTALL ICE&WATER SHIELD$IX FEETIMDE AT LEADING EDGE ONLY, AND THREE FEET IN ALL VALLEYS AND ALL ROOF PENETRATION&UNHEATED AREAS EXCLUDED. N COVERALL PERIMETERS WITH EIGHT INCH ALUMINUM DRIP EDGE. N INSTALL RIDGE VENT ANDIOR NAS NEEDED ROOF LOUVERS FOR ADDED ATTIC VENTILATION. N COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS. N REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF$2500PLFT.WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK.YOU MAY NEED TO HAVE A CARPENTER REINSTALL THE REMOVED SIDING, N CHIMNEY FLASHING; CUT ALL EXISTING TAR AND LEAD FROM ONE CHIMNEY(S).CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE WILFAD ANCHORS. PROPERLY SEAL REGLET JOINT. PLEASE ADD S500 00 TO ABOVE PRICE. ❑ REBUILD CHIMNEY FROM ROOF DECK UP WITH NEW OR USED BRICK. ADP-----"OVE PRICE. N COVER ROOF SURFACE WITH CERTAINTEED LANDMARK ARCHITECTURAC.LIFETIME WARRANTY RESAWN SHAKE S. N REPLACE DEFECTIVE ROOF DECKING WITH I X8 SPRUCE BOARDS AT AN ADDITIONAL COST OF$4.5OPLFT. N COVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF S4.00PSOFT. SHINGLES ARE TO BE STORM NAILED.(USE SIX NAILS PER SHINGLE) INSTALL SKYLIGHTS PROVIDED BY CUSTOMER,FRAME ROOF DECK AS NEEDED,PROPERLY FLASH UNITS WITH FLASHING KIT(S)PROVIDED, CUSTOMER TO PERFORM ALL INTERIOR WORK. ADD INCLUDED TO ABOVE PRICE. ❑ REMOVE EXISTING GUTTERS ❑INSTALL NEW SEAMLESS.032 ALUMINUM GUTTERS USING THE POSITIVE LOCKING BAR RANGER SYSTEM, N REPLACE DEFECTIVE OR ROTTED TRIM BOARDS AS NEEDED WITH#2 PINE PRIMED,ADD$15.00 PER FOOT TO ABOVE PRICE. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS. MECHANICALLY FASTEN ALL CONNECTIONS. CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA. OBTAIN ALL PERMITS AND CARRYALL NECESSARY INSURANCE AS REWIRED BY LAW.WE CANNOTACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS.CUSTOMER SHOULD COVER VALUABLES.GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE.HOWEVER,SOME MARRING AND OR MINOR DAMAGE COULD OCCUR. HAND NAIL ONLY,NO NAIL GUNS TO BE USED. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES ASPHALT SHINGLED ROOF SECTIONS OF THE HOUSE. CHIMNEY FLASHING:THIS SHOULD BE DONE AS PROPOSED ABOVE OR LEAKS COULD OCCUR. SKYLIGHTS:IF YOU WANT TO REPLACE ANY SKYLIGHTS THIS WOULD BE THE IDEAL TIME TO DO SO.WE ONLY CHARGE YOU OUR EXACT COST OF THE SKYLIGHT FROM OUR SUPPER.THERE IS NO LABOR CHARGE IF THEY ARE THE SAME SIZE. CERTAINTEED WIND WARRANTY UPGRADE:WE WILL INCREASE THE WIND WARRANTY FROM 1101(PyTO 130 MPH BY UPGRADING THE HIP& RIDGE AND STARTER COURSE TO MEET CERTAINTEED'S WARRANTY UPGRADE.NO CHARGE.YES WAR RANTY-AII work warranted to be free of installation defecs far 5 years;This is..coded to the installed item(s)and Neir repair only.Material warranted oy W mfg.to be free of defects for years,see Me manufacturers warranty for exact warranty performance. Customer has legal right under federal law to cancel this contract without penalty or obligation within four business days Irom the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side for cancellation procedures. Once all items in this wntract are completed as agreed,customer has 3 days to fulfill payment schedule.All parties agree that all disputes shall be settled by the dispute resolution process mothe back of this agreement. Please see reverse side,Dispute Resolution. Signing this Proposal marl i you have accepted all the terms as stated on the front and back of this agimmenj Please am merge side. 5'- Dale of Acceptance -3 D Z� �J Signature - - Signature i i PLEASE SEE REVERSE SIDE ✓