40 OCEAN AVE - BUILDING INSPECTION (3) Hie Commonwealth of Massachusetts - _ I — —
7 CI"I'Y OF
Board of Building Regulations and Standards
SALEfv1
?,m,, Massachusetts State Building Code, 780 CMR
Rerhtd.tlur 2011
L,
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Funtrly Dwelling
!SECTION
MSITE
Use Onl
Building Permit Number: °liieeed:::
Building Official(Print N;une) ure :aD,at:e
NIATI1.1 Property Address: . sors Map& reel Numbers
V o 6 ccAAu 1IIre-
1.la Is this an accepted street?yes t/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.1_c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood"Zone? MunicipalOn s stem ❑
Public Private❑ Check if yc - site disposal >'
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
O J i%l cs - )e„.,
N:miNnt) City,State.ZIP
yo oS-(4,u 4 ✓e 6 )-). -)1o. G6zC
No.and Street Telephone Emuil Address
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that npply)
New Construction❑ Esisting Building❑ Owner-Occupied ❑ Repeirs(s) Alterations) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
llem Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ fS-Z_-- 1. Building Permit Fee: $ Indicate how fee is determined:
_ Cl Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)s multiplier s
3. Plumbing S j 7 p0 — 2. Other Fees: $ K �(
q. Mechanical 01VAC) S List:
5. Mechanical (Fire S Total All Fees: S
Su uessionl
y Check No. _Check Amount: ----Cash :\mount__--
6. Total Project Cost: S ]N ZJ--p ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supe visisor License(C'SL) /,S Z //� C •
A/"' ICI J/,/ `I'v
N:mtc of C'SI. I folder �-C Sf Liecnse Number Expiration Date
V
K ` —t Rfle1Y �v � List CSL I)pc(see below)
No. anJ Street w I.)w Description
D 411,41C U Unrestricted(1) ilJin li to 35,000 cu. 11.)
Citplfo,n.State,ZIP --L— R Restrict IK2 Famil Dwellin
M Mason
RC Roofin,C'ovcrin
n WS Window and Sidin
SF Solid Fuel Burning Appliances
&Pt4—tew 7-- C. I Insulmion
'I'cle hone I(mail address U Denwlilion
5,2-Registered Home Improvement Contractor(HIC)
�1 I G/l,/ a-( t s r P OR C6"f
I IIC C ompan) Name or 111 Registrant Name I IIC Registration Number Expiration Date
N r-, BAP e� r ✓
No. and S— trees �-- lLi !KC M J)f ^CAN Ci�✓�nJ yam,.)
� 3 P )di ��a( Lmail address
Ci /Town•State,ZIP ' Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 C0111PLETED 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 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.
Prins O,,ner's or Authorized Agcnl•s N;lmc(I?fectrunie Signature) Dale
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 not have access to the arbitration
program or guaranty fund under NI.G.L.c. 142A.Other important information on the HIC Program can be found at
Ill•1»_�t;ov oca Information on the Construction Supervisor License can be found at%����y.nia;>.eo� 11p_
i When substantial work is planned,provide the information below:
T ulal fluor area(sq. R.) l including garage, finished basement'attics,decks or porch)
Gross living area Isy. R.1 Habitable room count
N'umberoffireplaces
- Vwmberol'bedruums -----
Numberofbathrooms _-----___—._—_ N'umberof halt;baths
�. 1)pc of heating system -----------------
-_— Number of decks, porches_
F)pe of cooling S)Stun_ ----------------
131closed _ Open .— -
3. "final Project Square Footage-may be substituted for-'rood Project Cost-
CITY OF SALEM
Rf UBLIC PROPRERTY
DEPARTMENT
11 N1 rt
I!� \lrA,/,l,\1;IU.\jl:t t'Al'• j,111'N,M.1 U.\LIII W I I,v1'77,^.
I'nl. qE?liu3u! •P 1x v7s•?tC•'r.YM
Workers' Cumpenaation Insurunce 110duviC Builders/Contractors/ElectriclynyPlumbers
li I dicant In urmaflo
PI a..1 in Le 'hi
. V:IITIC I"""' I K e � UN�C-.� 'D� )
'1,J4 1ress: �7e �
cily,st:Irc,iip. 429 c1/ sI 9 �i _
�'hune il:=0 �/J ��0 �
I •\ru 11,u in erlq,loyer•!cheek 1 6 ilIPrnprlats box;
1 t.un J empluyer with L( 4. [] I :un a ycneral coulraelar and I 1)M"/proluel(ruqulred);
L'snyscIf.
luyecs( •little).f huvu hind the sohr1, New cunxttuchun
i sold pmPtiehn ar partner• listed on the anachcdsheet : 1• moddins
u111(lave no L:mpluyuvw There sub-contractors have
ing fin Ina in any capacity lvorkers'camp• insurance ' Dtmolition
orker•cump. insurance S. ❑ We are a Calporation and ill 9, ❑ Mowing addiliund) ,r)TeenIIJvo eeelciMed their 10.0 Electrical repairs or additions
homcuwner duinuill work right oredemption per htCL 11.0 Plumbing rupuira ur addition.
.f NO warkers'comp. c. IS2.41(4),and we hnw na
cu rcyuired.) r .mployees.lP'o worked' 12.0 Roufrepuin
comp, insurJacti r%:q& d.l 13,001110
1ny,yglAca,e OI,e.bola Oue e1 mum.Ilw till u,1 Ihf Vol."w Iwiuw,rMlw., I
IIum.IlwrwIN.'AII,11 thm IAif olllJfrll into
n I a Afie wwlui eunrpma"Iun IMairy IufiuMMmilMe r,urlrwll,n INN 1Mcl IAf Eoe mitt u,taehud.m relut"'If Juana A''Vvf Olin lhal Alnr ulnlidt e,,,"r
un+I,INI,Auwin low na"N Nthe 1ue•eaer 1OIe mwl..hnw a now mp.1er11 in.Ilalhnx im
><IaA and Ilfe MYIke/e'lVm�,p,I,fy mtbl"anua
/,un on euryloyer that!U pruviJlnr rvurAeq'rurnpntra/Ion Grfrrrnne�/or my anp/upeat Br/ory/x rAt pu/&y unJ/u1 viy
hr�unnurGr,a f
Insuruacu Compalty Vnlnt u ti /✓r
1'ulicy Is ur Shcr•ina. Lie.dt NI lit C 2 ; 5 1
EApiratlon Data:Yf— /L
lob gild -\ddresd: 0tvZ-
Altnch "espy of tho workers'cumpemallnn pollc) duclarallun pug#(shovel NI rhttpollcy nu tb d vaPl ua date),
s,O
Pulluru II 1110 coverage as required prier imunt, ?!r\ ul•M(;L c. 1)2 till lead to the imposition 0/criminil Ipenalries of a
tine ale n1 n rA,, d inlYur une•year impri.runlncnr, Jt wcll iA civil penalhcs in the loan�f a STOP IVO RIC ORDER and a Rnt
oVup ra i!SO.rNI i Jiy Iguinv11fit v'ohmol. Ile adsn.w.•d that J copy orthls,li m m may bu IunvuJuJ Ill the Ullicd uf•
Im..vn,.unro ul':lly 1)1.\ :or in,"r.u'ee cuvcruye 1c,ni v shun.
/,/u hervAy l.rri/'r antler the saint s Ali 11111!:1 1, '•f ulyrr/nry rAur r/re hiurmur/oe l yruriJrJ ubu.y is true nnJ correct
I
i
weird in Ihir urea, ru At ruurylurrJ dy ciq ur ro,rn u��lriuL
r ire°r I'nwn:
i I„uin Yvrmiul.lcvmre a
g .\Whurity (cir0a,Inc1;
I. IL,.uJ
G. of Ilv.ilth !. Ih,ddnrj Ikp.,runeut I. Calp'f"on C'Ierk J. L•lectricJl fu, ,cc tar i,
� 1)uler
i I Plumping l",pcctor
1'"m.,cl I'v,mc
information and Instructions
led Allllevery Pcl4on in the service of anuther an.ler Any :untnct of hire.
\LIDi.tN huielty l,anerll Lasre Ch JQfCr 172 IeyWfCY JII Cl1IIIIJ)etl to QfOVlde workers' compensabun tar that cnpluyces.
Purhu.ult to[III*slAlule, An lTpluvaa is Jcbl
,•4Praas if unPI Wd. aril of svnaen." oration or usher legal cnhry, of Ally two or more
uY0,or the
�n.•mployct I4 Jclinad as ,an ndividual, partnership. diIIIJ he lV gory
cJ m a lout cntcrpnsa, And including the local rcprmmuatives'u ande`n p�o�ces.l However he
t IN 1, or trolled
og en bug ant of the
ecetver or uualee cal'.tit indivtJuJl, pasmenhtp, Jssalativa or other legal enaty,crop lay
Woos to do Inaintenunca,consauclion u `n' Jeakmed tocbe inee npluyer."
lling huuJ4
owner cal a)welling house having not more than three Apartments and who resides therein,of the occupant
hvclhng Iwuid of another who employq Pe
or,tit the rounds or building appurtenant thereto shall not because of such emp oy
CSC 6 also slates that"every state or local licensing agency shag withhold the Issuance a or
�IGL chapter 152. 4- O ulred.'
renewal of a license or permlt to operate a husinsac or to construct With the Insurance oreragelregor an
produced acceptable evidence of comp of its political subdivisions shall
Applicant who has not p 7SC(7)•rules"Neither he commonwealth our any
\Jdilionally. %IGL chapter 1 S-. 5-
enterinto any cuntract Ior the Perfamtancy of public work until acceptable eviJanw of contpliwtce with the unuranc
rcyuiremcnu of this chapter have been presenlcd to he contracting authority."
Applicants Ychecking I to out Yiluation mt4 if
addless(er)and phone n artnershi s LLP)twith o emp oyees u her than the
plc:ts+ rill out the workers' compensation atlldavit ii(es) ad ,bymillothe bongs that eir callificald(s)of
Y
naccisary,supply sub-contructor(s)name(q,
nswa ice: Limited Liability Companies(LLC)of Limited Liability partnerships if an LLC
have
inelnben car partners, an not require)to carry workers' compensation submitted to the DapuroWo t of Industrial
emplold
yees,a policy is required. 130 advised that this affidavit re t
\ccidenu for contlrm uion of insurance coverage \lee be sure to YIp and Jute re u sted, n the stlidsvit show
the low car if you are rc4uircd to obtain It workers'
hu ciderclunts i to the city li town that the application for the permit of license is being requested, not the D,Partmcnt o
Industrial Accidents. Should you have any 4llestioos regarding
culnpeneation policy,please call the Department at the ntunhet listed below. Self instu+J companies should enter the
ir
se mpe%urance license number on the 300ropriate line.
Cary,or Town Omelsl.
"Che Department thus provided u apnea at the bltst�m
the app
Please he aura that the affidavit is complete ;mJ printed legibly. heat
ft
Of the ailiiJuvit fur you to till out in he event the C hie of Investigations has to reference
Ilut you regarding Addition,
I'1:ase be aura to till in he purrnit/license nolber which will beused ar.need onl csubmlt Onel.01davit cad coon{cartent
ut
Y
ica under"lob oits Address'the I"Plicant 4houlJ write";III locutiuns in (' Y
Ihat neat submit multiple pennit'licallsa applications in any g provided to the
Policy information I if necessary)' cJ or marked by the city or town lnay be p
Is
u»vnl.",\copy of the utliduvil that has been officially Yump
town)ant as proof that a valid affidavit is on rite for Mure pmatita at licenses. A new atNduvit must be tilled out ntu
Jeer. Where:a home owner or citiacn is obtaining; license of pennit not related to any business or commareial vantwe
t i e. a Jug license nr Permit to burn leaves eta)said Person is NOT requited ro ratioscomp ,1 this atfida uthava.utY 4usauans,
I he )nice ,a lnvc4tigJtiuns wyuId ltke to hank you in Jdvaaee for your couparatiun and shoos)y
hlea,e do not hesitato to glvc us o coil.
cphune J
ncv Ucparnncnl's Jdare4s, tc The C number:
maowea" Of M=aehusetta
Deparament of Industrial Accident
01ftes of InvesdQadons
600 Wash+naton Street
803t0n, MA 02111
ref. 4 617-727-00 ext 406 Ot 1.877-MASSAFE
'it.us www.man.jov/dis
CITY OF S,V-&),f, AASSACHUSETi"S
BLLLDL%IG DEP.IATSLLN-r
110 W.".SHLYGTON ST"=, 3ie Roo it
ht. (978) 745-9595
KI\®FRF AY ORMOLL FAX(978) 740-9846
MAYOR DIRECTO THou'U ST.PtEUS
R Op pt'BLIC P40PE t7Y/3t:aMCVG CONNISSIONE1t
Construction Debris Disposal Aff7davit
(required for aD 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 c 40, S 54;
Building Permit N is issued with the condition that the dcbris resulting from
111 work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
lll, S ISOA.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
/ d
(name of/facility)
(address of racilily)
� re ofpe applicant
2J� l/
'Lue
.' hn.,if Ly
r ,
MDB Construction ]PRI i l P l )�`J-�SI
4 Tibbetts Ave `vim
AL
Danvers, Ma 01923-3914
- - - LICENSED & INSURED
WEB SITE H.I.C. #100273
CONSTRUCTION www.MDB-Construcbon.com ESTABLISHED 1986
TO Mr. 6 Mrs. Young PHON 617.710.6626 Dp 50/2011
40 Ocean Ave.
Salem MA 01.070 JOB NqgF4 LOCATION
JOB 4ygA JOB PHONE
We Hereby Submit specifications And Estimates For.
Renovation to hallway, spare room and bathroom to consist of the following items:
BATHROOM:
1. Demolition of all exterior wall surfaces, shower wall, ceiling and flooring.
Note: existing door to be re-used.
2. Installation of new shower wall, tub wall framing and miscellanous framing repairs.
3. Installation of R-13 insulation in all exterior walls.
4. Installation of one 66" tub unit, one console sink and one toilet.
Note: Tub and sink to be in new location, toilet to remain.
Note: Fixture allowance of $1,000.00 on purchase of sink, faucets, tub, shower valve and toilet.
5. Installation of one new Nutone or equal fan/vent/light unit, two wall sconces and one gfi receptacle.
Note: vent to be discharged into outside from roof location.
Note.: Light fixtures to be supplied by owner. (nubone vent supplied by MOB.
6. Installation of 1/2" blueboard and skim coat plaster as necessary.
7. Installation of 50 sq ft of Flagstone style flooring (materials allowance of $10.00 per square foot)
8. Installation of 1/2" concrete board in shower area.
9. Installation of 75 sq ft of wall tiles in shower area. (materials allowance of $2.00 per sq foot)
10. Installation of owner supplied mirror, paper holders, towel bars and three marble shelves.
HALLWAY:
1. Demolition of all walls and ceilings. (shelf to be re- installed)
2. Installation of R-13 insulation in exterior wall.
3, installation of one owner supplied ceiling light.
4. Installation of 112" blueboard and skim coat plaster as necessary.
SPARE ROOM:
1. Demolition of existing as necessary to patch wall area damaged by water.
2. Installation of 1/2: blueboard and plaster as necessary.
3. Patch crack in ceiling. _
MISCELLANOUS:
1. All job related debris to be removed by MDB
2. All building permits to be by MDB
EXCLUSIONS:
t Q-4- ier, 1------- --- i"-- L... W"rev —1 "iWR A.." lb- Math YM--'-. 1
We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of:
Fourteen Thousand Two Hundred Fifty and 00/100.Dollars 14,250.00
dollars($ - ).
Panto be ode as foflaws:
?ayment B1: $300.00 upon signing (for permit fee) Payment #2: $3,500.00 upon start
Payment 03: $3,500.00 upon plumbing and electrical start. Payment #4: $3,500.00 upon plaster start.
Payment 45: $2,000,00 upon tile start Payment #6: $1,450.00 upon completion
NOTE: Materials and fixture charges and or credits due to allowances will be r in payments 43 6 5
All material is guaranteed to be as worried.All work to be complated in a professional manner
acconrrng to standard practices. Any aaeraaan or deviaam trust alwve spedfiaamm Audrorired
involving arms casts will be executed only upon twitter orders, and will became an extra Sigrmwm:
charge over ams above the cmirmte.AD agreements eoMingant upon stakes.ooddenis er .
delays beyond our control Owner to tarry fire,tor. do and other necessary Insurance.Out Note:True proposal may ba Z6
v *em are fully covered by Worker's Compensation Insurmn m. _ vnthdrewn by us d not accepted within Days.
Acceptance of Proposal — The above prices, specificadons �—
and conditions are satisfactory and are hereby accepted.You are authorized Signature:
to do the work as specified,Payment will be made as outlined above. ---
Para d Aunts: y t /3.2O/.L s.g�a,,,.a, ���zt.t.L."4r�.... _
ti
I ,
Pipe chase
Shelving
Marble shelving
7
2-9" 3
Ld t
4` M�
io
�t �� e
tp F- n
Tiled shelf area Proposed bath
Existing bath
Young
40 Ocean Ave
Salem, Ma 01970
Not to scale