55 OCEAN AVE - BUILDING INSPECTION / ,l 7 The C'onumonwealth of Massachusetts
Board of Building Regulations and Standards CI'1')'OF
Massachusetts State Building Code, 780 C NIR ti,\LG\I
Building Permit Application To Construct, Repair, Renovate Or Demolish a
(Ale-or Tn'u-Family Divellin,\r
This Section For Official Use Only
Building Permit Number: Date:\ lied:
Building 011icial(Print Mane) Signature , Dute
a
SECTION I:SITE INFORMATION
1.1 Property Address: 1.3 Assessors.Map& Parcel Numbers
Sir 1_0 l�
1.la Is this an accepted street?yes no Map Nun,her Parcel Numhcr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed(Jxe Lot Area(sq It) Fronlage(11)
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.qo,§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Munici al❑ On silo Jis sal s stun ❑Check it' es❑ p Po' >� '
SECTION2: PROPERTY OWNERSHIP'
: ?Tr c�'Ie Colo
Na",e(Print (n• atc,ilP �_
�5 307 ,69
No.and Street Telephone Emil Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s Iterations) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work:
v
SECTION J: ESTOIATED CONSTRUCTION COSTS
I1e111 Estimated Costs:
Lab^or Qand Materialsl Official Use Only
I. Building f g Y � I. Building Permit Fee: f Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project C'ost'(Item 6)x multiplier x
), Plunihing S 2 —'-- _ ..._._._
Other Fees: S
q. \lech:mical (ll\AC) S Lisl:_
5 .\Icchanic;d (Fire --_-- --- _ —
Cu,+ressionI S Total .\II Fees:
qCheck No. _ ('heck Amount: _ Cash \inuwic _
o. Total Project Cost: J( i0 ❑Paid in Full ❑Outsr u,Jing Ilul:mce Doc:
e�G 1 001 olx-�rGC �7/l
r
SECTIONS: C'ONSTRUc.'rION SERVICES
5.1 ('onsiruction S )ervisor License(C'SI•) :7)'3 0 �s l 5z1 !
---- 11 — --- -- - ---
N I.Ice--Nunlher Pxpiration Rule
Nunc of C'sl. 11"Wer _
I is1 CSI. D) Isce 1100% l-_,_-_____
--r— � `..--- ------------ .I'}pu Description
No and S�vt
ll tlnrestrcied(lhlildin"hi to 15.000 Co. 11.)
__ _ R Restricted 1r2 Pmnil Dwcllin
Cit)ifoem..Stale,LIP AI �losan
covcrin
`� 't -. ._ µCS N'inJua ;ulJ SiJin
SF Solid Fuel Burning Appliances
I Insulation
1'cic bona Entail address D Demolition
5.2 Registered Home
�Je-rpvement Contractor(HIC) Ia sSC� 3
SC ' �/ 0/ V-0ct IIIC Registration Expiration Date
IIIC Contpa-010 NaeorIC egistrantNa�m
No.and Street n- Limail address
City/Town,State,ZIP Tcle hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152.4 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 .......... 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 Dwnei 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 trpe and accurate to the best of my knowledge and understanding.
,SZ (� I __ ro(/ a-1 A
Print Oenei s or.\ulhorireJ,\gene's Name I lilectrooic Sign:aurc) 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 Hume Improvement Contractor(HIC) Program).will no have access to the arbitration
program or guaranty fund under M.G.L.c. 1 a_'A.Other important information on the HIC Program can be found at
�sltw n .ns ,1 :V.I Information on the Construction Supervisor License can be found at io,: Inn
2. \%'lien substantial%vork is planned, provide the information below:
Total floor area I sq. ft.) - (including garage, finished bauntenCattics,Dacks or porch)
Gross living area(sq. it.) ---- —_ -_--- -- Habitable room count
\amber of fireplaces-_. Number of bedrooms
iNum her of bathrooms - . _ . _ .. Number of half haths .. -
I)pe of heating i)ilem _ . - N'umher of decks, porches
i
11 pe l eOp IIIg it sICIII 17I1cosed - - -_011cll _
). "Total Project Square Footage"maq he substituted lilr"Iotal Project Cost-
� 1
203 WASHINGTON 5T.N256
PRESERVE SALEM,MA 01970
carpentryI aintingIroofingIgutters PHONE:978.745.8745
SERVICES
FAx 978.745.3476
SALES@PRESERV ESERV ICES.COM
hu
55 Ocean Ave Condo Date sid:lo/z8/zo11
55 Ocean Ave
Estimator:Sean O'Connor
Salem MA, 01970 Email:sean@preserveservices.com
(503) 709-3969 Mobile:(978)395-7737
ROOFING ESTIMATE
COMMENTS Replace the roof on the front porch.
PRIOR PREPARATION
DISPOSAL: A dump truck will be used to dispose of the shingles.
ROOFING PREPARATION
COVERING: Tarp the exterior of the house so as not to damage the siding.
SHINGLE REMOVAL: Remove all layer(s)of old shingles.
NAILING: Re-nail roof decking as necessary.
CARPENTRY*
Remove the siding up 1 to 2 courses. Install the rubber underlayment from the roofing deck up the wall.
Install new cement siding.
UNDERLAYMENT
ICE AND WATER SHIELD: Install ice and water shield on the entire roof.
FLASHING
DRIP EDGE: Install drip edge on all perimeters.
WALL JUNCTION: Remove the siding, ice and water shield the junction, reflash with step flashing.
ROOFING MATERIALS
ASPHALT SHINGLES: Install architectural shingles.
LOW SLOPE/FLAT: Install rolled asphalt roofing.
l
LOPE/FEAT: Install rolled asphalt roofing.
NG
asic z$ 990D
F Sales Tax $ 0
Total Price $2990 including Labor& Material
Payment Terms: 20%deposit(day of start); 30% progress; 50%end of job McNisa/Amex
f: VYMr►�
Sean O'Connor Customer Signature
ADDITIONAL TO ABOVE ESTIMATE:
BID 1: Replace 2 downspouts on the left with 2 x 3" aluminum downspouts.
Price$425 Including Labor and Material
Installation Note:
If you have an older home that has dimensional lumber for roof decking you will need to cover your
attic because shingle debris may fall into the attic and create a mess.
*Above additional prices includes all discounts and coupons discussed prior to estimate. The
above quote is valid for 60 days.
*Warranty: Craftsmanship: Kyron Inc. DBA Preserve Services warrantees all work performed
for a period of 2 years. If any problems occur we will cover the cost of labor and materials. For the
warranty to be valid the invoice that was presented at the time of completion must have been paid in full.
Materials: The duration of the manufacture's warranty is specified in the materials section above.
Licenses:
Home Improvement Contractor(HIC): 123553
Protection: It is required by law that roofing contractors have a home improvement contractor
license. If a contractor is properly registered, you are entitled to limited protection by the
Residential Contractor Guaranty Fund up to$10,000. (The above is a only a summary of
Massachusetts General Law 142A) To check our license or our competitors go to:.
http://db.state.ma.us/homeimprovement/licenseelist.asi)and license 123553.
Constructor Supervisor(CS): 93403
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a u d nE Bui9drn r snr L,a
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CS g3403.
is se:
SEAM OCCNNOR :
2g CHESTNV?
' _SAI-EM,MP:01g7p ,
tt�tt _
E%piration:
Tr: t
b
onnniuncc
�g am n rs��°"ness"'ltego ation ..
Ofiiite o�`onsnmer CONTRACTOR
NO
� HOME IMPROVEMENT Type:
�6 Registration t23553 pBA
Expiration 31612,013
P e we Pamtm9
Sean O'Connor - o_
203 WASHINGTONST #256 undersetmtlry
SALEM,MA.01970
•
AC oRd CERTIFICATE OF LIABILITY INSURANCE e�i5�zoii
THIS CERTIFICATE M ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR.NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: 0 the certificate holder Is an ADDITIONAL INSURED,the poliey(les)must be endorsed. If SUBROGATION IS.WAIVED,subject to
the terms and conditions of the policy,certain policies may require anendorseme L A statement on this certificate does not confer rights to the
certificate holder in lieu of such endoraeme s.
PRODUCER NAME:CY Boynton. Insurance
Boynton Insurance Agency PNDNE ). (781)449-6786 FAX N,I.(781)449-4239
IR 72 River Park Street 'MAIL
PROREes:
cusmM 00004109
lNeedhalft MA 02494 .IMSUR 8 AFFORDING COVERAGE NAIC0
INSURED INSURERAMaE Specialty
Kyron Inc. nasuile:Nartford Insurance
DBA Preserve Services INSURER C:
203 Washington Street,0256 aERD:
Salem,MA 01970 IN9 INau=R:
INSURER
COVERAGES CERTIFICATE NUMBER:14-18 onion St. Condo REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
. BISR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICYW UNITS
GENERLLWMULITY EACH OCCURRENCE $ 1,000,000
DWAACE TO RENTED
E COMMERCIAL GENERAL WIBILTTY PREMISES Ilia acaarence S 50,000
A CL'AIMSMADE 1Z OCCUR la=13100002122 /23/2011 /23/2012 MED EXP(Airym pws ) $ 5,000
PERSONAL S ADV INJURY S 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO $ 2,000,000
% POLICY PRI LOC S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMB S
(Ea ectldarll)
ANY AUTO _ BODILY INJURY(Pm Panm) S --
ALL DINNED AUTOS BODILY INJURY(Per accident) S
SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (Per acleam) S
NON-0NNED AUTOS $
S
UMBREIIA DAB OCCUR EACH OCCURRENCE S
EXCESS LIAR CLAMS-MADE AGGREGATE S
DEDUCTIBLE $
RETENTION S
B WORKERS COMPENSATION 2L 'AC STATLL OTH-
ANDEMPLOYERS'LUUMUTY YIN
j ANY PROPRIETORIPARTNERIEXECUT1W❑ MIA A E.L.EACH ACCIDENT S 100,00
OFFICERMEMBER EXCLUDED?
(MWKWM In NH) 860080523N00910 /20/2011 /20/2012 E.L DISEASE-EA EMPLOYEE $ 100,000
n yaa deaciEe OF O
DESCRIPTION OF OPERATIONS Dakw E.L DISEASE-POLICY LIAR S 500,000
DESCRIPTION OF OPERATIONS ILOCATN)N81 VEHICLES(AURCh ACORDIOI,AddlSanel Roman ScN 1 ,NnanrpW MnRNnd)
CERTIFICATE HOLDER - - CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE
THE, EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Chestnut Place Natick Condominiums ACCORDANCE WITH THE POLICY PROVISIONS.
60 South Main Street
Natick, MA AITHDRIED REPRESENTATIVE
Michael Nerrill/MRM
ACORD 28(2009109) 01988.2008 ACORD CORPORATION. All rights reserved.
INS026(2w9w) The ACORD name and logo are registered marks of ACORD
CITY OF SALEM
Ali
PUBLIC PROPRERTY
DEPARTMENT
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position orerilnin+l penalties of
of up rn i'10 t10 a Jay I�uiva dlt vLthtrae Ile advl.a'd thm+copy of Ihls slatemwu may be IurwarJvJ to the Ullia'o Wt'
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' I�.,if lq lit nun:
I
information and Instructions
v v,san to the service of another Miller.'hy comnct of hire.
�t.u;,'ehuipy licneral Laws:hay(er Ii2 ey twres+Il euyrlo)ep to provide workerf compens+hon R,r hear employees.
I'unuant to his +t+tute.an c,epfrrree is JerineJ as a cry p'
.press or InIi oral or wniten." orahun or uhcr legal entity,or any two or more
urtnanhip.•rssuetanus.Cory lit ,.r or he
in c,nplygcr„Jelgjggncd i"an individual.i eter pten lit m vm loyees. However he
.,t the I;trequmg cngugeJ m a lomr enterprise.
rth p,rstsoeta wit or other legal enaty'empu ya �cehe amp
,eemvcr or uuaaee ul'.ut iudivtJual, p
employs ions to do maintan o f such employment be JeemeJ tu;t,on of flipaj, ,lit on ube dwelling ctnpluyer."
owner of a dwelling house having not more than thrd apartments and who refidas hermn,of he occupant of the
,ltvelhng huuid of aaohac who unman thereto shall not because
or on 'hc grounds or building aPD
�IGL chapter 152. t25C(6) slfo fracas thus"every Irate at focal licensing agr is i shag withhold the Issuance
o rad or
Ib
Usna Ilk the Insurance gSubJivisions ehsll
renewal Pt a license or permit to operate a husinses at to construct bulldings le the commes ego required."
e or any
cit of
uyplleuA, who has not produced jgcopl ab+tesle YlNepher he,:ommonwe+Ith nor any of ins political
\JJirlonally,MGL chapter 157, l-
5071 inter into any contract fa he parfomian a of Pit o the caairsct ,aluhrarsryviJanes ofcwupliwaee with hd insurance
gj
requirdmenis of his chuplat have bean p'
applicants chit boxes that apply to yuu(situation arid,if
os and Kona numMds)Blond with thou cdrtiflcatd(s)of
plea:ut rill out the worker' compensation affidavit cmnple d p by neekm{ with nit employ'go other than the
necessary,supply sub•eontractor(s)numals),aJJrss( td D
worker' compensation irouraAct. If an LLC or LLP does have
insw+na• Limited Liability Companies(LLC)or Limited Liability PaMenhips(LLP)
mmnbdr It plaint, are not reel) to carry
membeploy4MIass,u policy is required. Itd advisdJ that this affidavit'nay M submitted to the Ospurtmdnt of Industrial
vi
\ecidanu for policy
is requ re irnursnea eoverge klast be lure to sign and date the ut'fldavlL Tlsd atfitlsvit should
ution is regarding,the low ur if you eta requited t000btain
ta shouldWorkers'
their
he ridditt J to clad city or town that the application for the permit of license is WAS requested,not the WPaRmcat o
ent
industrial Aeeidants. Should you have any q
eotnpensatiun policy,please tall the 0eptWndnt at he nutnba listed below. Salfina comp
sel6insurance license number on the a ro slate line.
('Ity of'raws Offlelsls
The Da mien has provided u spud at the bottom
he a lieant
Ptcau he suro that the affidavit is cwnplete;mJ printed legibly. beam
it( jig aitiduvit for you lit till out in the event the Ottled of Investigations has to contact you regarding PP
i'I:use be sure to till in,ho parmitllied,rse nwnber which will bit usdd as a rel'only submiterence t Unlir. I1 addition,an app
thin must iubmit multipis pennih'licansd applications in any given yens, need only e one oteatiun indicating(Mien
�d the
marked by drd city or town tray be provided to he
rufiey infra motion(if necessary)and unddf"Job Site Address"the applicant should write"all luwtiuns in (cry of
htwnl.",\copy of the utfidavit that has bans afnciully stamp
Penn"not related to any business or comnwroial venture
applicant as proof that a valid JI vit is un laid to lure Htlure permits or licenses. A new a1Tlduvit must ha "'led out each
y ear. \0'hcr+humd owner or cilircn is obtaining a licsnsit er p
i i e. .1 Jug licanne or permit to burn leaves ate.) laid perstn, is 110T required Incomplete this atndavit.
I he )Itf:c,d Inve,rigatiuns,vauld lied w Jwnk YOU in advance lut your cooperation and ehuulJ you has .tnY ywshans.
plca.e Ju not hcsharo to grve us a call.
the ucpan nears adJra,f, telephone aThrJA
Comunanweakh of MI»achusetu
Depument of Industrial Accidents
Ofne• of[av"Updans
600 wuwriston Street
Boston, MA 02111
('el. 4 617-127-1900 ext 406 of 1.817•MASSAFE
Fax 0 617.727.7749
,,.115 ,rww.mass.joy/dig
CITY OF S,V-&NI, AlissiwFi 'SETTS
BLLLDLNG DEP.1ATtH.\T
120 W.ksj4LVGTON STAEgr, j e FZOOA
lM (978) 743-9595
KENMERF EY DAMOLL RUt(978) 740.9&9
MAYOI! TNO-%LUST.Pt XA4
D"EcrCA OF PLSLIC PROPEATy/q(:MDCq;COSLMISS(O.NER
Construction Debris Disposal Attldavit
(required for all demoli 'ho n and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section i l 1.5
Debris, and the provisions of MGL a 40, S 34;
Building Permit # i
l I s issued with the condition that the debris resulting from
I work shall be sposed of in a properly licensed waste disposal facility as defined by A1GL c
l, s lsoa. di
The debris will be transported by:-- -
n'l.it �v m pSl
(name of'hauler)
The debris will be disposed of in :
(name or raciliiy)
(iddres,Of
�idn+nue OrDermrt Jpphcanr
late