71 OCEAN ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
000 Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) P Date
SECTION 1: SITE IN RMATION A
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
I.Ia Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) 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.L.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check iPyes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2. wner'of ecord: IAAA
IAw 4 ) �` y 64few 11414 Ot n
Name(Print) City,Slate,ZIP
I � ce4" s t qas-�y(I_LJ s9
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building V I Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
a ll S i l+
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ b 8 p O I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $
❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier - x
3. Plumbing $ 2. Other Fees: $ ,q
4. Mechanical (FIVAC) $ List: /
5. Mechanical (Fire $
Suppression) Total All Fees:$
/ Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ lb �D 11 paid in Full 11 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
C'044-� C j���,v1 License Number Expiration Date
Name of CSL Holder L
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.fl.)
i U/ a s D R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
,+
SF Solid Fuel Burning Appliances
e l-4 5-31 nj O S 6 1 1 Insulation
Telephone Email address D Demolition ff
5.2 Registered Flume Improvement
Contractor(HIC) �'6 �' S3 CL l
vAw L�-SA4 �n-rwr ttn "9_ HIC Registration Number Expiration ate
HIC Lompany Name or HIC Registrant Name
No.and Stre t Email address
11tlil- � B� Ste— E/a Sy1 6
Ci /Town,State,Z P Telephone
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 ........K 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 �_ �AH �- \ �/ , 419
to act on my behalf,in all matters relative to work authorized by this building permit application.
T�A ✓� I[a ey la-/a6%
Print Owners Name(Elec rei is Si ture) Date
SECTION 7b:OWNERS OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 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.
nt Owner's Pri or Authorized Agents Name(Electronic Signature) Date
NOTES:
l. 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 M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,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
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
tip JU: 6 w
�, _.- CERTIFICATE OF LIABILITY INSURANCE J.
THIS CERTIFICATE IS ISSUED AS A MATTER Or INFORMATION ONLY AND CONI ERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 4MIFIl EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOE.; NOT GOIll. A CONTRA( I BETWEEN THE-- ISSUING INSURER(SL AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOIJ)l 14
hoidenis all ADDITIONAI. INSURFf 1. the polRyli's) Iss," Il orld-mmi, It SUBROGATION IS WAIVED,Isfitil Y,
file terms and coiditioss of I ll 'is"ar"pohil'., silly"),jum! ondoiseirl A statismitsit oil I cortifiIi:fshe(10if list confer riShts 10 the
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CERTIFICATE-HOWE-R___ (-ANCEILLATIONJ
THE ABOVE DESCRIBED Pi HE CANCELLED BEFORE.
Eddence of Insurance ITIF EXPIRATION DATE THEREOF NOTICE WILL BE OFIWEREA) IN
ACC(RTOVNGF,Vil THE POLICY PROVISI
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For NOW purposes aniv ............. .......
ACORD 25(2001 DCORPORAIION
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CLINTON GALVIN
102 DELMONT AVE,APT 2
LOWELL, MA 01892
71112014
ORec of C onsumcr A11min& Basiness YLegidvf:ou
HOME IMPROVEMENT CONTRACTOR type
Re9istr fion_ 169538
` Expiration. 7k11'2013 Private Cnrpoialioi
?,N AND SON ROOi=11VG lIVC.
si-.!P,iTON GAL'VIN
S):i IJ-W SALEM S f
14JAKEFIFLD,MA 01880 tlndersccretnry
The Commonwealth of Massachusetts
- - - - -= Department of Industrial Accidents
Office o//nvertigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Nand:(Busitass'/Organ)<mii /Individual): _Rl�i�i�^L._
'-< r/�
Address:__
Are nu nn emtoer will]
Check the appropriate box: Type of project(required):
em 4. [J 1 am a general contractor and I
(i
P Y - L-_j New construction
ployees(full and/or part-ime).' have hired the sub-contractors
2.❑ 1.am a sole proprietor or punnet., listed on the attached sheet. t 7- ❑ Remodeling
ship and have an employees Iliese sub-contractors have R. r1 Demolition
workingfor me;in an ea aell _ workers'Comp. tesurance q
Y p Y ❑Finilding addition
I,No wen'kers'rump. insurance We arc a corpixffiion and its
required-J officers have exercised[heir iU.❑ Elcclrical repairs or additions
,1.F f am a homeowner doing all work right of exemption per MGL I'I.�,f Plumbing repairs or additions
y npp myself r mmNo workers'comp. — employees.I(4) and or hour,no 12.n R her_pairs
P [No workers' � s.� r _
cool - 13_ _
ao insurance required� c inwrance regwred) ,..
ch ks Mix HII mua also fill om aw Re tion below vho iiig then tkcm'a topcnssho Policy inlinmalimt.
t Nomenwtxn whit submit this affidavit u0icating they srcdoing nu wwk aml Hteo hbvuiiWile caua morn nuts)submit a new of idavil indwatingsach.
ICnnvucmrs ewt chmk this Mix must ammhcd an rdditioiwl sha:t shown.µ tips,noun.of ate sub-canunctms u.0 aids wmkca'cutup.ptdicy information.
I am an employer that is providing workerv'compenvadon invurance for any e.mp/gyeay. Below iv the policy and,jab site
information-
Insiaance Company
Policy H or Self-ins.I ic.N ---L5�.at".u-aj-4 FT 1 i�.�6�'/ _/t Expiration Date
Job Site Address:7,v- <:ily/State/%ip:...
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
hailmc to securr,coverage as r_quimd under Sechou 25A of MGL c. 152 can lead to the imposition of erinrinal penalties of a
firm up lu$1,500.00:uu1/or one-year nnprisionnent,as well ny civil penalties in the tiwnr of a S tOP WORK ORDER and a tine
,It tip to$250 00 a day against di_violator_ Be advised that a copy of this statement may be forwarded to the Office o'i
Investigations of the D:IA for insurance coverage verificaGou.
do Hereby tarn er a a, S prna .. o/'per ry than the information provided above is trueand correct.
lldlL•I mti ...._ _ . I)nte:__
Phone IF:—.___..
(lfracial save only. Do not write in this area.to be completed by cite or town ofciat
City or'lown: Permit/License H
lvvuing Authority(circle one):
1.Board of Ilealth 2.Nuilding Department 3.Cityfl'ow,,Clerk 4,baeclrical Inspector 5.Plumbing Inspector
6.Other
Contact Perron: Phone k:
° Proposal
93 New Salem Street- Wakefield MA OISSO
iCk(i17-571A05G EmaiF.RyanArnl$on$GeL�le.a>m -
www.RyanAndSonaooting.com
Submitted To: lob location:
Ocean Avenue Condominium Association
71 Ocean Street 71 Ocean Street
Salem,MA 01970 Salem,MA 01970
PhOne#: 978-744-4059
PmpOSal date: December 27,2011
We are pleased to hereby submitthis proposal to furnish materials and labor,completely in accordance with the below specifications:
(Additional charges may applyfor any changes not included below in proposal either by request of owner,or if Ryan and Son Roofrngfinds unforeseen
circumstances that will affect the performance,quality or integrity of this job). In the event legal action is taken to enforce any provision of this
agreement, the prevailing party shall be entitled to all its reasonable costs,including reasonable in-house or outside attorney's fees. Not responsible for
debris in attic.
THIS PROPOSAL IS TO:
Install vinyl Alside Solid VIOMsiding:$16,600.00
• Prepare existing walls of house for installation of vinyl siding
• Install Tyvek house wrap on entire house
• Install vinyl siding on house,in style and color ofyour choice
• Install J-channel to match siding color around all windows and doors,to receive siding
• Install all outside corners to match siding color
• Install white vinyl soffit
• Wrap all soffit,fascia and rakes in coil stock
Clean tip:
• Will cover area with tarps to minimize debris
• Remove debris related to work
• NOTE: Please cover any belongings in the attic,as they will get dusty,ifapplicable
Payment Terms made as follows: ('Phis includes labor, dump&materials)
Install vinyl siding price: $16,800.00 K/ldvly RF*r- o tY.4Em— re
T0181 COSI.•(If no changes] $16,800.00 Peter Ryan
1't Payment due UPON Signing; $800.00 TfffWK Yo011
Balance due upon completion: $16,000.00
i
Respectfully Submitted by:/0-year—on
c L — epte$lHl:
All work is 100%guaranteed Pe all craftsmanshi II bfficr warrantees are through the manufa urec All arran s will be null&void if
job is not paid in full.Thank you for letting us serve you!!! Ryan And Son Roofing,Inc.is fully licensed(#159797)&insured.