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91 ORNE ST - BUILDING INSPECTION (3) g y. 6k-40 The Commonwealth of Massachusetts ' Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: D Applied: Building Official(Print Name) SignaturiX Date SECTION 1:SITE INFORMATION �Y 1.1 Prop r Address• 1.2 Assessors Map&Parcel Numbers 1.1a 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(ft) 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Record: ��/LG9�T,�QY1T .1fi>�lJ�� Name(Print) City,State,Z 91 Die 17 339-yy0-Z No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKz(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work: &',� -%S D! 6&A,7- 2yy /a�w SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ a ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (RVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ !' D ❑Paid in Full ❑Outstanding Balance Due: Y,Y\n t �� w Cps/�. kill QH SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cc:)C,. r / =f 0 f/T/3/t License Number Expinni n Date Name of CSL Holder v J��(% q�' Lis[CSL Type(see below) `e'� � Type Description No.and Street U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZTP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 9Tw 4AT07 '&A • —APA—Mrl; 'O�yrdlifj�IA I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 3 �7D�� �C©lL . / O7 HHIIC Registration Number Expiration Date HI ompany Name or H C Registrant Name f�L i �� fY9�� �JO eelaw7e;w 11W No.aMiNactree , mow e /wlo ��b�,_S��� Email address Ci TF/'FToo//JJwn,State,ZIP Tele one SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c152.§ 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 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 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 n�ithis/appli�tiioon is true and accurate to the best of my knowledge and understanding. �til�� .�/ ni OwnerroKAiithorized Agent's Name(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 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. og v/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,fmished 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"maybe substituted for"Total Project Cost" CITY OF S�U.ENJ, N'L-1SSACHUSEM BUILDIING DEPAR-MIENT • a• 130 WASHINGTON STREET,3w FLOOR °j TEL. (978) 745-9595 FAX(978) 740-9846 KIMBFRi EY DRISCOII MAYOR I ht lioAs ST.PtERRIi DIRECTOR OF PUBLIC PROPERTY/BUILDLNG COMMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r Please Print Leeibly Name(Busing-WOrganizatioMlndividual): Address: I'%UI�1ly' City/State/Zip: ��aQa�?y �ii9 /919�Q Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1,a I am a employer with 2— 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time). • have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp. insurance. 9, ❑ Building addition [No workers'comp. insurance S. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officer;have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13,❑Other comp.insurance required.] •Any spplivant tam checks box ill most also rill out the section below showing their warken'compensation policy infurmatiom t I I..who submit this affidavit indicating they are doing all work and then hire outside eontrecbta must submit a new affidavit indicating such =C.mrractors that check this box must attached an additional sheet showing the name of the subcontmcwn,and their wothers'comp.policy information. I am an employer that Is providing workers'compensation Insurance for my employees. Below Is the policy and Jab site information. Insurance Company Name. Policy#or Self-ins.Lie.#: 117".Y�O � ,��% Expiration Date: g2,� ,29 Job Site Address: City/State/Zip:=�e J,s"6;, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerNfy� puins Ides of perJury that the information provided above is true and correct Sienantre: Date! Phone OJjchd use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Ilealth 2.Building Department 3.Cityffown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: RON SHAH 5 Stuart Rd. Peabody, MA 01960 Tel.(278) 815-0789 Fax(979)977-7889 MA Lic#035-041 H.I.C. # 132777 Fed. I D# 13-4244899 EPA Lead Safe Renovator#NAT-32996-1 CONTRACT Re-sidefront of barn at 91 Orne St. Salem. MA as follows: 1. Supply building permit from the city of Salem. 2. Remove and dispose of existing siding, trim boards around entry door and right hand comer board 3. Install Asek corner board and Asek trim around entry door. Re-putty window above barn doors. 4. Install Tyvek or Typar house wrap. 5. Install primed#I r&r red cedar shingles, 7"to the weather coursing. We will use galvanized ring shank nails to install the shingles. 6. Prime all new surfaces with oil based primer and paint one coat of latex paint. We will also do the same for the existing window and door. Price: S 11,800.00 NOTICE: THIS CONTRACT MAY BE CANCELLED BY THE CUSTOMER BY NOTIFYING THE CONTRACTOR BY CERTIFIED MAIL OR TELEGRAPGH WITHIN THREE BUSINESS DAYS OF SIGNING. Schedule: Work to commence on or about June 13, 2016 and be substantially complete by June 25, 2016. All home improvement contractors are required to be registered and any inquiries about a contractors registration shall be directed to: Registration Division,Program coordinator One Ashburton Place Room1301 Boston,MA 02108 617-727-3200x25239 Warranties: All material and workmanship shall be warranted for a period of one year after final completion unless the manufactures warranty is for a longer period. Permits: The above project requires a building permit.The contractor shall obtain said permit.Owners who secure their own permits or deal with unregistered contractors shall be excluded from access to the guaranty fund. Terms of payment:Deposit of S 3000. due upon contract acceptance,balance to be paid weekly based upon percentage of completion. Do not sign this contract if there are any blank spaces. Accepted by ow er By contractor 4 Date 9_U atd �� i Unofficial Property Record Card http://salem.patriotproperties.com/RecordCard.asp Unofficial Property Record Card - Salem, MA General Property Data Parcel ID 28-0016-0 Account Number Prior Parcel ID 61-- Property Owner CABOT FARM TRUST THE Property Location 91 91B ORNE STREET LUTTS ROBERT T&RACHEL N TRS Property Use Multi-House Mailing Address 91 ORNE ST Most Recent Sale Date 11111900 Legal Reference 11687-582 City SALEM Grantor Mailing State MA AP 01970 Sale Price 0 ParcelZoning R1 Land Area 27.300 acres Current Property Assessment Xtra Features Card 1 Value Building Value 347,800 Value 69,800 Land Value 711,000 Total Value 1,128,600 Total Parcel Xtra Features Value Building Value 593,600 Value 69,800 Land Value 711,000 Total Value 1,374,400 Building Description Building Style ANTIQUE Foundation Type Brick/Stone Flooring Type Softwood #of Living Units 1 Frame Type Wood Basement Floor Concrete Year Built 1763 Roof Structure Gambrel Heating Type Forced WIN Building Grade Good(+) Roof Cover Metal Heating Fuel Oil Building Condition Average Siding Clapboard Air Conditioning 0% Finished Area(SF)3192 Interior Walls Plaster #of Band Garages 0 Number Rooms 7 #of Bedroom 4 If of Full Baths 2 #of 314 Baths 0 #of 112 Baths 1 #of Other Fixtures 0 1 of 2 6/16/2016 11:16 AM Unofficial Property Record Card http://salem.patriotproperties.com/RecordCard.asp Legal Description Narrative Description of Property This property contains 27.300 acres of land mainlyclassified as Multi-House with a(n)ANTIQUE style building,built about 1763,having Clapboard exterior and Metal roof cover,with 1 unit(s),7 room(s),4 bedroom(s),2 bath(s),1 half bath(s). Property Images 9 Disclaimer:This information is believed to be correct but is subject to change and is not warranteed. 2 of 2 6/16/201611:16 AM