3 PEARL ST - BUILDING INSPECTION t
\� The Commonwealth of Massachusetts - - - CITYY OF
-
Board of Building Regulations and Standards
SALEM
a)10�) Massachusetts State Building Code, 780 CMR RrrLre(.l&u 201(
JJJ
Building Permit Application To Construct, Repair, Renovate Or lish a
On' or Twu-Fcurrily Du r(ling
This Section For OI a Use On[
Building Permit Number: D to Applied:
Building 011icial(Print Name) Signature ate
SECTION I:SITE INFORMATI
I.fo}terty Address: _ 1.2 Assessors Map& Parcel Numbers
JJ
I.la Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
ZoningDistrictProposed Use Lot Area(sq t1) Frontage(11)
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 D/isposal System:
/ Zone: _ Outside Flood Zone? Munici al C'l On site disposal s stem ❑
Public l3 I rrvate❑ Check ifyes❑ p p 5
SECTION 2: PROPERTY OWNERSHIP'
2.1 awnert of Record:
YETi9YerS �/ r�r� titff- 9
N:une(Pant) City,State,ZIP
No.and Street / Telephone / Email Address
SECTION 3: DESCRIPTION OF PROPOSED W RW(check all that apply)
New Construction❑ Existing Building Owner-Occupied 01 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units Other Specify: -i- dew
Bri f Description of Pr osed Work': 1 C G
MAY D
S
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itern Estimated Costs: Official Use Only
(Labor and Materials)
I. Building S I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
'_. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ 9/
1. Mechanical (11\':\C) S List: '
5. \Icchaniral (FireS Total All Fees: S
Su tressionl
� Check No. Check Amount: Cash :\uxuuu:____
6. Total Project Cost: S /J �Q 0 paid in Full 13 Outstanding Bal:mce Due:
t ,
SECTION 5: CONSTRUCTION SERVICES
7S(rcet
ervisor License(CSL)
License Numintr Pcpir;niun Uolc
List CSL'I)pe(sec below) � tr—
TN Pe Description
A+ / (A 6FAe Q LI f Inmstricted(11 oldin gs no l0 35,000 cu. it.)
l
R Restricted I&? I.amil .... n rty(1 otrn,Sr c,ZIP M Masonr
RC Roolin Covering
W'S Window and Sid:-
/'^� SF Solid Ivet Burning Appliances
I Institution
h'I cic one Rmail address _ I Demolition
5.2 Registered Home Improvement Contractor(HIC)
-adf=e 7k
I I (. Col pan) Nam•or 111 R,w trant Name IIIC Registration Num irrtion Date
No tJ trees Email address
C(JAo All2r9crs q rele one
i /Town, ate,ZIP 'Tele hone
SECTION 6Esubject
WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 15C(6))
ompensation Insurance affidavit must be completed and submitted with this application. Failure to provide
it will result in the denial of the Issuanc f the building permit.
idavit Attached? Yes .......... No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
of the subject property,hereby authorize
y behalf,in all matters relative to work authorized by this building permit application.
s Narne(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.
I'nm Owner s or,luthonzeJ Agent s Name Ilaec •. 'gnawrc) Date
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 M.G.L. c. t ?A.Other important information on the HIC Program can be found at
w)t_).ma's ygp oca Information on the Construction Supervisor License can be found at g���q.nr-s:._ot:Jp_
_'. When substantial work is planned, provide the information below:
Total floor area(sq. B.) _(including garage, finished basentent'attics,decks or porch)
Gross living area(sq. it.) _ Habitable room count
Number of lircplaces- -_ Number of bedrooms
Numberof bathrooms ------ ------
-----_-------_------ Number ofhalfbaths _
I)peof heating s)stem -_---------_-.__— NuntberofJecks, pordtes -------- ------
T)peofcoolings)stem .. ----------
--- —_---------_-- Enclosed O en
----------
3. "fatal Project Square Footage"ma) be substituted for"Toud Project Colt-
- 5% CITY OF SALEM
PUBLIC PROPRERTY
3° DEPARTMENT
.1.1l. e:ly 191%4,91
III11 rt
I!C \Yn Hu.\U lu.�jCrlhl' M.i%%At.Iof r111r31'/7�
I'I•.1. 'i7t;f3.93',3 • I'Lr v/s.;/C.'trb
� 1 tllcant
Workers'allf In urinallo Cumpenxatlon Insurance ,\f(lduvit Uuilders/Cuntrector3/E lectriclifnx/ptumben
I/ oil .� Int Le 'hl
�I:IITte]IILnnlu.r;e7rganv�linrvinJlrnluulC� aYi r����
Wdres.r: �—
C ily,St:ltc,%ip OrGtPhone
ifi �7�
I .try t vorydoyer:'Chauk the apprnprlate box;
I. 1 inv a umpluyvr wish o2_ 4, ❑ I '1n a dcncral cnulnetor and I t yM nrprojeet(required):
�•0mnpluyvus(full illwur parl•iimr).a huve hireJ the suh•clinirach,n fi' ❑Name canstrucliun
1,1m i sold prnpriehlr,or partner• listod on the.,nached sheet 7 7• ❑Reinwleling ship and havd no clnpluycus These subcontractors have lrorkind file me In any Valli workers'colnp, Insurance. d' Demolition
I fin wnfitcra'cutup• insurance J. ❑ we ara a cnlporatinn and iu 9' ❑ ouildine iddagun
ruyuir&: oty'lcan hive unaircimVill their 10.0 Electrical repairs or additions
1.❑ 1 um a hmrwu,n+ur Juine all work right ufu.reniptinn per AIQL I L❑Plumbinr rcpuin ur aJJitiolta
myself. (K'o workers'comp• C. 152. �{I(4)•and we hnvd nn illsurancd rcyuired.j / unpluycen. (h,•o workers• l�•❑ Rwl'npuira
crnnp insurance reyuirud.j U.Q Other
.;t heuM Ihel thud*INA rl novel.Ilw till uu1 the vtrnua Wage dwwnt I I luTyel VlwfeMhe,lllM,ll ibis emllevll i14lleJ,in I x IkM wwtta/'elrlllyeuylun Jlrtley llllilrwlll/iu1►a F"+a Juinx cal.vurk 1ne IMw hew"side eunrnetew Mug.
r.MlrMl„Ir Ihel lheek Ind box Inlet neihed an ieattiu w Jove,,AYwieee the nL,1e rJlhe rux,:gmer
w vhnM a Ieew rinaeril inJlullinx vN'k.
/ilia un vulpleyrr dlur IV prvvlJ/nr 1vorArrs'rurnpermt/sa Lrrarnnee/or toy r/n oom and 1AeIr wvA,te•cony le,hcy Inlhnnenua
is/onnutl na pl J erp Blla/r/l/Ar pylLy eH��ol 1%/I
Imurancv C',Inlpaay Vame: _
I'nlicy 4 or Sulf•ins..Lid.ri: —
Etlpirallon O;ua:_�
/ub Sitd. .lddres.r:
.Utury t a copy Olt Iha)workers'cum
1.111ure pcnratlna pulley Jvelaralldn page(show)ll rhetpollcy number and expiration dare),
o.ccuro curaruge as required wider Sccliun:!r\ "I'-%IOL C. 152 eau lead to file iroltosition oferiminal yanallies of
wit m.)lO 0(Ma Jay 14ainll the 0.I10 anil/uru,w•yea nnprisun neat,
0/ ur wall as civil pcnalltcs in IN funn ofa STOP 1VORK ORDER and a fine
rti 141 to L'10_ vfol.lmr. Ile advrad thus a cwpy❑rthir.Iulelnunl may be Iur,varJeJ to the Ullicv of
InI..,n�all'Im ul':Iw UL\ .or imur.u'cu.Ilvcra;e ,.nti.utum.
/du/rrrrey,.reify rurJve dhr plrinr�mJpmu/tier v/prr/nry that//to in unna!/oa/ prur%JeJ ueerr is trur lord vorrecc
I
r1%//ciul,r,e u„/y. po,1n/�rritr in Utit urea,/u A.ra,,,pi'et.J ey e;ty or rolra„/�8 in
i
f itv ur I'n wn:
I„uin l VennirtLkentr
ti . ulAurify (circb nnul:
I. II0ivir 'If IIv..11f 11 !. Ihuhbtt�' Ikp.0 hwelll I. Cit) 'fund Clerk 4. L'Icctrloll In, lcrtur
� G. I)Ihvr
i I f Iumbiny In,ytNor
.__ I'hun.. 7•
information and Instructions
\l.l)aaC ltaaelU lJC^Cral Law!Chaplet 132 ,\yulres alliveplJ"+aa IA IhG`1Cry Je of anulhef Wt tell nny c ntnct f hire,s.
1'ornu.utt to mla>laluld, an+mplgr'et is Jelined a!" ry P' .
Press jf „nphcd, oral or written." two or snore
�n .•,nplupef,s Jctincd>s"an individual, partnership,.lssoeiauoo,corporahun ur other cgal entity,or any
t ,hC toregomg eny'jlI m a Joint entorprise, and iltciallod the legal rgal%malutives la an c.mslOccs Illowever. the
Occupant of the
,ecelver or ousted of.ut indi,vir,%, of ino rshlp, thr eta ee par or nthet legal a resides enaty. or( air work in such dwelling house
owner of a dwelling house having not ,Hare thanone to do nainllenYn e.unhruclion Jt rep in or the occup
,IwClling Iwusd Jf another whu a urtena 1 thereto shall oot because of such employment be doomed to be m employer."
or on the grounds or building app shag withhold the Issuance or
aY
�IGL chapter 132, i_3C(6) olio state!that"every lute or local llcenslal aK+aey
he for
table dsidesse of cumpllusce wltY the Insurance coverage required:
renewal of a license or permit to operate•husineu or to coutruet buildings to tof ice p mace subdivisions+hall
upplicar t wlta has not produced acceptable
%Jditianully, \,IGL chapter IS'' i2SC1l)fate&"Neither the tit acceptable
th not ce
corer into any contract for the perfomwncs ul'public such until acecptlble evidence ui wotpliartce with the insurance
rdyuinmenls of this dwpter have been presented to the comrouilto authority"
\ypgcents pp to our situation and, if
addnWe$)and phone nwnber(s)along with thou cditillcatall)Of
other
Pld:t:us lilt out the workers' compensation affidavit completely,by checking the,LLP)hwith no employees
other than the
necessary,supply lub•contraelor(s)name(+).
insurance. Limited Liability Companice(LLC)or Limited ipsm Liability st insurance.
( Department of Industrial
nelnbdrs er partners, are not required to carry workers'compensation insurance. If as LLC or Lnt dace have
employees,a policy is requited Ile advised that this affidavit
may
M submitted to the Dep
,\Ip pe sure to sl{e use Jule the uftldovlL Tice affidavit should
Of
accidents for contlrmation of insurance coverage to obtain+workers'
he rcamted to the city or town that the application for the rdi ni`he taw ar if you required ^�the P
I ndustrial,\ccidents. Should you have any 4
u'stiatu regarding companies should dnter their
colnpenwtiun policy,please call the Depurmteni at the nutntser listed below. self-insure
vclf•insurance license numbered the a ro riute line.
('sty or•rows Officials Department bus provided u spaed at the bottom
Please he sure that the affidavit is complete and p fir legibly. 'The Depa the applicant.
of die aif'idavit fur you w f 111 out in the event the C hInsi,: of Investigations has to reference
contact you ten addition'
of ill a if suvi to till in the PertniUliceosd nwnb+r which will bee^e` s Jeedeonly submtt�une(itRidavit ud ca an irn{current
any hwnt.+houid write"all luwtiuns in (city or
shot moat submit multiple penniUlNJ t�tiuP'labt5ile Address"the uPP � '� be rousted to the
policy iutormation I if neceasary)' ud or marked by the city of town,nay P
town). ,\copy Jf the alnduvil that has been officially sump
applicant as proof chat a valid affidavit is an file for tlrtun Petmite of licensee. Anew alllduvit tttust he tilled nut each
tu
y ear.applicant
a hums owner Jr citizen i!s 0" file t a license Jr pennit not related to any business ur commercial venture
t i e. a Jug licensa fir permit to burn leaves dte.) said Person is VOT required to complete this affidavit. usaumu.
I h< )i Ilse „t luvestigatiuns would Il;.e to dwok you in aJv:uua fur your cooperation and shuuld you haw•uty 4
plCa,e do out hesitatd to give us a call.
rhC U.ParunCltt'+ addrd+.t, telcphuna game C ran 1lonwealth of Massachusetts
D epuctraent of Industrial Accidents
Offles of Iaradgadons
600 ` "hlflgtan Street
Gaston, MA 02111
fel. q 617.727-4900 ext
02 a77d9"•MASSAFE
7 7
_,,.,1 3alvill-W.Mau.1lov/dia
CITY OF S.U-&Ni, ,1L1SSACHL'SET7S
SULDLNG DEP.IRTNILNT
120 W.tsmmTON STREET, 3ie Ft00R
T EL (978) 745-9595
KimsE tLEY ORMOLL RIAX(978) 740.9846
,MAYOR THo+W ST.PMJL"
DIRECTOt OF PLBLIC PROPERTY/a(:ILDNG CONNISSIONER
Construction Debris Disposal Atildavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 1 11.5
Debris, and the provisions of MGL a 40, S 54;
Building Permit i! is issued with the condition that the debris resulting from
11 work shall be disposed of in a properly licensed
1
I 1, S 150A. waste disposal facility as defined by MGL c
The debris will be transported by:
IF (name of hauler)
The debris will be disposed of in
6-e 9 ��
(name of facility)
�St� 5T r'7'ft' titA clfk 4C/
(address of facility)
rign.nue of permit applic t
9:IL r t
��te
P QPO�AL . RESKI)ENT1AIL REPAIR SERVICES '
Dump Truck Service • General Contractor -------------- —
sr+crr lea
ILIUM VALENTE,JR.
', 97 B1i23�t574 LICK 131251 �/�^//
POPOSAI. S IUMITTED TO; WORK TO BE PERFORMED AT
NAME ,p ADDRESS
ADDREss
DATE OF i LANS __"- ---
G�ril 1014.
We hereby propose to kimish the malcmalr and perform the labor necessary for the completion of.�(tUW� Af r ._.._k j
2 - f _ CAM
SWZ7 - :
I N% 3dx $dif _. 7-/
I
qw=l rwlred tl, bl „ „l:l3cil r, 1 jn;! lh:. ,tore omr'< ;n h2 performed vi al o�danr_a rrtl• ihr 1 Iwr��s and ,f)yOifiCatfons
I � �
� I,r•:,U';it hn .ibuvu ;rk ,ind �r,mpir t�;;l it I ,ubshnlial wo;lau rtP'*e n1;7ni: I L I Ih.' ri n :,I _ s
l� J�
Onilars I$
- i i payr irr:ts to he n le :;ts follows: -
I
I
Respectfully subnntled
;
i Per
� fl<ac Tf�is ;ul��.r::;;ll u�AV lie vvitL.Jrsvn
fly uc ,f not ncc rhecl ,,y:fllin
I
AG(, P IANCE OF PHOPOSAL
� : dl:c f i�cus, ,p .r_�h:•nlior� uId �:norl �� :n_. do 1t7;,C d'.tilr,; Ind lrr]nl;i h., L,��p��:�l. Yoli ;m" l!Ilftoitt' !o :_io ;ha vrD�i
.vill 0u.. :'r'
i
� Sl yinifue
PPC)PngA I
VINYL TILT REPLACEMENT WINDOWS
T
N RESIDENTIAL REPAIR SERVICES O
L ROOFING R
M
S Dump Truck Service • General Contractor NO 0646
D
D 978-423-4574 0
N LIC#13125 R
GUTTERS STORM WINDOWS ROOFING ESTIMATE
ESTIMATE SUBMITTED TO: JOB NAME JOB#
J "/ EIr S <A/lf
ADDRESS I JOB LOCATION
CITY/STATE/ZIP DATE
49 -
A_ e ,0 �3- 9-l
PHONE# FAX# CELL#
WE HEREBYAGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW...
NOTE: ONLY THE MARKED BOXES PERTAIN TO YOUR ESTIMATE.
WE AGREE TO:1. COMPLETELY STRIP THE ENTIRE SI Jo M!�tAJ M /1aA4 f IGYT /�A / 0,11C/� ROOFS)
OF THE EXISTING _ C _ LAYERS OF SHINGLES.
❑ 2. INSTALL A NEW LAYER OF SHINGLES OVER THE
EXISTING ONE LAYER OF SHINGLES ON ROOF(S).
❑ 3. INSTALL ANEW RUBBER ROOF(S) USING ALL NEW RUBBER ROOFING MATERIALS ON THE
O 4 INSTALL NEWIC &WATER SHIELD N � MrA/1/OIiF ROOF(S),
ROOFS EDGE, RAKES, VA LEYS, D`ORMERS�SKYLIGHTS, CHIMNEYS & FLAT ROOF AREAS.
J 5. INSTALL NEW Ir LB.ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THIF•/�IA'/�
��Yrl rA 1 I �e'✓f1.rl3�Yr_�
❑� INSTALL NEW 8 INCH MIA -e ALUMINUM DRIP EDGE ON THE ENTIRE
/9 i✓Piste.. ROOF(S).
O 7. INSTALL NEW ALUMINUM STEP FLASHING ON ROOF(S).
❑ 8. INSTALL NEW(VENT PIPE BOOTS) ON AJ ROOF(S).
f
❑ 9. INSTALL NEW(ROOF BOX VENTS)ON ROOF(S).
❑ 10. CUT& INSTALL NEW RIDGE VENT ON ROOF(S).
❑ 11. INSTALL NEW LEAD ON CHIMNEY ON ROOF(S).
❑ 12. INSTALL NEW SKYLIGHTS ON ROOF(S).
❑ 13. INSTALL id F . OF ROOF BOARDS OR PLYWOOD SHEATHING ON THE ROO OF THE , )1iA
Z)A'frl.4- t ��+A.� /�/1�rL/n COSTS$3.00 PER SQ. FOOT, COVERS MATERIALS AND LABOR.
0�4. INSTALL NEW YEAR SHINGLES ON THE
15. INSTALL REPLACE I REPAIR 4�/t TA Gf n1// / 11110
w �f//^I �r'A� �A>( `�
❑ 16. SPECIAL CONDITIONS (��YA✓ N.vhri �AtibY /141AY ✓ ISU�dida {'�+,Ve.<T_
NOTE: WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS.CUSTOMERS SHOULD COVER VALUABLES.
GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE BY COVERING EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH
TARPS TO HELP PREVENTANY DAMAGE DURING THE STRIPPING OF THE ROOF.HOWEVR,SOME DAMAGE AND MARRING
COULD OCCUR BEYOND OUR CONTROL...
NOTE: (IF)MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE,AN EXTRA CHARGE WILL BE ADDED FOR THE
(LABOR&THE REMOVAL OF THE DEBRIS)OVER AND ABOVE THE PRICE OF THE ESTIMATE.
We propose hereby to furnish material and labor- complete in accordance with the above specificatiobns for the sum of:
$ u/(A. rld 41:4s0 Dollars
i 1 6 rr
with payments to be made as follows: l/� r DD l/YJDd tor+ lbTv�
`. . Any alteration or deviation from the above specifications involving extra costs Respectfully a
will be executed only upon written order,and will become an extra charge over Submitted
and above the estimate.All agreements contingent upon strikes,accidents,or
delays beyond our control. Note-this proposal may be withdrawn by us if not accepted within 30--days. -.
krg3tttnre of Proposal
The above prices,specifications and conditions are satisfactory and are hereby Signature
accepted.You are authorized to do the work as specified.Payments will be .,.(��¢�.,� p
made as outlined above. 6�%Mj'Dale of Acceptance Signature "��