4 PHILLIPS ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
IV/ Massachusetts State Building Code, 780 CMR SALEM
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised,l/ar 2011
One-or Two-Family Dwelling
Building Permit Number: This Section For Official Use Only
Da ,Applied:
l3uilJing Otlicial(PHnt N,une). 'r �"'' - �.SI/
Signature-- - . Date
SECTION t6 SITE INFORi\WTION'
1.1 Prope�(t Address:
Lz Y,//'r� S� 1.2 Assessors blap&Parcel Numbers
L la Is this an accepted street?yes j/ uo Map Number
-- -- Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Proposed Us�--
Lot Area(sy ft) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards
Provided
Required Provided Rear Yard
Required Required. q Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private Cl Zone: _ Outside Flood Zone?
Check if es❑ Municipal❑ On site disposal system ❑
2.1 Owner'of Recor SECTION2: PROPERTY OWNERSHIP'
d: '
pme It rmt) NI C0. 0 1g16
City,State,ZIP
and Stae
�!t' D�tllrr�S S 76- 7y3,- 7Srf/
No.
Telephone Email AJJresg
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all thafap Ad
New Construction❑ Existing Building owner-Occupied Re airs s ❑ Alteration s
Demolition p O O Addition ❑
❑ Accessory Bldg.❑ Number of Units
Brief Description of Proposed \York': "I d,«, —� Other ❑ Specit'y:
Ole W / !!Bog 2 A fTa2 Oki' C3/4 C' elr ^
tidw.+ o I.a(I
SECTION 4: ESTINIATED CONSTRUCTION COSTS
Item Estimated Costs: rtD` O Mj7„y�/
Labor and,Materials) Official Use Only vvll//
Building S / s [SOCUr�o I. Building Permit Fee: Indicate how fee is determined:
1p 2. Electrical S ❑Standard City/Town Application Fee
(6 3. Plumbing ❑Total Project Cost"(Item 6)x multiplier x
4.
?. Other Fees: S V
Mcchm ncal (HVAC) S List:
II a 5. Mechanical (Fire
Su ression) S Total All Fees:S
6. Total Project Cost: S Check No,_Check Amount: Cash Amount_
°Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.l Construction Supervisor License(CSL) License Number Expiration Date
Name of CSL Holder List CSL'fype(see below)
ra' ie 44- Type 'Description
No.and Street U Unrestricted(Buildings u to 35,000 eu. IlJ
Alert �� d l�7p R Restricted 1&2 F:unil Dwell"'
M Mason
City/Town,State,ZIP RC Rnoting Covering
WS Window antiSidm
1 SF Solid Fuel Burning Appliances
�3 y��a �/QMail@V°Xry,a ' ` CtYN I Insulation
p Demolition
Email address �� �Y
'Tcic hone (� '[
5,1 11e! iistered Horne Improvement Contractor(HfC) kIIC Regtstrauon Number Grpirutiun Date
(tMo-T �rr� P� ( i
IQ-Ib 1, —M9N 1'i v1JK4 (�C
Ii1C omp; Nppme or kIIC Rem stmnt Nam (Pm M d V Emm address
o t- e K
No.aitdStr tt
JJ Al ik (G d 1
Cele hone
Ci /Town,State,ZIP
SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G L.C. 151.§ 25C(�
ance affidavit must be completed and sub mat
this affidavit will result in the ted with this application. Failure to provide
Workers Compensation Insur denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........
No.......
SECTION 7a:OWNER AUTHORIZATION:TO BE CONIPLETED WHEN-
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMITI,as Owner of the subject property,hereby authorize
2 q 6sQ
t9 act on my behalf,i matters relative to work authorized by—Ms building permit applicatt 1.
e Date
Print Own 0WnV4 rlaale(E ctro tc ignnture)
SECTION 7b:OWNER'OR AUTIIORIZED AGENT DECLARATION
By entering my name below,)hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accuri"t best of mdge and understanding.r
1) ar r W r e Date
P natu
Print Owner's ur Authonzed,\ ,,r s Name(LI Uronic Si nature)
NOTES:
will nol have access to the arbitration
I. An Owner who obtains a building permit to do his/her own work,or an net who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program),
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
Information on the Construction Supervisor License can be found at ww�+'.mass."oY'!ds
2. When substantial work is planned,provide the inform i a ion below:ige, finished basement/attics,decks or porch)
'total floor area(sq. ftJ Habitable room count
Gross living area(sq. ft.)_____— Number of bedrooms
Number of fireplaces Number of half/baths
Number of bathrooms Number of decks porches
Type of heating system — f_oclosed______,_,__Open
'type of cooling system
1. "Total Project Square Footage"may be substituted for"Cot l Project Cost"
3` CITY OF SM1 E.,f, tiL1SSACHUSETTS
1' BUILDING DEPARTNONT
� tr. 120 MASHiNGTON STREET, 3AO FLOOR
n = TEL (978) 745-9595
FAX(978) 740-9846
Kf1fBERLEY DRISCOLL
JNLAYOR THo.%w ST.PIERRs
DIRECTOR OF PUBLIC PROPERTY/8,L'ILDLNG CMNISSIONER
Construction Debris Disposal Affidavit
(required for all 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 NfG,L c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by tti1GL c
l 11, S 150A.
The debris will be transported by:
(name of hauler)
The debris will beadisposed of in
Al,v
J (name of facility)�
-- W0.L/
(addre 5 of taclhty)
I /
L - filrl0
signature of permit applicant
hate
Proposal
2FOSTER'COURT ALL-PHASE CARPENTRY
SALEM, MA 01970 MA HIC REG 138630
978-423-4712 MA LIC. CS 80570
PROPOSAL SUBMITTED TO: DATE
Greg Taylor November 23, 2013
STREET JOB NAME
4 Phillips Street Taylor
CITY,STATE AND ZIP.CODE JOB LOCATION.
Salem,MA 01970
PHONE JOBPHONE
978-745-75.91 978-807-5488
We hereby submit specifications and estimates for:
Tear out living room and foyer ceilings and intermediate wall between the rooms. Strip the wall
planking between the living room and kitchen.Tearoutthe stairs and upstairs bedroom.closet.
Reframe the ceilings, living room wall and stairwell wall for new blueboard and plaster.
Rebuild wider stairs and.install customer supplied stair treads. Install an access with a door under
the stairs.Customer to select handrail style.
Install a new window in the platform wall of stairwell.Tear out and install a new double-hung window
in upstairs hallway.
Install homeowner supplied hardwood flooring in living room,foyer and upstairs hallway.
Includes material, labor, permits, piaster and electrical work. Customer is responsible for paint.
Job will start January 19, 2014.Total cost: $15,600.00
Payment to be made as follows:
$10,000.00 on January 4th to order LVL beams and windows.Balance of$5,600.00 at finish.
All material is guaranteed to be as specified.All work to be com-
pleted in a workmanlike manner according to standard practices.
Any alteration or deviation from above specifications involving extra
costs will be executed only upon written orders,and will become an Authorize
extra charge over and above the estimate.All agreements contin- Sign; N
gent upon strikes,accidents or delays beyond our control.Owner to
carry fire;tornado and other necessary insurance. We carry liability Note:, This Proposal may be withdrawn by us if not
and workers'compensation insurance. accepted within thirty (30) days.
Acceptance of Proposal -The above prices, specifications '
and conditions are satisfactory and are hereby accepted.You Signature are authorized to do the work as specified.Payment will be made g
as outlined above.
Signature
Date of Acceptance:
NOTICE N NOTICE
TO o TO
EMPLOYEES EMPLOYEES
y �W
� W\
OqM S�6
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 — http://www.mass.gov/dia
As required by Massachusetts General Law,Chapter 152,Sections21,22&30,this will give you notice that
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
HARTFORD UNDERWRITERS INSURANCE COMPANY
NAME OF INSURANCE COMPANY
P.O. BOX 1450
MIDDLEBORO MA 02344-1450
ADDRESS OF INSURANCE COMPANY,
(GSGOUB-0197N77-1-13) 12-20-1.3 TO 12-20-14
POLICY NUMBER EFFECTIVE DATES
u�
JOHN J DOYLE INSURANCE 85 CONSTITUTION LANE #2H
DANVERS MA 01923
NAME OF INSURANCE AGENT ADDRESS PHONE#
WHEELER, TIMOTHY DBA 2 FOSTER CT
o�
WHEELER REMODELING
SALEM
'- MA 01970
"= EMPLOYER ADDRESS
m�
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
008055 W20PIG02 TO BE POSTED BY EMPLOYER