13 PICKMAN RD - BUILDING INSPECTION (3) . 13 1 )7 . -
I he C•onunomveallh of htassachuseus
i� Board of Iuilding Regulations ;utd Slandards CI'11 OF
\tassachusetlS Slate Building Codc.1SB C•NIR 5.\Lli\I
Building Permit Application fo Construct. Repair. Renovate Or Dent sh a Rr A"d I/w•:till
flue-ur Tuvt-/iunt/) Un'rllin.l
This Section Fur Official Use Onl
Building Permit Number: Date Applied:
Mr. ,, .Il IIng 011 ial 1,' Mn) y o
t uro Uatc
1.1 Pryp rVSECTION 1: SITE INFORAIATI
:4yof 1.2 Assessors Ale areal Numbers
I.la Is this an acce tad street? 'a no Map Number i'urcel Nunthcr
1•3 Zoning Information: 1.4 Property Dimensions,
Loniny District 1'rupuxeJ tl--�--- Lnl Area(s4 II►
Promuge I Iq
1.1 BuIIJInQ Setbacks(R)
Frunl Yard Site YwJs
Required Pruvidcd Rear Yard
Required Provided RequiredI'roviJeJ
1.6 Water Supply.IM.G.I.c. 40.§54) 1.7 Flood Zone Information, I.a Sewa`e Disposal System,
Public Cl PrI%ale❑ Zone: _ Outside Flood"Lune?
Check if es❑ Municipd❑ On site disposal s►stem ❑
2.1 Owgert of Reeords SECTION 2: PROPERTYOWNERSHIPs
lAtR M ysl2G r`n/�v7„q�y � � PezcvK- mI G
N,ww t l nnt) !^I Le
� I� Cil)•.Stata./.IP
Nu.:mJ Street
' --Fe—ft—phone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ ExistinilBuildin Owner-Occupied Repairsts) p s) O Addition ❑
Detttulition ❑ Accessory Bldg. ❑ Number of Units
Brief Description of Proposed Work :
Other O .Specily:
tl/ tv � Y4V W
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Rant Estimated Costs:
I Labor and.\laterials) Offlcldl Use Only
1. Budding S 1 4) 06 I. Building Permit Fee: S Indicate hose tee is Jetenitined:
`. FIeorlcal S -Z> 66ic ❑Standard Clty:Tusvn Application Fee
t I'Imuhutg S ❑Tuta1 Project Cosh 1 hens 6)x multiplier
CdC) v. Other Fear. S
J. \Icdt.mic.J ill\ \t') S List:
Su Inrssiunl S f rtal .\II Fces: S_ —
Iblal I'rvtjccl Coot i / aa L 11CA \'u.
`�V ❑('.lid in hull ❑0111standing 11a1.utcc Due:
Sl•:(•l'HIM S: CoNtirRU ril)N tiERVIlt
5,1 ('unstructiunSupenis rLicense(C'sl,) _(�_� .._ �:;,imm� 1),tc
Q � ��IQU
I Ist CBI. l' lie l'ee --
Namenl'(SI. IInIJar
.L�p,; Deicriptiun
a- -
Na. .mJ Sucet 11 I Innslricled Illuddin s tit In lt,lltln aI. IL1
RearieteJ I,t,? Pamil Dl+ellin
11 ;ulin
('il)i 1'ann.Slate.LII' H(' H,wtin l'u+arin
µ'S 14'inJo,v.mJ Sidin
"— SF Soli)1.uul Iluming APPllwlccs
I I llsulution
Danxdiliun
fmail:IJJruai
Talc hone O-�
�.2 R�fered llume Improvement Cunlnlcter(HIC) III(: Itegtatrullun Number I( pi wior lulu
77 sT o
IIIC Coulpun) Name kit
Rayiaru�iLN'+nla limuil uJJM1as
'; f'R I rur✓'r !�
No. will StreetVol C � 7d77
role hung
Ci 1ITown,State ZIP
SECTION III WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.c. 1S2. § 2SC(ti)
with this application. Failure to provide
Wort, Compensation Ins reacts affidavit must be completed and submitted
er
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..•••••
No...........
SECTION 7a:OWIVE AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property'hereby authorize
to act on my behalf,in all matter relative to work authorized by this building permit application-
Dwe
Trial uw wr s Nwne(Eleewnic Signuture)
SECTION 71s:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering Iny 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
Prim Qe ner's ar;\ulhonreJ,\guu i Nanw 11 I vin my ugn min)
Nam:
I \n Ussner ssho obtains a building permit to do his.her own work,or an owner who hires an wvegisl¢rcd cunuaewr
taut registered in the Nwne Inlpruvenlent Contractor(HICI Program).will nn have access to the arbitration
prI'llogram ur guurmt)Info malt er on he. c. 14 construction Other
important
or efine can be found attion on the ProgIli
ram c,nlbel1uunJ at
+ \\hen substantial,wrk is planncJ, pros ide the irlternlatiun below:
Iincluding garage. finished base nlenl,it ics,Jocks or porchl
rotsi flour arcs t sy. llabiwble room count
(Bross lie ing area I iy. It 1 ._. .. \wnber of bcdruonls . . .
\unlban,ilircplacei -. ..- _ - --- \unlber ill,hall balhs
\umherajhadtroouls . . - Nuntberol'decks• por,.hes
I\pe of he,uutg i)+Icm I'nclo.eJ _tthan
1 ..I',ial l'r„Iacl 1,I%ore 1:ool-11:C III,1\ ha .IlbJlllltQf 1pf I,d.11 l'fP�a�t(P+{••
CITY OF S.U.E.N11 N'LkSSACHUSETTS
BUtLDNG DEPAR-n NT
N+ 130 WASHNGTON STREET, 3" FLOOR
TES:. (978) 745-9595
FAX(978) 740-9846
KINt ERt FY DRISCOLL
,MAYOR Tt t0•tAs ST.PIERRH
DIRECTOR OF PUBLIC PROPERTY/BUILDNG CO\LMISSIONER
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 11 L5
Debris, and the provisions of MGL 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 MGL c
111, S 150A.
The debris will be transported by:
t�L� wtt'i� z vG,C
—T (namrbfhauler)
The debris will be disposed of in
(name of fa At;)
) �
(address of facility)
l
s ature of per i applic
D
dal
Jcbrivif.dx
The Commonwealth ofMassachuseds
Department of Industrial Accidents
Office of InVeShgadQnS
600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance davit: Builders/Contractors/Elect ridam ffllumbers
Applicant Information Please Print I:eglibly
Name `` vidaan: P e 17- �®
Address: l0 Zj�r=1 Gt9OM-7-i9ftV t'�
City/StateMP:— Phone
Are you an employer?Check the-approgriate hoc: Type of project(required):
I.P I am a employer with a, 4. []1 am a general contractor and I 6.. 0 New construction
employees(full and/or part time).• have hired the sub-conuactcus
2.El I am a sole proprietor or partner-- listed on the attached sheet.I 7. LA Remodeling
ship and have no employees These sub-contractors have 8. E] Demolition
working forme in any capacity workers' comp. insurance. 9. Building addition
[No workers'comp.insurance 5. We are a corporation:and:its 10.0 ElecUical repairs or additions
req>�•] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL I LEE Plumbing.repairs or additiom
myself [No workers' comp. c. 152,§1(4),and wehaveno 12.❑ Roof repairs
insurance required.].i employees. [No workers' 13.0 Olher
comp:insurance required.] -
spnyappliceatdatchocksbox#1mug wfnotaftsation below showing thevwoitcereoo oulplicymranua4on: .
tHomeownerswbosubi ittldsaffidntmdicermg6eymedoiegellworksndlbmbimmdm&eoaheciersmasksubmit4'mwaffidavit=dkedingsuch,
tConusesm .&d check fin box nuatalfacheda addi mid sheet showing&enameof9ueab-muaacku and dick workers'comp•policy 1xion"WO • .
lam an-employerthat isprmW!ng woriusrs'compensation insuraneefor nty.emplgyAmm Ddowis thepolky and,ZaG site
irrjormatiar ail UTu v¢L SNP <:�O:
Name:_
Insurance Company Na :_ 2
Policy#or Selfins.Lie M WCi- 3fS -379371--0/2 BxpiaationDate:
Job Site Address: �l L l:VV!/� l Cy/ftuzzip: 0 a! d
Attach a copy of the workers' compensation policy declaration page(showing the policy number and=piration date).
Faril=to secure coverage as rcquire.4 under Section 25A of MGL C. 152.can lead to•.ffie imposition of criminal penalties of a
fine up m$1,500.00 and/or oar-year imprisonment, as well as civil penalties in the form of a STOP WORK 0RD8R and a fte
of up to$250.00 a day against die violator:. Be advised that a copy ofthis.sudemegt may be forwarded to.lhe,Office of
fnvestigations of the DIA for insurance coverage verification.
f do hereby fy r the and ofperjury that the lnformadon prnovided above true Correct
3• D ft /0
phone#:
QjJMal use only. Do not write in this area,to be cempleledby c4fy or tmm f{,QFcial
City or Town' Peruft%iceose#
Issuing Authority(circle one):
1.hoard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone*:
I Customer Narne - `dui^ Z A-M Salesperson Name
��4ayyk``%�_ Street Address l-A P d,C AA) ) Date
puvlfty muJv AJlorpableA
A Division of Norcraft Companies,Inc. City,State,Zip °:;� 2..,t.-.-%1W M zi ul 70 Scale
30 East Plato Blvd.,St.Paul,MN 56107 Phone (M) Style&Color
612.297-0681
(W) Approx.Ship Date
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J.P. Construction Co. PROPOSAL
General Contractor
Quality Building & Remodeling
63 Trimountain Road 781-581-7077
Nahant, MA 01908
Submitted to:
Mr. & Mrs. Andrew Ingram Date : August 13, 2012
13 Pickman Rd. Phone : 978-745-1244
Salem MA 01970
We hereby submit specifications and estimates for: Kitchen Remodel
Permits Procure all necessary permits.
Demolition Remove existing cabinets,countertops,sink&appliances. Remove all debris from property.
Walls Re-work openings for two new windows.Re-work wall above frig to accept cabinet.
Entmge opening into dining room. Shim out wall at heat vents as needed. 15�
Insulate exterior walls, Install blue board, skim coat plaster. Prime&paint white.
Window Supply& install one Andersen casement�C-N-",one three lite casement CN-34,white.
Ceiling New blue board, skim coat plaster. Prime&paint white.
Cabinets Install owner's wall and base cabinets per plan,crown&base molding.
Countertops by others. Backsplash???
Plumbing Install owner's sink, faucet,disposal,dish washer& ice maker.
Remove gas line for stove.
Flooring Supply& install cement board underlayment.Install owner's tile&grout, sq. pattern.
Heating OK as is.
Electrical Install 6 recessed lights,duplex receptacles and switches per code.
Install owner's pendant fixture,under cabinet lights,disposal,dishwasher,stove&hood,
vented outside. Run new circuit for stove from existing panel.
Trim Trim-out window,doorways and headers. Install base molding. Painted.
$ 16,900.00
WE PROPOSE to fumish material and labor, for the sum of$
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner
according to standard practices. Any alterations from above specifications involving extra costs
will be executed only upon your orders, and will become an extra charge over and above original
estimate. This is to include, but is not limited to, hidden damages that are uncovered during the
course of the job, and any additional work required by local building inspectors.
UNLESS QUOTED IN ADVANCE, ANY ADDITIONAL WORK WILL BE BASED UPON A LABOR
CHARGE OF$50.00 PER HOUR AND THE COST OF MATERIALS PLUS HANDLING.
PAYMENT SCHEDULE: $ 1000.00 to order windows&permit. $3750.00 to start, $3750.00 on day 5,
$3750.00 on day 10,$3750.00 on day 15, Balance upon completion of punch list.
TIME SCHEDULE: Approximately 3 weeks plus countertops by others
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are s sfactory
and hereby accepted. You are authorized to do the work as specified
DATE OF ACCEPTANCE: � iY CUSTOMER SIGNATURE.
CUSTOMER SIGNATURE:
This estimate may be withdrawn by us if not accepted in thirty days
LICENSED AND INSURED AUTHORIZED SIGNATUR
MA CONSTRUCTION SUPERVISOR LICENSE #04983
MA HOME IMPROVEMENT CONTRACTOR REG. # 1075
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards -
Construction Supervisor 1 &-'_' Fumilc
License: CSFA-049833
JOHN B PAULA
63 TRTMOUNTAFi RD '' - -
NAHANT 14A 0008
Expiration
commissioner 04/2 412 0 1 4
OT
.. ea�vinm:piea.�.Ge o�./�aaaar./er� a�,.
jOffi.ce of Consumer Affairs&Business Regulafon -
WHOMEIMPROVEMENTCONTRACTOR
Registration i07527 - Type: -
Expiration: 8!4/2019 Partnership -
PONSTRUCT,—]OtJCO -_
John Paula- -
63 Trimountain Road a- _
Nahant,MA 01908 - ('�'
Undersecretary
r