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4 PIONEER CIR - BUILDING INSPECTION (2)
The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 730 C�IR SALErI I Revised hlnr 201! Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Us60n1 Building Permit Number, DSte , ppltedr, Building Official(Pant Name). Signature Date SECTION L•SITE INFORMATION 1.1 Proper,�Y Address: /7 1.2 Assessors N(ap& Parcel Number f l U C�,F'c C/!� I.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.1,c.40,§44) 1.7 Flood Zone Information: Lg Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesCl §ECT[ON Z:; PROPER'ty'OWNERSI3D'i 2.1 Owner'of Roe d: Name(Pn�{t) City, ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF 4SEA1yORK1'(checkell that apply) New Construction ❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) ❑ Alt eration('s),13_„ Addition ❑ Demolition ❑ Accessory Bldg. I Number of Units Other ❑ Specify: �. Brief Description of Proposed Work': \^ SECTION 4: E SLATED CONSTRUCTION COSTS- [rem Estimated Costs: Official Use Only... Labor and Materials I. Building S Q 1..Building PermitFeer.S' Indicate how fee is determined: �. F.lectric;tl $ [ ❑Standard,.CityfTownApplication Fee, ❑'rotal Project Cost](Item.6)s multiplier x J. Plumbing S 2. Other Fee4: S t. Mechanical (IIVAC) S List: GCl i. Medrmical (Fire $ SnP ressiun) _ Total All Fees: S Check No. Check Aaiuunt: _ Cash \nwuuC. A I'ntA Pinicct C )st: $ �' ` ❑ I'ud m Pnll ❑Out;taudin„ Il ilmce I)lia �' 3zR - 1 SEcrION 5: CONS"l-ituc •ION SERVICES 5.1 Construction Supervisor License(CSL) —e) —"Ua" _ °?- --.)l!✓L6. �I e ( f fj✓ Q J l�j �? YI I�G /1/ _ License Number Expiration Date Name of CSL I lolder List CSL'Type(see below) U 3 Type Description No. and Street C/ /! U Unrestricted Duildin s on to 15,000 cat. R. (:�r"GU/Z— "/1!;5 GI D �S Restricted 15c2F:unil Dwcllin Cityfrown,State,ZIP VI %,Iasonr RC Rootin Coverin %VS Window Ind Sidi.. SF Solid Fuel Burning Appliances 1 Insulation Ible hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) / � q ! iiL— 2 �M— //�� rn!J f![C Registration Number Expiration Date I IlC Cum any Name or fIIC Reg tmnt Nmne /� W,5 I No.and Street Email address n C' u G�A t'c-Gq SC6 City/Town,State ZIP Tale hone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152.1 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...........O 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 /5 i C �� Ph I s dl� to act on my behalf, in all matters relative to work authorized by this building permit application. 7-Ss� l3 Print Uwnei s N,unt(Electronic Signature) Date SECTION 7h: 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. 1-1411,0 1I4PQ.1SafY — 7- 13 Print owner's or Authorized Agents Name(Electronic Signature) Date NOTES: I. :1n Owner who obtains a building permit to do hisiher 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 find under M.G.L. c. I42A. Other important information on the HIC Program can be found at www mas:.hov%oca Information on the Construction Supervisor License can be found at Ivtvw.�nas ., u,, v�dL 2. When substantial work is planned,provide the information below: romi floor area(ml. 11.) —(including garage, finished basementlattics,decks or porch) t ross living area(sy. It.) Habitable room count — Number of tireplace;-"—_------ Number of bedrooms Jumbcrufbathr,ums NumberoFhalBbaths ---_ _---- I'rpo of heating;yslent ---- Number of deck.,/porches ...._-- ------- f�pe of cooling ;yacm -__-_"- --"-- Fildo.;ed - ()pen --_--- _- -- 4. `I, t.d Pnq�a �yuaro F„oLige" ut.ty he ;ub;tivard t;'r I'a.il I'rnjcrt('o;t" . CITY V1 Ji�Nl `.,L�s lJ �. , > s:�cHttsE 1 120 ~ ;y�" ©t.ttaLvc DEp.ta-ntgvr TON STitEfiT, 3 FCOOt �+ TEL(978).143.9595 B OEU Y DC{ISCOLL FL-%(978) 7-10-9344 � UYOR TElOSG19ST.PlFA1t8 _ - DIaECTOR Up PCOLIC PKOPE9TY�9CtLDLYG COSL�t15510,V ER Construction Debris Disposal Aff7davit (required for all demolition and renuvation work) In accordance with the sixth edition of the State Building Cada, 730 CD 1R section l l L S Debris, and the provisions of tb1CL a 40, 154; ©uilding Permit hl is issued with the condition that the dcbrrs resulting from this work shall be disposed of in a properly licensed waste disposal 111, 3 150A. as facility defined by t41GL o 1'ha debris will be transported by; /( t c ty-*vo Scy, C. (name ut'haulut) / The debris will bo disposed of in (nnma of t�cility) 41f 11 9"', •tpplicant J u� CITY OF SM.E111 XLkSSACHusETTS 13UIMLNG DEP PT1tENT • } ! , 120 W.,,SHLNGTON STREET,3"FLOOR d TEL (978)745-9595 FAX(978) 740-9846 KIJIBERLEY DRISCOLL THo&w ST.PIERRB MAYO1L DIRECTOR OF PUBLIC PROPERTY/HI:IIDL`IG COSMISSIONER Workers' Compensation Insurance Affidavit: Builders!Contractors/Electricians/Plumbert Applicant information Please Print Legibly Naine(Business.Organizatiotulndividual): R.r--i— Ar^r) ki A,J/SO/r( Address: 0 Al RV a/Y 14-U45 City/State/Zip: &l/ci V eCi A!)( 0 Phone#: .SG zs' o Are you an a layer?Check the appropriate box: Type of project(required): 1. a employer with 1 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-connectors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working.for me in an capacity. workers'comp.insurance. Y P ❑Building addition (No workers'comp.insurance 5. ❑ We area corporation and: required.) of Haas have exercised thew 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c..152,}1(4);and we have no 12.❑ Roof repairs insurance required.)t employees.LNo workers' 13.❑Other comp,insurance required.). 'Any appllrua chat chcsks box ill must also rill uutlhe sectim blow showing their worker'compenamion policy infurmotlon !I htmeowamt who submit this aRidavil indicating they am doing all work and than bile outside contractors most submit a new aMdavit indicating such :commcton that cheek this box most attachod an additional aboa showing tho name of the sub<antnctim and their workers'ramp.policy information. r am an employerthat is praviding workers'compensodon insurance for my employees Below Is the polley and fob site 17 Insurance Company Name: / M f' /'7 ee_ Y �J Policy 4 or Self-ins.Lic. #: /1 W C; L4 C_) /� Expiration Date: _3 Job Site Address: City/State/Zip: miseh 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 tine up to S1,500.00 and/or one-year imprisonmen4 as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator. list advised that a copy of this statement may ba furwardcd to the Office of Iavestigatians of the DIA for insurance coverage verification 1 da hereby Gerd y and r the p ins as penalies of perjury that ie 6rforarallon provided above is true and correct 't Data. Phone � �G sr S�x3 5-3; OJTchd ase only. Do not write in this area,to be completed by city ar town oJJlelat City or Town: Permit/License# Issuing Aulhority(circle one): 1. Board of Ilcalth 2. Building Department 3.Cily/town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _._..._. Phone B: Z - --- lU'd989Z << 6S998Sb8L61 Z£660 £S=OZ OE-SO-£TOZ y r KITCHEN INSTALLATION ESTIMATE WORKSHEET - USA 2686 R.J.CONSTRUCTION r Marjorie tubas 613 112 01 3 Category Categbry Breakdown Demo and Haul Away $1,760.00 Electrical $946•00 Plumbing $975.00 Tile,Repair NONE DrywallfRepair $1,100.00 Cabinetry/Appliances $2,224.00 Parking,Building,Electrical,Plumbing Permits $650.00 rr Customer Sign Ku re: ! Date: ^ 3 /3 Associate Signature: Date: , GC Signature: Date: C I II ZA 699999V9L6L SenISSUOE)U40P d9L £O£LL£FeW The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Home Improvement Contracting Home Improvement Contractor Registration Lookup You can search/filter the registration list by any of the criteria below. Search by Registration Number 1118509 Search Search by Registrant Name r� Search by City ...... .___ Zip Code Search Registrants Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Tuesday, June 4, 2013. Search Results REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS NAME INDIVIDUAL NUMBER DATE R.J.CONSTRUCTION MADISON, 118509 3 MADISON AVE 03/29/2015 Current RICHARD GROVELAND, MA 01834 166 103 2411--/1-391'—/, 3 to 3119 /-51 4 —/-30 F—W! 944' 1 to let If --�---434 I�--29 1 T— 3 we we 3ve—' 30"—/r184 �-30 -- 844 H . R V I-- W.3018 DW302424 W3311524 k1�JBVVB1 F C") Cr) B9FHR 02 IOD r CO CY) 0 C") row) ti 11 Lco ti IN —L 0 FINAL PLANX Cn 1 if 7 we 1--486 87 6 All dimensionssicm. size ds.g..Uo.. This is an original design and must -Designed:4/29/2013 given are subject to verification on not be released or copied unless Printed:6/3/2013 job site and adjustment to fit job applicable fee has been paid ow-job, conditions- order placed. itfk000076 Legend Drawing#: 1 I No Scale.; 2 1032- 51 4 —3091-3vo x 3 84 4vo 9414 37 3 go 3 7L --30"---"/184 30"— -84411 W302424RI-,,! 1 18 W9301 1iW1830Liuiiiuii], W30 Cr) C") W331524 IJ 618L IA-3a 4211 9FHR 1.4,IBWBlF3: 11 4 00 CID r 4, 0) 0 O 41 C") 0) CA) CA) C) co 136 -48 8 8 _7 MARJORMCUEAS _fbis is an original design and must All dimensions size designations Designed:4/29/2013 given are subject to verification on 4 PIONEER CIR not be released or copied unless Printed:4/30/2013 job site and adjustment to fit job SALEM,N4A applicable fee has been paid or job conditions. 978-744-5340 order placed. ROB P. A000076 Legend Drawing#: 1 No Scale. 1032 1 " 24" 36" 36" 2 r� DW302424R 03630 W3630 : .It U) 71 LO Co ," BCFW48L 24JASHW 3DB24 M 811 "411 2411 1 2 0" 43 2" ---- gn _._ — - -- ri --- - - - Alldim—ensions-- -size-desi- ations- - MA- RJORIE— -LUBAS This is a an original design and mu- -st Designed:4/29/2013 given are subject to verification on 4 PIONEER CIR not be released or copied unless Printed:4/30/2013 job site and adjustment to fit job SALEM,MA applicable fee has been paid or job conditions. 978-744-5340 order placed. ROB P. flc000076 El 1 Drawing#: 1 No Scale. 1661, 3a 33' 18' 30' V "; 1 q" 24" 44ri 34rr 29.1 rn a c rPly II 11 1 31 w72 524 o W3018 QF W1830L 30R DW302424R L FD ILJI M TOP 0) o 84WD ®®Q®®® 30L-REF 0 B I I M 8 0 RANGE1 g�WB lF3 SB30 B9FHR BCFW48L j M ;M u '� ' 3 18 3 18" 3 27" q 4 1pa pia v p 10 X VV 4 3 All dimensions size designations MARJORIE LUBAS 'This is an original design and must Designed:4/29/2013 given are subject to verification on 4 PIONEER CIR not be released or copied unless Printed:4/30/2013 job site and adjustment to fit job SALEM,MA applicable fee has been paid orjob conditions. 978-744-5340 order placed. ROB P. fk000076 Ell Drawing 4: 1 No Scale. I ' o � a is an t ORIE LUBAS Designed:4/29/2013iNotTionrenswing aistic tee dfe general 4 PIONEER CIR Printed:4/30/2013 appearance of the design.It is SALEM,MA not meant to be an exact rendition. 978-744-5340 ROB P. :fk000076 Legend Drawing#: 1 Item List � a DESIGN DETAILS Store: SALEM,MA �+ Store Address: 50 TRADERS WAY to y �( I Customer: LUBAS MARJORIE Home: (978) 744-5340 Work: (978) 744-5340 Ext: File name: fk000076.kit Description: Kitchen Order number: 255411 Sort order: Tall/Base/Wall Print date: 4/30/2013 Page 1/4 File name: fk000076.kit Description: Kitchen CATALOG ROOM Supplier 20-20 Technologies Wall doors: Drawer fronts: Tall doors: Drawer pulls: Base doors: Door pulls: Door style: Price List Item Qty Description User Code Manuf. Code Fin. Side 1 1 Doorway w/Frame DWAY-F Modifications: width = 37 1/2" width2 = 37 1/2" height= 84" depth = 4" 1.1 1 Right Reserved Space RSPACE 1.2 1 Left Reserved Space LSPACE 2 1 36"H Dble Hung Window#1 E36.DB-HUNG-1 Modifications: width = 43 1/4" width2 = 43 1/4" height= 36" depth = 4" 2.1 1 Right Reserved Space RSPACE 2.2 1 Left Reserved Space LSPACE Volume: 0.00 Weight: 0.00 Print date: 4/30/2013 Page 214 File name: fk000076.kit Description: Kitchen CATALOG THMASVIL Supplier Thomasville Wall doors: Terrace Cashmere Thermofoil Square Drawer fronts: Tall doors: Drawer pulls: Base doors: Terrace Cashmere Thermofoil Square Door pulls: Door style: Terrace Cashmere Thermofoil Item Qty Description User Code Manuf. Code Fin. Side 3 1 Tall End Pnl Wd 24W 84H TEP2484WD TEP2484WD B Modifications: width = 0 3/4" width2 = 0" height= 84" depth = 30" 3.1 1 Increase Depth End Pnls To 30"{+%) ID30-EP ID30-EP B 4 1 Base 18 Drw Lh B18L B18L B 5 1 Base 18 Wastebasket BW818 BWB18 B 6 1 Sink Base 30 SB30 SB30 B 7 1 Base 9 Fhd Rh B9FHR B9FHR B 8 1 Blind Corner Base Fw 48 L{48"W} BCFW48L BCFW48L B 9 1 3 Drw Base 24 3DB24 3DB24 B 10 1 Wall 33W 15H 240 W331524 W331524 B 11 1 Wall 18W 30H Lh W1830L W1830L B 12 1 Wall 30W 18H W3018 W3018 B 13 1 Wall 9W 30H Rh W930R W930R B 14 1 Straight Valance 72W VV72 VV72 B Modifications: width = 51 3/4" width2 = 0" height= 41/2" depth = 0 3/4" 15 1 Diag 30H 24W 12D Rh DW302424R DW302424R B 15.1 1 Md + Clear Glass 30"H MD30 MD30 B 15.2 1 Matching Interior {+%) MIP MIP B 16 1 Wall 36W 30H W3630 W3630 B 17 1 Wall 36W 30H W3630 W3630 B 17.1 1 Matching Interior {+%} MIP MIP B 17.2 2 Md + Clear Glass 30"H MD30 MD30 B 18 4 Tall Fir Full Height 6W 96H TF696FH TF696FH 19 4 Solid Wood Large Crown Mldg SWLCRM8 SWLCRM8 20 2 Toe Board .25 Wood TB8WD14 TB8WD14 21 1 Fir 3W 30H F330 F330 B Print date: 4/30/2013 Page 3/4 File name: fk000076.kit Description: Kitchen Item Ref City Description User Code Manuf. Code Fin. Side *22 1 Classic{Std} CLS CLS *23 1 Cashmere Thermofoil CASHM CASHM *24 5 Terrace Cashmere Thermofoil TERRC-CASHM-SQ TERRC-CASHM-Si Square `25 11 Terrace Cashmere Thermofoil TERRC-CASHM-SQ TERRC-CASHM-Si Square Volume: 152.70 Weight: 42.00 •: non-plan item PROJECT SUMMARY Volume: 152.70 Weight: 42.00 CUSTOM LABOR AND NOTE Print date: 4/30/2013 Page 4/4 KITCHEN MOLDING/CUSTOM DRAWINGS • - - • 0 - 1 .2 4 5 6 7 8 Date: %3� CUSTOMER NAME: -✓>a A^G-I-C DESIGNER: MEASURE PO#:_ .36 V:3_7 9 INSTALL PO#: STORE#: Z/vX O'Cabinet Height: y �ocking(Y/N): rtf Molding Dimensions: ❑Molding Positioning: Attach 20/20 drawings if available. l 1 -- ; --y -'J L L _ _r Molding Nomenclature: - w 4 C. I. J g i 1 J e Note:This drawing is an artistic MARJORIE LUBAS Designed:4/29/2013 interpretation of the general 4 PIONEER CIR I Printed:4/30/2013 appearance of the design.It is SALEKMA j not meant to be an exact rendition. 978-744-5340 ROB P. 1 - ._.__I fk000076 Drawing 4: 1