7 POPE ST - BUILDING INSPECTION I --- I'lie C'onu1101mcahh of M:u,achusclls
Board of Building Regulations and Standards CI I'1'OF
sp Massachusetts Stale Building Coda 780 C'NIR s.\LI:\I
L•:•' /4'riecl Ildr YI//
Building Permit Application TO Construct, Repair, Renovate Or Demolish a
/ble•or rn o-Funtdr D11"Hiltg
This Section For Dllicial Us,Onl
Building Permit Number: _ Uate A plied• _
lh ilding Ullicial(Print Nwne) ) / S11 ulure
Uotc
SECTION 1:SIT FORNIATION
1.1 Property AJJr��� 1.2 Asusson flap St Purees NumbersI.la Is this an accepted street? yes no Map Number Ilarcd Number
1.3 Zoning Information: 1.4 Property Dimensions:
Coning District I'rupuaed U.w Lot Amu(sq 11) Fronlage(11)
1.5 Building Setbacks(II)
Front Yurd Side Yards Rcar Yard
Reyuimd I'ruvidcd Required Provided Reyuimd Provided
1.61Vxter Supply:(M.G.I.c. JU.§») 1.7 Flood Zone Informations 1.8 Sewage Disposal System:
Porblic❑ Prls me❑ Zone: _ Outside Flood Zone?
Check if les❑ Municipal❑ On site disposal s)stvm ❑
SECTION3. PROPERTY OWNERSHIP'
Namv(Prno City.State.ZIP
c - a�Sd )
Nu.and Save` � / fe ep ona IH�1 AJdmss
SECTION J: DESCRIPTION OF PROPOSED WORK'(chec ll that apply)
New Construction❑ Existing Building❑ Osvner•Occupie. ❑ Repairs(f) Alterations) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Spvvity:
Brief Description of Proposed Work%
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itvnl Estimated Costs:
(Laburmld \lalerialf) Official Use Only
I. Building S I. Building Permit Fee: S Indicate how tee is determined:
'. Illcctrical S ❑Standard City'Tosvn Application Fee
❑Total project Cush l Item 6)x multiplier x
1 I'lunihing S v
_. Usher Fees: S
J. \IM1.1ilical ill\ \('1 S List:
n Total Project CoNI ) ( lic'A Vo. _. ( heck Anioulic .,_._C'.i,h \i nnou:
tip)
tO Piid in Full ❑Outslwding 11,d.ulce Due:
NE('I ION S: <'ONSI'R11(-IrIONSER%'ll'F.S
S,I ('uns rucliun . ullenisur l.icen/pe(C'SL1 C?�Ll
. _�Cf VN.h-9.
PN.nucof C l of l's1. l)pe l ee bolo„1.-_.._.Ikscripliun
11 (Inrc,IriM 111111IJ ill's li Io 1S,1I111).u. ll.l
He,IreteJ Ih?I .un11 D,wllin
CiH�I'o„n,.\LIII.LIP ..N slasun
IU' Hlalin Co,Grin
N s N'inJuw and SiJin
y�5 SF solid Fuel Burning Appl iwlces
I Insulutiun
'7 Finail aJJrc�+ D Demolition
I'e Ic hone /
t.2 Re Ist ed I ale I q j ov ement Cun tctor(H L7
III('Reptr Lion Nunnhcr F\pirulion Dili:
III 'Col Na, e o I IJ(' runt Nan
Email uJJrcis
Cityrrown, Slate P rOe hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.C. 152.11 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atlldavit will result in the denial of the Issuance of the building permit.
Signed AMdavit Attached? Yes .......... O No...........O
SECTION 7a: OWNER AUTHORIZATION TO BE C011IPLETED 1VNE1
1T
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERI1
1,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.
Date
Print Owner's Nmne(Electronic 5ignuture)
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the informaliun
contained in this application is tr and a cur to to the best of my knowledge and understandin.
9 Dow
� 1 ✓, � GO�YI ; -
. • I orveJ A 'au s Noma I I:I\vuoniv signalurol
I nnl l)„n¢r s 1 r \ul t L
NOTES:
I. .\n Owner who ublains a building permit to do his.her u,vn work,ur an owner who hires an unregistered contractor
tout registered in the Home Improvrntent Cuntm'tor IHIC1 Pro
will nu have access to the arbitration
program or y'uarmll) Lund under M.G.L. c. 141.�. Other important inlorniation on the HIC Program can be t'ounJ at
1111, 111.1110 on the CunstruetI n Supervisor License ears be found at„"" 111.1,• "„` 'll"
\\'hen substantial lurk is pLuvneJ, prwiJe the inl'u'I'l`tluJllion bclo1f, t linished base Ill elltamics. Jacks or poreln
r,,tan flour area 1'4 tl.l _ ___—.._ g g' S
Ilabilable roum count
Gruis11%ing ,lrealiy. 11.l .... __. . \timberof.Mroonli
\umhcr ill lireltlaces .. _._ I
\ulnhar of hathruonls \unlhcr o
\luuh¢r o1 fd"ks dciks p Ito
arches �
I pe of 11C.1ting i)dCnl
I\pe"I looting ,\,lam
I'nclo,cJ
1 "I„1.11 Prkilco Spore Foot gc 111,11 I`e ,nh,l1t1ltCd ilot l.n,tl Project ('o,t'
`�. CCCY UN S,1LE.N[, NWSACHUSETTS
t UL'IUDING DEP.\1jr, --T
` 120 W.\SFINGTON STREET, 3w 1•IOOR
TEL (978) 735-9595
FA-X(978) 7 iM844
_N t t3 E U-EY D RISCO LL
AAYO Z MONLU ST.PIF—RA9
DIRECTOR OF PUBLIC PROPERTY/0R:12ArNG CONLMSSIONER
Workers' Cumpensatlon insurance,%j77d3vit: l3uilderliContructurv/Electrlclans/P(umbers
\ I Illcant Informatlnta Icam PrItIt Legibly
.Vlllnd lOmiltu�cUrgJnlral' ndividual): '
Address:
Cily/State/Zip: Phone Al! �-o l
\re nu as employer'!Check the appropriate host
ryp l of prof eet(required):
I. I am a employer with ._ _ a, ❑ I arrt a general contractor and 1
entpinyca(full and/or part-time).* have hired the sub-contractors 6' ❑Ndw construction
2.❑ I am a sole proprietor or partner- listed on the attached shecL t I. ❑Remodeling
.hip and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. workers'comp,insurance.
[No worker*.comp. insurance 5• ❑ We are a enrparation and its �• ❑ Ouifding addition
rcquired.l officers have exercised their 10.[]Electrical repairs or additions
3.❑ 1 mn a hamcuwnur doing all work right of uxemption per MGL I I.Q Plumbing repairs or additions
myself.(No workers'Gump, c. 152, 01(4),and we have no 12.0 Roof mpairs
insurance required.) t umpluyees. (No workers'
cump. insurance ruquin:d.) U.QOlher
•.Illy,ppll,wn dW chitita two at must firs all out ilia,u bua�Wluw chewing(hair Ww4m'eamprnudun pulley inaumutlon.
'lf' nVuwltwwho.uhmit INS slfleavit indleaing theyim doingall.witandthat hireuuniJaeantmatoo mlut ruhmlla new nAJaril indlaing,uc4
$',,mrxwrs that 0,11;this box must IDachua an aJdldurud.hat rhu W ing the nwna al the rub.aunlnetura and Ihalr wartvn'wmp,pulley inrumunoe.
/urn an enpluym that/s provrdlnK workers'cumpeurar/un brsuranee/br my rtnp/ayarem Below/i the policy and fob slle
informs do'L
In..um itcc Company Name: .
Policy Our Salf•ins. Lic. to:
Expiration Data:lub Site.\ddruss:� CityiSlute/2ip:
.vuaub a copy o(the workers'camp satloa pulley declarallan papa(showing the Polley number sad expiration date). (/P.uluru to sccuru cuvemge as required under Section MA of SIGL c. 152 can lead to the imposition of criminal penalties of s
nne rap ro SI.5CO.UO and/or m1c1cir imprkonmen41s well as civil penalties in the farm ufa STOP WORK ORDER and a line
ai till to$2S0 la a Jay rguinst file viola:nr. Ile advised that a copy rat[hit.,t.atcntunt may bu turwardcd to ilia OIIICd at
Lrr evtiganun+.d dtu f7L\ Ibr IniurJncc covdcigc vcriticaliun.
/du/rereby vertijy ntrdae ilia paint wed penultlr.r,'filerjury di ur fire I'Vurrnufimr pro viddj bovo it True arrd r rrrre
�� /�
zz
I'hye d: -f-ld
U//ici vl the,rely. /l.r no/ .viu in//sir area, to,�a run, --ylNrd 5y'ay Ile to1.n',jilt ia2
('fry or I'nwn:
h.uirre .\ulharily
I. !fuard d Ileulih 1. Iln Jding Ihyt.tn nicnl 1, ( ityi holm Clerk 1. (ilaetri:11 linperrnr i. I'In,nbin;; Intpdehtr
Oilicir
l.o.I Lt�I i'�nun:
CITY OF 5A E.%is NEUSACHUSETTS
t \t,;UX iG DEP.1R7\tENT
I '0 1v..UWC4CT0N:STRE$T, }'FLOOR
172L (973) 741.959!
K110FRIP Y ORISCOLL FAX(973) 714984d
Nti YOlt Mo.Ws ST.Ftztu;
BU
D IREC CO R O P Pl C PROPIRT V/at:Mn L./C COSL111SSION E R
Construction Debris DISPOSai Atfldavit
(required for all demolition and renovation work)
In sccatdance with the sixth edition of the State Building Code, 730 C,NR section I I t.S
Debris, and the provisions of MCL o 40, 3 54;
9u wor Permit At " issued with the condition that the debris resulting from
111, S 1 JOA.
This work shall be disposed of in a properly licemed wrote disposal facility as defined by Nl(;L c
The debris will be transported by:
(n+me ut'heuler)
The debris will be disposed of in
( amp of d�ilily)
O� 6V
(iddrruoff Way) %
❑tn�roro of�ermif ipphtrnf
BBB f A.C. CASTLE CONSTRUCTION CO. INC.
METER' Telephone (800) 505-LEAK(5325) • Fax (978) 777-7750 .
Brian LeBlanc, President
Please mail accepted proposal to the office located at:
9 Tibbetts Avenue • Danvers, MA 01923
Unrestricted Vrrr�Mass Builders License No. 054882 Contractors Registration No. 166565
PROPOSAL SUBM DTO_ n ,�I PH t7 �0//// DATEwd j J
STREET �` 1+ JOB NA % /
l C12COE
CITY,STATE AND ZIP D� JOB LOCATION
ARCHITECT C//T// DATE OF PLANS JOB PHONE
ropo5C h e y to furnish material a d labor co ple i accordanc with spe fications belo for ( e.Aum of: �(
Ur ' �� ' ����� ()dollars $
Payment to be as follows:
i
NOTICE: All home improvement contractors a d subcontractors engaged in home Authorized t.
improvement contracting unless specifically exempt from registration by Signature:
provisions of Chapter 142A of the General Laws,must be registered with gent
the Commonwealth of Massachusetts. Inquiries about registration and Note:This proposal may be
status should be made to the Director, Home Improvement Contract
Registration,One Ashburton Place.Room 1301,Boston,MA 02108. withdrawn by us if not accepted within days.
WE NEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
A ROOF STRIP
We will cover the siding, bushes,and grass with Blue Tarps in order to protect the property during stripping.
We will strip up to 2 layers of roofing and remove all nails down to the bare wood.The ice and water shield will then be installed
at the bottom of all edges, under all step flashings, around all chimneys, skylights,and into all valleys.
We will install 15 pound underlayment onto all other areas of the roofdeck.The 8"aluminum dripedge will then be installed to all roof edges.
Any roofing pates will be covered with n flu 'nu rubber fl n Yr� �l ��'
The roofing material to be used will be��� 1 0 ar 1.* � L�7 p
,-Ala the d bqs wall be.cleaned and,dumped,on,a,daily.basis.by„us.,Magnetic,brooms—wili-be,used-o. raet:all oils fregyyour property. ..
We vnn�otecf yo!r prcper'y s best we can, however some foliage matting, breakage,or marring could occur. We cannot accept
responsibility for possessions inside of the house,or debris falling into attic areas. Customer should protect personal belongings.
EXTRA WORK IN WHICH A COST TILL ICE AD ED TO THE ABOVE PRICE.
Replace Rotted Roofboards JUC Install Aluminum Gutters
Relead Chimney(s) Install Aluminum Downspouts
Replace Facia Boards Install Skylight(s)
Install Ridgevent Rotted Roof To Wall Flashings
Install Roof Louvers Gutter Repairs
NOTES:
r
7/7
Zc612STPZ4AIL IL 9 l
Warranty manufactur to be free of defect years, see manufacturer's warranty for exact warranty performance.
All labor rfo unde thi contract shall be of good quality and free from defects not inherent in the quality required or permitted for
a period f yea T warranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient
mainten ce, impropeliop ation, or normal wear and tear under normal usage. This warranty shall be limited to the work performed by
A.C. Cast Construct' Co., Inc. and limited to either repair or replacement by A.C. Castle Construction Co., Inc. at its'sole discretion
and election. nd.all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the
occurrence of the event giving rise to such claim.This warranty shall not extend beyond any limits imposed by applicable law.
Payment and Penalties- Upon substantial completion of all work under this contract, customer shall within 3 days make final and full
payment of the contract price. Any and all unpaid balances shall accrue with interest at 5% interest per month. You agree to pay all
court costs and collection expenses incurred by A.C. Castle Construction Co., Inc. in the collection of any amount you owe under this
contract, including without limitation reasonable attorney's fees. Please note:any illegal layers of roofing beyond a second layer will be
an extra cost of 35 cents per square foot.
Arbitration-Any controversy or claim arising out of or related to this contract, or the breach thereof, shall be settled by arbitration with
the American Arbitration Association or a mutually agreed upon third-party. Any judgment upon an award entered in arbitration may be
entered in any.court having jurisdiction thereof. This section shall not apply to claims of A.C. Castle Construction Co.. Inc. for collection -
of past due accounts owed by the customer.
4tteptantr of 13- ropomil -Signing this proposal means you have accepted all the terms as stated. n
Dale of Acceptance �ytJ I- 1� �1 Z Signature � ef�PL�//(�