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11 POPE ST - BUILDING INSPECTION (2) The Commonwealth of\Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 730 C, $dMar a l Revised Mar 2011 1` I Building Permit Application To Construct, Repair, Renovate Or Demolish a �J One- or Two-Family Dwelling This Section Fek icial Use Only Building Permit NumberDate Ap hed:; Building OfFicial(Print Name) 'Sikiiature Date SECTION (: SITE INFORNIATION 1.1 Properly Address/ L2 Assessors Map& Parcel Numbers -JL1.1a 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.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private ❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2; PROPERTY OWNERSHIP" ` 2.1 Qwngr of Record: Tt7htJ EDay �a ►�rv, 0 /97o Name(Print) City,State,ZIP I I Pope- b?" 9-)6 33S/�G9 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) ; New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ I Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ti3�5pecify: �Rt,b a,id QQ R� Brief Description of Proposed Work": die a nd PIZ Qoof SECTION 4: ESTIMATED CONSTRUCTION COSTS- [rein Estimated Costs: Official Use Only,-, Labor and Materials I Building 3 I. Building Permit Fee S Indicate how fee is determined: 2. Electrical ❑ Standard Cityaown,Application Fee S ❑'Coral Project Cost i,(Itemb)s multiplier x 3. Plumbing i 2, Other Fees: S t Mechanical (HV.kC) S List i. Mechanical (Fire $ SnP ression) _ _ Coral All Fees: .'S_ Check No. Chcck Amount: Cash Amount 6. Total Project Cost SDO. ov l ❑ Paid in Full ❑ Outstanding -- 3 A 13alance Due: 0/"; z �'hP pCr/6Pc� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) l .JrJ� A - License Number Expiration Date Name of CSL I folder F List CSL Type(see below) '11C tfrc/L0^-- 31-- No. and Streit TYPe - � � Description U Unrestricted Buildings u to 35,000 cu. R.) L n! /; O O �{ itRcstricted lag Family Dwelling City/" own, State, ZIP M �lasonr RC coring Covering WS Window and Siding SF Solid Fuel Burning Appliances 7G/ 5ci? rat( I Insulation 1'elz hone Email address D Demolition 5.2 Registered Home Improvement Contractor(IIIC) 6 o7--S-do Y FIIC Registration Number Expiration Date I IIC Company Name or IIIC Registrant Name at S- /F2o si No.and L Street Email address 0l90 261 59 2 Id-i! Ci / own, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 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...........❑ 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 to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7h: OWNEW 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. Wt1( tar\ --�-2ANatJr- _ 3-oZc5 ay/3 Print Owner's or Authorized:\gent's Name(Electronic Signature) 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 Fionte Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at vvwwmrasi oowoca Information on the Construction Supervisor License can be found at www.rnass.g tv_-(IL 2. When substantial work is planned,provide the information below: Total floor area(sq. 11.) _(including garage, finished basement/attics, decks or porch) Gross living area(sq. tt.) _ _ Habitable room count Number of fireplaces Number of bedrooms - —.._—_-- Numberofbathroouts — Number ofhalE/baths _— _ fype of heating system - --.-.---- -----__-- Number ufTacks/ Porches — --- -- F)lie of cooling syatent -- —_---- Unclosed ---()Pell -- 3. "total hoject Squ:u'a Footage" utay be substituted r)r"I'W.11 Project Cott ' -- .Page No. of 'Pages Yvanfi s Proposal WM. TRAHANT JR. CONSTRUCTION, INC. 4TH GENERATION ROOFING 215 Verona Street LYNN, MASSACHUSETTS 01904 (781) 599-1211 • (781) 844-4551 • FAX: (781) 581--0855 H.I. LIC. #141778 PROPOSAL TTEDTO lij E-�Jy - PH`7�8 335 /(0 ( DATE l � — 2 3 t,TE rf O STREET r JOB NAME �J P' S r CRY,STATE and ZIP CODE - JOB LOCATION - ia\eT We hereby submit specifications and estimates for: We hereby submit specifications and estimates for: SHINGLE ROOF FLAT/RUBBER ROOF - - ------------------ 0 Strip entire roof ❑ Sweep entire roof clean O Replace any bad boards up to 100 linear feet ❑ Strip entire roof Z Install ice and water barrier first three feet up roof ❑ Mechanically fasten down ISO board insulation 0 Install ice and water barrier in all valleys and along dormers ❑ Install 060 Rubber Roofing on entire roof Q Install 151b. felt paper on remainder of roof ❑ Install metal flashing around perimeter of building ©Install eight inch drip edget7 ❑ Flash chlmney(s), pipe(s) and wall(s) --- ❑ Install ridge vent ❑ Edge caulk all seams ❑Flash or re-flash chimney(s) f t n e r ❑ Install new copper center drain O Install new pipe flanges ❑ Other. O Install`30 year shingl ❑ Clean up all debris ❑ Install gutters and downspouts ❑ Labor and materials guaranteed 100/.for five years —----- ------------ --- ------- -------------- - ------------- -- ----- ❑ Install trim coil ❑ Install new fascia boards ❑ Install new rake boards __. -_- --------_-__ ❑ Install sky light(s) - - ❑ Other. 12/Clean up all debris p'Labor and materials guaranteed 100%for five years O All shingle roofs are nailed by hand. 7 WE Proose hereby to furnish material and labor - complete in accordance with above 'specifications, for the sum of: 004 0o Total Price($ ��� ) . `*IF YOU ARE HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC, AS �`J /Jv.UC� WE HAVE,�NO CONTROL OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS.*w._ - -A All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifica- Authorized —�}-- tions involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to can fire,tornado, and other necessary insurance.Our workers are fully covered by Workmman's Compensation Insurance. acceptance of XLT� anal —The above prices, specifications and concritions are satisfac ory and are hereby accepted. You are authorized to Signature do the work as specified. Payment will be made as outlined above. Date of Acceptance: / Z ? Signature Please mail yellow copy to above address. CITY OF SiUHM) ANSSACHUSETTS y + BUILDING DEPAMIENr 120 WASHIINGTON STREET, 3'a FLC0R �,_��• ,' T EL (918) 745-9595 Ria(973) 140-9844 . Kl.\(nFRi FY DRISCO%1 AMR, TliohtAS ST.PI&QR8 DIRECTOR OF PUBLIC PROPERTY/BVI DLNG COhLMISSIONER Workers' Compensation insurance Affidavit: BuilderslContractori/Electricians/Plumbers Apnlfeant information please Print Legibly Muni:(Uusimssorgtniraliunrindividual): tA-311KAC� }21�t11nT 'S2 COt15f2Jc7tJh Address: 2tr s/err nC sr City/State/Zip: L-.IW"! ,In A- o/9aY Phone M: 7C'/ SSS i,2 I/ Arc an cmployer7 Check the appropriate boxt Type of project(required): i. I am a employer with / 4. 0I am a general contractor and 1 6. ❑Now construction eotployees(full and/or part-tim b on e).• have hired the suctractors 2.0 lain a sole proprietor or partner• lisled on the attached shcot t 1. ❑Remodeling ship and have no employees These subcontractors have B. ❑Demolitlon working for me in any capacity. workers'comp.insurance. q, 0 Building addition (No workers'comp.insurance 5. 0 we ate a corporation and its required.) officers have axerclscd their 10.0 Electrical repair$or additions 3.0 1 ran a homeowner doing all work right of exemption per MGL 11.0 Plumbin repuirs or udditlons myself.(No workers'comp. c. 152,111(4),and we have no 12, oaf repairs insurance required.)t employees.(No workers' 13.0 Other comp.insurancercquin:d.j -,day applicue tlW¢finks bat r I must also all out the serum blows showing thafr workers'tompsnudan polity i"110 nallon, '1l,vnvuwm"who submit this affidavit indicvina thcy un doing all worltand the¢I11rs a unidecanlrattars miss Misidt Snows affidavit indicating suck =Omi miors that chalk this box main insetted ass asWitiunat shsl showing the name of Iho sub.esmaxtars and that waiters'comp.policy Infdmu too. f an air employer that Is providing workers'compenradon itrsuraneerar any ea spluyeei t Below!x the policy and Jab she btforanutlon.Insurance Company Name. 9A27YgS J`- Policy 4 or Srlf-itts. Lic. 0: / 7 SV6 7 / Expiration Date: V-13•/3 IobSiteAddrcss: /I e ST CitylStatrl2ip:..S/�e^s,/YlROI97C) ,%itach a copy of the workers'compensation pulley 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 line up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form oft STOP WORK ORDER and a line of up to SM.00 a day against ilia violator. Ile advised that a copy of this statamunl may be t'urwarded to the Mica of Investigations of(lid DIA fur insurance coverage verification. /do hereby virdJy trader th_r ppul/tis wad Pee�ndhies ulpdr/ury thus the hi(urmuNoo provided above Is true and correct Dais, Chong, 1? S59 /dl / Ul)iciai use only. Oa imt virile in dox arrK to be cutrapleted by city or town aIJIC144 1 i I city nr7usvn: ._ Permit/f.lcense,4 _--- Gsuing,kulhurily(circlo one): 1. Board of liealth 2. Iluildiny Department .1.Cily4mvn Clerk J. Electrical Lopector 5. Plumhln4 inspector i i 6.Othar Contact Persntt: Phano It: °41 CITY OF S� NM , .� •• ' u-E , tiL1SSACHUSETTS ��j i• ' ) ` 131'llD4\GDEP.IRT\IENT TREET, 1 FLOOR T EL (978) 745-9595 IU%MERI Y DRISCOLL FM X(978) 7-10-9346 NLAYOX T�loxu ST.PIERBa Dimuca OF PUBLIC PROPERTY/81: D6\G C10Spt1SSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CNIR section l t L5 Debris, and the provisions of tb1GL c 40, S 54; Building Permit It 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: N)/r)0 i(? uc. ' (namc ot'hauter) The debris ,will be disposed of in 016t- (namc of Facility) _ (address of ta.dity) signaiurc 0epermit applicant -2o13 dale — 'I