84-86 PROCTOR ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts tpECqOAI ERV
s Board of Building Regulations and Standards �CI¢T{{YOF
Massachusetts State Building Code, 780 CMR , Imb APR ►5 AAettlse�F1ar 011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
f Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
o Cro n- s r
L l a Is this an accepted street?yes Y 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(it)
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 A On site disposal system ❑
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record* I
Name(Print) City,State,ZIP
089M , (LC3t OA. sT' 603,4-)9. 3232-
No. Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other Ot Specify: A 00
Brief Description of Proposed Work': G uT & x ,1 T/,v 6^7 T it o a/ti
tk7tlnts rLe Al s e o� T ups
LIP gr d� e e titer I s0lt e Te, C,> t S v
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ $ 1. Building Permit Fee: $—qJ_Indicate how fee is determined:
2.Electrical $ 5 ❑Standard City/Town Application Fee
❑Total Project Cost"(Item 6)x multiplier x
3.Plumbing $ 2. 06 — 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: S t Z 5 6 Z ❑Paid in Full ❑Outstanding Balance Due:
MP 4 ! 6�
SECTION 5: CONSTRUCTION SERVICES
5.1 Con r t.cHon Supervisor License(CSL) a Z 3, 1/ 3 , 2-
License Number Expiration Date
Name of CSL Holder U
l_
9��e--t—s_ li " List CSL Type(see below)
No.and StreetI p Type Description
TD/a d 1 L/ t� �� �./QZ� U Unrestricted 1 (Buildings u el ing cu.ft.
!.D ��/ / R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
_ �T SF Solid Fuel Burning Appliances
J M�k Da s/�(/tWw dA I Insulation
Tele hone �— Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
/ as 2 ->3 G. /J: /G
_/!�q, D. 'n 7 E."Al I7,g U CA-)OW HIC Registration Number Expiration Date
HIC CompanmRegistnt Name
4 7y6rr
A4 i1 e&MM-Emai,,urT1ye-*P � e-),y
No.and Street l address
D4An vets, wA a► 47- 9 ��fir �6o i
City/Town, 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 AA i m 1N K,,&s-j- '01 A M 'PO Q/v-c -
/
7
to act on my behalf, ' all mattersve to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of petjury that all of the information
contained in this application ' true and accurate to the best of my knowledge and understanding.
hA h
Prinf or Authorized Agent's Nam (Electronic Signature) Date
NOTES:
1. 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 Home 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
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/des
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
CITY OF S�UMN4 2ANSSACHUSETTS
• BUILDLNG DEPA&-niENT
120 WASHINGTON STREET,3se FLOOR
TES.. (978) 745-9595
FAX(978)740-9846
KI.,,IBFRi RY DRISCOLL
MAYOR THOMAs ST.PtERRIi
DIRECTOR OF PUBLIC PROPERTY/BUILDIING CONMUSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information A^ Plea se Print Legibly
Name(eusinestiorgnintionlndividual): AJT a-U ^/ /
Address: ct ( sy
'DA )Ve, , /91 D/g2 �City/State/Zip: Phone ff:
Are you an employer?Check the appropriate box: Type of project(required):
1.10-1 am a employer with Z 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7• ❑Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required] officers have exercised their 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.)t employees. [No workers 13.❑Other
comp.insurance required.)
•Any applicant that cheeps,box a t must also fill out the section below showing their warltess'compensation policy infumnatioa
*I lomeownim;who submit this sfRdavh indicting they are doing all work and than hire outside eammesera must submh a new wigidavil indicating such.
Coni neon that check this box most anached an additional sheet showing the name of the subeonmssm,mut their wad.,oomp.policy infarmmim
l am an employer that Is providing workers'compensadon Insurance far my employees. Below Is the policy and job site
information.
Insurance Company dame: (
Policy#or Self-ins,LLiie.#: / [ may/ l— Expiration Date: /
Job Site Address: ° y �is Pq C) CD t-,ST City/State/Zip: S/94/'+, Im
i
Attach a copy of the workers'compensation polity 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
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby eerrlf or the pa s d penalties of perjury that the information provided above is true and correct.attire; � /
Sig Date: � 6
Phone
OJfrial use only. Do not write in this area,to be completed by city or town affl I&L
City or Town: Permit/t.lcense#
issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CITY OF S.0 E.NI, TNLxsS.A.CHUSETTS
• BuUM NG DF-PART%IENT
130 WASHLNGTON STREET, 310 FLOOR
'I.I.. (978) 745-9595
FAX(978) 740-9846
KEMBERL.EY DRISCOLL
I UYOR THoma ST.PIERRa
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMSSIONER
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 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:
ci6�id�t-
--,
(name of hauler)
The debris will be disposed of in
G Ylit e��c3 T"tis Pew S / j n .
(name of facility)
(Address of facility)
r
rg ature of p rmit applicant
61
date
JcbrisalT.ilcx:
i
,,-1"
310" 3-4" 310" 34"
i
I
I
' I
i
Relocate heat Stea radiator
Pipe chase
l
Nj4i v� droll to
^ Inoraass vanity size b I h I di
7 51 sq. 05
ft.
• � _ iq
o � o
I
Delete closet
0.
1' 4'0"-- _1-11" 1'-4i740
�
I
t
i
i.
r-r r r
3-10" 3'-4' 3'-10" 3'-4"
i
I
i
Relocate heat Stea radiator
i
Pipe chess
i
I H
Increase vanity size
sgR. ' � ( 7 � 1 � 7
a
:� `l rs:er ar.ra
r
Delete closet
2'-0" 2'-0" . i'-10. 2'-0"
1' 4.0" II IV V-4- 3'10" -1-11"
7,1. , 7'-1•
I
Mir—I
G.P3U.Y]
I YL`GCn T.3 G1.0.Y.A{t1
NY_.N5;PLLE� —
isCt.S i\f.xR
AIR BARRIER
IMTHINPROFILE
' STRVCTURAL5HFATHINC)
vi
:o
�— Diagram courtesy of MaGrann Associates
Figure 2.1.3 —Architectural detail of tub installation with complete air and thermal barriers
l Fir
,w
w
y � N
f
r
Image courtesy of Energy Services Image courtesy of Building Science Corp.
Group
Figure 2.1.4 - Two installations of air barriers at tubs adjoining exterior walls
The installation of air barriers and insulation behind tubs and showers at exterior walls can be
achieved with proper planning starting with design (Figure 2.1.3). Also, shown in Figure 2.1.4, in
the image at left, the builder left insulation batts and drywall for his framers and held them
accountable for installing the materials where the tub was to be installed. In the home at right, the
builder left a thin board sheathing product to be installed by the framer. Another option (not
shown) would be to fill the cavity around the tub with spray-foam, which acts as both a thermal and
air barrier. In any of these cases, the tubs will be much less likely to cause comfort or moisture
problems. (Internal air-barriers for this detail are not required for Climate Zones 1 thru 3, however,
insulation behind the tub or shower is still necessary).
28
MDB Construction
_ 4 Tibbetts Avenue P�7Nt O P®�C`I AL
- Danvers,MA 01923-3914 JI lie`Y1 JI Fij' 1\J>'
978-815-8601
LICENSED& INSURED
F Visit Us At H.I.C.#100273
C 0 N S T R U C T 1 0 N ESTABLISHED 1986
- www.MDB-Construction.com
To Phone 603.479.37321 Date 1.21.16
Mr.&Mrs.Soulard JOB NAME/LOCATION
84 Proctor St. - First floor bathroom renovation(complete)
Salem,Ma 01970
JOB NUMBER 02170SUU JOB PHONE N/A
We Hereby Submit Specification and Estimates For:
Renovation of first floor bathroom to consist of the following items;
1.Demolition of all ceiling,wall,floor surfaces,fixtures,cl set we and entry door(to be reused).
2.Installation of R-15 wall insulation in exterior wall.
3.Electrical:Deletion of existing,installation of 1 GFI receptacle,1 light above medicine cabinet,1 vent fan light,1 recessed light,
2 switches and 1 vent timer. Note:Light fixtures,medicine cabinet to be supplied by owner,fan/light unit by MDB(Nutone or equal)
4.Plumbing:Fixture deletions,Install owner supplied tub,trip waste,toilet,sink,and faucet.Note:MDB to supply diverter valve.
Note: Owner to purchase fixtures and have delivered to job site. MDB will coordinate proper sizes.
S.Installation of venting of fan unit to exterior.
6.Installation of owner supplied vanity and vanity top,including pipe chase fabricated by MDB.
7.Heating:Removal of existing radiator and extending to under window location.
8.Installation of blue board and plaster finish on all walls and ceilings.
9.Installation of owner supplied wall tiles for shower and floor tiles.
10.Installation of existing moldings as possible,otherwise MDB will supply and install 3-1/2"Colonial style casings.
11. Installation of new baseboard to match existing as close as possible.
12.All job related debris to be removed by MDB.
13.Permits by MDB.
Exclusions.Unforeseen conditions,painting,boiler repairs,shower door,plumbing venting if not to code.
Note:Due to custom shower door MDB recommends that the customer coordinate with a shower door company.
We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of.
--Twelvethousand five.hundred_and;i x two DoBa-s=- $12,562.00-1-_--
Payment to be made as follows:
Payment#1:$4,500.00 upon start. Payment#2:$3,500.00 upon rough inspection Payment#3:$3,300.00 plaster completion.
All material is guaranteed to be as specified. All work to be completed in a
professional manner according to standard practices. Any deviation from above
specifications involving extra costs will be executed only upon written orders,and Authorized
Signature:
will become an extra charge over and above this proposal. All agreements
contingent upon strikes,accidents,or delays beyond our control. Owner to carry
fire, tomado and other necessary insurance. Our workers are fully covered by'
Worker's Comppemsation Insurance.
Acceptance of proposal — The above prices,specifications
and conditions are satisfactory and are hereby accepted.You are authorized Signature:
to do the work as specified.Payment will be made as outlined above.
Date of Acceptance: c2 I Signature: ���
V/te ((io�u�lrnrrrrrerr�l�a�Vl'ta1J[(f�/iJeC/J
7 Office of Consumer Affairs&Business Regala6on
MEIMPROVEMENTCONTRACTOR
- gistration 100273 Type:
xpiratlon: 6/15/�20`46_� DBA i
M.D.B.CONSTRUCTIOUna
Michael Burgess1� r
4 TIBBETTS AVE. si
DANVERS,MA 01923 .Z_i.i ��Tr
Undersecretary
Massachusetts Departm I of Public Safety
`.. Board of Buildinry Reo.n a ant standards
?tense: CS-023113
Construction Supervisor
MICHAEL H D BURGESS',.
4TIBBETTSAVE-
DANVERS MA 01923 = -
('1-j CK n Expiration:
Commissiane- 08/29/2017 °.