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12 QUADRANT RD - BUILDING INSPECTION
1 g The Commonwealth of Massachusetts ,SPECTIO AL & 5 WBoard of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR '�pp { e�1r�Nt1t �e SALEMall Building Permit Application To Construct,Repair, Renovate Or DehYASO N One-or Two-Family Dwelling y This Section For Official Use Only `! Building Permit Number: Date A ied: Building Official(Print Name) Signature 1 SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 12 G�un,8rant PA. l.l a Is this an accepted street?yes V 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: Zone: _ Outside Flood Zone? Public Lq Private❑ Check if yes0 Municipal tg On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record• .Derek+ roar aQ MC-CaMu Dem . MA ola'10 Name(Print) I ICity,State,ZIP 12, QJcurad 2d 918-141. 3-2oi No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Ed Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Workz: fe tYtprlusk 'L71d -ect. "ractn SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 6141:1'6no 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 43.0,(b 2. Other Fees: $ 4.Mechanical (14VAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ��t 6DD.6D ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /� vU CS D'I 33'l5 9I3)IL 61'IGn r. Muf License Number Expiration Date Name of CSL Holder List CSL Type(see below) V I I Ken rncvz by No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) dG War', . MA b1ci23 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Sidin SF Solid Fuel Burning Appliances �11k 1 14 3333 IuduQ brrwns klv. car„ I Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) I b 2101 I l J q'IL U1{1rSTS K,. ,ka, a -BGA� Cehtmr HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name -12 Hti e <St • 1tx1U a N .and Street Email address �hv'ers. �kIk bIgz3 9lk `I1�- 3333 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 ..........1t No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize "VJ*16 �A?) to act on my behalf, in all matters reellative to work authorized by this building permit application. Print O is Name(Electronic Signature)l Qr Date SECTION 7b: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. bat."It. Print Owner's or Authorized Agent's Name(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/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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" SCA 1 C-' 20M-05/11 • -/�c'�niirvrrn�rvn�/�[��`�l2lir[r'��ae//' � \ Office of Consumer Affairs&Business Regulation , OME IMPROVEMENT CONTRACTOR � Wistration: 103611 Type: :xpiration: 7192016. Private Corporation BROWN'S KITCHEN&BATH CENTER BRIAN MURPHY - - - 72 HOLTEN ST. Danvers,MA 01923 -- Undersecretary &-,COMMONWEALTH OF:MASSACII�SES . BOARWOF - - PLUMBERS` R7'10 :kASf ITTEit! ISSUES THE FOLLOWING ftCENSE ,, 1.10ENSED AS A MASTER PLUMBER BRIAN F MURPHY { - x � " 11 KENHORE UR iYANVEI2S MA 01923 112fi . T Su 93M-4 05/0l/76 z15009 Massachusetts -Department of Public Safety Board of Building Regulations and Standards _ Construction Supen isor License: CS-073375 .. BRIAN F MURPHY -- 11"NMORE DR Danvers MA 01923 g .72�- Expiration �" Commissioner 09103/2016 ^1 ® DAM(MWDDrYY m) A�o CERTIFICATE OF LIABILITY INSURANCE 6/1/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cheri Rossetti NAME: TGA Cross Insurance, Inc. PHONE (781)914-1000 AIC No:(7e1)224-5777 401 Edgewater Place &MAIILADDRE crosaetti@tgacross,com Suite 220 INSURERS AFFORDING COVERAGE NAICF Wakefield MA 01880 INSURERANautilus Ins Co 17370 INSURED INSURER B:PlVMOUth Ross Assurance Corp. BF Murphy Plumbing S Heating, INSURER CAssociated Employers Insurance 72 Holten Street INSURER D: INSURER E: Danvers MA 01923 1 INSURERF: COVERAGES CERTIFICATE NUMBERCL156140135 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD SUER POLICY NUMBER MWDD/YVYY MM/DD POLICY EFF POLICY E)IP R UNITS X COMMERCIAL GENERAL ABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RE A .CLAIMS-MADE 51 OCCUR PREMISES Ea=nce $ 100,000 a00NDNN455235 6/1/2015 6/1/2016 MED EXP(Any one Person) $ 5,000 PERSONAL S ADV INJURY $- 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑jEa LOG PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: Property damage-single Omit $ COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY Ea accident B ANY AUTO BODILY INJURY(Per person) S 20,000 ALL OWNED SCHEDULED PRC00001003545 6/1/2015 6/1/2016 BODILY INJURY(Par asadera) S 40,000 AUTOS AUTOS PROPERTY DAMAGE NON OMEO S X HIRED AUTOS X X AUTOS Per soddent Undemsumd motorist el s,,Ift S 20,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,0001 A EXCESS LURE CLAIMSMADE AGGREGATE S 1 000 000 OED FX I RETENTIONS 10,000 1SOMMM015775 6/1/2015 G/1/2016 S WORKERS COMPENSATION &ATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOWARTNERIEXECUTIVE YIN E.L EACH ACCIDENT $ 500,000 OFFIQE�EMC (Mandatory.. ER H)EXCLUDED? WCC5010092012015 6/1/2015 6/1/2016 E.L.DISEASE-EA EMPLOYE $ 500,000 (Mandatary In b.under DESCRIPTION OF OPERATIONS balm EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached R more space Is required) CERTIFICATE HOLDER CANCELLATION IWY C Of Salem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 121 Washington St. ACCORDANCE WITH THE POLICY PROVISIONS. Salem, MA 01970 AUTHORIZED REPRESENTATIVE Plumbing/Gas Inspector Thomas Gregory/CRl +Aa.-l ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS02512n1an11 BR 97'S KaVHEN & BATH CENTER. 72 Holten Street,Danvers,MA 01923 Telephone(978) 774-3333 " Fax(978) 774-8709 me Improvement License#103611 ' Mass.Builders License#073375 CONTRACT This co itract,dated below,for materials and/or labor to be supplied by Browns Kitchen&Bath Center (Hereinafter,referred to as the conuacw),at the sole request and order of: NAME: Margaret McCarthy PHONE:978-741-3202 DATE:Nov.24,2015 ADDRESS: 12 Quadrant Rd. Salem,MA 01970 (Hereinafter referred to t s the owner or buyer)to be supplied/performed at premises set forth above,subject to all of the terms and conditions set forth on both sides of the Agreement,as follows: Brown's%itche and Bath Center is happy to furnish you with a quote on your Bathroom project. Master Carpentry:We will move walls to studs.We will go over ceiling The outside walls wi r be insulated.The walls will have new blueboard and plaster. The shower wall will.have waterproof backer board with Owner supplied,Brown's installed tile. The shower base wiL have a rubber membrane with Owner supplied,Brown's installed tile There will also be ne w trim around doors and windows and around base of room. We will supply&in tall a new bathroom door We will supply and i'stall a vanity size color knobs are included with vanity The vanity will have a Corian counter top with integral bowl Above the vanity wil be either a medicine cabinet or mirror Flooring: The flop will be prepared for Owner Supplied,Brown's installed the Plumbing: We will lisconnect all fixtures. We will supply and"istall a Symmons shower valve Model#S4701(chrome) We will supply and"istall a Kohler S"Forte lave faucet.(chrome) We will supply and i istall a Highline Comfort height toilet w/elongated seat.(white) All work to be conne ted to existing plumbing.Any modifications to accept draws or other items will be extra. If any upgrades are nee'led a quote will be provided. Shower Door:Will a quoted(Please note that shower doors take 24 weeks after template) Heating: We wills pply and install 6'of baseboard Ventilation: Fan light vented to outside Electrical:Will be quoted *Tile quote is based on a straight installation.Intricate patterns or large tile are higher in price for install.Marble like tile is a higher price for install: *At lime ofjob all kno s,handles, TP holders,towel bars etc.must be on site for installation.If not on site during jab installation a service f e will be charged to return to job and install these items. Nothing other than sta red above is included in this quote No paint or paper.All sales tax is included.All work isfuily insured Any debris created by Browns will be disposed of by Browns.Local permit fees not included. *(Owner Supplied mam ial is the sole responsibility ofthe owner.Any defects or problems will be billed at an hourly rate. Door Style 00—(A tr Wiskej56t . AGREED PRICE: $16,000.00 Handle/Pulls Floor M 3 O 113 DEPOSIT: 6,nw Counter BALANCE DUE: I i rti0b.t� This quote is good (30)Thirty Days from date above. The owner represents and warrants that he is owner of aforesaid premises and that he/she has read this igreement,set forth on both sides. IT IS EXPRESSLY GREED THAT NO STATEMENT,ARRANGEMENT OR UNDERSTANDING,ORAL OR WRITTEN, EXRESSED OR IMPLIED NOT CONTAINED HEREIN WILL BE RECOGNIZED AND THIS CONTRACT CONSTITUTES THE ENTIRE AGREEMENT, It is further agreed that this contract is not subject to cancellation except by written consent of both parties. SALESPERSON: ', ACCEPTED: ACCEPTED BY: X X (SUBJECT TO ALL CONDITIONS ON THE REVERSE SIDE) 10711 15116' 75 8„ 158„ ; 8;6' 3611 32 6„ l.a(A6r. Thq ____�yt � CO G1,vanYtr" '�" ai 19' AL �1 N TOILET-1 O O -- ----- ----- (TI CD MIM M 1516 1 7091 33" 4 107" All dimensions_size designations Browns Kitchen Bath This is an original design and must Designed: 11/19/2015 given are subject to verification on 15 Elm St. not be released or copied unless Printed: 11/19/2015 job site and adjustment to fit job Danvers, MA. 01923 applicable fee has been paid or job conditions. 978-774-3333 order placed. Designl — I•pr All Drawing#: 1 No Scale.