8 RANDALL ST - BUILDING INSPECTION U� 71
The Commonwealth of Massachusetts
t Board of Building Regulations and Standards CITY
t ' ! Massachusetts State Building Code, 780 CMR, 71"edition OF SALEM
.� Revised Junutrry
BuildingPermit Application To Construct, Repair, Renovate Or Demolish a /. ./DUX
PP P
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied: V
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 1:SITE INFORMATION
1.1 Pro arty Address: 1.2 Assessors Map& Parcel Numbers
l.la 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 11) Frontage(11)
1.5 Building Setbacks(R)
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: 1.9 Sewage Disposal System:
Publi Zone: _ Outside Flood Zone? 1p
¢tea Private❑ Check if es❑ Municipal T On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 OwnSt of Recurd• n .
Name(Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofllcial Use Only
Labor and Materials
I. Building 5 1 I. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire Suppression)
S Total All Fees: S
( Check No. Check Amount: Cash Amount:
6. Total Project Cost: S O
1 ❑Paid in Full ❑Outstanding Balance Due:
30 i6vly Rv�
61V ve(zL'
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
\
License
Number Numberumber
L1\plrJtlUn Ua1C '
Name ofCSI-,N, v
[older
_Ag I.i`t CSL'fype)see below) y�
JV Description
Address / , U Unrestricted(up to i Cu.
✓[��-- R Restricted I&2 Family
Dwelling
Signature M Masonry Only
RC Residential Routing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burnina Appliance Installation
D Residential Demolition
5.2 Regbtered Home Improvement Contractor(HIC) ��
W ��� w S� ` Registration Number`
I IIC Company Name or 111C(tegistrant Name
Address tt^ Expiration Date
Signature Telephone
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...........0
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 to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
\ SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
s.'vry S V'-t1' ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Q,
Print Name 1/� /till_.
Signature of Owner or Authorized Agent Dates / 0(11T
(Signed under the pains and penalties of 'u
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 Home Improvement Contractor(HIC)Program),will gg have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 IO.RS,respectively.
2 When substantial work is planned,provide the information below:
Total floors 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
). "Total Project Square Footage"may be substituted for"Total Project Cost"
s
CITY OF SALEM
..
PUBLIC PROPRERTY
DEPARTMENT
l..W MI11 '•Mir.'•II -
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I'rt.`178•7134;H3 I'.\s:%7/•715'/N16
Construction Debris Disposal Affidavit
(required lur all demolition wid 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 p 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:
I name of hauler)
The debris will be disposed of in
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Shea Roofing Co.
17 '/2 Foster Street
Salem, MA 01970
(978) 745-7313
PROPOSAL April 27,2010
susmlrrwTo: Andre Aoun
8 Randall Street.
Salem, Me
We hereby submit specgiptions and estimates for.
To remove all existing roof shingles from complete main roof front bay
roofs and front entranceway roof.
To install ice and water shield covering(3)feet up from all roof edges
and along all flashing points prior to re-roofing.
To install all new metal drip edge along all roof edges, both horizontal
and vertical.
To install asphalt saturated felt paper covering all roof boarding prior to
re-roofing.
To install architectural(30 year windseal)roof shingles covering
complete main roof and front bay roofs.
To install up to 100 linear feet of roof boarding if necessary.
To counter flash and/or reseal the chimney flashings as necessary. If lead
flashing is too damaged on chimneys we will grind them out and re-lead at
an additional cost of$250.00 per chimney.
To re-flash, counter flash and/or reseal all sidewalls as necessary.
To install new roof flanges on roof vent pipes.
To install three new air vents on rear side of main roof.
Tore-flash, counter flash and/or reseal all skylights as necessary.
To clean out all gutter and downspout systems to insure efficient
drainage.
To clean up and remove all roofing debris from job site.
The new roof is guaranteed for five years against any problems created
by faulty workmanship.
We propose hereby to furnish material and labor—complete In accordance with above speU0rallons,fa the sum of:
Six Thousand Six Hundred and Seventy Five Dollars ($6,675.00)
Payment to be made as follows;
Upon Completion
All material Is guaranteed to be specified. All work M be completed in a wodonanlfke manner according to
standard practices. Any aheration or deviation from above specifications InwMng extra costs will be executed
only upon written omtem,and will became an extra charge over the estimate. All agreements contingent upon -
strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance.
Our workers am fully covered by Worlamm's Compensation Insurance.
Acceptance of Proposal—You are authorized to do the work as specified
Authorized Signature:
Signature: Andre Aoun,8 Randall Street,Salem,Ms.01970
Date of Acceptance: 4.29.2010