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14 RICE ST - BUILDING INSPECTION (2) TPJ — lLf $ q I The Commonwealth of Massachusetts Board of Building Regulations and Sta TIONAL S CITY OF M y, Massachusetts State Building Code, 780 C�MaCTiONAI SERY CES sALEmI Revise(Mar 2011 Building Permit Application To Construct, Repair, RenrMV U`DirtolAao 48 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: tr Building Official(Print Nzune) Signutur D:uc SECTION 1:SITE INFORMATION Pt Address: 1.2 Assessors Map& Parcel Numbers $± 5AIP-AA. accepted street?yes _ no Map Number Parcel Number Information: 1.4 Property Dimensions: t Propose)Use Lot Area(sy fl) Frontage(il) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Reyuin:J Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.d0,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone'? Check if yes[] Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP No.and Street 'telephone Entail Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify:____ Brief Description of Proposed Work': IzW� SECTION 4: ESTIMATED CONSTRUCTION COSTS Itcm Estimated Costs: Official.Use Only Labor and Materials) I. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard CityiTown Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Outer Fees: $ 4. Mechanical (IIVAC) $ List: _ 5. Mechanical (Fire Suppression) $ Total All Fees: Check No. _Check Amount: Cash Amount: G. Total Project Cost $ r ❑ Paid in Full ❑Outstanding Balance Due: C.�/�� ali , L LLC 0 2 L-1 ,© . 1 I t SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) r—S—tik-t) License Number lxpiruton ate Name of CS�L Holder I.ist CSL'rype(see below) U No.and Street Type Description -+r1)C t�k �� C)kq� ll Unrestricted(Buildings u to 35,000 cu. R.) -/ i'`7w R Restricted M2 FamilyDwelling City/Towa,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding �/f\ SF Solid Fuel Burning Appliances SC �ffT ,�f V I Insulation Telephone Email address D Demolition L, 5.2 Registered Ilome Improvement Contractor(IIIC) C> 8 I 3 7 � (�,'k1c.1`d S IIIC/Registration Numlxr Esp ration Date HI 'Company Name or If IC Registrant Name /(J C &uk No.and Street Email address �`b &I 3� S ��Yeu� �st283 97fS Sri n7(:) Cit /Town,State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG.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 .......... ML 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 pt�lAr �11\c�ytrtq ( Q n --I- to act on my behalf, in all matters relative to work authorized by this building permit application. i lC/ ,G�r �r /y Pr`mf'Owner�ame(Gectronic Signature) Date SECTION 7b: OWNER' 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. it 7 7�1f/�'� P wner's o Authorized Agent'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 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.nuiss.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns 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 _ Numberofbathrooms _ Number ofhalf/baths Type of heating system Number ofdecks/porches "Type of cooling system Enclosed_ 3. `Total Project Square Footage"may be substituted for"'Total Project Cost" frice of Cousumcr Affairs&Business Regulation License or registration valid for individul use only . CONTRACTOR before the expiration date. If found return to: ME IMPROVEMENT Office of Consumer Affairs and Business Regulation egistration: 1'86- TYPE: 10 Park Plaza-Suite 5170 VExpi t' 11-(41 01-6,c Supplement i:ard Boston,MA 02116 NATIONAL MAN AC�€M7�TMhNC. EDWARDS RICHARDS��-= P.O. BOX 365 TOPSFIELD, MA 01983 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards ConsSruction.$upervisor .x License: CS-080145 GEORGE VASELIOR 5 PITCAHtN WAX 3 IPSWICHMA 0938 -Z1 .�rio"` - Expiration Commissioner 1 012 61201 5 ti � C(TY OF S,Uzm t%c-1SSACJjUSETTS DL'ILDLYGDEPAR-n0NT 120 WASHLYGTON STREET, 3w FLOOR Its (973) 745-9595 KIMBERLEY DRLISCOLL F•L`t(973) 7-14)4a44 &LAYO;'t I1-{OSLtB ST.PIG.Rlt$ DIRECTOA OF PLSLIC PRO PERTY/a(:=LNG COJLNIISSIONEX Construction Debris Disposal Aff7davit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Cade, 730 CD,1R Debris, ;old die proyisions of Ib1GL c 40, S 54; section l t I.5 Building Permit 1#This work shall be is issued with the condition that the debris resulting from disposcd 111, S I SOA. of in a properly licensed waste disposal facility as de6ncd by IN1GL c 1'11c debris will be transportcd by: (nantc of hauler�—'— The dcbri3 will be disposed of in ; r (J Jless ottaelhly( Y15((J (C Ul llCl Rllt.1(](t(Il'.11 if i HIC#178186 NATIONAL Management Team Inc. National Management Team Inc. Painting,Roofing&Siding Office: 978-887-5870 P.O. Box 365—Toosfield,MA 01983 Fax' 978-887-5875 Casey Whitcomb 14 Rice St. Salem,MA 01970 (978)594-5147 Dear Casey, July 15,2014 The following estimate is for the roof installation for the property located at the above address.The following paragraphs describe the work that will be performed. Installation Procedure • Strip existing roof on the entire house down to the roof deck • Install an 8 inch drip edge on all leading edges(rakes&fascia) • Install ice&water on all leading edges&valleys • Transitional walls are optional and incur an additional cost for the siding repair • Install new vent pipe flanges • Check all exposed decking for mold penetration,rotted wood or other defects • Replace any rotted or damaged decking(we allow 32SF @ no charge,$95.00/sheet thereafter) • Replace any rotted or damaged ledger board(we allow 30ft.at no charge,$4.00/ft.thereafter) • Install 15 pound felt paper on all areas that is not covered by ice&water shield • Install new GAF Timberline Lifetime High Definition Architectural shingles • Install new ridge vent system fAdditional Specifications • Homeowner to choose color of shingles COLOR: ANIC-y • Our dumpsters are sent to a recycling facility;therefore no additional trash may be placed in them. The transfer station will charge us a fee for additional trash which will be passed on to the homeowner. • Chimney re-pointing and re-leading is not part of the roofing contract and will be quoted separately. • A new roof does not guarantee there will be no ice dams-Ice dams are caused by poor attic insulation and not enough ventilation • During a roof job,the nails could break the sheathing during the nailing of the shingles • We are not responsible for any of the cracks that may arise in any walls or ceilings • Please cover all your floors in your attic to protect from dust and debris • We will remove all of the job related debris from property and dispose in designated waste facility • Permit costs vary from town to town and are not included in this bid • This estimate price is good for six(6)months Cost for Labor&Material for Roof: $6,800.00 _Payment Terms: 1/3 deposit due upon signing contract: ry..sv- 1/3 payment due upon start of job: $ 1/3payment due upon completion of job: $ Total Amount Agreed To Be Paid: $ O Please sign and date all pages. Remit to: National Management Team Inc.-P.O.Box 365,Tppsfteld,MA 01983 The following schedule will be adhered to unless circumstances beyond National's control arise: Work Scheduled to Begin: TBD Job expected to be completed within 60 days of actual start date. Warranty: National Management Team Inc.guarantees all work performed for a period of one year. If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. Terms and Conditions: This contract is subject to the terms and conditions of paragraphs 1 through 14 attached hereto incorporated herein by reference � rrd I Do not sign this contract if there are any blank sp es Cf R, -rJ5 711SI d C, ) I5(/11-f III? Ed Richards—Project Manager Caseydoitcomb National Management Team Inc. Date Homeowner Date 1 CITY OF S:U-EN1 1vL-kss,ICHL;SETTS BUILDING DEPART\tr—NT 1 )s a 51 120 WASHNGTON STREET, 3w FLOOR y b TEL (978) 745.9595 Eux(9 7 8) 740-9846 KIMBERL.EY DRISCOLL .1,E-1YOR THo.\LksST.F1F-R E DIRECTOR OF PUBLIC PROPERTY/BULLor%G CO\NISSEGNER Workers' Compensation insurance Affidavit: Builders/Contractor.v/Electricians/Plumhers Applicant Information f Please Print i e ibiv Name(Busioess,Organi onliont Intl i viIIU:J): 1l/h�••xl['1[/1 C,�A(r liao Address: Q= A 3Sfii.t_) S�ws(2 114A14r melts 6)4o5— City/State/Zip: Phoned(: S -76 Arc y an employer!Check the appropriate box: Type of project(required): I. I ran a employer with 4. ❑ I am a general contractor and 1 6. ❑New conswetion employees(full and/or part-time).* have hired the subcontractors 2.❑ I ani n soic proprietor or partner. listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working tin me in any capacity. workers'comp. insurance. tl ❑ 0 Itiing addition iNo workeri comp. insurance 5. ❑ We are a corporation mid its required.) officers have exercised their 10.0 Electrical repairs or additions 3.❑ I ant a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. (\o workers'comp. C. 157, 91(4),and we have no 12.0.Roof repairs insurance required.) employees. (No workers' IJ.�]Other �Y� cutup.insurance required.) •,'1ny uppliumn tlut checks aux Al muar also rill our the section below showing their woden•compensation policy inlLrmadun. r l lomeowncts who submil this alTidavit indicating they are damn all work and then hire uutside cunnaciors trout sohmit a new arfWmil indicating such. :comm-tors thus check this box man anachul an addidurul shu•1 showing the mane of the mbaonlncton and their workers'comp.pulley information. I one art rurpluyer shut Ir pruvidiug workers'cumpmr.mrlun Lerurmue jar my a up/oyrrs. Qeluw Is N�a po/%y and Jub life infrunsulinn. Insurance Company Name: Pidicy 4 or Self-iim Lie. i ��� n/ __ � Expiration Date: Job Site Address: City/State/zip: Attach a copy of file workers'compensatlo 14 declarutlon pale(showing the policy number and expiration date). Failure to secure coverage as required under. cc 'on 25A of MGL c. 152 can lead to the imposition of criminal penalties of a itnc up to S1,500,00 und/or one-year impris mneo4 as well as civil penalties in(he fuon of u STOP WORK ORDER and a find nF up to S2AN a day against ilia violator. I3e advised that a copy of this statement may be I'unvardcd to the offilce of Inveatig.mons ofthc DIA for insurance coverage verification. /do hereby certify raider Are pains and penalties ujperjury tlrat use injurrnwlmr provided ubuve i.v true and correct. S inn flare Dane: Phunc t 7011hialuseunly.only. Oo nor write in this urea,rnbecunspleredby cityurtown,o1jiciuf n: _ PefnlitILIcenseNority (circle one):icahli 2. IJuildln;; Ueparlutent 1.Ci(yfrmsn Clerk 1. F:Iectriai Inspector 5. Plumbing Inspector son: Phunc Y: