19 RICE ST - BUILDING INSPECTION (2) fhe Commonwealth of Massachusetts
/I OF
Board of Building Regulations and Standards CITY
SALEM
Massachusetts State Building Code, 780 CMR Reri.red.t lux?oll
'�I t Building Permit Application To Construct, Repair, Renovate Or Demolish a
e�J One-or Two-Funtily Dtve!!Mg
This Section For Of cm I Use On[
Building Permit Number: to Applied:
Building Official(Print Nanne) Signature Date
SECTION I: SITE INFORMATION i
L I P ferVddress: 1.2 Assessors Map& Parcel Nu bers
7 /1'tcr2 .5�
1.1 a Is this an accepted street?yes no_ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
tuning District Proposed Use Lot Area(sq It) Frontage(II)
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? Municipal ❑ On site disposal system ❑
Public❑ Private❑ Check if cs❑ P 5
SECTION2: PROPERTY OWNERSHIP'
2.1 wnert of Record: Sc. I e lAA
.J
Name(Print) �`- T— City.State,ZIP
try ST �178-1yy _2)97
No. an�treet 'relephune Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(chec II that apply)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': Re kAdUe o/CA L 1 5{,a We V
S
SECTION 4: ES IMATED CONSTRUCTION COST
Item Estimated Costs: Official Use Only
(Labor and \lateriels
I. Building S 1. Building Permit Fee:$ Indicate how fee is determined:
❑ Standard City/Town Application Fee
'_. Electrical ❑S t
Total Project Cost (Item 6)x multiplier x
1. Plumbing S 2. Other Fees: $
4. Mcchanical (IfVAC) S List:
5. \I'chanical (Fire $
Su mssion) 'total All Fees: S
Check No. Check Amount: Cash
b. Total Project Cost: Soon m 0 Paid in Full ❑Outstanding Balance Due: ___ _
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/f0� License Number li�piruinn DateN;uncot C'Sl. Ito let / --
(. LA J_p ,;4 fNS f-el- o Liu CSI.�lypc(see below) U —
No.and Street Type Description
rtiC -Iw
U t Inrestricted(Buildin�s u' it)35,000 ca. fl.)
rin V-1� R Restricted I&2 Fmnil Dwcllin C uy(I otcn. Shoe,LIP
M Mason
RC Roolin Onerin
`Jp W'S Window and Sidin
SF Solid Fuel Burning Appliances
Insulation
'I cic hone ]'.mail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Tar✓G� S�ti S�ntc �6✓( {J 9-6-13
I IIC., ompany Name or I IIC'IRegis(ra Name IIIC Registration Number Expiration Duce
(nf street
(AS4 y/
Nu.Win Slrcet rr,,,,,,,, � CAGY�eC �1/� aYGa�c>✓
W,k- 01 nC+fGG�.`J�l gcgc-c&-yq Email aJ ress
Ci / own, State,ZIP Y Tcle hmne 11
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 25C(6))
Workers Compensation Insurance affidavit must beponipleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issua of the building permit.
Signed Affidavit Attached? Yes .......... Ei 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 Tck �l� J evt cck � v c41cYl
act on my behalf,in all matters relative to work authorized by this building permit application.
it Owner's Name(Electronic Signature) Dale
SECTION 7b:OWNERt 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.
Print Ott ner's n ,%tahor/ed A nt's ;me(FIcctronic Signature) _6-a /'t
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 nol have access to(he arbitration
program or guaranty fund under M.G.L.c. 1�12A.Other important information on the HIC Program can be found at
N—% Imb,.g;o%j,,c:i Information on the Construction Supervisor License can be found at ttwtr.nm:.:.�ot
2 When substantial work is planned,provide the intormation below:
Total floor area(sq. ft.) (including garage, finished basemenCattics,decks or porch)
Gross living:trey I sy. It.l __ Habitable room count_
Number of fireplaces______—____ Number of bedrooms ---------
Number of bathrooms ----------------
Numbcr of half.'baths
1)pe of heating system_
Number o(decks;porches -
Typea(coolingsystent_ (inclosed —Open --------
"fohtl Proicc( Square Footage"play be Substituted for"fohd Project Cost'
; � CITY OF SALEM
;#.
PUBLIC PROPRERTY
3° DEPARTMENT
n:I r'In11t 1•11
\I%1'M
I_'C lbnau.�l:1u.\i1NCl•)'
Workers' Cumpenaation Insurunce :\tOduvit: liullden/Cuntracturs/Ele trichtna/plumbers
� ) )I(t:ant Infilnnrtlo
�J-• PI � riot le 'AI
VillT1@ I Iluar h,wlllr;l)Ill rninW Ind,If maul 1: / ry S 1r Arc
h
(� ,I
City,State,zip- r'�!t^^rr -G f—7(�G`4;1�
.1ru I )mu ao vusidayerl Check the apprlipriate box)1 ❑ 1 n a umfI with d, ❑ I 111i a general Coll, Pill and 1 h)M'of Nuet(required):
Linysvif.
ycus(full antYur part-lime).r huvu hired the sub-cunvacturs rt• New wasirucliun
2. tole prop iuhtr or panncr• listed on the anached.,hoer : �. ❑Rmnaleiin(<d have no umpsuycas These iub•contractors have
y Air mu in any capacity, workers'comp, insurance. e' Demolition
rkers'culnp. inturdnce J. ❑ We an a cmporstion and ib q• ❑ OuilainR iwiliun
J.) olrrcers have exulciscd their 10.[]Electrical repairs of additions
omw'vner doing all work right Ofex.mplion per N(GL 1LQ pl tbiny repairs ur aJJitione(N'o workers'sump c. 1 J2,41(i) and we huvu noo required.) r anpluyces. lino workers' 12,Q uul repairs
cmnp insets..rcquircd.) 1). Other IrS
•'1�p•grpLcae rhW:hecb Etta AI may:Jw rill lnlr r
'I111 a1 w M VCIIYp Wow awwrpe their rwYlea'wp,tt
rwn vM trdmul lAia affli i,Wli line thy im 10're at""it r,W r ��I"^Itulicr ruh,,,trliwY
T.mIrlJlrn lAy tMca rhea Eat mWr auahwl.'t WduiurW,hay dtuwine 1M rwny hi M"side
cur nw10q mut wNntt a nw 41R41111 Indlulr'ne.,h.
aehrs anti thew uurYen'fO1n/,I"i rntenteehlN.
/urn un emlplayer rhul Ir prvrlJ/nr werArrs'rutnprnmlloe Lrrgnrnerr for my anp/oyeet Be/mr/s rhi pu/lay unJ/ul.tile
iajynnWGrIL p r�n
ImuruncuC'umpany Nome: !^ r pcc( r V I T(Jw ( r(t)$�Vu✓IeQ
1'411icy At or Sclr•ins. Lic.re: e pP O OG 91, 7
Jut) Site dddrein; lo ! Espirmton Dab: /"-'off ' - O �a
t-uCe ll �aduela C1ty,JWterLlp: �C(\ttule o copy of me workers' cumpe iidcr S palliulley ,%ularullun page Ishowlnq the policy number and explrulum date)•
ratluru w wcuro cui eruge as required uuJm Scctiun?Jt� ul'.%ICL c. 1 J2 cid lead to ille imposition of criminal penalties of a
r)tf up ri SLSnQtlO y 1Yur vie•* vi, onprixlit 311rt, ui well as civil pcnahtcs in the Amin ura STOP %VORK ORDER and a fine
,x up m i'SO q0 n Jay ryuinll the v6)lalnr. Ire aJn.wd that a copy ufthlh"JIVIl tl may be Iurwirded to the OI)icu oA'
lul,anyan'nu ul ;lw UL\ ter ra,m.u'cu cr'wcr�;e latlic shun.
hereby thrift I„Ider dill/min�'u,Jpan,/der u/'per/rlry Ihur rb e irr unnul/ow
�� / pru willed abat111me is true and corgi
I'I•' I: I (� Dale• d ^ 1 /-1(
`I Q G
V q
I 11j/lciu/mr mn/y, l)J 1841'write in whir urcu, to Ae ru,npleteJ Dy ury ur roan a//IriuL
� f ;IV ur I'nrrn: _
' pennir/Llewnle s
I,wing .\ulhurily (circlenne):
I. 16,.u'J r(I le.dll) !. Ilinldm j Ucp.0 nowt I. 1:i11.'ru'a a C'Ierk J, L'leclrir.tl lot
G. I)U1er
I.)a'tar j, Plumbing Inaycclor
1' „1Lml Pv,ml:
��..
.� 1'Au nc• 1•
information and Instructions
\LUi.IC IIUaella VC❑ef Jl Laws chapter lit ICquIits all etiy/lo)e ion to the sts to ervue of anothereultileer u,y c ntnct o lot Ihire.
I'unuJl,t to tills)latuta, an Irmplurea ii dctined as". .every pc
lion
or ❑nphcd, oral or Witten." oration or other legal cnhry,or lily two or inure
uMership,.tallid thtO°.Corp lu yr or the
r sa, and iltcluding the legal representatives of a deceased cts. Hewcver the
�n c,npluyar n Jetincd as"an Individual,P em to m .mploy
r the loteQJing engaged in J even en1crp
sire not mere than three ipamnenu and who resides therein,or rho occupant of th1
ieCCWlr or ItUfICe UI .al IIIdlYlda-11, plutnerahep,Jsseclauoa or other legal resides D
owner Wes dwelling{house having n none to three
maintenunca,can+uucrion or repair work on such dwelling house
.[welling haute of another who employ. Pg
ment be deemed to be in employer."
or .In the grounds ur building{appunanant thereto shalt not because of such imp oY
sSC 6 also states thut''every state or local licensing sue°Cy shau withhold the Issuoace or
\lGL chapter 132. S- O crate■buslnass at to eo"struet bulldings I° the commuowrultY far spy
renewal of a Ilccaw u►Pa►resat to up uaaa wlsb the Insurance coverage required."
:rypllcunl who has not produced aceep
sable avldeGeV of comp of its political subdivisions ihall
ppilaconally,�IGL chapter l S_', §'_SCt71)lati s"Neither the con+Inonw%:' not mY
enter iota any IGL%;It for the Partbmianca of Pal work until acceptable evidence of cuntPliarla with the inwnnea
levanted to the contracting authority.
reyuiremcnts of this chapter have been p'
Applies"$$ checking the boats that apply to your"lualion an4 if
JddrsWea)and phone number(s)sling with their cartificutets)of
Pia:�+e rill out the workers' coor(s)nasion affidavit completely,by with no employees other than the
necessury.supply iolseontractor(s)n its(s),
workers' Compensation itouronce. If an LLC or LLP dose have
insw�ance, Limited Liability Companies(LLC)or Limited Liability PaMershlpe(LL )
ndustrial
members at partners,are not required to carry
en,ployeas.a policy is requited Be advised that the�Iw be sure is lgr and Jute the ul'ndav�it.11tted to the DOW T1u of taffidavit°t off
.\ccidents for confirmation of insuraneo coverage. permit or license is being requested, not the Vep
nu have any 4uestioos regarding the luw ur if you ors required 10 obtain a workers'
panies should enter their
be rewmad to the city or town that the application for the pa
Industrial,\ccidanta. Should y arvnent at the number listed below. Salt-insured comp
compensation policy,pigs»call the Dap
self-insurance license number on the a ro riate lino.
(-try or Taw"Offlclale
at
ull
Please he surd that the affdavit is complete and pr
inted legibly. The Department has provided sp•Jcathe ao lietant.
of rho affidavit of you to till out in the event the Otlka of Investigations has to Contact use regarding P
licutioAs in an given year,need only submit one alTldovit indicating carte or
fill III a bit SUM1t t0 fill In the parTTllt/hCdnae I1W11ber which wi I be used a�0 reference ICrC'CC nUll,bef. I'1 addition,in is app Rant
that must submit multiple Pennitllicetsse aPP `" h mocked by die city ri town nay bar provided to the
Policy intbrrnal,on lif noceasary)and under"lab Site Address"the marked t ihould writs"all [nay b p o Y
tuwnl•"�\copy of Ilse uffldavit that has been officially sump'
permits or licenses. Anew alyldavif Inu:t be tilled out each
portrait not related to any business or commercial venture
applicant as proof that a valid affidavit is t file far tLtun
y ear. Where a home owner or Citizen is obtaining i license or p
Jul{licel>.w or PCrmif to burn leovea etc.) said Perimt is VOT required to Co'mpleta this affidavit. uesuons.
I he I)tti�e I t InveitiyJtiuns would lee w d,ank you in advance fat your cooperation and should you haw.Iny V
I,Ica,e Ju nut hesiratd to give us a call.
fhc Ucpartinant'i addta+s, rcicphund ab
gad rail Womat: assachuseltts
The Commonwealth Of M
Depament of Industrial Accidents
011fea of levesdgadans
600 Washington Street
Boston, MA 02111
fag. tl 617-127F 9�617-72 of 1.87' MASSAPE
us www.rnass.gov/tie
CITY OF S.U-&Nfg j�LASS.�CHL'SETTS
BLLWL%IG 0EPARTME2NT
120 WASHNGTON STREET, Y'FLOOR
TEL (978) 745-9595
FAX(978) 7406984
KI.N®E.RLSY DRMOLL
MAYOR THO.�tAs ST.Pmsan
DIRECTOR,OP mBLIc PROPERTY/HCILDLNG CMMISSIONER
Construction Debris Disposal At'Ittdavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 1 11.5
Debris, and the provisions of MGL a 40, S 54;
Building Permit /l is issued with the condition that the debris resulting from
this work shall be disposed of in a property licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
l" y Sel p (Ckels-��-T: r ,)
(name of hauler)
The debris will be disposed of in
(name of facility)
Geo!�e'kwN
--L(address of facility)
sign. re per applicant
JJfC
Il llll..ilf.l•.
PREFERRED MUTUAL ;IIV':JRANCE COMPANY
POLICY ISSUED ON THE CO-OPERATIVE PLAN
COMMERCIAL LINES POLICY RENEWAL TILL swess
COMMON POLICY DECLARATIONS.
Policy Number: CPP 0110 59 98 74
Named Insured and Mailing Address(No., Street, Town or City, County.State,Zip Code)
CHRISTOPHER TAYLOR DBA
TAYLOR SON CONSTRUCTION
6 WESTMINSTER ROAD
MERRIMAC MA 01860 Replacement or
Renewal Number of CPP 0100599874
Policy Period: From 01/2 912 011 to 01/29/2012 12:01 A.M. standard time at the mailing address of the
named insured as stated herein.
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE
WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED.
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
PREMIUM
Commercial Property Coverage Part $
Commercial General Liability Coverage Part $ 799.00
Commercial Crime Coverage Part $
ommercial Inland Marine Coverage Part $ 4.00
Owners & Contractors Protective Liability Coverage Part $
Commercial Auto Coverage Part(Not Applicable In Massachusetts) $
$
TOTAL $ 803.00
Countersigned: 12/01/2010 By
Authorized Representative
20-35200
JOHN H FERNEKEES INSURANCE AGY FOR AGENTS USE:
17 EAST MAIN STREET 182599874
MERRIMAC MA 01860
(978)346-0013
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART COVER-
AGE FORMS(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY,
CD-1 (06-10) Includes copyrighted material of Insurance Services Office, Inc.,with permission. Copyright. Insurance services Office. Inc- 1983, 1984.
AGENT COPY
Massachusetts- Department or Public Saretc
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 71325rl
-
CHRISTOPHER TAYLOR
6 WESTMINSTER RD
MERRIMAC, MA 01860
Expiration: 5/11/2013
(innmiv.iuner Tr#: 16756
0 Office�f C'o�m°'e'r.��rfaci s�'Birrsi estY's"�'egu"tafi"ou"-
HOME IMPROVEMENT CONTRACTOR
Registration y,12g512 Type:
` Expiration %/15(�013 DBA
wl
T &Son Construction. J;
irk --rl
Christopher Taylor s�--_
6 WESTMINISTER, �� I
MERRIMAC, Ma 01 r Undersecretary
�'gSTOP&H
SON
CCONSTRUCT140 )
ER TtA)"t
978420-8049
6 Wesbutuster Rd
Merrimac,MA 01860
Lic#071325 Mc#129512
Proposal
Propo&4 submitted To: Job Name: job#:
Diane Filtranty Remove of siding&^mplace 7 -20U
Address: - Job Incafion:
19 Rice Si 1g Rice St
Salem, MA oi97o Salem, MA oi97o
• Date:9/23/U DateofPlans: 975-20H
Phone#: E-mail: Architect
Home:978-744-7197 CT
Cell:978-317-3217
We hereby submit specifications and estimates for:
1. To remove one layer of cedar shake sand one layer of cedar boards.
2. Prep gable wall sheathing with Tyvek.
3. Remove coil wrap that is around four windows and bend new profile to
make up for the clad boards removed. Ice and water installed.
4. Install new white cedar shakes (R&R) to the existing course. (will use
used shakes to weave in course to make comer.
A. Light block will be installed to receive motion light.
B. Defective piece of decking out back will be removed and new/weather to
be installed. ' _
C. Debris will be loaded into trailer and removed. Magnet will-be run over
areas.
D. Permit will be issued.
* Any replacement of wall sheathing or carpentry required to complete above mentioned
work will be billed at $40.00 per man hour plus the cost of materials.
* Pictures will betaken along phases.
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