7 RIVER ST - BUILDING INSPECTION The Commonwealth of Massachusetts qa
F
VE
Board of Building Regulations and Standards
M Massachusetts State Building Code, 780 CMR 1011
Building Permit Application To Construct, Repair, Renovate Or Demolis
{� One-or Tivo-Family Dwelling
�Y This Section For Official Use Only
Building Permit Number: Date plied
v
—Building OlTicial(Print Name) Signature -pSECTION 1:SITE INFORMATION' c�t.l PropertyAddress: L2 Assessors"'ap 3r Parcel NumoI.I a Is this an acce ted street?yes no rl
M1fap Number Parcel rn1.3 'Zoning Information: 1.4 Property Dimensions: c"tuning District Proposed Use Lot Area(sq It) Frontag
1.5 Building Setbacl s(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Witter Supply:(M.G.L c.40,§5d) 1.7 Flood Zone Information: 1.8 Sewage�/Disposal System:
Public III/ Private❑ Zone: _ Outside Flood Zpne? Municipal "On site disposal system ❑
Check if cs
SECTION2: PROPERTY OWNERSHIP,
2.1 Owner of Record:
CAIZ0L <ArZA
Rime(Print) City,State,ZIP
7 1/Fic r-7' 9>�r> %6�d
No.and Stfcut Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction O Existing Building Owner-Occupied 12( Repairs(s) Ids Alteration(s) ❑ Addition O
Demolition ❑ Accessory Bldg.❑ 1 Number ofUnits_j I Other ❑ Specify:
Brief Description of Proposed\York': �ff4;,o /lauf A"o 1?! . 1/n;Cir !lrlih4 .rgLt�r
SECTION 4:ESTIDIATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and M1laterials
I. Building S Z � I. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(item 6)x multiplier x
3. Plumbing S P,QtherFees: S
4.Mcchanical (FIVAC) S List:
5. Mechanical (Fire S Total All Fees:S
Suppression)
Check No. Check Amount: Cash Amount:
6. 'rotal Project Cast: S ❑Paid in Full ❑Outstanding Balance Due:
A t (_ V H ism . Lt7z f�tilaG( I
f
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 5/�--291
Q'M qA/u? .✓u- License Number .rpi tion Date
Name of CSL Holder List CSL'rype(see below)
sr/ sl�n✓L sT
Type Description
No. and Street
U Unrestricted(Build in s LIP to 35,000 cu. It.)
R Restricted )&2 Family Dwelling
Cityflown,State,ZIP M Masonry
RC Rooling Covering
WS Window and Siding
SF Solid Fuel Droning Appliances
I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) /Q.0/d4i
M A34/Z(&"&/oy9,/ HIC Registration Number .sp' ution Dnte
HIC Cum any Name o HIC Registrant Name
No. ardStreet — ��F � 2L��y Email address
IEc�2GY MA o/S/ 1
City/Town,State ZIP Tele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. I5L§ 2$C(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 Istuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... a
SECTION 7a:OWNER AUTHORIZATION.TO BE COMPLETED W HEN
OWNER'S AGENT OR CONTRACTOlt APPLIES FOR BUILDING PERMIT
[,as Owner of the subject property,hereby authorize e3m�( 1co-'Fl,
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
60,Z4 64/Ze /Z //
Print Owner's None(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 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 Owner's o r gent's N:u (Electronic Signature) ale
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or art owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program),will Liot have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
www mass eov'oea Information on the Construction Supervisor License can be found at www.nrass."ov leis
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. it.) 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. "rotal Project Square Footage"may be substituted for"rutal Project Cost"
Barrowdough Contracting L.L.C.
341 R Rantoul St. Mass. State License#048291
Beverly, MA 01915
Mass.State Reg. #108188
' - -
°Member-Better Business gur.
10
Name Address
Accredited @U5in8sS Date :130/201 4]
Carol Carr
�� Start °
�
Salem ����w�mm
Fax 978 2:2 2251
MA. 0187U
Job Title Description
Roofing Strip the upper main roof and the adjoining lower 4- Ti Ce A�r
roof. Reshingle using GAF brand., Royal Sovereign,
three tab shingles.
• Strip off the Vx 3"wood slat boards located
under the wood shingles.
• Install Ice &water shield to the first six feet
of all roof eves.
• Install 8"aluminum drip edge along all fascia :1/V 11
boards and up all rake boards.
• Install fifteen pound shingle underlayment 5
to the remainder of all roof decks.
• Install new vent pipe flashing boots.
• Counter flash both chimneys using lead flashing.
• Reworking and resealing of all existing flashing.
• Install an .060 rubber membrane roofing
system to the dormer roof.
• Removal and disposal of all exterior debris.
Procurement of the roof permit included,
fees extra.
* Ten year limited warranty- rubber.
* Twenty-five year limited warranty- shingles.
Note-We did use three tab shingles on Hamilton-H-all.
�
We propose hereby to furnish material and/or labor-complete in accordance with above specifications for the sum of:
GUARANTEE--All materia i guaranteed to be as specified. All work to be completed in a professional manner according to
standard practices. Any u teration or deviation from above specifications involving extra work will constitute an extra charge over
and above the estimate. All agreements contingent upon delays beyond our control.
ACCEPTANCE VFPROP0SAL—'The above prices, specifications and conditions are satisfactory and are hereby accepted. You
are authorized tudo the work specified. A3'day rescission period exists from date ofacceptance.
Date of Acceptance
Signature
Signatuie
QTY OF SAUM, AWSACFIUSEM
j BUILDING DEPARTMENT
-----_ __ 120 WASHINGTON STREET,3AD FLOOR-
AL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THOMAs ST.PIERRE
DIRECTOR OF PUBLICPROPERTY/B=ING COA IISSIONER
Construction Debris Disposa/ 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 c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
lwlr� l -4,gJ' CO,
(name of hauler) -
The debris will be disposed of in:
(name of facility)
(address of facility)
Signature of applicant
ate
t° Crry OF SiU.ENI, NLUSACHUSETTS
BUILDING DEPAR•r.%ff_NT
- -- 3 -i) � 7rr�,l — ------------ --130-\X/ASHNC;TON.$Tlil:ET,.3rDFLOOR
mod. TEL (978) 745-9595 — — — --
F.{x(978) 7.10-•9846
KI GIBE?r F_Y DR)SCOLL
{iH,�YOR TrlontAS Sr.PtF�tfta
' DIRECTOR OF PUBLIC PROPERTY/OUB.DING COSMISSIONER
Workers' Cornpensation Insurance Afrdavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
VdInC(Husow.is organ iiatiorulndividual): 2rLci1✓G[�u/rY �a J� ` r iry/ ` `G
Address: vL
Tj—
Cily/Stott/Zip: 6trl. M4 yyf/J Phone H:
Arc yt a an employer"Check the appropriate box: Lo
project(required):
1. I am a employer with Z 4. 0 I am a genial contractor and 1New construction
employees(full and/or part-time)." have hired the sub-contractors
2.❑ I mn a sole proprietor or poring'• listed on the attached sheet. tmodeling
,hip and have no employees These sub-contractors have molition
working 7itr me in any eapaciry, workers'comp.insurance. ilding addition
]No workeri comp. insurance 5. 0 We are a corporation and its
required.] officers have exercised their ctrical repairs or additions3.0 I ant a homeowner doing all work right of exemption per MGL mbing repuirs or additionsmyself. (No workers'comp. c. 152, §1(4),and we have no orrepairsinsurance required.) t employees. [No workers'comp.inwranee myuirod.J er
•Any npplicunl dui check,box 91 trial also rill out me siitien belowshowina their moorhen'eumpen"llun policy urrnmadon.
'1 h,menwft"who submit this sinrlavil indicating nccs,am do;ng all work and then hire outride contactors most submit a row amdavd indicating such.
:C.nnrraun that chick this box mml aatchd in addidural A l showing IN nano of rha subaentncton and their workon'comp.pulley inrom+mien.
I unr ua eurpluyer t/tar lr pruvldlnl;rvorkert'ruwptruarlun hr-turuueejur my nnpluyert. Ueluw/x rhs policy andJub silo
iafirrorulian.
Insurance Company Name: �R
Policy i/or Self-ins. Lies. N: '1'��O P�� 7 Expiration Dale: � Z '
Job Site Address: 7 Ri� '� V7. City/Stalozip:l_A�f—, /—M 015;0
Attach a copy,of the ivorkers'componsatloo pulley declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of bIGL c. 152 can lead to the imposition ofcriminal penalties of a
tine up to S1.500.00 und/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and d line
orup to S250.00 a day against the violator. Ile advised that a copy of this statement may be furwarded to the 011iea of
Invesligationv ul'dte DIA fur insurance coverage verification. -
l du hereby certify under Me pules mud per Ides of perfury drat the 0rfurruudaa provided obuver�k true art currra•t
i-•m ty Date:
Phone if: 2/ �2 `-2-2
k
O//iris!use only. Do nu1 rvrire iu till.'area, to 6e ruarplef¢d by city ur ru rvn a/JJrta[
City nr Town:
Issuing Aulhurily (circle one);
I. Huard of Ilealih 2. nuilding ncpirtntcia I.Ciiyfroisn Clerk J. Electrical linpidur 5. Plnnibing Inspeewr
b.01 her
jCuntaU Person:— _-._ _ Phone:: ,
r ..
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction O Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District, as per the requirements set
forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance.
District: McIntire
Address of Property: 7 River Street
Name of Record Owner: John and Carol Carr
Description of Work Proposed:
Replace the existing wood shingle roof with 3-tab black shingles. The drip edge exposure will be no more than
314 n
Dated: November 24, 2014 SALEM HISTORICAL COMMISSION
By: ±ateisV
/��The homeowner has the option not to commence the work (unless it resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals) prior to commencing work.