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1 RIVERBANK RD - BUILDING INSPECTION (5) J� � The Commonwealth of Massachusctts ��y Board of Building Regulations and Standards Town of '•,kj� Massachusetts State Building Code, 780 CMR, 7ih edition eu.��.� Building Permit Application To Conslruct, Repair, Renovate Or Demolish a � i^ One- or Tun-Fcan�il}'Di+'e!!ii�g � J This Section For Official Use Oniy �^ Building Permit Numbe Date Applied: 1 � l /aJ-/ °-�— J Signamre: Building Commissioned I tor of Buildings Date SECTION 1: SITE INFORMATIOIV 1.1 Propert ddress: 1.2 Assesson Map& Parce!Num ers ``'��'i'� / l�:er/,�nLS. l�'� "3I —t3�y�-b '7� I.I a Is this an accepted stree['?yes__ no Map Number Parcei Number 1.3 Zoning Information: I.4 Property Dimenslons: _�L IZ 1 � /'♦5 �r Zoning District Proposed Use Lot Area(sq fl) Frontage(R) 1.5 Building Setbacks(ft) Front Yard . Side Yards Rear Yard Required Provided Required Provided Required Provided � 1.6 Wate/r Supply: (M.QL c.40,§54) 1.7 Flood Zone(ntormation: 1.8 Sewage Disposal System: �'� Public L9' Privare❑ Zone: _ Outside Flood Zone? Municipal 0 On sire disposal syscem ❑ '� Chetk if yesO i SECTION 2: PROPERTY OWNERSHIP� - ' 2.1 �wnpr�of.y�tecord: / �/+� [� � �/'`/� e�(��! �u✓Ye�y'\ . I /�Y�/`Li'�i� /��r�l. ,� ��N e nnt) G Address for Service: .- ���-- �r��� �a�- y� �� Signamre Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all thst apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) � Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: BrieFDescrip[ionofProposed Wo kz: K�+'C � G-+.'d- i/- % -- ��s.s 'v.J..,�r,...r � l.c.i,f.�v� i r r��oc> � �� � g SECT[ON 4: ESTIMATED CONS'CIdUCTlON COSTS Item Estimated Costs: Official Use Only Labor and Marerials I. Building $ �Z p�� - �. Building Permit Fee: S Indicate how fee is detertnined: 2. Electrical g ❑Standard City/Town Application Fee � �'��� ❑Total Project Cost�(Item 6)x multiplier x 3. Plumbing $ y' Dt�� - 2. OtherFees: S ������ 4. Mechanical (HVAC) $ .� n,,� List: 5. Mechanical (Fire $ Su ression — j�i� Total All Fees:S Check No. Check Amount: Cash Amount: 6. Total Project CosC S �l; � .� p paid in Full O Outstanding Balance Due: ���6����� M )c x SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) „G1M &Gr,� V' License Numbery Expiration ate .v /C, Npme of CSL- HHelder L List CSL Type (sec below) J _ Type Description Address U Unrestricted (up to 35,000 Cu. Ft.) R Restncted 1&2 Family Dwelling M Only Signature _ %7,F- -Masonry RC Residential Roofing Covering WS Residential Window and Siding Telephone SF Residential Solid Fuel Bunning Appliance Installation D Residential Demolition 5.2 Re isle Sd Home Improvement�contractor (HIC) I os h6i.-1-n19i IS -7 Registration Number HIC Compan ame or HIC Rstrant Name !/ Ex nation Date Address 6o1:_1)945 Signature . .. 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 oe building permit. Signed Affidavit Attached? Yes ..........a No ........... ❑ SECTION 79: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 r , as Owner of the subject property hereby authorize j Uisr a C ra r to act on my behalf, in all matters relative to work authorized by this building permit 11pplication. / Si nature of Owner Dater SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION iZ PAA er , as (jwner or Authorized Agent hereby declare that the statements and information 6n the foregoing application are true and accurate, to the best of my knowledge and behalf Print Name ignature of Owner or Auth rized Agent Date (Signed under the 2ains and penalties of er'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 not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations I I O.R6 and I IO.RS, respectively. 2. When substantial work is planned, provide the information below: Total floors area (Sq. Ft.) /5/G% Si�_ ref' (including garage, finished basement/attics, decks or porch) Gross living area (Sq. Ft.) A /A Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system 462�j Number of decks/ porches — Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted for "Total Project Cost" CITY OF SALEM, AUNSSACHLSETTS BURMING DEPARTJtErT a 130 WASHINGTON STREET, 3sa FLOOR "TIE L (978) 715-9595 FAX (978) 740-9846 KI\IBERLEY DRISCOLL MAYOR THOMAS ST.PtF1tR6 DIRECTOR OF PUBLIC PROPERTY/BUILDING COWMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information%I J� Please Print LeQTbly Name(Busine OrgamizatioNlndividial): / r7/ /J.r /1,>M4 -L. Jap -kyr Address: Lfrr,oA -r-/. City/State/Zip: % Z ,-4-X /!/i' CVE7K Phone#:__Gl7S' Are yyor? you yoemployeCheek the appropriate box: 1.1y 1 am a employer with 4. ❑ I am a general contractor and 1 Type of project (required): 6. ❑ New construction Vmployees (fu6 acid/orparttn-time" have hired the sub -contractors t �,,, � 7. WIremodeling 21I am a sole propriatar or parer- listed on the attached sheet ship and have an employees These sub -contractors have g. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition (No workers comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3111 am a homeowner doing all wort right of exemption per MGL I LEI Plumbing repairs or additions myself [No workers' comp. c 152, § 1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑th Oer Como. insurance reouired_I Any applicant that chucks box rl most also fill out the section below showing their woskm* mmprnsation policy infommtim, t l lonam ar who submit this aNidavi indicating theyare doing all work and them hire outoide comot has must submit a new a(fidavil indicating such. {astmel s shadchock this box must attached an additimal shed showing rha noose of arc sub -contractors and theirwodico' comp. policy information. law an employer that is providing workers' compensmian imuroncefor my employees. Below Is the polity and Jab sire informmiom Insurance Company Policy It or Self -ins. Lie. Job Site Expiration City/State/Lip: Attack a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this itaterrent may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert !nlier th�tW,! pena�es ofperlury that the information provided above /s true and correct OJfcial use only. Do not write in this area, to be completed by city or town official City or Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cily/town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: ___ Phone CITY OF SiUY"Nl, LkSSACHUSETTS Bumj= iG DEPAR'mm%im 130 W.ASHLNGTON STREET, Yo FLOOR TEL_ (978) 745-9595 FAX (978) 740-9846 KI.-,iBERLEY DRISCOLL MAYOR THomAs ST.PiERRE DIRECTOR OF PUBLIC PROPERTY/Buu.DLNG co%L%asstoNER Construction Debris Disposal 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 c 40, 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 disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in: �6��alJP 'I JvJ�-e. 01 L��SOiti (name of facility) (address of facility) Jcbris ffdm s Kofp�,rmitappli�cant % /z �/� I / date BKa9d aTB�u�{�i�iis`§�ii7� Construction Supervisor License License: CS 81143 Birthdate: 6/16/1972 Expiration: 6/16/2009 Trill 16877 Restriction: 00 JAMES R PHILLIPS 16 BROOK ST TEWKSBURY, MA 01876 Commissioner Tee iionrr�wouoea�� o�✓Giiamru�ivael� '1191 ��� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 157536 Expiration: 10/11/2009 TrN 259968 Type: DBA PHILLIPS HOMEWORKS JAMES PHILLIPS 16 BROOK ST. TEWKSBURY, MA 01876 Administrator Kim License or registration valid for individul use only before the expiration date. if found return to: Board of Building Regulations and Standards One Ashburton Place Rot 1301 Boston, Ma. 02108 y, Not valiut signator r Phillips' Homeworks 16 Brook St. Tewksbury MA, 01876 978-604-9158 jmphi117@veiizon.net I Name /Address I North Shore Kitchens Plus Estimate Date Estimate # 12/22/2008 1260 Description Rate Total Job: Robert & Dorothy Curran Salem, MA 25,760.00 25,760.00 Full Gut Kitchen Remodel for Ken Dempsey NSKP Includes: Permits and supervision of entire Kitchen remodel project. I will work closely with all subcontractors to make sure the job gets done right and finished in a timely manner. Demo Kitchen to studs, removal of all debris by Phillips' Homeworks, install new window supplied by others, widen kitchen doorway. Construction materials supplied by Phillips' Homeworks. Update electrical in kitchen (5) Decora switches (10) Decors outlets (12) 4" recessed lights and under cabinet lights as needed supplied and installed by Greico Electric. Install appliances. Update plumbing - new drain (PVC) and supply lines (copper) above floor. Remove old heat and install one large toe -kick heaters. All materials, and labor supplied and installed by Jim VanKnow Plumbing. Install appliances. Blue board and plaster by Mike Comstock Plastering. Hardwood Flooring installed by others. Flooring price not in quote. Kitchen cabinetry, installed by Phillips Homeworks. We will assist the electrician and plumber install the appliances. Trim and baseboard supplied and installed by Phillips' Homeworks. Tile installed by Phillips' Homeworks. Tile supplied by others. All appliances, fixtures, cabinetry, Granite counter tops, and tile supplied by others. Total Page 1 Phillips' Homeworks 16 Brook St. Tewksbury MA, 01876 978-604-9158 jmphi117@verizon.net Name /Address North Shore Kitchens Plus Estimate Date Estimate # 12/22/2008 1260 Description Rate Total Total $25,760.00 Page 4 0 -------�- / li I_DII ,�'t�S`�'�t� r L(i 121�i 1i deelgned by �O Ni��} �({ �� data 4ti 1 C VWZgq K -K-J, drawn by: -TCK Y AC U i L-A- z- i I � zu 183Tedwo St. 12' Mublehemd,MA01945MA- (q t drwg. no.: WZ 12a3 page: NOTE: PERSPECTIVE DRAWINGS REPRESENT THE ARTISTS INTERPRETATION OF THE GENERAL APPEARANCE OF THE ROOM 6 ARE NOT INTENDED TO BE A PRECISE DEPICTION. NOTE: ALL DIMENSIONS OWEN ARE SUBJECT TO JOB SITE VERIFICATION 3 ADJUSTMENT TO FITJOS SITE CONDITIONS. N 8 Do Z 'O N J�015E1zT 4 SRO-FRV IA AN �c - I RAVF�5ANK ROAT::, 1thead, wSt. 0 I 6AI SMI K. nq 70 Marblehead, MA. 01945 !�#� NOL- PERSPECTIVE DRAWINGS REPRESENT THE ARTISTS INTERPRETATION OF THE GENERAL APPEARANCE OF THE ROOM 6 ARE NOT INTENDED TO BE A FRECI5E DEPICTION. ' designed by: _ poq NA � FE`S( scale: I/ 1 ' /1 �� date:' II I drawn by: I D „V, ! f 24 12, Iq�D� drwg, no.: -WL q I � I age: Z NOTE: ALL DIMENSIONS GIVEN ARE SUBJECT TO JOB SITE VERIFICATION 6 ADJUSTMENT TO FIT JOB SITE CONPMONS. RD��?T �L7�ROTt-F� C�.IRP-,4h�i kms. 1:I tV'E7-N K. ROAD le3TdMA 0 . 01945 S Marblehmd, .-SALZiAi MA.. oig7o MA NQjL- PERSPECTIVE DRAWINGS REPRESENT THE ARTISTS INTERPRETATION OF THE GENERAL APPEARANCE OF THE ROOM b ARE NOT INTENDED TO BE A PRECISE DEPICTION. ` scale: /Z'_ �I_�rr designed by: 1 ONNA �I FN date:. I I' 1960Z-4.0,6 drawn by: L s e V rev: I I 19 IC6 drwg. no.: NOTE: ALL DIMENSIONS GIVEN ARE SUBJECT TO JOB SITE VERIFICATION b' ADJUSTMENT TO FIT JOB SITE CONDITIONS. .■ 1 r I� ju* IIT\ i�1i91■IIC�IGIICrII ■�rwli�swim •SII —_ _ I�I RD��?T �L7�ROTt-F� C�.IRP-,4h�i kms. 1:I tV'E7-N K. ROAD le3TdMA 0 . 01945 S Marblehmd, .-SALZiAi MA.. oig7o MA NQjL- PERSPECTIVE DRAWINGS REPRESENT THE ARTISTS INTERPRETATION OF THE GENERAL APPEARANCE OF THE ROOM b ARE NOT INTENDED TO BE A PRECISE DEPICTION. ` scale: /Z'_ �I_�rr designed by: 1 ONNA �I FN date:. I I' 1960Z-4.0,6 drawn by: L s e V rev: I I 19 IC6 drwg. no.: NOTE: ALL DIMENSIONS GIVEN ARE SUBJECT TO JOB SITE VERIFICATION b' ADJUSTMENT TO FIT JOB SITE CONDITIONS. .■ N 8 CID I t� t it 6 TPOWTRY 0—,U r-f-Arq designed by: .__ scale: Z I I Ia 41C4 1 .'��1�V^�0 V R�j�a�tT� 183 Ttd� Mmbleh ,, MA.St. 01945 - �--!-/ MA 61170 `a !Il2IE PERSPECTIVE DRAWINGS REPRESENT THE ARTISTS INTERPRETATION OF THE GENERAL APPEARANCE OF THE ROOM d ARE NOT INTENDED TO BEA PRECISE DEPICTION. drawn by no.:L'/Z9. page: fey: NOTE- ALL DIMENSIONS GIVEN ARE SUBJECT TO JOB SITE VERIFICATION 6 ADJUSTMENT TO FIT JOB SITE CONDITIONS. �I: � moi' • ... �,. RIV�R.SIbE f?�/}cF? 183 Tedq St. _ .... .. ...._... Mublebad, MA. 01945 .5ALF-M , 6 A _.: 01170 ....,- tlQIE PERSPECTIVE DRAWINGS REPRESENT THE ARTIST'S INTERPRETATION OF THE GENERAL APPEARANCE OF THE ROOM & ARE NOT INTENDED TO BE A PRECISE DEPICTION. deelened Ly. -90N NA, F�F7 scale: �y date: drawn by: $., rev: drwg.no. P -9 -06:,- NM - a e:NOTE: ALL DIMENSIONS GIVEN ARE SUBJECT TO JOB SITE VERIFICATION 6 ADJUSTMENT TO FR JOB SITE CONDITIONS. J y`� CL/i5�vf r �83 Tdk SSt. 5F'VL:L�.'1�... M& ON70 ,� 01945 NOTE: PERSPECTIVEDRAWINGS REPRESENT THE ARTIST'S INTERPRETATION OF THE GENERAL APPEARANCE OF THE ROOM Q ARE NOT INTENDED TO BE APRECISE DEPICTION. dealgned by �-NNAUUFN .._. _. scale: I Z r = i �yT�y drawn by _ +"44! rev. �. drwo.no.: ALL DIMENSIONS GIVEN ARE SUBJECT TO JOB SITE VERIFICATION 8' : ADJUSTMEfNTTO FIT J06 SITE CONDITIONS. M av i��!�o►i!�Iiio' JVY I . /5 lPom r F7 scale-. RDIkD It R:� L? mmwZ+,06 drawn �Y: 183 Tedow Sc Marblehead, MA. 01945 SALZM I lv'A 019,70 drive. n PERSPECTIVE DRAWINGS REPRESENT THE ARTISTS INTERPRETATION Of THE GENERAL N=, ALL DIMENSIONS GIVEN ARE SUDJECT TO J013 SITE VERIFICATION & APPEARANCE OF THE ROOM & ARE NOT INTENDED TO DIE A PRECISE DEPICTION. ADJUSTMENT TO FIT J013 SITE CONDITIONS. A - -