11 ROPES ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code 780 CMR
SALEM
6 ,
\vu, Re need,Ilm ?Ol!
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-ar Two-Family Dwelling
This Section For Official Use Only
Building Permit Numb r: 4g I Date Applied:
Building Official(Print Name) Signature ate
SECTION 1: SITE INFORMATION
1.1 Pro �ert� �y Address: 1.2 Assessors Map& Parcel Numbers
It
1.1 a 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 tt) Frontage(11)
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?
Public❑ Private❑ Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
21 Owner eczv, 6 ,'' X1( 01-9
Nmme(Print) City,State,ZIP
t l go i'�y i, 7-! / oil Z5/S�
No.mid Strom Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied kJ 1 Repairs(s) IN I Alteration(s) ❑ 1 Addition ❑
Demolition 10 Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Wor I: D l�7Ct fC�l b
AXXI
G AI 4144,il ZVt/
SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building $ l( �� rJ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: $
q. Mechanical (FfVAC) S List:
5. Mechanical (Fire S
Su ression) Total All Fens:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ �/ ®o 0 paid in Full ❑Outstanding Balance Due:
SECTION 5: CONs'FRACTION SERVICES
!N "
kConstruction'SSu''pe/rvisor License(CSL) C/ � /Q 7 �.�
'-: r(/J License Num�berr Fspiration Pane
fCSL IIoldcr l
��J -J��t r yt�� List CSL 1)pe Isee bdowl
o.and Street V�'�( Type Description
U Unrestricted(Buildin>s u' to 35,000 cu. 11.)
Citvy/d�own.rState.LIF R Restricted IX2 Family Dwelling
M Masonry
RC Roofin�Coverin
WS Window and Siding
SF Solid Fuel Burning Appliances
�[J I Insulation
Telephone Email address D Demolition
5.-2-�7Registered Home
/Improvement Contractor(HIC)
I DtV� � '" -"" "" wP'�it� HIC licgislratio Nwnber G spir tion Uale
HIC Company N:pne o IIC fie,i rant Nam _
!C 06
Ny_:yty1,S}reet.n-fin 'g -A 9 n 7 ,,L`,_„ Email address
Ci /Town,State,ZIP ty� l Telephone�f''�J�
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 of the building permit.
Signed Affidavit Attached? Yes ..........1M No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE CONIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR
�APPLIES FORK BUILDING PERMIT
I, as Owner of the subject property,hereby authorize w m- - r t0'f!/�'('c t �^
to act on my behalf,in all matters relative to work authorized by this building permit application.
Not Owner's Name(Electronic Signature) jDate
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 or Authorized Agent's Name(Flee onic Signature) Dale
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 N4.G.L.c. 142A.Other important information on the HIC Program can be found at
in_t�s�ov_'oca Information on the Construction Supervisor License can be found at tssvw.nia .�0�_dos
2. When substantial work is planned, provide the information below:
Total floor area(sq. ft.) (including garage, finished besenlent/attics,decks or porch)
Gross living area(sq. fl.) 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 ofcooling system Enclosed _Open
3. "Total Project Square Footage"may be substituted for"Fotal Project Cost'
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
.nic:s:1 v asiu u#t
Mt),rt
It^ilaCL•1'a SA F.M.M.U.,.tl.in W 1
fr.t.:771-713.93113 a 1:tx. 979-74C•'#x46
Workers' Compensation Insurance Afl)davit: Builders/CuntractursiElectricians/Plumbers
11,0011cant In(onn'ation Ple tie Print Leelhly
V:IITeltluaite,sfQraanvatinrvinJronluul l:
Address: Gj
CIIy,Srarc,/.ip �r�l.[� Phune0: &( �$— /(V�
7
.ire full an employer'!Check the appropriate box;
1')pa of pnrJaet(nyulrrd):
I.❑ 1 and a employer with 4. ❑ I ,un a general contractor and
I
wn I . r• Newcet p uyces(full and/ur art-time . have hit ❑ construction
2. p ) ed file soh-alntracwrs
M-I+un a tole prnprictor or partner- listed on rile anachcd sheet r 7• ❑Remodeling
ship:mJ have no wnpluycutt Theca sub-contractors have it.
❑ Damolirion
working lily me in any cupacily, workero'comp, insurance.
q. ❑ 0 Id"'S addition I Na workers'comp, insurance S. ❑ We area rnrpoFxtian and its
requirud.) Of icen have cccruiscd their 10.❑Electrical repairs or additions
3.❑ 1 can a homeowner doing all work right oreseniption per b10L l I.❑ Plumbing rcpuirs or additions
myself.LNo workers'comp. c. 132,¢1(3),and we hove no 12.❑ Ruufrepuirs
insurance required.) t cmpluyces.LNo workers'
comp insurance ruyuircd.J 13.❑Olber
ant,.yjlllvaa ihd chcclta boa Of mmm j6 tilt our the wabca bcluw rltuwinx iMir wwkwi cumpfnudiwe laJicy iuri"tNaiute
'11umw,wnon who ntbmit thin affidavit indiutinx that,an Juina dl work anJ then Ain whit ountrnettln mu#.utwnb an"affidavit inJi,mlinx etch.
•f.mtntaha,that ahvxk this boa mum anwhod an addirtuneL,hw1,huwina tha name tl/thiiiiiiiiiiialaille sub-coneaaws and#half Wuhan'atmp.ptdtcy mfbnnanur.
/"Off un ¢#"player slat Is prue•iJing workers'eampenrndon inwrnnee�ar my crap/uyers. Br/aw Is the pu/lay wed job site
i"jurutatiun,
Insurance:Company Vane:
Policy q ur Selr-ins. Lic.to: Expiration Date:
Job Sitc -Address: cay'state/Zip:
Affaeh Ifcopy or tlta workars',cumpensatton pulley declaration page(showing the policy number and cspiraliun date).
Pillar,to sccuto coverage as required under Section 23A ul'VIOL c. 152 can lead to rile imposition of criminal penalties`ora
line up h1 S l.SnO.tln anJ/ur unayear imprismoncnr,a.r well Js civil pcnJlht:s in the I•urm of STOP WORK ORDER and a Arne
of up to ilsn.00 a Jay'Iduinaf the violator. lie acivi.+ed thus a copy urthis mutcmcnl may be lurwarded to the 011ice uC
III1'"116j,mns vi the 01A Inr in,urmice coverage tcriliculum.
I Ja hereby a ertify nude the puinf, Ilea tf-1 u/'per/ury that the btj'urnnallon pro viJeJ u wit ba anJ corn rb
i fitaatnra /
�S— /
N.'r • I
U//lrial".re only, no not write in rhi.t area, to be rump/emJ )y airy ar town a//&'ruL
I
('itr or 1'otrn: PcnnirtlJcc•nsc M. I
I„uing Authority(circle one):
I. Iru.1 of Ilorlth E. Iluildim� Ucp
G. thhea .vunent ). CilVToun Clerk J. Electrical Inspccfor S. Plu"Ibinq In,pector l'�nu act 1'c null: _ Phone 1:
1
information and Instructions
I.1si.IChusetis taeneral Laws chapter 1�2 legores alI employers to provide workers' compensatuo tot their employees.
Mass.% u ro cilia aawte,an rmplus•re is defined us"...every pel:<on in the service of another un,kr any contract of hire,
Pur
c%press or Implied. oral or written."
An ernplup of a
er Is defined u"an individual,partnership,association,corporation or other legal entity, or any two r the
more
or the toneguulg engaged inajoint enterprise.and including the legal representatives ^deceased
la «s.employer How.vcr the
I eeelver or truxlee of .tit mclivlduai,p+umership,assoelation or other legal crag,employing ' P Y
owner of a dwelling house having not fore than ors too nr apartments
tenon a construction cond wtent repair work oherein.of he n such dwelling home
dwelling huuse of another who employ. Pe
or n the grounds or building appurtenant thereto shall not because or such employment be deemed to be in employer.'
o
�iGL chapter 152. �3SC(6) also states flat"every state or local licensing agency shall withhold the Issuance or
renewal of n license or permit st operate •buslarias or to construct buildings in the commonwealth for any
:applicant who has not produced ccept,bl eevidras her the eonu insuranceonce f compance with the
nonw rift n c any ofUcoverage
soli caltubJivisrons shall
\ddiliunally. %IGL chapter 15, a_ l 1
enter into any contract for the perfomance utpublic work until acceptable evidence of cwuplimce with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please rill out the workers' compensation affidavit completelyhone hec be,(,)along wiing the boxes th char cc riic'ate(0)Of
at apply to your on and,if
necessary, supply sub-contraclor(s)name(a),rddress(t:s)and p _
insurance. Limited Liability Companies(LLCworLimited
Liability
Paion irtnership(If an)with
or employe ore have
than the
nernbara or partners, are not required a to carry
employees.a policy is required Be advised that this affidavit may be submitted tand o the Department of Industrial
he runein eJ to the city or town that th ce coverage. Also be sure appl cation for the peon orolicense is b11111111 eing requt the ueJ,�not theelhpaRment of d
he industrial Accidents. Should you have any questions regarding the low or if you are required to obtain a workers'
compensation policy,please tail the Department at the number listed below. Self-insure)companies should enter their
self-insurance license number on the a ro riuta tine.
City or'rown Orrlclala
partment has provided u space
Please be sure that the affidavit is complete and printed legibly. The De the bottom
the affidavit fur you to rill out in the event the office of Investigations tax to contact you regarding the applicant I'Itau: be sure to till in the permit/license nunbar which will be used as a reference nunabur. In addition,an applicant
that mint submit multiple penniUlicmaxe applications in any given year,need only submit one aBiduvit indicating current
ite Policy information the unWaviry)At has been officially tarnpeJ or marss"the d tinder"Job Sked rby�tile ar ry or town tnay be provided to the in y or
Y P
town)." \copy
applicant as proof that a valid affidavit is on file for future peamits or licenxat t now affidavit must m lilted out each
y e:lr. \Where a home owner or citizen is obtaining a license or permit not relate)to any business or commercial venture
tie a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
I he litlicc Ill luvesrigatiuns would like to thank you in advance fur your cooperation and shuuid you have any questions,
please du nut hesitate to give us a call.
the u,;paroncm's address, telephone Lind fax number:
The Commonwealth of Massachusetts
Department of Industrial Accident
o[Aee of[avestlQadons
600 Washington Street
Boston, MA 02111
"Pei. p 617-727.4900 ext 406 or 1-877-MASSAFE
Fax M 617-727-7749
www.mam.gov/dia
CITY OF SMY. Nf, L L-1SSACHUSETTS
BLALOLNG DEPAR-MENT
110 WASHLNGTON STRM, 3°FLOOR
TEL (978) 745-959S
FAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THomu ST.PIERRB
DIRECTOR OP PLBL[c PROPERTY/BCIIDLNG COMIUMISSIOYER
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 l l 1.5
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
1 11, S 150A.
The debris will be transported
by:
(name of ha er)
The debris will be disposed of in
(name of facility)
(add s ortfacility) .
i
signature of ermit applicant
fl,
d' IC
Massachusetts- Department of Public Safeti
Board of Building Rc_ndations and Standards
Construction Supervisor License
License: CS 58495
Restricted to: 00-
PETER J GAR,RITY ;
589JERUSALEM RD#11
COHASSET, MA 02025
Expiration: 10(7/2011 -
(lnnmixeionrr Tr4: 8732
�g�, Otficc�l'c6osom�OO'reiiineiv` 7adoo—�
HOME IMPROVEMENT CONTRACTOR
Registration: 061064 - Type—
Expiration: 9l2212012 - DBAIn
-
x WTARRITY GROUPW ,7i. -
PETER GARRITY�,W�
zH-
589 JERUSALEM RD
COHASSET,MA 02025,- Undersecretary
Boston Carpentry/Garrity Group
Boston Mass,02122
857-294-6044
Isabel Lugo
11 Ropes Street
Salem Mass 01970
781 -632-7515
Scope of work
1-Complete kitchen to be demoed and disposed
including appliances and cabinets
2-Install new drywall in kitchen area then
plasteur,prep,prime and paint (Color to be picked by
Owner)
3-Install new kitchen cabinets and countertop .
4-Replace damaged appliances with new.
5-Install new sub floor in kitchen area then install
new ceramic tiles
6-All electrical to be checked for damages and
replace with new wiring
7-All trash and debris to be removed upon
completion of work.
8-All work to be done in a timely and professional
manner.
9-Livingroom to be prepped,primed and painted.
10-Replace floor in living room area.
Total Cost of Job $119000
Ist payment $4,000 2nd Payment $4,000 final $3,000