3 ROSEDALE AVE - BUILDING INSPECTION (3) lea
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
�-' Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For O cial Use CaA
Building Permit Number: e! '
A'�"ppll"i�ee&
Building Official(Prim Name) ,Signature _ Date
SECTION 1:SITE INFORMATION
1.�Pro�erty Ad,�re{s: / 1.2 Assessors Map&Parcel Numbers
OCA a 4 /�-V•�
L l 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 It) Frontage(it)
1.5 Building Setbacks(R)
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:
Public e- Private❑ Zone: _ Outside Flood Zone? Municipal 2f On site disposal system ❑
Check ifyesO
SECTION 2: PROPERTY OWNERSHIP' '
1 i Owner'of Record:Q� + a0r4Nk �'lus� Stile>� mot f DMO
Name( r'm) City,State,ZIP
3 kt(td-lt 9-7fi' 7
No.and Street Telephone Email Address
SECTION 3:DESCRD'TI N OF PROPOSED WORK'(check all that apply)
New Construction Existing Building bl Owner-Occupied Repairs(s) ❑ 1 Alteration(s)01 Addition ❑
Demolition ❑ Accessory Bldg.El Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': O N f G e t nl< 4
a e 4 I u ate (O(.t J < r H
f r� 5 I.rn(. Y r wU u �- h.-1 tl
w..rr
s. SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ - 1. Building Permit Fee:$ Indicate how fee is determined:.
2.Electrical $ ❑Standard City/To"Application Fee
❑Total Project Costs(Item 6)x multiplier x "*
3.Plumbing $ 2 Other Fees $ „.
4.Mechanical (HVAC) $ 1---� List ^'
5.Mechanical (Fire $ /
Suppression) Total All Fees:$ -
ck
6.Total Project Cost: $ lg'�' /d w ❑hPa dtin Full Chec0 Outstanding Balance ue:—= _
SECTION 5: CONSTRUCTION SERVICES +
5.1)Construction Supervisloor License( L) S O.!�
R'P l-UN I G(,.V Q Y1f c�' License Number Expiration Date
Na(/m_e of/CSL Holder µ�e1
IS'Pr�UG '•IV `y List CSL Type(see below)
No.and Street p Type .,..Description
i�t , ,n O-S 11',t Ik (� -I(j U Unrestricted(Buildings u to 35,000 cu.ft.
"`-�'1 R Restricted 1&2 FamilyDwelling
City/Town,State,ZIP Ivl Ma
sonry
RC Routing Covering
WS Window and Siding
(I(�WIP SF Solid Fuel Burning Appliances
97( 77/ (�7)� J4li+r}c97b'a rlvl� I Insulation
Tel hone Email address D I Demolition
5.2 /Registered
I1 el �'l Home Imlontractor(HIC) /// P3 c( y —
1aU ;7 FBC Registration bar E piranon Date
FILMY Name or C Registrant Name
No. Street Email address e/
5"�ce� S Lq Mf{ o19ob 77/(,73� "T
Ctfrown,State ZIP 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 a building permit.
Signed Affidavit Attached? Yes_......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PEWITW -
1,as Owner of the subject property,hereby authorize Ke ��i
.t t v\ ��l .c&,y c l`
to act on my behalf,in all matters relative tto, r authorized by this building permit application.
Print Own s Name(Electronic Signature) f Date
SECTION 7b:OWNEW 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
.`iinn�ythis application is true and I oaccurate to the best of my knowledge and understanding.
nt
Print Owner's or Authorized Agent's Name(Electronic Signature) ' 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 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.mms.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq.ft.) 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. "Total Project Square Footage'maybe substituted for"Coil Project Cost"
J I
.j Massachusetts -Department of Public Safeiy
?. Board of Building Regulations and Star•darn
Construction Supenisor I & ?Famik s.
I' License CSFA-056432
ICUM A MACDONALD
6 Genoa Avenue. _• e
Saugus MA 01906 i n -
J.r�w.ill 'i n-iu E
��- xpirefion
commissioner 08/31/2016
' ''Aasnaei:uset?s -Departme�e•r:' `icSafr
'oard:oPBuildmgRegula+ar5'anq fiards
Construction Supern isur I a1c ' Farah
License. CSFA-056432
KErM A MACDQNALD 'r
40 LOCKE ST#903 't� v `
Haverhill]MA 01930
l
n�W's xpiratie!-
j Ce missioner 08/31/2014
�..- V/eeuvrnronmcal�
Office of Consumer Affairs&Business Regulation
w"Al
MEIMPROVEMENTCONTRACTOR
gistranon 111834 Type:
lration 2/4/2015-.�- DBA -
KEITH MACDONALD CARPENTERIWOODWORK
KEITH MacDONALD -
40 LOCKE ST APT 903 - -
HAVERHILL,MA.OtA'+0
.. - Undersecretary
CITY OF&UMNI, INULSSACHUSE=
• BUILDING DEPARTSffrT
120 WASHINGTON STREET,Y a FLOOR
TEL(978)745-9595
FAX(978)740-9946
K'IJ®ERLEY DRISCOLL
MAYOR IHoMAB ST.Proaaa
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONDSISSIONER
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbera
Applicant Information Please Print
Name IBasinev//organimdon/ vi ): e l a L a o/1fA
Address: /,L0Ck
city/State/zip: rl(B uT at. /1 i 0I2 o I Phone#: 9-7 F 771 03p-
Are you an employer?Check the appropriate box: Type of project(required):
I.❑ 1 am a=player with 4. ❑I am a general contractor and 1 6. ❑N truckles
employee(full and/or pan-[ices).• have hired the atbcootractora
1 am a sole proprietor or partner- listed w the attached sheet: 7 emodeling
ship and have no cmpl.p These sub-contractor have S. ❑Demolition
working for
me to
any capacity, workers'comp.insmaoce.
9. ❑Building addition
[No worker'comp insurance 5.❑We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL i I.❑Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.❑goof repairs
insurance required.]t employees.[No workers' 17.❑Other
nce wrap.insura required.] _
•A•y apparaa that chmi abox al must also all our the aalim below slowing their workma'comprnerim polity infumwdou
'Iim,eowms wM suhmil mk affldava indioring awY art doing dl work and that sin aoxide cmurxmla matt wbmk anew afflMMt indiofiq such.
:Cmasron thor chat mu hat motanachedan sMirimwlca Mawieg an name oftlw Mavmnemn top,hek woken'comp.polity iafotmadm
lam ax employe that b providing worker'compensaddun boarmaee for my employees Below is the pollcy andfnb site
informaion.
Insurance Company Name
Polity 4 or Self-in.Lie.#: Expiration Date:
Job Site Address: City/State/Lip:
Attach a copy of the workers'compensation policy deelarataaa page(showing the policy number and expiration data).
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 ns civil penalties in the form of a STOP WORK ORDER and a rime
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to tho Office of
Investigations of the DIA for insurance coverage verification.
I do hereby r<rtlf der rh pains
%ypx pexald of ry that the information provided above is true and comet
Siswuurc �t / // Date: 4A Y L�/
Phone_#: 9'7E
Official use only. Do not write in this area,to be completed by city or town a teia2
City or Town: PermitlWcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityfibwn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CITY OF Si .&Ni, jLA ss 1CHUSETTS
BLB.DNG DEP.xmmim
' 120 WASHINGTON STREET,r FLOOR
TEL(978)745-9595
FAX(978)740-9M
KI\mERIEY DRISCOLL
MAYOR THOMAS ST.PmRRa
DIRECTOR OF PLBLic PROPERTY/BI:tIDB3G CO\L%MIONER
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 haulerl
The debris will be disposed of in
I�MCI 7�,AJ 7�i- S?
(name of facility)
6)44 /mow
(address of facility)
signntw of permit applicant
CAL date
o
WFBC3054 I VM2135I All measurements are finished
Le plastered walls,doors and wndows
from outside of trim to outside of trim - 5-Cut and use fillers,as needed
e Ihave Included: .
830 VS8243218 mini-touch up kit
quart of stain - 6-Cut and use the tall and panels on the
left and right side of the fridge.
107 s" 1•Maln kitchen:
'Hugel the 12"high wall cabinet over the
Calling height is app.91 1/2"-92"
TO 394" 67z O
The door style Is 1 1!4"overlay,so there Important!
31 TF384Is 1/4"from the top of the door to the top
of the frame;you can adjust the doors down I have reduced the depth of the wall cabinet over
cIe slightly to get a little more reveal, the fridge to 21"deep.
1839 3W 61224 W2439L W2439R
The SWCRMB crown has a 1 5/8"rise x The fridge needs 70 1/2"of height from the
1 5/8"projection.The W wall cabinets
rI, finished floor to the bottom of this cabinet,
i normally hang at 90";adjust accordingly so the 82112"height Is Important
M TEP2484WD TEP2484WD - for final calling height. (82 1/2"-70 1/2".12".)
® 28"
2-Cut and Install filters,as needed
F830 O F33
3DB1S F336 � g � 7-Hutch area;
N i The base cabinet Is
w 3-The SLSCR36L has been Vold of toekick to W'wide x 18"deep x 34 1/2"high
3DB30 make It easier to get through the doorways.
The Sllestone will be Installed on this base.
— o
0 Build your own platform The open bookcase Is
W'wide x 12"deep x 34 1/2"54"high
N and needs to be installed after the
fa co countertop.
mO Install the SWCRMB crown on the
cl� 4-Pantry/Fridge area: bookcase and to the ceiling
re
y 3 The telling heightwill be aPP•831/2"
0
rn p Build you own 41/2"toekick base and stack the
39"high wall cabinets on them. 8-Vanity area:
W1 R W3018 W2436L y
41/2"+38"+39"=821l2"to the top The vanity Is
of the cabinets. 24"wide x 18"deep x 32'high.
72<" * 63" Important,the wall cabinets are 18"deep. The Swanstone vanity top is for this vanity
a'34 99"
Cut and use the VV98 solid stock as raised baseboard The mirror Is 21"wide x 35"high
735 e" and flat soffit stock to the telling
All dimensions_size designations 2O 20�T This is an original design and must Designed: 11/29/2014
given are subject to verification on r E C H N 0 t 6 G I E S // not be released or copied unless Printed: 11/29/2014
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
mas muse kitchen final design 11-26-14 All Drawing#: 11 No Scale.