9D RUSSELL DR - BUILDING INSPECTION S� The Commonwealth of Massachusetts
p Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALE
Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mae-201!
One-or Two-Family Dwelling
(� This Section For Official Use Only
\^v'� Building Permit Number: Date Applied-
Bmldmg Official(Print Name) Signature D
te
SECTION 1.SITE INFORMATION
1.1 Property Address. 1.2 Assessors Map&Parcel Numbers
I 1.Is 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 ft) Frontage(ft)
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:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
Name(Print) City,State,ZIP
No.and Street Telephone P Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ OtherSpecify:
Brief Description of Proposed Work':
her•-•,.a 4-e 14�l• s� �lG.' �T.
X let �`.vG L'%�eSYr � •- e>�; i✓Z.i� S'..
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials) Official Use Only
1.Building S ur C3 I. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing S 2. Other Fees: S
4.Mechanical (HVAC) S List:
5.Mechanical (Fire
Su ression) S Total All Fees:$
6.Total Project Cost: S Check No. Check Amount: Cash Amount:
❑Paid in Full ❑ Outstanding Balance Due:
Mat ) '-k 1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) r
A / / j� �/ License Number • Expiration Date
_ Name of CSL Holder
R ]� List CSL Type(see below) i-A
No.and Streets Type Description
Unrestricted(Buildings up to 35,000 cu.ft.)
City/�own,State,ZIP t /`-,J '7 Restricted 1&2 Famil Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
08 (J G �3 ttiC?-y'�-ACC%j-lrt-•`t7j��t�'c 7 Insulation
'Iele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) .. _
HIC Registration Number Expiration Date
HIC Company Name or HIC�Rjegys[rant Name
ri�l/>"r her
Nol!,,��nd S ee[ f�iitt,� � 7
sl� t•vy,,,� ✓ q C-/f/e, ����. GL�% .+c�..S l'" Email address
City/Town,State,ZIP Tele hone
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 ----------❑ No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L as Owner of the subject property,hereby authorize z✓ �_ ,�!i�=t rt: ,� ..• yam.,,�•
to act on my behalf,in all matters relative to work authorized by this building permit appl cation.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' 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.
Pant Owner's or Authorized Agent's Name(Electronic Signature) Date
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 can be found at
Information on the Construction Supervisor License can be found at __ _t,__;_
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.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"may be substituted for"Total Project Cost"
CITY OF SOU EM, NWSACHUSETFS
° BuMJD .WG DEPARTMENT
120 W.%sHLNGTON STREET, 3m FLOOR.
TEL. (978) 745-9595
Fax(978) 7.40-9846
KIiiBERLEY DRISCOLL
'MAYOIS I Ho.%tas ST.PmRRE
DIREfTOR OF PUBLIC PROPERTY/BU:IIDDQG CONMaSSIONER
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:
e
L:R c z. D t,S Pos �L
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
signature of permit appf ant
e
&
i ate
Jebrisal7-.Jx
a
CITY OF S.U._F_N4 KkSS ACH SET'S
l3tiiLL)LtiG DEPAP.T9tElT
, p a 120 WASHINGTON STREET,3an FLoola
� TEL (978) 745-9595
RuX(978) 740-9846
KIZfi3EP_1__cY DMSCOT L
gA
OIRECTOR OF PUBLIC PAOPEATY/3UM.DD4G CO-NL lISSIO.iFR
Al Workers' Couapensation Insurance Affidilivit: I$uiickess/Contraceor�l9 lcctsiciangll°9anrn6ers
plicant information, TPlease Drina Le iblV
NalTle (Business.Organizatiowlndividual)_ LDI--)4 i\y I_�
:'Address: it �� �C 1/e y, /Z
'hone#:- ' 7Gr� ' �V ` 6�6.
J
.Are v rs ernployerP Check the appropriate box: Type of project(required):
1. ' 1 am a employer with e A. ❑ I am a general contractor and 1 6 New construction
employees(full and/or part-time).' have hired the sub-contractors
2.[] I am a soft proprietor or partner- listed on the attached sheet.> 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. [] Demolition
Working for me in any capacity. workers'comp.insurance. 9. El Building addition
[No workers"comp, insurance 5. ❑ We area corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions
myself.(No workers'comp. C. 152,§1(4),and we have no 12.[]Roof repairs
insurance required.]t employees.(ieto workers' I3.[�Other. 6L:
comp. insurance required.]
Any anplicmt ilud checks box BI mgst also fill out the secti°n below showing their workers'compensadon policy information.
t t 6tmeownxt who whmit this affidavit indicating they am doing all wade and then hire outside contmctors most submit a new affidavit indicating such
=C.,ntrectcm that chctk ibis box must anached an addatowal sheet showing the name of The sub-contractors and their work=,comp.policy information.
1 Urn an employer that is providing 1pori er5'compensation ill.vurance for my etttp
hrfornration, lDj'eeS. Below is the policy and jov site
7 '1 _
Insurance Company Name: >
Policy d ur Self-ins. Lic.H:. / /2IJJG 7 Expiration Datedt' !
Job Site Address: �� I�`1�7C-� �� CityiStatc/Zip:,./•
,Attach a copy of the trorkers'compensatio®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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the viotaron Be advised that a copy of this statement may he forwarded to the Off ice of
Investigatimts or the DIA for insurance coverage verification.
I do hereby certify s r reho ppaills gild enolfies of perjury that fire lJlfurnrvtfon provided above is twee end correct
SiMlIsire' �Zi3�- [late: Z
Phone;::
Official use only. Do not wade in ibis Brea,to be completed by city or towns ogr iat
City or Town: ._ Permit/I.icense#
Issuing Authority(circle one):
1. Board of Health 2. Ruilding Department 3.Cityrrot>n Cfers 3. Electrical inspector 5_Plumbing inspector
6.Other
Contact Person: - -- -___—,- Phone#•
American Properties Team, Inc. �
RECEIVED
6PEC '-`
; TIONAL SERVIC .z': .
1016 MAR 28 A (.D I
TO: 9D Russell Drive
FROM: Jennifer Pappas, Property Manager
RE: Deck Replacement
DATE: March 23, 2016
*+****��**x*x*mx*rrr►*.csr*+r*++��****:*s**s*******■xrr�****************
Please be advised that the Board of Trustees for Pickman Park has approved the replacement of
the deck at the above referenced unit. This approval is contingent upon it matching the existing
deck(composite materials can be used) and following the Engineering Alliance Deck
Specifications. The Board will not allow any design alterations.
We also require that permits be pulled in advance (regardless of what your contractor may tell
you), and then a copy of the final approved permit once completed must be sent to APT for the
unit file as well.
You will need to bring a copy of this letter to the Salem Building Department in order to receive
your permit.
Should you have any questions or require additional information,please feel free to call the APT
Service Team at (781)932-9229.
cc: Unit File
500 WEST CUMMINGS PARK•SUITE 6050• WOBURN -MA -01801.781-932-9229 -FAX 781-935-4289
Emery Construction, LLC.
Estimate
19 Kelley Road Date Estimate#
Salem Ma, 01970 2/9/2016 E15-218
978-880-2638
Nancy King
9D Russell Dr
Salem,Ma.01970
Description Cost Total
As requested,we have prepared an estimate for the replacement of the rear deck.
Remove and dispose of the existing deck.
Frame new pressure treated deck frame with 2 x 8 framing material.
All stringers&4 x 4's to be pressure treated as well.
All decking to be 5/4"x 6 pressure treated decking.
All rails to be pressure treated balusters and 2 x 4's.
All hangers and fasteners to be to code.
Permits will be obtained.
Painting and staining by others.
All existing footings to be re-used.
Total Stock&Labor 4,200.00 4,200.00
Total $4,200.00
I ' ,
Brett Emery
From: Nanci Cole-King <nancick@hotmail.com>
Sent: Saturday, March 26, 2016 10:47 AM
To: Brett Emery
Subject: Deck Replacement 9D Russell Drive
GoodVlorning-
'Just confirming that I would like to proceed with replacing my existing deck with pressure treated lumber for
the agreed upon price of$4200.00. Please call if you have any questions.
t
i
CONSTRUCTION, LLC
Commercial • Residential
IB ::f .t , �•
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-059344
-
BRETTSEMERY=
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SALEMIS MA 019�0 i -
Expiration
Commissioner - 09/25/2016 "
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`� �- .DRIVER S LICENSE q =�.
V09.25-2013 09 25-19
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BREITS
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V/[e Ton�iuoitbre?���o�C�/T�[tLnc%iJG'��J -
Once of Consumer Affairs.1 Business Regulation License or registration valid for individul use only
' OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registradon 176626 Type: Office of Consumer Affairs and Business Regulation
y Expiration 9/10/2017 DBA 10 Park Plaza-Suite 5170
EMERY CONSTRUCTION ,/ — (r Boston,MA 02116
BRETT EMERY „ 1 le
19 KELLEY RD
SALEM,MA 01970
Undersecretary Not valid with guature