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6 SABLE RD W - BUILDING INSPECTION
i; W The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OFSALEM Massachusetts State Building Code, 780 CMR, 7`"edition Revised January Building Permit Application To Construct, Repair,Renovate Or Demolish a /, 2008 One-or Two-Family Dwelling This Section Fo Official Use Only Building Permit Num r: Date Applied: Signature: Building Co missioned lns r o uildi s Date SECtIgN 1: SITE INFORMATION 1.1 Property Ad ress: 1.2 Assessors Map&Parcel Numbers L 2 1.1 a Is this an accepted street?yes no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District •Proposed Use - Lot Area(sq R) 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSBH1 2.1 wner' fRecord: fy/• v!Zw/i Nam rhd) Addressor Service: `l_7 8 7 Yy y9 Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORKz(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied <Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_L_ Other ❑ Specify: Brief Description of Proposed World': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only abor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2 Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $Suppression) Total All Fees: $ �]" Check No. Check Amount: C h Amount: (� 6.Total Project Cost: $ �� ❑Paid in Full ❑Outstanding Balance Due: S�v OL\�' r: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed fie Construction S rvisor(CSL) IAi�3 q q v e U �O License Number / Exp' lion ate A� , P Name of CSL-Holder / Lit CSL T see below/�. s Type( ) .1. —.ype Description Ad U Unrestricted(up to 35,000 Cu.Ft.) ,-z:� R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 ¢gist I-)ome Improvement Contractor(MC) ! G/ MC Cpppp��pan.y�Name or HIC Registrant Name Registration Number I "L �tP4��n ,� Crr Address `1A J�j �. Exp' ion Date Signs ho Telepne 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 ..........Z No—........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner ' Date SECTION 7b: OWNNEW OR AUTHORIZED AGENT DECLARATION I, /7 d ti,. Z a a ( 6 ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. B o 0020 B c. d Print Name 0 Sign r or A orize gent Date Si a under the sins and penalties ofperjury) 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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" Y' CrTY OF SALEM PUBLIC PROPRERTY PARTMENT I'.II: �1 r l '/1�''I 1 ,iC u'.J 11]L..Ir)I A![T •j.\I I\b \t.Ni 1r 111 J 1.�•1'/ \I ... Ir f11: w'M.'1.*•/w� Q 1'\t:'17b7 lS'I/M Construction Debris Disposal A111davit (required I'ur all dcnwlition Yxl nenuvation work) In accontW%X with the AN111 edition of the State Building Code, 730 CMR section 111.3 Debris. and the provisions of MGL a 40,s issued fthat th as defined by MGL o is issued with the condition that the debris resulting m sA Duildin6 laemtil M 1 4e d waste dispo This work shall he disposed of in a ptvpar Y 1 11. S 150A. The debris will be transported/by: IYYIM Yr haY1Qf) 1'ha debris will be disposed of in : (n.+rtlt ul w Ny .1/nalurt nrls.rmil apyllQarN .late Liersh Marlborough 508 485 8519 P.01 v ik R CERTIFICATE OF LIABILITY INSURANCE °"' "a"'°"""' 1MS/�09 PR0°YOe THIS CERTO+ICATE 12 Is ISSUED AS A MATTER OF MFORMATION Stephen W.Gereh Ina Agency Ina ONLY AND CONFERS NO RIGHTS UPON THE CERTiFicATe 0 Monument Avenue NOLOM TMS CERTIFICATE DOES NOT AmpEXTEND OR , ALTER THE COVERAGE AFFORDED BY THE POLICMS 6ELOW. Marlboro MA 07T92 INSURERS APPORWNG COVERAGE NAIL 4 Lola.Mania d bfa Central(woofing u A: Aflsada Casualty BO N.Warren Av$t wvjm a Granite gt"s - — Brockton MA CIM Q . USURER e COdERAOES THEPOuGESOFINSURANCELISMOBELOWHAVEBEENISSUEDTOTHERGLRV DNAMEDABOVEFORTHEPOLICYPERIODINWCATED.NOTWMiSTANDING ANY REQUIREMENT,TERM OR CON OF ANY CANTRACTOROTHER DOCUMENTWITH REVECTTOWNCH THIS C£RTIPkpRE MAYBE ISSUEOOR MAYP�AIN.THEINSLWANCEAF BYTHEPOLIGESoeacpaw ISSLMJECTTOALLTHETOIMS,EXCLLW"SAi ONSOFSUCH POLICIES AGGREGATE LIMITS SHOWN YHAVE OEM REDUOED BY PAID CLAIMS. - NIBN PQUCVMUMMtDMfS aaE��"�^ yuaAexcE i 000 000 F. A I x sa�uAaurr i149000792 itA 11/@9h0 CLAM MADE ❑OCCUR' 000 —jM5MOKAL A ADv WRAY s 11000,000 DEsiaru ,000 i IOEM A uMrAPn sAEM:� PMomA:Is.rn�noPAaa $1,000000 I P011L'r PN6 L1N: r:11EAt UADA. ' iry . up"W*jf=LmAV=roE AEDAvni1 Ipt i I vat - DN v- Darr f Ann Aura ' ,W°WER ro aTSAR rar. ADG A - R=FZfitlW�.u—UTAEUjW FaCN OCC i DCOUR ❑riADrsnwos _�.. s s .i acDUCrRE � ' YYDrtInFDa COl�/L4Aln[W - 7NDSTATU- AMDBelDT'®IS•(14ta)ny B AMAp�E AN71k6RF7IECUTr Q—T 7422M 0517APAM i 09I20/2010 M 100.000 a CED? LUJ E� 100 000 N` - D.L uMrr a ZTAO 00 crrHm PaeeworgM of weuTnona r weATnoxs r r MileuMmem ADDED av amoaearsrcesna>rM.warMrDIN: CERTIFICATE HOLDER CANCELLATION . Sf W ULD ANPC�i1�AaDYE aE$CPo6ED POLN'�!ei CANCEBISD aEiCWE THa i.'Q'1 W 1TION AttArAhior- Dse*n mlmswD�nmekxMiEwpaMppxoMAD 10wrawwred AttArltlrorgr MalMTOTrGaakrEWATEKMAMNAe®TOTMELWr.MHRM MTDeosoShA � 12$7 Wo►aestar Rd M09M No GELMUM aM OR trABDnY OF ARV Imm uran nW olsnLaeA rtE aDr rrra OR Framingham,MA 09702 AMMUL Phone: - AIIn oevzo me . Far 90S ACORD 2S(20 MJ) ®1 TION All R91Ms nerved. TTTe ALb�name and logo are ieandalad rmeMe OACORD 11�M 0C --- ML AJ k hKito 9-im, Al Proudly serving you to beautify and weatherize our New England communities. We are fully licensed and insured. SCOPE OF RK: Usng the Certainteed Integrity System: Strip off alil od roofing shingles down to the bare wood deck, and also nail down any loose sheathing t ughout entire roof. Apply three feet of ice&Water shield to the leading edge of all valleys, dormers eaves, and chimneys. (To p cat and prevent from freeze backs.) El/Cover the remainder of the roof using Roofer Select Premium Fiberglass Underlayment. (This application is a sture barrier.) Install new 8", white finish,aluminum drip edge to the entire perimeter of the roof,the leading edge, and allows water to run into the gutter. �11 new vent pipe flanges to all plumbing ve pipe. e-shingle the entire roof using �� /�_�i -c d a Sic — roofin shingles m our choice of colors. (Color: Choice: - ,� 2 J ) ip and Ridge caps installed. � stall�81ed to the peaks of the roof,for proper ventilath0 G`-'©.yqta 2/4 e vP^ T Dumpster removal and removal of all job related debris. o � 3/Q O ° 3f 6 0,0 TOTAL CONTRACT PRICE: lS� o�`� (Includes materials, labor,tax, and permit if applicable.) COMMENTS: If any deck sheathing replacement is necessary due to decay, an additional charge of$50.00 per 1611. board will be applied to the total job price.Plywood(remove&replace): $65.00/piece. Extra layers(over 2): 350.00/piece. TERMS: '/3 deposit, %3 due on start date, '/3 due upon completion(Depending on roof size,most are completed in one day) DELIVERY: 2-4 weeks;Note: We are not responsible for delays caused by weather, suppliers, subcontractors, building officials, asbestos abatement, hidden damages or conditions, accidents, acts of God, or anything beyond our control. Cis Thank you for the opportunity to submit this proposal. If you have any questions, please don't hesitate to cal I. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. JJ Please note conditions on back Respectful) ubmitted, Accepted B Name: Lo ony Pu o o Date: 'Project Manager Street: , AJ Exterior Town: Zip: O Signature: ^ Telephhopn - _ 12 Mechanic St • Framingham, MA •11P/N�)1q O Phone: (508) 380-8394 • Fax: (508)788-0920 • E-mail: ajexterior@hotmail.com MA Registration # 162391 (G) .7 S--, S-00 Conditions of Agreement: + Contract Acceptance: Upon signed contract by authorized parties, this contract and all work described herein, will constitute the entire agreement between AJ Exterior and the homeowner. •- - - Contractor Registration: All home improvement contractors must be registered with the Commonwealth of Massachusetts. Inquiries about registration should be made to: Director, Home Improvement Contractor Registration, P.O. Box 871, Taunton, MA 02780-0871, Telephone: (508) 821- 9375. General: All outside work areas will be let rake clean. Interior work areas, with the exception o attics, will be le broom clean. Roofing f P f .R f g may result in dust and debris falling into attic. Upon request ofhomeowner,AJ Exterior will cover the contents of the attic using tarpaulins; however, this contract does not include clean-up or protection of the contents in the attic.Also, this contract does not include moving the owner's property around the site,painting, cost ofremoval ofany asbestos or other hazardous materials, landscaping or repair of the grounds or paving due to site equipment. Matching of existingftnishes or colors will be limited to materials readily available at local suppliers. AJ Exterior is not responsiblefor replacement ofsatellite dish, wiring, or electrical housings, if necessary to remove these items in order to complete an installation. Change Orders: The owner is aware that the work may contain hidden damage, defects, or conditions such as decay, insect damage, asbestos, or substandard construction practices, that may require additional work not included in this contract. In this case,AJ Exterior will contact the owner with the additional charge to the original contract price. In the event the owner cannot be contacted, work will eb.minue to protect the residence from the elements(rain, snow, etc.). The�owner understands that any additional work will delay the completion oftheproject. � r Warranty: The contractor, AJ Exterior, agrees to correct any work thatfails to conform to the contract or workmanship that is defective within 10 years from the substantial completion date of the project at NO CHARGE to the homeowner. The homeowner agrees to notes AJ Exterior, specifying the nature of any workmanship defect, immediately.No warranty is provided for ordinary wear and tear,fading, abuse, neglect or casualty, or minor cracking/shrinking of concrete,plaster, grout or caulking. No warranty is provided for materials_ not directly supplied by AJ Exterior orfor used, re-installed materials, re-work or work done by others. This warranty excludes consequential and incidental damages. Permit Notice: If a permit is required, it is the obligation ofAJ Exterior to obtain such permit as the owner's agent. Owners who secure their own construction related permits or deal with unregistered contractors shall be excluded from the Guarantee Fund. Cancellation Policy: The customer may cancel this transaction at anytime prior to the end of the third business day after the date ofthis transaction under MGL c 93 s 48: MGL c 140D s or MGL c 225D s 14 as may be applicable. Arbitration: The following statement is required, under Massachusetts law, to be signed as part of this contract" "The contractor and homeowner hereby mutually agree in advance,that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Owner:Contractor: Notice: Th gnatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. _ The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties." l ,