6 SABLE RD WEST - BUILDING INSPECTION sth The Commonwealth of Massachusetts CITY OF
a Board of Building Regulations and StaII - '
SALEM
Massachusetts State Building Code,780 CMR edMar
'�t� Al► �Revrsed Mar 1011
Building Permit Application To Construct,Repair,ReJ4*td&21&oi'ISh P 1
One-or Two-Family Dwelling
`�., Thi;;Sec�Cru Ftx t3�c3a1 I3se .
liC/ suiid;ng Per�f ?< rttbe+ : A3�Ph®d:. _.
ZCa h
Balding OtSyisl(PrietTtame) $
1 SECTION 0DRIVIATION
1.1 Properg Ades : 1.2 Assessors Map&Parcel Numbers
1.In Is this an accepted street. es`V no Number Parcel Number
cePt ,y Map
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use .. Lot Area(sq ft) Frontage(it) .
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 O
Check if yes❑
SECTION 2 PROlER1 Y O�ViYERSII1Pt
2.1 Ownerr of Rec d r 1 R r10
/ VC/Q/� -
Name(Print)
I pp� �' City,State,ZIP ,
S4l7t�t'•�411• WCY1" �J7t�-St1.7-'�•7•� �H�.tl,/Sav `�2d"Q /l��w - co.n
No.and Strect Telephone Email Address
SECTION 3:DESCRIPTION OF PRUPOSED WORK$(check all that apply)
New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ Alteration(s) W Addition ❑
/ Demolition ❑ Accessory Bldg.O Number of Units_ Other ❑ Specify:
v Brief Descri lion of Proposed Work=: ✓t'
H . ,t[ 4g !
` f7 '
SECTION 4:ESTI1kiATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate kow fee is determined
❑Standard Chyfrown Applications Fee
2.Electrical $ O Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ Z Other Fees: $
4.Mechanical (HVAC) $ List'
5.Mechanical (Five $ Total All Fees:$
S session
Check No. Check Amount: Cash Amount
/ 6.Total Project Cost: $ ,�, ElPaidm Full ❑outstanding Balance Due: ..
GA t t fj M r-� t t e70 "7t Zk
SECTION 5: COMTRUCITONSERVICES
5.1 Coastrvctlon Supervisoi)ricense(CSL) J00k
SGM�QJ License Number Expiration Date
NameofCSLHolder "'` 4+:�. .i�ai, LA
List CSL Type(sce below)c/9 /3v irw 'bonNo.and Street U Unrestricted u to 35 0
NII ��ulXc /tt/9 C�► C��` R I Restricted Family Dwelling
City own,State,ZIP I M I Masonry
RC I Roofing Coverin
WS Window and Siding
e�X -�[ SF Solid Fuel Burning Appliances
y �l-8020 �jC.CAMP '- 14cif.Vey I I Insulation
/ Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) i97-o&,r2 201
JQW%a5 —T `tart']G HIC Registration Number Expiration Date
HIC Company Name or Mc e Name
a A iro�yliS KJtid G�j t '�45 f tSelli,LW. Me
NI'Dand S6rh 4 _ /,�q tA,4 r v 1 n�S-,S)—V Z0 Email address
Ci /Town State _f Tel one
SECTION t,WORKEM4 COI SATION ROURANCE AFFIDAVIT(AL I:c 152.§ 2SQ6))
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...........❑
S15C3ION is:OAR AMMOREZAIMN Tb Alt COAOLETEA WHEN
V01AW15 AGENT 0 CONTROR 1F0 _1,3 ING_
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.
Print Owner's Name(Electronic Signature) Date
SECTION 1b:OWNER'Olt AUTHDRUED 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.
V/ 1'1 N �n3'h�J4iR �-20—20 f fo
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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 fiord under M.G.L.c. 142A.Other important information on the HIC Program can be found at
w�vw.mass.eov�oca Information on the Construction Supervisor License can be found at wwwmass.eov/dos
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 halFbaths
Type of beating system Number of decks/porches
Type of cooling system Enclosed open
3. "Total Project Square Footage"may be substituted for"Total Project Cost" `
T ----- -
_ Proposal X
GBC 93 Burroughs Road Invoice_
CONSTRUCTION North Reading,MA 01864 978-551-8020
Submitted To: Liz and Jim Fogarty Phone:97&500-3036 Date: 7-16-2016
Address: 6 Sable Road West Project:Kitchen Remodel Location: Second Level
Salem,MA 01970
We hereby submit specifications and estimates for:
-Demo and dispose of all existing kitchen cabinetry,countertops, appliances, lighting,flooring
and sub floor, and baseboard trim.
-Cut existing opening from kitchen to dining room down approx. 6"to meet height of new base
cabinets.
-Trim opening on both sides to blend with existing columns.
-Provide all electric wiring and devices for all countertop outlets, appliances,recessed ceiling
lights and sink light.
-Install all plumbing necessary for new kitchen sink, faucet,disposal, dishwasher and fridge.
-Patch all ceilings and walls with smooth coat of drywall compound for all utility access openings
and around lowered dinning room opening.
-Supply and install new hardwood(3 %" Maple)flooring throughout kitchen area, sand and
apply three coats of polyurethane.
-Buff out existing dinning room hardwood flooring and apply top coat of polyurethane to match
new kitchen finish.
-Install all new kitchen cabinetry as per drawings including: wall and base cabinets, filler pieces,
toe kicks and crown molding.
-Install all owner supplied appliances and fixtures.
-Paint with two coats of finish, owner supplied paint, on all ceilings and walls.
-Install owner supplied tile and grout at all backsplash areas in subway pattern.
-Install new baseboard molding to match existing house.
-All debris to be removed from site and properly disposed of.
Exclusions: Building Department Fees, work to window door or heating, upgrade of electric
service, the cost of cabinets, countertops,appliances, hanging lights, back splash the
and grout, any special requests from Building Dept. and anything not mentioned
above.
We Propose hereby to famish materials and labor—complete in accordance with the above
specifications, for the sum of.
Twenty Two Thousand Five Hundred and 00/100 ($22,500.00)
Payment Terms: 30% down, 25% at start of work, 30% after all walls patched
and floor installed and 15% upon completion.
All work to be done in a workmanlike manner according to standard practices. Any alteration or deviation from the above
specifications involving extra costs will become an extra charge over and above the estimate. All agreements are
contingent upon strikes,accidents or delays yond our o trol. Owner to ny all necessary insurances.
Authorized Signature: Awcu
Note: This proposal may be withdrawn y us if not accepted within days.
Acceptance of Proposal — The above prices,specifications and conditions are satisfactory and hereby accepted.
You are authorized to do the work as specified. Payment will be made as outlined.
Date of Acceptance: �r` Signature
I v
169,5
��.,nA �L 2 � Q(
1 24„ 21" " 371,-;' " 21" 30" 24„ 1 \ � Ir, 1}' (n� S.
/ 5 35;" 82 �' 54��Z" P ou w�T
n'
22a 17e 5 27" 2 0, �] l ,Y 1
1 ,
Well Comer S an 36" 1 3 3 24"
--- I all lin out Spi�i.e Rack cod cfr�-LUv` �.' ` 36�lo
fV .'R a WWQRES6 STSBII�I'1WQR 6.'WS 130 W3012 30
N N (0 1 EPF SB30ST '24.D1SH1�f S 30-RANGED 8�2 tt_T F3 w J /
U
15"Trash Compactor
N
6"Spice rawers _.
CI) n J Super Susan
a:
2 Rollout S elves With
N 5 Wood Tiered Cutlery Divitler
N W
ry m w
a'm 2 R Ilout Shelves Movable I Ian Butcher Block Top
N �-
J
3 erage Cooler A
ml-
N
N N WI'y v
N Ci W
.
N I
mim N Tall Utility Cabinet 21" 1
With Adj?
stlble Shelves
rill
IV 1flM2.4_LqN
75e" 3 „ 3 " 3 " ... 18"
s
go". 31--" 28'-" 3 z e e
8" 97 a 20 t" 1:<1
1861"
All dimensions size designations 7(1 2V This is an original design and must Designed: 6/30/2016
given are subject to verification on TECHNOLOGIES not be released or copied unless Printed: 6/30/2016
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
Fogarty 6 Echo Kitchen All Drawine#: 11 No Scale.
Massachusetts Department of Public Safety
Board of Building Regulations and Standards.
License: CS-059W
Construction Supervisor
JAMES S INTRAVAIA
93 BURROUGHS RD
N READING MA 01964
ZU CA,_ Expiration:
Commissioner 02/19/2019
���R�l/I/IIunII/ORr[���O`nr�j'IAJrrC�IIJr�IJ
Office of Consumer Affairs&Business Regulation License or registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Vp Registration: 172037 Type: Office of Consumer Affairs and Business Regulation
Expiration 5/14/2018 LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
GBC CONSTRUCTION.LLC.
JAMES INTRAVAIA'` _
93 BURROUGHS ROAD
N.READING,MA 01864 -- t
Undersecretary Not vali without signatutu
re ',,
aIYOFSALEA MASSAMBETP.'
BuUMMDEMMANr
120WA9MV7U rSnWxrROC1t
UL(WS)745-9595.
PAXMV 74oA846
Bnom FLnrDRz; -Mz
MAYOR 11�ouesSr.Pe
Dinc7mcrPUBUCPPXEMY/BLMDA1G CHR
Construction Debris D1sposa/Aff1dav1t
(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 c4Q S 54; Building Permit 8 is Issued with the
condition that the debris resulting from this work shall be disposed of in a properiy licensed
waste deposit 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:
(name of facility)
141/
(address of facility)
ignature of applicant
Date
The CatnntOnwealth ofMassachuseds
Department oflndustriaiAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www raassgovldia
Workers'Compensation Insurance Affidavit:Bucklers/Contractors/Electricians/Plumbers.
TO BE FH.ED WnW THE PERhurnNG AUTHORITY.
Applicant information Please Pratt Ledbly
ti �•
Name(Bos;ness/ofgamzatioa/ftsd rividual): � l—
Address:_C)a bt,t.ttU A3
City/State/Zip:_0
L eYA , A /44 0lo r Phone A 4)r) 2D
Are yo as empbyerMbeck the appmpr4te box;
l.�em a employs with Type of project(required):
�_eagtbyees(fall part-time).
2.Q I am a sole prop idw m 7• ❑�w construction
MY capacity [No workers
�rs cOmP as urance e m forme in S eling
comp.instranx rerpuhed.]
3.0 I non a homeowner doing all work myself 1No workers'comp.insmame regnirea.]t 9. ❑Demolition
4.❑1 am a bomeowneracd will be biting conaaaNrs to conduct an work on my property. I will 10 O Building addition
ensure that all contractou either have workers'compensation insurance m me sole
proprietors with an employes. 11.Q Electrical repairs Or additions
5.01 not a general castanet"and I have erred the su&,muce inn fitted as the attached ab,,L 12.❑Plumbing repairs or additions
These sub-conbacons have employees and have workers'comp,iasum,,at 13.❑Roofrepairs
6.0 We are a cmpomtim and its offiem,bwe exercised thmright of exemption per MGL c 14.❑Otber
152•§1(41 and we have an employees.[No workers'comp,insurance mquhed.)
'Any applicant that dwclot box#1 must also fill out the section below showing their workers'comprasap®policy information.
1 Homeownars who submit this affidavit indicating they are doing all work and than hire outside cmtractm mist submit a raw affidavit indicating such,
tCmtracmrs that check this box must attached an additional sheet showing the mate ofthe mbconuagms and state whether ar ant those entities have employees. Ifthe sub-contractms have employees•they mite provide their workers•cmrp.pohcyntonbm.
lam an employer,that is providing workers'compensation insurance for my employees. Below is thepoliay andjob site
information.
Insurance Company Name: APV'3—f+�tBrr,M Cj r �j�.tgy2y
Policy#or Self-ins.Lic.#:_ (p(�q��}'JQ(��(p Expiration Date: §- �lol
G 5wc,1e 0,0,t.v /Job SiteAddress:_ Se- bpf^ r � City/Stete/Zip: Sc/w'w.rt+y9 014'>0
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required tinder MGL c. 152,§25A is a criminal violation punishable by a line up to$1,500.0o
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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ce under gins andpenaMes ofperjury that the ins ormmioa provided above is true and correct
i e Date- —ZO—ZOi b
Phon M
O,r'icial use only. Do not arise in this area,to be complered by city or town official
City or Town: Perm]VUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#•
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
le entity,or an two or more
employer is defined as"en individual,partnership,association,corporation or other gal ty, y
of P oJer
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association of other-legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenanoe,constriction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commomreakh for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have .._
employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the pernvt or license is being requested,not the Department of
Ladu.-. ai.;.cc dints. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter then
self-insurance license number on the!EEcoatc line.
City or Town Officials
Please be sure thatthe affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant'
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple penmt/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02 1 14-201 7
Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia