22 SCENIC AVE - BUILDING INSPECTION rt►3- ,
The Commonwealth of Massachusetts
W
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 Official Use Only
Building Permit Number: Date Appli
Building Official(Print Name) Signature ate
SECTION 1:SITE INFORMATION
1.1 Properly dress: 12 Assessors Ma &Parcel Numbers
umbers
.nr_ . p Qq _60q 6-O
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 ZPontng 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 Cl "Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 gqwner of Record:
Steve M�C�r S I-, wt , MA- 01G76
Name(Print) City,State,ZIP
7 7 Sccvti c_ /!vtc `jZfr Zto• 35az
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
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:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(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: Cash Amount:
6. Total Project Cost: $ /0G ❑Paid in Full ❑ Outstanding Balance Due:
cy M N1 uez) fro A.0
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
" Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
H
HIC Company Name or HIC Registrant Name IC Registration Number Expiration Date
No.and Street Email address
City/Town,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 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
I,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 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 ccurate to the best of my knowledge and understanding.
P nt Owner's or Au o ized Agents 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.mass. oP v/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 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'
i
"` QTY OF SALEM, MASSAC HUSEM
BUILDING DEPARTMENT
\' ` y r 120 WASHNGTON STREET,3R FLOOR
.+�� TEL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THOMAs STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONBIISSIONER
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 c40, 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 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
(address of facility)
Signature of applicant
Date
QTY OF SALEM, MASSACHUSETTS
BUILDING DEPARTbIENT
tr '! 120 VPASHINGTON STREET,YD FLOOR
TEL. (978) 745-9595
FAx(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THOIVIAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONEVIISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date 29 /J
Job Location �i2 S[�t)IC A'le
Home Owner Address /`tP
Present Mailing Address ary�P
The current exemption of"Homeowners" was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable
to the Building Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner" certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'S SIGNATURE ��
APPROVAL OF BUILDING INSPECTOR
Zolotas Bros. Inc
515 Lowell Street Peabody, MA 01960
T 978.535.4035 F 978.535.4032
zolotasbrosCcbaol.com
Project Title:
Second Floor Bathroom
Job Location:
Steve & Kim McCarthy
22 Scenic Avenue
Salem, MA 01970
T 978,210.3902
Date: August/2014
Michael G. Zolotas # 9809
Theodore E.Eliopoulos # 13065
Contract
Carpentry:
• Demo bathroom.
• Sheet rock&plaster were necessary.
• Install durock on the walls of the shower to accept tile installation.
• Install durock on the floor of the bathroom to accept tile installation.
• Install clients 36"x 18"x 34 %'vanity base w. one door w. two drawers.
• Install clients hardware on the vanity base.
• Install clients shower door w, chrome hardware.
• Install clients accessories (toilet tissue holder, towel bar, towel ring).
Electrical:
• All electrical work will follow Massachusetts Code.
• All electrical switches & receptacles to be white.
• Install two gfi receptacle.
• Install recessed lights in the shower area.
• Install clients ventilation fan/light to be vented outside.
• Install clients two light bathroom fixture over the recessed medicine cabinet.
Install Electric Heater
Plumbing:
• All plumbing work will follow Massachusetts Code.
• Install clients white shower receptor 60"x 30"
• Install clients shower drain w. chrome trim.
• Install clients shower valve w. chrome trim on the right hand wall of the shower.
• Install clients hand held shower w. shower bar&hose on the right hand wall of the shower.
• Install clients chrome lavatory faucet w. drain assembly.
• Install clients cotton white elongated front toilet set w. soft close seat.
Tile:
• Tile quote is based on a standard tile installation. Intricate patterns are higher in price
for installation. Marble/Granite like tile is a higher price for installation.
• Install clients tile &grout on the three walls of the shower.
• Install clients tile &grout on the floor of the bathroom.
• Install clients 18" radius seat
• Install clients 12" x 12" wall niche
Granite:
• Template & install for granite vanity top w. four inch backsplash.
Permit:
• Permit price not included in this estimate.
• Building permit, electrical permit & plumbing permit to be obtained & invoiced after
obtained from the city or town work is being done.
Debris:
• All debris created by Zolotas Bros. will be removed by Zolotas Bros.
Note:
• All work is fully insured.
• This contract will only be altered if there are unforeseen plumbing, electrical or structural
issues of the existing dwelling. Client will be notified before any further construction
continues.
• Any work requested by the client on site, which was not discussed before the job had been
started and is not included in this contract, will be billed to the client at an hourly rate.
Signature of Client:
The above names client is authorizing Zolotas bros. Inc to proceed with the project outlined in this
contract. Unforeseen plumbing, electrical or structure issues of the existing dwelling will be
brought to the clients immediate attention and discussed before any work proceeds forward.
Signature of Zolotas Bros.
Contract Total
• Permit to be submitted to client for payment after obtain from city/town.
• Any alterations or deviation from above specifications involving extra costs will be
executed only upon written order, and will become an extra charge over and above this
estimate. All agreements contingent upon strikes, accidents, or delays beyond our control.
• We may withdraw this proposal if not accepted within -25-days.
Payment schedule for Zolotas Bros. Labor Contract
Total Labor Cost (Zolotas Bros): $6,660.00
Contract Alteration Request Form
Must be signed by client before any alterations to the contract will go into effect.
Alterations to the original contract will be billed separately to the client.
Billing will be at Zolotas Bros. Inc hourly rate in addition with all materials used to complete the
alteration of the original contract.
Client Name:
Client Address:
Change Requested:
1.
2.
3.
4.
5.
6.
Client Signature
Signature of Zolotas Bros. Inc.
Date
OLOTAS
PEABODYX
Kitche Ba • Hardware
ZOLOTAS PEAB O DY KITCHEN BATH HARDWARE
515 Lowell Street, Peabody, MA 01960 I Tel 978 535 4035 I Fax 978 535 4032
zolotasshowroomra7.aol.com
www.zolotaskb.com
Project Title:
Master Bathroom Update
Job Location:
Steve & Kim McCarthy
22 Scenic Avenue
Salem, MA 01970
August/2014
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All dimensions size designations "tea/ This is an original design and must Designed:6/18/2014
given are subject to verification on 2�1/1 aoLOGIES 20�!% not be released or copied unless Printed:7/22/2014
job site and adjustment to fit job applicable fee has been paid orjob
conditions. order placed.
mccarthy bathroom All Drawing#: 1 No Scale.