5 SCHOOL ST - BLDG PERMIT APP 14-522 TRIM Tip - � � -► szz � � � I �.,�� �y®�.va
ED
PECT40NAL SERVICESThe Commonwealth of Massachusetts
Department of Public Safety
n. G11 Massachusetts State Building Code(780 CMR)
2114 SEPBLUA lo4ttnApplication for any Building other than a One-or Two-Family Dwelling _
(This Section For Official Use Only) M cn
Building Permit Number: Date Applied: Building Official: rn
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street addr ss is not av le) -^t
No.and Street City/Town Zip Code Name of Building(if applicable) t—
SECTION 2 PROPOSED WORK - m
Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rowsbelovZ
Existing Building❑ Repair irl Alteration'❑ I Addition❑ 1 Demolition ❑ (Please fill out and submit Appeudlx 1) rn
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
.Age building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Q�
Is an Independent Structural Engineering Peer Review required? Yes ❑ No l,Y
Bri�`E.pescri tlon of Proposed Work: �1
nq
SECTION3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable).
A. Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
R Fact F-1❑ F2❑ I H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2.0 I-3❑ I-4❑ M: Mercantile❑ - R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1❑ S•2❑ U: Utility❑ Special Use O and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ ILA ❑ IIB ❑ HIA ❑ IHB ❑ 1 rY ❑ 1 VA ❑ VB ❑
SECTION 7.SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) '
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public O Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site
nden one: or on sites stem❑ required❑cl trench or specify:
Private❑ or i '
. . �'Z y permit is enclosed❑
R
-fight-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
NApplicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ 1 Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION'S:.PROPERTY OWNER AUTHORIZATION
Name and Address of Pro Own
t s /Yl A DI�j7v
e Print No.and Street City/Town Zip
1�roperty Ownergontact Info do ,Qt,cjx5_.Art
Vll L o67 �f -a,3�'3 Kdcoj-�e��t�yovlel�Uriil2U�,l'lel
Title Teleph ne No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby a thorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
building is less than 35,000 ca.ft.of enclosed space and/or not under Construction Control then check here 01-.d"skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
-3it)4y —r�T�Aibpt �754?S41.oq jam ��de 122062
$'6
Name(Registrant) Telephone No. e-mail , �r Registration Number
L 2 �,Z!N)a 2� • �Ot wcklTe>ti t Yt �lq/ZOII
Street Address City/Town State Z _ Discipline pirxF ation Date
10.2 General Contractor
Company Name
Name of Person Responsible for Construction License No. and Type if Applicable
2'7 -Gfis 2 (�,�C.�Gt3TL ✓YIQ• b It3 J
Street Address City/Town State Zip
U 1,0 =_ ICI'-wj+GJ(✓at_(P %a 66.4. cc----,
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT .G.L.c.152.§25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes O No 13
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE -
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ L 6 bG '-
Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ is 0 000 . (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 ofL_W knowledge and unders g. 9 �4
o� 1Z.'� IAD- I 7o g78 &779(v 4�
PleaseEtint and sign name Ti r Telephone No. Date
2 '1 17NCAS �. �(COC'Ey762 "'L' G lei?0
Street Address City/Town State Zip
Municipal Inspector to fill out this,section upon application approval:
Name Date
L
'CITY OF SAI.EN•i, NWSACHUSETTS
1' BUILDING DEPART>IE.NT
s
�t<I 120 WASHIINGTON STREET, 3'o F100R
T EL (978) 745-9595
F.A-x(978) 740-9844
KI%IBERL.EY D RISCO LL k.A.%YOR T}{Oht 1S ST.P3FRRH
�
DIRECTOR OF PUBLIC PROPERTY/BL'ILDr-NG CONNISSIONER
Workers' Colnpensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant lnformatinn Please Print Leeibly
�� k .—
V,tlltc(nmin�¢/s�]Organir�atignm�Indsi/vi�du•�al): Q �y`--' \L,
Address: ` Z V•`<6 �1 '—"
Cily/State/Zip:<�+I fo fy4 O t430 Phone m ":`f 7 S S 7 et 4'IQt54
Are you can employer?Check the appropriate host: Type orproject(required):
L❑ 1 am a employer with 3. ❑ 1 am a general contractor and 1 6. ❑New construction
and oyees(full and/or part-time),* have hired the sub-contractors
2 1m a solo proprietor or partner. listed on the attached shcet. I 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity*
workers'camp.insurance. y. C3 Building addition
]No workers•'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 11.0 Plumbing repuirs or additions
myself.(No workers'sump. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.) f employees. [No workers' 13,0 Other
comp. insurance required.]
•Any upplicaat that checks box f 1 must also fill uul ilia section below showing their worken'eompenmion puliey inlirrmatlun.
'I hrmvowm"who suhmit this smtinvit indicating they arc doing all work and then hire outside contractors most suhmil a new afndwit indicating such.
!C.nnmetun Ihut chuck this box must anachal an addniurrut sArel showing the mmno or the mbavnlnetom and their worken'camp.policy inrurmmion.
I am un eurptuyer dint is providing Ivorkeri'coespmuailon insurance for my employees. Holow is the policy and fob silo
injtrutulinn.
Insurance Company Name:
Policy it or Self-itts, Lie.H: Expiration Date:
Jab Site Address: City/Stale/Zip;
Attach a copy of the ivorleers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ofLIGL c. 152 can lead to the imposition of criminal penalties of a
line up to S 1,500.00 and/or one-year imprisnnmcrl,as well as civil penalties in(he form ofa STOP WORK ORDER and a tine
of up to S25Q(lo a day against ilia violator. 13e advised that a copy of this statement may be funvardcd to the Office of
In%estigationx arthe DIA for insurance coverage verification.
I du hereby rerd car er tire pubts mid penalties o perjury/rut the infurinutioa provided above is true and correct.
Si••n t re' - Uatd' —�� Y--
Of/ic use only. Du not wtile in this area, to be completed by city ur town off&luL
City nr Town: Pcrmi0.lccnse p ---. ..---_ . .---
Issuing Authurily (circle one):
I. IJoard of lleallh 2. Building Department 1.Cilylrmun Clerk J. Electrical hupcclur S. Plumbing Inspector
6. Odter
Cuntnct 1'erton:,__--..._..._--... _.__---- Ph•mc!t:_._.
a�Vl�La4uec�u�aelT4 ..
Office of Consumer Affairs&Business Regulotion
ME IMPROVEMENT CONTRACTOR
is
Is 122002 Type:
` xpirahon 7/9/2016 DBA
J'R.TFSTAVERDE AND SONS
f ,
JOHN TESTAVERDE !I
27 UNCAS RD.
GLOUCESTER,MA W930 i
Undersecretary I
Massachusetts -Department of Public Safety.,
Board of Building Regulations and Standards
Construction Supervisor
License: CS-060678
JOHN R TESTAVj5RD
27UNCASRD S
GLOUCESTER IRA
� Y
92w Expiration
Commissioner 02/16/2015
a
J. 1 '. TE�T'AV EERD EE & SON
Residential Remodeling Services L
Naomi
DEPOSIT INVOICE 8/18/14
Cogswell Condominium Management
#5 School Street
Salem Mass.01970
978-884-7015
EXTERIOR REPAIRS AND PAINT
Scope of Work:
• Obtain necessary permitting.
• Install staging poles and planks to access both second floor bump out areas of building.
• Remove all rotted trim moldings and plywood sheathing for repairs.
• Repair or replace rotted window sashes,frames,and operating hardware.
Install all new sheathing and moldings using composite and pvc materials where possible.
• Sand,prime,and paint all sheathing,moldings and windows
• Remove all construction debris from job site.
Terms: Billing for labor and materials reimbursement due upon receipt will be submitted periodically as
the job progresses
PROJECT BUDGET:
We propose to furnish materials and labor—complete in accordance with the submitted specifications,for
the estimated cost of Thirteen thousand dollars-$13,000.00
Estimated cost based on visual inspection of exterior of building. Final cost and completion date may vary
due to possible additional rotted areas exposed,other on site conditions,customer requests,and requests
per order of building department.
Work to begin on or about 8/29/14 and due to be completed by 11/l/14
PAYMENT SCHEDULE:
Payment#1 $3500.00 Deposit Due(for permit,materials and labor)
Additional payments due upon receipt for labor and materials as job progresses.
SIGNATURES:
-- I/We accept the terms and details described in this document.
T�2
Respectfully submitted,
John Testaverde
estaver„a Son
27IJncas toad
G�gucestep,Mass. 01930
9.78-979-9604
jsrtestaverde@yahoo.com