28 SHILLABER ST - BUILDING INSPECTION 5 0
�a The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALE\1
� 1 Massachusetts State Building Code, 780 CMR Revised.tlur?011
i Building Permit Application To Construct, Repair, Renovate Or Dcm a
One-or Two-Family Dwelling•
This Section For 'teial Use On
Building Permit Number: Date Applied:
Building OlTicial(Print N�une) Sign ore Date
SECTION 1: SITE INFORMATION
1.1 Pro erty ddrem: c— 1.2 Assessors Nlap At Parce umbers
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed the Lot Area(sy fU Frontage(Il)
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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 gQZ� r'of Reco .
I"w19 Y- 1IoA/6o,,) c.ti AA J
N;une(Print) City,State.ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED NYORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) Cl I Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Descri tion of Proposed Work':
�r`.i� a 1�15 mod✓ �c-r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
ILabor and \laterials)
I. Building S 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
?. Electrical S ❑Total Project Costa(Item 6)x multiplier x
i, Plumbing S 2. Other Fees: S
4. Mechanical (UVAC) S List:
t. Mechanical (Fire S Total All Fees: S
Suppression)
�. Check No. _Check Amount: Cash Amount:--
6. Total Project Cost: S ® ❑Paid in Full ❑Outstanding Balance Due:
` I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor rcense(C'SL) 2p1/ Q 4 �
License Number ISspi�rliun Date
N:unc of C'SI. I IuWcr
S�uv1 Gas.. l n�•�� List C'SI-l)pe(see below)
N�o�. a/nd Sheet "Type Description
c 4-,,d3. /H)J of U Ilorestrictcd(13uildinp up to 35,000 Co. 11.)
Cityifoml. Stine.ZII -- R Restricted Is? Pamil Dwcllin
M Masan
RC Roolin Covcrin ,
///��� WS Window and Sidin
7J�� /. `� A /t},AS�„ 1 Insulation
fuel Burning Appliances
�'/' �4 ✓ /r' 7 c1✓ I Insulation
"I'cic hone lima it aJJres- /7Z,' U Demolition
5.2 R tstered Home ,Improvement Contractor(HIC)
I IIC'C�'oi/»pun ame ar I IIC It¢gistrgnl Nayt� I IIC' Registration Number Expiration Date
� � Ns r_r.✓ i
No.��,,yyt��,,,S,tr�e�et�q
j'✓Cllzo! /'1r,->J [/LS�y/ ��'�,��.-7�� Email address
Ci /Town,State,ZIP Telephone
`7
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152. 1 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 .......... Cr- 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 $ { =DECLARATION
to act on my behalf,in all matters relative to work authorized by this
Pnot Owners Name(Electronic Signature)
SECTION 7b:OWNER' OR AUTHORIZED
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 accurate to the best of my knowledge and understanding.
r
1AB' /'gi, 10111.// /
I not Omer s or,\uthonzed Agent's Na line(Electronic.Signature) Dale
NOTES:
I. An Owner who obtains a building permit to do hisiher 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. 1 q'_A. Other important information on the HIC Program can be found at
oc.i Information on the Construction Supervisor License can be found at2. t�tt tv.ngl .gpm_'Jp.
When substantial work is planned,provide the information below:
Total floor area(sq. R.) (including garage, finished basenment'attics,decks or porch)
Gross living area(sq. R.t _ Flabilable room count
Number of lireplaces--_ _ Number of bedrooms - -
Ntun her ofbathrooms ----------_---- _ N'umberofhalfbalhs
1'y pe of heating systenm __-- -- Number of decks, porches
i)peol'coolin¢ system
- ---- .___-------_—_.--- I'ncloscd
i. "folat Project Square Footage"may be substituted for"Total Project Cost"- --__---- - ----- ---
CITY OF S.V.E.NI, NLASS.-kCHUSETi'S
SULDLYG DEP.IATMENT
110 W.uHLNGTON STREET, 31O FLOOR
TIEL (978) 745-9595
K!J®ERLEY DRWOLL FAX(978) 7IQ9846
MAYOR THo-%w ST.PmxAz
DIRECTOR OP PLaL1c P40PEATY/9L:anLYG CO-NNISSIONER
Construction Debris Disposal Aftldavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section t 11.5
Debris, and the provisions of MGL a 40, S 54;
Building Permit Atis 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 tr/annsportcd by:
(name WT uler)
The debris will be disposed of in
(name
of facility)
(iddressorfacaity)
signature orpermi plicant
dire
a
CITY OF SALEM
PUBLIC PROPRERTY
S° DEPARTMENT
.I,np Mf I Y'inlV ul1
Nli,nt
1C (rn,rn.�,n u.�il:a Cut' • inu•.w,M.hs.p.111 a I I,JI97J
Ihi.`.0 471Y/i'r5 •Fix v7N•7eC•n.IM
Workers' C0111M atlon Insurunce .li0duvit: UuilderVCuntract 1 f ) uri/llretrlclynyPlumbera
Bean In urmalio
p PI ' . Int Le 'hi
VillncllLr.nle,vl)raanuninrvinJlvnluull: eY rJ :y✓, �Cjsugr-
Athlrc...v: V� 11 v-x &Iq
Cily,Srarc.7ip _ 1 dAyJ/
------------
I'hunr ih
1Are re)nu an vmliloyer7 Chvek the:ylpniyrlure box:
1, 1;m1 J umpluyur with�_ 4. 0 1 am a general cunlraelor and 1 I)M arpruiuct(required):
Lr*
yacs(cull�nd/ur puri•time).• have hired the aub•amuactur4 h' ^uw construction
i sole prnprictrlr nr parinca limed on the anached sheet : )• ❑Rernodelins
ship and bav►no mnpluycus These iub cantneton have
ng fie mY in any capacity, w orken'comp, msuronee. g' f)emolirion
orkarx'comp. insurance 1 ❑ we are a colperelion and its q' Cl Duddinr addition
d) dfyleOn have usurcirutl their t0•❑Electrical regain or addititxtx
hulnuu,wlur duine all work right of u�emption per NICE 110 Irlumbing repairs ur udditiary
(�'o ,varkun'comp, e. 132,41l4).and we have nn
co required.) r anployuuv. (No wnrken' 12'0 Ruoi'relwirs
arnnp insunncorcquind.J I).QUrhar
•qnr.,pphcue Ihul:Each Eon rl mar aim lire uW IM Vanua 41uY dwwury Ik,IY wwlW'camrenaWiuY iwliey mrir,l„Ili,r►
'Ih.nw,.wn•n why,ilYmil IAi••rT1,1eW!indlaa,ine It1,rt+,e Jima,il wurk nW thaw Alp aWide currncpre Inw/•utw,Y a new nnJauil irwtiar,n .,
C,MrrwllYn IAr aMsk rn,e twx Ter.rn>;hrr.�n aJJYiurW dluel.huwine the iueM Drat ruk.ae,r
rerNYe dlld their wYAYp• a N'k.
/mY un a ulployrr/hat lr pry 1•ld/gq rverAnx'comperraUoa Llmnrnce jot/Yy r/n u, 'pdrvy m/Mrnri
injrrnrurirna � p/J rr.6 Brluv Is the pulpy Ynd/u1 rite
Insurance C'umpany Vmnc �y1,
I'ulicy a ur Sclf•inx. LiC.h: / AJ lr6 -
r Elipiratwn Date: i/ / Z
lob Situ Addres.v:
.1t7ul;h a cu C'upSt;lte/Llp; �J'✓Pe� ��°�
yr ur f la ,workers' eompentatlnn pullc) duuiarwitio page(showing the Polley numbur and eirpiratlua date).
I'ullufV to weure cuaenge is required uodur Si miun?!A ufJiGL c, 132 eau lead to the ilnpoxition of criminal yanoitiq of a
rL,c III)ri sa M,rM and/or una•year nnpri.nnllmunt, a.r Ivcll ua eivd("Jill"in the Iurm of a STOP 1VURK ORDER and a ant
atop m i'1t) )n a Jay.Igairw the violnlar. fie adviscd thut a copy urlhms..filvmunt may bu IurwurduJ w the Ullicu�I'
Iln a.hguunnr ui;hu IllA I: r nnur.u'ce . ,cru,e ,:u liaaUun.
/Flu/r.•rrAy!arli�Y rmJa'r drr puinr, rrJ un. //a•r u/pre/nry/AW//rr in unnY//Olt/• yrvrrJrd ubuve ix our and a•orrt'c4
I'I•i r • , )ate' /!�/ /��
r1//lriu/rnr un/y, /)o.rnr�arirr in r/sir urru, /u Ar rul"RIVI d A
I Y cily ur/mwn a//lriuR
( iry or 1'o,Yr1: .
panniul.lcanac st
f„uing .tuthurity (ciralo noel;
I. 11"Arti rlla.41111 1. Iluddnt'� Ihp.I rtua•nl I. (:ih.'In„n G. thhar C'Icrk /. l•'lcctric.11lu•faorur :,
i I f`fwnbir,g In,pector
dl�.�lll.,cm
I
Information and Instructions
s to provide workers' wmpensauan htr their nlnct f hire+
ve Ll+an In the Scrvlce ui anuther ull,ttr any.o
�Lusacbu:ens General Laws chapter I i2 Icyta as all eu ry pel
11urw.mt to aus,utula, .m reeplal'td is dclined ar'•. .e ry P' .
vprees or ImphcJ, oral of written." o f an two or more
�n c,npfupar 1+JetincJ as"an Individual, purtnenhip,a illil the
4: corporauun car other Icbal entity, Y
lit In ,.nlplo)Cos. HOwcvcr the
. t the Klreyumg engugcJ In a lumt enterynsa, and ntcluding the legal represeoutives of a Jecea.eJ tmpluycr,car 1 e
I t�Cly tr rt o"ll; a cal an Illdlvldual. petmmshlp, "A"'attoa or other legal ena11jly ll therein.
Y g '
lling house
e r+ont to Jo maintenunca, ruction
lnenl be JCCrnCJ toof(cp,14 work oll `be inaclnpluYN.
owner of s dwelling Qohwhu employving not e pe than three apartmenu and who rniJet therms or the occupant of tits
,Iwc Iling hutne urenant theroro shall lot becattse of such P
or,,n the grounds or building uPP
�IGL chapter 132. 413C(6) also States that"Ivory state or local trust buildings
dings i shall ommold the issuance for a or
Ueaee with the Insurance coverage required.'
renewal of s Ilccast of Penult to operate•business or to construct buildings Ia the commoeweultY or any
Applies who has not produced acceptable evldsact of curelp of iu political Subdivisions+hall
ldditionully, �IGL dlupter l S.. i 1-5Ctll,latet'•Neither the commanw%:l nor gay
enter into any contract for the performance ul pubhcthwork nl Tact is ail luthoritytablir evidence ufewupli ulce with the insurance
requirsmenls of this chapter have been presented
Applicants checking the boxes that apply to Your situation an4 if
compensation at1(davit cmmpletelyhone checking
th elong with their';anillcuta(s)of
Please till out the workers' comp es);tad p with fin employtvs other than the
necessary,Supply sub-contractor(s)namaU)r Adrotsl
hervis
workers' ecnlpensuti 'bmittud to the Departtment of��atrial
Iro cssary. Limited Liability Companies(LLC)or Limited Liability Pa. orthips(LL
memban Of partners.are not requited e adviser hat this uffidavit Inay
late employees,a policy is requited. Also be sun tt sills sad dots the uilidavlL That°In�rvnt`nshould
Ueatian far the permit or lieams is being requested, not the Dap
\ecidefile for 111#city of to of insurance covcroae the low of if you are required to obtain u workers
he renlmed to dv city or town that the apD uestiotu regarding
Industrial,%"idents. Should You have anY 4
calliper policy, plea call the Depurvnent et the nwnbar listed below. Sslf-instued eompaaies should enter their
.calf-insurance license number on the a ro riute line.
city ar.rows official,
please he Surd that the affidavit is complete ,utd printed legibly.Inv The Department has provided u spore h thu bottomL
Of lie atriduvil for you to till out in the event the 0 hie f investigations has to nce nut you regarding the appiicana
need only submit ono 1111davit indicating curent
I'I:um be soar to till in'he p,;rmit/licalse nwnber which will ba used❑e a ratafCrlCC IlulllbaG In addltlJnr an aPP vit or
owt must Submit multiple pannib•licaluta aliPlic"Oho in any given year, u provided w the
policy information of necessary)and under"Job Site AJampe J car rousedtby+lit city ore town l Inay be pin l' Y
town). •%copy of the urlldsvit that has been offtci f tb ly stamp'
applicant as proof that a valid affidavit is can rile for tLttaro permits of licenses. A new at)1Javit must be tilled nut each
or permit not related to any business or commercial
year. 1Yharo a hwne owner car citizen is obtaining a license
commercial venture
I i_,, .t doll lictllas nr permit t0 I7ofn Ito Vet CfC.)fold ptrVelt It NOT o requitedour Out eratmm and should this you haw.uly quesuons.
I he I)Ilicc ,d Inve'llyatiuM would Ilk* 10 dtank yllu 111 aJVallee (car Y P
ptea.e du nut hesilare to give us s call.
lephuna and rax mben
the U:pantnalt's addra+s. Ie The Commonwealth of Mamchusetts
Deportment of Industrial Accidents
Once of Itivesdgadans
600 Washinston Street
8wton, MA 02111
Tel, q 617.127E 900 7
ext 02 at 1-817-MASSAFE
,,.III w,lnllr.rnyss.jov/dig
3.
IS, OTY OF SALEM, MASSAC.HUSETTS
,} t DEPARTVIFNT OF PLANNING AND
COMMUNITY DEVELOPMENT
Kt9mERu.'),DRISCOLL 120 \NASru NC;roNSrRFF:r • SALFM,-VI:LSSACIit:8lCrrS o1970
MAYOR TFLE:978-61.9;i685 ♦ F:LX:978-740-0404
LYNN GoONIN DUNCAN,AICP
DIRECTOR
HOUSING REHABILITATION LOAN PROGRAM
WORK WRITE-UP
PROPERTY INFORMATION: -7
Homeowner: Michael Bonbon Date: August 15, 2011 ._
Property: 28 Shillaber Street _ Phone #: 978-335-3181
Prepared by: -.Kevin Nestor,_Housing Rehab Specialist Case #: _-----
I. LICENSE: The contractor must meet all local and State licensing requirements and be duly licensed.
2. INSURANCE: Contractor must show proof of adequate liability insurance and workmen's compensation
coverage be provided.
1 PERMITS: The contractor must obtain all required building permits prior to starting work. Copies of the
required permits must be submitted to the Housing Program.
4. CODE REQUIREMENTS: All workmanship must conform to the Program's guidelines, all applicable
Massachusetts Building Code and local codes and must be of acceptable quality, as determined by the
Housing Programs Inspector.
5. WORK AREAS: The owner must completely remove all furniture, stored items and other obstructions in the
work areas identified herein. Items must be moved to a non-work area and covered by the owner or
relocated to temporary storage as needed. Neither the Program nor the Contractor is responsible for
owners' items improperly relocated during construction. Work can not proceed unless work areas can be
freely accessed by the contractor(s) on a regular basis during the term of the contract. Failure to provide
regular and unfettered access to work areas may be cause for contract termination.
Contractors are responsible for verification of field conditions measurements and quantities.
Submission of a bid is presumptive evidence that contractor has evaluated all site conditions which
pertain to the work herein Permits and Permit Fees to be included in all bids.
28 Shillaber Street Paget August 15, 2011
WORK SPECIFICATIONS FOR REPAIRS
Section 1.0 Roof Replacement
1.1 Tree Branch Removal /Trimming
A few branches on a small tree near the right rear corner of the building
overhang the roof. All branches shall be removed/cut back at least ten feet from
the roofline. Remove all branches and other materials from the property.
1.2 Demolition
Remove all asphalt roof coverings, drip edges, flashing, etc. from the entire
building. This shall include but may not be limited the main structure, all
dormers, the front porch, the one story addition on the left side, and the asphalt
shingles over the bay windows on the front of the building. All roofing materials
shall be removed down to the sheathing. Do not remove the gutters and
downspouts. A dumpster must be on-site prior to the demolition work. Properly
dispose of all debris.
1.3 Sheathing
Remove all defective roof sheathing. Replace all defective sheathing with new
exterior grade plywood properly secured to the framing. Allow for 200 square
feet of new sheathing in the base bid.
1.4 Vents
Supply and install new ridge vents according to the manufacturer's specifications.
Replace the two roof vents at the rear of the building with new vents the same
size and dimensions as the existing. Provide a sample or specification sheet of
the new vents to the owner before ordering or installation.
1.5 Asphalt Roof
Supply and install aluminum drip edges along all exterior walls. New drip edges
shall also be installed at the edges of all gables, eaves, and the dormers. The
drip edges shall properly overhang the gutters.
Cover the perimeter of all roof areas with a double row of 36 inch ice & water
shield (Grace or approved equal). The minimum width of the ice & water shield
shall be 72 inches. The ice & water shield shall also be installed in all valleys,
around all three chimneys, and at all other penetrations. Cover all remaining
areas with 15 lbs. felt paper.
Install new step flashing at all three chimneys and the skylight. Install new flashing
in all areas where the roof abuts the vertical building sidewalls (the siding,
dormers, etc.). Install metal or rubber fitted flashing at all other penetrations.
Cover the entire roof with 240 lbs. 30-year, three tab asphalt shingles
(CertainTeed, GAF or approved equal). The color shall be black or charcoal.
grey. Verify the color with the owner.
28 Shillaber Street Page 2 August 1 S, 2011
i
I
Section 1.0 Roof Replacement (continued)
1.6 Chimneys
This building has three chimneys. The front and right side chimneys need minor
repointing. The rear chimney needs substantial repointing. Remove and
properly dispose of the television antenna attached to the front chimney.
Replacement of the step flashing was specified in Section 1.5. The contractor
shall also replace the counter flashing on all three chimneys. Remove the
existing counter flashing. Supply and install new counter flashing embedded at
least one inch into the chimneys. The new counter flashing shall overlap the step
flashing a minimum of three inches.
Repoint all three chimneys above the roofline. Remove all loose bricks. Replace
all defective or missing bricks with new materials that match the existing. Tuck
point the entire chimney raking the joints and applying new mortar in compliance
with ASTM specifications.
1.7 Downspouts
The existing gutters and downspouts shall remain in-place. One additional
VI/
downspout shall be installed at the one story addition on the left rear side of the
building.
Supply and install a new 3 x 4 inch aluminum downspout to the existing gutters.
Verify the exact location with the owner. The work shall include all required
elbows, straps, hooks and accessories. The color of the new downspout shall be
white. Adjust the pitch of the gutters so they properly drain all rainwater. Supply
and install a leader or splash block to direct the water away from the building.
28 Shillaber Street Page 3 August 15, 2011
11. INDEMNIFICATION
11.0 The OWNER and the CONTRACTOR shall save harmless the CITY against claims for injuries to
persons on the premises of the project or damage to project-related property.
11.1 The OWNER and the CONTRACTOR are required to reimburse the CITY in the event such claim is
successfully prosecuted by an injured third party and damages recovered against the CITY.
11.2 The OWNER and the CONTRACTOR shall be required to carry all necessary and required
insurances for the work to be provided under this AGREEMENT and for coverage of loss or
damage on any premises affected by this AGREEMENT. This shall include, but not be limited to,
insurances and certifications for contractors, subcontractors and vendors.
12. DEFT BLANK INTENTIONALLY
13. NOTICE TO PROCEED
13.0 The execution of this AGREEMENT constitutes notice to the CONTRACTOR to proceed with work
specified herein, or attached hereto, no sooner than three (3) business days following the date
of signing of this AGREEMENT.
IN WITNESS THEREOF, the CONTRACTOR and the OWNER (S) have entered into this AGREEMENT as of
the date first written above.
FOR THE CONTRACTOR: FOR THE OWNER:
By: Perry Brothers Construction, Inc. By: Michel W. Bonbon
Contractor Owner
William Perry ,
Authorized Signatory (Print Name) e
Signature Date
Dat
WITNESS:
By: Jennifer Kolodziej
Authorized Representative of the
City of Salem, Massachusetts
(Tatble
Page 7 of 8