11 SHORE AVE - BUILDING INSPECTION Ll G1L i z
The Commonwealth of Massachusetts CITY OF
Board of Building RegulationsandStandardsNSP RECEIV`.i7
JJECTIC`IAL SEP,`;S'��. 1
Massachusetts State Building Code, 780 CM K " Revised,t1ar 2011
O Building Permit Application To Construct, Repair, Renovate°i01] JtM s J A 2
_ One-or Two-Fmnily Dwelling JC L J
1 This Section For Official Use Onl
Building Permit Number: Date Agred:
I� Building Olticial(Print Name).
Signature Date
SECTION 1:SITE INFOR61ATION
LI Property Address: 1.2 Assessors Nap&Parcel Numbers
rl Sha•� ��
I.I n Is this an accepted street?yes no M1fap Number - Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
"Coning District Proposed Use Lot Area(sy It) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yanis Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40.§34) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check If yesC3
SECTION2: PROPERTY OWNERSHIP''
2.1 OwnertofRecord
/ : Nlv3 f�}�P�VI /}
( 0/)2 n ��DN n City,
Klwte(Print) State,ZIP
JAve 4-y(L 91Y 7Y/ ix3t�G
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Gri Owner-Occupied Erl Repairs(s) Efj Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work-:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
Cl Standard City/Town Application Fee-
2. Electrical $ ❑Total Project Costs(Item 6)x multiplier s
3. Plumbing S P Qther Fees: $
4.Mechanical (FIVAC) S List:
5. Mechanical (Fire $ 'total All Fees:S
Su ression) -
Check No._Check Amount: Cash Amount:_
6.Tot:d Project Cost: S �� ❑paid in Full 11 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 C^onsyructma i Supery or License(CSL) 1�-° /' /d,
/J,, �^V License Number Expiration Date-
N:mrieorCSL Holder 1 / List CSL Type(see below)
Type � �-- �..'� Description .
No. and Street
U Un stride teal Dui mi a el 35,000 cu. It.
R Restricted 1&2 F:unil Dwellin
City/ruwn,Slate,"LIP M Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
�D.r_E 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Conn /6
/tractor(HIC) 7Pf 7 j Z$
PeI� �^ �JO�I / y c// 1 /j HIC Registration Number E.pirution Date
IIIC Comp:my Name or tI1C Registrant Name
17 � _o e SY'
No j:o=? ` d /,q_ Email address
Cityrrown,State ZIP Telephone
SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G,L:c.15L§ 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 IsSuanc,9 of the building permit.
Signed Affidavit Attached? Yes .......... No........... O
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 C� /•`l�N iiv
t9 act on my behalf,in all matters relative to esJc authorized by this building perm' application.
n/'dD pr oil e J A
fat Owner's Name(Electronic Signature) Date
SECTION 7b:OWNERI ORAUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the in ormation
contl no 11 ppltc 'on is true and a curate to the best of my knowledge and understanding. _
lvf'int wner's or Authorized Agent's Name(Electronic Signature) Dale
NOTES:
I. 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 LI.G.L.c. I42A.Other important information on the HIC Program can be found at
+aww mass.eov:'oca Information on the Construction Supervisor License can be found at w+v�'Jns
2. When substantial work is planned,provide the information below:
"rota) floor area(sq. R.) .(including garage, finished basement/attics,decks or porch)
Gross living area(sq. it.) 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.. "rota[ Project Square Footage"miry be substituted for'"rutul Projcet Cost"
Q'I Y OF SALEA MASSACHUSEM
BuuDING DEPARTAzNT
120 WAgMGM STREET,YO FLOOR
UL(978)7454595
KIIv]BERLEYDRISOXL FAX(978)740-9846
MAYOR THMAS ST.PIERRE
DIRECTOR oppuBjjcpRoPER7y/BuiLDmcubmwomR
Construction Debris Disposa/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 00, 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, 515i)A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
ujdoc�w��
(name of facility)
(address of facility)
S72-DA(e
of applicant
2 /�
Offices:
377 Lowell Street,Wakefield, MA 01880
Tel: 781-245-4900
Q�� Fax: nAndSouRoof
I!e 81-245-4999
www.PeterRYaMndSonRoofing.com
and'
ROOFING, Inc.
Submitted To: Job Location:
Conrad Pronewski 4)0\,
1 I Shore Avenue 11 Shore Avenue
Salem, MA 01970 Salem,MA 01970
Phone#: Unknown 9`f9-
Dail: Unknown
Proposal date: September 14,2015
We are pleased to hereby submit this proposal to furnish materials and labor,completely in accordance with the below speciflcauses:
(Additional charges may apply jar any change's not included below in proposal either by request of owner, or if Peter Ryan and Son Roofingfinds
unforeseen circumstances that will affect the performance,quality or integrity of this job).In the event legal action is taken to enforce any provision of
this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorneys fees. Not responsible
for debris in attic. WERMIV
Strip entire roof to hare wood and re-Shingle: $6080.00
• Strip existing shingles down to bare wood
• Check for rotted wood and replace(at time&material)
• Nail down any loose wood
• Install ice&water shield to first 6-feet,and in all valleys and around any protrusions
M • Install premium synthetic underlayment(in place ofstandard 301b.felt paper)
BBB• • Install all new 8"white drip edge on perimeter and step flashing,where needed
• Install manufacturer suggested starter course of shingles
• Install 1KO or GAF Lifetime/architectural shingles in color of your choice
• Install ridge vent
• Cap ridge vent properly with manufacturers suggested cap(GAF Timbertex®or IKO Hip&Ridge 12)
• Properly flash any protrusions and all new pipe flanges,ifany on roof
clean Up: '
• Cover area withtarps to minimize debris and remove debris related to work
• NOTE: Please cover any belongings in the attic,as they will get dusty,ifapplicable
���t1lFIll�;tY�Jd�t
$eSt cladascostot'" "it;la6o�"aum <ttateriitl w�=_.t .. °`Pa9ipagt . rd0lei � � ;�: t r��
vt pay t due upo signor 1,388 ' 0
Total(ieSL <8-0.00
glallll� Total baI r due o on I on: D0.00
� Kindly remit payrrient to`Peter Ryan", T
Co
Respectlully Submitted by: Accordantly: .
Our craftsmanship is 100%guaranteed 9.10-years. A warrantees are through the manufacturer.All warrantees w#b .seetlaid in full.
Paler Ryan an oofing,Inc License N 17887I(Tkank you for letting us serve
Peter
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