Loading...
3 SKERRY STREET CT - BUILDING INSPECTION 1 - /to The Commonwealth of Massachusetts Town of Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR, 7"edition Building Dept t v. Building Permit Application To Construct, Repair, Renovate Or Demolish a *kmmwdwa a ru-Furaift Diteffing coon For ORcial Use Only Building Permit Nu Date Applied: Signature: Bwldt oings Date 1: SITE INFORMATION Al.Property Address: 1.2 Assessors Map dt Parcel Numbers x X��v S% CT S�4LV�, .t,nd Ma Number Parcel Number 1.1 a Is this an accepted street?yes no p 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(fl) 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.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Reeord: CL��/� ? X3-t Lxpy XName(Print) Address for Service. . 7 Sror a g�f88 Signature Telephone SECTION 3: DESCRIPTION Oii OSED WORKS(cheek all that apply) New Construction❑ Existing Building❑ Ownied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Numits Other ❑ Specify: Brief Description of Proposed Work-: GtT/l-I. I SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: 0111cial Use Only Item Labor and Materials I. Building S 1. Building Permit Fee: S Indicate how fee is determined: O Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost-(Item 6)x multiplier x }. Plumbing S 2. Other Fees: S 4. .Mechanical (HVAC) S List: 5 .Mechanical (Fire S Total All Fees. f Su reA510n Check No. _Check Amount: Cash Amount_ 6. Total Project Cost: S 3 M3000 ❑ Paid in Full ❑Outstanding Balance Due: tA/l"=t P-rz 7 5M-r 4 wt 6S on/ SECTION 5: CONSTRUCTION SERVICES r 5.1/LLicensend.,iCo�nssttrrunction Supervisor(CSL) C/T� ap /✓�, License .Number pirat n Dale N;ime ut CSL- 1y1Jer List CSL T �o Al-O ��J.EKs�/ A1 YPe(,cc Mow) (J Jr s --7 Type Descn uon U Unrestricted up to 35,000 Cu. Ft.) Signature R I Restricted 1&2 Family Dwellin r-Ig�� '�7/'i�.Q/o .S1 .Mason Only ,r C 7 ! RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Btaming Appliance Installation D Residential Demolition S�f�11Hos�e_Imov �ot_Con�ctor(HIC) ly „r/_r fJ- / F�If� C�or tp�-yty� Name or HIC Rrgistrant Na�n� Registration Number !'� Q57Jf 6;0 ;ymC4 !a!7� �( A �y r, / 2Z 2(T d �Ha Of/t7� Eapirati n Date ignarure Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6)) Workers Compensation Insurance affidavit must be com leted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc the building permit. Signed Affidavit Attached? Yes .......... Er No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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. Signature of Owner Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 1, ��>1"0 Q� 2 . �e1��`— ,as Owner or Authorized Agent hereby declare that the statements and i formation on the foregoing application are true and accurate,to the best of my knowledge and beh .�n Pr' N ignature of Owner r Authorized Agent Datdr (Signed under the pains and Penalties of r 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 W have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and I IO.RS, respectively. 2. When substantial work is planned.provide the information below: Total floors 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 heating system Number of decks/ porches Type of cooling system Enclosed Open 1. "Total Project Square Footage"may be substituted for 'Total Project Cost" CITY OF SALEM PUBLIC PROPRERTY �•. y DEPARTMENT St\Ihi'RIF.Y URISc:ULL MAvoa 12C WAsruvG fac STREET•SALEM.MA9AC1 n\Ii'rtY 019P' TEi.:978-743.9595 •F:vx:9M740-9946 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Antrlicant Information Please Print Leeibly Vame tBuciiieWOrganizationtlndividunly. ga4s 6yb� C� r Address: /'o fQDY 04Od'r 5;,57z�:r LGi CitylStarci'zip: e--�1G lahone # ' 79, 762' a/O/" Are_ou an employer?Check the appropriate box: Type of project(required): I. i ant a employer with ? 4. ❑ 1 am a general contractor and 1 6. [] New construetioa employees(full and/or pan-time).• have. hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. : 7. ❑ Remodeling ship and have no etnpioycost These sub-contractors have S. ❑Demolition workingfor me in an capacity. workers'comp. insurance. Y9. ❑ Building addition (no workers'comp. insurance 5. ❑ We are a corporation and its 10. Electrical re required.) otTeers have exercised their ❑ pain or additions 3.❑ 1 am a homeowner doing all work right of exemption per MOIL 11.0 Plumbing repairs or additions myself.(no workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.) t employees. (No workers' 13.❑ Other comp. inswrance requirsd.] -Any apphicuta that chocks tax nl most aiw till an the%action bolaw showiag heir workam'cunipentaaioa pulicy infoama ua '1lo uwwnen who submit this affidavit indicating they are doing all work and then hire outside etaltm00111 must sulnnu a new affidavit indicating such. :Conowunc,than check this box mush attached an additional-how showing the namo of the sub-comractors and their wuhan'comp.policy infwmatiun. I am urn employer that Is providing workers'compensation it urancefur my employees. Below is the policy and job.rife information. Insurance Company Name: , Policy#or Self-ins. Lic. #: �e ©�7 �Z�-/ Expiration Date: Job Site Adlress: L City/slatvzip: ���Gcf_ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expira[iun date). Failure w seethe coverage as required under Section 25A of.'vIGL c. 152 can lead to the imposition of criminal penalties of a Fine op to S1,500.00 and/or one-year imprisomncnt,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. He advised that a copy of this slawment may be forwarded to the Office of lincangations ol'Ihc DIA for insurance coverage veriticatiun. i do hereby eery' i t the pains and penalties ofperjury char Noe information provided above is true and correct: Official use only. Do not write in Nls area,to be completed by city or town ojjirial City or Town: Permit/l.icense# Issuing Authority(circle one): 1. Board of liealth 2. Building Deparhnent 3.City/Coen Clerk 4. Electrical Inspector 5. 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." An employer is defined as"an individual,partnership,association.corporation or other legal entity,or any two or more 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 or other legal entity,employing employ a. However the owner of a dwelling house having not more than three apaitments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction 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 shag withhold the issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth 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 rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)mame(s),addresses)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 alldavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. 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 their self-insurance license number on the approPria[e line. City or Town Officials Please be sure that the 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 ilia permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense 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 tilled 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. l'he Otlice of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents o®ee of Investipdans 600 washingtorl street Boston, MA 02111 Tel. k 617-7274900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-65 www.mass.gov/dia RAPID ROOFING GENERAL CONTRACTING CO. P.O. BOX 605 SALEM , MASS. 01970 978-740-0101 MASS LIC # 128253/144946/CS 10 1965 RAPID ROOFING IS A DIVISION OF COYNE&SONS CONTRACTING CO. ROOFING ESTIMATE TO. 8/14/2009 GRETCHEN CLARK 3 SKERRY STREET CT. SALEM, MASS. 01970 978-740-9488/978-210-1081 CELL JOB SITE ADDRESS. f SAME RE; COMPLETE STRIP OF ENTIRE MAIN ROOF OF BUILDING AND ADDITION ROOFS ON LEFT SIDE OF BUILDING. AND FRONT MAIN ENTRANCE ROOF. 25 YR. 3-TAB ASPHALT ROOFING SHINGLES. PLUS ASSORTED REPAIRS. ESTIMATE # 09-0024 WE AGREE TO. 1. COMPLETELY STRIP THE ENTIRE MAIN ROOF, LEFT SIDE ADDITION ROOF, AND THE MAIN ENTRANCE ROOF OF THE PROPERTY, OF ALL ROOFING MATERIALS ON THE BUILDING AT THE PRESENT TIME. NOTE.. WE AGREE TO REMOVE ANY ROTTED OR DAMAGED ROOF DECKING BOARDS ON EITHER THE MAIN ROOF, SIDE ADDITION ROOF, OR FRONT ENTRANCE ROOF AREAS OF THE BUILDING, AND INSTALL NEW WOOD DECKING BOARDS IN THOSE AREAS, FREE OF CHARGE 2. INSTALL NEW WATER& ICE SHIELD ON THE EXISTING MAIN ROOF AND SIDE & FRONT ROOF AREAS, OF THE ENTIRE BUILDING OF THE PROPERTY, ALSO ON ALL RAKE AREAS, VALLEYS, DORMERS, CHIMNEYS, OR FLAT ROOF AREAS OF THE ENTIRE BUILDING. 3. INSTALL NEW 15 LB. ASPHALT FELT ROOFING PAPER ON ALL THE EXISTING MAIN ROOF AND SIDE ADDITION AND FRONT ROOF AREAS OF THE ENTIRE BUILDING OF THE PROPERTY.. 4. INSTALL NEW 8 INCH ( WHITE ) ALUMINUM DRIP EDGE ON THE ENTIRE MAIN ROOF AND SIDE ADDITION AND FRONT ROOF AREAS OF THE ENTIRE BUILDING.. 5. INSTALL NEW ALUMINUM STEP FLASHING ON THE SIDE ADDITION ROOF WALL AREAS ON THE BUILDING OF THE PROPERTY. 6. INSTALL ALL NEW VENT PIPE BOOTS ON THE ENTIRE MAIN ROOF OF BUILDING AS NEEDED.. 7. INSTALL NEW CERTAINTEED 25 YR. 3-TAB ASPHALT ROOFING SHINGLES AND CAP ON THE ENTIRE MAIN ROOF AND MANSARD ROOF AREAS OF THE ENTIRE BUILDING OF THE PROPERTY. 8. SEAL UP THE EXISTING FLASHING ON THE CHIMNEY ON THE MAIN ROOF OF THE BUILDING.( FREE OF CHARGE). 9. GLUE DOWN & REPAIR THE EXISTING RUBBER ROOFING MATERIAL WHICH IS COMING OFF THE REAR MAIN ROOF OF THE PROPERTY. 10. FIX THE EXISTING HOLE IN THE ROOF FACIA AREA ON THE LEFT SIDE OF THE BUILDING. 11. REMOVE &REPLACE APPROXIMATELY 68 FT. OF SEAMLESS ALUMINUM GUTTERS OF THE ENTIRE HOUSE. HOMEOWNER HAS CHOICE OF COLOR OF GUTTERS.. 12. WE AGREE TO REMOVE ALL ROOFING DEBRIS AND TRASH FROM THE PROPERTY. BREAKDOWN OF COSTS. COMPLETE COST OF MAIN HOUSE, ADDITION ROOFS & ENTRANCE ROOF OF ENTIRE BUILDING, RUBBER ROOF REPAIRS 25 YR. SHINGLES /2 LAYER COMPLETE STRIP................. $ 2,800.00 WHICH INCLUDES MATERIALS,LABOR, DEBRIS REMOVAL.&PERMIT COSTS.. REPLACEMENT OF HOUSE GUTTERS............................. $ 680.00 WE HEREBY PROPOSE TO FURNISH ALL MATERIALS AND LABOR-COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS FOR THE SUM OF.... $ THREE THOUSAND FOUR HUNDRED EIGHTY DOLLARS -S 3,480.00 WITH PAYMENTS TO BE MADE AS FOLLOWS.................... $ 1,740.00 DOLLARS DOWN/$ 1,740.00 TO BE PAID IN FULL UPON THE COMPLETION OF THE WORK.... RESPECTFULLY SUBMITTED BY' RAPID ROOFING CO. OF SALEM , MASS OWNER CHRISTOPHER R. COYNE SR. NOTE-THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN- 21 DAYS, ANY ALTERATION OR DEVIATION FROM THE ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS,WILL BE EXECUTED ONLY UPON WRITTEN ORDER, AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE. ALL AGREEMENTS ARE CONTINGENT UPON STRIKES,ACCIDENTS,OR DELAYS BEYOND OUR CONTROL. NOTE; WE CANNOT ACCEPT ANY RESPONSIBILITY FOR ANY DAMAGES,OR DEBRIS FALLING INTO ATTIC AREAS, CUSTOMERS SHOULD COVER VALUABLES,GREAT CARE WILL BE USED TO PROTECT THE EXTERIOR STRUCTURE BY COVERING THE EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENT ANY DAMAGES DURING THE STRIPPING OF THE ROOF,HOWEVER SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR CONTROL, HOMEOWNERS MUST MOVE ANY VALUABLES AWAY FROM THE BUILDING,PRIOR TO THE STRIPPING OF THE ROOF. NOTE; IF MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE IN THE ESTIMATE,THE OWNER OF THE PROPERTY WILL BE IMMEDIATELY NOTIFIED,THE OWNER ACCEPTS ALL RESPONSIBILITY,AND (AGREES)THAT,ANY EXTRA CHARGES WILL BE ADDED FOR THE LABOR AND THE REMOVAL OF THE EXTRA DEBRIS,OVER AND ABOVE THE PRICE OF THE ESTIMATE.... ACCEPTANCE OF PROPOSAL THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENTS WILL BE MADE AS OUTLINED ABOVE.. DATE OF ACCEPTANCE O SIGNATURE SIGNATURE SIGNATUR CITY OF SALEM PUBLIC PROPRERTY T DEPARMENT tic �l A91iNt:: i atttT•$OF at,)t��V:i a.!11 s::9I. To.9794454 9f Farts 9W4C-%% Construction Debris Dispose( Affidavit (required for all demolition and renovation work) in accordance with the sixth edition of the State Building Code. 7S0 allt soction l 11.3 Debris,and the provisions of M. GL c 40.S 54. Building Permit N _ _ is issued with ft condition that the debris rt:sulting font this work shall be disposed of in a property licensed waste disposal facility as defined by.%AGL e I It, S ISOA. The debris will be transported by: Hume of hauler) fhe debris wilt be disposed of in home oY ixlllty) �..Ag