23 SOUTHWICK ST - BUILDING INSPECTION (2) I The Commonwealth of Massachusetts
'n? Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR,7`h edition
Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised
One- or Two-Family Dwelling Aril 15, 2009
This Section For fficial Use Only
Building Permit Number: Date Applied: - '
Signature:
uil g ommi sioner/I or o Date
SECTION 1: SITE INFORMATION
1.1 Property Addr ss: 1.2 Assessors Map&Parcel Numbers
e3 c5lMddr WIC Sr
1.to Is this an accepted street?yes ' no Map Number Parcel Number
1.3 Zoning 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❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record L9171
Nam t3'rmt) Address for Service:
�( �614 9719 -8!9�g�
Signature Telephone
SECT N 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
DST Nsr� �o,�c
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:
2.Electrical g ❑ Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire Su $ Total All Fees: $
Suppression)
.d Check No. Check Amount: Cash Amount:
6.Total Project Cost: S q2,00 ❑Paid in Full ❑ Outstanding Balance Due:
O K— v_--tz,,m I r
Asa 1'0 M IRN(W_ 5J
SECTION 5: CONSTRUCTION SERVICES
22 Cow 13
5.1 Licensed Construction Supervisor(CSL)
'14y -wro'noy License Number Expiration Date
Na CS Holder/
List CSL Type(see below)
Type Description
AdsA� U Unrestricted(up to 35,000 Cu.Ft.)
R Restricted 1&2 Family Dwelling
Signa M MasonryOnly
RC Residential Roofing Covering
Telepho WS Residential Window and Siding
�pZ A SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Regis tere Home Improvement Contractor(HIC) q
_leN��?��N M
HIC Compan Name or C Registrant Nam Registration Number
7— wi I (/ 00i6— -7
Address
t nzw Expiration Date
gn 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 .......... M No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, "y� 'V ►'1 C as Owner of the subject property hereby
authorize f �/ ����C p/ to act on my behalf,in all matters
relative to work auth ioT zeo�this building permit application.
Si atu e of Owner t Date
rpp / SECTI N 7b:,O/WNEW OR AUTHORIZED AGENT DECLARATION
I, IVY It FI' YV ,as6vaner op-Authorized Agent hereby declare that the s tements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print N 2.
Signatur A o ze t Date
(Signed under the pains and penalOs of eju )
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I O.R6 and 110.R5,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 halfibaths
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"
T _ _
-
4 � �e rpoixmarrxrucvti�ltc a�pj�j�aaar��iQPGU
y t.�i �_-\ Office of Consumer Affays&Busi ess Regulation •
ME-IMPROVEMENT CONTRACTOR Jb
= egistration *.143416 Type_;f `
piration 7/,�Sf2014a DBA'i
g _
k � �HENDERSON C,ONST����-�1
t �5
x.n
f JAY llfENDERSON''
R Alf ,28A WINTHROP AVE'q €
c i
BEVERLY,MA.019t5
� r- „ • y Undersecretary
' y" bla+.+a�bu+c[[+ Dip trtmui[nt,Ppbl�c S ttch._�;:_
�BBar"d of Buildu7 R��ui,tGonti cintl St uularAfh. .
_ :r ' Construction Supervisor License a-=*
A K• • One- and, (wo-Family Dwellings '
; Licenser CSC 58227 " :!
JAY J HENDERSON
Y 47 PICKERING ST, oy
DANVERS MA 01923 ..,
Expuattgn 10/15120t'3z
8799
•v y,'bEawpa.+'t�Rc�,.-r.:'rta z-,.. w .-. -..P-,-. .:a. �-. "�` _
The Commonwealth of Massachusetts
[fie DeparftmiofladzmfjWA=Ments
�' Bl�ixaticrrs�atlaas
600 Washington Street
Boston,Masi 02111
Workers'Compensation Insurance Affidavit
n _
ity
� �� , �\ ✓ 1 �! '✓ (.� ,f` / h rat �. ♦�G�—�. � ✓ ���L
I am a homeowner aerfo� ing all wori; myse;f.
`I am a sole proQre:or and have no one working in any capacity
Me 10
(-i I am an emciove-, providing workers compensation or my emoievees working on this job.
t anv name-
ddr -
city-, oaone
in nc•co. ioiicv
I am a seie=rocre:or, gene:-ai contrac:or,cr homeowner(cacr ortei and have hired he contra-ors listed below who have
the foilcwing worken' comcensatien coiices:
:om anv name•
d '
tv hone
insyr2nce co.
anv name•
city: o ha ne:'
inSUr2nCe CQ. RoUcy 14
FaBnre to secre mvenge a required ander Secdan'3A of MGL 1c3 ca lead m the imposition of eriminai pemiaes of s fine up to SI e"and/or
not veers'imprisonment ss well as mil Pennines in the farm of a STOP WORK ORDER sod a riot of S100-00 a day•gtiost rn . I andersmnd nut a
copy of this sutemmt may be forwarded to the Office
�of Iaveaagsdoos of the D(A for coverage veriritsaon.
I du Hereby c under the pau7it d penaltief afip�jtvy that the informadort provided above a true an "tarruc
Si / Date
Prim name' J �` f.+��-�' �/ Phone
otDaal w only do not write in this area to be compfeted by city or town official
city or town: permiclicenseX r'IBuildiag Department
OLicensing Board
check if immedutc response is required OH"ftb a Office
n"
. OHu1tL Department
.: Mother
eea[act person _phone A: _ .
HENDERSON CONSTRUCTION — -- — -
Page No. of Page
y{ , NIA'Reg. #102286, CCee. ,
28A Winthrop Ave.; PR®PoVI�'
BEVERLY, MA 01915
w vy
(508) ,927.0544 All home.improvementcontractors and subcontractor
engaged in home improvement contracting, unless
ly exempt,
on. by Pinovisio'ns,cr
Submitted I( 4 t Chapter 1'42A of the generall laws,mlust be registered Witt
70 1� Cv�,.11 ;'� e-` Q, � „_......... ::. ,. the Commonwealth, of.Massachusetts: Inquiries abou
registration and status should be in to the Director
ICGIJ` y�1CtV�E
i n , z Home ImprovemenfContract Registration,One Ashburton
Place, Room 1301, Boston MA'02108 (617) 727-8591
1.,, 'JOR NAME/NO.
'PHONE DATE �}} JOB LOCATION
29.I-LI�2oi 3 '11M 2 '-P_ '1" J t•�e. C>y (Y�:tJ_, -
ARCHITECT DATE OF PLANS
>
L_.,-ne...e.i.....,en-nn,L�netmaJc.rn.hu...enn..._._�_ . -•
We are submitting specification and estimate for work to be performed and materials to be used
I as part of a proposal to Ms.Kathleen Gaetz, of 23 Southwick Street- Salem MA 01970
1. Construct a new porch on the left side of the house at rear door..
2. Framing for porch: 2 x 8, 16 inches OC of pressure treated lumber, with ledger bolted to
building. Joists doubled at all sides, supported by PTL 6 x 6, anchored to concrete footing.
3. Porch surface shall be 1 x 4 Cambara decking laid diagonal to joist,with "A inch spacing,
face nailed with stainless steel nails.
4. Install a set of steps to the porch surface with 2 x 12 stringers c&PTL and treads of
Cambara decking close risers with AZEK.
5. Porch and step railings shall be constructed of AZEK Premier hailing and Post Kits.
6. Closed area from apron to grade with plastic pre-finished lattice in white.
7. The work area shall be cleaned up and trash shall be removed to a dumping site.
r it
'`: > Construelaei , . � h s s I v -- ....-,-
�1'
v
WORK SCHEDULES a , - .:__.. __:,. '.--:;.
4' Contractor Nall n t begin the work or order the matenals before the thirtl tlay following the signing of this Agreement,unless specified here n writing Contractor will begin the work on
t - about , 7 ,l 3.(date) Berdng delay caused by circumstances beyond Contractors comrol,the work will be completed by
Z I date):The Owner here
�, acknowledge and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall norbe cod "deretl as violations of this Agreemi
a WARRANTY k_
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of following completionand sh
comply with the requiremems of this Agreement_In the event any defect in workmanship or materials;or damage caused by the Contractor,his subcontractors,employees or agents,
^`r? discovered within one.year after completion of any job,including cleanup,the Contractor shall,at his owd expense,forthwith remedy,repair,correct;replace,or cause to be remedyf
repaired,or replaced,such damage or such defect,iirmaterials or workmanship.The foregoing warranties shall survive any inspection pedonnetl in connection with the agreed-upon wt
>,. -. . � .
We ProPOSe hereby to fumish material and labor complete'In accordance with above specdications for the sum of
C70
L r•KJ14,SCrr\A O . UY�C
� �Y Qr� - dollars($ �' U�
P ymeni to be made as follows g - «
.. by; .? , . �.-- -�-,upon signing Contract, 1Y1S
9 . n Name otcor,"clor/Designated Registrant
completton
Street Address .. ....._
l (Ot?a �p�/
($ ) upon completion of � �10 1 t70r L �-�'• 0. 1� /^ �� )
`__Cdy�State j -Phone U^
made forewdh upon
f y e r< ,. completion of work under this contract. o al secun .. a
Registration No ^'� S h
Notice:Y�No agreement for home improvement contracting work shall require a.
>down payment(advance deposit).of more than.one-third of the total contract price. Name of salesman -, 7
or the total amount of all deposits or payments which the contractor must make,in ,JQ.4, )� -{ Y /, -
' advance, to,order and/or otherwise obtain delivery of special order materials and Auihonzed signature -
equipment whichever amount is greater. l
Note' This proposal may be witfidrawn by us if not accepted vAhin da,
ACCeptance-Of PrOpOSa[ =I have read both sides of this document and accept the prices,specifications and conditions stated. I understand
1hat'upon'signing this proposal.becomes.a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above.
You,,'the Buyer;may cancel this transaction at any time prior to midnight of the third business day after the date c
this transaction'. Cancellation must be done in writing.
Y DO'NOT SIGN THIS CONTRACT IF THERE ARE ANY'BLANK SPACES.
SlgnaNre !/t Oats SignaNre. _ Date
mooicrssu®®iruseim,a�.own.maeevxartraumataaonso '- - - IMPORTANT INFORMATION ON BACK II