2B STILLWELL DR - BUILDING INSPECTION (4) The Commonwealth of Massachusetts
J - Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SdMar Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Da Applied: l"
Building Official(Print Name)V Signature Dale
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
le
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 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 apply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage DD''sposal System:
Public Private❑ Zone: _ Outside Flood Z!>t<? Municipal ItY On site disposal system ❑
Check if yes
SECTION 2: PROPERTY OWNERSKIP'
2.1 Owned of Rec� J, M 4- d !q Za
�Cc tt,{a. � !"1�tH
Name(Print) City,State,ZIP
P,6 l ZFl 5A46 9 /9 rb-RA nD�{@ �oy� e,-.d
No.and Street Tel Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOW(check all that apply)
New Construction❑ Existing BuildingIni Owner-Occupied ❑ 1 Repairs(s) ellA@eration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑1 Number of Units, Other ❑ Specify:
Brief Description of Proposed WorkZ1� /E'er/cG �c /nS h// {7eu✓ /e" /oofs 7�
410
S �d� ✓u In v�� — o. e 1 r S.h y /�iNnin
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building pO 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ [3 Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ .S Oo Od 2" Other Fees: $
4.Mechanical (RVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 6 SOON 00 ❑Paid in Full 0 Outstanding Balance Due:
1
SECTION 5: CONSTRUCTION SERVICES
5.1 ,Construction Supervisor License(CSL)
///i�•4—'/' License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) v
No.and Street T '" Description -
Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
Ortfrown,State,ZIP M Masonry
RC Roofing Covering
_ WS Window and Siding
SF Solid Fuel Burning Appliances
MF�codw�^con�n��6m•%o I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
/""/ G�nGw.�
HIC Registration Number Expiration Date
HIC Comg y Name or HIC Registrant Name
No.and Street mail address
Cd /Town,State,ZIP 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 .......... 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 /�//�/oe/ � W
to act op my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's fq#C(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
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 of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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 can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps
2. When substantial work is planned,provide the information below:
Total floor 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 half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
CITY OF S.-uX11, NIASSACHUSETTS
BUILDING DEPARTJIENT
• 120 WASHINGTON STREET, 3'a FLOOR
TEL (978)745-9595
FAX(978)740-9846
KIMBERLEY DRISCOLL
MAYOR THomAs ST.PIERRa
DIRECTOR OF PI:BLIC PROPERTY/BI:ILDING CO%L%MUIONER
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Analicant Information y
/ Please Print Legibl
Name(BusimssOrganimtioNlndividual): 11 41� mod ✓ih
Address: 7 ��
City/State/Zip: Phone #:
Are you ton employer?Check the appropriate box: Type of project(required):
1.0 1 am a employer with :?— 4. 0 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the subcontractors
2.0 1 am a sole proprietor or partner- listed on the attached sheet: 7. 91 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. workers'comp•instuatrce. 9. 0 Building addition
[No workers'comp. insurance 5. 0 We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'comp. c. 152.§44).and we have no 12.0 Roof repairs
insurance required.]t employees. [No workers' 13.0 Other
comp. insurance required.]
•Any applicant that checks bee Of most Was,fill out the section below slowing their worker'enmpemadon policy intermation.
'I Inmi»wnas who submit this affidavit indicating they ar,doing all work and then hilt outside comraeter most submit a new affidavit indicating s ad,
;Contractors that check this boa must attached an additional sheet showing the name otdo sib. fflmclor and their warless'comp.policy information.
Ian an employer that is providing workers'compentadon lasamnce for my employem Below Is the po/Icy and fob site
information. //// ✓/l
Insurance Company Name:.
Policy 4 or Solf--ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attack a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fee
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
1 do hereby certify under the pains and penaldes ofpeifury that the h formadoa provided above is true and correct.
Sienature:,J � Date'
Phone#:
Official use only. Do not write In this area,to be completed by city or town off c ac,
City or Town' Permit/1.Icense#
Issuing Authority(circle one):
1. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person' _. Phone#:
7/o........ rueul/�.��,P/�'�ailJacfirJeCla
` Office of Consumer Affairs&Busifiess Regulatiop
• F 6 OM
E IMPROVEMENT CONTRACTOR Type:
egistrauon 105029
xpirauon 7/16/2614 Individual
i MICHAEL F.GOODWIN JR' rt
F
Michael Goodwin Jr.
7 HOLT.RD.
EPPING,NH 03042 A� -T 4 Undersecretary—
�_ ,4lascachusettx- Department of Public Sareh
(�JS Board of Building Re-,ulafions :mtl Standards
Construction Supervisor License
License: CS 81670 '----�
MICHAEL F GOODWIN i
7 HOLT RD .
EPPING; NH 03042 -
Expiration: 8/8/2013
<'unnNssiuner
-. . Tr#: 2951
Oct. 15. 2012 9 : 59AM No. 1418 P. 1
To: Salem Building Department
Fax: 978-740-9846
RE: Bath renovation at 2-B Stillwell Drive, Salem, MA
Attached, please find email correspondence approving the bath renovation project from
my condo board based on the proposal from Mike Goodwin.
Please contact me with any questions or concerns.
Regards,
"- 10/ > 0/2-o�
Paula Finn
2-B Stillwell Drive
Salem,MA 01970
Fax: 617-768-9570
Mobile: 617-429-6047
Oct. 15. 2012, 9 : 59AM No, 1418 P. 2
1,,x Lill I . L.tJl111MV� F L4�1r 1 of 1
XFINIIY Connect pbfnn04@comcast.ne
+Font Size-
RE: Bath renovation - Pickman Park
From:Mary Ann Waldron<mwaldron@apffln.com> Mon,Oct 01,2012 08:00 PM
Subject:RE: Bath renovation-Pickman Park
To:'Paula Finn' <pbfinn04@comcast.net>
HI Paula
You are all set. Please be sure that the vendor has the proper Insurance to cover you In case something goes wrong. All trash etc.must be removed
from the property by the vendor-
MaryAnn
MaryAnn E. Waldron
Condominium Coordinator
American Properties Team,Inc.
500 West Cummings Park.Suite 6050
Woburn,MA 01801
Direct Line(781) 569-2626
My Direct Fax 781-569-2613
Have you been to your new"APr Online Service"site available to all Owners of our managed communities?Do we have your email
address?We want to make sure you are getting the communications we send through "email blasts"that give you a summary update of
your meeting,helpful tips,notification of events and emergency information quickly! If you have not gone an your site yet, please contact
me so I can help you get SIaRCd�
_....,. _ .... ............. .-..-,....,._. . ......._......_. ..........-. . . ..,.-......-.... _.
From: Paula Finn[mailto!pbfinn04@comcast net]
Sent: Sunday,September 30,2012 7:39 AM
To: Mary Ann Waldron
Subject: Bath renovation-Pickman Park
Hi Mary Ann,
I am attaching a contract for an upcoming bath renovation for the Board's review and approval.
Regards,
Paula Pine
2-B Stillwell Drive
----Original Mesgage----
From:mfg0odwlnconlpany@gmall.com rmallto:mfgoodwlncompany@gmall.com]
Sent;Monday,May 21,2012 12:21 PM
To:pbFnn04@comcast.net
Subject:Estimate from MF Goodwin Company
Dear Paula Firm
Please review the attached estimole. Feel free to contact us if you nave
any questions.
We look forward to working with you.
Sincerely,
Mike Goodwin
MF Goodwin Company
978A23-8463
http://web.mail.comcast.net/zimbra/h/printtnessage?id=433200&tz=America/New_York... 10/15/2012
Oct. 15. 2012 9 : 59AM No. 1418 P. 3
Proposal
130 Centre St.
Danvers, Ma. 01923 978-423 8463
Paula Finn 5/15/2012
Stillwell Dr. Unit 2B
Salem Ma
Project Description Total
This estimate is for the following work. 6,500.00
Bathroom remodel.
M Paula,
Here is the revised estimate for the remodel. I will supply the Americast tub
which is the porcelain glazed steel tub that we had talked about.
I hope this helps.
Regards,
Mire
Scope of work;
We will apply for the proper building permits.
We will disconnect and take out the tub vanity, toilet and file floor.
We will install a new Americast tub, drain, shower valve, shower head and tub
spout.
The walls in the shower area will be covered with Durock tile underlayment to
prep for the tiles.
We will install the tiles in the shower area and grout them.
We will install Durock tile underlayment on the bathroom floor and then tile the
bathroom floor and grout it.
Total
Signature
mfgoodwincompany@gmail.com
Page 1
Mass.CSL #081670 Mass. HIC #105029
Oct 15. 2012 9: 59AM No. 1418 P. 4
Proposal
130 Centre St.
Danvers, Ma. 01923 r 978-423-8463
Paula Firm 5/15/2012
Stillwell Dr. Unit 2B
Salem Ma
Project Description Total
We will reinstall the existing toilet, vanity and sink.
All rubbish will be removed from premises.
Homeowner will provide the new shower valve, tiles and grout.
References are proudly given upon request
The work will take approx 2 weeks to complete.
City permit fees are additional.
The walls will be ready for paint.
Total estimate: $ 6500.00
Additional:
To paint the walls, ceiling and trim in the bathroom would be an additional $
450.00
To install a tile backsplash between the cabinets in the kitchen would be
$550.00 for the installation.
Total . $6,500.00
Signature
mfgoodwincompany@gmail.com
Page 2
Mass.CSL 4081670 Mass. HIC #105029
10/15/2012 10: 40 9786833147 PAGE 01/01
CERTIFICATE'QF LIABILITY INSURANCE �'�IMMMUY""'
10/15/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE GOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTAM V E OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: s the certificate holder m an ADDITIONAL. INSURED, the PoliCY088) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions otthe policy,certain Policies may require an endorsement A Statement on this cerbficate does not confer rights to the
certificate holder in lieu of such endarsamen 9).
PRODUCER TAO
TM.P. Roberts Insurance Agency _-
1060 Osgood Street 978) 683-88) 683-3147
North Andover, MA 01845 BINSUIUIGS)AFFOROINGCOVERAGE NAICP
... ._ n:Norfolk G DadhamINSUREDMICFLAEL GOODWIN R a:AIM MutualME COODWINR C;7 HOLT ROADGEPP7NGr NH 03042 E:RF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO LICY PERIOD
INDICATED. NOPM1h7HSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANO CONUTIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN nE UCm BY PAID CLAIMS.INSR ... . .-...
NM SUER- ..._ .. ... .... ....A TYPE OF INSURANCE POLICY"LIMBER MMN EFG PII V Exp
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CLAIMS
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MEDE (Aryone Denm) S 5 000...
PERSONAL&ADVINIURY S... 1„000 000
GrNERALAGGREGATE & 2,000 p�p
GEN'LAGGREGAT.'>LINTT APPLIE$PER PRODUCTS-OOMPIOP qGG $ J�p�.000 POLICY PRO- LOC _ -
AUTOMOBILE LIARIUrf B
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ANYAUTO (FP eccitleik) .$
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AUTOS AUTOS
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AUTOS PROPERTY DAMAGE S "
(Per eceigom)
UMBRELLA LIAR .-_... S ..._ -
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EXCESS UAW CIIM$-MADE H EAC OCCURRENCE S
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ANDEMPLOYERS'LIASILITY YIN VWC6015175012012 2/15/12 2/15/13 % T.ORYLMLLIS�_. J TH _
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLE$ tAnbch ACORD10I.AdsMm.lRBlre Nm Schgtluk,Nmore open 1preyUwd)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE AeOVe DESCRIBED POLICIES BE CANCELLED BEFORE
CITY 'OF SALEM THC EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE;WITH THE POLICY PROVISIONS-
120 W.ASHINGTON STREET
SALEM, MA AUTHDRRED REPRESENTATACONe
25(2Di 0/05) The AC ORD name and logo are registered marks of ACORD
8 RO CORPORATION. All rights reserved,
Phone:hone; Fax: (978) 740-9846 E-Mall,