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49 SUMMER ST - BUILDING INSPECTION Che Commonwealth of Massachusetts uhn Board of Building Regulations and Standards SITY OI Massachusetts State Building Code, 780 CMR t01b NOV .1 8 Aev%, A4,r 2011 Building,Permtt Application To Construct, Repair, Renovate Or Demolish a? One-or Two-Family Dwelling This Section For Official Use Onl Building Permit Number: Date Ap led: Building Official(Print Name). Signature Date �+ SECTION I:SITE INFORMATION; 1.1 Propertt��Address: 1.2 Assessors blap&Pnrcel Numberss- 'ir9- SVArA ST 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 11) Frontage(11) 1.5 Building Setbacks(R) " 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? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if yesCl SECTION2: PROPERTY OWNERSHIP!` 2.1 Owerl of Record: rn �^A LF rya MA QI 10 y 1n RGI� Rn/p J �hme(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ owner-occupied ❑ 1 Repairs(s) ❑ Altemtion(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Speciry:V7121 P-1-RKH/L&w Brief Description of Proposed Work': 'S-Tap I�ND tla F}I/�blL SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials I. Building S - sad M� I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S t.Mechanical (HV;\C) S List: 5. \lee hanicaI (Fire S Total All Fees:S r cession) Check No. Check rlmounk Cash Amount:ut:tl Project Cost: S q,504, 00 ❑Paid in Full ❑Outstanding Balance Due: Sr=�o To N •O MPtI_Ev t1 �Z�i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor Liceq`e(CSL) 101 O,9_0 itLicense Number Expiration Date N:unc of CSL`Holder�J ,� / W�-r- List CSL'rype(see below) y L I5 - F-go A � ST -Type : - Description No.and Streets p I �� . LYN/� M U Unrestricted Na in a R 1035,000 cu. . r�� R Restricted I&2 Fwnil Dwelling Cityfrown,State,ZIP M Masonny RC Rooting Covering WS WindowandSidin 5't �ry SF Solid Fuel Burning Appliances 1- Q(' 1 I Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) g P )7g1ys ` 6-448 \J.XuL14')t'N`7M1} &i:R UiyST TNe HIC Registration Number Expiration Date ,HIC conotg Na ea Regisrt_rant Name JNo dmid f.r.-ou t rn� D•IS��� Email address L-�- Al /Q J 1 ✓` 1 Ci /Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L:c.In¢ 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 70:OWNER AUTHORIZATION TO BE.COMPLETED WHEN. OWNER'S AGENT OR CONTRACTOR APPLIES FORBVII{L�DIN1G'.PERMIT I,as Owner of the subject property,hereby authorize t/".F- Lx t9 act on my behalf,in all matters relative to work authorized by this building permit application. PRI(- MA-aC,MND � i- HL Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,) 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 Aut rorized 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 nuf have access to the arbitration program or guaranty fund under M.G.L.c. 1 d2A.Other important information on the HIC Program can be found at Aaww mass.eov'oca Information on the Construction Supervisor License can be found at www.inass.�!ov:'dns 2. When substantial work is planned,provide the information below: "total floor area(sq. R.) (including garage,finished basementlattics,decks or porch) Gross living area(sq. R.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths 'type of healing system Number of decks/porches Type ofcoolingsystem Enclosed Open 3. "Ibtal Project Square Footage"may be substituted for"rot:d Project Cost" ai i VS VALE Di������Yl AaAW J WAMM %D�EItiBYID�OCEL PAr 70-90 I&YCR ltrorusST.P crFEMWJF"kUT/MffMMCOW#MjGW COW# C®nst MMOn Debris Dispose►/Affldavft (required loran defnontion and renovation work] In aocorcbnoe wlLh the s6rth edition of the State g Aft code, 780 alb, Sermon 111.5 Debris; and the prorlsions of A4GL WOO S 54; boil ft Permit if is lsseed with the condition that the debris r+esultigg from this work shag be disposed of in a properly fteraed " waste deposit facility as defined by M6L c 111,S 150A. The debris will be transported by: (name ofhau*.) The debris will be disposed of in: (name of facility) CO n 1A-AIcr 7' C y A- Y214 (address of facility) Signature of applicant Date Page No. of Pages �na#txt� �xo�os�x1 I I : WM. TRAHANT JR. CONSTRUCTION, INC. �\ ' 4TH GENERATION ROOFING \ 215 Verona Street LYNN, MASSACHUSETTS 01904 CSL#101220 (781) 599-1211 • (781) 844-4551 • FAX: (781) 581-0855 H.I. LIC. #141778 PRO SAL SUBMfIT�EEDyTTO pH E DATE �t� IrIC�dVI fJ 7� ��8 �/s nf— ��• LCjrS' STLREEET(; JOB NAME CITY, ATE and ZIP CODE - JOB LOCATION C,--Iem We hereby submit specifications and estimates for: ' We hereby submit specifications and estimates for: - SHINGLE ROOF FLAT/RUBBER ROOF S p entire roof ❑ R_eshingle ❑ Sweep entire roof clean ----------------- R pl a any bad boards up to 100 linear feet Str' entire roof Inst Ice and water barrier first three feet up roof ICJ M chanically fasten down ISO board insulation Install is and water barrier in all valleys and along dormers Install 060 Rubber Roofing on entire roof Install r on remainder of roof — stall metal flashing around perimeter of building— — - Install eight inch drip edge - hite ❑ Black ❑ Mill - as himney(s), pipe(s) and wall(s) - ------ --— -----Bl ----- ❑ Inst I ridge vent dge caulk all seams - ---- -- ------------------------------ ---------------------------------- la or re-flash chimney(s) ❑ Install new copper center drain - Inst -new pipe flanges — El Other: - -= --- - ------- ------------------------------ nstall'lifetime shingle Color_c�ucf c lean up all debris ❑ Install gutters and downspouts abor and materials guaranteed 100%for five years -0❑ Install trim coil ------ -------------- ---- C(�t ❑ Install new fascia boards ❑ Install new rake boards 1./�a74 'i7 ---------------------------------------- --------- ----------- _�-� - - - ------- ❑ Install sky lights) . r ------------------------------------------ ------- ------- ❑ Oft I n up all debris J - - Ly L or and materials guaranteed 100% for five years All shingle roofs are nailed by hand. We 19ropose hereby to furnish material and labor i— complete in accordance with above specifications, for the sum of: i ' "Total Price($ 171-500 ' 0 ) . *IF YOU ARE HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC, AS f WE HAVE NO CONTROL OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS.** All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specific, Authorized tions involving extra costs will be executed only upon written orders, and will become an Signature„ extra charge over and above the estimate. All agreements contingent upon strikes, - accidents or delays rs are our control. Owner m carry fire,tornado,and other necessary _ insurance.Our workers are fully covered by Work Yman's Compensation Insurance. - Lartne of propQ$M4—The above prices,specificatiolis. ns are satisfactory and are hereby accepted.You are authorized to Signatur —as specified.Payment�^y1I be/�ade as outlined above. ptance: ! I 0I S - Signature w copy to above address. - - - The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02 114-2 0 1 7 www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information � ) —��� l( Please Print Legibly Business/Organization Name: A),�PULTpro 11�.►QtT74-r.-1 �iR CONS Address: V r R/J Ali+ 5T City/State/Zip: L�NNIL' 171/4 OIA70`f Phone#:791-9'71-- 12II Are you an employer?Check the appropriate box: Business Type(required): 1. I am a employer with�� employees(full and/ 5. ❑Retail or part-time).* 6. ❑RestaurantBar/BatingEstablishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales line].real estate, auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] B. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]* 11 ❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, -'�, P fi l ��r with no employees. [No workers' comp.insurance req.] ❑12. Other *Any applicant that checks box NI must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#l. 1 am an employer that is providing workers'compensation insurancnef�or my employees. Below is the policy information. Insurance Company/Name: L01l/TrNCrrL1t- -\ C A V!�(_`r/ CO Insurer's Address: rlpt�O S��,9ryt o✓�1� 1:j 0-976 a1S� U64)0P-)1` sJ— City/State/Zip: 1/> f�✓(t—C /'t,' ! 1' pQl`��D�yy f /� Policy#or Self-ins.Lic.# �pS�r U 3 � V � / t/ ©_ tO Expiration Date: lY� 0 y 17 Attach 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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. I do hereby certif, under the pains and allies of perjury that the information provided above is true and correct. Q� � 0 r ` Signature: �] �G-t:-tp-LGtib�. � Date: I ! — )4j(0 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 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 employees. However,the owner of a dwelling house having not more than three apartments 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 shall 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 fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate 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 affidavit. 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 appropriate 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 the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). 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 filled 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 www.mass.gov/dia Fonn Revised 02-23-15 Massachusetts Department of Public aafefy E011F i � Board of Building Regulations and Standards License: CSSL-101220 Construction Supervisor Specialty t - W011AM RTRAHANT,JR 215 VERONA STREET •; • LYNN MA 01904 MZu CA, Expiration: 1 Commissioner 02110/2018 relo limiou va0d for individual use only Office of Consumer Affairs 81 Busiaeas Begulation before the expiration date. if found return to:HOME IMPROVEMENT CONMCTOR go�tiou office of Consumer Affairs and Business Re RegrstrationR��8945Type:- -- _ 10 Park Plaza-Sane 5170 Expiraho Corporation Boston,MA 02116 WILLIAMTRAHANYdNlug - / WILLIAM TRAHANTf� _�_ tY;. T 215 VERONA ST .,, � �' " ��, �— Not valid without signature LYNN,MA 01W4 - Undersecretary