85 SUMMER ST - BUILDING INSPECTION (2) 3S GK S-7ss
The Commonwealth of Massach ^s .'•,
nRegulations' c �ALSEPVI `. CITY OF
Board of Building a'id s SALEM
Massachusetts State Building Code,, 780 CMI�R 29 Revised Mar 2011
Building Permit Application To Construct, Repah'�eliovafe Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Appli .
5-p
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
Property Address: 4 1.2 Assessors Map &Parcel Numbers
ZS-'5 SLAm m e t' k,
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
I— 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' f Recorr7l c +^n
W\ r. F�tAIQ� aloyri Yt IQS �
Name(Print) City,State,ZIP
$ SzF-21UQ # XQ -
No.and Street Telephone J J Elmul Address J CDM
SECTION 3: DESCRIPTION OF PROPOSED WORIO(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other N Specify: /tee
Brief Description of Proposed Work2:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ O 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ 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 $
76Totalssion Total All Fees: $
Check No. Check Amount: Cash Amount:
Project Cost: $ ❑Paid in Full ❑ Outstanding Balance Due:
2S1 --P-rtjpoo t /O[ g23
Chat,t-45p vo 6X 5 �2S
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
• �N . �-p r �'� ��� Licens 1e Number Ex ratio Date
Name of CSL Holder n r
�$` -^ n C��\)P—r S� List CSL Type(see below)
No.and Street Type Description
I f U Unrestricted[ricted(Buildings up to 35,000 cu.ft.MOSSG)kof_ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP' M Masonry
RC Roofing Covering
WS Window and Siding
Qr` SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ).i%LOCtt
��Sli QG2 k9 �C. HIC Registration Number E p r ion Date
HIC Come y Name or HIC ReP�strant Name J
�$ 1 If•'1'nr��✓Qt �l inuirl-hskor f t
No.and Street Email add ess
-ci'1SB 9 77- 3F I Q rt tOV� . r
t /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 ..........x 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name Electronic Signature) Date
SECTION 7b:OWNER'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 Authori ed 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.gov/oca Information on the Construction Supervisor License can be found at Www.mass. oe v/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basementiattics, 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"
i CITY OF S.-�I.&NI, INLASSACHUSETTS
B11LDLIIG DEP.,mN LNT
' 130 WASI-INGTOri STREET, 3�FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KINIB RI FY DRISCOLL
THOMAS ST.PIERR6
MAYOR
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONWISSIO;•iER
Construction Debris Disposal 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 c 40, 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 disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
G .w\"kc)
(name of facility)
n
ddress of facility)
signature of permit applicant
11LO
date
dcbrisatT.duc
CITY OF SALENI, \rL'�S&ACHL'SETTS
a
BUUMING DEPART%MNT
120 WASHINGTON STREET,San FLOOR
TEL (978) 745-9595
FAX(978)740-9846
1CIMBULEY DRISCOLL
MAYOR TTlo&w ST.PtERRB
DIRECTOR OF PI;BLIC PROPERTY/11CUMING,COMdBSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbera
Applicant Information Please Print Le ibl
Name(BusimmwOrranizatioNlndividual): -- 2 inY 1
Address: �Ia k �p C� i) \,Is r St
City/State/Zi Q f c 0192! Phone#: cl 7 Tr Q 7 73 3711 ,
I
Are you an employer?Cheek the appropriate box: Type of project(required):
I. 1 am a employer with 1 4. ❑ 1 am a general contractor and 1 employees(full and/or pan-time).
• have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet: 7• ❑Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9. ❑ Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI 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. insurance required.]
Any applicant that checks boa BI must also fill out the section below slowing their workers'compensation policy infomaahm,.
*I Inmewmen who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new,affidavit indicating such
:Cunuactom that cheek this box anus[attached an additional sleet showing the nano of the sub-Contractors and their wotkem•comp.policy information.
t am an employer that is providing workers'compensation Insurance for my employees. Below Is the polloy and Job site
information.
Insurance Company Name: a j--2 JzCJ
Policy#or Self-ins.Lic.M C f — 5 to ] 2. Expiration Date:
Job Site Address: Su m yl[` t' !S�. City/State/Zip: vv,- �Mas� I
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 wall as civil penalties in the form of STOP WORK ORDER and a fine
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.
too hereby cent under the pains and penalties of perjury that the information provided above Is true and correct
t ere• Dote: 1
Pc
OJfcfal use only. Donor write in this area,to be completed by city or low"offeciaL
City or Town: Permit/l.lcense#
Issuing Authority(circle one):
1. Board of Ileallh 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:— Phone#•
NORTH SHORE ROOFING
281 Andover St. Danvers, MA 01923
(978)977-3816 Fax: (978)762-4667
Mr. Greg Koulas 04/13/16
1 A. Baldwin St.
Peabody, MA.
Ref: 85 Summer St. Salem
The following is a proposal .
1) Remove the two existing skylights located on the rear portion of the roof and legally dispose of the
debris.
2) Block the openings with'/< in. roof decking .
3) Install either % in. or 1 in. insulation over the new roof decking which will be mechanically
fastened.
4) Install EPDM rubber membrane .060 60 ml. which will be fully adhered over the new insulation .
5) Supply and install two bathroom vents , wooden curbs will be built for the vents and the curbs will
be flashed with uncured membrane .
6) Remove the existing lead flashing that was damaged by squirrels from the bases of the chimneys ,
grind out new joints and install new lead flashing where needed .
7)Front of roof only . Remove the existing asphalt roof shingles down to the bare roof decking .
8)Replace any deteriorated and/or damaged roof decking if and where needed .
9) Install 6 ft. of ice and water barrier along the perimeter of the roof.
10) Remaining exposed roof decking will be covered with Rhino roofing underlayment .
11) Install 8 in. aluminum drip edge flashing along the perimeter of the roof.
12)Install new asphalt roof shingles , color and style to match the existing asphalt roof shingles.
13)Re-secure the existing gutters by tightening the existing hangers as well as adding additional
hangers where needed .
14)All roof related debris will be legally disposed of by North Shore Roofing.
15)Quote includes a permit .
TOTAL PRICE: $5,300.00
-5%ANGIE'S LIST DISCOUNT: $265.00
NEW TOTAL PRICE: $5,035.00
PAYMENT TERMS
PAYMENT DUE UPON COMPLETION: $5,035.00
Acceptance of Proposal - By signing this proposal you have accepted all of the terms as stated above .
Date of Acceptance !—� /T, 2 8!fP Home owner -
N.S.R.
Peter ller
*Member of the Better Business Bureau*
*Voted "Best of Boston-North 2010 " by Boston Home Magazine*
*North Shore Roofing carries liability insurance as well as worlanen compensation*
*Mass. Construction Supervisor License#99622* *Mass. Reg. #128691
License or registration valid for individul use only
before the expiration date. If found return to:Office of Consumer Affairs and Business Regulation Office of Consumer Affairs& Business Regulation
Office
IMPROVEMENT CONTRACTOR
10 Park Plaza-Suite 5170 Registration ``128691 Type:
Boston,MA 02116 Expiration: 5/5/2017 DBA
NORTH SHORE ROQFING i
i
y z
a q PETERMILLER7.
281 ANDOVER ST
Not va rd without signaTure DANVERS, MA 01923 - _—
Undersecretary
Massachusetts Department of Public Safety
.� Board of Building Regulations and Standards
" License: CSSL-099622
Construction Supervisor Specialty
PETER MILLER
ANDO
STREE
r 291 VERS M,A 0923
DANVERS MA 01923 "iy
Expiration:
Commissioner 09/06/2017
� 1