57 SUMMIT ST - BUILDING INSPECTION •i� The Coin mom weal th of Massachusetts
�. Board of Building Regulations and Standards CfTY OF
Massachusetts State Building Code, 730 CMR SALE
ar
Revisedd Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivv-Family Divelling
This Section For Official Use Only `
Building Permit Number:, Da ApphedS,
1
,I00 Building Official(Print Namt) signature -Date
/UI .00
SECTION 1:SITE7NFORNIATIO
11 Property Address: L2 Assessors Map& Parcel Numbers
57 St,, + v sPLVM
1.la Is this an accepted street?yeses+ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(it)
1.5 Building Setbacks(it)
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 yesCl
S1 CTION2:; PI20PERTY'OWNERSHIPL '
2.1 9pwnert of Record:
, 7rxg j am#u,* Fit1.Tz 5ACZ-M A20 OH70
Name(Print) City,State,ZIP
6-7 Sums✓-] Sr `i7P-g28-n73
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED.WOR.W(check ail that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ar I Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': Roote.n 4% n, .6 >^ x tu,"k, AN wdlc
10*+h t4.4d.M W MLLt ag m (�A4e taflY OAM 844W m / eaffj
It V . e e mt
eaul-
SECTION 4: ESTINUTED CONSTRUCTION COSTS
Item' Estimated Costs: Offteial Use Only
Labor and Niaterials
1. Building S C I. Building Permit Fee:S Indicate how fee is determined:
CI Standard.City/Town Application Fee
-. 61cetricol $ ao. de ❑'rotal-Pro'ectcost3(Item 6)x multiplier x
3. Plumbing i 6"00,nd 2. OtherFees: .S
1, ,Me-chanic.tl (I IVAQ S List:
i. Mech.uie (Piro
Suppres3l,ffl; -
_-- $ Total :\ll Fees:.S_
Check No. _--Check Amount: (:ash Amount
I'nCtl I'rnjcet ('osC ) /7 2otS,db --r, / I ❑ Paid in Pill El outst.tndim" ll.d.tnce Umo:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) qS_ g13a (}'1• 14
Gep LO VAN tl License Number E.cpiratiun Date
Nnme uFCSL I ladder List CSL Type(see beluw)
2 3 Type Description
No. and Street
U l�Z 3 Unrestricted Ouildin s u to J iA00 w. lt. -
LyiV , R Restricted 1&2Famil D%Mlitut
L
city/rown, State, ZIP Masonr
RC Ruotin Coverin
\VS Window and Siding
_ SF Solid Fuel Burning Appliances
�81-760 -2�3o WHtt&YI�II ���' CoIA t Insulation
l'ele hone Email address D Demolition
5.2 Registered Hume Improvement Contractor(111C) ' 9,c�,(—1 1
GcQAiD W N It ;Z HIC Registration Number Expiration Dale
111 Ccmpany Name or HIC Registrant Name
1� 3 Cat"4 Alt i)al /— WHtI E t'61l AOL. Cnr1 ,
NA,and Street o 1�2 -160 -2030 Email address
t�-�JEQS �A 3 `i$I
City/Town, State, ZIP Tele hone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. 1 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...........
13
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 G� ✓`o\\ k
to act on my behalf, in all to lative rk authorized by this building permit application.
D �' Date
Print Owner's Name(Electron c Signature
SECTION 7h: OWNER' OR AUTIIORIZED 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.
LIED YVNI1E 15, A - ).3
Print Owner'>or Autlwrized:\;ent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an Owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor(HIC) Program), will mre have access to the arbitration
program or guaranty fund under 1M.G.L, c. 142A. Other important information on the HIC Program can be found at
www m;tss.,�uv:S c,3Information on the Construction Supervisor License can be round at www.mas;.!v,,�dL
? When substantial work is planned,provide the information below:
rot:d flour area(sy. 11.) ___ _(including garage, finished hasement/otlics, decks or porch)
iron; living;trca Habitable room Como —
Number Of hetlrOMM
VunhcrotImthromn;
I'cpe of ha.uing;y;tem I iinnbcr of deek,,' porCltCs --—_—
N _
tcluscd _ t tpcn
1. -1 of.il P(-1J, :t �,iu vC I wl.t,e" Impy he ;ub;tind:d r;,, d.il I'rnjcd l_o,t" - - -
47F — 7H0- tlty6
,- Ct-n' of SALEM) Aks&kCHUSETTs
BUILDING DEP.1IM ENT
.� ),• 120 WASHNGTON STREET, 3'u ROOK '
Z3sea - TFL (978) 745-9595
M.%iD RLF_Y DRISCOLL THo,%EASST.PIF_xM
{AyOR D IRECTO R OF PUBLIC PROPERTY/BUILDING CON MISSION ER
Workers' Cumpensation Insurance Afiidavit: Builders/Contracturx/Electricians/Plumbers
Annllcant information �t Please Print LegbtY
Name(OusinessOryanizatiom Individual): VInes RiA £ Ca6 ,a4ta,r. aid_
Address: fl b,n11>;...rk, �n e
City/Sratcalp: MejIgoelfacE fA4 MOPhana
Flain
employer?Check the appropriate box: Type of project(required):
employer with_� 4. 0 1 am a general contractor and 1 6. ❑New construction
ees(full and/or part-time).• have hired the stab-contractors
sole proprietor tar partner- listed on the attached sheet t 7. ❑Remodeling
d have no employees These subcontractors have S. 0 Demolition
g for me In any capacity. workers'camp.Insurance. 9, 0 Building addition
rkers'comp.insumnea 5. 0 We are a corporation and ibrequrd.) officers have exercised thdb l0.❑Electrical repairs or additions
J.❑ 1 ant a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. (Now workers'comp. c. 152,§1(4),and we have no I2.0 Raof repairs
insurance required.] r emplayea.LNo workers'
comp.insurance required.] 15.0 Other
•Any uppllcanl dW chce4t hex tt mwt also tilt uuf IN uctioo balow,howine thdir"Ilan'mmptnaadun pulley inlitrmutlun.
'I hvnvuwwnrr who submit this affidavit indlealne they aodoina all work and thon biro wisidecontncten mum submit a new onldavit indlalna such.
:C,wmaon that chalk this box must anachod an addidonal,howl showintt the nano of the mbsontracfon and thdk wurkmn sump.policy Infamudon.
!um tan eutployei that is providing workers'camprureden luxurunn jar my empluyerx Below If the policy and fob site
injartnalfan.
Insurance Company Name: Tn..slerc M.,nwC
Policy 4 or Sclf•ins. Lie 0: TEQA-• StS%x'/l—A—Pt Expiration Date: I latt ZD tat
)tab Site Address: 5-7 S .,..:! sf- City/State/Zip: SDI«, t1M4- OIS7a
.\Itach a copy of the workers'compensation poliey declaration page(showing the policy number and expiration data}
Failure to secure coverage as required under Section 25A of vfGL e. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in this farm of a STOP WORK ORDER and a line
of up to 5250.00 a day against rile violator. Ile advised that a copy of this.rtawment maybe forwarded to the Oflicet of
Investigations of the DIA for iosurance coverage verificafium
/du hdreby certfjy nude p od prrtalddx ujpddury drat the htjunnallon provided above is true surd correct
' ,. t Ilam• '�s,�arss
r r, ,i• 5 tY—TTro-4rrir
D/jfcial rue unly. Do not write in r/ds urea,to be completed by city ue town n/flelu! !
I
Citynr'I'uwn: Permit/I.Icense,9
Issut]tg Aulhuriiy (circlo one): — -_-- _
1. Ouard of Ilealih L Building, mpartmenl .1.City/rown Clerk I. Eleetrial Inspevtur 5. Plumbing Inspector
6.Oltier ._.
Contact i'anntt: .__ ... 1'hnna 7:
CITY OF S,ULE 2 1NL1SS.ICHUSETCS
y"y 4 BUILD=DFP.%1T'.% NT
120�.� WASHLNGTON STttEET 3 *r FLOOR
TEL (978) 745-9595
:clJ10E2LEY DRISCOII F.L�c(J78) 710-9345
NU MIL I�to+I,�3ST.PtExItB
DIRECTOR OF PLBLIC PROPERTY/Bt;M=NG COSQIISSIONE:Z
Construction Debris Disposal AftIdavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Coda, 730 CMR section I l 1.5
Debris, and the provisions of bIGL c 40, S 54;
Building Permit k 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
l 11, S I50A.
The debris will be transported by:
�vwnsltrc Q x
(name urhaulcr)
The debris will be disposed of in
(name or racility)
too-a � ,�A
(address or aadity)
signarure ufpermit applicant
z�
'I
s ,
Woodridge Contracting
Woodridge Contracting
17 Goldsmith rd Estimate
Newburyport,MA 01950 1 bate I Estimate#
(978)590-4567 02/11/2013 1 1141
woodridgecontracting@yahoo.com Cm. Date
Address
Donna Fritz -
57 Summit st.
Salem,MA 01970
Activity Quantity I Rate Amount
•Demolition 1 0.00 0. 00
-Remove and dispose of all faux brick and paneling in kitchen
-Remove and support wall between den and kitchen. We will have to support wall
with false wall till we support with beam - -
-Remove Sliding door between kitchen and den
-Remove All wood in den area. This includes walls,ceilings,and all window and
door trim.
- Remove old Counter tops
-Remove Cabinet right of the window
-This includes all disposal of material by contractor
•Framing 1 0.00 0.00
-Install double LVL beam in order to span and support new opening in kitchen
-Install two new down post to support beam
-Install post in basement for extra support if necessary or required by inspector.
-Frame in two new closets on each side of window in den. Closet will be framed
and have one solid wood door per closet installed.
-frame bench seating area between the two closets. This area will be finished to a
paint grade finish. _
•Plumbing 1 0.00 0.00
-Install new sink and faucet after counter tops are installed.
-Move baseboard heat if necessary.
-Does not include install of garbage disposal -
- Sink and fixtures not included.
Continue to the next page
r
Page(0)of{I}
Activity Quantity Rate Amount
Electrical 1 0.00 0.00
-Install six new recessed cans in den area.
-Bring den area up to date to meet mass.code.
-Add plugs to counter area in den area.
- Install two new pendant lights over new bar top counter
- Install new light fixture in kitchen.
-Customers to provide all fixtures.
-Estimate does not include any unforeseen conditions which might include
conditions that do not meet Mass,code.
-This does not include cost of fixtures other than the recessed lights _
•Plaster 1 0.00 0.00
-Den area.
-Walls,new closets,and ceilings. All surfaces will receive new blueboard and a
smooth plaster finish.
-Kitchen
-All walls will receive new blueboard and smooth plaster finish.
-Ceiling will not be plastered.
- New beam will receive plaster and ceiling around will be patched to match existing
ceiling
•Finish carpentry 1 0.00 0.00
- Install two new doors in closets.
-Install new bench seat with two sets of double doors.
-Install new baseboard in den and kitchen area
-Install new window trim around windows and doors in both the kitchen and den
-Install new threshold between kitchen and den.
•Painting 1 0.00 0.00
-Prime all new plaster
-Paint ceilings. In kitchen I would recommend one fall coat of prime on ceilings and
then two coats of ceiling white Benjamin Moore.
-One coat of high gloss white paint on all trim
-Two coats of paint on walls.Eggshell Benjamin Moore.
•Total 1 17,200.00 17,200.00
Total $17,200.00.
�ed By A cepted Date
y�a-7f 13
1
Woodridge Contracting
Woodridge Contracting
17 Goldsmith rd Estimate
Newburyport,MA 01950 Date Estimate#
(978)590-4567 02/11/2013 1141
woodridgecontracting@yahoo.com Ex-pT Date
Address
Donna Fritz
57 Summit st.
Salem,MA 01970
Activity Quantity T Rate Amount
Demolition 1 0.00 0.00
-Remove and dispose of all faux brick and paneling in kitchen
-Remove and support wall between den and kitchen. We will have to support wall
with false wall till we support with beam
-Remove Sliding door between kitchen and den
-Remove All wood in den area. This includes walls,ceilings,and all window and
door trim.
- Remove old Counter tops
-Remove Cabinet right of the window
-This includes all disposal of material by contractor
•Framing 1 0.00 0.00
-Install double LVL beam in order to span and support new opening in kitchen
-Install two new down post to support beam
-Install post in basement for extra support if necessary or required by inspector.
-Frame in two new closets on each side of window in den. Closet will be framed
and have one solid wood door per closet installed.
-frame bench seating area between the two closets. This area will be finished to a
paint grade finish.
•Plumbing 1 0.00 0.00
-Install new sink and faucet after counter tops are installed.
-Move baseboard heat if necessary.
-Does not include install of garbage disposal -
-Sink and fixtures not included.
Continue to the next page
i
Page to)of f I I
Activity Quantity Rate Amount
•Electrical 1 0.00 0.00
-Install six new recessed cans in den area.
-Bring den area up to date to meet mass.code.
-Add plugs to counter area in den area.
-Install two new pendant lights over new bar top counter
-Install new light fixture in kitchen.
-Customers to provide all fixtures.
- Estimate does not include any unforeseen conditions which might include
conditions that do not meet Mass,code. -
-This does not include cost of fixtures other than the recessed lights
•Plaster - 1 0.00 0.00
-Den area.
-Walls,new closets,and ceilings. All surfaces will receive new blueboard and a
smooth plaster finish.
-Kitchen
-All walls will receive new blueboard and smooth plaster finish.
-Ceiling will not be plastered.
-New beam will receive plaster and ceiling around will be patched to match existing
ceiling
•Finish carpentry 1 0.00 0.00
- Install two new doors in closets.
-Install new bench seat with two sets of double doors.
-Install new baseboard in den and kitchen area
-Install new window trim around windows and doors in both the kitchen and den
-Install new threshold between kitchen and den.
•Painting 1 0.00 0.00
-Prime all new plaster
-Paint ceilings. In kitchen I would recommend one full coat of prime on ceilings and
then two coats of ceiling white Benjamin Moore.
-One coat of high gloss white paint on all trim
-Two coats of paint on walls.Eggshell Benjamin Moore.
•Total 1 17,200.00 17,200.00
Total $17,200.00
Ace epte� Acc Pied Date
,w gcg�zo
�y
Woodridge Contracting
Woodridge Contracting
17 Goldsmith rd Estimate
Newburyport,MA 01950 L Date Estimate#
(978)590-4567 02/11/2013 1141
woodridgecontracting@yahoo.com Exp..Date
Address
Donna Fritz
57 Summit st.
Salem,MA 01970
Activity Quantity Rate Amount
•Demolition 1 0.00 0.00
-Remove and dispose of all faux brick and paneling in kitchen
-Remove and support wall between den and kitchen. We will have to support wall
with false wall till we support with beam
-Remove Sliding door between kitchen and den
-Remove All wood in den area. This includes walls,ceilings,and all window and
door trim.
- Remove old Counter tops
-Remove Cabinet right of the window
-This includes all disposal of material by contractor
•Framing 1 0.00 0.00
- Install double LVL beam in order to span and support new opening in kitchen
- Install two new down post to support beam
-Install post in basement for extra support if necessary or required by inspector.
-Frame in two new closets on each side of window in den. Closet will be framed
and have one solid wood door per closet installed.
-frame bench seating area between the two closets. This area will be finished to a
paint grade finish.
•Plumbing - 1 0.00 0.00
-Install new sink and faucet after counter tops are installed.
-Move baseboard heat if necessary.
-Does not include install of garbage disposal
--Sink and fixtures not included.
Continue to the next page
A_.
Page (0)of{l}
Activity Quantity _____R_a_te____7 Amount
Electrical 1 0.00 0.00
-Install six new recessed cans in den area.
-Bring den area up to date to meet mass. code.
-Add plugs to counter area in den area.
-Install two new pendant lights over new bar top counter
-Install new light fixture in kitchen.
-Customers to provide all fixtures.
- Estimate does not include any unforeseen conditions which might include
conditions that do not meet Mass,code.
-This does not include cost of fixtures other than the recessed lights
•Plaster 1 0.00 0.00
-Den area.
-Walls,new closets,and ceilings. All surfaces will receive new blueboard and a
smooth plaster finish.
-Kitchen
-All walls will receive new blueboard and.smooth plaster finish.
-Ceiling will not be plastered.
-New beam will receive plaster and ceiling around will be patched to match existing
ceiling
•Finish carpentry 1 0.00 0.00
-Install two new doors in closets.
-Install new bench seat with two sets of double doors.
-Install new baseboard in den and kitchen area
-Install new window trim around windows and doors in both the kitchen and den
-Install new threshold between kitchen and den.
•Painting 1 0.00 0.00
-Prime all new plaster
-Paint ceilings. In kitchen i would recommend one full coat of prime on ceilings and
then two coats of ceiling white Benjamin Moore.
-One coat of high gloss white paint on all trim
-Two coats of paint on walls. Eggshell Benjamin Moore.
•Total 1 17,200.00 17,200.00
Total) $17,200.00
Accepted By Accepted Date
a Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-073991
r. is
GERALD WHITE=`
23 GLEIVDALE DR M Y. L
DAIYVERS A 61923UIQI
92 _,p, a ,��!"`" _ ,•_ Expiration
Commissioner - 04L07/2014
61reoY onsumerA
-HQM�'f�.MPROV EM �»
•�egis'�a9on�1291' � z ' Individual x m�{
r F Expiration 7L1912013*a < ti: A;
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GeadWhite
9L
a � � Y Geraalssd White
23 G'lendale Dr �= —
Danvers,MA 01923<<^-, „ Undersecretary
1 � 9 � 77