35 SUNSET RD - BUILDING INSPECTION The Commonwealth of Massachusetts R CE N
Board of Building Regulations and Standards & CES
Massachusetts State Building Code,780 CNIR IPdSPECTIOIIP.
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or DemoM a0C _2 A & 4 q
One-or Two-Family Dwelling
This Section For Official Use Only
iBuilding Permit Number: kDate Applied:
w -t� /o /
Building Official(Print Name) Signature Date
1 SECTION 1:SITE INFORMATION
J.1 Property Aj I p 1.2 Assessors Map&Parcel Numbers
SLth S� /�Ol, J(c/P_M� /"IQ.
_ L l a Is this an accepted street?yes—A/ 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?Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record-
- /A a. ^ /��o
�i-n rrlo,-� ,�rtcrt? (>
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ 1 Existing Building R( Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition aa'- Accessory Bldg.❑ Number of Units / I Other ❑ Specify:
Brief De cription ofp�rroposed Work : & r
Cd n� Lt�c.��/Cwci cl.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ 4 00 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 $
Suppression) Total All Fees: $
7�02� 00 Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ / ❑Paid in Full ❑Outstanding Balance Due:
(Yl P6 L-'E::Q I C)` g FA-(D.
K�� owe
SECTION 5: CONSTRUCTION SERVICES
5.11 C,onstructio(n Supervisor License(CSL) �70� /�
L� c r rrY 4 oLry-%a rr2. License Number p ion Date
Name of C older
p— List CSL Type(see below)
, I/Ow Aye,
/J Type Description
No.and Street
Q n VP( Mo. 0 r `To23 U Unrestricted(Buildings to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/rows,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
778-777—N980 1-19/QRY4/JA50,V0461-.00M I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ,//g 2g i/ 76 �Jd
q rre. HIC Re/giststrati'onn Number Expiration Date
19 ,,om� gqi Name o rC Registrant Name
/. VVr law /e AP,VAMIf Sdn)G)0OL , e6M
VStreet ' o. 0/9-3 X_7�'�Inb Email address
VPrS, / / /d
City/Town,State ZII' 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 a�4 r ry 14t fro rV-f
to act on my behalf,in all matters relative to work authorized b is building permit application.
('ra'rc/ep
Print Owner's Name ctronic 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 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/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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"may be substituted for"Total Project Cost'
i CITY OF Si�1L.E;li, 2 LkSSACHUSETTS
BUILDING DEP ART%MNT
• 120 WASHINGTON STREET, 3ro FLOOR
TE1- (978)745-9595
FAX(978) 740-9846
KIMBERLIBY DRISCOLL
MAYORTHOtitAS ST.PM1zRE
DIRECTOR OF PUBLIC PROPERTY/BUI DLNG CONDIISStONER
Workers'Compensation insurance Affidavit: Builders/Contractors/Electriefans/Plumben
Applicant Information Please Print Le¢ibly
Name(eusines&Organizwion/individtd): /-0 r-ty J--ct- 1 q rrP /v/OSD/t LdYI/YA �nr
Address: ' 11l t)w /Ma
l ?ye t
City/State/Zip: Don]�,4,,Ma- 01923 Phone#: 9ZP- 777--` C1d?G
Are you an employer'Check the appropriate box: Ty
pe of project(required):
110 1 am a employer with / 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the sttb-cmttractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t ❑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 10.❑Electrical us or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MOL I I.[]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.�Odiec/�Ct3ene l yeq�V
comp.insurance required.]
•Any applicant that chocks brat rl must also fill out the section below showing their worker/compensation policy infonmulea.
'I lattwawoas who submit this atRdavii indicating they ax"Sall work and then hire ouside commctaa must submit a new attidarit indicaing such
;Contactors that check this tax most anadW an additiatW si xt showing do name of am nrbcontrectars and their warkes'comp policy inimmmina.
l am as employer that b pravidbnq workers'compensadon Insurance far my employeex Below&the policy andfob s/te
information. A �vv�� y/
Insurance Company Name: / t > /,+ //� t / n Qe4 l
Policy#or Self-ins.Lie.#: lq we.�6Oy-7403 45VDZ71240/SAExpiration Date: 6—/- II20/44
Job Site Address:��;Un5d /�' �1Prnd /I
. City/State2ip: R. D/ 7p
70
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
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 fine
of up to$250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of
Investigations of the MA for insurance coverage verification.
l do hereby Ify #der the as and penaltles ofperfary that the information provided above is true and correct
Phone S�2 - Ll? O
Offleial use only. Do not wrote in this area,to be completed by city or town offrclaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Berard of Health 2.Building Department 3.Cilyffown Clerk 4.Electrical Inspector 5.Plumbing Impector
6.Other
Contact Person: Phone#•
Larry Lamarre Mason Contractor ( PROPOSAL ]
15 Willow Avenue -
Danvers, MA 01923
978-777-4980 Date Proposal#
MA. Lic # 090702 H!C Reg. # 149864
8/1/2015 508
Name I Address Job Name:
Front Landing and Walkway
Gordon Angel Job Location
3 Sunset Rd.
Salem,MA 01970 3 Sunset Rd.
Salem,MA 01970
Customer Phone: 978-825-9039
Description Job Cost
Install new front landing and walkway. 4,725.00
Work to consist of the following:
-Remove side railings and support column and set aside.
-Remove the existing front steps and walkway from job site.
-Clean off concrete base and construct landing using bricks for the three sides with limestone on the perimeter of the top
of landing with bricks in center of landing.
-Cut off iron support columns from side railings and clean off rust and prime and paint.
-Install iron columns to both sides or landing.
-Excavate soil from walkway area and remove from job site.
-Install stone pack to walkway area and compact.
-Install Pine Hall English Bevel pavers,set in course sand,to walkway.
-Install polymeric sand to joints between pavers.
The front landing will be 6 wide and 42"deep.
The front walkway will be about 32"wide and about 16'long and will flare out to meet the outside of front landing.
The quoted price does not include any carpentry work that may be needed to repair any rot that may be found on the
house sheathing,sill or framing.
The quoted price assumes that there is a usable concrete base beneath the existing front steps.If there is not a usable
concrete base beneath the steps,then there will be an additional charge of$1200.00 to excavate,form and pour a new
concrete base making the total price$5925.00.
Additional information pertaining to this proposal Total Job Cost for Proposal $4,725.00
The quoted price includes materials and labor.
This proposal may be withdrawn if not accepted within 30 days. Authorized Larry Lamarre
Signature
CONDITIONS FOR PROPOSAL Acceptance of Proposal
1/3 down payment when work begins. Sign and return 1 copy upon acceptance
Remainder due upon completion ofjob. Q n
Signature \.4 �',/� Date l%
—lei r S
r�nG Ries ,c/e,,,7c p
F
t
i
{
i
Ma�nn� dd�'�
a ; Lv PJ"A
if
1F
f
`4
I
r, �� y ri
3 t
{
i
} t
j ,