15 SURREY RD - BUILDING INSPECTION The Commonwealth of Massachusetts
g° Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
r: = This Section For Official Us my c'=
Building Permit Number. Date App ed:RD
6.. 0/
Building Official(Print Name)-�+sl n*, ,`�.�;+i,',. s, _ Signature •Date
SECTION is SITE INFORMATION"
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
/T ,Su/l2�_C�gO
L I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: t
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) n
m
1.5 Building Setbacks(ft) :z
Front Yard Side Yards Rear Yard RL
O
Required Provided Required. Provided Required Provide4—
Ln
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: A -
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
s . 4,sM , q3 ;;SECTION 2: PROPERTY OWNERSHIP'4_=
�s —
2.1 Owner'of,[teco d:
Dull'e ( fi�mri✓1 S4,4fln , mcf_. D 670
Name(Print) City,State,ZIP n
J`i�-3y-37zy -3vcud ba "rl -e
No.and Street Telephone —� Email Addrefs
SECTION 3:DESCRIPTION OF PROPOSED WOW,,(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Descrip 'on of Proposed Work : M EX15EIII
Q n C a i
L tr
p CONSTRUCTION COSTSSECTION 4:ESTIMATEDa,
Item (Labsor and MaEtimated terials) 's �"` Official Use Only i:If , �
1 Building $ s 1 Building Permit Fee:$ Indicate how fee is determined:
❑Staudari) City/Town Application Fee,,,.F �"t"'
-- arx: - -s:. -2.Electrical $ h
❑Total_ Project Costs(Item 6)x multiplier x px = '� t°t
3. Plumbing $ 2 F Other Fees:'$
4.Mechanical (HVAC) $ Ltst - '''r•= _ �++�` +�•'`- ar'.
5.Mechanical (Fire s
Suppression) $ Total All Fees $
Check No'. ' Check Amount:: Cash Amount:` '
6.Total Project Cost: $ ❑Paid in Full ; '❑Outstanding Balance Due �•i= +`tl 's
A5 �NlP.
-- G(a L_L_ lD lye Iv ov ✓ ►o t c tit u�o
Sc� -V-D o �F(Ct� ✓ IC7I1'( Im (atl_�
' `SECTION 5:_CONSTRUCTION SERVICES RT
5.1 Const uction Supervisor License(CSL) 0—O
tuber x 2 -Za to/y
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
o.an Street—[, Type�` _ ''-Description
/ - n q .�✓�`I // a l z�� U Unrestricted(Buildings s u el 35,000 cu.ft.)
Ci Town,Stale,ZIP R Restricted 1&2 Family Dwelling
ty M Masonry
RC Roofing Covering
a q WS Window and Sidin
r U a� J SF Solid Fuel Burning Appliances
q7if-YYO-OaI cavils 1 Insulation
Telephone Email address D Demolition
L;-2 RRegistered Home Improvement Contractor(HIC), / 3,9•Z
0/6
�re �� �42 ut'''�✓ -� �— HIIC-,Reegistr tion Number Expiration Date
HIC Company Nam m
No.a Street mail address -
n'V47 MJ: 0P702-
Ci /Town,State,ZIP Telephone
. SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.L.c.152.§ 25C(6)) y
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 lac OWNER AUTHORIZATION TO BE COMPLETED WHEN + n
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .
I,as Owner of the subject property,hereby authorize_ RaeiyA /f L- C44/&-
to act on my behalf,in all matters relative to work authorized by this building permit application.
%)uli, C ft,vat _ /D'/o'/�l
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION i "•< i _
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.
Ail L. C/w(, A9-/o-/4
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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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 halfibaths
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"
CITY OF S.U.E.\l, iNLNSSACHUSETrs
BUMDNG DEPARTMENT
F 120 WASHNGTON STREET, 3" FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
lU�{BFRr FY DRISCOLL
MAYOR T Homts ST.PIERRs
DIRECTOR OF PUBLIC PROPERTYJBUILDLIG CO%MSSIONER
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:
5CjW;Le5 r7�-
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
signature of p rmit icant
date
dcbrivfl.diq:
PROPOSAL
Pagel oft
S®NTZ
Roofing Services,Inc.
0]6.Menm gwma.lym.Mq%B9 M0
Mu.70160}9]W F.78169 9909
September 16, 2014
Mrs. Julie Cadmore
15 Surrey Road Re: New Shingle Roof
Salem, MA 15 Surrey Rd
Salem, MA
Via Email: 1Vcudmore(ikmail.com
Max Sontz Roofing Services, Inc. is pleased to submit pricing for Roofing work at your
residence at above mentioned address. Please be advised that pricing is based upon full time,
continuous presence; no phased work has been considered. *Please see Exclusions,below.
SHINGLE ROOF INSTALLATION
1. Protect all walls, windows, shrubs, etc. with tarpaulins and plywood where necessary.
2. Install new ice and water barrier at all eaves, and around all roof penetrations.
3. Cover remaining exposed roof area with new 15# non-perforated, asphalt saturated felt
underlayment.
4. Install new 8"white aluminum drip edge flashing along outside perimeter areas.
5. Install new Certainteed LandMark "Architectural' Shingle; color TBD from mfg. standard
colors.
6. Flash all,roof penetrations: vent stacks,etc. to watertight condition.
7. Install Ridge vent at Main roof location only.
8. Clean all roof construction related debris from jobsite daily and complete walk-thru clean up
at completion of project.
9. All work is guaranteed by Max Sontz Roofing Services, Inc. for a period of (5) Five years
upon completion and Lifetime manufactures warranty.
PROPOSAL
Page 2 of 2
BASE PRICE: Shingle Roof
SIX THOUSAND FIVE HUNDRED DOLLARS........................................$6,500.00
*Due to the recent manufactures' raw material cost increases and market uncertainty, Max
Sontz Roofing Services, Inc. will hold pricing for a period of 30 days for acceptance.. We
have been advised that potential additional material cost increases.
*Please note:Materials and work listed below are not included in above base price.
• Fascia trim and soffit vent work
• Cutting or patching of roof decks
• Custom color
• Protection from damage by other trades
+ Overtime
• Temporary roofing,phase roofing, or patching.
• Winter conditions
Thank you for the opportunity of quoting. Should you require additional information please do
not hesitate to call me.
Very truly yours,
MAX SONTZ ROOFING SERVICES,INC.
Randy Craig
i II
'r h `
�• a ,.
CITY OF S�UEINI, ti'LLSSACHUSETTS
• BUILDING DEPARTSMrT
120 WASHINGTON STREET,3aa FLOOR
�D TEL(978)745-9595
FAX(978)740-9846
KI3iBERLEY DRISCOLL
MAYOR THOMAS ST.PmRRE
DIRECTOR OF PUBLIC PROPERTY/BUH.DL*IG COS06aSSIONER
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information G Please Print Legibly
Name(Busirn Organintion/Individuai):-"—X e-ejie/J�f 1 pio
Address: 6At� F—
City/State/Zip: Phone (1: 7 I'Sy3 430y
Are you an employer?Check the appropriate box:
Type of project(required):
1. 1 am a employer with /J� 4. ❑ I am a general contractor and 1 ,
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I 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 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions
myself.(No workers'comp. c. 157,§I(4),and we have no 12,5(Roof repairs
insurance required.)t employees.(No workers' ME]Other_
comp.insurance required_)
Any Applicant that checks box N I must also fill out the section below showing their workers'cotnpenamion policy infomatt".
1 lomeowners who submit this amdavh indicating they art doing all work and dwo hire outside contractor,most submit a new afrdavil indicating such
'Cuntractan that check this box must anachrd an additional sheet showing the name of the subs mracers and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below Is Nle policy and Job site
information. L
Insurance Company Name:j�5_ (r/��01541 9
Policy b or Self-ins.Lic.M (JJG MC f79 Expiration Date: q—30'/5 '
lob Site Address �J_ 7UQ y�i t6� City/State/Zip:
Anach 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 S 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$230.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of dte DIA for insurance coverage verification.
I det here y ce i y and t wins a d. nak ofperfury that the information provided above Is true and correct.
Date*..i>n t tr 6�C.tr—v— Ao —�f/ —/LJ
�,r�
Phone tt: '77CJr� 0" 3 ` MO R
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/l.feense N
Issuing Authority(circle erne):
1.Board of Ifealth 2.Building Department 3.Cityfrown Clerk 4.Electrical inspector S.Plumbing Inspector
6.Other
Contact Person: Phone k:
10/10/2014 FRI 8: 09 FAX 2004/006
The Commonwealth of Massachusetts
OF
„1r Board of Building Regulations and Standards CITY S M
Massachusetts State Building Code,780 CMR
Revisedd Mar Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
u� r ThtsSeet[onFprOfficialUseOnly
',. ButldmgPerrmtNuin6er .DateApphed: _ -
9mldtag Officral(Pnni Name) Stgnamre •t., are.
" ,,, � SECT-T6L*11 SITE INFORMATION - •,'._!
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
IS 5uL y� 0
I-Ia Is this an accepted street?yes no Map Number Parcel Number
1-3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) -
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zane? Municipal❑ On site disposal system ❑
Check if yes❑
p$ECTION2 PROPERTY0�4NER_ SHiPt - -
,,,. r
21 Owner of pd: QQ� �t
Name(Print) City,State,ZIP
rS��fi2Qev fZ.� �j78 37/-3Z�y �vc�d� bam�.i .ro
No.and Street Telephone �— Email Addre s
SECTION 3 DESCRIPTION OF eROPQSED WORKZ(check all t1laLaggly) P
i New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Altennion(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Descrip'on of Proposed Work: M 5 J, i�1
Lt7 n !
t�t'.0 4 tr AA2 W 2 2A AL, a RXA 1 f Itf u a A L 5
' _ ), .r;; SEG'I'�ION4 ES"L11MM?tT'ED:CONSTRUC7340NCOSTS'",
Item Estimated Costs:
Labor and Materials) 01Pte1a1 UsQ Oaly'"
I.Building $ 1 BuddtrgP4rtmiFee'$ tRdteatehowfeeasdetemutied
2.Electrical $ ❑Standard �tty/1'own Apphcatton;);:ee
❑Total Proje✓;t Cost(Item 8)x mulfiptter .� x "
3.Plumbing
4.Mechanical (HVAC) $ Ltst._ 3 = =
5.Mechanical (Fire
Suppression) $ Total All Fees $ - s
ChuckNo: Check Amount Cash Amount
G.Total Project Cost: Is ❑pard in Eull O-Qutsta?(dtng Balance Dte
I
10/10/2014 FRI 8: 08 FAX 0003/006
i CITY OF S�UYM, IN-WSACHUSETTS
BUTEDLNGDEPARn m\T
d 120 WASHtNGTON STREET, r FLOOR
TEL (978)745-9595
FAX(978) 740-9846
KI,jBERLEY DRISCOLL
MAYOR THONE"ST.PIERRH
DIRECTOR OF PUBLIC PROPERTY/BUII.DLNG CONMSSIONER
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 o€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:
Pe ublikc5 l ;tes tar ��55
(name of hauler)
i
The debris will be disposed of in
�hom�r�,,r� ®����.��s a%N��.sriic;es � ► �
(name of facility)
(address/of facility)
signature of rmit icant
date
! debriaulT_Joc
10/10/2014 FRI 8: 11 FAX 0006/006
PROPOSAL
Page 2 of 2
BASE PRICE: Shingle Roof
SIX THOUSAND FIVE HUNDRED DOLLARS........................................$6,500.00
*Due to the recent manufactures' raw material cost increases and market uncertainty, Max
Sontz Roofing Services, Inc. will hold pricing for a period of 30 days for acceptance.. We
have been advised that otential additional material cost increases.
*Please note: Materials and work listed below are not included in above base price.
• Fascia trim and soffit vent work
• Cutting or patching of roof decks
• Custom colors
• Protection from damage by other trades
• Overtime
• Temporary roofing, phase roofing, or patching.
• Winter conditions
Thank you for the opportunity of quoting. Should you require additional information please do
j not hesitate to call me.
Verytruly Y yours,
:
MAX SONTZ ROOFING SERVICES, INC.
Randy Craig
i
I
10/10/2014 FRI Bill FAX 2005/006
PROPOSAL
Page 1 of
Roofing Services,Inc.
82 S ndumon Av e,L} ,MA 01902-1900
PBane781503-93M Fax 70159}9399
September 16, 2014
Mrs. Julie Cudmore
15 Surrey Road Re: New Shingle Roof
Salem, MA 15 Surrey Rd
Salem, MA
Via Email: iyeudmore0,Email:com
Max Sontz Roofing Services, Inc. is pleased to submit pricing for Roofing work at your
residence at above mentioned address. Please be advised that pricing is based upon full time,
continuous presence; no phased work has been considered. *Please see Exclusions, below.
SHINGLE ROOF INSTALLATION
1. Protect all walls, windows, shrubs, etc. with tarpaulins and plywood where necessary. .
2. Install new ice and water barrier at all eaves, and around all roof penetrations.
3. Cover remaining exposed roof area with new 15# non-perforated, asphalt saturated felt
underlayment.
4. Install new 8" white aluminum drip edge flashing along outside perimeter areas.
5. Install new Certainteed LandMark "Architectural' Shingle; color TBD from mfg. standard
colors.
j 6. Flash all roof penetrations: vent stacks, etc. to watertight condition.
7. Install Ridge vent at Main roof location only.
8. Clean all roof construction related debris from jobsite daily and complete walk-thru clean up
at completion of project.
9. All work is guaranteed by Max Sontz Roofing Services, Inc. for a period of (5) Five years
i
upon completion and Lifetime manufactures warranty.
10/10/2014 FRI 8: 08 FAX 2002/006
CITY OF&1 ZIM, NLASSACHUSETTS
z ftuxl t;DEPART1tEN'T
' 120 W�4HINGTON STREET,30 FLOOR
TEL(978)745-9595
FAX(978)740-9946
KINIBER.i.EY DRISCOLL
T
MAYOR HObfAS ST.PIERRE
DIRECTOR OF PI:BLIC PROPERTY/KI2DING CObDBSSIONER
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lesihiv
T �1P/
Name(BuzitxsvOrganixatioMndividual): � (,n� f/J/ k6l. 1"10
_ Address O✓U p
City/State/Zip: Phone m 7d 1-673— 236a
.kre you an employer?Check the appropriate box: Type of project(required):
1.§tl am a employer with 4. 111 am a general commete r and 1
employees(full and/or part-time).* have hired the subcontractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling
ship and have no employees These subcontractors have 8. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9, CI Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its ME] repairs or additions
required.] officers have exercised their
j 3.❑ t am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
j myself.[No workers'comp. e.15Z,§1(4),and we have no 12. Roof repairs
insurance required.]t employees.[No workers' 11C]Other.
comp.insurance required.]
;Any applicant that ducks box nl must aim fill out the section below showing their ivorkcts rompensauan policy btrmmadues.
}I lameownas who submit this a tidavii Wincing they ire doing ellwork and this him outsidecontmcmn mmt submit.n oew amdavil iMicuing such
lContr•ton that check this box must anadud an addnioml sheet showing the name of the a bw au tsxxo and their workers'comp.policy infomution.
1 am en etupleyer that is providing workers'compensation insurance for my employees, Below Is thePolley and job stile
infornrufion. _ /
Insurance Company Name:n!fl (r-/�labee,
Policy B or Self-ins.Lie,#:_�.UG no�913��7._.9 Expiration Datc._ '.30'/� '
I /^/
Job Site Address:5_ `V U 9z City/Slate/Zip: 5/3LL�n I rswot
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 S 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 S250.00 a day against the violator. Be advised that a cupy Of this statement may be forwarded to[be Office of
investigations of the DIA for insurance coverage verification,
1 do there re ify and ( wins d pal' of perjury that the inforrrrarlou provided above Is true and correct
Sign ature \ q�p,r� Datc'
Phone#: 7U
Official use only. Do nor write In this urea,to be completed by city ur town official
City or Town: PermitiUcense#
Issuing Authority(circle one): -
i.Board of Ifeallh 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Persan: phone#:
'Massachusetts -Department of Public Safety ,
Board of Building Regulations and Stand;r s�
Construction Supen isor - ,q
License: CS-091313
RANDALL L.CRMG24
Wenham MA 014$4 e• <;
J . ,rw ' Expiraho
commissioner 1 2 2012 01, .
w
P