55 TREMONT ST - BUILDING INSPECTION (3) v ,
ootg
a� the Commonwealth of Massachusetts --- -
IBoard of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised.I Gs 201tA
Building Permit Application To Construct, Repair, Renovate Or Deniolish a
One-or Twu-Funnily Duelling
is Seen n For Official Use lily
Building Permit Number: e Ap ed.
7 IoZ j
Building 0111cial(Print Name) Signature . Date
ION l: SITE INFORMATION
I Property Address: 1.2 Assessors Map& Parcel Numbers
} I.I a 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 I) Frontage(II)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.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 ycs13
SECTION 2: PROPERTY OWNERSHIP'
s Owners of Record:
N:une(Print) City,Slate,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
�Ct5
SECTION a: ESTIMATED CONSTRUCTION COSTS
licit Estimated Costs: Official Use Only
Labor and Materials)
I. Building S 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
i. Plumbing S 2. Other Fees: S
q. ,Mechanical (HVAC) S List:
S. ,\lachani cal (Fire S —
Su ,ression) 'rota) All Fees: S
G. Total Project Cost: S Check No, Check Amount: - —Cash -----
l w�•(w ❑Paid in Full 0 Outstanding Bakince Due:
I
SECTION 5: CONSTRUCTION SERVICES III
5.1 Construction Supervisor License(CSL) I'I
License Number --- F.cpiraaion Date
Nance ol'C'SI- I lulder
List CSL Type(see hclo%)
No. and Street Type 1 1 scriplion
U Ihvcs(ricted s D' o 000 cu. 11.)
Cigfuan,State, R IicstricIc &?Fadn 0
1
J5
M Nlasovy
RC Royring Covering
W'S I Windo%vand Siding
SF Solid Fuel Burning Appliances
I Insulation
'felt hone limail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
t
IIIC'Rcgistr;nion Nunnbcr Expiration Date
IIIC'Company Name or IIIC It strant Name
No. and Street r57Email address III
City/Town,St ,ZIP Telephone ICI
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...........❑
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 matte elative to work authorized by this building permit application.
X
Print vner's ane(Electronic Signature) D.to
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 Ottner's or Authorized Agent's Name(Flecoonic Signature) - Date i
NOTES:
I. An Owner who obtains a building permit to do hisiher 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%I.G.L.c. MIA.Other important information on the HIC Program can be found at
uca Information on the Construction Supervisor License can be found at"�k,w.nc,.s!yob dp,
2. When substantial work is planned, provide the information below;
Total floor area(sq. It.) (including garage, finished basement'attics, decks or porch)
Gross living area(sq. 11.) Habitable room count
Number of fireplaces_.----- Number of bedrooms ---------------
Number ofbathrooms _ _ Number of half baths
Number of decks porches -
1)pe0fc00lingsysteol______._._—__-._____.-_ inclosed --- Open
i "focal Project Square Footage'ntay be substituted for Total Project Cost"
CITY OF S.UF.NvI
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXE.MMON
Plesse"I
Job Location
Ham OwnsAddress S5—,-,',2�WJW7- sT
Hams Owner Telephone 7S- yr 3 9 x-s
Preset Mailing Address rs 1-z9r5W7-s ;-
no cumms exemption of"Homeowme was extended to include ownw-occupied
dwellings of two Units or leas and to allow such homeowners to engage an individual for
hire who.does not possess a license.provided that the owner acts as overview.
DEFINITION OF HOMEOWNHIt
Persons) who owns a parcel of land on which he/she reddest or intends to resider on
which then is, or is intended to bs,a one or two family dweWng,attached or detached
structures accessory to such use and/or farm structures. A person who constructs more
thm one home in a two year period shag not be considered a homeowner. Such
"twmeowner"shall submit to the Building Official,on a form acceptable to the Building
official, that he/she be responsible for all such work performed under the Building
Permit
The undersigned"homeowner'assumes responsibility for compliance with the State
Building Code and other applicable bylaws and regulations.
The undersigned "homeowner"certifies that he/she understands the City of Salem
Building Oeparanent minimum inspection procedures and requirements and that he/she
Mill comply with said procedures and requirements.
HOMEOWNERS SIGNAMM
APPROVAL OF SUILDNG CISPECTOR G�sw
See other side for state code
AMERICAN HOME 1WROVEMENT
105 ATLANTIC AVENUE
SALISBURY,MA. 01952
Phone(978)465-2283
E Mail roadking-103@comcast.net
June 23,2011
Marc Bouchard
55 Tremont St
Salem,Ma.01970
JOB PROPOSAL
We are pleased to quote the work you requested to be performed at your home as described below:
Provide materials and labor to frame,roof and side an Entry addition area according to owners plan and
attached,specifications_.._ _.... ._. . .__
Note:There is no concrete/cement block work,plumbing,electrical,wall finishing,insulation,interior
carpentry work(Stairs to be left with rough treads)or finish floors included in this contract
Customer will acquire building permit.American Home Improvement is not responsible for extra work
ordered by any Municipal or State official.
Extra work if any can be done by a written and signed change order or @cost plus 20%on materials.Labor
as follows:Carpenter @$30.00/Hr.,Master Builder/Carpenter @$55.00/Hr..Painting priced if needed.
All debris created by above work shall be removed from site and disposed of properly.
Above work to be performed in a professional workman-like manner.Contractor to furnish and
install the above complete in accordance with the attached specifications.
For the sum of$9,467.00
NINE THOUSAND FOUR HUNDRED SIXTY SEVEN DOLLARS
PAYMENT TERMS:
Deposit due upon acceptance of proposal$3,200.00
When Framing complete$4,000.00
When addition roofing complete$2,000.00
When work complete$267.00
(Aifthorima Signature D %
C omer's Signature ate
AMERICAN HOME IMPROVEMENT
105 ATLANTIC AVENUE
SALISBURY, MA. 01952
Phone(978)465-2283
Email roadking-103@comcast.net
June 23,2011
Marc Bouchard
55 Tremont St
Salem,Ma.01970
SPECIFICATIONS
These specifications are intended to supplement the plans and together with the plans,
are to be used-for-performing-the-work,-Where there is-a-discrepancy-between the plans and the - -
specifications,the specifications shall supersede.
DEMOLITION
Remove siding,roofing and trim as needed,existing exterior door,kitchen and closet walls as discussed and
existing cellar stairs.
FRAMING
Floor 2x8 joists(including filling in existing cellar stair well)with'/4"t&g plywood sheathing.
2x4 walls with'/:"cdx plywood sheathing.
2x6 rafters and ceiling joists with Yz"cdx plywood roof sheathing.
ROOFING
I.K.O."Cambridge"30 year asphalt Architectural shingles.
I.K.O Ice and water"Armorguard"on first 3'-0"at roof eave.
White aluminum drip edge on eaves and rakes.
Ridge vent
9�6ia EXTERIOR MILLWORK
Two"Jeld-wen" 1W'x 6'-8"fiberglass doors.
Two White"Silver Line"Energy Star rated,LowE,Argon filled(made by Andersen)octagonal vinyl
windows with grills between the glass.
One White"Silver Line"Energy Star rated;LowE,Argon filled double hung viiiy?"window with grills
between the glass.
HARDWARE
Two"Schlage"style"Plymouth"brass deadbolts and locksets.
SIDING
White wood gram textured double 4"vinyl.
TRIM
Fascia:White aluminum coil stock provided by customer.
Soffit: Perforated(ventilating)vinyl.
CITY OF S.UE.M. NWSACHUSETTS
8LammG DEPAIMS 0NT
120 WASHNGTON STRM, 3iO FLOOR
TIL (978) 745-959S
F&X(978) 740-9846
KISBERLEY DRMOLL
MAYOR T7tows ST.Pmxtta
DIRECTOR OF PLBLIC PROPERTY/BUTLEING COMMISSIONER
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 Al 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 150A.
The debris will be transported by:
v/r a6L ZZ421.2
(name of hauler)
The debris will be disposed of in
(name of facility)
azrd e�G UrCJ
(address of facility)
signature of permit applicant
ate
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