100 TREMONT ST - BUILDING INSPECTION ga The Commonwealth of Massachusetts RECE Ven
Board of Building Regulations and Standards INSPECTION 1- S v S
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or P 4 2
One-or Two-Family Dwelling {
This Sect on For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Dais
SECTION 1:SITE INFORMATION
r
1.11Property Address:
n'r r t 1.2 Assessors Map&Parcel Numbers..1�fP�v�:� �
1.1a Is this an accepted street?yes f 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(it)
Front Yazd Side Yards Rear Yard
Required Provided Requred 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:
tt J Name(Print) City,State,ZIP
617 -)33"'LSJy
No.and Street Telephone Em,]Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Erl Alteration(s) ❑ 1 Addition ❑
Z�y Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Q,-- RrXIT
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ +�00. 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
. $ Other Fees: $
4.Mechanical (HVAC Lis _�
5.Mechanical (Fire $
Su ression Total All Fees:$ i
U O Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ e, r of, ❑Paid in Full ❑Outstanding Balance Due:
q / 1Z
iSECTION 5: CONSTRUCTION SERVICES '
x
onstruction,Supervisor License(CSL)
�(r � 7'0
,
l�M�l.it License Number Expiration Datef CSL Holder
Tf a�16jP i S, List CSL Type(see below)
Sveet 'FType Description
_ rj� l7 U Unrestricted Buildin s u to 35,M
a/ cu.ftJ
[ R Restricted 1&2Famil Dwellin
Cnyaown,State,ZIP M Maso
RC Roofm Coverin
WS Window and Sidin
� 7SF Solid Fuel Burning Appliances
5 7�KI�1 )pt11�71b t^° I Insulation
ele hone Email a ess D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
15Ila3 5-/ 7-asr
�m�t�i� HIC Registration Number Expiration Date
HIC Company Name or C Registrant Name
No.and Street
Sail address
G )�vl - a/u-2�� 9z�-7�fu-ak�5
City/Town State,ZIP Tele hone
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 .......... El No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUBAING PERMIT
1,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: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
"off my knowledge and understanding.
Pont Owner's or Authon 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.eov/oca Information on the Construction Supervisor License can be found at wxv v.mass gov/dos
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" yoo 5 F j—
i
1 Massachusetts -Department Of Public Safety
�+ Board of Building Regulations and Standards.
Construction Supers isor Specialty ,
License:CSSL 100819'
SCOTT M ICIDNEy
24 BRADFORD SIR
SALEM MA 019a0
s
Expiration
12/04/2015
Commissioner
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Cofactor Registration
'=.�..= Registration: 151123
Type: Private Corporation
Expiration: 5/1 712 01 6 Tr# 254750
J.B. KIDNEY & CO INC.
SCOTT KIDNEY
41 OSBORNE STREET
SALEM, MA 019705vr
��UPdate Address and return card.Mark reason for change.
~' ---Y Address D Renewal Employment Lost Card
SCA 1 0 20M-05/11
License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation before the expiration date. If found return to:
ME IMPROVEMENT CONTRACTOR Type. Office of Consumer Affairs and Business Regulation
gistration: ,151123 10 Park Plaza-Suite 5170.
- xpiration: 5/97(2i 1:6 Private Corporation Boston,MA 02116
J.B. KIDNEY&CO INC: , r
SCOTT KIDNEY -
41 OSBORNE STREET C46�--�6•d•e
to of va id without signature
SALEM,MA 01970 Undersecretary
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It '
). B. KIDNEY & CO., INC. RooalrMetWorkers
41 OSBORNE STREET • TELEPHONE(978)744-2875 • FAX(978)744-2252 • SALEM,MA 01970 • jbkidney@venzon.net
September 2,2014
Steve and Adam
Bradford St.
Salem,MA 01970
Dear Steve and Adam,
As requested we are quoting you on the following work:
New Shingle Roof
• Strip shingles off the main house,back porch and garage down to the roof boards.
• Install 3' of Ice and water shield at the eave of the roof on the main house.
• Apply 50 pound felt paper to the remainder of the roof.
Install new 8" aluminum drip edge along the eaves of the roof and up the rake
boards.
• Furnish and install Certainteed Pro Shingles to the entire roof.
• Re-work and reseal chimney flashings.
• Install shingle caps for the ridge of the roof.
• Furnish and install new soil stack pipe boots to all stacks.
• Reuse vents and properly re-flash.
• Clean up debris on a daily basis and properly dispose of.
Cost to do this work will be EIGHT THOUSAND FIVE HUNDRED ($8,500.00)
DOLLARS.
Clean up debris upon completion of the work and furnish workmen's compensation and
public liability insurance to protect the owner in case of an accident while work is in
progress.
Any rotted roof boards must be replaced on a time and material basis before work can
continue.
The above quote includes all labor, material,fabrication,equipment,disposal,and
insurance costs.
If you have any questions on the information detailed above please contact us. We look
forward to working with you.
J . B, KIDNEY & CO, INC Roofers
Metal Workers
41 OSBORNE STREET • TELEPHONE(978)744-2875 • FAX(978)744-2252 • SALEM,MA01970 • jbkidney@verizon.net
September 2,2014
Steve and Adam
Bradford St.
Salem,MA 01970
Dear Steve and Adam,
As requested we are quoting you on the following work:
New Shingle Roof
• Strip shingles off the main house, back porch and garage down to the roof boards.
• Install 3' of Ice and water shield at the eave of the roof on the main house.
• Apply 50 pound felt paper to the remainder of the roof.
• Install new 8" aluminum drip edge along the eaves of the roof and up the rake
boards.
• Furnish and install Certainteed Pro Shingles to the entire roof.
• Re-work and reseal chimney flashings.
• Install shingle caps for the ridge of the roof.
• Furnish and install new soil stack pipe boots to all stacks.
• Reuse vents and properly re-flash.
• Clean up debris on a daily basis and properly dispose of.
Cost to do this work will be EIGHT THOUSAND FIVE HUNDRED ($8,500.00)
DOLLARS.
Clean up debris upon completion of the work and furnish workmen's compensation and
public liability insurance to protect the owner in case of an accident while work is in
progress.
Any rotted roof boards must be replaced on a time and material basis before work can
continue.
The above quote includes all labor, material,fabrication,equipment, disposal, and
insurance costs.
If you have any questions on the information detailed above please contact us. We look
forward to working with you.
F
IIf this proposal is accepted we will send you a contract detailing a payment schedule to
be signed and a copy returned to us.
Sincerely, otoV\a°r > g-7— j clr
J.B. Kidney & CO. Inc
d, 4
Scott Kidney - ]-/y �
�r
Certificate of insurance is available upon request. „ F
Payments:
2 Payments:
• $4,250.00 is due up front.
• $4,250.00 is due at the end of the work.
Dale= 9- 7-14
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CITY OF SALEM, MASSACHUSEM
BUILDING DEPARTMENT
120 WASHINGTON STREET,3m FLOOR
TEL. (978) 745-9595
F
KIMBERLEY DRISCOLL FAX(978) 740-9846
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING 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 c40, 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 deposit 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:
(name of facility)
(address of facility)
� a
Signature of applicant
Date
CITY OF SM-EM, NL1SSACHUSETTS
4 BUILDING DEPARTNIL•NT
120 WASHINGTON STREET, 3"a FLOOR
T EL (978) 745-9595
v F.Lr(978) 740-9846
Kl%iBERt F.Y DRISCOLL
`�L1YOR THDMAs ST.Pmms
DIREuOR OF PUBLIC PROPERTY/BUILDING CONLMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractor..i/Electricians/Plumbers
Applicant informatinn t l Please Print eeibly
NntnelliminessOrg,mizmion;Individual): �8 �\i:t;AQA
,
Address: �// 0 S . cr,t•-yy a S h
City/State/Zip: Sc� AM, QW -7d Phone hl:_
Are yn an employer?Check the appropriate box: 'Type of project(required):
I. I am a employer with 4• ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or pan-time).' have hired the sulscontractors
2.❑ I am a sole proprietor or partner• listed on the attached shcet. t 7. ❑ Remodeling
ship and have no employees These sub-contractors have N. (] Demolition
working for me in any capacity. workers'comp. insurance. y ❑ Building addition
[No workers'camp, 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' sump. C. 152, §1(4),and we have no 12.FAR'knor repairs
insurance required.) t employees. [No workers' 13.❑ Other
camp. insurance required.)
•Any bppli"a ilia[checks but BI mast also 1,11 out the acctiun b:lowshowiiia their worked cumpemmion policy istA matiun.
'I Itlmeow'nere who wbn,il this Wl,hvit indicAng ihey ore doing all work and then hire outside eantmetors latest submit a new afttdavil indicating such.
<'n,imctan thus chcsk This box mawl ntachal an addiniowl ehma showing tilt name of the subaanuacton and Iheit warken'camp.policy information.
I ant an employer that Is prnvidinx tvorkerr'compeuradon insurance for my employees. Below is he poilry lard job.vita
h1faralarion. ''II
I nsurlice Cumpa ny Na me:_ 64'_1/of 4-0�'cr(• nG:-�
Policy 4 or Sulf-ins, Lic. d: Expiration Date: '
nub Site Address: /Lin T'ruv"7t n 5 City/State/Zip: 52a&n MA A p• -70
Attach a copy of the woriters'compensation policy declaratlon page(showing the policy number and expiration date).
IF'ailure to secure coverage as required under Section 25A ofMOL c. 152 can lead to the imposition ol'criminal penalties of a
line up to S 1,500.00 undlor one-year imprisonnsen4 as well as civil penalties in the form of a STOP WORK ORDER and a line
of up to S25000 a day against rho violamr. Ile advised that a copy of Ihis.st atemcnt may be runvardcd to the Oflice of
htveaigwiuns al'the DIA For insurance coverage vcrilicatiun.
I do hereby rerruuder r seejpain_r and penalties ufprrjury that the hifunnWion provided ubuve is true and correct
Data:
Phttnc �' 1 7 rf_ 2-! U c�i 6 7
Official use wily. Do not,vtite in this area,to be cunrpleted by eiiy ur to,un njjit•Iu2
City nr'J'nw'n: PermitI7.1censcN
Issuing authority (circle one):
I. Ruurd of Ilealth 2. Mlildlm„ Ocpartuu•nt ,i.cityi anvil Clerk 1. Electrical Inspector 5. I'lumbing Inspecror
6. Other
1 Contact Verson•