29 VALLEY ST - BUILDING INSPECTION (3) I
'y
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CffY OF
Massachusetts State Building Code, 730 CMR $d Mar
71 Revised Mnr 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivv-Family Divelling
"Ibis Section For Official Use Only
Building Permit Number: Date A red.
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORINLATION.
1.1 Pr rty ddress L2 Assessors Map& Parcel Numbers
d
1.1 a Is this an accepted stree . yes_ no Map Number Parcel Number
1.3 Zoning Information: • 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tt) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.O.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 es❑
SECTION 2:, PROPERTY OWNERSHIPL
2.1 nherloMecoft
Name(Print) City,State,ZIP
—� " m �
No.and S otre set Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORIO'(c eck all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) V1 Alteration(s) ❑ Addition ❑
Demolition Cl Accessory Bldg. ❑ Number of Units_ Other ❑ Speci
Brief Description of Proposed Work":
SECTION 4: ESTEMIED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only, ,
Labor and iVtaterials
I. Building 3 L Building Permit Fee.S ' Indicate how fee is determined:
2. Electricalvs �zzz-7
❑Standard.City(rown Application Fee
❑'rota!Project Cost (Item 6)x multiplier x
3. Plumbing2. Other Fees: S �O[
1. Mechanical (UMList:
i. ;Mechanical (Firlbtal All Fees SCheck No. CheckAntounC Caah \uwunt1'nf.tl I'rnjcct ( t7 I till in Dull ❑ Outstandin Il iltnce DII�
SECTION 5: Ct)NS'l-RUCTION SERVICES
5.1 Constr ion Supervisor ((teens S .)
�L — ---
License Number Gepinttimt ,
Name o Cif to dcr List CSL Type(see below)
p Description
No. and St [
U Unrestricted Buildin s UO to 119 cu. R.
G/ Restricted 19e2 Fumil Dwellin
City! own,State, ZIP Nlasonr
RC Rootin Covcrin
WS Window and Sidin
1 SF Solid Fuel Burning Appliances
UI Insulation
"fele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
MC Registration Number Expiration Date
l IIC Company Name or IIIC Registrant Name
No.and Street Email address
City/Town,State, ZIP 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 ✓tGf D%'ry
to act on my behalf, in all matters relative to work authorized by this building permit application.
do �/
Print Owner's Name(Electronic Signature) Date
SECTION 7h: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and cent nowfedge and understanding)
Print Ow'ner's or Aullwriced Agent's Name(Electronic Signature) Date
NOTES:
1. All Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Nonce Improvement Contractor(HIC) Program),will Plot have access to the arbitration
program or guaranty fund under M.G.L. c. 1 12A. Other important information on the HIC Program can be found at
wwv.ma>s...uvhl c:
wwev m;u<.eov-aea Information on the Construction Supervisor License,can be Found at _L
2. When substantial work is planned,provide the information below:
Total floor area(sy. ll.) __—__ _(ioclueling garlge, finished basement/attics, decks or porch)
tiros; livin :uca(sy. R.l __ _ Habitable room count
Num'cr of tinplaccs.-.--_--_---— Number of bedrooms
Vwnbcrofbathrooms Numherof haltibaths --- ------ --
fcpo of hc.ttiog sysient . .. __.- --___._-- :umber of dec k ' port ic,
------------------
I\he ofcooling ;y;tcot 1?11closcd Upon
- — -- — ----------------
4 I'll it I nq-,•et 1yu,u Foot i,e ntay be 'nb;hnitcd f�)i I' ril Plojcct ( o)t"
Z,
i
CITY OF Sa]1Y4M, NIASSACHUSETTS
• BI:iMtNG DEPARTMENT
120 WhSHiNGTON STREET;310 ROD&
TEL (978)745=9595
F.tx(978),740.9846
KISfBERLEY DRISCOLL
MAYOR THObtASST.PmRRfi
DIRECTOR OF PUE LIC PROPER?Y/BUILDLYG COSLIIISSIONER
Yorkers' Compensation Insurance Affidavit: Buitders/Contractors/El'ectriclansiPlumbers
Aprillcant Information Please Print Le ibl
Name(Ousintss:organiiatioNlndividu t
Address: /� /�
City/State/Zip: r 1 � �� Phone � ��(�41l /
Are you an employer?Check the appropriate box: 'type of project(required):
I.f I am a croployer,witJto 4. El am a general contractor ands 6, Q New construction
employees(fLil and/or part-tuna).' have hind the sub-conlr7cbms
2.0 lam a'sole proprietor M or part listed on the attached sheet.t 7. ❑Remodeling
ship,and have no employee' These sut contractor have- tt. Q Demolition
m working-for ein any capacity::, worker'comp tnsunmce''„ q Q building addition
[No worker'comp;insurance S. El we ace a'coiportum and': i
aquircJ.J ofticer have exenisedtli'it 10 Q Electricai repairs or additions
3.0 famahomcowncrdoing all work rightofexemptionper(NGL Il.QPiumbingrepairsoradditions
mysclf..(No workers:comp. c.,152, 'I and we have do , 12 Q Roof repairs
imnlralicerequired.J?` cmployees:(Naworkers'.'. -, 13.Q,Othrs
comp inurrarice,nquiied.J '
•Any appiltaot that chocks bane 6l must also fill ouuhe section below showing their worn sml comprnsndOn poltt.Y mfarmadoe:
I Iw wownen who submit this affidavit indicating they am doing all work and then him outride centmetas must submit anew anidavii indicting such.
:commons,that chtecit Ibis box mtmtattachoden additional abet showing the Owns Offtiuli-eme dam aid tho4'workeq"comp:pullry' infoamanaa:..
I urrr ue employer thin lr prodlding workers'comprnsatloti hesurance jar+ny empluyeeR`Belo.Is iAb policy and Job site
injormudon'
insurance Company Name:
Policy 4 or Self-ins. Lie.ti: Expires,on Date: '
Job Site Address: Ciwy statr zip:
Attach a copy,of the workers'compensation policy eclaratloa page(showing the poticy number and expiration date)
Failure to s can coverage as iequired onJer.SationdSA of&fr a.152 oar lead to this imposition.ofariminal penalties eta
tine up to 51,50o.00 ontl/or one-year imprisonment,as well aseivil penalties in the fonn of a STOP WORK ORDER and a fine
of up to S230.00 a Juy against the violator: Be advircd that a copy of thiY statementmay 6e:forwarded.to the Oftice'oF
Investigations or the DIA for insurance cny�rabe vcriticahon;
I do herebyeerr4&under the pains and peuuldes ufperJury lhu - us rotiat provide./above is true and correeL
Si-al Si-nalt rc4Oaroi-
Chong ..L,..
O/Tcia!use only. Do not rvrke in Mli urea,to be comp/clad by city of/oww dfJtefgt
City or Town: Permit/i.leense l)
issuing Authority(circle one
1. gourd of Ileallh 2.Building Department 3.Cilyffown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone It:
CITY OF S,UZNf, L WSi;\CHusETTs
.i�)� BL'tLDLYC DEP.1R131E,�iT
O t` 1?0WAS.HLYGTON i2.,�;��j� �TZF&T, 3 F�.00Z
` s%'' TEL (978) 745-9593
IstDESI EY DRISCOLL FL<(973) 740-9344
i,UYOR TF OAUST.PIEMS
DuECTOR OF Pl:aLIC PROPEATY/ElL=LYG COJL\ttSSIO,V ER
Construction Debris Disposal Affidavit
(required for all demolition mid renovation work)
In accordance with the sixth edition critic State Building Code, 730 C1&fR section l l LS
Dcbris, and the provisions of MGL a 40, S 54;
Building Permit/« is issued with the condition that the debris resultin
this work shall be- g from
disposed of in a property licensed waste disposal facility as defined by,LIGL o
( l 1, S 150A.
The debris will be transported by:
Yr)
[lie debris wi11 be disposed of in
' _ /A
(name of icdily)
of�tllalw
sib;rtamro PPtir ik;int —
J.uc
z B�B R A.C. CASTLE CONSTRUCTION CO. INC.
MEMBER Telephone (800) 505-LEAK(5325) •-Fax (978) 777-7750
Brian LeBlanc, President
Please mail accepted proposal to the office located at.,
9 Tibbetts Avenue • Danvers, MA 01923
Unrestricted Mass Builders License No. 054882 Contractors Registration No. 166565
PROPOSAL SUB DgrO -IT
^a PHO DAT
t77cinlMrA III,STREET I/ JOB NAME
CITY,STATE AND COpE JOB LOCATION
ARCHITECT DATE FPLANS JOB PHONE
Urir o{105etreby to furnish-maate and labor=complete in accordance with specifications below for the sum of:
. . .. dollars s S
Paymerit to be as follows
lrY t�V tf 4(� ,
C
NOTICE: All home improvement contractors and subcontractors en9 ageW in home Authorized J
improvement contracting unless specifically exempt from registration by Signature:
provisions of Chapter 142A of the General Laws,must be registered with
the Commonwealth of Massachusetts. Inquiries about registration and 11Z7Agent
status should be made to the Director, Home Improvement Contract Note:This proposal may be
Registration,One Ashburton Place,Room 1301,Boston,MA 02108. withdrawn by us It not accepted within days.
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
A ROOF STRIP
We will cover the Siding,bushes, and grasses with Blue Tarps in order to protect the property during stripping.
We will strip up to 2 layers of roofing and remove all nails,screws and staples down to the bare wood.The ice and water shield will then be
installed at the bottom of all'edges, under all step flashings, under all roll flashing, around all chimneys, skylights, and into all valleys.
We will install 15 pound underlayment onto all other areas of the roofdeck.The 8"aluminum dripedge will then be installed to all roof edges.
Any existing pipes will be covered with n w minum rubber flanges.
The roofing material to be used will be
All the debris,will be cleaned and dumped by us on a daily basis. Magnetic brooms will be u ` d t extract a its from your property.
We will protect your property as best we can, however some foliage matting, breakage,or m g could occur.We cannot accept
responsibility for possessions inside of the house,or debris falling into attic areas. Customer should protect personal belongingS.. 1
EXTRA WORK IN WHICH A COST WILL B ADD D TO THE ABOVE PRICE. 3 l
Replace Rotted Roofboardss Install Aluminum Gutters
Relead Chimney(s) 1/1 Install Aluminum Downspouts
Replace Facia Boards Install Skylight(s)
Install Ridgevent GnK d' l° otted Roof To Wall Flashings \
Install Roof Louvers 1/ V Gutter Repairs '
NOTES: tZ
/ f
[�
1- ) I 1
'/ Joc
Warranty anufacturer be Be of defects for years, ee manufacturer's warranty for exact warranty performance.
All labor eyfe TIQO under is co tract shall be of good quality and free from defects not inherent in the quality required or permitted for
a pert of years/This arranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient
maint nance, mproper oper on,or normal wear and tear under normal usage.This warranty shall be limited to the work performed by
A.C. tie Construction Inc.and limited to either repair or replacement by A.C. Castle Construction Co., Inc. at its'sole discretion
and elect) all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the
occurrence of the event giving rise to such claim. This warranty-Shall not extend beyond any limits imposed by applicable law.
Payment and Penalties - Upon substantial completion of all work under this contract, customer shall within 3 days make final and full
payment of the contract price. Any and all unpaid balances shall accrue with interest at 5% interest per month. You agree to pay all
court costs and collection expenses incurred by A.C. Castle Construction Co., Inc. in the collection.of any amount you owe under this
contract, including without limitation reasonable attorney's fees. Please note: any illegal layers of roofing beyond a second layer will be
an extra cost of 35 cents per square foot.
Arbitration - Any controversy or claim arising out of or related to this contract, or the breach thereof, shall be settled by arbitration with
the American Arbitration Association or a mutually agreed upon third-party. Any judgment upon an award entered in arbitration may be
entered in any court having jurisdiction thereof. This section shall not apply to claims of A.C. Castle Construction Co., Inc. for collection
of past due accounts owed by the customer.
21rreptante of Proposal -Signing this proposal means you have accepted all the terms as stated.
Date of Acceptance U S a-0 3 Signature