63 VALLEY ST - BUILDING INSPECTION (3) e . .1k
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 CMR, 7th edition OF SALEM
Revised January
Building Permit Application To Constru ,Repair, Renovate Or Demolish a 1, 2008
One-or Two-F ily Dwelling
This Se on n For Official Use Only
Building Permit Numb Date Applied: .C7
Signature:
Buildifigtommis ion / ector of Buildings Date T
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2,Assessors Map&Parcel Numbers
& * V AL-Ey sage--r
Lla 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 11) Frontage(11)
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? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
,qT6poaa t 16 Douc-c—rrc— (a3 VP xey ST SAvc A, Mint
Name(Print) Address for Service:
,�J> f7uA2 [off � -9)R- 8a6 -OR4t/
a Signa ITelephone r
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Buildingo Owner-Occupied (8' Repairs(s) ❑ Alteration(s) 8f IAddition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work : rZe !lovitTG r-J 6XIs71 Locit-riw.L,
UPOMG rntuM ; ^(s7�t CA'01-46-rs -,0eVTruUc. vVAu, Rc--rL^z4V_:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ (e, t<tIv 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ 77, UT-0 ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Q Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 1 , 0 0 ❑Paid in Full ❑Outstanding Balance Due:
b 4"Zt2r21-e,_JrL
w
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) CS [0 1 7.5Z
�O P1,J -&—&4 \c License Number Expiration Date
Nays of CSL-Holder y N List CSL Type(see below)
Address Type Description
U Unrestricted u to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwelling
Signature _ M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Re Igistered HSme aTement Contractor(HIC) ::J4 ' v
HIC Coom my Name or HIC Registrant Name ' Registration Number
Address G - t - ZG//
"7 3-Ca yjq Expiration Date
Signature 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, Grfwtrg, l 1� -t>oUGC—rrC as Owner of the subject property hereby
authorize P7Cu5 o� D fit" tau I L,9 to act on my behalf,in all matters
relative to work authorized by this� building permit application.tX vwlR d L�C1C�0 h'21 It o
'Signaturf of Owner ' Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.—
Print Name
Signature of Own Authorized Agent Date -
Si ed under the vains and penalties of
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I10.R6 and 110.115,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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 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"
CITY OF SALEM
-, i PUBLIC PROPRERTY
DEPARTMENT
h4'11`R DA%
\I 11 qc 120 WAil IINGI'ON SIItEET • SAT r\I, MAiiM]It if.I i J19''.:
TEI:978-'4 9g95 •PAX:978J40.9846
Construction Debris Disposal At'lidavit
(required fur 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-ot MGL_c_40, S_54;
Building Permit # is issued with the condition that the debris resulting front
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris will be transported by:
I . �2` o �•S�os Ps l
(name Of hauler)
The debris will be disposed of in
(name u(faci ily)
(address of facility)
C J 2
signature of permit applicant
date
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Contact vstw; _ J%one�#:
$ EL: E-3- LE
DE:siGN & 8 'UIL.,.D
252 Elliott Street
Suite 2
Beverly, MA 01915
HIC# 160578
September 15 2010
Stefano Cornelio and Stephanie Doucette
63 Valley Street
Salem, MA01970
This price reflects the aspects of your proposed kitchen remodel project as outlined in the attached scope of work.The budgets
reflect complete remodeling from permit and demolition through finish cleaning. All electrical and plumbing work is performed
by licensed tradespersons.Any change orders must be signed by homeowner before change is allowed. The proposal includes
all necessary insurance.
Scope of Work See attached scope of work
Revised total: $8, 992
Labor/building materials/cabinetry install as per scope of work attached
Payments received: $ 1, 500 8/23/10
Remaining balance: $7, 492
Payment schedule: $2, 500 upon demolition
$2, 500 upon install of sheetrock walls
$ 1, 000 upon install of cabinetry
$ 1, 000 upon completion day
$ 492 within 10 days of completion
Thank you for choosing Belisle Design+Build for your upcoming project.
Pg. 2
Job Scope of Work Cornelio/Doucette Residence, 63 Valley St., Salem, MA
General-
Site preparation to begin work and protect non-affected areas of house
• Existing textured ceiling to remain.
• Existing refrigerator and range to be temporarily relocated to dining room for storage during the
renovation.
Note: Existing refrigerator and gas range to be saved for re-use.
Note: Materials to be provided by homeowner. cabinetry, counter tops, all appliances, all plumbing
fixtures, all light fixtures, the floor and cement board subfloor, tile backsplash, interior door to stairwell
with hardware (hinges and knob)and new window.
Demolition/Disposal-
Demolish and dispose of all interior cabinetry and counter tops at kitchen.
• Removal and disposal of sheetrock walls at all interior walls of kitchen.
• Removal and disposal of sheetrock soffit above cabinets up to existing textured ceiling.
Note: Existing textured ceiling to remain
• Demolish and disposal of all flooring down to existing subfloor in kitchen.
Carpentry-
• Frame in new door location for door to stairwell.
• Install a new owner provided door at newly framed location.
Note: Pre-hung door and hardware provided by homeowner.
• Enlarge door opening from kitchen to dining room as feasible once sheetrock has been removed.
Proposed stain grade pine comer bead molding at both kitchen and dining room side of doorway
• Install a new owner provided double hung window at existing location including a stain grade 2 'A"
colonial style casing and sill
• Sheetrock, tape and sand new walls at kitchen
• Patch as necessary existing walls in stairwell from new door location
• Patch as necessary existing wall of dining room with newly enlarged door opening.
• Install new owner provided cabinetry and moldings per owner provided cabinetry layout plan.
• Install a new 3 ''/2" high one-piece stain grade pine baseboard as necessary at perimeter of kitchen.
• Provide and install ductwork from new microwave to exterior gable end of house above kitchen
including an exterior endcap.
Provide and install insulation and vapor barrier at exterior wall of kitchen.
Rough/Finish Plumbing/Gas line/Heating-
• By homeowner
P9,3
• Removal of all oRd ftlures and devices at tc chern and a4ok*W a$ir&V waM
. Demo old dryer outlet
. Provide and istall five (S) new hokxjeno iunet fgiDts an o emote sw4 ch
. Relocate two(2)switches at afn6nng wag
. Relocated and replace svVIchmg nag'dnf of new moor to stairwell
. Relacated existing sv✓Ach to sfaanvelf sigh#to ieff of new door location
• Provide new outlets fair owe suvoled applances
. Rekxxde fixtaure over sink and uWaatl owner suoaa'.6ed W fadwe on a new switch
. Install a new aeanlaad owner slued ce&V farm Ight in a n ewjunac6uon box
. Supply four (4(bcKImpkpsh outlets wired back to new ptanieA
. Ware new disposal kxAp hg a separate switch
. VAre for new foespcK a heater
. Add one (f)updated smoke detectaar
BackspkEft-
. B
Adygm-
By
Re"com-
e BY
Clealdng-
. t3noann chxzwvj and vecuuming of kitchen once BeWe portion of carpentrywork us completed.
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