11 WEATHERLY DR - BUILDING INSPECTION I CFO (.-3
The Commonwealth of Massachusetts
Board of Building Regulations and Standards RECEI EU CITY OF
Massachusetts State Building Code, 780 CMR INSFECTION� ER�F16ES
W
evcred Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a 31
One-or Two-Fancily Dwelling A
This Section For Official Use Only
Building Permit Number: Date plied:
Building Official(Print Name) Signature D to
SECTION 1: SITE INFORMATION
1.1 Property dress* 1.2 Assessors Map&Parcel Numbers
�L �)e rig lx.
1.1 a Is this an accepted eet?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(R)
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 caner of Rec rd: ,
l��� rr _gy p✓� 2 /q n�1 �-D
Name(Pnn[a City,State,ZIP
No.and Street JTO Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': _ j
���
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ Lf a a ❑Paid in Full ❑Outstanding Balance Due:
SENT M C,PJ. 3tsjLS J.AaaviC CRDtabp L-T-R
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
[ S - oi o8 �
P d [4 1 l &I JAA J License Number Expuatio Date
Name of CSL Holder
0
C��l a)0t�.yo(� l�x��� List CSL Type(see below)
INo.and Street ` Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
l yl V "l R Restricted 1&2 Family Dwelling
City wn,State,ZIP M Mason
ry
tD
Roofin Coverin
Window and Siding
Solid Fuel Burning Appliances
��� 1 Ol '� �• -C ��!l/LIQ,�� �� ' Insulation
Telephone Email addres Demolition
� Registered Home Improvement Contractor(HIC)
�hlI A �d � r)'L-A HIC Regis qEp 4-t. Date
1C Com aln�y�la�,mCeyppr HIC Re r rt Name
llp �r dA Y �g Pt1 b J! 'LLl�lllJl�J( (tN {1
Conn ,o.and Street � � Email add` s C .
1
Cit own, tate,ZIP Telephone
`M .
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...........x
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING 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 lectrome Signature) I DJtc
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 an accurate to the best of my knowledge and unders �nding.
EnnUind
1 J�� ,
Print Owner's or AuthorizeAgent's Nfmc(Electronic Signature) 10ate
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 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 S�U.E:NI, T)vL-�SS,-kCHusE rrs
Bt:MDCgG DEPARTRiEVT
120 WASHINGTON STREET, r FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KIMB RLEY DRISCOLL
LMAYOR T HO&W ST.PIERRB
DIRECtOR OF P1:BLIC PROPERTY/BULGQING CObtMMIONER
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 1.11.5
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:,
±Lud
(name of hauler)
The debris will be disposed of.in :
(name of facility)
6 66-6 I. , 2
(address;of facil' yt4 ) 1
signature er apph
°2 / J
to
dcbri�f7Joc
CITY OF SM EN4 N ICHUSETTS
• B1:ILDLNG DEP 4Rn&NT
120 W jSHINGTON STREET,3"D FLOOR
T EL (978)745-9595
FAX(978)740-9846
KI\fBERI.EY DRISCOLL
MAYOR T HOMAS ST.PiEM
DIRECTOR OF PCBLIC PROPERTY/BUILDING COMMSSIOV ER
Workers' Compensation Insurance Affidavit: BuilderslContractors/Electricians/Plumbers
A licant in ilrmation Please Print Legibly
J
Name(BvsincvtiOrganizatioro''Individual)�: /fn
Address:_ � Q 1 � n 14 f�f PAL ALA
City/State/zip: LgVUY\ ,)'1 , Iql()) Phones:
Are ou as emplayer?Check the appropriate box:) _ Type of project(required):
.171 am a employer with `l' — 4. I am a general contractor and 1 6. ❑New construction
17
employees(full and/or part-time).* have hired the subcontractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet:: 7• ❑Remodeling
ship and have no employees These sub-contractors have S. [] Demolition
workingfor me in an capacity. workers'comp.insurance,
Y9. 0Buihiing addition
(No workers'comp. insurance5. ❑ We area corporation and its
required.] officers have exercised their 10.Q Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'comp, c. 152,§1(4),and we have no. 12,Q,Roof repairs
insurance required.]t employees.[No workers' 13. Other r
comp.insurance required.] y"'
•Any applicant tka ehccks two al must atwt fill out the section below showing their workm'compensation policy inrummion
t Itorswou ne,who submit this affidavit indicating they ate doing all work and then him Outsidecanttaetara must submit a now,affidavit indicating"IL
=Cmuracon that chink ibis box mtstamachod an additional And showing The name of the sub• ftusoton and their workers'comp:policy mromwim,
l am an employer that is providing workers'competuardon insurance formy employees. Below Is the policy and fob site
information. ��1� D
Insurance Company dame: (/ It / 1 t /I ./,P h A e>'t LLI
Policy 4 or Scif-ins.Lie.N:AW(7--qQ_DODr )09-W1 1_4 xpimtiou Date:�a
Job Site Address: I t UC21 l0 J�J 2\4 City/StatelZip: f / Y rI
Attach a copy of the workers'compensation policy declaration page(showing the policy number and esplradou 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 S250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance, verage verification.
do hereby certij de a pa ns and enal of per ury that the informatiou provided above is true and correct
SiLina t lire; Dnt
Official use only. Do nor write in this area,to be completed by city or town off chat
City or Town: Permit/License
Issuing.Aulhority(circle one):
1.Board of health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S. plumbing Inspector
6.Other
Contact Person: ..Phone#:
'1L1NO�� x1 Page No. of Pages
E.B. Windows and Siding Co.
756 Westem Avenue 4438
Lynn, MA 01905
O� 781-592.9747 Fax 781-592-9746
®o E-mail: ebwfindoa@nm.wm
PROPOSAL UBMITTED TO °, % PHONE DATE
E
l/ -Z y o .ss
STREET JOB NAME /
CITY.STATE a d ZIP CODE JOB LOCATION
s
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for
L'/.rs.'�
Or PrOpOSC hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
Y� �
3 OL P / /lOz+ HK F/' i- w Illy z /?/r�'' Ki0 dollars($ �,_®�).
[Payment to be made as follows: ® D g ^jam•
7-
Lmaterial is guaranteed to be as specified. All work to becompeted in a workmanlike
ording t� standard practices.Any alteration or deviation 5mmabovespeciNaalions'� uthorizedxtra costs will be executed only upon written orders, and will become an extra Signature
r and above the estimate. All agreements contingent upon strikes, accidentseyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This p of oral mays are fully covered by Workman's Compensation Insurance. withdrawn by us if,Rbt accepted wi in days.
E
ce of Proposal —The above prices,specificationsare satisfactory and are hereby accepted. You are authorized Signature
as specified. Payment will be,rrtade"as outlined above.
ce: _//t7 /�! *� Signature
Marcia Kirkpatrick
From: Thomas St. Pierre
Sent: Wednesday, March 04, 2015 8:03 AM
To: Marcia Kirkpatrick
Subject: FW: 11 Weatherly Drive, Salem - Priscilla Harris
fyi
From: Cyndy Anselmo [ma ilto:cyndy(Oecollc.net]
Sent: Tuesday, March 03, 2015 8:02 PM
To: Thomas St. Pierre
Subject: 11 Weatherly Drive, Salem - Priscilla Harris
Hi Tom,
Not sure why, but the previous email I sent to you regarding the window replacement program for the above-referenced
unit was not received by you. The Board of Trustees of the Weatherly Drive Condominium Trust has approved the
replacement windows to be replaced by EB Window&Siding Company, of Lynn.
Please let me know if you need anything further.
Cyndy
Cyndy Anselmo
East Coast Properties, LLC
Real Estate and Property Management
400 Highland Avenue Suite 11
Salem, MA 01970
P: 978-741-2003
F: 978-745-9684
cvndy(2b,ecpllc.net
1