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52 WEATHERLY DR - BUILDING INSPECTION (2) N A The Commonwealth o t S Ulf Department of Pub afety r3u Massachusetts State Building Co�de g(78 Nj[2n A Building Permit Application for any Building other,0 ak7tte or Two Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:L/OC TION(Please indicate Block#and Lot#for locations for which a street address is not available) Ham' �, Yi'/ram No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used Iff New Construction check here 0 or check all that apply in the two rows below Existing Building IV Repair❑ Alteration P Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Mkloi ✓e o G Are building plans and/or construction documents being supplied as part of this permit application? Yes V No ❑ - is an Independent Structural EngineeFF,,m$$Peer Review required? JJ // Yes ❑ No �/ l Brief Descripption of ProposedWork:{1ifo��+ 1Grr © a�" fe.17/mac/.ai �hC ��� CgZ/A46J, Co✓a/- e r f J_ f it SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR ' CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E. Educational ❑ F: Facto F-1❑ F2❑ H: h Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) ` IA TBD - HAD IIB0 IIIA0 IIIBD IV O VA0 VB0 SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Sri I Flood Zone Information Sewage Disposal: Trench Permit: Debris Removal: Public Check if outside Flood Zone V Indicate municipal A trench will not be Licensed Disposal Site Private❑ or indentify Zone: or on site system❑ required 0 or trench or specify: permit is enclosed❑ Railroad right-of-Way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes[] or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY "" w Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: Owe. ( /0 4D1a� Pz/ SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Dt oe' I7 -2iz-�v/ Titre Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby a,u/thoriizes %p/4l"'/ �c0Jw117 7f1o// &* Name Street Address CityCi y/T� State Zip to act on the property owners behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10��.22�GJJeneer/ral Contractor e / / -/ Company Name Name of Person Responsible for Construction License No. and Type if Applicable 7yo/f. Xd £moo/4 ✓� _ 03a17, Street Address f/ ity/Town State Zip 9 _ 391d 97� _% 3- `6/63 IWker ^C-60odw1'14, Co/n Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT .G.L.c.152.§25C 6 _ A Workers Compensation Insurance Affidavit from the MA Department of Industrial Acciden must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the' uance of the building permit. Is a signed Affidavit submitted with this application? Yes No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ O O, ego Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ 0 e2 ©, a 0 appropriate municipal factor)=$ 3.Plumbing $ , 00 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ 8 6 6.Total Cost $ Enclose check payable to 'a C70 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. Please print d siy�t name Title Telephone No. Date _ J/rJ�9/�Lt?r/ Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name 7D7 ,. Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block# and Lot# for locations for which a street address is not available) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where a licable No. Item submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State 1p Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State zip • The Commonwealth of Massachusetts Pririt,Form Department oflndustrialAccidems t Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name Business/Or MF Goodwin Co. ( ganiaation/Individual): Address:7 Holt Rd. City/State/Zip:Epping MH 03042 Phone #:978-423-8463 Are you an employer?Check the appropriate box: Type of project(required): 1.21 I am a employer with 3 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. URemodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance? 9• Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEl Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those',mtities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the pol y and job site information. Insurance Company Name:AIM Mutual Ins Policy#or Self-ins. Lic.#:VWC 6015117501 Expiration Date Job Site Address: rJ'j City/State/Zip: -5��i0 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Gerd under the ains and enalties o er•u that the information provided above is true and correct Si 3 moo/ Phone#978-423-8463 Official use only. Do not write in this area,to be completed by city or town ofjiciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:— Phone#: i CITY OF SM EM, NLxSSACHLSETTS • BUILDLNG DEPkRTs[&NT \ � 130 WASHINGTON STREET, 3� FLOOR TEE- (978) 745-9595 FAX(978) 740-9846 KI.,IBERL.EY DRISCOLL MAYOR THomm ST.PWMM DIRECTOR OF PUBLIC PROPERTY/BUII.DING COMIISSIONER 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 At 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: �L1�Ga,�lw,h Go� (name of hauler) The debris will be disposed of in : / (name of facility) Sov�Giii 57 G�orT�'pc✓y/ (address of facility) signature of permit applicant date dcbri.aIf dm 1 Massachusetts -Department of Public Sarery Board of Building Regulations and Standards Construction Supen kt,r License: CS4181670 NQCHAELF000ODWIN . - 7 HOLT RD t Epping NH 03041 Commissioner 08/08/2015 C`J e�,iir�unurr ea/f/r o//Ci�li rrr/rr.,•fG . - - . '- L Office of m Consuer Affairs&Busrfiess Regulation .License or registration valid for mdividul use only a diDME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:Registration: - �Re B 105029 Type: Office of Consumer Affairs and Business Regulation 3 Axpiration:,: 7/162014 Individual 10 Park Plaza-Suite 5170 r' Boston,MA 02116 MICHX'L F.GOODWIN JR. .Michael Goodwin Jr. -EPPING,NH 03042 Undersecretary Not valid without signature — 1221" X -12" -12"- 27"---' 24" 30" 15" J 3n — 20, " — —42-," 2 �"--4r 31" 24 - 12"--15' —2 „ 1 3r� Wall Corner Susan v F3 W2730 W2430 W3012 W1530R�,� cu N IT 0 o, . , U \ 3DB15 24.DI:BEPF 30-R1 ANGE31 B15R F3f, -Ti ro( 212o11ou -hell C, o L/Es ' ih � o "' ! 1 1/2" Base End Panel rMil U- Diagonal Corner Sink Base M _ `>� ~ `With Tiltout Tray m 2-Rollout Shelves -- rn rn w 1- a k1� N mIW 41- toN ml W M �@@ CO -W M > LY 6 M _ry x N No Crown Molding (n Cabinets to Existi, aQ 12" 15" - --- — — 27"—� All dimensions size designations - 20a'°"lag�,; This is an original design and must Designed: 5/1/2014 given are subject to verification on TECHNOLOGIES Pam' not be released or copied unless Printed: 5/1/2014 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Turner 3 Kitchen All Drawing#: 1 130 Centre St. Estimate Box C-1 Danvers, Ma. 01923 WilY 1010 978-423-8463 Lynn Turner 5/15/2014 52 Weatherly Dr. Salem Ma. Project Description Total This estimate is for the following work. 5,850.00 Kitchen remodel Hi Lynn, Here is the revised estimate for the kitchen remodel. I have included moving the plumbing to the corner for the new sink location. I also increased the amount for the electrical because the outlet in the corner will need to be relocated. I included installing the additional cabinets and moldings in the dining area. I noticed that the cabinets going in the dining area have glass doors on them, I did not include interior lighting but I can if desired. If you have any questions please do not hesitate to give me a call or send me an e-mail. Regards, Mike Scope of work; We will disconnect the existing appliances and fixtures. The cabinets and countertops will be removed. We will open up the bottom of the soffit over the microwave to make sure that Total Signature mfgoodwincompany@gmail.com Page 1 Mass.CSL #081670 Mass. HIC #105029 130 Centre St. Estimate Box C-1 Danvers, Ma. 01923 978-423-8463 Lynn Turner 5/15/2014 52 Weatherly Dr. Salem Ma. Project Description Total the venting is installed properly. We will install the new cabinets according to the same existing layout and install new hardware. Once the countertops are installed our plumber will hook up the dishwasher, sink, drain and faucet. Our electrician wire the microwave and make sure that the countertop outlets are up to code. All rubbish will be removed from the premises. References are proudly given upon request. City permit fees are additional and will be billed separately. Homeowner to provide the cabinets, hardware, sink, faucet, garbage disposal, appliances, countertop. The work will take approx 2 weeks to complete. An allowance of$750.00 is given for electrical work. The work will begin the week of July 7 2014 All work shall be completed in a workmanlike manner according to standard business practices. Any deviation from the above specifications involving additional work and/or materials shall be completed upon written authorization and may be an additional charge. Total Signature mfgoodwincompany@gmail.com Page 2 Mass.CSL #081670 Mass. HIC 4105029 IV 130 Centre St. Estimate Box C-1 Danvers, Ma. 01923 978-423-8463 Lynn Turner 5/15/2014 52 Weatherly Dr. Salem Ma. Project Description Total Total estimate: $ 5850.00 Payment schedule; A deposit of$2,000.00 upon starting. A payment of$2,000.00 upon major installation of the cabinets. The balance of$1,850.00 upon completion Acceptance of Pr posal: Homeowner: Date: Contractor: `'` Date: 717- �/Y This proposal may be withdrawn by either party within 48 hours of signing. Total Signature mfgoodwincompany@gmail.com Page 3 Mass.CSL #081670 Mass. HIC #105029 130 Centre St. Estimate Box C-1 Danvers, Ma. 01923 978-423-8463 Lynn Turner 5/15/2014 52 Weatherly Dr. Salem Ma. Project Description Total Total $5,850.00 Signature mfgoodwincompany@gmail.com Page 4 Mass.CSL #081670 Mass. HIC #105029