71 WEBB ST - BUILDING INSPECTION (2) �b3
The Commonwealth of Massachusetts
° Board of Building Regulations and Stand r�ECT,ONAIESER ICEITY of
Massachusetts State Building Code,780 ALEM
Revised Mar 2011
Building Permit Application To Construct,Repair, Renov31.00nilisip . 5'i
One-or Two-Family Dwelling 11 Ua JJUU��
This Section For Official U Only
Building Permit Number: Date Ap ied:
Building Official(Print Name) Signature V Date
R ':w SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
'n (V-gA 5- erz�0'
l.l a 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 ft) Frontage(ft)
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 Ownerr of Re��cyyrd:
ARV YP r.r or TYtr
Name(Prino/ ' City,State,ZIP
7/ &4g/S 76z- i?73 - 7Z-60
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(cbeck all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units other 'Specify:
Brief Description of Progosed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS P
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ e-0 "vim 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
i ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other.Fees: $
4.Mechanical (HVAC) $ List 'lr_ry
5.Mechanical (Fire $ -
Suppression) Total All Fees:$
6.Total Project Cost: $ 9 2,z Check No. Check Amount: Cash Amount:
❑Paid in Full` ❑Outstanding Balance Due:
Ntl�i t to
SECTION 5: CONSTRUCTION SERVICES
• 5.1 Construction Supervisor ense(CSL) S.L — i3 ,2/V
�e 6t R i 7/44-s / License Number Expiration Date
Name of CSL Holder
TAN A-,-- List CSL Type(see below)
No.and Street AlType _ .. Description ,
�0SDf/ A 0 ses- U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP Masonry
C Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
'J �l Q�G?3T/ZCI� /raj•enO-Y I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
/2i7 T,F�ae i �2�o�iN(r /,1'7di83
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and AA4pSdN Nth 03Uj/ Jr Email address
Ci /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 .........—.5r 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
1 . V X r. ✓ a--10—eL L -6-Z.d/5�
Print Own is 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 of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
a 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/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 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 SM E:NI, NLUSACHUSETTS
Bu=NG DEP,,Ri".%m%T
`L 130 W.ISHINGTON STREET,3w FLOOR
T EL (978) 745-9595
FAX(978) 740-9846
KI.MBERLEY DRISCOLL
MAYOR T HoNtAs ST.Pw-m
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 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:
�.ex� w cJ, s�vs�fL
(name of hauler)
The debris will be disposed of in
/ (name of facility) A
(address of facility)
ignature permit applicant
.� / �) 2dl y
date
CITY OF SU1 E;NI, NIASSACHUSETTS
• BUEMLNG DF3A&1-%M iT
120 WASHINGTON STREET,r FLOOR
TEL (978) 745-9595
FAX(978)740-9846
KIMBERLEY DRISCOLL
MAYOR THOMAS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUR DINIG COMMMIONER
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(BusintsoiOrganizatiowlndividw•d): Xi/
Address:
City/State/Zip: �,SuoJ� �� D3eS/ Phone
Are you an employer?Cheek the appro box:
Pate Type of project(required):
1.❑ 1 am a employer with 4. JAI am a general contractor and I
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9, ❑ Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
requited.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 L❑Plumbing repairs or additions
myself[No workers'comp. c. 152.§44),and we have no 12.XRoof repairs
insurance required.]t employees.LNo workers' l3.❑Other
comp.insurance required.]
•Any applicant that chucks box kl must also fill out the action below shoaiag lids works, uMpemyion Policy infomntios.
I lomeownen who submit this affidavit indicating they am doing all work and thou hire outside controcau s most submit a new affidavit indicating and,
:Contmtton that chak this box must attached an additional sheet showing the name of that sub comma m and their workers,ramp.policy infanwtion.
1 am an employer that tr providing workers'compensadan lnsurancefor my employees. Below is the pulley and/ob site
information.
insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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. 132 can lead to the imposition of criminal penalties of a
fine up to S1.500.00 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. Be advised that a copy of this statement may be forwarded to the Office of
invesfigatiunv or the DIA for insurance coverage verification.
l do hereby certify utr r ins rat s f Jury that the informadon provided above is true and comet
sianatu >>4� Dare-
Phone
Oficial use only. Do not write in this area,to be completed by city or town oflicfal
City or Town: PermidUceuse#
Issuing Authority(circle one):
I. Board of health 2.Building Department 3.Cityffown Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
�� �
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
=__--
Registration: 157288
fa r Type: Ltd Liability Corporation
� Expiration: 9/20/2015 Tr# 243419
RJ. TALBOT ROOFING & CONTRAiCTING
ROBERT TALBOT i t
8 JOAN AVE. a r
HUDSON, NH 03051
Update Address and return card.Mark reason for change.
SCA 1 G 20M-06/11 Address 0 Renewal Employment Lost Card
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction supen isor Specialty
License: CSSL-101775
ROBERT J TALBq'T
8JOANAVE
HUDSON NH 038 1
J� W Expiration
Commissioner 1 2/1 312 01 4
.r
MA. H.I.C.REG#157288 R J Talbot Roofing & Contracting, Inc. Salesman: RAC C.•
LICENSE#CS SL 101775 Residential,Commercial&Condominium Roofing Solutions
FED ID#26-0661197 1-888-755-1535 J 603-755-1535
p www.talbotroofing.com
K�NAME: V V KWPrITB�_ I BOS COMM IW[,S ADDRESS: -7 F W CAB 5>1r �t-1 AAp
HOMEPHONE#: CELL#: _70Z'ZZ.3__ (a0 EMAIL:
1. Contractor agrees to do the following work: Si121P + Pe-UUF M)4-rhJ HCtaE jV0 CM,Lk C)IJ Lau�K
2. Install tarps from roof to ground to protectthe house&landscaping.
3. Remove existing layers of shingles and dispose of them properly. �z - " few-%) -.
4. Inspect for rotted wood.Will replace roofing boards at$3.75 per foot and 1/2"plywood at$2.00 per square foot.
5. Apply feet of GAF 1Nitt}T1j'F,t�'4T Ice&Water Shield to all eaves and feet to all valleys/openings.
W1Ci�
6. Apply Synthetic Fiber Reinforced paper to remaining area.Name: GA+ DW( ArK.MQ .,
7. Install Heavy Duty 8 inch drip edge to all eaves and rakes.Color to be: hit- Mill—Brown—Copper
8. Install new pipe flanges to all existing pipes. umin /Copper
9. Install Certainteed or GAF Architectual Shingles to manufacturer's specifications,to include swift or pro starter shingles to all eaves.
10.Shingle Name GA�+ T1 wi3E U_1�_Iz_ Color. 3L-A'TX
S1'L_Pr-121D�
1:1.Install Shadow Ridge/�he�{ustom4Cap on all ridges and hips.
GAF ocna" 'wevu 00UPT10-1
12.Install went to all ridges to ensure proper ventilation.
13. Re--Lead Chimney YES/NO.New lead will be sealed with Geocel.
14.Worksite will be cleaned on a daily basis and all areas will be gone over using a 3--foot magnet.
15.WII necessary permits will be the responsibility of Talbot Roofing&Contracting.
16.Talbot Roofing&Contracting will supply customer with Uability and Workers Compensation Insurance Certificate prior to any work being
performed.
17.Upon completion and payment in full,your new roof will have a workmanship warranty fora period of 1 years issued by Talbot Roofing&
Contracting and 0 years honored by the shingle maufacturer for material defects.
18.Any changes to the specification will be executed by a written change order and will become an extra above and beyond the original contract price.
Talbot Roofing is NOT responsible for attic debris.
Note:This proposal may be withdrawn by Talbot Roofing,if not accepted within 30 days!
Comments: MME II-ICt,ubta P-E- FUgSHt1J6 (3) s�LyLaCid-fS wiTli+ kFF-S
The Contractor agrees to pftform the work, furnish the materials and labor specified .
above for the sum of: $ 9, ZA® t°p
Payments to be made as follows:
$S.06-1 upon signing contract(not to exceed 1/3 of total contract price.)
$ by Jam_or upon completion of halfway point.
$ �by��_or upon completion of work specified.
Contract Acceptance:Upon signing,this document becomes a binding contract under law.
b S, 4 C0114,U y,#O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESI!!
OwnerSignature ^lJJ/Jl. Contractor's Signature Z�
Date: S/13 II`�' /�/� Date:��/3��y
Talbot Roofing Contracting • 8 Jo Ave, Hudson NH 03051 • 603-755-1535 or 1-888-755-1535