117 WEBB ST - BUILDING INSPECTION (3) Pj -1 - Z2 GK 3oZ-3l $q$°e
The Commonwealth of Massachusetts RECE� ED 06
rw Board of Building Regulations and Standards n
Massachusetts State Building Code, 780 CMR INSPECTION $E ALEM
Revised MAr,2Oi l
Building Permit Application To Construct, Repair,Renovate Or Demol ' P
One-or Two-Family Dwelling 10�U
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.�Nperry tjdyessa 1.2 Assessors Map&Parcel Numbers
L la 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'
2tVwner IfRecor 4 O( n O
� c/SA 'Lw M 2
Name(Pri t)Nq City,State,ZIP
No`ld Str�et elphone_ Z EmaO Address
SECTION 3:DESCRIPTIO F PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building T1Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other pecify:
Brie escription of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ p w 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 1 ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ression Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 13 2W 0 paid in Full 0 Outstanding Balance Due:
i
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License CSL) t
, ��� License Number Expir.lion D to /
Nam of CSL Holder
� x
„C�� List CSL Type(see below)T Description
No.(anId'�Sveet A'
W ttJt h�� /�(� O���� U Unrestricted(Buildings u to 35,000 cu.ft.
TTT ail'll6 Restricted 1&2 Family Dwelling
ayfrown,State,zip M Masonry
RC Roofing Covering
WS Window and Sidin
[,p /� SF Solid Fuel Burning Appliances
C4 ll- -1 AA I Insulation
el hone Email address ^ D Demolition
5.2 Registered Uome Improvement Contractor(HIC) //tii q
C HIC Registration Number Ex ati n Date
HIC Comp y e HIC a tr Name
No.a,d Sve t Email address
G,tide b2�SL �,zr�iSl/, —� e 3
Cr /Town,State, I � Tele hone r
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 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNERr OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
ed in this ap icatio is tr and orate to the best of my knowledge and understanding.
P ' wner's or An 'zed Agent s lectronic Signature) Date
NOTES:
I. 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.eov/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 basemenUattics,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"
CCI'Y OF Si�I E.NI, i%'L-\SSi1CHLSETTS
\ BLAMING DEPART`,W-NT
' t i 120 WASHIINGTON STREET, 3'a FLOOR
TFL (978) 745-9595
F.Aa(978) 740-98.16
KIMBERL F-Y DRISCOLL
"A'\YOR THOb415 ST.PtERRH
DIRECTOR OF PUBLIC PROPERTY/BI:ILDr\G CO\L\IiSSfONER
Workers' Compensation Insurance Aftidavit: Builders/Contractors/Electricians/Plumbers
A i slicant Informatinn Plcase Print 1, ibl
Va1T1C (nusin¢sOrganiralinn.'ICndividu:d): (,(,�
Address: V
City/State/zip: DZt h M11; c7 (_
Arc yo n employer?Check the appropriate bust: '
�-r P 'type of project(required):
I. am a employer with /_\ ) 4, ❑ I am a general contractor and 1 g, ❑New construction
employees(full and/or part-time).• have hired the sub-contractors
2.❑ I not a sole proprietor car partner• listed on the attached sheet. t 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. C] Demolition
working for me in any capacity. workers'comp.insurance. 9, ❑ f�uiWing addition
(No workers'camp. insurance 5. ❑ We are a corporation and its
required.) officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions
myself.(No workers' sump. C. 152, §1(4),and we have no 12.❑ Roof repai
insurance required.) t employees. (No workers' I3. ther - O
comp. Insurance required,)
'•Anv appk:uo not ehccks box 01 must nisu rill out the ac,ton below showing their wolterWolters,eumpensadun policy inlirnnanun.
I lommtwm"who euhmil this affidavit indicating they arc doing all work and then hire outside cummcna,oral nihmil a new jMdavil indicating such.
;r'.'n1mcton that uh,ck this box oral mnachal an additiurod ahnn thawing the none of the subFcntncfom and their workcra'camp.Policy intatmafion.
I unr can eaployer dint is providing fvorkeri'compensation la.rurance or my employees. Deloly is the policy and Job site
infirraturian. `I
Insurance Company Name:�q (c{�/+� C Q V'
Policy it or Scif-ins. Lic.N: �N C1- ( lV� CS� p Expiration Date:
fob Site Address: ��7 (" / 6)�- City/Stale/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
h'ailuru to secure coverage as required under Section 2JA of MGL c. 152 can lead to the imposition of criminal penalties of a
line up to S1,500.00 und/ur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
or up to SM O(I a day against the violator. Be advised that a copy of this statement may be furwarded to the Of lice of
Invcstigutiuns of dte DIA for insurance coverage verification.
/do here cer 'y under the pit a nal s pe 7 that the brfurmutlmt provide)ubuve is true and correct
�im I rc'
(7J/iciaC use atiy. Do not rvrue in rhi.r area,to be completed by city car Io wn n/JleiuC
cCity orm l' vn:
L"sing,%ullwrity (circle one): -- - --- - ---
I. lioord of Ilcalth Z. Ouilding Dcpminivnt 1.City(rmvu Cluck 4. Fleetricul tntpectur 5. Plumbing fnspecrur
6. Other
I �
Cn ntact Person: Phone 3:
o � COMMERClA1. , I�ESI[)ENTIAL
ROOFING, S 'ECIALSiS
COROLLA
ROOFING errs nvi tir
WINI WROP. MA 0Z15-' FAX: ((,17) 56I t7?G
ItAVWCUf10L11ftA�Fl hCi C'i1,N SnIJEq OS OIA AROC)FINC,UILU
Steve Stoddard .Duly 8,2014
Lighthouse Construction Co.
47 Bates Avenue
Winthrop,Mass. 02152
Work. To Be Petfforrrred At:
1.17 Webb Street
Salem,MA
We hereby propose to furnish all the materials and perform all the labor necessary for the cornplclion f
the following;
I. At the main upper shingle roof, front porch roof, front bay window roof, and rear lower
porch roof. - Strip and remove existing shingles&flashings down to wood deck.
2. Remove old wooden gutter from the front bay window roof.
3. Replace any damaged or rotted wood deck at a unit cost of$3.50 per foot.
4. Install new 8"white aluminum drip edge at all outside perimeters.
5. Install Ice&Water Shield at the eaves, sidewalls of dormers,and around penetrations.
Install new 15 lb. underlayment over the remainder of the wood deck.
6. Install new Lifetime architectural-style shingles, ridge vent at the peak. Re-flash 2 veil
pipes, 3 skylights, and 1 chimney. Chimney pointing to be done by others.
7. Install new rubber roof at the front bay window roof and at the front porch roof.
8. Clean and remove all debris caused by the above work from the properly.
All material are guaranteed to be as specified and the above work t0 be performed in accordance with.>p:e
drawings and specifications submitted for the above work and completed in a substantial workmanlike manner`cm
the sum of:
$13,700.00 (Thirteen thousand,seven hundred dollars)
With payment to be made as follows:
1/3 - upon mobilization 1/3 - when half complete 1/3 - when 100%Complete
Workmen's Compensation and Public Liability Insurance on above work to be taken out by Corolla Contra-'Jn„
Inc. and provided to the owner prior to commencement of roofing work.
Respectfully Submitted: Robert J. Corolla tr.,President
Note-This Proposal may be withdrawn by us if not accepted within 30-days.
ACCEPTANCF_ OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized tc co
the work as specified. Payment will be made as outlined above.
Date: ` Signature: ('
`Q QTY OF SALEM, MASSACHUSETTS
i�a 1�Iri� BUILDING DEPARTMENT
120 WASHNGTON STREET,31D FLOOR
TEL. (978)745-9595
KIMBERLEY DRISCOLL FAx(978)740-9846
MAYOR TY-IOMAS ST.PIERRE
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 c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
r -Z-�- &- o
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of fAcility)
1
Signature of applicant
Date