33 WILLIAMS ST - BUILDING INSPECTION (3) j -TiE) - 114 - los
e Commonwealth of Massachusetts
' 9s Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 20I1
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date AppKeQ
Building Official(Print Name) + Signature Date
SECTION 1:SITE INFORMATION
Moperty Address: 1.2 Assessors Map&Parcel Numbers
ltl�\\ic',,vtif �s't1"t,�Y
1.1a 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?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
.-�.r`�0.sav� � Fib �L.2h, KAJ
Name(Print) City,—State
_; s W1lli awts S%--0"4 tp8- 018
No.and Street Telephone Email Address
, SECTION 3:DESCRIPTION OF PROPOSED WORKz(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work : C,..t o vt4 yt.i
irnn {�rcMrFtc-tv�a1 S'h h-oles
T
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ '7 Z� 1. Building Permit Fee: $ Indicate how fee is determined:
( 2.Electrical $ O ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 0 2. Other Fees: $
4.Mechanical (HVAC) $ O List:
5.Mechanical (Fire $ - w
Suppression) O Total All Fees:$
Check No. °' Check Amount: Cash Amount:
6.Total Project Cost: $ 2J� ❑Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Cd'�
` U
�Q\g� �t\)� � � v�o\ License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) t�,V1 r'CSMC�
\\Rl MaSSOI�n \5 (��e Pc�,r<�}an lt�ldl
No.and Street Ty e Description
Unrestricted(Buildings up to 35,000 cu.ft.
f Restricted 1&2 Family Duelling
Cityffown,Stag- c M Mason
ry
RC Roofing Covering
WS Window and Siding
qq� SF Solid Fuel Burning Appliances
JVV'�'I'�13U 1Y1t0C�""fANt G1+Y'Oult Vt51. C 6Wl I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) c
Ida�4�2
Q o3-c�S-zb�
-1-SLIq�� •X o�V&� ,, 0" Q HIC Registration Number Expiration Date
HIC Company Name or HTC R istrant Name
t{a 1llev�c 2orl ih� ronC�raiw� .t +tom(
No.and Street Email address
6}t l�c>r�l-or,V"1� ,OL4�� �-3��-3�
Ct /Town, StaNP 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
T,as Owner of the subject property,hereby authorize �2o6ce + 0 I S U((IVQw
to act on my behalf,in all matters relative to Aork authorized by this building permit application.
Cx0
Print Owner's Name(Electronic Si • re Date
SECTI :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 its true and accurate to the Apsyf my knowledge and understanding.
Print Owner's or Authorized Agent's Name o ) 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. ov v/oca Information on the ConsWction Supervisor License can be found at www.mass.gov/des
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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.UY.Al, NLUSACHUSETTS
B1 ILE)TI IG DEP kRT\IENT
\ 120 W ASHIINGTON STREET, Yo FLOOR
T EL (978) 745-9595
FA.r(978) 740-98"
KINiBERLEY DRISCOLL
MAYOR T HomAs ST.Pmm
DIRECTOR OF PUBLIC PROPERTY/BUILDIING 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:
(name of hauler)
The debris will be disposed of in
(name of facility)
tiro Mcba kS- "Itk- i CC,\r-A
(address of facility)
signature of permit applicant
date
a�bi�tr.a�
Proposa/No. 11185 Date 513112014
P:800-771-3938 F:800-771-1543
• ! • 1191 Mass. Ave., Arlington, MA 02476
Proposal
Name Jason Le se Address 33 Williams Street
Address 33 Willia s Street Salem, Ma
Salem, M
Phone Numbers
Main 508-397-1318 work
Email jason.leesT @gmail.com Cell Fax
DescriptionWork
We hereby propose to furnish and perform the labor necessary to:
Steep Slope Roof:
• Drape outer walls of house with tarp to prevent damage to house and adjacent landscaping from falling
debris
• Strip and dispose o�all roofing material down to roof boards of which the first two layers are free then
only 35 cents per square foot for each additional layer
Provide a comprehensive inspection of deck to include replacing damaged lumber, of which up to 64
sq. ft. of plywood or164 linear ft. of roof boards will be replaced free of charge. Additional sq. ft./linear ft.
is $2.95. Also, each 'roof board, if needed, will be re-nailed using 2 3/8" galvanized ring shank nails
• Remove existing sk ,light(s), and install new Velux skylight, and flashing kit. Labor free of charge,
customer to pay for cost of skylight and flashing kit only. No interior finish work included
• Install Owens Comm Ig WeatherLock Flex 6' up from the bottom edges, Tin valleys, around all
protrusions, and 9" round all rake edges.
• Wrap the Owens Coming WeatherLock flex over onto fascia. Install 1 3/8" PVC shadow board clamping
the WeatherLock FI X.
• Install Owens Corning Deck Defense where no ice and water shield is installed.
• Inspect and replace damaged step flashing, where needed
• Install 8" drip edge I n all edges of roof
• Remove lead from base of chimney, replace with new lead and seal with high-grade chimney caulking
• Install limited lifetim I Owens Corning TruDefinition Duration architectural shingles
Replace all pipe bo I is
Price estimate INCLU 'ES cash discount and $250.00 Angie's List Coupon
Ranch Renovations Till obtain any permits and will be reimbursed by the customer for said permits and/or
any city fees incurred.
Client Initials Ranch Renovations Initials Ranch Renovations—Page 1 of 2
Work Description . . Proposal
M
Terms & Conditions
If your roof is replaced during the 'nter or spring when there is snow on Ranch Renovations is not responsible for interior damage resulting from
the ground,expect to find some fing debris after it is melted.If you call water penetration through a pre-existing skylight.
us once it is all melted,we will gI ly come back and clean the lawn.
In the unlikely event of water infiltration resulting from snow and/or ice on
Any satellite dishes on the roof I have to be removed in order for the roof the roof,neither Ranch Renovations nor the product manufacturer is
to be installed correctly.We will our best to install the dish in the same responsible for interior damage.
location as previous,and facing same direction.You may still need to
call your satellite dish company, d have them realign the dish after the We at Ranch Renovations always relead chimneys and other stone brick
roof is completed.Fees are the r ponsibilly of the customer. surfaces to ensure that where the bricklmortar meets the roofs surface is
water tight.Please be aware that brick,stone and mortar are porous and
Secure any loose or delicate obj c is on your walls or shelves before the can deteriorate over time.As such,rain,especially driving rain,can
work is begun.Roof work can shl�� a the house,and walls.Take something penetrate above the area of the work we performed.
down if it is particularly importandt you.
You may cancel this transaction,without penalty or obligation,within three
Ranch Renovations is not respo able for roofing debris that may fall into business days(excluding Sundays and Holidays)of the date of this
transaction.To cancel this transaction,mail or deliver written notice to
the attic.At Ranch Renovations, a always strip your roof to ensure the
best possible installation.Small ices of roofing debris and/or sawdust Ranch Renovations,7 Mystic street, ctiin (ex ludi 02Sun no later than
may fall into your attic as a resul f installation.We recommend that you midnight .After
third day of this transaction(excluding Sundays and
Holidays).After the third day there will be a service charge equal to 25%of
cover your belongings. the total contract.
Roof Colo Drip Edge/Edge Metal Color
Price includes labor, m terials and removal of debris. 15 Year Guarantee on Labor
Estimate $7,264.00 Deposit $500.00
Payment 1/3 of pay nt at start of job, balance upon completion.
Terms
Respectfully Submitted bert O'Sullivan Per Ranch Renovations
Note:This proposal may be withdrawn by us if not accepted within 15 days. j
Acceptanceof • • •
By signing this contract, customer authorizes Ranch Renovations to obtain permits on their behalf.
The above prices, specific ions and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. Payments wi I be made as outlined above. G/( p% v
Date
Signature Signature
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
a 1 Congress Street, Suite 100
Boston,MA 02114-2017
wwtt.massgov/dia
Workers' Compein sation Insurance Affidavit: Builders/Contractors/Electricians/plumbers
Please Print Le ibl
Applicant Informatio
Name (Business/Organi i fi n/Individttal): vu ht V
Address: I "G
Phone one#:
Are you an employer? Ch ck the appropriate box: Type of project(required):
1.� I am a employer with 4 4. ❑ I am a general contractor and I 6 ❑New construction
employees (full and/o part-time).* have hired the sub-contractors Remodeling
listed on the attached sheet. ❑
2.❑ I am a sole proprietor r partner- g• ❑Demolition
� These sub-contractors have
ship and have no emp oyees employees and have workers' y ❑Building addition
working for me in an capacity. comp. insurance.t
[No workers' comp.i surance 10.❑Electrical repairs or additions
required.] I 5• ❑ We are a corporation and its
officers have exercised their 11.❑Plumbing repairs or additions
3.❑ I am a homeowner do ng all work right of exemption per MGL
gh P P 12. Roof repairs
myself. [No workers' comp. c. 152, §1(4),and we have no
insurance required.] t 13. Other
employees. [No workers'
comp. insurance required.]
"Any applicant that checks boxy#] oust also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this'aff davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tcontractors that check this box on st attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractorsI ave employees,they must provide their workers'comp.policy number.
workers'compensation insurance for my employees. Below is the policy and job site
I am an employer that is pr willing
information.
Insurance Company Name: Fr' C• Ch UrCIn
Expiration Date:Co 5
Policy#or Self-ins. Lic.I#: e 1 A n
City/State/Zip: `O\P�M M A
Job Site Address:
Attach a copy of the wor ers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverag a
ORK ORDER and fine a e s required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties a
fine up to$1,500.00 and/o one-year imprisonment, as well as civil penalties in the form of a STOP W
of up to$250.00 a day aga t the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA r insurance coverage verification-
Ida hereby ceru/y under a pains and penalties of perjury that the information provided above is true and correct
' Date: d(o L,3
Si ature:
Phone#: - al
o
fficialonly. io of write in this area,Tcompldedby city or town official.
n ermitlLicense#iority(cir le one):Health 2. wilding DepartmenClerk 4.Electrical Inspector 5.Plumbing Inspector
Phone#:
son:
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
• I ( Construction upensnr
Liense: S-098135 Y
0
Robert J OsuBivan7
1191 Mass AvenueTv
Arlington MA 02d76
3
I -,nth` Expiration
Commissioner 04/05/2015
� - - __.. .. . . -.- -gyp_..:.. ... _•.._...�., ,__.___�_ ;
�e rFnvrvrorrrocnll�olC%f�aurrc�ruc/b'
1{ Office of Consumer Affairs&Business Regulation
1 ME IMPROVEMENT CONTRACTOR
I—
gistration: 123542 Type:St piration 315/201.5.. DBA
Owl
Ranch Renovations
Robert O'Sullivan
42 BELLEVUE RD
ARLINGTON,MA 02476 -- — —a
Undersecretary -
1
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Unrestricted-Buildings of any use group which
contain less than 35,000 cubic feet (99Int )Of e
enclosed space.
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Failure to possess a current edition of the Massachusetts
'.State Building Code is cause for revocation of this license.
For DPS licensing information visit: www.Mass.Gov/DPS
License or registration valid-for individul use only
_ before the expiration date. It found return to:
Office of Consumer Affairs and Business Regulation _
10 Park Plaza-Suite 5170
Boston,MA 02116
9(-C*
Not valid without signature
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