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7 WILLOW AVE - BUILDING INSPECTION (4) The Commonwealth of Massachusetts Board of Building Regulations and Standards OFSALEM CITY 1 Massachusetts State Building Code,780 CMR,7"'edition Revised January Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008 ^' One-or Two-Family Dwelling ll'�1 This Section For Official Ke only Building Permit Number: Date Ap lied: Signature: Building Commissioner/Inspector of Buildings t SECTION 1:SITE INFORMATION 1.1 Proggerty Address: 1 2 Assessors Map&Parcel Numbers 7 llxdTl'e Mt. n IR 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: Zone: _ Outside Flood Zone? Public 13� Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Donvnlr. DDIAhv& 7 Gyllbkv O e 1pm Name(Print) Address for Service: 970- 979- 135M Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(cbeck all that apply) New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs(s) J§ I Alteration(s) ❑ Addition ❑ '- Demolition ❑ 1 Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work': Kt nyd It 211cl ar Om SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only Labor and Materials I.Building $ q3 00 — 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ZOOO — ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 35"00 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ I 9L, 900— ❑Paid in Full ❑Outstanding Balance Due: 0-1'aa z5tCC44hC/ SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) "7 3 37 s 3 l Z 1 1�� r z /U,0ah y 7 3 3 7 S— License Number Expiration Date Name of CSL-Holder List CSL Type(see below) Address 1. T Description 7a;-o/fir n ,5/ 67 Unrestricted(up to 35,000 Cu.Ft.) DQnl///s NOR Restricted 1&2 FamilyDwelling Si re M Masonry Only G i Q J� RC Residential Roofing Covering Telephone O WS Residential Window and Siding t717({ - 77�{- 333 3 SF Residential Solid Fuel BurningAppliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) rou4 rs L%r Cr�ur, ,F ��, 103011 HIC Comp Name or HIC Registrant Name Registration Number ,atnan I' lAx r IQ l / 7�cl�/� Addre�s}$ 'l C�} r� b -'7�' D, d H-j)') 2 i:)"ninu 0/76 —7 —333�r Expiration Date Signature Telephone SECTION 6:WORKERS'C PENSATION 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 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. Signature of Owner Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of 'u ) 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.a 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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" Massachusetts - Depilt tment of Public Safel, Board of Building Regulations and Standards Construction Supervisor License i License: CS 73375 BRIAN F MURPHY 11 KENMORE DR DANVERS, MA 01923 i Expiration: 9/3/2012 [', unnisionrr Tr#: 1799 . Te limnmeaaswea/!/i o�./�.amac�eitaella -\ Office of Consumer Affairs&Business Regulation VSBRWN' HOME IMPROVEMENT CONTRACTOR Registration 103611 Type: Expiration 119/2012 Private Corporatio KITCHEN&Bxrm CENJER BRIAN MURPHY 72 HOLTEN ST. g �_a Danvers, MA 01923 - Undersecretary Cp�(59M NWEALTH OF MASSACHUSETTS 4 � 1� InN a a a ♦ a � LF,�ENSECY�AS�AM A S T E { ISSUES THE ABOVE LICENSE rO iI ifl) pY u. f l� Yam` 8 p A F7S7 � hTA 01 3 126 r p , ACORD_ CERTIFICATE OF LIABILITY INSURANCE B ID CR j DATii/1o/l0 PRODUCER ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 Phone: 761-914-1000 Fax:781-246-2601 INSURERS AFFORDING COVERAGE NAIC# :NSUREC INSURER A: Arb.11. Protection Ins. (A) 41360 INSURER 8: SF Murphy Plumbing & Heatin IncInc &Browns Kitchen & Bath I INSURER C' 72 Holten street INSUREa D' Danvers MA 01923 NSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'OLICYEFFECTVE POLICYEXPI bff- LTR NSRC TYPE OF INSURANCE POLICY NUMBER ,ATE MWOOM DATE(MMIDDNYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 8500025389 06/01/10 06/01/11 PREMISES(EE ncc mce) $ 300000 CLAIMS MADE Fx1 OCCUR MED EXP(Any one person) $5000 PERSONA-&ADV INJURY $ 1000000 GENERAL AGGREGATE s2000000 GENT AGGREGATE LIMIT APPLIES PER: PROCIJCTS-COMP/CPAGG 12000000 POLICY PJERP LOG Ben. 1000000 AUTOMOBILE LIABILITY CCMBINEU SINGLE LIMIT $ 1 r 000,000 A ANY AUTO 99770400002 06/01/10 06/01/11 (Ee Er.d.rt) ALL OVvNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIREDAJTOS BODILY INJURY X NOF}OWNEDAJTOS (Per acdderrt) $ PROPERTY DAMAGE $ (Per Ecdderr) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAJ BRELLA LIABILITY EACH OCCURRENCE $ 1000000 A X I OCCUR ci-AJMs MADE 4600025390 06/01/10 06/01/11 AGGREGATE $ 1000000 $ X1DEDUC'NBLE $ RETENTION $10000 $ WORKERS COMPENSATION AND X TORY LIMITS I ER A EMPLOYERS'LIABILITY 909SO20609 06/01/10 06/01/11 F L.EACH ACCIDENT s500000 ANY PROPRIETORIPARTNER/ ECUTIVE OFFICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE1$ 50 0000 IIYECIA-P iOVISIO E.L.DISEASE-POLICY LIMIT 1500000 SPECIAL PROVISIONS Oelvn OTHER DESCRIPTION OF OPERATIONS I LOCATIONS T VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION s2am-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Salem NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Public Works Dept IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 978-740-9846 120 Washington Street REPRESENTATIVES. IN Salem MA 01970 AUTHORIZED SENTATI ACORD 25(2001108) ©ACORD CORPORATION 1988 i i _ 1 19' AL o — — — - !o do -- — CO CD `- -- lb r w m --�- - ct N J��Ol.t,l,} a (�..k"`.art.'' - — - -- ,xYio�re.✓:§` .+k - I i All dimensions size designations 202 This is an original design and must Designed: 7/28/2010 given are subject to verification on r[<NNol.Ocas not be released or copied unless Printed: 7/28/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. I Design All Drawing#: 1 Scale:0 1/2"= F! VITEII CT` TER 13 Elm Street ' Danvers;MA 01923-2058 Mailing address: 72 Holten.Street,Danvers, Mft 01923 Telephone f978j 7744333 • Fax(97&f 774-9709 Home.Imp vvementLicense#103611 • 1 dw- Buildem License#073375 CONTRACT This contract,dated below,for materials and/or labor to be supplied by Browns l rtchen&Bath Ceater (Hereinafter,m&nvd to as the contractor),at the sole request and order of: NAME. Dominic Donahue PHONE:478479-1398 DATE:Aug. 2,2@40 ADDRESS 7 Willow Ave. Salem,MA 01970 -(Hereinafferrefer, taastheownerorbuye0tabesappiiedipesfonnedatpremisessetfetchabow:;subjectma&oftheteen$and conditions set fortboa bothndesot the.Agreement,as-fellows: Brown's Kitchen and Bath Center is happy to furnish you with a quote on your Bathroom project carpentry We will remove walls to the studs.We will also remove the ceiling. The outside walls will be insulated.The walls will have new blueboard and plaster. We will supply and install a membrame to form shower base,this will be tiled with owner supplied tile The shower walls will have waterproof backer-board and tile walls.(tile supplied by owner and installed by Browns) There will also be new trim around doors and windows,and around the base of the room. Above the pedestal will be a mirror. Floating: The floor will be prepared for owner supplied and Brown's installed tile.(ifhardwood is possible we will adjust cost accordingly) plumbing: We will disconnect all fixtures. We will remove existing tub and reinstall in same location once floor is tiled(no changes to tub or tub plumbing— tub is being refinished by other) We will supply and install a Symmons shower valve Model#S96-1,this will be moved to the and wall We will supply and install a hand shower with a shower amdiverter and a hook We will install owner supplied pedestal and faucet. We will install owner supplied toilet. All work to be connected to existing plumbing.No piping changes under floor.If any upgrades are needed a quote will be provided. Shower Door:None at this time.Price will be quoted once decision is made.(Please note that shower doors take 2- 4-weeks afterlemplate) Heating:None Veatilation: Fan vented to outside. Electrical;We will supply and install a GFI outlet.We wilI instaIi a fan.. We will install owner supplied light above mirsnr.AH electric will be connected to the existing electrical service,ifany upgrades anti needed a quote will be provided.(Allowance for electrical is$2000.00 but this will be quoted). Door Style AGREED'PRICE:$14,800.00 Aandwpulls Floor 173 DEPOSIT: 30 00 .f)� Count BALANCE DUE: (j-0 -d- - -- --.----- ---'-3iiisyaoDeiaBo�Tor(3tt57ti`vty"Dayst�o�"d��ed,eve�97teoa�ver:npreset�serid-'warisiits�tlrefhe;smmeeol'�'aev'ai�-pretmsesai, ._ thatbetshe has read this agreement,sot fmihter bothsides. . IT IS EXPRESSLY.AGREED T13ATNO STATEMENT,ARRANGEMENT OR UNDERSTANDING,ORAL OR WRITTEN, EXRESSED OR IMPLIED NOT CONTAINED HEREIN WILL BE RECOGNIZED AND THIS CONTRACT CONSTITUTES THE ENTIRE AGREEMENT, it is further agreed that this contract is not subject to cancellation except by written consent of both parties. i SALESPERSON: ACCEPTED: �W ACCEPTED'B TLJ R�I L � 4 Ib�1�C y