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20 WINTER ISLAND RD - BUILDING INSPECTION The Commonwealth of Massac�q TIOHAL SERVICE W OF Board of Building Regulations and 5t:indards.y CITY M Massachusetts State Building Code, 780 CNM SALEM 14 JAN - b P 1: 2 9 Revised Mar 2011 Building Permit Application To Construct,Repair, enovate Or emolish a One-or Two-Fancily Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION l 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1 .20 W/Nr6e /SufNO RoRO l.la Is this an accepted street9 yes we 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(it) 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 G Private❑ Zone: _ Outside Flood Zone? Municipal I3"On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownert of Record: Name(Print) City,State,ZIP a0 WlAr7--X iSyki. AP Vk-Nell-*95- eow No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) [I>✓ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work`: R6f',1 iK f vo <.eSTrA- -I re&4aN.}Lc� nNr 100017aAlS OL BATM/LC H )WI-0 O'IE 9f.OL'CO3P+ LYLE TD PLi.IMd'/Nl 4,60* L4Mi1GE SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1. Building $ L`9 0.40. 91 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 000 OU ❑Standard City/Town Application Fee ❑Total Project Cost;(Item 6)x multiplier x 3.Plumbing $ j 000 , 014 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: S S/ 000 . O U ❑Paid in Full ❑Outstanding Balance Due: .1p -Tb i)vucsz SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 411- G.PitNT 1046f License Number Expiration Date Name of CSL Holder List CSL Type(see below) [L /y cHn�etrr�No Rotes No.and Street Type Description 44&1901V106A?1e y, NH O-ToS3 U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling Citylrown,State,ZIP M Masonry RC Roofing Covering INS Window and Siding SF Solid Fuel Bunting Appliances dW-5y8-y869 7/0 ahoo Cowl [ I Insulation Telephone Entail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) H HIC Company Name or HIC Registrant Name IC Registration Number Expiration Date No.and Street 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 ..........ll**' No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,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: 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. 6196Lv7- Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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. og v/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" a CITY OF SUXIM, XWSACHUSEM 13t:ILDL\G DEPART\(v'r 120 WASHiNGTON STREET,Yet FLOOR TEL (978)745-9595 FAX(978)740-9846 ICI%BERLEY DRISCOLL MAYOR THomaS ST.Pmitas DIRECTOR OF PL•BUC PROPERTY/BUTIMLdG COMMSIONER Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMe(BusincssOrganirafiondlndividual): Address: /`I G-HAR trt�j.C/tnt? Roc✓ City/State/Zip: Nrf 1-w" Phone#: ��v3�Ss8-YBsS' Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 4. 0 1 am a general contractor and 1 6. 0 New construction 7( employees(full and/or part-time).* have hired the sub-conuacters I�4 2.S 1 am a sole proprietor or partner. listed on the attached sheet: 7. 0 Remodeling ship and have an employees These subcontractors have 8. 0 Demolition working for me in any capacity. workers'comp.insurance. 9. 0 Building addition [No workers'comp.insurance S. 0 We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowncr doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.No workers'comp. c. 152.§1(4),and we have no 12.0 Roof repairs insurance required.)t amployces.[No workers' )3.❑Other comp.inwuancc required.[ 'My appamm that chocits bent el must also Tier wt the secliun below showlafg their workme cea l asuioa policy infininatipo. o It-who submit this aflfdsvit iMiming they use doing MI wait and than hire outside cost meat•ultr ait a new atRdavit idfmting sack :Cumrxtan that cheek thu but,must anadrod an addifiorcd chew showing the satin of the sub.,,,,ocmn and their¢asters'comp,policy infermarion. lam an empinyar thatirprovidfng workers'eampeneadon fnsarma efor my employees, Below is fke podeq and fob she information. lnnlrance Company Name- Policy#or Self-ins.Lio.#: Expiration Date: Job Site Address: City/State/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration elate)t, 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 SI.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 Investigslions or the DIA for insurance coverage verification. /do hereby ceetlfy under palas and penakles of perjury that the information provided above/s true and correct Phone�: C6o3> s�rr-Y�s"� Officfal use only. Do not write in this area,to be completed by city uptown of)7cial City or Town: _ PermidUcense# Issuing Ant hority(circle one): 1.Board of tlealrb L Building Department 3.CityfFown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#• QT'Y OF SALEM, MASSACHUSE M BUILDING DEPARTMENT a 120 WASHINGTONSTREET,31OFLOOR TEL. (978)745-9595 KIMBERLEYDRISCOLL FAX(978)740-9846 MAYOR TYiOMAS STTIERRE DIRECTOR OF PUBLICPROPERTY/BLIILDING COMMISSIONER HOMEOWNER LICENSE EXEMPTION PLEASE PRINT., Date t— :2 � q Job Locationn�,�X Home Owner Address ��� %/l lL> 0/ 9 7 U Present Mailing Address The current exemption of"Homeowners"was extended to-include owner-occupied dwellings of two Units or less and to allow such homeowners to engage an individual for hire that does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official, on a form acceptable to the Building Official,that he/she be responsible for all such work performed under the Building Permit. The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeowner" certifies that he/she understand the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with such procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING INSPECTOR CITY OF SALEg AwsAaiuu P3 BuaDnwDErAxnffwr 120 WA9MYMMSTREET,3XDpLoGR 7L(978)745.9595. FAX(978)740-9846 RIMRFRiFYDRISQ7LL MAYOR 7kRauc ST.PI M DntEcrcotcFPuaucrRoFzm/BumDmo sSfo7�m Construction Debris Disposa/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 156A. The debris will be transported by. (nam of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signat4 re of applicant _ - 7 i ( Date �y �—�' Proposal Proposal No. FROM vd CI AJAr-I I 6t et Va/lp�Lyyl� �! I y ,�_�, �j�/� .�r�� y Sheet No. . ) t,3� Pf QU11UA)41T -IC!' v`v Date G-raf FAUG f )ri6� 0�PQ5'5 i Iq //& Proposal Submitted To Work To Be Performed At Name t� � av Street Street l A t City State Ciy Date of Plans State Architect Telephone number We hereby propose to furnish all the materials and perform all the labor necessary for the completion of l All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and 'specifications s�ubmi�tted for above work and completed in a substantial workman Ike manner for the sum of with paN nts to be made as of o u o lNlAt, ��` V ` l pp Dollars ($ )• Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become on extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other, necessary 'nsur� p�q above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by r P)n K Respectfully submitted Per J igg Aji "/(�L ! Note—This proposal may be withdrawn by us if not accepted within yt/�� days ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. r V � Accepted -'_,_;A: t\ �� r 'r l%� Signature�.( � *" �-�-- Joseph Bennett PO Box 49, Steep Falls, Maine 04085 (207) 337-4013 Email: benneettjoe66@gmail.com Mary Page 20 Winter Island Road Salem, MA 01970 Scope of Work 1. On Sunday, December 13, 2015 we did an onsite review of a specific Scope of Work as created by RJS Associates, Inc, and was provided a copy of said Scope of Work at that time, see Attachment#1. 2. Our estimate was based solely on this Scope of Work (Attachment#1). Our origin estimate was for $51,000.00 to supply all materials and labor to complete this work. Approximately one week later we discussed pricing with Debra Bettinger at RJS Associates and agreed to complete the original Scope of Work(Attachment#1) for$46,650.57 at that time. During our discussions concerning this work I brought to her attention some associated costs not addressed as specific line items in Attachment#1. 3. On December 28, 2015 1 received a revised Scope of Work approving the $46,650.57 we discussed for Attachment#1.This revised Scope of Work (Attachment#2) lists many of these additional tasks and costs discussed and referenced in #2 above. 4. This estimate is based on completion of Attachment#2 as the Scope of Work for this project. General Notes • All additional work to be executed upon approved written orders. • Due to the nature of renovation work we are not responsible or liable for any unforeseen hidden conditions involving extra work. We will provide one estimate free of charge for this additional work. All additional estimates for this same work will be completed for$50.00 per hour, invoiced as part of the estimate and payment due upon receipt regardless if estimate is approved or not approved. In the event that this additional work is awarded to others all previously contracted work as dictated by this proposal/contract still applies as previously agreed and approved. Given that we were the first contractor hired it is understood that we are the designated supervisor for all work directly related to this contract and all associated AWA's (Additional Work Authorization) and CO's (Change Orders); all scheduling of others is to be coordinated through us directly. It is the responsibility of the Owner to direct his/her additional Contractor(s) to establish this chain- of-command regarding all work directly related to the completion of this project. • Our hourly rate is $50.00/man hour for all projects performed "time and material" (T&M). We often stock the required fasteners and supplies necessary to complete projects and will Invniro c,irk mmtorimlc withniit n cnloc roroint • Upon completion unless noted differently final cleanings are as follows: o Exterior: Rake, sweep and magnet run to pick up loose fasteners from the ground. o Interior: Broom swept. • Insurance Certificate available upon request. • All required permits and fees are the responsibility of the Owner unless noted differently in the Scope of Work. • Standard hours of operation, unless noted differently above, or restricted by town/association regulations are: Monday—Saturday 7am-6pm. • We are to have access to running water, electrical power and circuit breakers at all times during agreed hours of operation. • We may supply a dumpster and/or portable toilet on-site for use by our workers only, locations to be determined by Owner if applicable. Payment Terms/Schedule • TOTAL COST to complete above work to be $51,000.00 • $15,300.00 (30%) deposit due upon acceptance of proposal and to begin work. • $15,300.00 (30%) payment due upon completion of all wall surfaces to the point of paint ready surfaces. • $10,200.00 (20%) payment due upon completion of all new flooring, paint, dining area custom bench and completion of all work in bathroom. • $7,650.00 (15%) payment due upon completion of all work less kitchen cabinets & associated countertops. • $2,550.00 (5%) payment due upon satisfactory completion. • All invoices are due upon receipt unless specifically noted otherwise. Note: this is a fast paced project expected to take approximately 6 weeks start to finish. No completion date is implied whatsoever. • 5% late charge to be assessed on all outstanding invoices over 7 business days past due. • All invoices remaining outstanding for over 30 days will be assessed an additional 5% late fee and collections turned over to civil court and/or a collection agency. All charges rendered by this third party are the responsibility of the Owner. • A Return Check Fee of$100.00 to be due immediately on all returned payment checks. It is agreed that all documented bank fees related to the returned check is additionally the responsibility of the Owner. Respectfully submitted otIJanuary 2, 2016. JoscNpWBennett Contractor Acceptance of Proposal The above proposal is hereby accepted. You are authorized to complete the work as specified above. Payment(s)will be made and adhered to as specified above. We have read, understand and agree to all terms, specifications and conditions as outlined above. Approved: Printed Name: Mary/Page Date: % ' ' RJS Associates, Inc ,,tt 1820 Turnpike Street , (/� Suite 207 � " �•-+� North Andover, MA 01845 (978) 655.4994 X14-(978)655-3571 dbettinger®rjsassociates.biz Insured : Mary Page Address : 20 Winter Island Road C Salem, MA 01970 C C A Polley No HP357623 If Action Description C Interior Kitchen Replace Acoustical Cell. 12x12 Replace Cell Insulation Batt 9 o Replace Strapping/Ceiling Furring 1 X 3 Replace Cove Molding 2 3/4 Paint Cove Molding 2 314 Replace Calling Fixture Replace Drywall/Shestrock Wall 1/2 & Fit �(( �� Replace Fit Insulation Batt 3 1!2 I w Outside wall only Replace Paneling P/F Plywood G/a tom ' '" Half the walla Replace Wallpaper Half the walls Remove/Reset Outlet(s) Enclosed Const. Remove/Reset Switch(es) Enclosed Const. Replace Cased Opening Lg. Hardwood RJS Assoclates, Inc lBsuRM: Mary Page Polley No : HPU7523 Clem Nw&w 15F Action Deseription Interior Kitchen Replace Wall Cabinet AN Wood Replace Base Cabinet All Wood Replace Counter Top Postformed Replace Ceramic Tile Backsplaeh RemovWReset Kitchen Sink S/S Db W/Fauc Remove/Reset Dishwasher Remove/Reset Washer 2 Remove/Reset Built M Range 1 Remove/Reset Refrigerator 2 Replace Vinyl Sheet Floor �� e Dining Area Race FDtrywalUSheetrock Wan 112 & Replace Wan Insulation Batt 3 M Two outside walls only Replace Wallpaper Helf the walb Replace Paneling P/F Plywood Replace Base Cabinet All Wood Replace Counter Top Postiormed Replace Bunt-In Bench Seat Replace Vinyl Sheet Floor 0l¢j a Hall / Replace DrywaA/S"heetrock Cell. 112 & Fit Replace Cell Insulation Batt 9 Replace Strappinsi/Cellina Funine 1 x 2 RJS Associates, Inc INSURED: Mary Pape poky No : HP357623 Claim Number : 151 Action Description Interior Hall 1 Replace Paneling P/F Plywood G/Q Hall the two walls Replace Wallpaper G/Q Half the two walls Replace Vinyl Sheet Floor G/Q lvemlo Hall 2 l.oetO�)Q Paint Ceiling[2 Coats] Bathroom �,�,n Replace Vanity48 Dus !�(J Replace Counter Top Postformed Special Remove/Reset Sink Special Remove/ResetToilet Replace Floor Tile Vinyl 12x12 G/Q Replace Undedayment Lauen 114 0 Bedroom I C7 offset 1 Replace Drywali/Sheetrock Walt 1/2 & Fit Inside wall that abuts bathroom Replace Wallpaper Paint Door Trim Set 2112 1 Side Paint Window Trim Set Paint Hardwood Base RJS Associates, Inc INURED: Nary Pape Poiky No : HP367623 Claim Number ISM589 04 .�� -7 Action Description Quantity/Unit General Actions Special Move/ProtecUReset Furniture 2.00 RM Special Subcontract Cleaning Clean 1.00 LS Team INcludes damo0tlon,drying and clean up O Clean After Repairs are Completed &00 HR Actin SUB TOTAL OVERHEAD@ 10% PROFITS 10% SALES TAX @ 6.25% (On Materials Only 3 �4✓ V V " �/ LESS DEPRECIATION LESS DEDUCTIBLE NET CLAIM AJ s� � Details Page 1 of 1 The Of ii is YJeGsfw of 5c Executive Ji iw of P,bl; "2fety and Secufity(EOPSSi Mass.G—Home State Agoncies ensee Details FullName: 096RANT E PAGE Gender: Owner Name: Address: Address 2: City: LONDONDERRY State: NH ipcode: 03053 ojmtrV7 Ll 'ted tates License o: CS-094251 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 5/9/2014 Issue Date: Expiration Date: 5/5/2016 License Status: Active Today's Date: 1/7/2016 Secondary License: Doing Business As: atus Chance: Lic se Renew I o Pre-requisite Information No Discipline Information ocumen um Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=283192& 1/7/2016 Proposal Proposal No. FROM V J�f l�I � G � ,����,, rr�/�� ,r�� Sheet No. t,3j ��t[U�. 1C� �`fp/ Date, Proposal Submitted To Work To Be Performed At Name k1ovStreetStreet N City State Cif) Date of Plans State Architect Telephone number We hereby propose to furnish all the materials and perform all the labor necessary for the completion of All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and 9specifications ry—s�ubbmgiittted for above above work and completed iin� �a ubstanntitiall w orkman ike manner for the sum of ( �lj(/ e`V ev �1 � 6 N��j l���tC/6r✓' I Dollars ($ ,. with payments to made as fo laws: Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other, necessary (n,suran�ce�p�g above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by 1�®IN �/L.d 1C2 Y Respectfully submitted ! Per O i IvNy Note—This proposal may be withdrawn by us if not accepted within A)Ipr days ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted T :L. Z Signature jT4d'�