70 WINTHROP ST - BUILDING INSPECTION r
The Commonwealth ofMassachuse RECEIVED
'uh Board of Building Regulations and Stan at�3sECT10HAL S E R I I C E I OF
TEM
Massachusetts State Building Code,780 CMR RevisedMar2011
Building Permit Application To Construct,Repair,RenoV&tM&ilipisA 4
One-or Two-Family Dwelling
This Section For Official Use Only
r Building Permit Number; Date Applied:
Building Official(Print Name) :. Signature — ate
,.
SECTION 1:SITE INFORMATION
- 1.1 Property dress: 1.2 Assessors Map&Parcel Numbers
. 70 GU 1 N }�/'D�S7t'
L I 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(it)
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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP) '
2kOvt{ner�off'Rrord: � -
U ono-1o5. S< �iq
Name(Print) City,State,ZIP
?0 Le.116 geo I?9gzWy167
No.and Street Telephone Email Address
SECTION 3:DESCRIPTIONS OF PROPOSED WOftk. (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Prop sed fork: it— .a s 1
�
[ &221 i i3c,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Pee:.$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑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: $ S 6 d,0 ❑Paid in Full ❑Outstanding Balance Due:
rc�T,�t -q-o N.o . z(L-0 s:
SECTIONS: CONSTRUCTION SERVICES
5.1 Clonstruction Supervisor License(CSL)
License Number Ex 'cation Date
Name of CSL Holder U
^ � A f 1 n�Jn 4 ,3
List CSL Type(see below)
�( h � r
No.and Street Type Description
PPG O U Unrestricted(Buildings u to 35,000 cu.ft.
1 '� / R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
S I Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /7 1 y O 2 7 2e%6
IA44 V t2 o S Con Sfd I C 1 /r)at ) r'J C HIC Registration Number Expiration Date
Company Name or HIC RegistrrTne
`f �,y��2 s% luatJr2e S�/ if
N andS$treeey g y// Ema l addresscry 7 'L?/
Ci /Town,Sidle,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 suance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........❑
SECTION?a: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 715:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains nalties of perjury that all of the information
contained in this application is true and best of my knowledge and understanding
Print Owner's or Authorized Agent's Name onic Signature) Date
NOTES:
1. An Owner who obtains a buildi permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home I provement 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
wxnyji s.eov,'oca Information on the Construction Supervisor License can be found at%v Aw.mass.gov/duets
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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
u1pokers'Compensat
I Congress Street, Suite 10O
Boston,MA 02114-2017
www.mass.gov/dia
�3rm- ion Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERIYHTTING AUTHORITY.
Applicant Information ,�^ /// 1_ _ / Please Print Letribly
Name (Business/Organization(lndividual): ,M/tI�/LO� CD/l S'17 N cll o y
Address: 67PfM6f/45i- ST
City/State/Zip: &,�6 /q4 Phone#: ?g/ g` q 9/3
Are you an employer?Check th appropriate box:
Type of project(required):
I. I am a employer with temployees(full and/orpart-time).` 7. ❑New construction
2.❑I am a,sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.(No workers'comp.insurance required.)
9. El Demolition
3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance.= 13.❑Roof repairs
6.❑we we a corporation and its officers have exercised then right of exemption per MGL c. 14.❑Other roO F r'epCa C
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
-Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: *CRf b 11( 0 S ct✓ANC-e
Policy#or Self-ins.Lie.#: �C^ 2� ' 20 —a 0 2-0 0 5�_ E �xpiration Date: Z-Job Site Address: 70 W 1 t7 f iO jo S`f City/State/Zip: 5k4Le4-( kAK4 '
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ida hereby certify under a pains and penalties ofpertury that the information provided above is true and correct.
Su mature Date:
Phone#: ( cneg 81
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple pemdt/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
�2'v �. .. V`� Naynmcaauoea�e� auec�upelLd -
OtTieeofConsumerAffairs&Bursas Reg illation
-' - -
`r - - ME IMPROVEMENT CONTRACTOR
istmUon: fi`1'462 Type:.
it
�s. t Plration:�f-3/_-1`�4/201�� Coryora}i6n
MAVROS CONSTRUCTIO INC i'r
. MIHAEIA. MAVROS
14 GARDNER ST
PEABODY,MA 01960 Uudenceerefxry
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-=721
JOHN L KARAVOLAS 71
+ ?/
29 ABINGTON AAE a .7
PEABODY MA 01. Ili
i
Expiration
Commissioner 09/25/2016
r<
��MAVR®S , PROPOSAL
�L1/CONSMUCTION INC. ,
i June 22,2015 _
14 GARDNER ST 1
1 R �PONTIUS ICHARD
i
PEABODY MA 70 WINTHROP ST '
978 5315055 CELL 711111448133 SALEM MA
HIC#171401 9787414167
I MAVROS@COMCAST.NET
I� MAVROSCONSTRUCTION.COM I
f
PROPOSAL
Description: entire roof
1. Complete roof preparation
2. House to be protected by tarps and plywood to protect landscaping,and shrubs
3. Entire roofing materials to be removed to existing decking
4. Site to be cleaned everyday debri removed by dumpster
5. Deteriorated existing decking replaced up to IDO I ft
6. 8 inch metal drip edge installed at eaves and rake edges
7. New metal step flushing will be installed where is necessary
8. New plumbing vent flushing will be installed and flashed
9. Install new pipe boots on all exhaust pipes.Install chimney flashing
4
10. Gaf leak barrier installed 2 rolls high at all eaves to protect from ice dams and meet
code
11. Gaf leak barrier installed in all valleys around penetrations,and chimney to protect
I critrca areas
12. Install titanium u d 1 synthetic roofing underlayment on entire roof.
13. Install architectural shingles oprx 16 sq including caps
14. Install cobra ridge vent.
We hereby propose to finish labor and materials complete in accordance with the
proposal for the sum of$5,600.00
I
MAVROS CONSTRUCTIONINC
RESDENTIAL*COMMERCIAL*INDUSTRIAL,*LICENSED*INSURED
ACCEPTANCE OF PROPOSAL
PZ
This agreement made the 06/22dae 2015 by and between mr RICIIARD PONTIUS I lem matter called
the owner and MA VROS CONSI ANC: hem at after Called the contractor. Witnessed,that the owner and the
contractor for the considerations named agree as fidluw>.
Article 1 Scup; of Work.
The contractor shall furnish all of the labor and materials to complete all of the work As written on the proposal
and accepted by the owner.
Article 2.Timc of Completion
The work to be performed under this contract shall be completed no mum-
'Ihen 3 DAYS weather permitting .Changes to the scope of work by
The owner will add to the completion date.
Article 3.'1'be Contract Price
The contract price as agreed upon is S 5,lNNLCN)RE R(R)E I R)USI: SEII.PROPOSAL PG I
Article 4. Pn=ss Payments
40%when we start. rest when we finislI
I & half"/ interest per month on any unpaid balance. All attorney Pecs and court costs shall be horn by the
owner if collection Procedure:must be implemented.non pavment or customer hold backs,following completion of
job as outlined in contract will result court prcccdings.
Article 5.WarranKy
']'he contractor warrants his workmanship 7 NTARS AND 40 YFARS PACI'ORN'WARRAN N'
Article 6.Changy orders
Change orders must be in writing and signed by both the owner and contractor And shall he incorporated in and
become a part of the contract.
Article 7. Insurance
The contractor will provide the owner a cope of his current insurance certificate.
Article 8 cancel contract.
The client has 3 business days to cancel contract from the day of acceptance.
6,111T.DTOTIIIS OF 6/22i 2015
RICK:\Rl) ):' A
IIJS � A.AI:\\'ROS
14 GARDNER ST * PEABODY,MA 01960 * Tell:-(978)5315055
L
CITY OF SALEg AWsACHUSEM
BUIIAIIJG DEPARRTAzxr
120 WASH NGIIONSTREET,YoFLOOR
TkL(978)745-9595
KHaERLEYDRISOML FAX(978)740.9846
MAYOR THOMAS STYMRRE
DIRECTOR OF FUBL1cPROPEm1BUIIAANG omaassiomR
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 ti I z 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:
6°f n ,4 tip //'K 6-
(name of hauler)
The debris will be disposed of in:
(name of facility)
ook s� z
(address of facility)
:s#iae of pplicant
D
Date