1 WITCH WAY - BUILDING INSPECTION c�K � �F 3 i 8 ��q �
� The Commonwealth of Massachusetts
� BoardofBuildin Re ulationsandStandards RECE YED � Q
Massachusetts State Building Code, 780 CMR ��SPECTIO�i� t- �����
Revised Mar 2011
.� Building Permit Application To Construct,Repair, Renovate Or D,�poli�a_ A ��: 46
One-orTwo-FamilyDwelling �-�U��
� 'Ihis Section For Official Use Only
Cl Building Permit Number: Date pplied:
�J �'
(�(1 Building Official(Print Name) - Signatur_ v� Date
��l SECTION 1:SITE INFORMATION
�
I 1.1 Pro e dr�is: /� ///�� 1.2 Assessors Map&Parcel Numbers
� + �/� (/v —
11a s this an accepted street?yes no Map Number Parcel Number
11 1.3 Zoning Ioformation: � 1.4 Proper[y Dimensions:
l
Zoning District Proposed Use Lo[Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yazd Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.4Q§54) 1.7 Flood Zone lnformation: 1.8 Sewage Disposal System: .
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal O On site disposal sys[em ❑ �
Check ifyes0
SECT[ON 2: PROPERTY OWNERSHIP'
21 Q �qf Rec�rd: � - �. �� A�,� D . / �
A✓1�..�i /''G Z _
Name(Pri ) City,State ZIP _ ��Sp�l._��J�
o' ��� —3� ,�
No.and Stree[ Telephone Email Address
SECTION 3:DESCRIP'fION OF PROPOSED WORKZ(c6eck all that appty)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ Alteration(s ❑ Addition ❑
Demolition ❑ AccessoryBldg. ❑ N berofUni[s Other .Speci : O
B�nef- escripti�fProposed WorkZ: ` �cI'
> �
+ �p
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofticial Use Only
Labor and Materials
l.Building $ � 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical g ❑Standazd City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2, Other Fees: $ 9 '�
4.Mechaoical (HVAC) $ L��� �,• �� . I
5.Mechanical (Fire �
Su ression $ Total AII Fees: $
� Check No. Check Amount: Cash Amount:
� 6.Total Project Cost: $ � �� p pa�d in Full ❑Outstanding Balance Due:
1 `� I�l l� � �,1� Q'U 1-�. p,
�
Y�-2 � ��cwr�
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supe is License(CSL) 1
- �_.��/ License Number piratio Date
Name of CSL Holder' -
1' O List CSL Type(see below) y
No.and StroCt r�1 Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
Ci own, O[e ZI _ M Masonry
RC Roofing Covering
WS Window and Siding
SF SolidBurning Appliances
I Insulation
Telephone Email address D Demolition
5.22 Registered Tome Improovemenn 6,ontractor(HIC 12/���/
HIC Registration Num her xpiration Date
HIC„C� a or IC Registrant Name
—lL
street � �S/• 7/may? Email address
Ci /Town, ,ZIPL Telephone J
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 BU DING PERMIT
I,as Owner of the subject property,hereby authorize �
to ac;
behalf,in all ma �lj�atrve 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 thi application is true accurate to the best of my knowledge and understanding.
7/ 0
Print Owner's or Authorized Agent's Name(Electronic 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.gov/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 dec /porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost ey;7
Massachusetts -Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards contain less than 35,000 cubic feet(991M )of
Construction Super,isor enclosed space.
License: CS-103080
STEVEN C ffiOU ` _p��
2 NEPTUNE ROA2)A'PLtz,1�40�f
EAST BOSTON IOWA
Failure to possess a current edition of the Massachusetts
Expiration State Building Code is cause for revocation of this license.
Commissioner 01/27/2017 For DPS licensinginformationvish: ~v.Mass.Gov/DPS
-�/e`fr o�unm,+roen/U ojc�/(os:admNtG t License or registration valid for individul use only - -
S°- mceof Consumer Affairs& Business Regulation
I before the expiration date. If found return to:
ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation
egistration: 171254 Type: 10 Park Plaza-Suite 5170
:ard
Boston,MA 02116
rExpiration-':-3/1%2078- Supplement t.
M GENDRON 8 SON CONSTRUCTION LLC.
}
e
e
STEVEN HIOU
P.O.BOX 1024 1
DERRY,NH 03038 Not valid with t signature
Undersecretary
MGS
CONSTRUCTION
ProposaLrcentract
Roofing Insti lladoln
FROM:
RIGS Construction LLC Michael I Manick
P.O. Box 1.024 781-MGS-ROOF 781-647-7663
(2 Lake ave.) mmanidc@mgsconstructionllc.com
Derry, NH 03038 North East Sales,Manager
Phone:60:1-216 2633 www.eW4MGSROF.com
Fax:603-432-3282
PROPOSAL SUBMRTED TO::
i
Christine-OSden
1 Witch Way 1 Witch Way
Salem, MA 01970
chrisobie@oamcast.net Salem, MA.0970
978-741-3598
V MGS Construction will remove and dispose of all existing roofing material and flashing from roof field
RrMGS Construction will supply and install V of ice and water shield atsoof eaves.andvalleys T to
rake locations,V around all sky lights (f any), pipe be otstroof penetrations
&TMGS Construction will supply and-install 100%of Ice and Water shield to all dormer roofs"y window
bump outs and entry roofs (under 3172 pitch if any)
MGS Construction:will overlap the ice and water shie?d 10 over(ascialrake boards to help protect
against ice dam damage
grMGS Construction wilfsuppiy and install roof shingles
O 3-Tab Shingles:.
WArchitectural
Designer
WMGS Construction will hurricane nail 6 nails per shingle to protect against blow offs
grMGS Construction-will supply and-install a professional grade drip edge
3
9rMGS Const action will supply.and install starter strip
EZPro Start
❑;Weather Blocker
9MGS Construction will supply and install'roof,mutilation
❑'Cobra Vent
WSnow Country
0 Master Flow
W MGS Construction will supply and install DedC Amcor
GKMGS.Construction will supply and install`ridgy:cap shingles
WSeal-A-Ridge
❑Timbertex
J;.- 0tT :
R+
0
J
1tgSt k 7100
++F
Y' t�py\ll fi� 10 J
1 Ye�ratrartteed > ' 7DOO 140
t
4
112JGL�1Al
IEH�� ]ICES _J
In,the event that unforeseen rot is found.A plywood rephicement charge in the amount of$50.00 per
sheet(labor and material)will be billed additionally to ON,Contract amount Should ledger Ward be in
need of replacement the cost will be$2.50 per linear foot and will be billed additionally to the contract
amount below.
Any items not stated above are to be considered as an extra charge and will be invoiced separately from
this billing.All other agreements to be made in;writhig bidween the customer and MGS.
TERMS/NOTICES: RESIDENTIAL
MGS Construction.is not responsible for any shrub, landscaping, lawn or loose personal property
damage while work is in progress. it is the home ovaiee-3 responsibility to ensure that prior to the start of
the project alt areas of concern are prepared for start of project;Any shrubs, plantings that are potted
and easily able to move should be pulled away from the house to ensure that no damage will be endured
by work in progress. MGS Construction will tarp from th3 roof to the ground according to standard
practices to try and avoid causing any damage to any plantings and shrubs:however;due to the weight of
roofing shingles,and personal cleaning up the site MG: Construction.is not responsible for any damage
to plantings or shrubs within 15 feet the residence.All plantem; grills,patio furnishings, and other
precious objects should also be moved prior to the starl'r of any roofing or vinyl siding project.All vehicles
should be parker at least 15 feet away from the home during all work in progress this is due to debris
that could fall and or hit the vehicle.Meg Constriction is not responsible for any damages to this
property as this-should be.considered as a formal notion.All interior wall hangings;including shelving,
pictures, and other precious objectsshould be removed due to heavy hammering until the project has
been completed.
MGS Construction takes extreme care in the setting up of the equipment; scaffolding, and tarpsmsed on
each project in order to protectall_property and Iandscsrpes.,Anil exterior damages to property incurred
by MGS Construction will be remedied repalredhesolvod by MGS Construction. However,we cannot be
held liable for damages to plant and or flower beds,stimbbery,etc. located within 15 feet of the perimeter
of the work area.
MGS Construction will not held liable for cracked of damaged drywall or for any interior objects that.
may vibrate,shake,or fall due to heavy hammering or normal.construction Work.
5
OTHER TERMS:
Color&ow by hm eownOr
Dobe: .08-21-15 . SlgnaEuW.
6
L
WARRANTY:
Manufacturer's warranty:The manufacturers all cany limited warranties on all products used(usuallypro
rated afters years).MGS Construction is a-certified Certainteed 5 star installer and a Master Elite GAF
installer.This allows us to offer the following warranties :)n top of the manufactures warranty:
❑GAF System Plus
WGAF Golden Pledge
MGS Construction will warranty their craftsmanship for 15 years from the date of completion.This does
nottinclude acts of nature and or damages incurred by others.
PAYMENT TERMS:
We hereby propose to furnish labor and materials to complete in aC0Da e WIMP a ove
specifications,for the sum of $L,000
'[ U NC OOMMPLETIONOFTHE"PROJECT
PAYMENT WILL BE UE.IN UPON DATE OF C
All material is gauranteed to be as specified.All work to be completed in a workmanlike manner
aeoording to standard practices.Any alteration or clevistion from the above specifications involving extra
j costs will be executed only upon written orders,and will become an extra charge over and above the
estimate.All:agreements contingent upon strikes,,accident or delays beyond our control.The first.visit
discount is valid only on day this Proposallcodiract was created with your sales consultant.The -
gauranteed price is valid for one year from the date the:Contract/Proposal was created with your sales
consultant.This proposal is subject to acceptance within the time frame stated above and it void
thereafter at the option of the undersigned.
9
Authorized Signaturel -� ir,,�./
ACCEPTANCE OF PROPOSAL
By signing this proposal.it will then:in fact:be oonsidendf to be ai legal and binding contract between
Christine OBrien and MGS Construction.The above prices,specifications and
conditions are hereby accepted.You are authorizing aIGS Construction to do the work as specified
above. Payment will be made as outlined above.Shall MGS Construction not reoieve payments in
accordance with the above stated terms all work in progress will be stopped immediately untilpayment
has been recieved from you the client.Upon not receiving the final payment for the completed contract/
projects, MGS Construction has the right to hold you the client responsible for all and any reasonable
legal,filing, and attorney's fee's necessary for MGS Construction to collect payment at yourexpense.
ACCEPTED: l
Date: U6=21=15 Signature: f � `�
Signature:
ALL ACCEPTED'PROPOSALS MUST BE SIGNED ANDA URNED`TO OUR OFFICE,
UPON ACCEPTANCE.
CSL Signature:
'r
CERTIFICATE OF LIABILITY INSURANCE DATEIMM/ODIYYYYS
TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
• CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE
OR PRODUCER.ANILM&SIMIELCATE 14OLnFR
• IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to
he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not Confer rights to
he certificate holder in lieu of such endorsemen s.
PRODUCER CONTACT
NAME:
PLANRIGHT INSURANCE PHONE E(AICN-1:
224 MAIN ST STE 2A (AIC,No,Ext):
EMAIL
SALEM,NH 03079 ADDRESS:
76HMH INSURER(S)AFFORDING COVERAGE NAICN
INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY
M GENDRON R SON CONSTRUCTION LLC DBA MGS INSURER B:
CONSTRUCTION INSURERC:
INSURER D:
P O BOX 1024 INSURER E:
DERRY,NH 03038 INSURER P.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INS S TO CERTPYTHAt THE POLICIESNSU CE LISTED BELOW NAME BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS ANDCONOTIONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY
PAIDCLAIMS.
INSR ADD SUB POUCYEFFOATE PCUCYEXPDATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) OMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE REMISES
OCCUR. ES( RENTED $
REMI (Ea ocwrtence)
EO EXP(Any one Person) $
ERSONAL B ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $
POLICY PROJECT[3LOC RODUCTS-COMPIOP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALLOWNEDAUTOS BODILY INJURY $•
SCHEDULE AUTOS (Per person)
HIREDAUTOS BODILY INJURY $
(Per accident)
NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAR M OCCUR EACH OCCURRENCE $
EXCESSLIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ S
A WORKER'S COMPENSATION ANDX WCSTATUTORY OTHER
EMPLOYER'S LIABILITY YM UB-4292P583-15 061J02015 067302016 UMrts
ANY PROPERITORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDEDT NIA E.L.EACH ACCIDENT $ 100,000
(Mandatory In NH) E.L.DISEASE-FA EMPLOYEE $ 100,000
Ilyes.des beunder E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATK)NsiLOCATIONSNENICLESIRESTRICTONSISPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED N THE CERTMCATE HOLDER AFFECTING WORKERS CONN?CO VERAGS.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
M ACCORDANCE WITH THE POLICY PROVISIOt EC'
AUTHORIZED REPRESENTATIVE ,
� J
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP (STIP,�Afffthts reserved.