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7 WOODSIDE ST - BUILDING INSPECTION 1 - --- I'hc Commonwealth of Massachusetts is '� Board of Building Regulations and Standards SALG\I OF+ 5,\L Massachusetts State Building Cute, 730 C'MR l 'L,,., N.ri.nal.ILn 'till Building Permit Application To Construct, Repair. Renovate Or Demolish a One-or T4o-Funtils Dtrrllinp This Section For Olrcial Use Only Building Permit Number: e A pticd: / �j� _ Z L( Ju h v Building 0177cial(Print Mane) I Si lure Date r Sf' SECTION I:SITE INFOONIATION4Z 1.1 Property Address: 1.2 Assessors.Nap Parcel Numbers 1.In Is this an accepted street? 'n no blip Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed the Lot Area(sq It) Fnnttage(II) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c. 40.§ 1.7 Flood Zone Information: 1.8 Sewage Disposal System: ZoneFl ood Outside 'Lune. Public t7� Private❑ — Municipal Check if �es❑ P dOn site disposal system ❑ SECTION I: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Nalno(Print) City.Slat.ZIP 7 4f/t2:;'JS '- 57— 99 V-ge q-?I P9 No.and Street relephone Email Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction ❑ I Existing Building❑ Owner-Occupied O Repairs(s) ❑ 1 Alteration(s) ❑ AdditidE03 Demolition ❑ 1 Accessory Bldg. O 1 Number of Units_ Other . pecil'y: Brief Description of Proposed 1Vork': pl sn �tV,,F y SECTION J: ESTIMATED CONSTRUCTION COSTS licill Estimated Costs: Ofllclal Use Only Il..tbur;tttd Materials) y I. Building S I. Building Permit Fee: S Indicate how fee is determined: lilectrical S O Standard City+To%n Application Fee ❑Total Project Cost'(Item 6)x multiplier _.._ .x _ 1. Plumbing S ?. Ocher Fres: S- List: ���C J. M"11.mic.d ill\.W) S List: U Virc Fi„rcuionl S lard .\IlFees: S - - - Check No. ('hock Amount: Ca. h \momw Tntal project Cust: S — ❑ Paid in Full ❑ Outstanding Il.1 ;lncc Doc: SE( I'l0N 5: CONS i-RUcriaN SERVU F'S 5.1 Construction Sul)er%isur License F\piratwii Pate Namc of0l, 11,11&r I Ist('St. l,N -------- r pe DusNriptiOn No, aid StrM 3 5,000 cu It I ii I Inresiricled(lltilldinEs ti p to It Rc.,tricted 1.c 2 Famil) M%elliIIII (711)irkmli.State./W %I Mason RC R,xiling L'overing t14.2ee e— A'S Windim Uld Sidin SF A Solid J�uel Burning Appliances L I 111sulatiOn I VIVPlIone L rillail addressaddressi) D I Demolition 5,2 Registered llume Improvement Contractor(IIIQ 3/ —7�r J.6 In 111C lkeglitration Ntankr Expiration Date I C pill) N� �rl Registrant Name 0;nc, No. and Street t:n1ail address CiOrrow,nZe.5L relephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.1 25CM) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the lssuancrof the building permit. Signed AMdavit Attached? Yes .......... No...........C3 SECTION 7a: OWNER AUTHORIZATION TO BE COf11PLETEDWHEN 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 O%Nncr's Nuane(Electronic Signature) Data SECTION 7b: OWNEWOR 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. 7A Print 0micr'.4 or Name IFINCLS1111V Signattiror nito NOFES: I, ;In 0,,g:stc,�It t to do his her own %vork,uran owner who hires an unregistered contractor I have access to the arbitration Ilut re reyiubta'ns a building pernii It the Hume Improvement Contractor 11-110 Program). will LU program or guaranty fund under NNI.G.L. c. 142A. Other important information on the HIC Program can be found a: %%W% W.1, �O% -,.I information on the Construction Supervisor License can be found at kk �O% SIP, 2. \\lien substantial work is plaoned, provide the intbrination below: rota) flour area(sq. n., (including garage, finished basement attic.decks or porch) Grois It%ing area i iti. tl.) Habitable rouni count \tmj�croffircplacci Number ol'bedrooms \mnhcrol hathrvoins Number ofliall haths I)peot heating Sy item Nionhcrot'decks, porches 1*' I oial Prow Stluare Fool,wc­ilia) be st,inNititacd fir* 1'oial project Cost" C['I'Y OF SALEM, AkSSACHUSETTS a. BUILDING DEPAk mcsT h�) 'f �• ��� 130 \'//.1SHLVGTON STREET, 30 FLOOR \.tat• ,.' TEL (978) 745-9595 Rut:(978) 7.10-98.16 l<I.N(13F f1t F.Y DRISCOL L TtiosLu ST.PIEUS A UYO:t DI:LECTOR OF PLSLIC PROPERTY/BLRDtNO COJLNIISSIONER Workers' Compensation Insurance Alitdavit: Builders/Contructurv/Electrlclans/Plumbers 1111llleant Informatlnn Please Print Lea_ihlx Name (Ft alto+s Urgtmaalion InJividual)t d� //{(! �r1 �t ��t!C� S Address: City/State/Zip:&Al. -14 a Phone N: -77e '—�/�—� Are you a _employer?Check he appropriate box: Type of project(required): L., aln a employer with �, ❑ I am a general camraclor and I 6. ❑Now construction entplayces(Rtil and/or part-time).* have hired the susconirsctors 2.❑ I am a sale proprietor or partner- listed on the attached sheet t 1. ❑ Remodeling .hip and have no employees These suscontractors have s. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. Building addition (No wurkcrs:comp.insurance S. ❑ We are a corporation and its roquired.( officers have exercised their 10.❑ Electrical repairs or additions ).❑ 1 am a homcuwnur doing all work right of exornptiun per MOIL I I.❑ Plumbing repairs or uddifions myself.(No workers'sump. c. 152, 11(4),and we have no 12.0 Roof repairs insurance required.(t employees.(No workers' Ij,O Other comp.insurance required.] %,,y epplkim dust checks but xt must ahw fin uul the melim bulaw ahowins their"hism,compenudun policy mnomanon. '1 Lvnvuwm"whka,uhmit Ihis sttldavil indieuana they AN duina all work and that him wisiale Contractors mint rolnnil a now arrrdsk indl=ine.urh. l'„mnelun that ahavk this bear must aaachad an IJdiliunal.hsl ahuwintl tb nurne o/the mlhsumncturs and(halt workers'wmp,policy froorsrstlon. lain on rurplayer(but!s pruvldlnrr warken'cumprurar/an lusuranee/or my employers, Below/s the poRry and job sire in/orumllnn. In,urntce Company Name:_ Policy 4 or Self-ins. Liu. th Expiration Date: tub Silo Address: City/State/zip: .11tacb a copy of the workers'compensation pulley declaration page(showing the policy number and expiration data). F.tiluru to scum coverage as required under.Cection 21A of s(GL e. 152 can lead to the imposilian of criminal penalties of a rine up to 11,500.00 and/ur one-year imprisonment,as Well as civil penalties in the form of a STOP WORK ORDER and a tine �Iekill to S2j0.00 a Jay against file violamr. Ile advised that a copy of this,latumvilt may bat furwardcd to ilia Ofiica of Lrvc,tigatiun.+�dthe nl�\ iur insurvtcc coverage vcritic❑ilea. /du hereby verb,(y auJdr the point mrd penaliler,a)"perjury that the hifunauNon provided above its true rind correct. i,:mirure: bard: U/licial rue anly, ll.r rroI write ire this area, 10,5e cunrplrl¢J 5y city ur town njjlriuL City or fu,vn:. -_ _ _ I'ermiuf.lccme I,+uin; ,\ul IlWily (circla one): —_. ...__ . I. Board ul Ilcallh Dcletrlotcnl 1. ('ilyi fawn Clerk J. I•aectrlc.tl fn,pechtr I. I'huahint; Inlpectur 6. Other -- --__---- . l��nl.tal I'erutn: Phone 1: r � CITY OF S.V-&Nrl Aus,kcfiUSETTS t ULDLNG DEPART. tE,`r 120 WASHNGTON STXW, J`ROOK ILL. �97� 74�959! K130FRr Y OR=OLL F,�X(97a) 14Q9846 NCAYO1t mov,V ST.PtZAAS DIRECTOR OP PL BLlc PROPHRT'/31;MDLNG cowlissION Eli Construction Debris Disposal At'ildavit (required for all demolition and renovation work) fn accordance with the sixth edition of the State Building Code, 730 CMR section 1 11.S Debris, and the provisiam of MGL a 40, S 54; Building Permit a 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 NIGL c l 11, S I50A. The debris will be transported by: --� 04me of hauler) The debris � ff will be disposed of in : (name of fam)ity) (�ddren aYf��il,iy) �fpermit ippticint _ lJ'a VINYL TILT REPLACEMENT WINDOWS I T - N RESIDENTIAL REPAIR SERVICE5 O ROOFING R L M N10 - 0673 S Dump Truck Service • General Contractor D D 978-423-4574 0 N LIE#13125 R GUTTERS STORM WINDOWS ROOFING ESTIMATE ESTIMATE SUBMITTED TO: JOB NAME JOB# IR44 14-r ,'r_ A k ADDRESS JOB LOCATION CITY/STATE/ZIP DATE PHONE# FAX# CELL# C1�k- 7l ' gjpq WE HEREBY AGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW... NOTE: ONLY THE MARKED BOXES PERTAIN TO YOUR ESTIMATE. WE AGREE TO: y� ©�1. COMPLETELY STRIP THE ENTIRE 44AI Al -'1 P,./a-r ROOF(S) OF THE EXISTING /— ) ' LAYERS OF SHINGLES. ❑ 2. INSTALL A NEW LAYER OF SHINGLES OVER THE EXISTING ONE LAYER OF SHINGLES ON ROOF(S). 0'3. INSTALL A NEW RUBBER ROOF(S) USING ALL NEW RUBBER ROOFING MATERIALS ON THE nY/fiY Ltl,*-^i I 0'4. INSTALL-NEW ICE&WATER SHIELD ON M/--W A./--4,Pt, 14 "' f.l v. ROOF(S), (ROOFS EDGE)RAKES, VALLEYS, DORMERSySKYL'I+GHTS:,)CHIMNEYS & FLAT ROOF AREAS. O 5. INSTALL NEW I5' LB.ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE /f'/A-I.f! 0'6. INSTALL NEW 8INCH �r/!'aaT ALUMINUM DRIP EDGE ON THE ENTIRE r9' C ROOF(S). ❑ 7. INSTALL NEW ALUMINUM STEP FLASHING ON,}� � ` ROOF(S). O 8 INSTALL NEW(VENT PIPE BOOTS) ON /7A4+ 4 I& < A-r ROOF(S). ❑ 9. INSTALL NEW(ROOF BOX VENTS) ON 1'r�t y 1✓ ROOF(S). .- ❑ 10. CUT& INSTALL NEW RIDGE VENT ON ROOF(S). ❑ 11. INSTALL NEW LEAD ON CHIMNEY ON T ROOF(S). 0'12. INSTALL NEW SKYLIGHTS ON ILr1ir Cl.l� t / yYel ROOF(S). O -1-3. INSTALL 1,V FT. OF(ROOF BOARDS) OR(PLYWOOD SHEATHING) ON THE ROO,D'OF THE A�iY /Ylw��✓r< AJ vA 5 �^ , COSTS$3.00 PER SQ. FOOT, COVERS MATERIALS AND LABOR. O 14. INSTALL NEW Z 4 YEAR f YA ! 7 Al ly.„L,.,. SHINGLES ON THE / / n ROOF(S). 0'15. INSTALL/ REPLACE/REPAIR 1A k f ,&,-✓A-1 /.'�4rr .. ^w-f A<1 I(lJvv /<a4� �A k A/ ,��)Penl,eriY•. H rs�A,R1.�9<v9 IAAfe.6 *1 0:7' l4 t I^7Yr,.. � 11,4-4 4.f a / 1/nr,✓n�.n/7'..�cfa4,/� f/,4�'a f�.<A+/>, C.`NTir.ur S. �,.�"'.frl(!nr I � 1 0 16. SPECIAL CONDITIONS *fit I NOTE: WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS.CUSTOMERS SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE BY COVERING EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENTANY DAMAGE DURING THE STRIPPING OF THE ROOF.HOWEVR,SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR CONTROL... NOTE: (IF)MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE,AN EXTRA CHARGE WILL BE ADDED FOR THE (LABOR&THE REMOVAL OF THE DEBRIS)OVER AND ABOVE THE PRICE OF THE ESTIMATE. We propose hereby to furnish material) and labor- complete in accordance with the above specificatiobns for the sum of: $ Aim- /&9w, 1 r /lA�r• Hri��vr�( T/G�a 4�/�/I Dollars with payments to be made as follows: 1f/t3 '-"f �/Cif� z/Ar-d Any alteration or deviation from the above specifications inwlving extra costs Respectfully '::f:�> r / will be executed only upon written order,and will become an extra charge over submitted and above the estimate.All agreements contingent upon strikes,accidents,v, delays beyond our control. Note-this proposal may be withdrawn by us it not accepted within l!J days. cAircrom Of props-at The above prices,specifications and conditions are satisfactory and are hereby Signature ", accepted.You are authorized to do the work as specified.Payments will be � - -- -- + made as outlined above. / / \ Date of Acceptance 4 ` b Signature