1A WOODSIDE ST - BUILDING INSPECTION (p3, GK-
The Comtnonwealth of Massachusetts M e.NYE T
Board of Building Regulations and Standards =;�tSPE—- +A1 S iY/�
Massachusetts State Building Code, 780 CMR SALEM
Revi�sgd��y11ar 11
Building Permit Application To Construct, Repair, Renovate Or Det�O 6-11 b Il
25
One-or Two-Family Dwelling
�^ This Section For Official Use Only
C�O Building Permit Number: Date Applied:
n Building Official(Print Name) Signature We -
f� SECTION 1: SITE INFORMATION
1.1 Prope ddres,: 1.2 Assessors Map& Parcel Numbers
1.la 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(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'
2.1 O ' f Record: � L
Nam7ffrnt / City,State,ZIP 10,
f IA14 e z f 97r-�9
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) ❑ Alteration(s) Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ umber of Units_ Other 167—peci : O 710-
Brief Descnpt n of Proposed orkZ:
r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ % 0 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ s
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Cons'tr9ction Supervisor Lice se CSL)
ficcenssee 4Number E cpiration Date
Name of CSL Holder
/ / List CSL Type(see below)
No.and SStrtro6t C� Type Description
c /2� U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City own, t ,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.22 RReegpstteey5yn4 Home rovemennntt Co for(HI n� 2 �1 0
/ / ✓ �/ P - y �J"f/ HIC Registration Number /xpi tion Date
HI �a C any Na r HIC egistmnt Name
a
N treet �/,// �� Email address
City/Town, S 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 APPLIE FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize oe" Le
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: OWNER[ 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 a lication is true and acute the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
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.eov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basementiattics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halffbaths
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' o 0
Jflfly (� f-7I1711fJlfC'fflt�fl f /dGfliifGC�CIiE'
Office of Consumer Affairs aid Business Regulation
n,
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 171254
Type: Supplement Card
Expiration: 3/1/20t 8
M GENDRON & SON CONSTRUCTION LLC
STEVEN HIOU
P.O. BOX 1024
DERRY, NH 03038
Update Address and return card. Mark reason for change.
Address Renewal Employment Lost Card
.- 0ffiee of Consumer Business Regulation License or registration valid for individut use only
u OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:.
Office of Consumer Affairs and Business Regulation
Registration: 171254 Type: 10 Park Plaza-Suite 5170
Expiration: 3/1/2018 Supplement Card Boston.NIA 02116
M GENDRON&SON CONSTRUCTION LLC.
STEVEN HIOU
6 ENGLISH RANGE RD
DERRY. NH 03038 ("ndersevetarr Not valid witho tsignature
Unrestricted-Buildings of any use group which
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards contain less than35,000 cubic feet(991m )of
Construction Supervisor - enclosed space.
License: CS-10 t3090 I
STEVEN C WOU
2 MagW E ROAR APOW 0
EAST BOSTON 1RA j0 Failure to possess a current edition of the Massachusetts
�'' State Building Code is cause for revocation of this license.
J� Expiration
Commissioner
0112712017 rdr DpS t)censing information visit: vsww.Mass:Gov/DPS
f CITY OF S.0 ENI, TNLkss ka-iusETTS
BLILDLNG DEPARTNI&NT
130 WASHNGTON STREET, 310 FLOOR
TEt_ (978) 745-9595
FAX(978) 740-9846
KI\tBERL.EY DRISCOLL
,MAYOR Titomm ST.PmRRS
DIRECTOR OF KBLIC PROPERTY/BVUMLNG COMMISSIONER
Construction Debris Disposal 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 c 40, 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 disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
G
(name of facility)
(address of facility)
signature of permit applicant
date
dcbri.ffdow
i CITY OF S.UX.M, .MASSACHLSETTS
BUILDIING DEPARINBUNT
• 120 WASHINGTON STREET,3'a FLOOR
TEL (978) 745-9595
FAX(978) 740-99"
iQ�{gFRI-EY DRISCOLL
✓MAYOR T3IOMAS ST.P>F.RRB
DIRECTOR OF PUBLIC PROPERTY/BL'ILDLNG CO%MSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
AilDliC2nt Information ! se Print Le ibi
Name(Busim-ss:Organizationllndividuap: U L/
Address ZIL
City/State/Zip: Phone M-4� J2
Are you a .employer?Chec th priate box: Type of project(required):
L am a employer with" 4. ❑ 1 am a gteneral contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity, workers'comp. insurance. 9. ❑Building addition
[No workers'comp. insurance 5. ElWe are a corporation and its 10.❑Electrical repairs or additions
required.) officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.011ouff repairs
insurance required.)t employees. LNo workers' l3.❑Other
comp. insurance required.)
'Any applicant that chrxsts box#1 must also Fill not the section below showing Their workers'compensation policy informadom
t I lonwownera who submit this aflidavil indicating they me doing all work and then hire outside contractors mat submit a thew affidavit indicating such.
:Conumrtors that chick this box must attached an additional sheet showing the narne of the subs ntracttors and their workers'cmnp.policy information.
I am an employer float is providingkn'eompensadon Insurance or employees. Below Is the policy andJob site
information. 1
Insurance Company Name:
Policy#or Self-ins.Lie.M 2 Expiration Date:
Job Site Address: City/State/zip.
Attach a copy of file workers'compensation policy declaration page(showing the policy number and expiratton date).
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 S1,500.00 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. Ile advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification
F do hereby certify and h Ins and pet es of that the information provided above Is ue and arrest.
Si
'n't t Date:
Phone %
Official use only. Do not write in this aren,to be completed by city or town oy iciaL
City or Town: Permit(License#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: — Phone#:
PROPOSAL/CONTRACT
RoofReplacement
FROM:
MGS Construction LLC
PO Box 1024 PAGE NO. 1 OF 12 PAGES
Derry,New Hampshire 03038
Email:mmanick@mgsconstructionllc.com DATE: May 5,2016
Office: (603)216-2633 Cell(781)647-7663 REVISED May 24,2016
Fax: (603)432-3282 Cell(781)MGS-ROOF
PROPOSAL SUBMITTED TO:
Sharon Pedersen
lA Woodside St ADDRESS: 1A Woodside St
Salem,MA
CITY/STATE: Salem,MA
978-745-9739
JOB NAME: Roof Replacement
We hereby submit specifications and this proposal/contract for the following:
BREAKDOWN:
MGS Construction will remove and dispose of all existing roofing and flashing to entire main roof and shed
MGS Construction will remove all debris and coordinate all trash removal
MGS Construction will supply and install 6' of GAF Weather Watch ice and water shield at all roof eaves
MGS Construction will supply and install 100%of GAF Weather Watch ice and water shield to dormers and entry
roofs(3 pitch and under)where necessary -
MGS Construction will install 3' of GAF Weather Watch ice and water shield at all rakes
MGS Construction will install 3' of GAF Weather Watch ice and water shield around all penetrations (vent pipes,
chimneys,and skylights)if necessary
MGS Construction will supply and install GAF Deck Armor to the remaining roof field
MGS Construction will supply and install GAF Pro-start manufactured leading edge to complete the roof perimeter as
the manufacturers suggest
MGS Construction will supply and install new fleshings and drip edge(white)including re-leading of any/all existing
chimneys
MGS Construction will supply and install GAF Timberline HD lifetime architectural shingles
MGS Construction will.hurricane nail 6 nails per shingle to protect against blow offs ro N
MGS Construction will supply and install GAF color match caps to all ridge locations
MGS Construction will cut up roof to wall transitions into current shake siding,wrap ice and water 6"-8"up roof to
wall transition INCLUDING UPPER RAKE AND CORNER BOARD ON SAME SIDES
MGS Construction will supply and install PVC where siding was previously removed.Finish with drip cap
PEDERSEN,SHARON 3
ROOF REPLACEMENT
MAY 2016
MM
RUBBER ROOF BREAKDOWN:
MGS Construction will supply and install 1" ISO EPDM .060 membrane roofing and all necessary flashing,bonding
adhesives and accessories in strict accordance with manufactures regulations(shed dormer rear of main)
In the event that unforeseen rot is found.A plywood replacement charge in the amount of$60.00 per sheet or barn
board in the amount of$3.50/linear foot (labor and material)will be billed additionally to the contract amount.
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 writing between the customer and MGS Construction.
TERMS/NOTICES:RESIDENTIAL/COMMERCIAL
It is the home owner's/associations responsibility to ensure that prior to the start of the project all areas of concern are prepared for
start of project.All planters,grills,patio furnishings,and other precious objects should also be moved prior to the start of any
roofing or vinyl siding project.All vehicles should be parked 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.MGS Construction is not responsible for any damages to this property should
these guidelines not be followed as this should be considered as a formal notice.All interior wall hangings,including shelving,
pictures,and other precious objects should also 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 tarps used on each project in order to protect all
property and landscapes.Any exterior damages to property incurred by MGS Construction will be remedied repaired/resolved by
MGS Construction.However,we cannot be held liable for damages to plant and or flower beds,shrubbery,etc located within 15'
of the perimeter of the work area.
MGS Construction will not be held liable for cracked or damaged drywall or for any interior objects that may vibrate,shake,or fall
due to heavy hammering or normal construction work.
ASPHALT WARRANTY: RUBBER WARRANTY:
Labor:GAF Golden Pledge Warranty Labor.MGS 5 Year Craftsmanship
Material:GAF System Plus Warranty Material:Warranty Carried By Manufacturer
PAYMENT TERMS: '
We hereby propose to furnish labor and materials to complete in accordance with the above specifications,for the stun of Nine
Thousand Dollars($9,000.00)with payments to be made as follows:
Upon Completion of Project
ACCEPTANCE OF PAYMENT TERMS
All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.
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, accident or delays beyond our control. 's
proposal subject to acceptance within 30 days and it is void thereafter at the option of the undersigned.
Authorized Signature
ACCEPTANCE OF PROPOSAL
PEDERSEN,SHARON 4
ROOF REPLACEMENT
MAY 2016
MM
By signing this proposal it will then in fact be considered to be a legal and binding contract between Sharon Pedersen
named above and MGS Construction.The above prices,specifications and conditions are hereby accepted.You are
authorizing MGS Construction to do the work as specified above. Payment will be made as outlined above. Shall MGS
Construction not receive payments in accordance with the above stated terms all work in progress will be stopped
immediately until payment has been received from you the client Upon not receiving the final payment for the
completed contract/project,MGS Construction has the right to hold you the client responsible for all and any reasonable
legal,filing,and attorney fee's necessary for MGS Construction to collect payment at your expense.
ACCEPTED:
SIGNATURE: (. /'` ._�Y -� - DATE:
SIGNATURE: DATE:
I allow MGS Construction to use my home in pictures for marketing purposes.
SIGNATURE : o aCL
DATE: Z Z6l�0
This proposal is valid for 30 days from date of receipt
ALL ACCEPTED PROPOSALS MUST BE SIGNED AND RETURNED TO OUR OFFICE UPON ACCEPTANCE.
PEDERSEN,SHARON 5
ROOF REPLACEMENT
MAY 2016
MM