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12 DUNDEE STREET - BUILDING JACKET 0 1 Z DUNS �T rperTab® OversizedTeb Folders 90%Larger Label Area ® 9M[AO ///. SMEAD KEEPING YOU ORGANIZED No. 10301 wr.wiv[+[a wd.mu8A GET ORGANIZED AT SMEAD.00M MlKfwcmaww(o IMMUNSUMER COMMONWEALTH OF MASSACHUSETTS SUFFOLK, ss. Board of Building Regulations and Standards Docket No. 2010-319 Candi Derderian, ) Complainant ) V. ) Douglas Dubin, Respondent ) HEARIN_G DECISION Procedural History This matter is before the Board of Building Regulations and nStPdards (`Board") as a result of a complaint filed by Candi Derderian("Derderian"), of_1-2-Dundee_Stieet;Salem, MA 01970, alleging that Douglas Dubin(CSL Number 59622)("Dubin") violated 780 CMR with respect to a renovation/reconstruction project of a three-season room at Derderian's home ("Complaint"). In accordance with 780 CMR, notices of the Complaint and notices of hearing were provided to the parties.' A hearing was held on November 4, 2010,in which Derderian, Dubin, and Thomas McGrath(Building Inspector on behalf of the City of Salem) appeared. Exhibits The following Exhibits were entered into evidence: Exhibit 1: Copy of the Complaint Exhibit 1 A: Copies of contract, building permit and related documents. Exhibit 2: Copies of photographs of various aspects of the project. Exhibit 3: Dubin's response to the Complaint Findings of Fact The following findings of fact and.conclusions of law are supported by substantial evidence, based upon testimony, documents entered into evidence, and administrative records of the Board. G. L. c. 30A, ,¢11(2), x'14(7). 1 On or about June 3, 2009, Derderian hired Dubin, d/b/a Double D Construction LLC,to repair/rebuild a sun porch room at her home. The contract included the following specifications: remove existing glass roof system; re-frame roof with 2 x 10 framing stock; install laminated beam to support roof, then install 5/8 plywood on roof; install new rubber roof and tie in to existing roof; pine trim all areas connected to roof; under porch install two new four foot deep footings; repair all rot on outside of porch; install pine trim throughout bottom to cover all framed area; install sheet rock ceiling. In addition,there were several hand-written changes, such as the installation of a new gutter and a new skylight. (Exhibit 1 A; Derderian's testimony). 2. During construction, Derderian noticed that roofing shingles were being applied, and recalled being told that the roof had a sufficient pitch so it did not need a rubber roof, and that the shingles would look better. (Derderian's testimony). 3. Sometime in October 2009, a few months after the work was completed, Derderian first observed that water leaked near the skylight. (Derderian's testimony; Exhibit 2). 4. Dubin's workers returned to determine the cause of the water leak, but could not do so. At some point, Dubin's workers applied caulk to the outside of the skylight on the flashing, as shown in Exhibit 2. Shortly thereafter, Derderian had a representative from Velux(the manufacturer of the skylight) review the skylight and he informed her that nails had penetrated the flashing and that the roof pitch was below the minimum Velux required. She was told that the mistakes in installation voided the Velux warranty. Derderian hired another contractor, Bob Sullivan,to look at the skylight and consider whether to replace it with a smaller unit. The photographs in Exhibit 2 show that plastic sheeting had been put over the skylight. Sullivan temporarily put on the plastic sheeting because, at that time, it was not clear where the leaking was occurring. (Derderian's testimony). 5. Derderian discussed some options with Dubin about how to address the skylight problems, including reflashing the unit or replacing the unit with a smaller unit that would be compatible with the roof pitch specified by Velux. (Derderian's testimony; Exhibit IA correspondence), 6. Derderian believed, according to what the Velux representative told her, that the skylight installed required a 15 degree roof pitch, but the roof pitch was actually 12 degrees. (Derderian's testimony; Exhibit IA, Velux service maintenance invoice). 7. Derderain believed that Dubin would meet with her around Thanksgiving 2009 and had agreed to reflash the skylight. Sometime around then, Derderian discovered another leak, as shown in the photographs in Exhibit 2, coming through part of the wall. One of Dubin's workers attempted to caulk the gutter (shown in Exhibit 2), but the caulking did not stop the leak. Derderian had another contractor attemptto caulk the siding where it joined the door/window frame. It was not clear whether water penetrated through the wall approximately where the roof joined the wall or just above the window/door frame. (Derderian's testimony). 8. The City of Salem issued a building permit for Dederian's project on June 26, 2009, for"repairs to 3 season porch,roof, install new skylight." On or about July 23, 2009, a City building official, Thomas McGrath performed a final inspection and approval. (Exhibit IA, Building Permit 882-09). According to Derderian, McGrath told her that he was upset that no other inspections had been called for, but he approved the final inspection nonetheless. (Derderian's testimony). 9. McGrath explained that the City does not typically do interim inspections when the work involves only roof coverings, But, when a roof system is reframed,the City 2 wants to do an interim or framing inspection. On or about November 5, 2009, McGrath issued a letter to Derderian which stated that Dubin violated the following sections of the State Building Code: 5115, Failing to obtain Required Inspections; 5117, Workmanship, Installing systems contrary to manufacturer's instructions; and 5903, Improperly installing roof flashing. (McGrath's testimony; Exhibit IA, City of Salem letter,November 5, 2009). 10. McGrath did not determine the precise pitch of the roof,but estimated that it was less than 22 degrees. The fact that the roof covering was changed from a membrane to roof shingles caught his attention. But, if the roof coverings included ice and water shield beneath the roof shingles, McGrath would conclude that the roof coverings were likely adequate. However, the skylight added another factor because of the roof penetration and the roof pitch the skylight manufacturer required. (McGrath's testimony). 11. McGrath admitted that he should not have signed off on the permit on July 23, 2009, given the reservations he had at that time and his subsequent conclusions which he stated in his November 5, 2009 letter. He also opined that the water penetration problems also showed why he should not have approved the final inspection. (McGrath's testimony)., 12. Dubin recalled that, in addition to his son, he had Steve Silverman, whom he believed had a CSL, on site. Part way through the reframing and rebuilding of the shed roof,Dubin and Derderian discussed adding a skylight to the project. (If that change had occurred during construction,then the work may have commenced before the building permit was issued because the building permit application and the building permit both specified the installation of anew skylight. (Exhibitl A)). They identified the skylight(which Dubin ultimately installed) and, according to Dubin,he "just didn't really go for the pitch issue." He admitted that roof pitch is off from the Velux specifications,but, at the time, he was focused on putting in a 4' x 4'unit to allow the most light possible, (Dubin's testimony). 13. Dubin was not certain,but recalled the final pitch for the roof was just under 4 in 12;maybe 3.5. But he recalled having installed ice and water shield on the entire roof. (Dubin's testimony). 14. Dubin explained that the change from installing a rubber roof to a shingle roof was based on having a shed,rather than flat roof. He stated that he "ended up paying for the rubber which is ice and water barrier, `cause [he] rubber roofed it with ice and water barrier." Also, Dubin recalled that having a shingle roof, rather than a membrane on the exterior,would look better with the rest of the house. (Dubin's testimony). 15. Dubin admitted that he did not call for an inspection of the roof framing before he installed the interior finish. He recalled having asked Thomas St. Pierre if he needed to remove the interior roof finish, and was told that everything looked fine. Dubin recalled the St. Pierre did the final sign-off as shown on the Building Permit, although he also recalled that McGrath looked at the project around the same time. (Dubin's testimony). .16. Dubin admitted that his worker had put some nails through the flashing and confirmed that the Velux representative had come to the same conclusion. Dubin believed that they solved the problem by resealing the nail holes. He also recalled 3 that the Velux representative concluded that the pitch was slightly off, and Dubin agreed with that conclusion. (Dubin's testimony). 17. Two or three nails penetrated the flashing for the skylight as shown in Exhibit 2. (Exhibit 2; Dubin's testimony; Derderian's testimony; Exhibit 3). 18. With respect to the second leak(on the side of the structure), Dubin believed it may have come from where the existing roof joined the new siding. He recalled having had step flashing installed when the new T•111 siding was installed, as shown in Exhibit 2. (Dubin's testimony). 19. Dubin recalled having done a few hose tests after addressing the side leak problems and not having been able to get those places to leak again. (Dubin's testimony). 20. As of the date of the hearing, Derderian had not noticed further leaking around the skylight. (Derderian's testimony). 21. With respect to the side (second)leak,the recaulking has made a difference, according to Derderian, but there have not been the types of extreme rains where the leak first appeared. (Derderian's.testimony). 22. There was no evidence that any other part (other than the vicinity of the skylight)of the new roof leaked. (Derderian's testimony). Discussion The general issue is whether Dubin failed to comply with 780 CMR, meaning the 7th Edition of the Massachusetts State Building Code (780 CMR) ("Code"). 780 CMR 110.R5.2.8(3), given when the work took place. . The Code requires the CSL holder"to be fully and completely responsible for all the work"being supervised and to "be responsible for seeing that all work is done pursuant to 780 CMR." 780 CMR I10.R5.2,15,1. Generally, all work must "be under the control of the CSL holder. 780 CMR 5116.1, "Except for work under the control of a licensed tradesperson subject to other codes and/or regulations, the licensed construction supervisor shall be responsible for ensure that all construction-related activities are performed in compliance with 780 CMR 51.00 through 99.00 and the approved construction documents, and all manufacturers' recommendations, as applicable." Id. (emphasis added). Any violation of 780 CMR in the work the CSL holder is supervising can be grounds for "reprimand, suspension or revocation of a license." 780 CMR 110.R5.2.8. ("It shall be unlawful for any person . . . to erect, construct, alter, extend, repair, remove, demolish any detached one-and two-family dwelling or any equipment regulated by 780 CMR 51.00 through 99.00, or cause same to be done, in conflict with or in violation of any of the provisions of 780 CMR 51.00 through 99,00." 780 CMR 5118.1.) The CSL holder must operate under the general rule that"all work shall be conducted, installed and completed in a workmanlike and acceptable manner, and in accordance with manufacturer recommendations, so as to secure the results intended by" the Code. 780 CMR 5117.1. The Code 4 shall be construed to secure its expressed intent, which is to ensure public safety, health and welfare insofar as they are affected by building construction, through structural strength, adequate means of egress facilities,sanitary conditions, light and ventilation, energy conservation and fire safety; and, in general, to secure safety to life and property from all hazards incident to the design, construction, reconstruction, alteration, repair, demolition,removal,movement and/or use or occupancy of detached one- and two-family dwelling buildings, structures or premises. 780 CMR 5101.4. Although the Code should be interpreted and applied in a remedial manner to ensure that Code deficiencies are corrected,see 780 CMR 5101.4, such interpretation and application do not relieve the CSL holder from his responsibility to ensure Code compliance while he is on the job. In considering whether the CSL holder complied with the workmanlike and acceptable manner standards of 780 CMR 5117.1, the Board also considers whether the Code deficiencies should have been avoided at the outset, i.e. done right the first time. The first issue involves the roof design and the roof coverings that were installed. Asphalt shingles may be applied on roof slopes of two units vertical in 12 units horizontal (2:12 or 17% slope) or.greater. 780 CMR S90S.2.2. For roofs from two in 12 to four units vertical in 12 units horizontal, two layers of felt underlayment is required, as specified in 780 CMR 5905.2.7. But, under 780 CMR 5905.2.7.1, which specifies when ice barriers are required, "two layers of underlayment cemented together or . . . a self- adhering polymer modified bitumen sheet, shall be used in lieu of normal underlayment." 780 CMR 5905.2.7.1. Thus, if the roof has a slope of less than two in 12, asphalt shingles may not be used. There was not substantial evidence of the precise pitch of the roof. The Velux representative stated that the skylight unit was installed at twelve degrees. McGrath estimated the roof at less than 22 degrees, Dubin believed the pitch to have been just under four in 12. A pitch of two units vertical in 12 units horizontal is 9.5 degrees; four in 12 is 18.5 degrees. Even if it is assumed that the lowest pitch, twelve degrees,was correct, then the roof had a pitch greater than two units vertical in 12 units horizontal. Accordingly, the roof pitch was above the minimum for the use of asphalt shingles with the appropriate underlayment. Based on 780 CMR 5905,2.7.1, if the entire roof had an underlayment of ice and water shield,which would qualify as a modified bitumen sheet, a single layer of such a material would have met the Code, Here,there was not substantial evidence that Dubin failed to install materials that these Code requirements. Next is the issue of complying with the manufacturer's specifications for the skylight. The Code generally specifies that manufacturer's specifications control how to install certain products, such as windows and skylights. See e.g. 780 CMR 5117.1 5308.68; 5613.5.1. The Velux representative concluded that the roof pitch was below 5 the 15 degree minimum required for this size of skylight. Regardless, Dubin admitted that he did not consider the minimum pitch for this particular Velux unit because he had installed them before and had already framed the shed roof at its final pitch. Further, the final pitch was close to the minimum. Although there was evidence that the installation of the skylight was an afterthought--- after the new roof had been framed and installed, the decision to install a skylight was memorialized in the building permit application and the building permit. Also, there was evidence that the parties agreed about putting in a 4' x 4' unit to allow in more light than a smaller unit would have allowed. Obviously, two alternatives should have been considered: (1) install a smaller skylight that would have comported with the roof pitch; or (2) change the roof pitch to accommodate the larger skylight in order to comply with Velux specifications. But, instead, Dubin decided that what was being done was "close enough". This did not comply with 780 CMR 5117.1. The next workmanship issue, which was not significantly in dispute, was the penetration of nails through the flashing of the skylight. There was substantial evidence that the nailing errors caused water penetration. Again, this did not comply with 780 CMR 5117.1. However, as will be discussed below, had the flashing not been damaged, the skylight issues may never have arisen. Next was the water penetration problem in the wall, in the vicinity of the door/window unit and/or where the existing roof joined the new wall. Whether the water penetration related to a roofing application or only wall covering, the Code makes it very clear that these systems must keep water out, 780 CMR 5703.1; 5903.1. Finally, there is the issue of required inspections. The Code requires "inspections during construction at intervals sufficient to ensure compliance." 780 CMR 5115.2. To ensure that these inspections are performed in a timely fashion, the CSL holder must ensure that the building official is notified. 780 CMR IIO.R5.2.15.1; IIO.R5.2.15.2. Here, the framing for the new roof system was covered by interior finishes before the building official was given an opportunity to inspect the framing. Thus, Dubin failed to ensure compliance with 780 CMR 5115,2, I note, however, that there were no issues about the structural integrity of the framing, and the building officials did not require Dubin to remove interior roof finishes to expose the framing. Administrative Penalties After finding that the CSL holder has violated any part of 780 CMR or 780 CMR 780 CMR 110.R5), the Hearings Officer may issue a reprimand to the CSL holder, or suspend the CSL holder's license for a period of time, or permanently revoke the CSL holder's license. See 780 CMR I10.R5.2.8; I10,RS.2.9.5. In addition, "the hearing officer may order the license holder to retake the CSL examination." 780 CMR I 10.R5.2.9.5. 6 As discussed during the hearing,the violations described above do not justify revoking Dubin's CSL and/or requiring him to retake and pass the applicable CSL examination. I also note that this is the only complaint against Dubin on record with the Board. There was substantial evidence that had the skylight flashing system not been damaged by nailing, there would have been no evidence of leaking, nothwithstanding the fact that the roof pitch may have been slightly below the minimum required by Velux. The admitted workmanship errors and failures to more closely determine the roof pitch,however, could have been easily avoided, While the roof pitch problem was obviously more challenging to correct after construction, correcting at least the flashing to comply with the manufacturer's instructions would not have been too difficult. Caulking the nail holes may prevent further leakage,which can meet part of the Code, but did not meet manufacturer's instructions. Conclusion For the foregoing reasons, Douglas Dubin, CSL No. 59622 is hereby issued a REPRIMAND for the Code violations set forth above. SO ORDERD BOARD OF BUILDING REGULATIONS AND STANDARDS By its designee, CHRISTOPHER N. POPOV Hearings Officer DATED: January 6,2011 Any person aggrieved by this decision may, in writing,request review of this decision by the Board. The filing of such a request shall not stay any the disciplinary action specified by the Hearings Officer, The Board may review the decision at its discretion. If the Board decides to review the decision,the review is an administrative review that shall be based solely on the administrative record and is not to be construed as a second hearing on the same complaint. After such review, the Board may either deny the request or remand the matter to the Hearings Officer for further proceedings, as directed. The filing of such a request with the Board shall serve to toll the timing provisions of G. L. c. 30A, §14 until such time as a final decision is rendered by the Board. 780 CMR 110.R5.2.10. 7 In accordance with G. L. c. 30A, §14, any person aggrieved by this decision may appeal to the Superior Court within 30 days after receipt of this decision. 780 CMR 110.R5.2.10.1. 8 v , The Commonwealth of Massachusetts Town of � Board of Building Regulations and Standards 01+7 Massachusetts State Building Code, 780 CMR, T"edition Budding Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a t One- or Tit'o-Family Duelling This Section For Official Use Only Building Permit Nu bee Date Applied: Signature: Building Commissioner/I pector of Buildings Date SECTION I: SITE INFORMATION LI Property Address: 1.2 Assessors Map& Parcel Numbers 1.1 a 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(B) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.L C.40,954) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal[3 On site disposal system ❑ li Public❑ Private❑ Check if es[3 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: �Ukt e 57' SK-1--,K "et Ca,n d R L70-1r r i&2.. i e(Print) Address for Service: 61/576 Signature V Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK=(check a hat apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Propo ed Work.': m � . I SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials 1. Building S 1. Building Permit Fee: E Indicate how fee is determined: /n� ❑Standard City/Town Application Fee 2. Electrical 5 to ❑Total Project Cost'(Item 6)x multiplier x ._ 3. Plumbing E 2. Other Fees: S 25 , 4. Mechanical (HVAC) 5 PICAC List: CJ — 5. Mechanical (Fire 5 604 Cj Total All Fees: S Su ression Check No. _Check Amount: Cash Amount: 6. Total Project Cost: b 0 Paid in Full 0 Outstanding Balance Due: r . f i SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Numbv� s ration ate N,yme of CSL Hyl er List CSL Type(sec below) �er Addres' Type Description U Unrestricted(up to 35,000 Cu. Ft.) R Restricted 1&2 Family Dwellin Signature M Masonry Only RC Residential Routing Covering Tclephon WS Rrsidenual Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 ReglstereQHotnelmyrovempot3Controctor(HIC) /��.4 / HIC Company Name orMIC Reg str Name Registration Number Address �7 y/— i'Enpi ion Dat Signatur '— elephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 2SC(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 BUILDING PERMIT 1, C A IJ 9J 2 [ -e ,cf e r d�r , as Owner of the subject property hereby authorize ��w' / V.bi/7 to act on my behalf, in all matters relative to work authorizeTiby this building permit application. k �- 6 2Z v nature of Owner Date SECTION 7b: OWNEWOR AUTHORIZED AGENT DECLARATION 4 /P + !• as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print N G m S i g n a t direbT Vwner rAut gent Date (Signed under the pains and penalties of perjury 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I0.116 and 110.115. respectively. 2. When substantial work is planned,provide the information below: Total floors 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' • f (� The Commonwealth of Massachusetts Board of Building Regulations and Standards SALEM A4C" T?tY63fr«« Massachusetts State Building Code,780 CMR j se Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a L° �CT `4 $ OR One-or Two-Family Dwelling `This Section For Ole ;Use , Building Petstit,NEmther:. Date App.• ox Ito f` Ruildiog Off,+cial(Prmt Name) D. SECTION 1 STfE flV>1ORMATIOI�I 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /2 1, C1 Lla 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(ft) 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Cbeek if yes❑ SRCTION2 PROPIERTYOWNERR"' 2.1 Ownerr of Record: p(ei ZO rGlt4 • D'-rcie,%y, lug .wo. Name(Print) City,State,ZIP /'•) L- A Jr=& ri No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ !Accessory isting EBIdg. Owner-Occupied ❑ Repars(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Number of Units_ Other ❑ Specify: Brief Description ofProposedWorkz: Qlp t, ThM SECTION 4:ESTP ATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials 1.Building $ y 1• Building Permit Fee:$ Indicate how fee is determined: E3 Standard City/fown Application Fee 2.Electrical $ p Total project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ h 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Su ression cY Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 'L(� ❑Paid in Full ❑outstanding Balance Due: C/p,L.L_ C,C)r.J r2 F\c "iv(L ) C JZf l 1.4,-_D 1 Cl 1 1g L M o9') SECTIONS: COA1STItOMON SEI3VICES 5.1 ,Construction Supervisor License(CSL) AAS.. License umber Expiration Date , Name'.of CSL Holder List CSL Type(see below) t i 1e.w e No.and Streett Typ Description(Buildings up to D-^ f S a(4�� R Restricted l&2 F Dwelling000 cu.ft. City/rown,State{ZIP M I Masonly RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances _W-Iit 2 V! I Insulation Telephone Email address D Demolition 5.2Registered Home Improvement Contractor(HIC) /G i-/c)3 i/3/16 a.C *S �V� i L(—C— HIC Registration Number Expiration Date HIC Co parry Name or HIC Registrant Name q�/I eN'_^ .Ic. Oc /c...L / No.and Street a Email address Cy n.J,t(<- ra.n 7-S�YI'Zi Ei' Ci /Town State ZIP Telephone SECnON tk WOAICEW CO1t4FENSATION RgSUX4NCE APF IAM, (NLG.I..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 ..........e-�' No...........❑ SECTION 7a:OVVNKR AUTHORIZATION'ib Uk COMPLETER WHEN QWT4ER'S AGfNTR CO _ >F©�$[I ING PERLMR I I,as Owner of the subject property,hereby authorize AA J f r%--� to act on my behalf,in all matters relative to work authorized by this building permit application. Pi'MrOwner Name(Bleetr6mc Signature) Date SECTION 76:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name el ereby attest under the pains and penalties of pedury that all of the information contained in ation is true and accurate to the best of my knowledge and understanding. Print er'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 mm mmLggv/oca Information on the Construction Supervisor License can be found at www.mass.eov/das 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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"maybe substituted for"Total Project Cost" l • ja Gi-I"TUFSa�E.� - PUBLIC PROPERTY DEPAR'TM&NT o..auFnsr•,•,••••• Maros 130 WAs umam snsar�iti�V�naau s�rR ot970 To.M74S.9Sy•FAx:jm?4c 9N0 APPLICATION FOR TDB REPAIR. RENAVAPMJ%W !CONSTRUCTION • DEMOLITION. OR CHANGE OF USE OR Ot�c'rTp�ivrv_ rrnn *nr EXISTING Sigumm OR BUII.D2 fPlWwty 0 SITE INFORMATION cation Names Buk*V op"Add - is loafed In s:Caawallon Ana Y/N HWWIG DWW Y/N /V 2.0 OWNERSHIP INFORMATION 11 Owner of Land Name: CAN .D e2 6 e2,` .i Address. a Dv+,( e if S Telephone: 7 7 ( 9 9� 3.0 COMPLETE THIS SECTION FOR WORK IN EYlSTIdp BUILDINGS ONLY Addition $,., Renovation Number of Storiesed Change in Use Demolition Approximate year of Area per floor(st) d construction or renovation of existing building 9oef Description of Proposed Work: 21 A 2-PmD J-e L --Mail Permit to: _ 7 • /3 C/,4A c What is the current use of the B ilding? Material of BuilclhV? W sfl ifdwelWq,how marry unit? �A) WIN to Bullring COntorm to Law?_� f S _ Asbestos? Amhit ds Nara Addmm and Phone Medwoe's Name Address and Phone !.{ `-6 S9 supervisors License M �1 0`F_8 HIC Registration d Conswcoon Estimated Coat of Profed i �, O9 o Parma Fes Cal AWw Permit Fee: Estimated Cod X$71$1000 Residential _ — Estl nAW cost X:1l/$I000 c«mrm.reiaL An Additional$5.00 is added as an Adminie mdm dtargs. Make aura that an fields are property and Iegibty written to avoid delays In processing. The undersigned does hereby apply for a Building PwrrA to build to the above stated uli specatkxte . signed under penally of PerJury x LAI Date o H 3 � ® A $