0046 WASHINGTON SQUARE SOUTH - BPA-12-100The Commonwealth of Massachusettsi1nAIr
Department of Public Safety
lossac husetts State Building Code(780 CNR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
Phis Section For Official Use Only)
Building permit Number: _ Date Applied:N711-11_ Filuilding Official:
SECTION 1: LOCATION(Please indicate Block p and Lot N for locations for which a street address is not available)
y6 k/y - f r rf 1 __ O l 2Q -- 0/aHw c/ do C 411yp/7 r __---
No.and Street City /Iown Zip Code Name of Building(it Lill pl it Able)
SECHON 2: PROPOSED WORK
lidiliun of NIA Slate CMIC List'(_ If New Construction chuck here or chock all that apply in the two novs below
Fxisling Building Repair D1Alteration Addition 1 Demolition (please fill Out and submit Appt'ndix 1)
Change Of Use Change o(Occupattry Other Specify:.___
Are building plans and/or cunsl ruction dtkunsn is being supplied as part of this permit application? Yes No
Is an Independent Structural Engineering Peer Review required? Yes O No IsY
Brief Descriptirnytof Proposed Work:A ,f f! /'ei /'OO Ow aKa( S7
l
I
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,Oli
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed (.See 780 CMR 34)
Existing Use Group(s): I Proposed Use Group(s):
SECTION 4: BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.)
Total Area(sq. ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as a licable)
A: Assembly A-1 A-2 Nightclub A-3 A4 ElA-5 B: Business E: Educational
F: Facto F-1 F2 H: High Hazard H-1 H-2 11-3 H-4 11-5
1: Institutional 1-1 1-2 1-3 14 M: Mercantile R: Residential R-1 R-2 R-3 R4
S: Storage Si S-2 U: Utility Special Use an( please describe below:
Special Use
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
A - Ill IIA 11B IIIA IIIB 1 IV 1 VA VB
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information:Sewage Disposal: Trench Permit: Debris Removal:
Public Check i(outsidr Hood zone Indicate municipal A Ircnch:will not be Licensed Disposal Silk,
required Or trench or spctily:___
Ft ivate or indeltiity Zoiiv:_ or on Site Sy stertr
permit is ent lose(
Railroad right-of-way: Hazards to Air Navigation: Al t I1,,l...
Not Applicable trurlure within airpr.rl approach arva? Is their rov WWI nntpit'tod.'
ur Gnarnl to Build rntlosc( 1 es or No Yes No
SEC LION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Fd i lion,ot Code. L so Group(s) . I t lit,of Consl rill lion: Octu pool Load pt'r floor
Does lhr hu ild ing cnnlain an Sprinkler Syslt m':—_—.. ._Spet ial St i pu 1,11 ions
E
SECHON9: 1'ROI'F.li'1'YOWNI:lRAU'1'IIOIiIZA'1'ION c O
Nome.md AJdrrvs/snul Nroperl\'Otcncr
d/7e1_lL_l1on.At
Name(Print) No and Street City/Town Lip
Property Owner Contact Inlormalion:
Title Telephone No. (business) Telephone No, (cull) e-mail address
Il applicable, the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative it,work authorized by this building permit application.
SECTION 16:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,Ix111 cu.ft.of enclosed s ace and or not under Construction Control then check here 0 and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
TW/7 1 rf5 to
Name(Re istru,a t) Teleph one Nu. e-mail address Registration Number
Street Address City/Town Slate Zip Discipline Expiration Date
10.2 General Contractor
C mippany Name
3. nrj w 7.2 f
Name of Person Responsible for Construction License Nu. and Type if Applicable
PO t4A- 2-4 2- S9lzn, // /,r Zit D/170
Street Address Citv/Townn St. e Zip
f4Bk 2y3 0LOnr yU /t e/20tyr 7
Telephone No. business Telephone No, cell a-mail address —
SECTION 11: wt twriNisntjO%iN<uu:.Va'r:vY-n M.G.L.c.152.§ 25C6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this a ffidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes BY—No
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item
Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6) _$
L Building S r 0&1 Building Permit Fur=Total Construction Cost x_(Insert here
2. Electrical S appropriate municipal factor)=$
3. Plumbing
Note: Klinimum fee=$ Contact muni, all[4. Mechanical (HVAC)
5. Mechanical Other
Enclose check payable to6. Total cost 2 r //
a/ — (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering nw name below, I hereby attest under the pains and penalties of perjury that all of the in n tion contain 'd in this
application is true and accurate to lie best ofnnv know ludgo Jed understanding.
Please paint and sign i c Title cleph®oll[
Y ,,
Date
Street Addn'ss City fown/ Stale .. ip
Municipal Inspector to fill out this section upon application approval:
Name — Date
Professional Roofing Contractors , Inc.
James W. Shea,President
P.O.BOX 262 45 DEARBORN STREET
SALEM,MASSACHUSETTS 01970
PHONE (978) 744-6888 FAX(978) 744-8814
professionalroofingQverizon.net
PROPOSAL
July 6, 2011
Mr. Anthony O'Donnell
O'Donnell Funeral Home
46 Washington St.
Salem,MA. 01970
RE: O'Donnell Funeral Home, Washington Sq., Salem, N A.
To make the following roof repairs:
1. Install new rubber roof over front bay window with new edge flashing.
2. Replace two sections of roof aprons below mansard roofs by removing old roof paper and
installing new rubber roof and metal roof edge flashing. (location driveway side)
3. Replace missing aluminum flashing on ridge of mansard roof.
4. Remove slate and flashing in valley of mansard roof, install new 16 oz. copper step flashing
and re-install existing slate. (location driveway side)
5. Repair hole in existing rubber membrane.
6. Repair 50 missing and crack slate in different locations on roof.
7. Repair slate and chimney flashing on driveway chimney.
8. This'proposal does not cover, and in no case shall Professional Roofing Contractors, Inc. be
liable for, the removal or damage to HVAC units, conduits, gas lines, water lines, and
electrical lines whether located above, below or in roof system.
r'
TOTAL COST...............................s .............$12,900.00
ACCEPTANCE OF PROPOSAL
TERMS OF PAYMENT