0083 BARSOW ST - BPA-15-1384 ROOFING 3S°� C4— )LA33 9J5:: t D IJ 16 $ c30
The Commonwealth of Massachusetts
°•• Board of Building Regulations and Standards CITY OF
• 1}�J/� Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 1011
Building Permit Application To Construct,Repair, Renovate Or Demolish a -
One-or Two-Family Dwelling
I This Section For Official Use Only
T cc Building Permit Number: Date Applied: I ' //(
_ Building Oficial(Print Name) Signature Date
( SECTION 1: SITE INFORMATION
(� 1.1 Property ddr 1.2 Assessors Map&Parcel Numbers
3 �a.san/s: S
t 1.1a 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(it)
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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
•
2.1 Owner'ofeco �� 1
�rn �Gy:I � 7rS7®�
Name(Print) N N �R' C WA I N da City,State,ZIP---.,,
7
No.and Street Telephone Email Address
IAAwe SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
l7PI� ' New Construction❑FExisting Building❑ Owner-Occupied ❑ Repa rs(s) Alteration(s) ❑ 1 Addition ❑
SC)OS Ps
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work : [•-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
�) l / Check No. Check Amount: Cash Arftount:
. 6.Total Project Cost: $ V /i U v ❑paid in Full ❑ Outstanding Balance Due:
Mr-r„, F �� a ;; G�ovcs,vlz. a iso
-fU � `Yosti��cr�p�loc / 07-30(
tZb'7 //
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
• z
I,rl,e ', phC License Number irati n at
Name of CSL Holder
4,0 ✓S,GR G/e— List CSL Type(see below)
No.an Street Type Description
- yy �-] r7 U Unrestricted(Buildings u to 35,000 cu.ft.)�2 / '( ��/' �V R Restricted 1&2 Family Dwelling
Cify/Town,Stat6,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
/+ SF Solid Fuel Burning Appliances
- I Insulation
TelephoneEmail address D Demolition
5.2 Registered Home IImprover(pent Contractor(HIC)
! 6/)G U HIC Registration Number Expirati n Date
HIC Co qmy Name or HIC Regi tram N m
r�� Sp
No.and Street [ Email address
city, State,ZIP Telephone
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 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 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
contain in this ap ' ti s true and a to the best of my knowledge and understanding.
Prin er's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building pemtit 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. ov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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 decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
71 Prospectst
e . Brockton, Ma, 02301
so
LENIA CONSTRUCTION INC. l 08-232-1194
icon ac o ns truc t i onirjc(g1 ive.c om
-- CUSTOMER INFO.
ROOFING PROPOSAL
NAME: G ,. . i�5u rtpL
JOB LOCATION: M3 V5011`670W >I 0WIFM 00'O
PHONE: !FAd - p (— EMAIL: '
We hereby propose to furnish the materials and perform the labor necessary for the completion of:
6/"trip entire shingle roof to roof boards.
eeplace rotted wood ($60 per each ledge board or plywood)
nstall 6 ft of ice&water shield on all roof bottom eves,valleys,under all step flashings&around all fixtures.
/Remainder of roof to be covered with synthetic underlayment felt paper
CI New 8"white drip edge at all eaves and rakes
tewVew
vent pipe boots on all pipes.
ridge vent(cobra)on main ridges.
ash chimney as necessary(EXTRA CHARGE if entire chimney.needs new lead flashing)
[Llf stall architectural GAF Lifetime shingle COLOR ,t flier L'0 ,'
lean up and remove all debris from job and conduct a magnetic sweep of property
licensed and Insured
Pumpster and permit included,Protect all landscaping and driveway if needed for dumpster.
Contractor is not responsible for attic clean-up.
•. Provide electric power in case there is no out of house
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WodmwnCempmutlon Nwnnw
W ropose ereby m furnish mater nd Iii to in eordsree with above specifications for the sum o
nlad�noc�sotr,�2w��►yt+crtc • DOLLARS
With payments to be made as follows:
1/2 prior to start, remainder on completion
Respectfully submitted by Jesus Lema:
Acceptance Of Proposal-The above prices,specifications and conditions are satisfactory and are hereby accepted.You
we authorized to do the work as specified.Payment will be made as outlined above.
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Date 1 k pr.i._ .ZO(� Si nature
ouaiiii E:rivein lasta)raaf lona aerundm lmmal{wMerwndmwa ham leave dab.
The warranty Mall It the Manor from damage to Me building an ordenb resumng ham rant leakage Ion a pealed of Me(5)yore,
beginning from Me data of completion of Me project.The wamnty Wall wear and Indude repair w replammeat of any damaged cabrrer
cteuctun,Intertw atrudure,Irdador components and cantanb of the building,resuldng from not leakage directly attributed m dw
aonbaclo/a wmrkauthat .
• a Price quote is valid for 30 days from date submitted Date: ``L'�