6 HERBERT ST - BUILDING INSPECTION Iry
$ -735 LKS -77
The Commonwealth of Massachusetts
Board of Building Regulations and Standar ds�r u CITY OF
Massachusetts Slate Building Code,780 CM2 ,SALEM
" edMm�2011
F' Building Permit Application To Construct,Repair,Reno goyepKrlistl a
One-or Two-Family Dwelling t7 A '43
I .�es�On�r:+ oiai•i�se..
But7ding Permit DlirmlSer . Date App3ioti
t
aitdu+g ,;cta1(PritaName) 310 Data
_ SR,CTION 1: f7Rilf1►TffJN
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
t'v crt.T S T
1.la Is this an accepted street?yes_ no_ Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 8) Frontage(fl)
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 ❑
Cheek if es❑
SECTION 1i- PR4PidRTY pWNIGSHIPt
2.1 OW ert H771t ReM a lt- arg7l�
euz» Melt—
em
Name(Print) City,State,ZIP
b Ile aee-Tgi g7� AX7>dv*
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORIfs(ebeck all that apply)
New Construction❑ Existing Building Owner-Occupied 01 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units__a, I Other ❑ Specify:
Brief Description of Proposed Work": fi9tajoag 8Af;r1e& ae PT Me*.) k.raN./
SECTION 4:ESTEWATIID CONSTRUG3'It1N COSTS
ItemEstimated Costs: OSlicist Use Only
=Materials)Materials
1.Building Is yr e0 O 1. Building Femur lieu$ Indicate how foe is determined;
2.Electrical $ D Standard Chy/rown Application Fee
O Total Project Gust'(Item 6)x multiplier x
3.Plumbing $ poo e' 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fres:$
Check Net. Cheek Amount: Cash Amount•
6.Total Project Cost: $ AQ S 000 O Paid in Pull O Outstanding Balance Due:
',kpt JC-Zt—T • L t A 6- or,) >=t t..e.
h1rait G. � . Wtta�Ll, B�Zj
S1tiMO N s: COMTRUCTIRN.IlmVICEs
5.1 Construction Supervisor License(CSL)
License NumberrExpiration Date
Name of CSL Holder
List CSL Type(see below)
� /`I,oh/r J.G L G qne
T .,3�Scafption
No!and Street �jJA
HQ/',�� U Unrestricted 'dm m w
35 000 .ft.
Ctle f l / /'"/t•7
R Restricted M2 Family City/I'own,State,ZIP M
RC I Roofing Covering
WS Window and S' '
.� CP/f./� SF Solid Fuel Burning Appliances
Sof, r1"3Z✓o6rf ��IHYA✓/M14CGAKJ I Insulation
Tel hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / 7 6
MA,feoprn gods COct- HIC Registration Number Expmmon Date
HIC Company Name or BIC Registrant Name
�nTi., ....r,rc5 r _r Su�rz 3o'r—F _ 7A�� �Afalllf*re//MUCO
No.and StreetEmail address
Reris.L//�! oiri/s So8y3zSo6q
Ci /Town State ZIP Tel hone
SECTION(5 WO IMW MUENSAT14DN 94SURANCE AMDAV1T(WLG.L c.152.125"6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Faihue to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........❑
SKIN 7a 0"RRAUTH6RI7AU0NT0 sE C6WLETED WHEN
9WNER' A99NT QR CONTRACTOR AM4PF0Jt_ ING PURMJT
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:OWNER'OR AUTHORUM AGENT DECLARATUM
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application istrue
c"f'' tg gb_ knowledge and understanding.
M,,
-P,,/ J ,�,n // 6itsl<e
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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
wnvw.mass.eov/oca Information on the Construction Supervisor License can be found at wxMAlgas. ov/d s
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 beating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
M assachusetts Home 1 mprover ent. .cotjr-,KaGr
This form solisf)es all basic requirements of the states Home I micicvernent Contractor Law(MGL charter 142A),but does not include standard
language to protect homeowners Seek legal advice if necessary. Any person plaratlrghmieinprovenertsshouldfirst obtain ary 'A
MissacnusEtts Consumer Guide to Home Improverte t"before agreeing to any work on your residence You may obtain a free copy by oatling the
Office of Consumer Affairs and Business Regulation'sConsuma Information Hotlineat 617-9738787 or 1.888-283-3757 or on our webste,
Homeowner Information Contractor Information
Name Q,Wp%Nave . .
WCW2)y a ,4-s
greet Address(do nd u ma Fbst Of iioeSm address) od Sslespersont Owner Nam
4rca ,-
ECO-7- s i 0 1cr NI!
Cityrown state Zip Code Business Address(must includel aWed addrms)
019 y0 oo c w a1 ow rd4S GTrL g✓,m a-0"'7—F
Daytima hate Evening PhoneCityrrown Sae Zip Code
e,lC.e�lx dtfl b'
Mailing Addness(it different from above) BSrsners Ph one I Federal Employer lD or SS Number
Fiureimprweiwt Car WR%Nunbr Eglireimdex
�54�w Lex ra{uire;tt�ffi mrd hmie
4. avaidareg�iratimm noar 7
j7
The Contractor agree to do the following work for theHaneavner:
(Describe in data thework to completed,spedfying ootype,brand,and grate of matadelstoboured,uw Wttiorwst asifm ggm.)
Ple4s"e, Sere. Arrgc,rfea A,ST"GAr AOeW*6,#*r"e4P4r. , &&erZF-- -1"57-,SA1cAP(Af4
7-#,ts oc rx%�A,cr i5 -ore ofudo I&,*rzoors AeoT De 4.f 20,,* ,
Required Permits-The following building permits one required Proposed!Sta'tandCompletiohSchelule-The following schedule Wil
and wil l be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Ctwnerswhosecuretheir own permitswill be
exdudedfrom the Guaranty Fund provisions of 8/X2,114Datewhencontractor will begin contracted work.
MGL chapter 142A.) Q�y 1 D,VL ,fir c aeyi!
pr/t-,,rr at,mi- /P••'�r /! .!o /!►Date when contracted work w u be sitrsta ti ally completed.E!d,ftirs.Y !�,T
Total Contract Priceand Payment Schedule -
TheCorlractor agrees toperform thewodc,furnish thernsterieand laborspecifielabareforthetotalsanof: �/O "s0aa M-)
Paym,entswil1,benmdeaxordirgtothefalowirgschedude ?/O*� ssod, },y.7-,�4Wkh A�rwra�,w7;O,rSy ✓e,mr77`�
$ upon signing contract(riot to exceed 1/3 of thetetal central price gr th ecost of special ods items,whichever its er)
$ by l t or upon completion of
$ by ! f or upon completion of
$
upon completion ofthecontrac. (Law fortocsdamandirgfullpaymetuntilcontractIscorpletedtobothpony'ssatisfation)
I'hefdlowirgmatelal/equipnentmustbetpedtl $ tobapadfor
ordered beforethecartractel work beginsin order
to meet the completion sdxdle(""). $. to be paid for
NOTES:(`)Including all finance charges(")Lav requ irestha any deposit or down-payment required by the contractor beforework begins may
not exceed thegreaa of (a)one-third or thetotal contract pricsor(b)theattuaf cost of army special equipment a custom made materiel
if . which must be special ordered in advance to meat the completion sdhedula .
E)mre%Warranty-Isanexoresswarrentybeineorovidedbvtheoontradorg,jNo❑ Yes(all terms of the warranty must be attached to the contract)
Subcontractors-The contractor agrees to be solely responsible for completion of thewok described regards% theactiorsof any third
party/subcontractor utilized,by the contractor. The contractor further agrees to be solely responsi ole for all paymentsto all subcontractors for
j
materials aid labor under thi,_this reame'd
Contract Acceptance-Upon signing,this document beoDmesabinding contract under law. Unless otherwise noted within this docrred,the
contract shall not imply that any lien or ohs security interest hasbeen paid an the residence Review the following cautions aid notices
carefully before signing this contract. .
0 Don't be pressured into signing the contraoL Take time to read aid fully understand it. Ask questions if something is unclear.
❑ -MalcewmthecmtraSoheiavdidHormimorm Contraxor,Reejisb-Aim. The law requires most home impove entcontractorsand
srboontracorsto be registered with the Director of Hann Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Plaza Room 5170,Boston,MA 02116 or by tailing 617-9738787 or 88&283.3757.
4 Dos the contractor have insuratee7 Alk the Contractor for his insurance ogmpaty information so that you can confirm coverage or ask to
see a copy of a"proof of insurance document.
Contractor Arbitration
The Home I mprovenwit Contractor Lan+provides homeowners with the right to 1 nitiate an arbitration action(as an
alternative to court action)if they hate adisputewith ac ortrac tor. The sane right is not automatically afforded to a
contractor, however. The contractor would have to resolve any disputeheshe has with a homeowner in court unless
both parties agree to the optional dauseprovidedbelow. This dam would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a di spute
concerning this contract,the contractor may submit the disputeto a private arbitration firm which has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
tMtobitration asprovided In Massachusetts General Laws,chapter 142A.
Homeowner's nature Contractor's Signature
NOT(CE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute
resolution initiated by the contractor. The homeowner may initiate alternative dispute resol ution even wherethis
section is not separately signed by the parties
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Lav(M GL chapter 142A)and other consumer
protection laws(i.e. M GL chapter 93A) may not be waived in anyway, even by agreement. However, homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatical ly excluded from ell Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a
timely and workmanlike manner. Homeowners may beentitled to other specific legal rights if the contractor
guarantees or provides an expresswarranty for workmenshi p or materials. In addition to guarardees or warranties
provided by the contractor,al goods sold 1n M usetts carry an Implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawful ly agree maybe
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights If you have
questions about your oonsumer/homeowner rights,contact the Consumer Information Hotline(listed below).
Execution of Contract
Thecontract must be executed in du licateand should not be signed until acopy of all exhibits and referenced
documents have been attached. Parties are also advised not to sign the document until all blank sections have been
filled in or marked as void, deleted,or not applicable. One original signed copy of the contract with attachments isto
be given to the owner and the other kept by the contractor. Any modification to the original contract must bein writing
and agreed to by both parties Contracted work may not begin until both parties have received a fully executed copy of
the contract, and the three day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advanceof the dates specified on the payme nt schedule in cawswherethe
homeowner deem him/herself tobefinandalyinsecure However, in instances where a contractor deems himtherself
to be financially insecure,theamtractor may requirethat the balance of funds not yet due be placed in a joint escrow
account asaprerequisite tocontinuing the contracted work. Withdrawal of funds from said account would require the
signatures of both polies
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consume rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home improvement"
contact:
Consumer information Hotline
Offioeof Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787,888-283-3757 or visit the OCABR website at htto:Uvrww.mWsgovlcrahr!
If you want to verify the registration of a contractor or if you have questions or need additional information specifically
about the contractor registration component of the Home Improvement Contractor Law,contact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation
10 Park Plaza Room 5170. Boston. MA 02116
❑ NOTICE OF CANCELLATION
YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR
OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.
IF YOU CANCEL,ANY PROPERTY TRADED IN, ANY PAYMENTS MADE
BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE
INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN
BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU
CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF
THE TRANSACTION WILL BE CANCELLED.
IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT
YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN
RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR
SALE;OR YOU MAY, IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF
THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE
SELLER'S EXPENSE AND RISK.
IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE
SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF
CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT
ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE
TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER
AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL
OBLIGATIONS UNDER THE CONTRACT.
TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND
DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE, OR SEND A TELEGRAM TO [Name of Sel er ,,AT [ ddress of Seller's Place
of Business]NOT LATER THAN MIDNIGHT OF E� date).
Q� I HEREBY CANCEL THIS TRANSACTION.
Date: °L , Ifo Buyer's Signature
List of Renovations 6 Herbert St. Salem Ma. 01970
Owner: Wendy Meigs
General Contractor: Marciano Construction Corp. HIC 4176589
Date: 8/10/16
Scope of work 2"d floor apartment, front and rear halls(l"to 2"d floor only) and cleaning only of
attic
Permit, City of Salem
Cleaning...washing walls and woodwork in APT, front and rear halls(to 2"d floor)
Patching subfloors after plumbers and electricians
New 1/2 underlayment in entire APT.
Skim coat plastering entire apartment and back hall(surfaces durabond coated Is')
Bath: Provide pedestal sink or vanity, toilet, pan (membrane), mud, wonder board shower walls
& bathroom floor. Provide and install ceramic tiles in shower walls and bathroom floors.
Contractor choice of all of the above.
Plumbing: rip and dispose of old useless plumbing. Provide new plumbing for pressure
pipes for kitchen and bath, reconfigure drains for kitchen and bath. New baseboard in
kitchen, front room, middle room and front hall.
Electrical: Disconnect various inappropriate electrical on 2"d and 3`d floor, provide
and install electric heat in bath and long narrow bedroom, provide all new switches
And outlets and covers 2nd floor. Rip and disposal of all old lighting fixtures, and install all
new lighting fixtures in APT and Front and rear halls. Install electric stove.
W/Cand G/L Insurance
New floors: Kitchen WB and ceramic, 3 other rooms (New 1/4" Prefinished H/W) Contractor
choice.
Prep and paint front and rear halls
Prep and paint entire APT Contractor choice of colors.
Carpet front and rear halls (Front patterned Milliken carpet, rear Commercial Carpet) Contractor
choice.
Carpentry, framing, hanging doors wall patch, sheet rocking, installing kitchen cabinets,
Strapping ceiling ,install vent from bathroom, remove 1 widow &patch etc.
Disposable supplies, saw blades, nails, plastic coverings
14 new replacement windows (rip and dispose of old, insulate cavities, provide
and install Contractor choice
Kitchen Cabinets and counters (allowance of$6,300.00) Contractor choice
Clean up and patch walls upstairs (UP TO 5, 4'x8' SHEETS OF 3/8 SR) (3`d floor)
Dumpster/dump runs
Total $105,000.00
Please note the following: 1. This contract is for renovation work and not deleading work.
2. The owner will provide all new electrical lighting fixtures and vent fan for bathroom.
3. The owner will provide all appliances, stove, refrigerator, microwave, etc
4. Thermal barrier of exterior walls and attic floor to be done by "Mass Save".
There will be a cost from "Mass save"to the owner that should be heavily discounted.
MCC will work with the homeowner to help understand and coordinate the process with MASS
SAVE. This will be much less expensive than if Marciano Cons. Corp. hires subcontractors to do
the work. Thermal Barrier of exterior walls and attic floor is not part of this contract.
5. If the building inspector requires additional work over and above the scope described above,
it will be at the owner's expense. (on a time and materials basis)
6 . Terms: 26,250.00 down payment
26,250.00 when rough electrical and rough plumbing approved
26,250.00 when framing, sheetrock and plastering finished
13,125.00 when replacement windows are installed.
6,562.50 when kitchen cabinets and counter installed.
6,562.50 at completion
Finally, should there be any extra's will remit within 5 days of billing by contractor.
The Commortwepllh ofMampaxse%cr
Depmomext oflidustrid .4ecidents
I Congress S¢ 4 Suite 100
B.osto4 AL4 02114-1017
www.mmmgov/dfa
Workers'Compensation hmuraace Affidavit BaDders/Contrac(or&WJec kiaosfflhwd era.
TO BE FIK"wnm TBE Fixtha7TINGAUTHOR1TY.
Amkmd
bibrintil
ePita LeER&
Name(Basine5s�01Za6on/lndividualJ:. O of
City& Y. Ifs Phone#: /0 8 93ysa 6 y
are yommemployerT Oedc the
appraprpte6m:
ZYAe P 7 rrctiond):
1. 1 m a employer.ri empbyees(talc amNorpmFt®e).'� `7• ❑�Bpn
2.Qlamasok «pmWerahpamQhavcmeerplo�pn!'n?ka'a fmmem g: ,
myeapadty.iNo werkms'ea®p. eequ&edJ
3.01®ahom�rmcd®s.a wodcmyatru pati walana eo�.;nsmmmee requvedJt
9: ODetnolttiUn,
10 0 Bmldmg"eddt'h'ou.
4.Olama� atomdnLbebkiisc�aamaroembaallw"mkm-yproperty. lw�l -ensurethat all centimeters ddwhm m ima,mmpenssiom mauance mm sole 11.0 Electrical repairs or additions
prrp�laorswimmuvapoyeea. i2:DPlumhiugrepeaeai'edditi�s
5.0lamagemal eenmtiilwamdlane tderdtbe euD•baoofetai isreEmau edrlroM 13• ' Roof' ..,
7bexesab-ecmesepe�beve amplones aodbeve wo�c�'emp•ot . . � ., .
6.Qwemacorymetica mol itsokt hmeaercadPocir-*kofeaempdonpaMQ.a - 1<30ther :. .
151.41(4),end we baYememployesa.'[No wad�a'teerp kmomcerequed.I-' . . - -
•Anym�NrnosPoet bum it muR also$B ratPoetroeuoo helots mhot?laa tbdr worlms em> aeeNm palley -
t Hommwneerwho submit ibi alTa&k itldieitfmg Pory ere dologaa aculi�arSiioe auWdew etmert eobmkeaeivaffidavitmdieam�g rush
lConvaiim Poo check Pols bm meet puachedao'aiddi6md m6aetshOwiegthe mml;of9ifsub-oatitrinarao8 ante"hodmei oosme Cease have .
employees.tf>heeubcauQpna.Lave.cm#o 3#mXmwET!ided-w«ms'cmRDoh7z .
law w yar tlarrirpvvidiog werJters'compansagm hargraompr my ea0460i. 8elotp it the pouwga idJab slue
h>jotmodoa
Insurance Company Name: / D
Policy#or Self-ins.Lic:#: Espiraaiou Date:
Job Site Address: �i tl1C 3aG7s< caymmazzip o p« rU
Attach a copy of the workers'compensation policy declaration page(shown M the policy crossbar and expirgifin date).
Failure to secure coverage as required under MGL'c.152,§25A is a mit al violadga punishable by a fine up to$1,500.00
and/or one year impristlmnmi,as wen as civil penatlies m the form ds STOP WORK ORDER end a fine of up to SM-00 a
day against the yioLttoi.A copy ofthie stetanmt iuey be fiuwerded to the`Office of hrvestigaticas.ottlte DIA far ice
.coverage verification.
I do hereby Ceti pains d pwahies ofpajwy thetlhe infornatioa provided aboM it vae and enrred
Dan: ���ell i,
Phone#
Q.S"a ice/are only. Do not twice in anis area,to be eosphled by city or town official
City or Town: PermiULIcense#
Issuing Authority(circle one):
1.Board of Health 2.Bmilding Deparmtent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
ti.Other .
Contact Person: Phone#:
C rry CF SALEg A+IASSAaiMETP.
DAMBAN '
: I"WA2RWMSVjZr,3wROOR
nu. 745.9995.
FAXMV 740-91ib
BZAa�ERIEYDdRiS�L
,hyty� 7laasrasSr.Pauara
Dnracwx cFpL arc rlsr
Construction Debris Disposa/Affidavit
(required forail demolition andrenovation work]
in accordance with the sbM edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL o40,S 54; Building Permit it is issued with the
condition that the debris resWft from this work shall be disposed of in a properiy licensed
waste deposit 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:
(name of facility)
a Tasty -,
(address of facility)
Signature of applicant
Date