2 LOGAN ST - BUILDING INSPECTION RECEt`lED
r tri s',nl rFi�`IIC,ES
The Commonwealth of Massachusetts
Board of Building Regulations and Standar�(( P FOR
Massachusetts State Building Code, 780 C1vPR15 10 2 S �MICIPALITY
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family L4velling
^� This Section For Official Use Only
1 Building Permit Number: Date pplied:
Building Official(Print Name) Signature Date
N SECTION 1: SITE INFORMATION
1.t�operty dere �� 1.2 Assessors Map& Parcel Numbers
(V J d
L l a Is this an accepted street?yes_ no Map Number Parcel Number
1 1.3 Zoning Information: 1.4 Property Dimensions:
Ln 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.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public 13 Private 11Check if yes❑ Municipal❑ On site disposal system 11
SECTION 2: PROPERTY.OWNERSHIP[
2.1 Owner of Record:
lop
Name(Pri t) City, State,ZIP
7, 7174' .4.✓ 3y 97,9 Q�3
No.and Sire' Telephone ' Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Buildin Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work'':
L /1_,�/1Ar
✓r a
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
L Building $ Q t7-D 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) S List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amom t:
6. Total Project Cost: $,042% ❑ Paid in Full ❑Outstanding Balance Due:
Mr—,tt x17160 t84ior' t,,., 174 -7
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
� 7
o
License Number Expiration Date
Name ol'CSL Holde
> o /'t n n.f-, /, '� n �,� List CSL Type(see below)
No.and Street F ` -�C^-�' Tyke- Description
GIi
19 ;4— AiJ A-1) 0/ 9 2 / U Unrestricted(Buildings u wto 35,000 ca ft.)
City/Town,State.ZIP f Restricted 1&2 Family Del,i-
M Mason',
RC Roofin Covering
WS Windowand Siding
O �I / f SF Solid Fuel Burning Appliances
Telephone �J I Insulation
Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
/2/92,f3 / 47
HIC Registration Number Expiration Date
HIC Company Name or HIC Regisy,nt Name P
A'a
No.and Street 6
Email address
Cit /Town,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 lssuanp-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 authorized („) 1y2''� f L�,� i/v� 7���r,
to act on my behalf,in all matters relative to work authonzed by this building permit application.
Pnnt Owner's Name(Electronic Signature) Dat
SECTION 7b:OWNEW OR AUTHORIZED AGENT'DECLARATION
By +ng-m nan below, I hereby attest under the pains and penalties of perjury that all of the information
-colvained in this app cation is true and accurate to the best of my knowledge and understanding.
P int Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,of an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(I-11C)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important informatiat on the HIC Program can be found at
www.mass.gov/ocainformation on the Construction Supervisor License can be found at www.niass.gov/dr)s
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basement/attics,decks of porch)
Gross living area(sq. R.) Habitable room count
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of half/badis
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"
'Q\ Office of Consumer Affairs&Business Regulation
1HOME IMPROVEMENT CONTRACTOR
Registration: 176928 Type:
Expiration: 10/10/2017 Corporation
AS CARNES ROOFING,INC.
BARRY CARNES
30 ARROWHEAD FARM RD
BOXFORD, MA 01921 Undersecretary
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-000230
BARRY S CARNES' -
30ARROWHEAUF +ARM�o ,\
Boxford MA 01921
Expiration
Commissioner 03/0712016
Proposal
�aX Oek CCW 19-"e Carnes Roofing,Inc.
30 Arrowhead farm Rd Page 1 of 1
Boxford,Ms.01921
978.887.1431
MA.CS-000230 and HIC Reg.176928
Proposal Submitted To:
BOB&SHERRY JULIEN Data September 16,2015
2 LOGAN ST Project Name SAME
SALEM,MA 01970 Address
978-335-3498
We propose to furnish material and labor-in accordance with the specifications below:
Sixty Four Hundred Dollars($6,400.00)
Payment to be made as follows:$300.00 Deposit,Balance Upon Completion]
Notice:All home improvement watmciors and subcontractors engaged N hone improvement conaaceng,unless specifically exempt from registration by provisions of Chapter
142A of the General taws,must be registered with die Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Mess.gov/lloanses website.
ROOF PROPOSAL
E STRIP ROOF OF UP TO TWO LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH THE UPGRADED RHINOROOF TITANIUM U20 HIGH
PERFORMANCE SYNTHETIC UNDERLAYMENT MEMBRANE.COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE.
E ICE DAM PROTECTIOW INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVER ALL HEATED AREAS SIX FEED WIDE AT THE
LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEY(S)AND SKYLIGHT CURBS WITH ICE AND WATER BARRIER.
E COVERALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE.
® INSTALL GAF COBRA RIDGE VENTiAND/OR❑ ROOF LOUVERS FOR ADDED ATTIC VENTILATION.
E COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE.
E REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF$25.00PLFT.WE MAY NEED TO REMOVE
THE SIDING TO PERFORM THIS WORK AND YOU MAY NEED TO HAVE A CARPENTER REINSTALL OR REPLACE THASECURE
THAT WAS REMOVED.
E CHIMNEY FLASHING:CUT ALL EXISTING TAR AND LEAD FROM ONE CHIMNEY(S).CUT NEW REGLET WITH CAW AND SECURE NEWLEADFLASHING IN PLACE WITH METAL ANCHORS. PROPERLYS L-REG125)OINT. PLEASE ADD$5M.D0 TO AICE.E COVER ROOF SURFACE WITHCERTAINTEEDLAthDMARK 240 LIFETIME ARRANTY DESIGNER SHINGLES.
E REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH SIMILAR -ANADDI ZONAL COST OF$4.0)PSOFT/PLFT,
❑ COVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT ANNAL COSTE NAILING: SECURE SHINGLES WITH EIGHT IN TOTAL COATED ROOFING NAILS AS PER CERTAINTEED SPECIFS.❑ SKYLIGHTS:REPLACE EXISTING SKYLIGHTS WITH NEW VELUX OR WASCO UNITS.WE WILL PROVIDE THE S &F ING KITS ATOUR EXACT COST FROM OUR SUPPLIER.OUR LABOR CHARGE IS$75.00 EACH IF THEY ARE THE SAME SIZE.INTO S EXCLUDED.REMOVE EXISTING GUTTERS ❑INSTALL NEW SEAMLESS.032 ALUMINUM GUTTERS USING THE HIDDEN ZINGER SYSTEM.REPLACE DEFECTIVE TRIM BOARDS WITH CUSTOMERS APPROVAL USING NO.2 PRIMED PINE,ADD$15.00PE PROPOSAL.
❑ INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY FASTEN ALL CONNECTIONS.
CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA,THE PROPERTY OWNER AUTHORIZES AS CARNES ROOFING TO OBTAIN
ALL PERMITS.WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES.
GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE,HOWEVER,SOME MARRING AND OR MINOR DAMAGE COULD OCCUR,
IN ADDITION,WE CANNOT BE RESPONSIBLE FOR ITEMS FALLING FROM WALLS,SHELVES OR CEILINGS DURING THE ROOFING PROCESS.
SPECIAL INSTRUCTIOW
THE ABOVE PROPOSAL INCLUDES ALL SHINGLED ROOF SECTIONS OF THE HOUSE.
CHIMNEY FLASHING:THIS SHOULD BE DONE AS PROPOSED ABOVE OR LEAKS MAY OCCUR.
WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITII AN UPGRADE TO THE
CERTAINTEED HIGH PERFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YES. (W
EMAIL ADDRE>T) �C
Warranty:All work warranted against installation defects for 5 years;this warranty is limited to the installed item(s)and its repair only.Material is warranted by
the manufacturer against defects for 50 years;see the manufacturers warranty for exact warranty performance.
Cancellation:Customer has legal right under federal law to cancel this con1bact without penalty or obligation within three business days from the date of
signing this agreement via Priority Maul Delivery Confirmation. Please we reverse side.
Dispute.Resolution under Massachusetts Home Improvement Law 142a:All parties agree that any and all disputes relating to this proposal shall be
settled by arbitration.This fmm is user friendly and does not require lawyers.Please see reverse side.
Signing this Proposal raj;you have accepted all the terms as stated on the front and back of this agreement. Please see reverse side.
*Date of Acceptance 176a Signature �r�✓1/` \/ � ' I,.f'lr/`
(/ ' ,y—
*SignaNre� Signatu _
PLEASE SEE REVERSE SIDE
CITY OF SALEM
WASTE AFFIDAVIT
As a result of the provisions of MGL Ch.40-s54, I acknowledge that as a condition of
building permit# all debris resulting from the construction activity governed by
this building permit shall be disposed of in a properly licensed solid waste disposal
facility, as defined by MGL Ch.111-s150A.
Waste Disposal or
Solid Waste Facility: ALLIED WASTE
Address: 300 FOREST ST
Town/City, State, Zip: PEABODY, MA 01960
NAME OF HAULER: AB CARNES ROOFING, INC. DUMP TRUCKS
DATE: 11-26-2015
SIGNATURE OF APPLICANT:
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Tw urkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le ibly
Name (Business/Organization/Individual):AB CARNES ROOFING INC
Address:30 ARROWHEAD FARM RD
City/State/Zip: BOXFORD, MA 01921 Phone #:978-887-1431
Are you an employer?Check the appropriate box: Type of project(required):
LQ 1 am a employer with some employees(full and/or pan-time).`
7. L] New construction
2.F 1 am a sole proprietor or partnership and have no employees working for me in
8. EJ Remodeling
any capacity.[No workers'comp.insurance required.]
3.[]l an a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition
4.F 1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 E] Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.W]Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.❑We area corporation and its officers have exercised then right of exemption per MGL c. 14.❑Other
152,§I(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tConuactors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether m not those entities have
employees. Ifanc sub-contractors have employees,they must provide their workers'comp.policy number.
]am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:TRAVELERS INDEMNITY CO OF AMERICA /-- — -�
Policy#or Self-i s. Lic. #:6HU6-OG36156-6-15 Expir tion Date: 10/15/2016
Job Site Address: City/State/Zips.__
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fuze of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification.
I do hereby certify untis and pen Ities ofperjury that the information provided above is true and correct:
� 6- '
Signature: Date:
�Z-
Phone#:978-887-1 31
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
NOTICE Z NOTICE
TO u
o TO
EMPLOYEES 4y EMPLOYEES
T WW
/O V\
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017
617-727-4900 — http://www.state.ma.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
P .O. BOX 1450
MIDDLEBORO. MA 02344-1450
ADDRESS OF INSURANCE COMPANY
(6HU6-OG36156-6-15) 10-15-15 TO 10-15-16
POLICY NUMBER EFFECTIVE DAT-E�
PRESCOTT & SON INS 963 EASTERN AVE
<� MALDEN MA 02148
N -0F_INS RAN-CE NT ADDRESS PHONE #
°= AB CARNES ROOFING INC �, 30 ARROWHEAD FARM RD
BOXFORD
MA 01921
MPLOYER ADDRESS
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
000849 W20P1G15 TO BE POSTED BY EMPLOYER