5 NORTHEND AVE - BUILDING INSPECTION d y
.i A t ''-
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR Z � AW244 A �S
/
Building Permit Application To Construct, Repair, Renovate Or Demolish a evtsed Har l01
One- or Two-Family Dwelling
This Section For.Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION I: SITE INFORMATION
My A ess: �� 1.2 A�ssors Map&Parcel Nu I ef�
• /
I.I a Is this an accepted street?yes se no Map Numbed Parcel Number
1.3�S_ng Infor_mahL .4 Propnsions:
m i Y
Zoning District Proposed Use / Lot A (sq ❑) Frontage
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required P ed Required 'rovided Required Pro
1.6 Wate pply: (M.G.L c.40,§54) 1.7 Flo one Information: 1.8 Sew sposal System:
Zon Outside Flood Zone?
Pu Private❑ — cipal ❑ On site disposal system ❑
Check if yes❑
CTION 2: PROPERTY OWNE HIP'
1 caner of RVIVIOec VI Salem
w 'V' }j�, ^ ^ O1 0I`C
Name P int) City,State,ZIP 1
No.and Street Telephone Fraud Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s)X I Addition ❑
Demolition ❑ Accessory Bldg. 0. Number of Units Other ❑ Specily:
Wirf DescriedQn of P oposed W r PA$
Il e I
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only -
Labor and Materials)
I. Building $ 1. Building Permit Fee: $ indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ —�— 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $Suppression) Total All Fees: $
S Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ l��l D F1Paid in Full ❑Outstanding Balance Due:
MI\IL_P-M Its Sr:VsE $I3D
i�
SECTION 5: CONSTRUCTION SERVICES
O
5.1 Cot struction Supervisor License(�)
OS�S�es G Au License Number Expiration ate
Name otCSL Hol •r �V'��•�
List CSL Type(see below)
8`
No.a d Street Type Description
CT /ti/ Z_7U Unrestricted(Buildin s up to 35,000 cu. ft.)
VO { R Restricted 1&2 Family Dwelling
City/Toy , Sta Ip M Masonry
RC Rooting Covering
WS Window and Sidin
060 11SF Solid Fuel Burring Appliances
53 .04S 2LSVEC0331@Gw� I.0 k.X I I Insulation
Telephone Email address D I Demolition
5.2 litegistered Home Improvement ontracto (HIC) Ac& , /T7704
T 7 7 0 /I 2,"1 z)
� tet'
l0 ssvcL:7AR 111C Registration Number Expiration Date
F p'ny
NU-ne,rat HIC Regis[rName f ��
Marri �� aVFCn$3 )Q=)6"!4-C,0kt
n.and r e- Ma— 01840 860 -1S 3.04S Email address
City/Town,State,Z115 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 .........X No ...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Ownerof the subject property,hereby authoril
to act on my behalf, in all matters relative towork authoilzV by this building permit application.
V'nc e Skein lna.V1 "1
Print Owner's Name(Electronic Signat re) f Date
SECTION 7b: OWNERn OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contain d in this application is true an acct rate to t best of my -nowl�Qge and understanding.
GI L Z�
Print Owner' ut orizcd Agen . n lectronic Signature) V Date
NOTES:
I. 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
www mass. og v/oca Information on the Construction Supervi se afound at www.mass.euv/dns
2. When substantial work is planned,provide thein alion 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 Proje quare Footag-e" may be substituted for"Total Project Cost"
CITY OF SALEM, NLaSSACHUSETTS
BuiLDNG DEPARTMENT
130 WASHINGTON STREET, 3' FLOOR
TEL (978) 735-9595
FAx(978) 740-9846
jCL,jBERLEY DRISCOLL
;"SAYOR TH uAs ST.PtER LE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMISSION£R
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defincd by MGL c
I 11, S 150A.
The debris will be transported by:
43P - I-ru ! , i rt L,
(name of hauler)
The debris will be disposed of in
B ;-
���
(name of facility) y�
3�s LAV, Ive S ,� AveeJL4, -e
11a�L1AA / QZ096
(address of faetlity)
signature of permit applic t
fZ-4- 12,6 le
date ,
dcbrisalld,x
\ The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Ulki,kers'Conapensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/mdividuap: Budget Exteriors/C/O Lou Milano
Address: 354 Merrimack Street ( Entry C, Suite 500 )
City/State/Zip: Lawrence, MA 01840 Phone #: Home/Fax:860-315-5266 Cell:860-753-0452
Are you an employer?Check the appropriate box: Type of project(required):
1,[Z]I am it employer with 10 employees(full and/or part-time).' 7. ❑ New construction
2❑I am a sole proprietor or partnership and have no employees working for me in g. ❑ Remodeling
any capacity.[No workers'comp.insurance required.]
' 9. ❑ Demolition
3.E]I am a homeowner doing all work myself'.[No workers'comp.insurance required.]'
10 ❑ Building addition
4.F1 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions
proprietors with no employees.
12.[—]Plumbing repairs or additions
5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 11 LN Roof re airs (1
These sub-contractors have employees and have workers'comp.insurance 1
4.X Other
6.L]We are a corporation and its officers have exercised their right o(exentption per MGL a t
152,h 1(4),and we have no employees.[No workers'comp.insurance required.J ti S
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comry policy number.
I am an employer that is providing workers'compensation insurancefor mV employees. Below is the policy and jab site
information.
Insurance Company Name: Atlantic Charter Insurance Co. / 781-593-1200
Policy#or Self-ins. Lie. #: C�BC2000 017401 Expiration Date: 07/31/2017
Job Site Address: S /V V 1 (2 hye City/State/Zi e� 0 19-1c)
Attach a copy of the workers' compensation policy declaration page(showing the policy: umber and ex iration 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 fine 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 DIA for insurance
coverage verification.
/do hereby car ' u er the p sand pens ties n erjury :a![ire inj rma[ion provid�d above is true and correct.
Si natur . Date:. u �b
Phone oma Fax : 860-315-5266 Cell : 86V753-0452
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):
I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
RESET,FORM
s
Office o1'Consumer Aftairs Business Regulation
10 Park Plaza - S'uite 5170
41 Boston, Massachuetts 02116
F1orne Improvement Contractor Registration
Registfation. 177704
'type: Supplement Card
Expiration. 2/112018
BUDGET EXTERIORS
LUBOS SVEC
354 MERRIMACK ST ENTRY C
LAWRENCE. MA 01840
Updato Address and relurn card, Nark rea."n for change.
Address Rerimal �'' f(mploymeni Lnst Gard
"�'Oi7re 6f Comu mei`An.",&fiusinr_cs Krgula lien 1,iee11se nr ztgis(,ation valid f6r individual ase wily
",.n'1r' beture the expiratiun date. f f found retuni to:
=1 H�bME IMPROVEMENT CONTRACTOR -
OfficeofConsumer Affairs and Business Regulati6n
Registration: 177704 yp 1.0 Park Plaza-Suite 51719
T e:
Expiration 21112018 SuyplemeM Card Bosinn,MA 02116
HUfi CET EXTERIORS
L154 ME SVEC
354 MER2IMACK SY ENTRY C"
LAWRENCE,MA 01840 (}nderscrretar)•� va id't1�fi nh uts.anatuty
P w�
Massachusett Depart liHit of#'fibiiC Sasety
"card of Sult-Jio,r� RCgUlati.)n 4:-id,t'stGnr
con'tinctiun 1','Uprr*i:,vr .�f Vv
_ Licenrso' CS-097519 vv. k
0
LUBOSSVEC
827 THOMPSONio r
Thompson CT 06277 t
�r
G;iYfVtSI55tDp^"f
08131/2016 "
t
J
Page 1 of 2
I .
CONTRACT TERMS AND REQUIRED NOTICES
Notice: All home improvement contractors and subcontractors engaged in 7
t!
by the provisions of Chapter I 42A of the general laws,must be registered
home improvement Contracting,unless specifically exempt from registration
with the Commonwealth of Massachusetts. Inquiries about registration and a,,7dRr-,a,-e a/' ,�;"X'ld AD,- le--;,
status should be made to the director,Home Improvement Contractor N4
Registration,One Ashburton Place, Room 1301, Boston,MA 02108. 354 Merrimack Street (Entry C, Suite 500) - Lawrence, MA 01840
888-49BUDGET - Fax (781) 333-5240 - budget-exteriors.com
I/We hereby agree and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install, construct and place the improvements
according to the specifications,terms and conditions, on the premises below described which INVe represent that we have good record title in our own name.
Owners Name. Vince Sheahan
Home Phone 978-968-0664 Work Phone Email Vsheahan@gmail.com
Job Site Address 5 Northend Ave Salem MA 01970
Massachusetts Contractor Registration # 161932
Work Specifications described attached on pages —of.
Permits: The contractor agrees to apply for and obtain all construction related permits(building/electrical/plumbing)but shall not be deemed responsible for
delays in the work described in this agreement caused by regulatory,permit granting,or inspection agencies,authorities or individuals.
Notice: The homeowner who secures his own permits will be excluded from the guarantee fund of MGL Chapter 142A.
Price:The contractor agrees to do all work described by the contract for the total price of $7,980.00
Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of no more than one-third of the total
contract price or the total amount of all deposits or payments which the contractor must,in advance,to order and/or otherwise obtain delivery of special
order materials and equipment,whichever is greater.
Payment Terms: Advanced Deposit $4,000.00 Payable on signing of contract
Interim Payment 1 — Payable at start.
Halfway Payment Halfway through project.
Final Balance $3,980,00 Payable on completion unless otherwise specified.
Work Schedule: The contractor will not begin work or Order material before the third day following the signing of this agreement unless specified in writing.
I he,contractor will begin work on or about . Barring delays caused by circumstances beyond the contractor's control,the work will be
substantially completed on or about The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and
that such delays that are not avoidable by the contractor shall not be considered as violations of this agreement. The contractor shall not be liable for any
delay or non-performance caused by strikes,accidents,weather or any other contingency beyond its control.
Insurance: The contractor agrees to maintain workers compensation and comprehensive general liability insurance during the operation of this job to cover
the acts of its employees and or agents.
Warranties: The contractor warranties its workmanship for up to a period of 7(seven)years and assigns the rights to any manufacturer's warranties to the
homeowner after substantial completion and payment of the contract terms.
You may cancel this agreement if it has not been consummated by a party thereto at a place other than an address of the contractor,which may be his main
office or a branch thereof,provided you notify contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or delivered,not later
than Midnight of the third business day following the signing of this agreement.The instrument and any and all other documents attached hereto and signed
by the parties set forth the entire contract between parties and may be modified only by mitten instrument executed by both parties.Receipt of a copy of this
contract and duplicate notice of cancellation and explanation thereof is hereby acknowledged.
Notice: Cancellation of this agreement after three business days will result in a restocking fee of up to 33%on custom products and 25%on non-
custom order products.
HOMEOWNER: Do not Sign this contract if there are any blank spaces.
IN WITNESS WHEREOF, the parties her ntosigned theii ameson8/19/2016
J IV
41,ii,eb
Budget Exteriors, inc. Rep a-Ia! Homeowner
�Z.Z
Accepted Budget Exterior®ric V Homeowner
Page 2 of 2 0
Owners Name: Vince Sheahan
7_4
354 Merrimack Street(Entry C, Suite 500) - Lawrence, MA 01840
Work Summary 888-49BUDGET - Fax (781) 333-5240 - budget-exteriors.com
We hereby propose to furnish and perform the labor necessary to:
- Drape outer wall of house with tarp to prevent damage to house and adjacent landscaping from falling
debris
- Strip and dispose of all roofing material down to roof boards of which the first two layers are free then
only 350 per square foot for each additional layer
- Provide a comprehensive inspection of deck to include replacing damaged lumber, of which up to 64
square feet of plywood or 64 linear feet of roof boards will be replaced free of charge. Additional square
feet/linear feet is $3.00.
• Inspect and replace damaged step flashing, where needed.
• Install 8" white drip edge on all edges of roof
• Re-lead chimney to include grinding out mortar necessary to remove existing lead/tar, install ice shield
around base of chimney, install new lead where existing once was, and seal with high-grade chimney
caulking
• Install IKO Cambridge limited lifetime architectural shingles
• Install Cobra style ridge vent at peak of home
• Install Bitumen self-adhering high temperature ice shield 6' up from bottom edge of roof, 3' in valleys,
and around all protrusions
• Install synthetic underlayment where no ice and water shield is installed
• Install IKO Leading Edge Plus starter shingles and IKO Hip and Ridge 12 Accessory Shingles
• Replace all pipe boots
• Storm nail (6 nails) all roofing shingles
• Keep driveway and walkways debris fee each night and remove all job related debris upon job
completion
• All manufacturers product warranties will be provided to homeowner at job completion
• Budget Exteriors will obtain all permits and shall be reimbursed by customer for cost of permits and/or
any city fees
• All workmanship guaranteed by Budget Exteriors for 7 years
• Project does not include any outbuildings
Address is Northend ave
For Low and
Roof Color i Charcoal gray Edge Metal Color White
A-- J