59 OCEAN AVE - BUILDING INSPECTION The Commonwealth of Massachusetts
s� Board.of Building Regulations and Standards
CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Dat Applied:
> �
O�
Building Official(Print Name) Signature ate c5.x,50
1 SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Sq OOFAm AvE.
LI a Is this an accepted skeet?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners of Record:
To,nn S 'SADI RA AO�Hexry &LuAo MA oiro
Name(Print) City,State,ZIP
S4 OWr4 AVC, 4 is-7yl— Sv98 Saadra_doktrtQ msrl.com
No.and Street Telephone Email-Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work :
RgAlopeL TINF>4$� PEA ME51[TN P�Ftn1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ z 77S 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 320 ❑ Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ q7So 2. Other Fees: $
4.Mechanical (HVAC) $ _ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 2 2
7 5 ❑Paid in Full 11 Outstanding Balance Due:
StNO - S � tVthSi KZEpDtN(�4 O1 <jfo1 —ML°vb
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-D864S3 612/201-7
License Number E it tion Date
Name of CSL Ho er U
List CSL Type(see below)
S9�1 rrN 61�T
No.and Street Type Description
READ W G, M f��g67 U Unrestricted(Buildings u to 35,000 cu.ft.
+� R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
781-4t1�(-8489 Sk0.4fCr�Ohc�se�nlwrl�.Corv+ 1 Insulation
_
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
11.;1Z4503 10 2 2016
HIC Registration Number Ex ir tion Date
HICCompany Name or HiC Re �snant Name
65 grass �s�er@ohJestgn�tid•cork
No. and tree[ Email addre
err, -s1-944-&4189
ANA � MA g�W08
Ci /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 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 .511011W [(CAS , 9!
to act on my behalf,in all'afters Ir a ve to or au Jprized by this building permit application.
Ttieran�.s �ohce-f (/,G�
Print Owner's Name(Electr nit ignature) ate
SECTION 7b: OWNER' 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 application is true and a t o?the f my knowledge and understanding.
rin Owner's or Authorized Agent's Nam lectronic Signa Date
NOTES:
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
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.Qov/dns
27 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"
I
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass gov/dta
Wworkers'Compensation Insurance Affidavit:Buildera/Contractors/Electricians/Plumbers.
TO BE FILED RTTH THE PERMITTING AUTHORITY.
Applicant Information /y Please Print Leffibly
Name (Business/Organization/Individual): a,I l o
Address: 579 14t 9 k s+,e2't—
City/State/Zip: GOA i WW 0(861 Phone#: 79t- q'4t{- Eq 01
Are you an employer?Check the appropriate ax: Type of project(required):
1.d1 noun employer with employees(full and/or part-time).+ 7. []New construction
2.E]I am a sole proprietor or partnership and have no employees working for me in S. ®Remodeling
any capacity.[No workers'comp,insurance required.] 9. El Demolition
3.0m 1 aa homeowner doing all work myself[No workers'comp.insurance required.]t
4,[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[]Building addition
ensure that all contractors either have workers'compensation insurance or arc sole 11.Q Electrical repairs or additions
proprietors with no employees. 12.E]Plumbing repairs or additions
5.Q I son a general contractor and I have hired the sub-contracture listed on the attached sheet. 13 �Roof repairs
These sub-contramors have employees and have workers'comp.inswence.t .
6.❑We are a corporation end its officers have exercised their right of exemption per MaL c. 14.[:]Other
152,§1(4),and we have no employees[No workers'comp.insurance required.]
*Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information.
t Bomeowaemwho submit thisatfidevit indieatingiheyarodoingeN+vm mdtherrtnmeubidecanosetoramusFsnbmittnewefiidavitindieetingsueh.
tContractors that check this box must attached an additional sheet showing the came of the sub-contractors and state whether or not those entities have
cmployaes. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that isprovidingworhers'compensation insurancefor my employees. Below is thepolicy andjob site
information. / / / // // /V
Insurance Company Name: �Q]"1 g6,gl [ +u b /i t,/ > �/rf lllsu✓,20ce (�o-
Policy#or Self-ins.Lie.#i y 9 WC-7 O H h Expiration Date: 7-17,1 20
Job Site Address; City/Stata/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
_u—and/ocone�-yzseu psisonment,asave"4iuii-penalties-intbe-fe ERanda-fine-Gfup-to4!250"nom
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certifyd alnr p affia ofperlury that the information provided above is true and correct
Date:
Phone#:
O,j)7clai use only. Do not wrUe in this area,to be completed by city or town ofi7ciai
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
L�;
Office of Consumer Affairs&Business Regulation ! k License or registration valid for indtvidul use only
E IME ENT CONTRACTOR before the expiration date. If found return to: (f{
Veglstrat1PoRncV
19-2§08 Type: -: Office of Consumer Affairs and Buspirahon n-10=616 Private Corporatic:. r 10 Park Plaza-Suite 5170
Boston;MA 02116
GAi_AXY CONTRAGT'h7G. IC,� -
i ' I
" STEPHEN KASPER
65 BASS POINT
MA R6 If Gj'
NAHANT, 0190E Undersecretary
Not valid with t signature
>: Massachusetts-Department of Public Safety Unrestricted-Buildings of any use group which .
Board of Building Regulatibns and Standards contain less than 35> Dobie feet(941m')of i
Construction Supervisor enclosed space.
License: CS-086453
STEPHEN E KAS R 'x, i
59IfighSt
Reading MA 01887 ®J z 1
Failure to possess a current edition of the Massachusetts II
Y
State Building Code is cause for revocation of this license.
Expiration For DPS Licensing information visit: ~u,Mass,Gov/DPS
Commissioner 06/02/2017
f
I
i
I
Galaxy Contracting, Inc. Estimate
dba OUR HOUSE design+build
59 High Street Date Estimate#
Reading, MA 01867 7/14/2016 2997
Name/Address
Tom&Sandra Doherty
59 Ocean Ave
Salem,MA 01970
Project
Kitchen&1/2 bath
Description Qty Rate Total
Materials to be supplied by owner or purchased through Our House 0 18,500.00 0.00
design&build if needed include:all finish materials unless already in
quote:flooring,cabinets and countertops,finish trim,doors and
windows,light fixtures,plumbing fixtures,valves,faucets,drains,
sinks,appliances,accessories,hardware and paint.Contractor will
provide a separate quote to supply finish materials if selected and a
detailed list of all finish materials is required to schedule remodeling
work.Installation of commercial grade appliances will require a
qualified subcontractor and additional charges will apply.
Allowance Price for Budget Purposes Only.Not included with this
scope of work.
Materials to be supplied by Galaxy Contracting include all 0 0.00 0.00
substrates,frame to finish wall:framing lumber,wire and electrical
boxes with devices,pipes and fittings,insulation,water proofing,
subfloor underlayment and drywall.Included with this scope of
work.
Total $32,725.00
Phone# Fax# E-mail Web Site
(781)944-8489 (781)872-1742 skasper@obdesignbuild.com www.ourhousedesignbuild.com
Galaxy Contracting, Inc. Estimate
dba OUR HOUSE design+build
59 High Street Date Estimate#
Reading, MA 01867
7/14/2016 2997
Name/Address
Tom&Sandra Doherty
59 Ocean Ave
Salem,MA 01970
Project
Kitchen& 1/2 bath
Description Qty Rate Total
Insulation to code with spray foam on exterior walls in the kitchen 1 1,800.00 1,800.00
and 1/2 bath plus the floor in the 1/2 bath.Materials will be trimmed
flush with framing in all finish areas. We will air seal windows.
Drywall. 1/2" Blueboard and Skimcoat smooth finish veneer plaster. 1 3,550.00 3,550.00
All exposed ceiling and walls.
Prepare and paint ceiling,walls and trim.Kitchen,hallway and 1/2 1 1,850.00 1,850.00
bath only.
Flooring Allowance for 1/2 bath and hallway only.Supply and 1 1,050.00 1,050.00
install owner supplied ceramic tile.
Installation of owner supplied kitchen cabinets,mouldings and trim. 1 4,800.00 4,800.00
Design plan required for fixed pricing.Additional charges will
apply for finish work in adjoining dining room space.
Installation of appliances should be arranged with supplier and 0.00 0.00
completed on delivery.Plumber and electrician will connect
appropriately.
Installation of owner supplied Tile back splash.Subway tile,brick 0 1,800.00 0.00
pattern,labor only.If selected,not included with this scope of work.
Permit fees 2.5%of construction costs with application and 0 0.00 0.00
inspection schedule.
Total
Phone# Fax# E-mail Web Site
(781)944-8489 (781)872-1742 skasper@ohdesignbuild.com www.ourhousedesignbuild.com
Galaxy Contracting, Inc. Estimate
dba OUR HOUSE design+build
59 High Street Date Estimate#
Reading, MA 01867 7/14/2016 2997
Name/Address
Tom&Sandra Doherty
59 Ocean Ave
Salem, MA 01970
Project
Kitchen&1/2 bath
Description Qty Rate Total
Kitchen Remodel.Existing kitchen space approximately 175 sq.ft. 0 0.00 0.00
1/2 Bath approximately 30 sq.ft.Design plan required for fixed
pricing.
Design Services will be quoted separately.Existing and Proposed 0 0.00 0.00
Conditions.Redesign of existing space.Plan and computer
generated renderings of designed spaces. Any design adjustments
necessary after demolition and during construction.Assistance with
selection of finish materials throughout Design and Construction
phases.Assistance with procurement and coordination of finish
materials will be provided for materials that are purchased through
OUR HOUSE design+build only.A handling fee will be charged for
any product/material purchased by client that requires coordination
by OHd+b.
Structural Engineering if required.Additional charges may apply. 0 0.00 0.00
Not included with this scope of work.
Lead Safe Containment Procedures will be performed as required by 1 800.00 800.00
the EPA RRP regulations.The work area will be contained and
cleaned daily to prevent dust from spreading to other areas of the
home.Contractor will use a sealed vacuum system to collect dust
and particles.
Abatement.Discovery of asbestos,mold or any other dangerous 0 0.00 0.00
materials may require specialized services.Additional charges will
apply.The existing kitchen floor will be tested for asbestos.
Total
Phone# Fax# E-mail Web Site
(781)944-8489 (781)872-1742 skasper@ohdesignbuild.com www.ourhousedesignbuild.com
Galaxy Contracting, Inc. Estimate
dba OUR HOUSE design+build
59 High Street Date Estimate n
Reading, MA 01867 7/14/2016 2997
Name/Address
Tom&Sandra Doherty
59 Ocean Ave
Salem,MA 01970
Project
Kitchen&1/2 bath
Description Qty Rate Total
Abatement.All asbestos containing materials(ACM)if being 0 45.00 0.00
disturbed must be handled and disposed of by a Massachusetts
Division of Occupation&Safety,(DOS)licensed contractor under
all DOS and DEP rules and regulations.Asbestos testing fees.$225
for the survey plus$45 per sample for testing.
Additional charges will apply for repair and replacement of 0 0.00 0.00
substrate materials.To be determined after demolition.Additional
charges will apply.
Kitchen.Complete demolition of existing kitchen and 1/2 bath. 1 4,200.00 4,200.00
Remove existing cabinets and counter tops.Remove fixtures and
appliance. Remove drywall on ceiling and walls to expose existing
framing.Cover and protect existing tile floor in the kitchen.Remove
tile floor in the 1/2 bath area.Prepare for renovation.All debris will
be contained and removed to an off site location.Trash removal fees
are included.
Lally Columns.Dig and pour footings.Supply and install]ally 0 1,500.00 0.00
column or footings in basement if needed for posting and support.
$1500 per footing. If needed to support additional weight.Not
included with this scope of work.
Framing,furring and strapping of existing ceiling and walls as 1 1,875.00 1,875.00
needed to prepare for drywall.Add blocking for proposed cabinets.
Labor and materials. Additional charges will apply for changes to
ceiling height or to level ceiling or floor.
Additional charges will apply to remove walls between kitchen and 0 4,500.00 0.00
adjoining rooms.Install engineered LVL beams to carry load with
posting to foundation.Not included with this scope of work.
Total
Phone N Fax N E-mail Web Site
(781)944-8489 (781)872-1742 skasper@ohdesignbuild.cem www.ourhousedesignbuild.com
Galaxy Contracting, Inc. Estimate
dba OUR HOUSE design+build
59 High Street Date Estimate#
Reading, MA 01867 7/14/2016 2997
Name/Address
Tom&Sandra Doherty
59 Ocean Ave
Salem,MA 01970
Project
Kitchen&1/2 bath
Description Qty Rate Total
Additional charges will apply for changes to ceiling height or to 0 0.00 0.00
level ceiling,walls or floor.To be determined after demolition.
Labor and materials.If required,not included with this scope of
work.
Installation of appropriate subfloor materials to patch in existing 0 0.00 0.00
subfloor and prepare for new flooring in the 1/2 bath area only.To
be determined after demolition.Labor and materials. If required,not
included with this scope of work.
Allowance Pricing to remove kitchen window.Existing RO 59.5"W 1 2,400.00 2,400.00
x 40.5"H.Install new Pella window and finish exterior to match
existing.Existing opening.Additional charges will apply to change
opening size.
Plumbing for kitchen remodel.To code.Plumbing for dishwasher, 1 3,250.00 3,250.00
sink and faucet,garbage disposal,ice maker.No changes to existing
plumbing locations.Plan is to connect new,owner supplied fixtures,
to existing rough plumbing at new locations per design plan.
Plumbing.Add or relocate gas line.If selected,not included with 0 1,550.00 0.00
this scope of work.Site visit by licensed subcontractor required.Gas
permit required.
Plumbing.Drain boiler and remove existing baseboard heat in 0 2,250.00 0.00
kitchen.Reconnect heat loop to add kick space heater.Supply and
install electric kick space heater. If selected,not included with this
scope of work.
Plumbing for the 1/2 bath. Install owner supplied toilet and vanity 1 1,500.00 1,500.00
Total
Phone# Fax# E-mail Web Site
(781)944-8489 (781)872-1742 skasper@ohdesignbuild.com www.ourhousedesignbuild.com
Galaxy Contracting, Inc. Estimate .
dba OUR HOUSE design+build
59 High Street Date Estimate#
Reading, MA 01867 7/14/2016 2997
Name Address
Tom&Sandra Doherty
59 Ocean Ave
Salem, MA 01970
Project
Kitchen&1/2 bath
Description Qty Rate Total
Kitchen Electrical.Pricing does not include any necessary work 1 3,200.00 3,200.00
needed to re-feed any devices outside of the work area.Reuse
existing circuits if possible and add new circuits as needed.Provide
wiring to code for 1-dishwasher,1-garbage disposal, 1-microwave,
2-20 amp circuits for kitchen counter top outlets..Existing 200 AMP
service.
Electrical.Radiant Heat Optional.Supply and install 120 volt 0 1,800.00 0.00
radiant heat pad under floor tile with dedicated circuit and separate
digital thermostat.Includes installation of tile mud to level floor and
secure heat mat.If selected.Allowance$1800 for 50 sq.ft.
Finish Electrical.New lighting plan.$250 per recessed light or 0 250.00 0.00
pendant light.Allowance Price for 5"Juno recessed light fixtures.
Allowance Price. If selected,not included with this scope of work.
Electrical.Under cabinet lighting.Supply and install Juno 120 volt 0 375.00 0.00
LED fixtures 12" 18"or 22".$315 per location. Low voltage
lighting also available,pricing to be determined on selection of
product.
Designer Lighting if selected,not included with this scope of work. 0.00 0.00
Electrical Appliance outlet.Supply and install 40 amp,240 outlet 0 525.00 0.00
for stove.If needed.($525).
Remove existing service and install new 200 amp service with 40 0 2,950.00 0.00
circuit Murray panel,ground to water pipes,supplementary ground
and label panel.Allowance Price.If selected,not included with this
scope of work.
Steam heat is existing.Remove one radiator and send out to be 1 1,250.00 1,250.00
refinished.Replace shut off and reinstall refinished radiator.
Venting for stove hood or microwave to exterior($950).Installation 1 1,200.00 1,200.00
of stove hood or microwave($250).
Total
Phone# Fax# E-mail Web Site
(781)944-8489 (781)872-1742 skasper@ohdesignbuild.com www.ourhousedesignbuild.com