60 ORCHARD ST - BUILDING INSPECTION $`7 0'30 cls 2 7s�
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 20]7
Building Permit Application To Construct,Repair, Renovate Or Demolish a
�Oney_or,�T-wo-Family_DwelingA
This Section For Official Use Only
Building Permit Number: Date Applied:
r 5Y V
Building Official(Print Name) Signature Datea
SECTION 1: SITE INFORMATION C=
l.l�roperty Address: 1.2 Assessors Map&Parcel Numbers —
U o/CG1,¢jl/� S7 Cr r
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: Iv
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) GO .;
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 Owner'of Record:
Name(Print) City,"State,ZIP
60 ooec4l o 57 (WT ?W 079y C'Ptos*oy0Gra1Ye-C
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building 2r Owner-Occupied Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ 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:
❑ Standard City/Town Application Fee
2.Electrical $ a
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ - 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire S
Suppression) Total All Fees:$
�� Check No. Check Amount:_Cash Amount:
6. Total Project Cost: $ ❑Paid in Full ❑ Outstanding Balance Due:
MAt L-&�o gl 1,2, 1 « 7-o C, C-.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
y�
1660511 S '/7• 1
License Number Expiration Date
Name of CSL Holdef
List CSL Type(see below)
377 Lowell X
No.and Street /// Type Description
U Unrestricted(Buildings up to 35,000 cu. ft.)
City/'rowntate,ZIP R Restricted 1&2 Family Dwelling
Mason
R Roofing Covering
WS Window and Siding
WZ�f7/0(] — SF Solid Fuel Burning Appliances
7, y?�,�O,X>'tS n'f t°•CdM I Insulation
Telephone ' Email address D Demolition
5.2 R/e-g� r
iste ed Home Improvement Contractor(HIC)
�P � fd7 ' �" ' t, =M HIC Registration Number Expiration Date
HICvpanGCI Name of Is�istrant Name
7
No. and Sire t �A J Email address
7av/•_1�Y,r• fLyGt) ess
Ci /Town, State,ZIP Telephone
SECTION 6c 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 ..........k!r— 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 Felcl— zt �lf�7
to act on my behalf, in all matters relative to work authorizedby this building permit application.
&D COMD a,�eC /G A
Print Owner's Name(Electronic Signature) Date
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
contained in is application is true and accurate to the best of my knowledge and understanding.
Print Owner's or.A rued Agent's Name(Electr6nic Signature) - 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.gov/oca Information on the Construction Supervisor License can be found at LA .mass. ov/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"
! Offices:
UIR18i0firinglint
^ 377 Lowell Street,Wakefield,MA 01880
Tel: 781-245-4900 "W"R
Ron and sir Fax: 781-2454999 www.PaterRvanAndSORROOfng.com
Submitted To: lob Location:
Bud Coady
60 Orchard Street 60 Orchard Street
Salem, MA 01970 Salem,MA 01910
Phone ilk 617-921-0794
Email: epcoady@gmail.com
Propealdata: August 11,2016 Revised dam: August 12,2016
We are pleased to hereby submit this proposal to furnish materials and labor,completely In accordance with the below specifications:
(Additional charges may apply for any change's not included below in proposal either by request of owner,or if Peter Ryan and Son Roofingftnds
unforeseen circumstances that will affect the performance, quality or integrity of this job).In the event legal action is taken to enforce any provision of
this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorney's fees.Not responsible
for debris in attic.
so,EXV-0
Strip Main roof to baro wood and re-shingle: $8,357.00
• Strip existing shingles down to bare wood
• Check for rotted wood and replace(at time&materia!)
• Nail down any loose wood
4 • Install ice&water shield to first 6-feet,and in all valleys and around any protrusions
Mow Install ice&water shield entire rear lower sloped section
BBB. Install Grace ice&water shield to entire roof deck
• Install all new 8"white drip edge on perimeter and step flashing,where needed
r • Install manufacturer suggested starter course of shingles
• Install IKO or GAF Lifetime/architectural shingles in color of your choice
• Install ridge vent
• Cap ridge vent properly with manufacturers suggested cap(GAF Timbertexg or IKO Hip&Ridge 12)
• Properly flash any protrusions and all new pipe flanges,ifany on roof
Overlay shingles over eldsting shingles on Shed: $580A0
• Install GAF or 1KO Lifetime architectural shingles in brand&color ofyour choice
Clean UP:
• Cover area with tarps to minimize debris and remove debris related to work
• NOTE: Please cover any belongings in the attic,as they will get dusty,ifapplicable
FAN
ROW
it n#: Ie .. 17s.atl FIN
IN
0.
I"payment due upon signing: $2,987.00
Total COSI $951111110 Total balance due upon completion: $6,700.00
Kindly remit payment to `Peter Ryan". Thank youi
P_RespectlullY Submitted bY: Accepted bY: mss( i*•ef
Our craftsmanship is 100%gu anleed o 10-years. A warrantees are through the manufacturer.All wrt
aantees will be null& oid ifjob is not paid in full.
Peter Ryan an oofing,Inc. License#178871 l Thank you for letting us serve you!!!
cc: Evan
The Commonwealth of,11assachusetts
Deparinteut oflndu.strial Accidents
Office of Investigations
' 1 Congress Street, Suite 100
Boston, J1.4 0211,E-2017
wtvtetnass.govIdia
Workers' Compensation Insurance Affidavit: Bniiders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lesibl�'
Na111e (Business,OrgvtizatiomIl di�idnal): Peter Ryan and Son Roofing, Inc.
Address: 377 Lowell Street
CityiState/Zip: Wakefield, MA 01880 Phone ;#: 781-245-4900
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑■ I ant a general contractor and I
employees (hdl and/or past-tine). have hued the sub-contractors 6. ❑Ne;v consuitctiou
`'.❑ I ain a sole proprietor or partner- listed on the attached sheet. :. ❑ Remodeling
slip and have no employees These sub-contractors have S. ❑Demolition
working for use in any capacity. einployees and have workers'
9. Bt ilding addition
[No workers' comp. insurance comp. insurance.,
-
required.] 5. ❑ We are a cotpor<ation and its I0.0 Electrical repairs or additions
3.❑ I am a homeowner doine all work officers have exercised their 11.0 Plumbing repairs or additions
myself o workers' con right of exemption per NIGL
Y � iP� l.. ❑ oofrepnus
insurance required.] t c. 152. §1(4). and I,ie have no
employees. [No workers' 13. Outer
coup. insurance required.]
;.A
ny applicant that checks box x1 must also rill out the.section below showing their workers'compensationma
policy infoation.
Homeowners alto submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Coauactors that check this box must attached an additional sheet shoiting the name of the sub-cmrtmams and state whether or not those entities have
employees. If the subcontractors have employxes.they must provide their workerscoutp.policy number.
I are an employer that is proytding workers'compensation insurance for!ny employees. Belo+t•i.s the policy grid job Site
information.
Insurance Company Natue: N/A (I am not required to carry W.C.as I have no employees) Please see the Sub-Contractor's W.C.
Policy 4"-or Self-ins. Lie. ;*: N/A Expiation Date: N/A
Job Site Address: 60 QRC*jffl-RA rS T City state Zip:
Attach a copy-of the workers' compensation policy declaration page(showing the policy number and expiration (late).
Failure to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the inposition of criminal penalties of a
fute•up to$1.;00.00 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. Be advised.that a copy of this statement may be forwarded to the Office of
hivestieations of the DIA for insurance coverage verification.
I rho hereby es, under the pains and penalties ofperju),that the information provided above is true aiid correct.
SiglanueF-
Phone»: 1-245-4900 or 617-571-9056
Official use only. Do not wehe in this area, to be completed by city or Iowa official,
City or Town: Permit/License h
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 T:
T e Co monwealth of Massachusetts
epa inentoflndustrialAccidents
I ongress Street, Suite 100
oston, MA 02114-2017
www.mass gov/dia
Workers' Co pens tion Insurance Affidavit:General Businesses.
TO BE ILE WITH THE PEMMITTING AUTHORITY.
Applicant Information Please Print Lettibly
Business/Organization Name: J & B RC OF€NG, LLC.
Address: P.O. Box 1362
City/State/Zip:Brockton, MA 02303 Phone M 508-663-6208
Are you an employer? Check the appro riate box: Business Type(required):
1.FV_1 I am a employer with 4—e ploy es(full and/ 5. 0 Retail
or part-time).* 6. ORestaurant/Bar/Eating Establishment
2.0 1 am a sole proprietor or partnershi and ave no 7. f-1 Office and/or Sales(incl. real estate, auto,etc.)
employees working for me in any c pati
[No workers' comp, insurance requ red) S. 0 Non-profit
3.0 We are a corporation and its office hav exercised 9. 0 Entertainment
their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing
no employees. [No workers'comp. insur nce required]* 11.0 Health Care
4.0 We are a non-profit organization,s affed y volunteers,
with no employees. [No workers'c mp. i surance req.] 12.0 Other
'Any applicant that checks box#i must also till out th secti4 below showing their workers'compensation policy infomtation.
1f the corporate officers have exempted themselves, ut the orporation has other employees,a workers'compensation policy is required and such an
organization should check box N 1.
I am an employer that is providing wtnrnet,
'co ensation insurance for my emploj>ees. Below is the policy information.
Insurance Company Name: J & B Insurance e Ag ncy Inc d/b/a: Rocco Rose Insurance Agency
Insurer's Address: 360 Oak Street
City/State/Zip: Brockto023 1
Policy#or Self-'ins. Lic. # 6HUB9F316 Expiration Date: 04-04-2017
Attach a copy of the workers' comn p licy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requireSect on 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year nme t,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 vioe a ised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insuranage erification.
I do hereby certify, under the pains and p attic ofperjury that the information provided above is true and correct.
Signature: l Date:
Phone#: ,v;'i '• F t 'y
Official use only. 0o not write in this a ea,ti be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Depart nent 3. City/Town Clerk 4.Licensing Board 5. Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
Peter Ryan and Son Roofing,Inc.
;P�ter101aSo LICENSNRE
HIC License : 78871
Exp. Date: 05-28-2076
Offae of CnnwmtarAffairsS Busloa.a ReBidxttunl.iearse at a isd,uimr valid!m'iudni tn1 us'011,
5 =. M£IMPROVEMENT CONTRACTOR hufare the expiration date. If found return ea:
s {vgist@tion 178871 Type: Office of Consumer A(Snirs anti Rusine5s He-,u n
latia
>?t -expiration: 5128t26t8 Corporation iU Park Plnxa-Suite 5170
Boston,MA 02116
n -
PETER RYAN&SON:ROOFING[.INC.
PETER RYAN
l
383(REAR)LOWELL ST SUITE'2a- -x?/.x r �&
fP/hKEFiELD,MA 01880 Cndersrwreuiry
CS License -0- 106054
EXP. Date: 05-77-2079
Massachusetts Department of Public Safety
Board of Building Regulations and Standards j
License:CSSL40WS4
Construction Super visor Specialty
PETER RYAN
377L :ELL 5TREE„T+' .i r
WAKEFIELD MA 81890 5 _ i
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Commissioner
Expiration:
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