27 ORD ST - BUILDING INSPECTION The Commonwealth of Massachusetts
\ Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 CMR,7'"e ' ton OF SALEM
Revised January
Building Permit Application To Construct,Repair,Reno to Or Demolish a 1,2008
\ One-or Two-Family Dwellin
qY\A1 This Se i n For ffici se Only
Building Permit N ber: Applied:
r
Signature: U 4''n
Budding Commissio r/Inspector of Buil Date
SECTIO 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Lla Is this an accepted street?yes no Map Number Parcel Number t
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
From 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 Oyer'of Record:
Oita- nlPlt�'�/ 7 O/L6 J" 'PeLxEM M4
Nam (Print) Address for Service:
of?r 6/C 6935
Signature Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work?: '� / M/LII / i
d 1
n/ , iC L— 1
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 $ ❑Total Project Cost'(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: $ 5 13Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
CT sL to to 6 3 /Z I /y
44ViJ—e7 o t. Ld—J License Number Expiratio Date
Name of CSL-Holdern i
/ - /L �.� List CSL Type(see below) /(( E✓J
Address ®RC
Description
Unrestricted u to 35,000 Cu.Ft.
Restricted 1&2 FamilyDwelling
ire p Maso Onl
�s� i o F�' Residential Roofin Coverinlephone Residential Window and SidinResidential Solid Fuel Bumin A liance Installation
Residential Demolition
5.2 Register ^/C-r' p�msnt Ci ntractor,,AVI C6
y/ �l_PP � 71 t�JJ
Inc Co pang Name r Hl Regis I e Registration Number
J d� r 21 Z.7� /
ddress bs E M Expiraion Date
azure Telepho
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
I, 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.
Signature of Owner Date
/J /J
SECTION 7b:OWNNER'OR AUTHORIZED AGENT DECLARATION
1, /'j]i/r//J t� /'&j'�PLL, L(N`Jt C.Cf ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Name
A-igiffifure of Owner or j9dilmriied Agent Date--7
(Signed under the pains and penalties of
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and i IO.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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
CERTIFICATE OF LIABILITY INSURANCE"
RODUM (617)471-122D FAxr (617)479-5147 THIS CERnFICATE IS ISSUED AS A MATTER OF-INFORMATION
Dnioy Insurance Agency, Inc. HOLDER.AND
HS CERTIFICONFERS CATE DOES NOT`pAWjfd,•EXTEND OR
.00 Victory Rd. ALTER THE COVERAGE AFFORDED BY:THE..POLICIES•BELOW.
Co 4nincy MA 02171 INSURERS AFFORDING COVERAGE MAIC 13
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OVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICI TT .•NOTWiT}iV*DINo';
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DocumENT wrrH RESPECT TO WHICH THIS CErtT1�TCATE MAY BE'ISSLIES OR
MAY PERTAIN THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS-AND CONRiTONS OFSUCH
POLICIES.AG®ATE LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS.
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CERTIFICATE HOLDER CANCELLATION
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DATE TIGRAOP,THE INUING MLIRER WILL ENDEAVOR.703ti1T.•
NOMETOTHE CERBFICAT6 MOLDER NAMED 7077.,,, BUTPAIUAiE'40 DdSOSWII'
IMPOSE NO OBLIGATION OR UA01LrrY OF ANY Items DAO/N. 413uI!II L fISA6brts OR '
REPREBENTA
AUIIRIR�D ASND . .
ACORD 25(2009101) ®1988-2009 ACORD CORPORATION.JUI rh"reserved
INS025010m) The ACORD name and logo are registered matt of ACORD
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H.J.Knight lntemHtional Ins=ccAgmcltes,Ino. HOLDER THIS COUIFICATE DOES NOT AMEND,-bCMW Co. .. .
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ADMDR4dDftmgVWTA77
11'13SMIchusetts- Dcp:uZmcntnFPublic ..^..
Board of Suildin. Snft•[c I —'
C Rc,•ulatinnx and Standards
Construction Supervisor Specialty License
License or registration valid For-Indlvldul use only
License: CS SL 101003 "` 1 More-the-expiration date. If found return to:
Restricted RF,WSBoard of Building Regulations and Standards
' !One Ashburton Piece Rau 1301
STAVROS 'MOUTSOULA'S JIBloston _11 WILSON STREETEM, fvlA'01970 .
----� Expiration: ]2j14/�017 I Noty widrout signature
[bmmizztuner
Tr#: 101003' '
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oar ut a ions an tan ar s
One Ashburton Place -Room 1301
Boston.Massachusetts 02108
Home Improvemed-Centractor Registration
:. ..�i; .-.. -.-.- Registration: 154326
;':. • ?'ati' =%`.' Type: private Corporation
."��IIkkr. Expiration: 2272011 Tr0 279846
ALPINE PROPERTY SERVICES`COx1 �=
STARROS MOUTSOULAS
11 WILSON STREET
SALEM, MA 01970
Update Address and return card.Mark reason for change.
• C3 Address 0 Renewal Employment b Lost Card
� nP9CA1 O Snh1-07N/-PC899n _ _ ._..�.—
07
Board of Building Regaled asand Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Regis RdT. IM26 One Ashburton Place Rin 1301 ,
Ex Iift;.iW2712011 Tr# 279846 Boston,Mo.02108
:='f' `e:-Ogate Corporation
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ALPINE PROPS„ E5:l0,INC.
STARROS
11 WILSON STREf`'"'7;.,>
iaL=,:� Nai valid without signature
MA 01970 Administrator
I
The Commonwealth of Massachusetts
Department oflndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organization/Individual): / /��� �/�// �/ SC4,k✓p eta
Address:_ 7 ?i S /g a Sa i./ sr
City/State/Zip: T1>Qt)l7 d Alf-0Fj Phone n
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑Building addition
[No workers' comp,insurance 5. We are a corporation and its ME]Electrical repairs or additions
required.] Pq officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.,[No workers' comp. c. 152, §1(4),and we have no 12.1]Roof repairs
insurance required.)t employees. [No workers'
13.5d Other Jr
comp. insurance required.]
"Any applicant that checks box#1 must also 511 out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they am doing all work and then him outside contractors must submit a new affidavit indicating such.'
tConuaetors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below,is the policy and job site
information.
Insurance Company Name:_ MA*51 c (.(h1711')z �st/A&z leir (?a
Policy#or Self-ins.Lic.M //J e' Expiration Date:
Job Site Address: 7i� 17/`�l S� City/State/Zip:C IU., '—QI F7 o
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 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 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
Investigations of the DIA for insurance coverage verification.
I do kegoby certify under the pains and penalties ofperjury that the information provided above is true and correct
Si Date: 7-13410
Phone #: -
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 M
MC#167567
EIN#56.2618812
OLYMPIC Job#:
Roofing-Siding-Painting Office: 978-887-5870
239 Boston Street-Toosfield,MA 01983 Fax 978 887 5875
Peter Hinchey -
237 Locust St.
Danvers,MA 01923
(978)618-6839
Email: bloomie99@aol.com
Job Location:
27 Ord Street-Salem,MA
October 7,2010
Dear Peter,
Revised: October 18,2010
I have prepared the following estimate for the installation of the vinyl siding at the above location. This will be a frill coverage job with no
maintenance required and lifetime warranty. All work will be performed to the manufacturer's specifications to ensure a lifetime warranty. Below
is a brief description of the work that will be performed.
Vinyl Siding,
• Go over existing clapboard siding
• Install 3/8 insulation board over all areas prior to vinyl installation
• Install CertainTeed MainStreet Double 4"vinyl siding
• Flash all windows and doors
• Securely nail all loose boards and wood
• Replace any rotted wood @$12.00/ft.
• Scrape away any old caulking around any doors and windows
• All overhang and eaves will be dressed with soffit panel
• All trims will be wrapped with aluminum coil stock
•. We will install new vinyl corner,j-channels and casements throughout .. . .
• Vinyl corners will be six inch white traditional flat super corners on six areas of building.
• Install metal-coil freeze board below large gable on top front section of house -
• The soffit and face boards will be done to match the windows
• Price includes installation of PVC corner on porch and PVC brick molding around rear door enhance
• Price includes the installation of solid soffit on front and right side porch ceilings 1-
• Price includes removal of(12)new storm windows to be put in storage 6{&w YJ I IAc►�l—CY\�''n ''`
• Separate price for vinyl on(2)three-sided bumpouts
• Separate price for strip and re-roof of porch(price includes 30-year 3-TAB shingles)
• Separate price for(3)pairs of shutters(Color=Wineberry)
• Foundation will not be covered
• We will remove all job related debris
• Job will be started and completed without any interruption
• Vinyl permits vary from town to town and are not included in this estimate
•
COLOR-
Please
OLORPlease initial all options You are choosirs below:
Cost for Labor&Material to Go Over Vinyl Siding: $12,950.00
Cost for Labor&Material for Vinyl Siding on(2)Three-Sided Bumpouts: $ 995.00
Cost for Labor&Material to Strip and Re-Roof Porch: $ 995.00 ^r •fes
Cost for Labor&Material for(3)Pairs of Shutters: t $ 195.00 `1 I L,
Payment Terms: W deposit upon signing contract $-6 615•113 work in progress $!�r b 41gand 1/3 upon completion$
Remit to: Alpine Property Services Company,Ine,P.a Bax 365,Topsfield,MA 01983
Total Amount Agreed To Be Paid: $�1'31 ,
The following schedule will be adhered to unless circumstances beyond Alpine's control arise:
Work Scheduled to Begin:_TBD' - Expected Date of Completion: TBD
Warran Alpine Prop ervices- c.guarantees all�work performed grind of one year. If any problems occur,we will cover the cost of
all Is r a terialTo orrect the p oblem to meet the customer' atisfacti The v 1 siding material will have a lifetime warranty from the
a •e
'c Connors, ro ectMan r PeterHinchey
A pine Property Servi Co any Inc. Homeowner