1 PRESTON RD - BUILDING INSPECTION ��1 � �►� to sc�
The Commonwealth of Massachusetts
F-
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR SALEvI'
;tolb SEP j
2-fegedMar 2011
p— Building Permit Application To Construct, Repair, Renovate Or Demolish a 1 FF-- 2-- 2q
o One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
I 1.1 Pro erty dress: 1.2 Assessors Map& Parcel Numbers
���
I.1a Is this an accepted street?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. fir'of$eeerd: 00r-
Na (Pri City,State ZIP ZIPP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ 1 Existing Building Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Additiop ❑
Demolition ❑ Accessory Bldg. ❑ I Nu ber of Units I Other Specify
Brief escn on f ropose Wor ':
cS/ i
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ If 1, Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: I
0
5.Mechanical (Fire
Suppression)
$ Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ y �� D ❑Paid in Full ❑Outstanding Balance Due:
M t�l,,x^0 10 I nt
� SECTION 5: CONSTRUCTION SERVICES
5.1 Co truction Superv(yoLice
,[L nse(CSL)
O
U License Number Expiratio Date
Name of Holde
n /fCS[, /ot /' List CSL Type(see below)
No.and SV t Type Description
/QAµ U Unrestricted(Buildings up to 35,000 cu.ft.)
/"✓/ R Restricted 1&2Family Dwelling
City�'I'ow� te, — M Masonry
RC Roofing Coverin
WS Window and Siding
SF I Solid Fuel Burning Appliances
1
1 Insulation
Telephone Email address D Demolition
5.2 gistered Ho a Impr e t Con ac r C) /�
W & e e -6 6 HIC Registration Number Expitation Date
HI Comp ny alpe or R g}s ame
No.-end S et Email address
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 the building permit.
Signed Affidavit Attached? Yes .......... No...........0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUIL ING PERMIT
I,as Owner of the subject property,hereby authorize L)
to act on my be alf,in all matters relative to work authorized by this building permit application.
Jzg S L
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 inSt//t]]vi�s application is� ytmeaniaccurrate to the best of my knowledge and understanding.� V
Print 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,or an owner who bites 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 RIC Program can be found at
www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dQs
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 deck orches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost" 0 0 0
CITY OF S.UX.M, AXSSACHUSETTS
• BI:QALNIG DEPARnMNT
120 WASHINGTON STREET,3sa FLOOR
-ISL (978) 745-9595
FAx(978) 710-9846
Kl,%(BERL EY DRISCOLL
MAYORI1tOAlAS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUILDING CMI.\RSSIONER
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
NatT1C(Business.OrganizatioNindividual)C 6
Address: CSC
City/Statc/Zip: Phone
Are you an employer?Check the appropriate had., Type of project(required):
1.❑ 1 am a employer with 4. 1 am a general contractor and 1 6. C1New construction
employees(full and/or part-time).• have hired the subcontractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t ?• modeling
ship and have no employees These sub-contractors have ,yam ❑Demolition
working for the in any capacity, workers'comp.insurance. 9. ❑ Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required,] officers have exercised their 10.[1 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions
myself.[No workers'camp. c. 152,§1(4),and we have no 12, toof repairs
insurance required.]t employees.[No workers' ! tha
comp.insurance required.]
•Any applir.m that chucks box bl most also rill out the section,below showing their workers'corepenswino policy information
t I hmwuwntxs who submit this affidavit indicating they art doing all work and then hire outside contractors most submit a now affidavit indicating such
'Comraxors that check this box most aeached an additiwml sheet showing the narno of the sub-comradon and their workda'comp.policy information.
I am an employer that Is pravidin arkers'compensation insura for my employees. Below Is the policy and job site
information
Insurance Company Name: A M01 .e4e
Policy 4 or Self-ins.Lie.q: 3 �(O't/ �(J ""b Expiration Date: '71
O r
Job Site Address: '-effZ" XQZ City/State/Zip: — 7
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
11.1
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 S 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations or the DIA for insurance coverage verification.
I do hereby c Njy a er the pains and les perjury that the information provided abov Is true all,
llcorrect
pg
Si -t tae : ZG Z_61
Official use only. Do not write in Nils area,to be completed by city or town oricial
City or Town: Permit(License
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other,
Contact Person: _ Phone p:
h ,< CITY OF SSU ENI, , LaSSACHUSETrS
BUU-DLNG DEPkRT%lENT
130 W.,,sm-4GTON STREET, 3' FZ-OOR
off`
TEL (978) 745-9595
FAX(978) 740-9846
KIN
tggRlF-:Y DRISCOI L
T
MAYOR �tortAs ST.PtERRe
DIRECTOR OF PUB11C PROPERTY/SMI)MG CONnass10NER
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 defined by MGL c
111, S 150A.
The debris will be transported by::
(name of hauler)
The debris will be disposed of in
(name of facility)
&4Z L
address of facility)
Y)
signature o£permit applicant
926h-6 / �
date
JcbriwfCJx
Page 1 of 2
HEIGHTS
ROOFING,
Proposal
Property address 09/5/16
1 Preston Rd.
Salem, MA 01970
Dear: Sir Tzortzis.
Based on my visit to your house located at the above address and our discussion, I have prepared the
following proposal. Please review the following outline of the general specifications and the work
required in order to complete the job to your property.
The following project/work will be completed in accordance with the building codes set forth by the
Commonwealth of Massachusetts 780 CMR:
Description of Job: Residential Property located at 1 Preston Rd Salem, MA 01970
1. Install CertainTeed Monogram vinyl siding over the old siding all around the house.
Materials used:
Install foam insulation over the old siding.
Install aluminum starter strip on the bottom of the old siding to hold the new vinyl siding.
Install 0.46"Thickness Double 4"vinyl siding over foam insulation.
Install white aluminum on the front porch,front doors and back windows.
Install 3/4 J-channel around trim windows, doors and other necessary areas.
Install Vinyl super corners 5Y2"face and 20' length on every corner of the house.
Install undersill trim.
We will be using 2 Yzz hand nails to hold the vinyl siding, J-channel, vinyl super corners and aluminum
starter.
Labor and Materials: $13,850
Project subtotal: $13,850
HEIGHTS ROOFING INC.
190 HAMILTON AVE, LYNN, MASS 01902
TEL: 781-913-4404
Page 2 of 2
Work could begin within (3) to (4) weeks of acceptance and take approximately two(2) weeks to
complete, depending on the weather. Once started, all work will be performed in a timely and
professional manner. Please note that any changes to the above listed specifications would have to be
discussed and re-evaluated as expected. I need half of the money for materials,the other quarter when I
complete half of the job, and the last quarter when I finish the job.
CONTRACT ACCEPTANCE: Signing this proposal means you have accepted the terms and specifications
as stated in the proposal and authorize HEIGHTS ROOFING INC to begin work at your property. In
addition, the signing of this proposal by both parties' converts this proposal to a binding contract
between the two parties.This proposal may be withdrawn by us if not accepted within 30 days.
ACCEPTED BY: SUBMITTED BY:
Signature: / Signature:
IV V7 Contractor
By: By: Roni Lopez, Heights Roofing Inc.
�Date accepted:�/ G //�G� Title: President/Owner
materials
GUARANTEE:Ten 10 solely covers present property owner from any defects mand/or workmanship
as described in this contract under normal weather conditions.
HEIGHTS ROOFING INC.
190 HAMILTON AVE, LYNN, MASS 01902
TEL: 781-913-4404
J
_ � �f2-f �C 3�2172.f 7?711Gf%L�fL ��:/L'LCLuifL'�CS'IiLG:�G,�,i
° Office of Consumer Affairs and Business Regulation
3L
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 166178
Type: individual
Expiration: 5/5=18 Tr# 290aa9
STEVEN HIOU
STEVEN HIOU
2 NEPTUNE RD.
E. BOSTON: MA 02128
Update Address and return card.Mark reason for change,
_ Address T Renewal _ Employment T Lost Card
. .`
fiein&Bu
Office of Consumer Asiness Regoisdon
License or registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
. „� — . Office of Consumer Affairs and Business Regulation
i
Registration: ;YiDe'
" R 165178
xp, 10 Park Plaza-Suite 5170
Expiration: 515120.8 Individual,P Briton. MA 02116
STEVEN HIOU
STEVEN HIOU
2 NEPTUNE RD. — —
E. BOSTON, MA 02128 Undernecretan Not valid witho "signature
Unrestricted-Buildings of anY use group which
Massachusetts _Department of Public Bacontain less than 35,000 cubic feet(991m3) of
Board of Building Regulations and Standards enclosed space.
^License: CS403M
STEM C FIROu;
2 NEPTUNE ROA6 AVM
EAST BOSTON RA y Faifure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
0112 t?on
17 ForDPSLiconsinglmatmationvisit: wenv,MM.Co /DPS
Oommisseoner 01/2Yl?.017
rc
Office of Consumer Affairs and Business Regulation
xJ 10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration 183771
Type: Corporation
Expiration: 11/9/2017 Tr# 272189
HEIGHTS ROOFING, INC. _ . ------
RONI LOPEZ
190 HAMILTON ST
LYNN, MA 01902 -
Update Address and return card.Mark reason for change.
Address F1 Renewal 1.7 Employment (- Lost Card
SCA1 C, 20M05M1
:tom- ORte offoasumtr Affairs&Business Regulation License or registration valid for individal use only
before the expiration data If found return to:
�
jItOME 3fi0n: EMENT CONTRACTOR'•1�' � Registration, 183771 Type: Office of Consumer Affairs ted Business Regulation
10 ParkPlaza-Suite 5179
ExpiraBott 1102017
Corporation
c./..;; Boston,MA 02116
HEIGHTS ROOFING,INC.
RONI LOPEZ /
190 HAMILTON ST
LYNN,MA 01902 Undersecretary Not valid without fare