85 PROCTOR ST - BUILDING INSPECTION VI-1 C-f-, 14 Z�
The Commonwealth of Massachusetts rEC tVEX2
Board of Building Regulations and Standards
��+'EC.T1flN L SEiitf
Massachusetts State Building Code, 780 CMR 11 CQF� SALEM
Y Building Permit Application To Construct, Repair,Renovate Or Dc�mo�i9 a eytsed b1pr 011
One-or Two-Family Dwelling H �`EE JJ
This Section For Official Use Only
Building Permit Number: Date A pliliied: /
/ ice'
Building Official(Print Name) Signature Date
— F–(D SECTION 1:SITE INFORMATION
1. ro erty Address: 1.2 Assessors Map&Parcel Numbers
�' al -YO✓ ��"
I 1.1 a Is th an accepted street?yes no Map Number Parcel Number
II— 13 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:
r re A ,
Name(Print) City,State,ZIP
Pro
('3i 1 ro C 3ti L S( - kb5-g'o
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) V� I Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work : ( lY 2
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item 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 I _
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: J/
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ �� ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 09 9 A�6 /
r;-1 Iq E�/ License Number Expiration
Name of CSL Holder
(o-2a' k)p ' ; U
� r- List CSL Type(see below)�CC
No.and Street Type Description
� n vU Unrestricted(Buildings u to 35,000 cu.R
City/Town,in State, a run ' 71 � R Restricted 1&2 Family Dwelling
M M
C
Roofing Covering
S Wmdow and Siding
_ 7 9P6 SF Solid Fuel Burning Appliances
97� I Insulation
Telephone Email address D Demolition
5.2 Registered home Improvement Contractor(HIC)
ff __ 5 )- q -316-
THC egrs tion Number Exp 'on Date
RIC Co Nam r HI e ' tl;Ta fi
b:ZMT,0x- i ii�d{
No. a Street Email address
I .L�� yl e<� X14 oig6� S'7F479--79 0
Ci /Town,State, Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152.4 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 ..........fll-� No.........-11
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.
Print Owner's Name(Ek tropic Signal=) 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 this application is true and accurate to the best of my knowledge and understanding.
Print Owner's Authorized Agent's Na*(Electronic 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(IHC)Program),will not have access to the arbitration
program or guaranty fiord under NLC.L.c_ 142A.Other important information on the RIC Program can be found at
w-ww.mass. og v/oca Information on the Construction Supervisor License can be found at u+ww.nmassgov/dps
2. When substantial work is plarmed,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of haVIbaths
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
ROOFING ESTIMATE ERIC A. T E E L CSL. 99509
HIC. 150452
ROOFING
Commercial and Residential • Fully Insured 7
DO� 1 et,�-ems I
I.hss
4 lie Ceve t,
P.O. BOX 648 4
Rowley, MA 01969 978-479-7420 ericteel@hotmail.com
7E SUBM D TO: r JOB NAME JOB#
E ' P L
ADDRESS JOB LOCATION
,� /3 r
Cm/STATErZIP
PHONE# t� y�J 9 FAX CELL# C•
WE HEREBY AGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW...
NOTE: ONLY THE MARKED BOXES/PERTAIN TO YOUR ESTIMATE.
WE AGREE TO:
1. COMPLETELY STRIP THE ENTIRE 1'(� ✓� ROOF(S)
OF THE EXISTING LAYERS OF SHINGLES.
O 2. INSTALL A NEW LAYER OF SHINGLES OVER THE
EXISTING ONE LAYER OF SHINGLES ON ROOF(S.
O 3. INSTALL A NEW RUBBER ROOF(S), USING ALL NEW RUBBER ROOFING MATERIALS ON THE
4. INSTALL NEW ICE&WATER SHIELD ON ROOF(S),
ROOFS EDGE, RAKE)VALLEYS,DORMERS,SKYLIGHTS,CHIMNEYS,&FLAT ROOF AREAS.
5. INSTALL NEW_ _LB.ASriALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE
i l 9
6. INSTALL NEW 8 INCH W ALUMINUM DRIP EDGE ON THE ENTIRE
v
;j ROOF(S).
O 7. INSTALL NEW ALUMINUM STEP FLASHING ON ROOF(S).
(1k 8 INSTALL NEW(VENT PIPE BOOTS)ON ROOF(S).
O 9. INSTALL NEW(ROOF BOX VENTS)ON ROOF(S).
O 10. CUT&INSTALL NEW RIDGE VENT ON ROOF(S).
11. INSTALL NEW LEAD ON CHIMNEY ON ROOF(S).
NOTE: (IF)MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INUIGAI Eu At"Viz,AN roc I nq tst viral nc Auurlu ry ,mc:
LABOR 8 THE REMOVAL OF DEBRIS OVER AND ABOVE THE PRICE OF THE ESTIMATE.
We propose hereby to furnish material and labor—complete in f�qprdance with the above for the sum of:
g /fie Dollars
with payments to be made as follows:
Any alteration or deviation from the above spertificatioees involving extra costs Respectfully
wia be executed only upon written order•and win become an extra charge over submitted
and above the estimate.All agreements contingent upon strikes,accidents,or Note—this Y be yawn by us d not aocepled within days
-14
delays beyore0 our mmol.
Arreptanre of roposa(
The above prices,specifications and conditions are satisfactory and are hereby
Signature,
accepted.You are authorized to do the work as Specified.Payments will be
made as outlined above. 7 L
Date of Acceptance Signature