Loading...
19 SUMNER RD - BUILDING INSPECTION The Commonwealth of Massachusetts OF F� Board of Building Regulations and Standards SIALEM Massachusetts State Building GCode, 780 CMR Revised Mar 2077 _ Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Fancily Dwelling This Section For Offici I Use Only Building Permit Number: I Dat Applied:. 1 ' Building Official(Print Name) Signature Date � ) SECTION 1:SITE INFORMATION ` 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /9 Sump�f r� p L la 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 R) Frontage(Il) 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: /11A Ol 970 TDIu, }(a{vey r Name(Print) City,St 9 ciliffi12f Fd �q7y XO-71bq 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': 3 1 1h 0 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ t (1�� 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: 5.Mechanical (Fire $ r6lTlotal ression Total All Fees: $ 1 Check No. Check Amount: Cash Amount: Project Cost: $ 10 3 Z ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES _ 5.1 Construction Supervisor License (CSI-) �,t^ �t f -(-\\ 1 p/ACi Licen<c Nullhol ENpualion Dai, . Naltle of CSI_Holder ' List CS[-T pe(sec b6o.A) f Type Dcscnpucll aao�ITCEI _ �� Unrestricted(13rild"l s a to=5,001)eti L t �f C� '..�. «`�..'' E 1 Reslrioed 1.42 Family Dwelling Cilyfrown, Slate,ZIP M Masonry � RC E00fing Cmerin WS Window and Sidin SF Solid Fuel Burning Appliances l Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor (HI ,__JZ y t t �C'Mr' �E\Y\CX�f�I �dT BIC Registration Number Expinbon Date �IC Company Name or MC RegistrantOName ' .So\ SEnlJOr't f- No.and Street Email address 9A ogo`k3 galio -0sto 1 Ci /Town.State,ZIP Tele hone SECTION b:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(AI.C.L.c 152.9 25G(ii)) WerkeTs Compensation Insurance affidavit must be cmnpleted 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 7z:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR A�PPLI\ESS FOR BUILDING PERNUT 1,as Owner of the subject propery,hereby authorize ) " NCA` `\ 3 v\C5'C�\`C>N to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date MapplicatiDn ' B ER! OR AUTHORILED AGENT DECLARATION Ened art ,t under the pains and penalties of perjury that all of the information urate to the best of my knowledge and understanding.me nic 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. ov!oca Information on the Construction Supervisor License can be found at nL% .mass eov/dos 2. When substantial work: is planned,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 half/baths Type:of heating system Number of decks!porches YP g Type of cooling system Enclosed Open 3. "Total Project Square Footage"map be substituted for"Total Project Cost" Ike COMPSonweald, of Al'assachusetls 2)eparftenr of Indusj'scsad'er,1s j Ca itgrc-8s strew. szsatc 1706 TOf WA.A14 61IM-20 z ��'� 1-r-eayav rasss.�4a r/alxp lhJtrkers' Compersati©m Irisucaca:e Infsdarvit;I#taald€1'�/G anYFrcYors!Islec�iciagsll"1ur+ral:ers. TO PIE Fd-im VkgTITHE PMKW '.G A€Ti LdCRrll-2'. �ulit:anY laeforrnatio- _ , f PI&ase PrmS Le7•'llll '1liZ.H7.e ($usmcss/i?rgawzatioa{I,,,cli..�idual}r � �-- AaldTess: t !P�IVM-:r t2'VC City/State/zip: 6 i+��a f! it � e�l# Phone t: Are you an employer?Check ike appropriate boas employer with ape of project(required): ®ployec(fail a�lmpan-ire).' �-®lama stile Prolirietm or Parme+skip andbave noempioyem working int in 7. ❑New GOI1ShilCtiOIl . me a�capacity.[No workers'camp.immance a¢yoveet] �.�emodejing 3.0 7 em s homeowner dcag all work myself(Na worker_'comp,insrvaue tegamhl.]1 9• ❑DDemolirion 5.®1 am 2 homeowner and wa-dl be banag rontractms m cm&d 2➢walk w>aS Prof y. 1 wvl l ❑Hnildirlg ad(1it)On ehume 8121 all ccncc ms-a- campencetion inssance of me sole 3 3. Electrical r P+oPrietms vdiffim employers. ❑ zpail5 ey additions 12.®Plumbing repays -`.❑]�a general comracAm and]b2ve}�talb-coaoacton listed on th¢attrshed steel or addition, , These sub-cc=actors hcv employees 2nd have workers'srntp.inamance,7 19. hoof 7epa7;Y5 6.®We are a rorgor28on and its offices here¢exercised the'¢tigla off ea l4. Other 152,§1(4)°and eve have no em 1 eos. =mqui per MGL c. poy [No workers°comp.msmance requied.j . -Any appbcw#that chinks box#] mast also fill out the erection below showing theirworkers'romp¢o-sahon pohc5.imformatlon t Homeowners who mbrmt this affidavit indicamng they me doing all work and then hire amide cma2ctors must t4=oatractoas that check this box mast cached m additional skcei _jagthe name of the S0 a new affidavit iothcamng aoch employees. if the sab-camtrncmra have loaces, sab-con4actors and stale whetkermmrtthosee�ities have e� trey must provide theh workers'coM1P,policy manber. I am aB employer that is providing workers'compensation irtsttrancefor my employees Below is the information, i (6 poGr7'and job site Insurance Company Name:U l}IZl f_VIlLR 4C I Dd7 C CZF /t l Ulo- A?!iz Policy#or Self-ins.Lie.#:_ 7 015"V -Zt)- /p Expiration Date:_ ,� Job Site Address:__ // Stpmr 0-d Citylstate/Zip: c17" n _ /1l/1 Attach a copy of the workers'compensation pokey declaration page(show ng the policy number and e zpiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S1,50DDD andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of lip,to$250.OD a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ve " I do hereby the pafris and pMulties ojperjury that the infortnaYfon provided above is true and correct: St allure' p Date: Ia�/S��S Phone#: St1R-ZeBd'�35'6 F kd ase only. Do nor write in dais area,to be completed by city or town official, or Town• Permit/l iccuse# ng Authority(cirele oap), ard of Health 2.Building Department 3.ChytTown Clerk ht.Electrical Inspector 5.Plumbing Inspector her Contact Person: Phone#: lif E i H P F 0 V L M E NT C C i 2TRACT4D F, II)f 'bc ffjre n' I I +T' ,:InYr isI L 12,- 7 flsf&a.hl -�CVVEF HCME RLYODEi'N�C- 12ROUR L' C. I VORK Vc-'RDIM 2�01 SEPPOR-f DPI VE-S7E E-,10 :HlESTER.FA 19or ot v2U Iykhout sigm2lum i MassQcbUscIkIs Deparirr, ,m of Pubbc Sa-,,my BvMd 01 Building RepuAzdjom and Stond,4rd, tic"se:CS-0S i645 MARK E MORUNI 2B NEWEIL DR M A7TLEBDRO OA q Expigaston- D911812,DIT -N U.'41 Smwv-m' rswD, D about:blank Jotw and John Harvey NATIONAL NEADOUART'ER5 31-79843 zsDlSeapart Wu 111 i�OWER pumper 09,2015 888-REM0DEL ., MA KIC40 165619 CUSTOM REMODEUNG AND IMPROVEMENT AGREEMENT tauyehap mtom,.uon and oaeedWton of the Property: Project Number:31-79843 ernbot „�,,,,�.,r Joyce Harvey (M)21D-3-164(do)se§CO) John Narvoy (416)2103183(✓dM§Cel) 16 gonna:Rd Canty:Earn / UU z TowneMp: Buyers)fisted above hereby jointly and severalty agrees to purchase the goods and/or servoes of POW Home Remodeling Croup and.its vendors(-Contracor')In accordance With the prices and Terms described in this 6 page document and the Product Specifications,which are incorporated as Dan of the Agreement(001190W01Y.Vas'Agreemenn. This Agreement represents a Cash sale of goods and services. Buyer(s)agrees to pay the Cosi Of The goods and services purchased as described herein,regardless of timing or approval of any financing Buyi n(s)may sash for dek purohaso. Purchase pro Jnstitilathin Dates: Dow Payment: St8.829.29 u�hluze twm.r:ai�o saw Balance Dire on 516.633.29 . Eatimatad-P/oj'xt Sf°ert'3`ro 4`week$ Substantial Completion: Eatimatatl Project COmPletion:1 to 2 days MOited Of Payment: . OUwr 6wpne)xkmrbcba NR as aro mneroomWaeohaam .NmaNawannoa. owe r . Oapocbnc�s»trd nq kiaraeab akuls<44 tleh,4anw,. Ste OtlgMusa+m Cerieaore. 9 Buyer(o)hereby adam,10903 receipt of 8 COPY of the pamphtet.-The lead-Sete CeN9ed Guide to Renovate Right,Informing Buyw(s)of the potential rloc of lead hazard eirposure from renovation activity to be pert omred in or at Buyers)'Property.at Vre addre wnsen above.BuYera)receieed this pamphlet on me date of this Agreement,before cornrnencwrent of work. ,�BuYer(s)'"data TMs Agreement constitutes ow entire agreement axle understanding between the parties,and this Agreement replaces any and 811 prior,negoVatioM raproserojo ons,or e" ens,either written or oral No amendment modification or weh^w of VtisAgroinalard shag be valid or epeetive unless in writing and signed by both pwdes. Buyw(s)hereby adacwtedges that SUM(s)1)has read tha entire Agreemerdand nos reoeihied a completed,signed,and dated copy of ods Agreement,including the two abootnparr/fNotice of Cancellation terms.on the date first wftn above and 2)was wally(rimmed Of ha4tw right to canca911Aa t erteadial,. .geyer(s)also agrees and uhderatends that If Buyer(s)5nance6 the work wtth a thud-perry,the hams of!w tblt lic"Tpa 0 ` contained on saperete documents.6xAw➢ng any,finance charge Figurepientotoas not applicable. DD HOTwN THIS A6R mmr IF THERE ARE ANY BLANK.SPACES. ' � .. J irate read antlwaivatlaiUr Piga W IhA 6 paYealpal�nan4 ' '� xi n$ Yftw Htlfns BamodeRng, ;coup 21091T5y `. 8ipnature otRefnodaWig Consultant IiH h"Pappas, d' .john Nttevay YOU,THE BUYERIAL MAY CANCEL THIS TRANSACTION AT ANY 71#9 PRIOR TO t1aQtNONT Oi THE TJMRD DAY AFTER THE BATE'OFTHIS TRANSACTION, SEE THE ATTACHED NOTICE OFCA"CgLLX "P"j&FORAH `- TAMS PoOHL OMANATION Olp F. December 05:2D1 5,21 1 of 1 12/15/2015 3:04 PM NATIONAL HEADOUARTERS Joyce and John Harvey 2501 Seaport Drive.Chester,PA 19013 _ .. _ _ 'f�l(7VIER 31-79843 �IlllDecember 09,2015 888-REMODEL ... MA HICK 168616 PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number: 31-79843 December 09,2015 Joyce Harvey (978)210-3184(Joyce's Cell) 19 Sumner Rd (978)210-3182(John's Cell) Salem,MA,01970 County:Essex Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goads and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications (collectively,this"Agreement"). Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Mon 12/28 between 9:00a and 10:00a. Roofing-GAF Inclusions: For steep slope roofs,the application includes Timberline Ultra HD Lifetime Shingles with 50-year non prorated labor warranty. Also includes removal of existing shingles,installation of F-style drip edge,Weather Watch ice and water shield, Deck Armor breathable roof deck protection, Pro Starter starter strip,Snow Country ridge vent exhaust,Timbertex premium ridge cap shingles, PowerVent intake ventilation,all flashing where needed and 6 nails per full shingle.All applications used only where applicable.Clean up and haul away of all job related debris. To protect our clients,Power HRG includes,at no additional cost,the removal and replacement of up to 300 square feet of soft or rotted roof decking if needed on steep slope applications. Any additional wood replacement needed,over and above the 300 square feet we provide will be done at a cost to the homeowner of$3.57 per square foot. (Buyer initials ). For Example:After the shingles have been removed,if we find there is a need to replace 325 square feet of wood,Power HRG will pay for the first 300 square feet. It is the responsibility of the homeowner to pay for the cost of 25 square feet of replacement at$3.57 per square foot,which in this example is $89.25. For low slope roofs,which are roofs with a pitch below 2/12,the application includes a 15-year non prorated labor and material warranty, removal of all existing roofing materials,new decking,TriBuilt base and cap sheet,drip edge and flashing,where applicable. Roofs with cedar shingle removal will include all new decking as part of the installation. Clean up and haul away of all job related debris. It is agreed and understood by and between the parties that the Product Specifications,along with the Custom Remodeling and Improvement Agreement,constitutes the entire understanding between the parties,and replace any and all prior negotiations, representations,or agreements,either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless such changes are in writingand signed by both Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read the Product Specifications. I have read and received each page of this 2 page agreement. Power Home Remodeling Group Buyers) Buyer(s) /12/09/15 /12/09/15 /12/09/15 Signature of Remodeling Consultant Signature Signature Michael Pappas Joyce Harvey John Harvey YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. December 09, 2015 21:03 III II III III IIII II I III I I III III Pagel of 2 6ATIONAL HEADOUARTERS - Joyce and John Harvey 2SOl Seaport Drive.Chester.PA 19013 y,„�_-,H„r,,,. . f�OWER 31-79843 December 09,2015 beer 888-REMODE-�� MA HIC#168616 Project Specifications Roofing: Whole House 1 1825.0'x1.0' ROOFING: Models GAF Styles Architectural Shingles Types None Configs None OPTIONS: Color Pewter Gray I Removal Standard Shingle I Installation Details None OAPLUMMIA1S CORPORATION Pe~Gray d S} i Y A, tial Measu e e December 09, 2015 21:03 III VIII)I I I II II VIII II III III II IIII Page 2 of 2