42 TURNER ST - BUILDING INSPECTION Lf2- �
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 1011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
Q This Section For Official Use Only
O Building Permit Number: Date A 'ed:
tnt 'N
J Building Official(Print Name) Signature gate
SECTION 1:SITE INFORMATION H
1.1 Property Address, 1.2 Assessors Map&Parcel Numbers t r
\ 1.1 a Is this an accepted street9 yes no Map Number Parcel Number c
nE
k- 13 Zoning Information: 1.4 Property Dimensions: sa'i
IV �,
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'
2.11 Owner R��d:. Y,,.
Name(Print) � City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work :
`lam\c�..�tc-ter t� S
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials) oa
1.Building �'\�o 1. Building Permit Fee:$_T 4 Indicate how fee is determined:
2.Electrical $
[3 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
Suppression)
$ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ��, �j ❑Paid in Full ❑Outstanding Balance Due:
Seo V-D IJ F( 15TD�tG -
-mra-, a 1 j3
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder 3� ) y /
List CSL Type(see below)
"�>O LAN-ovl �.
No.and Street Type Description
J„��- Q \�1� U Unrestricted(Buildings u to 35,000 cu.ft.
�A R Restricted 1&2 Family Dwelling
City/Ibwn,Sta ZIP - M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
) . , HIC Registration Number Expiration Date
HIC Compo tt N e or,H�.gistrant Name
No.and szr y
O \ Q1� � \� Email address
CiCi /T�te,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 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.
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 this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF SL1LE2 l� ASSACHUSETTS
BETIDING D13AR-17SIEN T
• a 120 WASHINGTON STREET,3aa FLOOR
TEL (978) 745-9595
FAX(978)740-9846
KISfgFRi EY DRISCOLL
MAYOR THOMAS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Analicant Information Please Print Legibly
Name(Businesw'OrganizatioNlndividual): u AV` �,_-_�- �—�
Address: � �- A'4--k—
City/State/Zip: Phone !#:
Are you an employer?Cheer fhe appropriate box: Type of project(required):
1O 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the subcontractors
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 It. ❑Demolition
working for me 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 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions
myself.[No workers'comp. C. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.)t employees.[NO workers' 13.❑Other
comp.insurance required.)
'Any applicant that chocks box 01 most also fin out the section below showing their workers'wmiaemad policy infumtation.
t I hxsrcowren who submit this affidavit indicating they are doing alt work and than hiss outside connactots must submit a new alydavil udiadas such
=Cuntraaon that check this box must attached an additional sheer showing the some of too sub-contractors and their wodxn'ownp,policy information,
I am an employer that h:providing workers'compeamdon lnsarancefor my employees. Below Is the policy and job site
information. ' ,
Insurance Company Name:
Policy#or Self-ins.Lia#: ! `_ ` '�� \� Expiration Date:
Job Site Address:1-D-�� S91, City/Stawizip: saaJ"Nol,
Attach a copy of the workers'compensation policy declaration page(showing the policy number an expiration date).
Failure to secure coverage as required under Section 2SA of MGL c. 132 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 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 of the DIA for insurance coverage verification.
1 do hereby certify underpains and penahles ofpeijury that the information provided above Is true and correct
Sianalure: Date Ib
Phone
Oficial use only. Do not write in this area,to be completed by city or Iowa official
City or Town: Permiduccose#
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#•
i CITY OF S�ULENI, TNvLxss k HUSETTS
BuUMLNG DEPARTMENT
120 WASHL-4GTON STREET,Ya FLOOR
°
TEL (978) 745-9595
FAX(978) 740-9846
KI�iBERL.EY DRISCOLL
MAYOR T How s ST.PtERRe
DIRECTOR OF PIBLIC PROPERTY/BUILDING COMMISSIONER
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:
Sl-.-?-, C��ot �,ZCj
(name of hauler)
The debris will be disposed of in :
(name f facility)
(address of facility)
zp&
signature of permit applicant
date
debrisalUm
I
Shea Roofing Co.
: 17 % Foster Street
Salem, MA 01970
(978) 745-7313
PROPOSAL September 2,2016
SUBMITTED TO: Dave Bystrom
42 Turner Street
Salem, Ma.
We hereby submit spectfications and estimates for.
To remove all existing roof shingles from complete main roof including
both mansard roofs.
To install ice and water shield covering all lower roof edges, under all
flashing points and cover top flatter sections completely prior to re-roofing.
To install up to 50 linear feet of roof boarding as necessary.
To install synthetic underlayment paper covering all roof boarding prior
to re-roofing.
To install all new metal drip edge along all roof edges both horizontal and
vertical.
To install architectural (Certainteed Max Def Weatherwood) roof shingles
covering complete roof as mentioned above.
To install new crickets behind both chimneys then counter flash, re-flash
and/or reseal the chimney flashing as necessary. If lead flashing is too
damaged on the chimney we will grind it out and re-lead at an additional
cost of$350.00 per chimney.
To install new roof flanges on roof vent pipes.
To replace front rake boards and top mansard trim with PVC trim boards,
extending rakes beyond roof edges as discussed.
To counter flash, re-flash and/or reseal all sidewalls as necessary.
To install two louver roof air vents on top rear section of main roof.
To clean up and remove all roofing debris from job site.
We propose hereby to furnish material and tabor-complete in accordance with above specifications,for the sum Of:
Five Thousand Eight Hundred and Thirty Five------------------------ ($5,835.00)
Payment to be made as follows:
One third to start balance upon completion
All material is guaranteed to be specified. All work to be completed In a workmanlike manner according to
standard practices. Any alteration or deviation from above specifications involving extra costs will be executed
only upon written orders,and will become an extra charge over the estimate. All agreements contingent upon
strikes,accidents or delays beyond our control. owner to carry fire,tornado and other necessary Insurance.
Our workers are fully covered by Workman's Compensation Insurance.
Acceptance of Proposal-You are authorized to do the work as specified.
Authorized Signature:
Signature:
Date of Acceptance: