3 WEST TERRACE - BUILDING INSPECTION • The Commonwealth of Massachusetts 1iN� u CITY OF
Board of Building Regulations and Stantlaa¢is � LacE4`'al SALEM
Massachusetts State Building Code,780 Cl Revised Mar 2011
Building Permit Application To Construct,Repair, RenttVT Q%iolbh�,
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
1 SECTION 1:SITE INFORMATION
1.1per Addres.�. �L�� 1.2 Assessors Map&Parcel Numbers
1.1 a 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 OWNERS IP' A�
2.1.90er'of Record.
Name(Print) City,State,ZIP
No.and Street Telephone 'Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Buildin Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bld . ❑ N ber of Units Other pecity: -e C a
Brief Descriptio of P osed Work
life-
C
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor d Materials
1.Building $ 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 $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ (O ❑Paid in Full ❑Outstanding Balance Due:
`r
SECTION 5: CONSTRUCTION SERVICES
5.1 Constr ction Supervis�or L/y'rense(CSL)
License Number 9xpiration bate '
Name of CSL Holder
List CSL Type(see below)
No:and Sir Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
J1� R Restricted 1&2 Family Dwelling
Cityll'own,. _.-- M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Re tered Home mprovement C o C)
4 L / 1
g/�S yntract
t
f�61 !/GVl�v C I egistration Number Vxpiration Date
HIC m any N e or HIC Registrant ame
•_op &2G�ACL
N . Street n —1 Email address
Ci /Town ,ZIP tt T_eleph/o(ne
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: OWN AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT Off CONTRACTOR APPLW FOR BUILDING PE T
I,as Owner of the subject property,hereby authorize J
to act on my behalf,in all matters relative to work authorized by this building permit application.
/`Ii� l6 0
Print Owner's Name(Electronic Signature) D
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name low,I hereby attest and the pains and penalties of perjury that all of the information
contained in this a90icaqPn is true an accu a to the best of knowle a and understanding.
4
P er's or Authorized Agent*Name(Electronic Signature) ate
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. ovg /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 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 dec /porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Co
PROPOSAL/CONTRACT
FROM, Roof Replacement
i
MGS Construction LLC S
PO Box 1024 - PAGE NO. I OF 12 PAGES
Derry,New Hampshire 03038
Email:mmanick@mgsconstructionlle.com DATE: September 22,2016 !
Office: (603)216-2633 Cell(781)647-7663
Fax: (603)432-3282 Cell(78 1)MGS-ROOF
PROPOSAL SUBMITTED TO: [
Jennifer Minery Iltp
3 West Ter ADDRESS: 3 West Ter
Salem,MA G
jminery(a7hotmail.com CITY/STATE: Salem, MA h
425-802-6584 l
JOB NAME: Roof Replacement
We hereby submit specifications and this proposal/contract for the following:
BREAKDOWN: I
MGS Construction will remove and dispose of all existing roofing and flashing to-entire roof
s
MGS Construction will remove all debris and coordinate all trash removal g
MGS Construction will supply and install 6' of GAF Weather Watch ice and water shield at all roof eaves
MGS Construction will supply and install 100%of GAF Weather Watch ice and water shield to dormers and entry
roofs(3 pitch and under)where necessary
MGS Construction will install 3' of GAF Weather Watch ice and water shield at all rakes
MGS Construction will install 3' of GAF Weather Watch ice and water shield around all penetrations(vent pipes,
chimneys,and skylights)if necessary
MGS Construction will supply and install GAF Deck Armor to the remaining roof field
MGS Construction will supply and install GAF Pro-start manufactured leading edge to complete the roof perimeter as I
the manufacturers suggest
MGS Construction will supply and install new flashings and drip edge(white)including re-leading of any/all existing
chimneys
MGS Construction will supply and install GAF Timberline HD lifetime architectural shingles
QCW4e_r )
gray
MGS Construction will hurricane nail nails per shingle to protect against blow offs
MGS Construction will cut and prepare all ridges for proper ventilation as needed
MGS Construction will supply and install GAF Snow Country ridge vent according to the manufacturers suggestions at
ridge locations
MGS Construction will supply and install GAF color match caps to all ridge locations I
MINERY,JENNIFER 3
ROOF REPLACEMENT
SEPTEMBER 2016
MM
gRg
i
Option:
Mgs Construction will apply same specifications as above to garage
If option selected add Fourteen Hundred Twenty Five Dollars to contract pricing below ($1,425.00)
Sign re to acc pt _
X
t
4
In h event t at unforeseen ro is found.A plywood replacement charge in the amount of$60.00 per sheet or barn
bo in the amount of$3.50/linear foot (labor and material)will be billed additionally to the contract amount. d
Any items not stated above are to be considered as an extra charge and will be invoiced separately from this billing.All
other agreements to be made in writing between the customer and MGS Construction.
TERMS/NOTICES: RESIDENTIAL/COMMERCIAL
It is the home owner's/associations responsibility to ensure that prior to the start of the project all areas of concern are prepared for
start of project.All planters,grills,patio furnishings,and other precious objects should also be moved prior to the start of any
roofing or vinyl siding project.All vehicles should be parked at least 15 feet away from the home during all work in progress this is
due to debris that could fall and or hit the vehicle.MGS Construction is not responsible for any damages to this property should
these guidelines not be followed as this should be considered as a formal notice.All interior wall hangings,including shelving,
pictures,and other precious objects should also be removed due to heavy hammering until the project has been completed.MGS
Construction takes extreme care in the setting up of the equipment,scaffolding,and tarps used on each project in order to protect all
property and landscapes.Any exterior damages to property incurred by MGS Construction will be remedied repaired/resolved by
MGS Construction.However,we cannot be held liable for damages to plant and or flower beds,shrubbery,etc located within 15' of pp
the perimeter of the work area. R
MGS Construction will not be held liable for cracked or damaged drywall or for any interior objects that may vibrate,shake,or fall
due to heavy hammering or normal construction work.
ASPHALT WARRANTY:
Labor:GAF Golden Pledge Warranty
Material:GAF System Plus Warranty
PAYMENTTERMS:
We hereby propose to furnish labor and materials to complete in accordance with the above specifications,for the sum of Six
Thousand Six Hundred Fifty Dollars($6,650.00)**PLUS OPTIONS CHOSEN"with payments to be made as follows:
Upon Completion of Project
ACCEPTANCE OF PAYMENT TERMS
All material is guaranteed to be as 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 and above the estimate. Alla reements contingent upon strikes, accident or delays beyond our control. This
proposal subject to acceptance within 30 da a aid thereafter at the opti of the undersigned.
C.
Authorized Signature
r
Y
MINERY,JENNIFER 4
ROOF REPLACEMENT
SEPTEMBER 2016
MM
3
3
3
ACCEPTANCE OF PROPOSAL
By signing this proposal it will then in fact be considered to be a legal and binding contract between Jennifer Minery
named above and MGS Construction.The above prices, specifications and conditions are hereby accepted.You are
authorizing MGS Construction to do the work as specified above. Payment will be made as outlined above. Shall MGS {
Construction not receive payments in accordance with the above stated terms all work in progress will be stopped ¢
immediately until payment has been received from you the client. Upon not receiving the final payment for the t
completed contract/project,MGS Construction has the right to hold you the client responsible for all and any reasonable
legal,filing,and attorney fee's necessary for MGS Construction to collect payment at your expense.
ACCEPTED:
SIGNATUR DATE:
Q
l
9_
SIGNATURE: DATE:
I allow MGS Construction to use my home in pictures for marketing purposes.
SIGNATURE: DATE:
This proposal is valid for 30 days from date of receipt
ALL ACCEPTED PROPOSALS MUST BE SIGNED AND RETURNED TO OUR OFFICE UPON ACCEPTANCE.
3
MINERY,JENNIFER 5
ROOF REPLACEMENT
SEPTEMBER 2016
MM
i CITY OF S.U.E1%1, ',L-kSSACHUSETTS
• BUHMIIING DEPART>IENT
120 WASHINGTON STREET,iso FLOOR
°
TEL (978) 745-9595
FAX(978)740-9846
KI%iBERLEY DRISCOLL
MAYOR THOMAS ST.PtERR6
DIRECTOR OF PUBLIC PROPERTY/BL:UDLNG CO%L%IISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A t licant Informationzw PI t se Pri Legibly
Naive(Busitnst 1',:OOrganizatioNindividuat): �Z
Address- l 6 e
City/State/Zip: Phone #:
Are an employer?Chec p opriate box: Type of project(required):
1. 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or pa -time).' have hired the subcontractors
El am a sole proprietor or partner- listed on the attached sheet. []Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9. ❑ Building addition
[No workers'comp.insurance 5. ❑ We aro a corporation and its
required.] officers have exercised their l0.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I IIbing repairs or additions
myself.(No workers'camp. c. 152, §1(4),and we have no 1 f repairs
insurance required.)t employees. [No workers' 13.C3Other
comp.insurance required.]
•Any applicant that chtt4s box gt most 2180 fill out the section below showing thea workers'compensation policy information.
'I lomvowmm,who submit this affidavit indicating they are doing all work and then hire maside connector;must submit a now afiMdavit indicating such
:Contractots that check this box mtw 2n2ched an additional sheet showing the name of the sub�coatrsetors and their workers'comp,policy information.
I am an employer that Is provi7-er
erg'compensation insurance for my employees. Below is the policy and Job site
information. '��
Insurance Company Name: /� S// 4_�
Policy#or Self-ins.Lie.#: ( /�' Expiration Date:
Job Site Address: ( V�/y� City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire on 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 S1,500.00 and/or one-year imprisonmen4 as wall 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.
I do/tereby certjy at e _ ins and toUles fp 'ary that the information provided above Is tr and c rrecb
Date:
Oficial ase only. Do not write in this area,to be completed by city or town afJlcisd
City or Town: PermitiLlcense#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other.
Contact Person: _____ Phone#:
eCITY OF S.0 ENl, .NNLkss kcHUSETTS
x
BL'ILDLNG DEP M.IENT
130 WASHIINGTON STREET, 3"FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
(Q-,tBERL.EY DRISCOLL
MAYOR T HoNtAs ST.Pmm
DIRECTOR OF PLBLIC PROPERTY/BI MLNG COSWIISSIONER
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 faciht )
Y
L- lam- �r
—� (address of facility)
signature of permit applicant
datel
a�nd,;tr.a<w
� License or registration valid for individul use only
ice of Consumer Affairs& Business Regulation before the expiration date. If found return to:
ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation
Registration: 171254 Type. ]0 Park plaza-Suite 5170
= '
Expiration: 3Jfl20fg Supplement Caro Boston,MA 02116
M GENDRON 8 SON CONSTRUCTION LLC.
STEVEN HIOU
6 ENGLISH RANGE RD - ----- "-' - "
DERRY,NH 03038 Not valid witho t signature
Undersecretary
Massachusetts - Department of Public Safety Unrestricted -Buildings of any use group which
Board of Building Regulations and Standards Contain less than 35,000 cubic feet (991 m)of
�•i"nig ut ii...I Siij":i �m
enclosed space.
License: CS-103080
STEVEN C MOU,'
2 NEPTUNE ROS 9 '
EAST BOSTON iRAa
Failure to possess a Current edition of the Massachusetts
` ` State Building Code is cause for revocation of this license.
Expiration
For OPS Licensing iMormation visit: www.Mass.Goy/DPS
Commissioner 01/27/2017