16 WINTER ST - BUILDING INSPECTION r q ► C
The Commonwealth of Massachusetts CITY OF
L' B
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised Ahw 2011
uilding Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dtvel ing
This Section For Official Use Onl'
(� Building Permit Number: Date Applied `
l q Is
-Building Otl)cial(Print Name) Signature• '
Dole
SECTION 1:SITE INFORMATION.'•
1 I
1.1 Property AddresppEAssessors &Parcel Numbers
,I & GUlr2 ier isy<1I.I a Is this an acce ted street? esno Parcel Number
1.3 Zoning Information: ensions:
Zoning District Proposed Use Frontage(tl)
1.5 Building Setbacks(R)
Front Yard $1Ja Yar" - Rear Yard
RyyuireJProvided - Required Provided. Reyailed Provided
1.6 Water Supply:(M.G.L c.J0,§Sd) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? - - System 13
C1.
Public Private OMunici O On site disposal
d :cso --
SECTION 2: PROPERT YOWN E"Hie
2.1 Owners of Record: �l•�CL�s �7
Rhjrne(Pring - City,State;ZlP
/G cUr.� Cdr F
Telephone Email AddressSECTION 3:DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
tion❑ Existing Building❑ Owner-Occupied O dtepairs(s) O Alterations) 13 Addition O O Acceuory Bldg.O Number of UnitsOther O Specifyon of Proposed Work': /
0 sit 3
1-61
SECTION a:ESTIMATED CONSTRUCTION COSTS
hem Estimr
Official Use Only
Labor a
1. Building S Building Permit Fee:S Indicate how fee is determined:
tandard City/Town Application Feer
2.Electrical Sotal Project Cost.'(item 6)x multiplier x
3. Plu bing 3ther Fees: S
d.Mechanical (HVAC) S :
S.Mechanical (Fire Sal All Fees:S
Su ressiun)
ck No. Check Amount: Cash Amount:
G.Total Project Cult S aid in Full 11 Outstanding Balance Due:
rnia, r� 1 -ZAN-1
SECTION 5: CONSTRUCTION SERVICES k
5.1 Construction Supervisor License(CSL)
hAr//a a C2 License Number Expiration Date
Name of CSL Holder a5
List CSL Type(see below)
Ty Description
No.;ad Street
-5,4601 � S _ U Unrestricted(Buildingsa to 35,000 cu. 11.
R Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masomy
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
-?(J--3?-ryJ" I I Insulation
Tele Kona Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
J/Q r/I 6,440- HIC Registration Number Expiation Date
HIC e47TO
or HI Regi st a t Name
No. 9 urge A-u 7
7
/'7/5
^5
zfy Email address
Ci /town State ZIP Telephone
SECTION 6:WORKERS'.COMPF,NSATIONINSURANCE AFFIDAVIT(M:G,L c:I#_§ 2$C(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 Isl Lance of the building permit
Signed Affidavit Attached? Yes ........ No...........O
SECTION lax OWNER AUTHORIZATION TO BE.COMPLETED WHEN,
OWNER'S AGENT OR CONTRACTOR APPLIES FOB:BUBUILDING' MI
PERT
xa � &
I,as Owner of the subject property,hereby authorize [f[ d,
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Ant /m�cr�
r2_—?—IS—
Print Owner's ante7Electronic Signature) Date
SECTION 7b:OWNEW 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.
mild-z �'�� Nh -7-t
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.linp ovemenl Contractor(HIC)Program);will n have access to the arbitration
_..Other
—
program or guaranty Pond under M.G.L._c. IJ2A.Other Important m Dins-mon on the HICl'rogram can be toimd3t- --
vesaw.m:tss.t:ov'oca information on the Construction Supervisor License can be found at ww"w.mass.�rov;dns .
2. When substantial work is planned,provide the information below:
'notal floor area(sq. ft.) ,(including garage, finished basementlattics,decks or porch)
Gross living area(sq. R.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
rypc of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "notal Project Square Footage"may be substituted fur"Toed Project Cost"
Licensed fr Insured Estimate
"The right hand for the Job"
�.� Date Estimate#
12/4/2015 485
Name/Address Project Address
Nancy Amara 16 Winter St
Salem,MA 01970
Description Total
All penetrations shall be properly sealed
Completion means satisfactory cleanup,removed of debris
The total for this project is including Labor and Materials 2,475.00
NOTE:Paint is not included.
Payment terms:
$ 4000.00 down payment
$ 3275.00 upon the job is in progress
$ 2000.00 upon the job is completed
Me ntWractor �Ho Owner
Walt ales Manager
ez
www.mendezcontractor.com ge
y�SPu,► S,'1� * -/),,1s„ �,�.0,.
NOTE: Any alteration will be approve by all parties before is done Total
these may result an extra charge. $9,275.00
Page 2
Llceased fi lru Estimate
he right hand for the Job^
Ion Date Estimate#
12/4/2015 485
Name/Address Project Address
Nancy Amara 16 Winter St
Salem,MA 01970
Description Total
The following Estimate for the property located at above address.
The following paragraphs explain the work that Mendez Contractor will carry out.
SCOPE OF WORK: NEW SHINGLE ROOF AND WINDOWS REPLACEMENT
MAIN ROOF -
• Strip existing 1 layer of slate roof
•Inspect underlayment for any rotten wood or damage areas(this will be extra labor and material)
Replacement will be on a time and materials basis
•Nail down all loose decking
•Inspect flashing on transition walls and replace it if necessary(this will be extra labor and material)
•Install ice and water shield on all leading edges,valley and transitions(minimum 3 R along the bottom of
the roof edge)
•Install 8"drip edge along the bottom edge and sides(White)
•Install 15 pounds of felt paper
•Install starter strip
•Install new shingle roof 30 yrs architectural with 6 nail per shingle
All penetrations shall be properly sealed .)
Completion means satisfactory cleanup,removed of debris
TOTAL FOR LABOR AND MATERIAL 6,800.00
-WINDOWS REPLACEMENT
].Remove all old trims from inside and outside
2.Remove old windows tL w 1vt cto•✓S
3.Frame the opening Small.
4.lnterior Wall;Install plywood TYVK clapboard siding.
S.lnterior;Install new fiber glass insulation,New dry wall tape and compound.
6.Install new double window.
7.Interior, Install new trims.
8.Exterior;Install new ice and water shield around the window.
9.Install new flashing on top of the windows.
1 O.Install new Trims.
NOTE: Any alteration will be approve by all parties before is done Total
these may result an extra charge.
Page 1
CITY OF SALEA AWSAa4USET'IS
BtarDnJGDvArram
120TA9mCMSV.EET,rJ )OR
TEL(978)745-9595
PAX(978)740-9846
YDOERLLEYDRISGOLL
MAYOR Trlor+lAs ST.PIERBE
DIREcrOR OF rl]Bucrxo)ERTS/BLIIIDm azwssiObU
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 c40, S 54; Building Permit g is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit 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)
(address of facility)
Signa-:ire of applicant
Date