B-19-1134 - 0007 1/2 ADAMS STREET - Building Permit i
t
The Commonwealth of MassachiOW&110NA - SERVICE)
* Department of Public Safety
Massachusetts State Building Code(780 CMR)20(t9 OCT _q A 5: 51 .
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
�(J Building Permit Number; Date Applied: Building Official:
SECTION I:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
r ) A S SakeM- amcS 0(T
v_ No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2;PROPOSED WORK
Edition of MA State Code used If New Construction check here Wror check all that apply in the two rows below
Existing Building W Repair Alteration ❑ Addition❑ Demolition 2-(Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: A- &,^C '
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No lit"
Is an Independent Structural Engineering Peer Review required? Yes ❑ No Et
Brief Description of Proposed Work: v S — O C 1,114
O r
t �S '' L' to• Eyr .
Smi2E Ar1j
r {T • C N
t19L n O4.15Ir 5'6tc4-A14i#v C Y VC K - V rN f 5t d f- .
SECTION 3:COMPLETE THIS SEC TIO IF.EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY. '
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CUR 34) O
Existing Use Group(s): Proposed Use Group(s): Pd h`
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.) -
SECTION S: GRO (Clieck as app 'cable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4 O A-5 O B: Business ❑ E: Educational ❑
F: Facto F-1 O F2❑ H: High Hazard H-1 O H-2❑ H-3 O H-4❑ H-5 O
1: Institutional I-1 O 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2 O R-3 O R4❑
S: Storage S-1❑ S-2 O U: Utility O Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 1110 IIA13 IIBO IIIAO 111110 IV 1 VAO VBO
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal O A trench will not be Licensed Disposal Site O
Private❑ or indentify Zone: or on site system❑ required O or trench or specify:permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: ;.N.I_�\,,.!_I_itoric Cumniksiga Rovicty I,'rocc.s:
Not Applicable O Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes O or No O Yes O No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?:_ Special Stipulations:
c
SECTION 9:-PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Name(Print) No.and gJeet City./Town Zip
Property Owner Contact Information:
rj
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes 77
Name Street Wddress__. City/Town J State Zip
to act on the pro pert owner s behalf,in all matters relative to work authorized by this building permit application.
SECTION 10 CONSTRUCTION CONTROL(Please fill out-Appendix 2)
building is-lei 35,000 cu:' .of enclosed s ace and/or not under Construction Control then check here and ski Section 10.1
10.1 Re 'stered Professional•Res onsible for Corisiruction'Control
OnA
Name(Registrant) Telephone No. & "d '°q1— , Registration Num r
I— Mai - uhrP,qi�k re4, . aS_01
Street Address City/Town State Zip Discipline Expiration Date
10.2;General C6nteactoor
Company Name
Name of Person Responsible for Construction License No. and Type if Applicable
9 1 116-ry.. I ny . Sallsbv r M4. AW, p f' .
Street Ad ess City/T State Zip
Telephone No. usiness Telephone No. cell e-mail address
SECTION 11:WKER ORSCO: MPENSATiCJN INSt1RANCE AFFI[)AVIT"M.G.L.c.152: 25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes 17 No 13
SECTION-12•CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$ =
1.Building $
Building Permit Fee=Total Construction Cost x,(Insert here
2.Electrical $ appropriate municipal factor)=$ _ (
3.Plumbing $ 2 5 •C7e
4.Mechanical (HVAC) $ { Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ 9[ (contact municipality)and write check number here,
SECTION 13:"SIGNATURE OF BUILDING PERMIT APPLICANT _
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.
Please print and si name Title Telephone No. Date
7_0 M bar,.
Street Address City/Town State Zip O/�
+b
Municipal Inspector to fill out this_.section upon application approval
s e Date
i CITY OF S��L M, IN iSS.'�CHL'SETTS
BL:ILMG DEPARTME214T
` 120 WASHINGTON STREET,31D FLOOR
TEL (978)745-9595
FAX(978)740-9846
KI.\IBERLEY DRISCOLL
MAYOR TrIOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BULDLNG COMMMIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A»plicant Information Please Print Leeibly
Name(BusifwWO(gani:ation/individual): C,500 H s Q
Address:_ Q b-e r r-, 1,ry ,
City/State/Zip: �CQ 1)\4 a Phone q
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
2.employees(full and/or part-time).* have hired the sub-contractors
lam a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ 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 1 I.❑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' 13.0 Other tt2�
comp.insurance required.]
•Any appficam that checks box U I must also fill out the section below sbowina their workem'compensation policy infummlon.
r 114—owrws who submit this affidavit indicating they arc doing all work and then hire outside contnretom must submit a new affidavit indicating such.
Contractors that check this box must anachod an additional sheet showing the name of tho subavntractom and their workers'comp.policy infam ation.
I am an employer that Is providing workers'compensadon Insurance for my employees. Below is the po/Icy and Job site
informatioe.
Insurance Company Name: 0 Lct JJe,
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address:__Z ^ oqq S City/State/Zip:_ SQhplf2 SAS S
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be adviwd that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I.do/tereby y under the pal d na/t/es of perJary Mal tAe informatlon provided above is true and correct
.1
lr 1)a
Phone#:
FlIssulnEgIlAulhority
fficia use only. Do not write in this area,to be completed by city or town oJf riaL
ity or Town: Permit/License# _
(circle one):
I. Board of liealth 2. Building Department J.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: __ T Phone#•
,r CITY OF SM EN1, NLkSS.,ACHUSETTS
BL UMLNG DEP kRTNC&NT
i 130 W ASHINGTON STREET,3'R.00R
T EL (978) 745-9595
FAX(978) 740-9846
KIN
tBERLEY DRISCOLL
MAYOR Tmms ST.PmRRB
DIRECTOR OF PLBLIC PROPERTY/BUILDING COMMMIONER
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:
(namt of hauler)
The debris will be disposed of in
(name of facility)
CoCb fY.'.el t.cz S .
(address of facility)
signature of permit applicant
date
debriatrda
I Cx)s+,N(,
1
LO r
, C
LVL
taubla I^-.v1, rw�+nn�a
i
2
(.� G LIP
cn
_ G
_ 1 z
r
i
z a-
. c
• G
U
C �
aH O
cg
570
OD
" 3
• 1 f
9
x p n
_ x
i
i
i
e
z �
� � o
t!' Z
CO
v
o tT rb
74
r 7
G
i
� N
9�
Z
� 0
n
T� s
EACA
c Q
17
p -+
Z r LA
P +, _ � x
7' -�
® � C� rl
If
x
-b X
r
Scott Stone Construction OA o'=: September 11,2019
Quality At it's Finest #777
www.scottstoneconstruction.com
FOF,I` 3 season porch (removal,& rebuilt
9 Bayberry Lane
Salisbury Ma, 01952 S,`L L TO: Tom Balabon
Phone:978-985-6517 7 Whipple way
Fax: 978-462-3525 Kensington N.H.
Job Location
Salem Mass
§t?ESCRiPT10N AMOUNT
Demo
!Hoping for a controlled rip. Remove 1 floor at a time section by section. Temp walls
1built and supported to carry load while removing walls to rebuild plumb and level as
i
possible.(AII windows removed to lesson load, openings will be covered for weather.
v
Roof section to remain in use throughout and new porch frame will tie into existing roof. i... . ...._ ..._...,._._.. ......w.. _......,__
windows to be removed and thrown away(30 yard dumpster on site
exterior walls to be removed and braced section by section.
interior floor removed and rebuilt over foundation 3
,Note
there is a possibility a larger section or even all 3 levels of the porch may have to be
iremoved if we cant build new platform around bracing starting on 1 st floor foundation..
New platform floor is our starting point for new walls etc
i
Materials __. i
=2x6 pt
12x6 8 i
#2x6 10
2x8 8
12x10 10',12'floor joists(ceiling joists F
=1x3 strapping
'2x4 k d Spruce 8'
`Laminated beams(porthole framing ? E
3/4 t&G plywood _ _... __.m.._..
A
11/2 cdx plywood. .._. I
R-21 Fiberlass insulation (foam for windows?)
House wrap (stapled
silI seal (foundation)
`Seal tape windows
a
Hardware nails timber lock bolts and carriage bolts
1 x3 PVC exterior window trim
�2x10 triple headers
possible foundation vent if needed I
Interior
R-21 wall insulation.
J
1/2 sheet rock!paneling removed
'.window trim (pic framed 2 1/2 col case
joint compound
(paper tape
je-z sand 45
toats joint compound floated over paper tapeulate around window r o. before trim and ext jambs
_.. _.... ..,_,.._ . _.. ....v...,, . _.. ._ .._._..,.. ..............
{Note- existing porch frame was built to the outside of the old shingle siding
rwhich puts a bump in the walls We will be framing to the existing frame so when
,the new 1/2 plywood is installed it will be the same as the existing, so when the rest
_I
of the house is stripped to re side everything will be correct
I
Windows
...... ,,
,
I aloted 750.00 dollars for each window group being 6 window groups
'2 or 3 double hung windows per groupor a 5 ft glider window decision will need to be_
Imade before new window openings are framed
� M
[Quote is for above estimate of 3 season porch removed and rebuilt using materials
,stated above Porch to be constructed new frame sheathing windows and trim
lexterior and sheetrocked interior new structure joint compounded and windows trimmed
1paint is separate quote
stripping the back of the main house,the existing siding and the cedar shakes
?and vinyl the back side is a separate quote
., ,..,
s
s.
I
'Total materials labor and dumpsters 24,312,00
PAYMENT SCHEDULE
To start $8,104.00
=.Midway $8104.00
i
3/4 way$ 4052.00
Ion completion 4052.00
,..4». M...».�.
r
<ux„ ..;.. ....w,.... .x, n,n». ..rw».. ,>.. rx+...;;;•uxww,»,r»;;>»:xs<.vaw-„r.x..,:;m n>...n7».v._._.�«.ram:-.x.7
i
A
t S,
i
r
vwnv v.»x,ra n...mm.»»•.r:a»wxr�ren»na:xaxmvx:.m»......w'n»r:n:.mw»«ma r. .x »Nn»mx x.xxrwr. wv :::..me,wwwve.wru:. .wn.=...,rwr- ..+g}i
»1
j Yq`p`
AI
I.row....,:.... ........ ,,......, w-,.r..r-... ..,w...
Make all checks payable to Scott Stone. If you have any twos - r
i
questions concerning this Contract,contact Scott Stone, THER
978-985-6517, smstone77@comcast.net I _ 11 I
TOTAL ,r:.._ ,. .,$24,31»2 00
THANK YOU FOR YOUR BUSINESS!
Any permit fees will be extra
All material is guaranteed to be as specified by manufacturer, and the above work is done by code at the
contractors discretion.
Full Payment is due upon completion. If payment is not made within 3 days of completion late fees will be added
Any alteration or deviation from the above specifications involving
extra cost will become extra charge over and above the estimate. Dump/Dumpster fees are an additional cost
Roofing Cost are based on a 1 layer strip, If strip is required. Unless stated otherwise in contract.
All agreements contingent upon delays beyond our control. Purchaser agrees to pay all cost of collection,
including attorney's fees. This proposal may be withdrawn by us if not accepted accepted within 10 days.Changes
of material cost may change, if cost have gone up and proposal was not excepted in a timely manner. I
Owner agrees that if they breech the contract before work is started, contractor may demand 25% of the contract
price as it's stipulate amages for breach.
Signature: te: �'27' ��