B-19-1158 - 0031 BUFFUM STREET - Building Permit The Commonwealth of Massachus
Board of Building Regulations and S"ar s CITY OF
Massachusetts State Building Code, 780 CMR SALEM
i Revised Mar 2011
Building Permit Application To Construct,Repair,Renovatee, r Demolish a
One-or Two-Family Dwelling
=' This Section For Official Use Only
�{> Building Peruut Number. Date Applied
Buildmg Official(Fruit Name); Signature Date':
s
SECTION 1.SITE INFORMATION.
1.1 Property Address: 31 Buffum Street 1.2 Assessors Map&Parcel Numbers
N/A 27-0048-0
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R2 R2 5227.2 50
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
15 N/A 10 N/A 30 N/A
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 UWNERSHW
2.1 Owned of Record:
Steve Zuretti Salem,MA 01970
Name(Print) City,State,ZIP
31 Buffum Street 323-400-9715 sz1084@gmail.com
No.and Street Telephone Email Address
SECTION 3.DESCRIPTION OF PROPOSED WO RKZ(check all thatapply)
New Construction❑ Existing Building® Owner-Occupied ® Repairs(s) ❑ Alteration(s) ® Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units 1 Other ❑ Specify:
Brief Description of Proposed Work2:Replacement of windows �.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs. .Official Use Only
. .
Labor and Materials
1.Building $12,500 1.'Building Permit Fee:$ Indicate how fee is determined:'
2.Electrical $ ❑ Standard City/Town Application Fee
'Total Project Co`sr3(Item 6)x,mulfipher x
3.Plumbing $ 2. ,Other Fees: $ /
4.Mechanical (HVAC). $ List C
5.Mechanical (Fire ti
$
Suppression) Total All Fees: $
Check No Check Amount: Cash Amount
6.Total Project Cost: $12,500 ❑Paid'm Full ❑Outstanding Balance Due:`
SECTION 5 ;CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-110171 06/06/2020
Lee Dearborn License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) 11
32 Buffum Street
No.and Street Type •` } Descnphon
Salem,MA 01970 U Unrestricted(Buildings up to 35,000 cu.ft.
R Rest
ricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
617-997-6441 Leejr@themg.us I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 186309 10/23/2020
Lee Dearborn,DBA The Makers Guild HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
32 Buffum Street Leejr@themg.us
No.and Street Email address
Salem,MA 01970 617-997-6441
City/Town,State,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 ..........El No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT Ok CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize Lee Dearborn,DBA The Makers Guild
to act on my behalf,in all matters relative to work authorized by this building permit application.
Steven Zuretti 10/16/2019
Print Owner's Name(Electron Signature) Date
SECTION 7b:;OWNERt OR AUTHORIZED AGENT DECLARATION.
By entering my name below,I hereby attest under th ams end penalties of perjury that all of the information
contained in this application is We n rac rate to e be of my knowledge and understanding.
Lee Dearborn 10/16/2019
Print Owner's or Authoriz gent' Name(1 e�ctro 'c 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.maauov/oca v/oca Information on the Construction Supervisor License can be found at www.mass.g_oy/dpss
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 decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
CITY OF &USINI, i XSSACHLSETTS
BulIzING DEPARTMENT
i b 120 WASHINGTON STREET,r FLOOR
TEL (978)745-9595
FAX(978)740-9846
KE BERLEY DRISCOLL
MAYOR THoNw ST.Pmm
DIRECTOR OF PUBLIC PROPERTY/BUILDING COALNUSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(BusineWOrpanizatioNlndividual): The Makers Guild, Inc.
Address: 32 Buffum Stree, Unit 2
City/State/Zip: Salem MA 01970 Phone#: 617-997-6441
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
employees(full and/or part-time).' have hired the sub-contractors
2.❑ I am a sole proprietor or partner-
listed on the attached sheet. 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. Demolition
workingfor me in an capacity. workers'comp.insurance.Y9. []Building addition
[No workers'comp.insurance 5. IXI We are a corporation and its 10 Elrepairs Electrical or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL I l.[]Plumbing repairs or additions
myself.[No workers'comp. e. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers 13.0 Other Window Replacement
comp.insurance required.,
•Any applicant that chocks box&1 must also fill out the section below showing their workers'compensation policy information.
l lomeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such
=Contramors that Check this boat must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infomtation.
I am an employer that Is praviding workers'compensation Insurance for my employees Below is the pollcy and Jab site
information.
Insurance Company dame:
Policy#or SOPins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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 S1,500.00 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 advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correrL
Signature: Date, 10/16/2019
Phone#. 617-997-6441
Official use only. Do not write in this area,to be completed by city or town official
City or Town: PermillUcense#
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#•
QTY OF SAIEK MASSACHUSEM
BUIIDING DEPARTbsw .
120 WAsHmWN STREET,31D FLOOR
1IEL.(978)745-9595
FAX(978)7400846
KHMERLEY DRISOOLL
MAYOR 'IHcmAs STPmRRE
DIRECTOR OF PUBLIC PROPERTYIBUQDIN6 C0fiW&%asIER
Construction Debris Disposal Affidavit
(required for all demolition & 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,S54;Building Permit# is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licenses
waste deposit facility as defined by MGL c 111,S150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
(name of facili
address of facility)
ty)
f
llgWa7la of a i t
(today' date