B-19-1228 - 0061 BUTLER STREET - Building Permit Gk 7.1c�
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
is,Section FOr'Othclal-Use Orily
r
Building Permit Number Da p'Ited
A
Bu►lding Official(Pant Name) _, Signature Date.,"
SECTION';1*SITE'"INFORMATLON ; d^': r
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
4", lb U7L.FA sc-
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:
Zone Outside Flood Zone?
Public Private❑ Municipal B-6tCsite disposal system ❑
Check if yes❑
m `'SECTION 2 PROPERTY OWNERSHIP' : '
2.1 Owner'of Record:
JAm.,E 64-PeWsr-jF: SirzE�Wl. Aqp of q7
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3 DESCRIPTION OF PROPOSED WORK`(check a1C that apply)„
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work: RV_8 v t� S-n 91 or-W P01--C1rh
SECTION4c ESTIIVIATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
1.Building $ O OC7 1 Buildntg Permit Fee $ Indicate how fee is determined:
2.Electrical $ ❑Standard,City/Town Application Fee
r❑Total"Project Costa(Item 6)x multiplier z
3.Plumbing $ j2Catlier Fees° $
4.Mechanical (HVAC) $ Ltst '
5.Mechanical (Fire $
Total All Fees:$
Suppression) .,,
Check No Check Amount: Cash Amount.
6.Total Project Cost: $
❑Paid;in-Full ❑Outstanding Balance Due:
� l�
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SECTION 5:. CONSTRUCTION SERVICES.
5.1 x
n(OA
truction Supervisor License(CSL) Og/%7✓10 P. l vn�A License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) L/
f U ✓C�G S� Sd- Type Dptio
No.and Street escri n
�`f-7 D U Unrestricted Buildin s u to 35,000 cu.ft.
470 R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Coverin
WS Window and Siding
SF Solid Fuel Burning Appliances
q -590-90 f Ccgu I L.p 1�1 N C o I Insulation
Telephone Email address D Demolition
5.2 a istered Home Improvement Contractor(HIC) 3$2� /
D
q✓ o N. CVrt A HIC Registration Number E ira ion Date
HIC Com ai N {e or HIC Re 'strant Name
10 p (�yIth0.� S� CC U1 c.��iv GOM�Cs�ST� NET
No d Street tmail address
klk-m MA 011-1U g72,-Se0-%?,4
City/Town,State,ZIP Telephone
--SECTION 6 4WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M:G.L c 152.§ 25C(�).
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes.......... ...........❑
SECTION 7a.,OWWNER AUTHORIZATION TO BE COMPLETED WHEN `
OWNER'S AGEN.T,OR:CONTRACIT'OR APPLIES FOR B/UiII:DING';PERIVIIT
I,as Owner of the subject property,hereby authorize H t I h$Li o M. ` Mk A
to act on my behalf,in all matters relative to work authorized by this building permit application.
SgwittF LgQen5E€ 11&tt9
Print Owner's Name(Electronic Signature) / Date
SECTION 71: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.
4; 1-,r�,a M . a),�A d-t/1-1 -
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
Y = 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.gov/oca v/oca Information on the Construction Supervisor License can be found at www.mass.gov/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"may be substituted for"Total Project Cost"
L
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CITY OF SALE1ti1, 1�I�'�SS.�CHUSETTS
BUM131NG DEPARMSC&NT
120 WASHiNGTON STREET,r FLOOR
TEL (978)745-9595
FAX(978)74O-9846
KIN. BERLEY DRISCOLL
MAYOR THOMAS ST.Pi>rM
DIRECTOR OF Punic PROPERTY/BUILDING CONL UMIONER
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbera
Applicant Information �t Please Print Legibly
Name(Bumsssr'Organizadon/individual): oft C- r9vtt_mi-4-
Address: 1 1C) P►rill A-SW� s'1
City/State/Zir -j��� k -- °j`nc> Phone#: 9'M-14`t 7-7'/C
Are you an employer?Check the appropriate box: Type of project(required):
I.�am a employer with / 4. ❑ 1 am a general contractor and l 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑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 are a corporation and its 10❑Electrical repairs or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11-❑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
comp.insurance required.]
•Any applicant that cheeks box Nl must also fill out the section below slowing their workers'compensation policy information.
t I&xneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
;Contrm-ton that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'camp.policy information.
1 am an employer that is providing►vorkers'compensadon Insurance for my employee& Below Is the policy and Job site
information.
Insurance Company Name: .�•� �• arts Go.
Policy#or Self-ins.Lie,ti: V wG , I ego- f o Z 1'N 5 - Zo i q A Expiration Date:--- 3/it 2 0 +
Job Site Address: r 3vsz.urR aT City/State/Zip: t MA oi�c
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 advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby, adon provided above is true and correct
en
t nr Da I r1 i
Phone it: 978=7N�I-Zfr/c7
OJrcial use only. Do not write in this area.to be completed by city or town of,J'IciaL
City or Town: Permit/1.lcense#
Issuing Authority(circle one):
1.Board of Ileaith 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other,
Contact Person: Phone#:
i
CITY OF S�UE11►i, 1►LkSSACHUSETTS
BUUMLNG DEPARTNIENT
130 W ASHINGTON STREET, 3'FLOOR
40.
TF.L. 978 745-9595
FAX(978) 740-9846
KIMBEn EY DRISCOLL
MAYOR T Holy m ST.PIEm
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMUSSIONER
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:
Gee ,V to 5 2,^vD,-,1--,
(name of hauler)
The debris will be disposed of in :
(name of facility)
zcys--e-421�
(address of facility)
p rmi applicant
date
debrisalr doc
77. C&C Building and Remodeling LLC. Estimate
�r 10 Purchase Street
Salem,MA 01970 Date Estimate#
(978)744-2810 8/16/2019 2019-5009
Name/Address
Jamie Lapensee
61 Butler Street
Salem MA 01970
Project
Description Total
This estimate is for removing the existing front porch and building new porch in the same location.We will demo the 10,900.00
existing front porch down to the ground and prepare to build new porch using Pressure Treated lumber for all the
framing and the decking,and rails.The existing roof will retrain as is and will be temporary supported. Once the old
porch is removed we will dig and pour new concrete footings as per building code.We will then build new porch using
the pressure treated lumber and per building code.The framing will be in the same location as the existing and the same
elevation.Once all fiamine has been done we will install new costs.The Pressure Treated Decking will be installed and
new pressure treated rails will be installed.The under side of the porch will be closed off with MDO plywood and
painted white with trim.A new exterior door will be installed to access the bottom of the porch.
The roof over the porch will be stripped and a new layer matching existing will be replaced.
Permit to be obtained by the contractor.
All rubbish to be removed from the premises:
Payments as follow:$4,000.00 Deposit,$3,500.00 due upon framing complete,$3,400.00 due upon completion
Any Questions please feel free to call.
Total $10,900.00
Signature