14 APPLETON - BPA-10-938 ROOF , The Commonwealth of Massachusetts CITY
Board ol'Building Regulations and Standards
1 sµ s OF SALF:M
assac Mhusetts State Building Code, 780 CMR, 7 edition
1 Revised Jwruurt�
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This. eclion For Official Use Only
Building Permit N er. - ! Date Applied:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
L l 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 R) Frontage(11)
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: 1.9 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if es❑ P po y
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner of Record:,
Name(Print) Address for Service:
972 -979' �aY6
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Iteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other Specify: gCkf�Ff U&
Brief Description of Proposed Work':
5 �.USiI ( 2Cg i G Ate/
pq-C AelAJ sia 7—,�7/G0 &0e) r A
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
[6.
Building $ I. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
Electrical S ❑Total Project Cost'(Item 6)x multiplier x
Plumbing S 2. Other Fees: S /
Mechanical (IIVAC) i S List: h
Mechanical (Fire S Total All Fees: S
Suppression)
oCl Check No. Check Amount: Cash Amount:
Total Project Co ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) (25 lO/�4�S-
le— , r�'��R/ — License Number F.4iratioli Wte
i
Name ol'CSI - IIt, er U
OD ' fJ K. ���.���G�� �� List CSL"type(see below)
G�J r)�= I Description
U Unrestricted(up to 35,ODO Cu.Ft.
Restricted 1&2 Family Dwelling
Signature M Masonry Only
2-7,--3 7 41�O—01'0 r RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
�rn
Lwdgnature
RegistrationNumber
Z7 ?�lO/ Espirati n Date
/Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, , as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTIO�N�7bb:O/WNERt OR AUTHORIZED AGENT DECLARATION
"e �Qlf'�� —,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing apofication are true and accurate,to the best of my knowledge and
behalf.
-5'
Signature ol'O r or Authorized Age
(Signed under the pains and penalties ofperjury)
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 Improvement Contractor(HIC)Program), will no.1 have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115. respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"
RAPID ROOFING
GENERAL CONTRACTING CO.
P.O. BOX 605 SALEM , MASS. 01970
978-740-0101
MASS LIC # 128253/144946/CS101965
RAPID ROOFING IS A DIVISION OF COYNE&SONS CONTRACTING CO.
ARCHITECTURAL SHINGLE ROOFING ESTIMATE
di . , . _ _
TO. 5/24/2010
JAMES WILKINS
19 APPLETON ST.
SALEM, MASS. 01970
978-979-9046
JOB SITE ADDRESS.
SAME
RE; ROOF ESTIMATE#010-076
COMPLETE STRIP (2 LAYER STRIP) OF 25 YR- 3-TAB SHINGLES (14. SQ)
INSTALLATION OF 30 YR ARCHITECTURAL ASPHALT ROOFING SHINGLES -
ON ENTIRE MAIN HOUSE ROOF& BOTH SIDES OF THE (FIRST) REAR
ADDITION ROOF OF THE BUILDING..
WE AGREE TO.
1. COMPLETELY STRIP THE ENTIRE MAIN HOUSE ROOF & REAR ADDITION
ROOF OF ALL THE EXISTING TWO LAYERS OF SHINGLES ON THE ROOFS
OF THE BUILDING AT THE PRESENT TIME.
2. REMOVE ANY ROTTED ROOF DECKING BOARDS OR SHEATHING ON
THE ROOFS OF THE BUILDING, AND INSTALL UP TO 100 FT.OF EITHIER
ROOF BOARDS OR SHEATHING- FREE OF CHARGE ( ONLY IF ROTTED
AREAS ARE PRESENT).