0015 BARNES CIRCLE - BPA-10-306 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
' Massachusetts State Building Code, 780 CMR, 7`'edition OF SALEM
Revised January
Building Permit Application To Construct, Repair,Renovate Or Demolish a 1, 2008
n(\ One-or Two-Family Dwelling
This Section For Official U e Only
Building Permit Niy&er: e A ied:
Signature: IA" �(o )d.�Jo
Building Commissioner/fiispectoro BuilfijgjyDate
SEC - TTE INFORMATION
1.1 Proper Address: / 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes__,G 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:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP`
2. Owner`of Record: ^-�
)n.\,,c\ l Mou�Sc�r,\ems 5 C� nx-"e n;V�to_�etm
Nap1,,e,{\P nnt) \ Address for Service:
Sign�tureture— — � � Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Pt,I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work:
L2,1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials Official Use Only
1. Building $ — 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
6. Total Project C Check No. Check Amount: Cash Amount:
ost: $ Oo
11 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
iaou5a
License Number Expiration Date
Name of CSL-Holder
M (�n List CSL Type(see below)
A
[� L�7�c—�5�.\vt-_.. C� Type Description
ddiei U Unrestricted(up to 35,000 Cu.Ft.)
Signature�`� Restricted 1&2 FamilyDwelling
Masonry Only
'l19 k--ls \�o`Z�l Lk RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Buminr Appliance Installation
D I Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
�t s c s�k-c= `�s.�1-rv.c `t Q on / S 3 1-122
HIC Company Name or HIC Regis t Name Registration Number
Addres I ( —'�(O -2o I O
1R -•�1 y Expiration Date
Signature Telepphonehone
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 .........P*-- No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�t, � , as Owner of the subject property hereby
authorize t�sZ.a� v5.v.�\v sL`t\S7C`C.rW t�o^l h�ty Meito act on my behalf,in all matters
relative++to work`authorized by this build emrit application.
Signature of Owner V Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury
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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,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 j
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"
Y a4 E �4
a i,
t` - le
8 Yorkshire Road
Marblehead, Ma 01945
(978)356-5419— (866) PRESTO-7
HIC#153422- - - CSSL #100452
FID #20-5794889
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT.•
John Moutsoulas 15 Barnes Street
15 Barnes Circle Salem
Salem, Ma DATE OF PROPOSAL:
October 17, 2009
Having visited and examined the site of the proposed project and being familiar with the
conditions relating to the construction, including the availability of the materials and labor,
Presto Painting& Construction hereby proposes to furnish all materials, labor, equipment and
supervision required and to complete the work in accordance with this contract document.
ROOFING:
<House>
I. Strip off all existing asphalt roofing shingles and dispose of properly& legally.
2. Inspect existing roof deck boards; inform customer of any rot..
3. Install 6 feet of Grace Ice & Water Shield to prevent ice backups.
4. Install 30 lb heavy duty tar paper.
5. Install aluminum drip edge to all perimeters of roof areas.
6. Install new 30 year Architectural asphalt roofing shingles. COST: $7,400.00
INSURANCES:
FULL PROPERTY AND LIABILITY INSURANCE IS THE RESPONSIBILITY OF PRESTO
PAINTING&CONSTRUCTION INSURED UNDER NATIONAL GRANGE
MUTUAL INSURANCE policy#MP089800 expiration 11/15/09
FULL WORKERS COMPENSATION COVERAGE INSURED UNDER GRANITE STATE
INSURANCE COMPANY policy#WC6482591 expiration 12/12/09
(insurance certificates are available upon request)
PAYMENT SCHEDULE:
Payments are to be made as follows:
One half upon beginning and balance including any extras in full when work is complete.
OTHER COMMENTS:
Presto may withdraw this proposal if not accepted within ninety(90)days.
All materials are guaranteed to be as specified.
Care will be taken during the progress of the work, all surfaces needed will be covered to prevent from
any damage or harm occurring during the work day.
Work area will receive a complete inspection at the end of each workday and will be swept and cleaned
daily as found.
All surfaces will be prepared and finished in a manner that meets professional standards.
Presto Painting&Construction will obtain any and all necessary construction related permits, any owner
who secure their own construction permits or deal with unregistered contractors shall be excluded from
access to the Guarantee Fund.
No work shall begin prior to acceptance of proposal.No verbal agreement is accepted
NOTE:
All home improvement contractors and subcontractors shall be registered and any
inquiries about a contractor or subcontractor relating to registration
should be directed to:
Director,Home improvement Contractor Registration
One Ashburton Place Room 1301
Boston,Ma 02108
(617)727-8598
Do Not Sign This Contract If there Are Any Blank Spaces
ACCEPTANCE OF PROPOSAL:
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are
authorized to do the work as specified. Payments will be made as outlined above.
Authorized Signa
oanm akris
Presto Painting&Construction
Signature
John outsoulas
15 Barnes Circle, Salem Ma
Date of Acceptance `61 q\0e1
"HIGHEST QUALITY AND CLEANLINESS--YOUR PRODUCT OUR BUSINESS"
NOTICE OF CANCELLATION:
Homeowner may cancel this transaction without penalty or obligation, within three business days from
the date of acceptance.
If you cancel, any property traded in, any payments made to you under the contract or sale and any
negotiable instruments executed by you will be returned within ten business days following receipt of
cancellation notice and any security interest arising out of the transaction will be null.
If you cancel you must make available to contractor at you residence, in substantially as good condition as
when received, any goods delivered to you under this contract or you may wish to comply with the
instructions of the contractor regarding the return shipment of the goods at your expense and risk.
If you do make the goods available to the contractor and the contractor does not pick them up within
twenty days of the date of cancellation you may retain or dispose of the goods without any further
obligation. If you fail to make goods available to contractor, or if you agree to return the goods and fail to
do so, then you remain liable for performance of all obligations under this contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any
written notice to Presto Painting& Construction at 8 Yorkshire Road, Marblehead, MA 01945 no later
than midnight of (date).
I hereby cancel this transaction.
Homeowner's signature:
Date:
CITY OF S.UEN , 2AXSSACHUSETTS
• BUILDING DEPARIMEI iT
• ` p 120 WASHNGTON STREET,ate FLOOR
a� TE1_ (978) 745-9595
FAX(978) 740-9846
$GMBERI�EY DRISCOLL
MAYOR T Hobw ST.PIF.RRH
DIRECTOR OF PUBLIC PROPERTY/BI:IMLNG CO%L\BSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ` �/w Please Print Legibly
Name(Busitx5vorganiz`ationilndividual): 1 `\�STU a\�l\V-�Yllo -''s \ "oil �CAn nifty
Address:
City/State/Zip: n.yt )\"Nt§a� %j\ s O t\S Phone#: `18\- 1a'D L\2
Are you an employer?Check the appropriate box: Type of project(required):
I dN:4am a employer with'— 4. ❑ 1 am a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
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
working for me in any capacity. workers'comp. insurance. q. ❑ Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.) officers have exercised their P
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LE]Plumbing repairs or additions
myself [No workers'comp. C. 152,§1(4),and we have no 12.12},11oof repairs
insurance required.)t employees. LNo workers' 13.0 Other
comp.insurance required.I
-Anv applicant that chicks box 91 must also fill out the section below showing their wuskess'compensation policy infomtmion.
t I ksnleowron;who submit this affidavit indicating they am doing all work and then hire o tsidecontractom most submit a new affidavit indicating such.
=Contmetum that chick this box must aaaehed an additiotul chars showing the name of the sub-eontrecton and their workers'comp,policy information.
I um an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site
information.
Insurance Company Name: Q--S,-'^'N- �-t5 \+t��.�t \�rY✓ AtY\��t� tom_
Policy 4 or Self-ins, Lic.#: 0 d(o-t-\9- q\ Expiration Date: l 2 _k4 0=�
Job Site Address: \51 e"=,tQ g q City/State/Zip; . )Q Y\'ry \01% `OI%1,,-ID
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. lie advised that copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby cerr at a the pains and penahles of perjury that the information provided above is true and correet
Sicn purr )ate: 10�\o(\ipkoi,
Official use only. Do not write in this urea,to be completed by city or town ofriai
City or Tuwn: Permit/l.)cense# __
Issuing.lulhority(circle one):
1. Board of llealth 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other_
Contact Person: _ Phone#•
1
CITY OF S.UE.�I, UNsSACHUSETTS
Bt:II.DLNG DEPAR-MENT
\ `bj 130 WASHNGTON STREET, 3�FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KIJiBERLEY DRISCOLL
TMAYOR T HO.%us ST.PmRRE
DIRECTOR OF PUBLIC PROPERTY/BUIIDLNG CONLMSSIONER
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
l 11, S 150A.
The debris will be transported by: 1 II
(name of ler)
The debris will be disposed of in :
(name of facilit )
`(Lddress of facility)
4�igkof applicant
date
Jebrisaf Am
:%hosachuselts- Deparu7ent of Public Saki. '
1 Board of Building„ Regulations and Standards
Construction Supervisor Specialty License
License: CS SL 100452 - -
Reslrictedto: RF,WS -
.1
IOANNIS MAKRIS
8 YORKSHIRE ROAD
MARBLEHEAD, MA 01945 4.
e
Expiration: 1/27/2012
Cwunn6+timer Tr#: 100452
�Y Bam-1 mg egu a'f a andiY`S(andar s- C
HOME IMPROVEMENT CONTRACTOR I
- Registration; 153422
Expiration: 11/302010 Tr# 280631
Type: Private Corporation I _
PRESTO PAINTING AND CONSTRUCTION COMPANY '
LOANNIS MAKRIS.
317 B HAVERHILL STREET ,,,,`
ROWLEY,MA 01969 Administrator
I