29 BARSTOW ST - BUILDING INSPECTION (2) qq°O
The Commonwealth of Massachusetts
Board of Building Regulations and Standards", CITY OF
Massachusetts State Building Code, 780 CMRI CEIV�® sed MaSALEr42011
Building Permit Application To Construct, Repair, RcrfKafeV&%AiA
One-or Two-Family Dwelling
This Section For Official Use Onitalb.,MAI
Building Permit Number: . Date Applied:
Building Official(Pool Name) Signature Date
-
SECTION'1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
Bea nS_� S+_ SC L YY� mA
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 to Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Acquired Prov idcd Required Provided
1.6 Water Supply: (M.G.L a 40, §54) t.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check iryes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 'iwne�gf Record:
R 1 lawn S cLL-Q-\-\& . KA A I)\ cc l 0
Name(Print) City,State,ZIP
21l Begs lz-N+ On 8--7 L1 S-2419
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ teration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ []Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ '
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ G I tkgcl ❑ Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES'
5.1 Construction Supervisor License(CSL)
Rr /�� � License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
Unrestricted(Buildings up to 35.000 cu.ft.)
-'-� R Restricted 1&2 FamilyDwelling
City/Town, State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
p ^ SF Solid Fuel Burning Appliances
Insulation
Telephone Email address Vle_Y ZO D Demolition
5.2 Registered Home Improvement Coonnt-ractor(HIC)
i 7 _C. �ia_�A- l I�IJIYUC"�1t51/� �'i:. CRe���nNmbe
�0 —�� 3�h,C HIC Registration Number Expiration Date
t C CT eAIC Ax t Name
accc �223 an
No.and Street Email address
banva 111F� btu 2 3 a1g `�Z2`t�b { ve�az�-tank
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 e 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 -C - Dix 4 A ' S P SW\V�QQ �1
to act on my behalf, in all matters relative to work authorized by this building permit application.
21 � I 0AaJ9PC\_� 6113 /1
Print Owner's Name(Electronic Signature) Date
SECTION 7b: 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
cent a'ned in this a plication Ashrue and accurate he best of my knowledge and understanding.
c ;ndell s�13 �C�
Print O ner's or Authorize Agent's Name(Electronic 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
ww.mass.w aov/oca Information on the Construction Supervisor License can be found at www.mass.eov dns
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"
r' CITY OF SALENMi 1t'WSACHUSETTS
131-:11MI IG DEP ARTME.NT
120 W.ASHINGTON STREET. 3'a FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KIJiBE tL.EY DRISCOLL
MAYOR T'Haz`IAs Sr.PtERRs
DIRECTOR OF PLBLIG PROPERTY/lIUMD]ING C0Al2MISSIONER
Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Vanc(Busixssprganixationindividual): ~ co ,
Address: I bD =M0JA &,4 0 QAniej"t 1t �--2 I I -S Es
city/State/Zip &- �J,,�4� O 1 q 15 Phone a: 9"7 R g 22 9 B'D U
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. 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
working for me in any capacity. workers'comp. insurance. 9. n Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.) officers have exercised thew 10.0 Electrical repairs or additions
3.[ [am a homeowner doing all work right of exemption per MGL t LE] Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12. it re airs
insurance required.)t employees. [No workers' te-
comp. insurance required.] 1 Y 11
'Any applimN chat checks box 9l must also rill out the section below showing their workers'compensation policy mr mtstion.
t l It n warn who submit this Affidavit indicating they am doing all work and then hire maside contractors most suixtnn a tow atrdavii indicating such.
'Contraction that check this box must attached an additional sheet showing the name of the sub�comactors and their workers'comp.policy information.
I om an employer that is providing workers'compensation insurance for my employers. Below fs the poUcy and Job site
information.
Insurance Company Name:
Policy#or Scif-ins.Lic. M. Expiration Date:
Job Site Address: Z —1 QaAS+C5-W S . City/State/Zip:"slottAA-N Cjk9-7O
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$230.00 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.
1 do hereby r jy under the pain rd penal uj Ja that the information provided above is t e and correct
t nr ' �! o Date: J`— 1,3
Phone#: �7 b / Z f q r o y
Ofricial use only. Do not write in this urea,to be completed by city or town official
City or Town: Permit/I.icense#
Issuing Authority(circle one):
1.Board of Health 1. Building Department 3.City/rows Clerk 4, Electrical Inspector 5. Plumbing Inspector
6.Other �_......._
Contact Person: Phone#:
r CITY OF S�kLEN1, TNLxSSACHL'SE-rrs
• Buu-DrNG DEP 1RTNMNT
120 WASHiNGTON STREET, 3m FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KIN[BERi EY DRISCOLL
MAYOR THoat.►.e ST.PiERRB
DIRECTOR OF PLBLIC PROPERTY/BUILDIING.CONMOSSIONER
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:
-A
(name of hauler)
The debris will be disposed of in
(name of facility)
2 7 a FxA-kpr Md Ep P�v�g , N H
(address of facility)
signature o permit applicant
s /(3 /tom
date
dcbriwlydx
Propozal
x 2388 ,7D&3A.C. CASTLE CONSTRUCTION CO. INC.
MEMBER
' MBE 0 �� Telephone (800) 505-LEAK(5325) • Fax (978) 922-9800
Brian LeBlanc, President
Please mail accepted proposal to the office located at.
100 Cummings Center, Suite 113E-5 • Beverly, MA 01915
Unrestricted Mass Builders License No. 054882 Contractors Registration No. 166565
PROPO L SUBMITTEZ0 PHONE e�,�� DATE S
k. r i
STREET - J004AME ,a ,. �,) ,,1 C (r
CITY,STA�A D ZIP CODE �.y JOB LOCATII-OIIJ�
DATE WORK IS SCHEDU Ed TO BEGIN DATE WORK IS SCHEDULED TO BE COMPLETED JOB PHONE
lVe f roP0t?ie hereby to furnish material and labor-complete in accordance with specifications below for the sum of:
r
i r ,r ! dollars($ )
Payment to bg as follows:
3 down, the balan e upon completion.
to l I
NOTICE: All home improv ant contractors and subcontractors eng in home Authorized , jn
improvement contra ss spec'rfically exempt f registration by SignalUre: '
provisions of Chapter 142A of the , ust be registered with Agent
the Commonwealth of Massachusetts. Inquiries about registration and Note:This proposal may be
status should be made to the Office of Consumer Affairs and Business
Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116. withdrawn by us if not accepted within days.
WE HEREBY SUBMfT SPECIFICATIONS AND ESTIMATES FOR:
A ROOF STRIP V `l lA IL t
We will cover the siding, bushes, and grasses with Blue Tarps in order to protect the property during stripping.
We will Strip up to 2 layers of roofing and remove all nails,screws and staples down to the Bare Wood and renail all loose boards.
The Ice and Water Shield will then be installed at the bottom of all Edges, under all Step(lashings,under all Roll flashing,
around all Chimneys,Skylights,and into all Valleys, in heated areas only.
We will install 30 lb.Synthetic Deck Protector Underlayment to all other areas of the roofdeck.
Nk The 8", dumipo""Oripedge will then be instalIt�lre,,d to all roof s.Any existing Pip s will be cov red wt new Alum' m Rubber Flanges.
.� The roofing material to be used will be� +t'•�art , 1 c� (�2, '
The bottom of all roof edges will have a Pro Starter course with a glued edge for wind uplift.We will Storm Nail II shingles,using 6 nails per shingle.
- —
All the Debris will be cleaned and Dumped by us on a daily basis.We will cleanout all Gutters, Downspouts and Elbows. Magnetic brooms will be used to
extract all nails from your property.We will protect your property as best we can,however some foliage matting, breakage,or marring could occur.
We cannot accept responsibility for possessions inside of the house,or debris falling into attic areas.Customer should protect personal belongings.
EXTRA WORK IN WHICH A COST WILL BE ADDED TO HE BOV1'E,Jf!�RICE.
Replace Rotted Roofboards 1a 4Wttstall Aluminum Gutters
Relead Chimney(s) pt( a a Install Aluminum Downspouts
Replace Facia Boards Install Skylight(s)
f
Install Ridgevent � � �� 1 Rotted Roof To Wall Flashings
�j.✓IC4✓-S� „ y u/_
Install Roof Louvers r _ Gutter Repairs
NOTES: ,
d. .
s
n
Y
Warranty by.by
.,manufa,cture to be free of defects for Vers, see manufacturer's warranty for exact warranty performance.
All labor p ormed un of t is contract shall be of good quality and free from defects not inherent in the quality required or permitted for
a period f-years. T is warranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient
mainte nce, mproper)o ration, or normal wear and tear under normal usage.This warranty shall be limited to the work performed by
A r. r. tla Cnnctri ir4in rn Inn and limited to aithar renair or ranlacemPnt by A C. Castle Construction Co.. Inc. at its'sole discretion
r r / U
. . � ,. .c /, dollars($ 1�3. 7 7 )
"I Pay Tent to b4 as follows:°
3 down, the balance e upon completion.
NOTICE: All home Improv ent contractors and subcontra�engain home Authorizedimprovement contra ss specifically exemration bySignature:provisions of Chapter 142A of the ered with v Agent
the Commonwealth of Massachusetts. Inquiries about registration and Note:This proposal may be
status should be made to the Office of Consumer Affairs and Business
Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116. withdrawn by us if not accepted within days.
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: i I:
A ROOF STRIP �`��� S
`,
We will cover the siding, bushes, and grasses with Blue Tarps in order to protect the property during stripping.
We will Strip up to 2 layers of roofing and remove all nails, screws and staples down to the Bare Wood and renal all loose boards.
The Ice and Water Shield will then be installed at the bottom of all Edges, under all Step flashings, under all Roll flashing,
around all Chimneys, Skylights, and into all Valleys, in heated areas only.
We will install 30 lb. Synthetic Deck Protector Underlayment to all other areas of the roofdeck.
The 8".AWmiaasrDripedge will then be installed to all roof edges.Any existing Pipes will be covered wit/h.new Aluminum Rubber Flanges.
The roofing material to be used will be �rT'{1� %�
The bottom of all roof edges will have a Pro Starter course with a glued edge for wind uplift. We will Storm NaV II shingles, using 6 nails per shingle.
All the Debris will be cleaned and Dumped by us on a daily basis.We will cleanout all Gutters, Downspouts and Elbows. Magnetic brooms will be used to
extract all nails from your property.We will protect your property as best we can, however some foliage matting, breakage,or marring could occur.
We cannot accept responsibility for possessions inside of the house,or debris falling into attic areas.Customer should protect personal belongings.
EXTRA WORK IN WHICH A COST WILL BE ADDED TO THE ABOVE PRICE.
Replace Rotted Roofboards �C� f 5 liG install Aluminum Gutters
Relead Chimney(s) 1,n '�; t i' Install Aluminum Downspouts
Replace Facia Boards Install Skylight(s)
Install Ridgevent 1✓IC 4j U` Rotted Roof To Wall Flashings
Install Roof Louvers ) f� f<> � .4 �� 6,1�11-�, ' Gutter Repairs
NOTES: o G . "
- � v
Al,i
Warranty by manufacture Ito be free of defects forgers, see manufacturer's warranty for exact warranty performance.
All labor performed under this contract shall be of good quality and free from defects not inherent in the quality required or permitted for
a period/of years. T is warranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient
maintenance,ImDrOperoperation, or normal wear and tear under normal usage. This warranty shall be limited to the work performed by
A.C. C tle Constructio Co., Inc. and limited to either repair or replacement by A.C. Castle Construction Co., Inc. at its'sole discretion
and ele tion. Any apd all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the
occurren a of th ent giving rise to such claim. This warranty shall not extend beyond any limits imposed by applicable law.
It is our obligation to obtain any and all necessary related permits. PLEASE NOTE: owners who secure their own construction-related
permits shall be excluded from access to the Guarantee Fund.
Payment and Penalties - Upon substantial completion of all work under this contract, customer shall within 3 days make final and full
payment of the contract price. Any and all unpaid balances shall accrue with interest at 5% interest per month. You agree to pay all
court costs and collection expenses incurred by A.C. Castle Construction Co., Inc. in the collection of any amount you owe under this
contract, including without limitation reasonable attorney's fees. PLEASE NOTE: any illegal layers of roofing beyond a second layer will
be an extra cost of 35 cents per square foot for each layer beyond a second layer.
Arbitration -Any controversy or claim arising out of or related to this contract, or the breach thereof, shall be settled by arbitration with
the American Arbitration Association or a mutually agreed upon third-party. Any judgment upon an award entered in arbitration may be
entered in any court having jurisdiction thereof. This section shall not apply to claims of A.C. Castle Construction Co., Inc. for collection
of past due accounts owed by the customer.
The homeowner's three day cancellation rights under MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable.
91(rreptante of Proposal -Signing this proposal means you have accepted all th/t9r, s'as statedand us as acting agent for permitting.
//lDate of Acceptance -> �/f ���' Signature �
iN C= _�ZIQC 1^ /�L j �N
c,
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
- - Registration: 166565
- Type: Corporation
Expiration: 6/9/2016 Tr# 251720
A.C. CASTLE CONSTRUCTION CO INC `'?
BRIAN LEBLANC —#
9 TIBBETTS AVE
DANVERS, MA 01923
'Update Address and return card.Mark reason for change.
Address ❑ Renewal ❑ Employment ❑ Lost Card
SCA t 0 2010-OS/11
�e�'ommo�uoe¢lCh g2�la�h.�tc,'
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
lowOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration 166565 Type: Office of Consumer Affairs and Business Regulation
xpiratlon B66F2016;_ Corporation -10 Park Plaza-Suite 5170
_ Boston,MA 02116
A.C.CASTLE CONSTRUCTION CO''INC.
BRIAN LEBLANC -
9 TIBBETTS AVE
DANVERS.MA 01923 - Undersecretary Not valid without signature
''`• '�"" t a "' `'''"' '"�' ° Massachusetts Department of Public Safety
IVY Board of Building Regulations and Standards
r
L s License CS-054882
K�4 �
Construction Supervisor
r uu
BRIAN A LEBLANE
,�� ���Alr•''; n I� 9TIBBETTS AVE%
DANVERS MA 0992
_ ryDq"
Expiration:
e' .I Commissioner 09/17/2017