55 BAY VIEW AVE - BPA-16-158 CHIMNEY LINER 3S� c� 59-7 t nr ,-Vlch 1 sr
i The Commonwealth of Massachusetts
Q OF
Board of Building Regulations and Standards CITY M
Massachusetts State Building Code, 780 CMR SA
Revised M Mar
ar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Family D velling
This Section For Official Use Only
�^ Building Permit Number. Pate App�ied: I
Building Official(Print Name) Signature
ton SECTION 1: SITE INFORMATION
y 1.1 Proper Address: 1.2 Assessors Map &Parcel Numbers
- 5' �vveaw AN& _
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:
Public❑ Private ❑ Zone: — Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qwner'of Record:
Name(Print) Qity,State,ZIP SNo.and Street�- Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s)>< I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Lin s fu Q C� SFa i tt�sS ,__S—j 0e t i N A;�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
' Labor and Materials
1. Building $ ao 1. Building Permit Fee: S__Indicate how fee is determined:"
❑ Standard pP City/Town. Application Fee
2.Electrical $e ❑Total Project Costa (item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ /
4. Mechanical (HVAC) $ List: S
5. Mechanical (Fire $ Total All Fees: $
Su ression _ —
Check No. _Check Amount: _Casks Amount:
6. Total Project Cost: $ S Q� ❑Paid in Full _ CI Outstanding Balance Due:
3� t-1 CpNY '2. Glatit.�n `•-�_ J � fvv�7\l. ,
l lJt l�''� ��Gc�j Gfa u �T� 6�fiS.SE2V- rook V n SCa S=32 31 3
SECTION 5 CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS 106q& a2� ��
ttytr,/'� &(GLrr✓t)a t,, License Number Expir lion Dat
Name of CSL Holder
p 'A List CSL Type(see below)
No.and Street Type - Description _
100 bol,4 /lit!f' Q (pp 0 ( U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town, State,ZIP M Masonry
RC "Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
l/yci,}p �Q�,.,G� I Insulation
Telephone Email address !��e D Demolition
5.2 Registered Home Improvemeent Contractor(HIC)
wr 5wmf
tlan-yl/LGt,� HIC Registration Number Expiratio Date
HIC CIC mopany Name or HIC Regiftrant Nam
LDS 960CltAvwt. �rf ® %/�S�+LLI G c/S cO>tt
No.and Street Email address
Ci /To n,w Stafe,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 .......... No........... ❑
SECTION Tat OWNER AUTHORIZATION TO BE COMPLETED WHEN'
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDIING PERMIT
I,as Owner of the subject property,hereby authorize i ll�Seeyea�"
to act on my behalf, in all matters relative to work authorized by this building permit application,
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
contained in this application is true and accurate to the best of my knowledge and understanding.
444 `.Fq� a o
Print O 's r uthorized Agent's Name(Electronic Signature) ate
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. o@ v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dam
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"
Office of Consumer Affairs And Business Regulation
10 Park Plaza.- Suite 5170
Boston, Ma
$sachusetts 02116
Hoine-Improvem�ontractor Registration
7 -_
Registration: 125338
Type: Supplement Card
i Expiration: 11/24r2D17
BILLY SWEET CHIMNEY SWEEP -=
ED HARRIGAN - µ
PO BOX 287
SWAMPSCOTT, MA 01907
��` ,:' s-_:#��• Update Address and return card.Mark reason for change.
SCAI a 20M-W1 Address Renewal Employment Lost Card
� .... �/<R�or,rnrronu+ear(/to�'Q?��rurre/rateQ3
p
*FxpInAIprU-'
of Consumer Attain&Business Regulation License or registration valid for individul use only
before the expiration date.If found return to:
E IMPROVEld1ENTCONTRACTOR
Office of Consumer Affairs and Business Regulation
isnaU°n 4 $. Type: 10 Park Flares-Suite 5170
f /:', Supplement CardBoston,MA 02116
BILLY SWEET CHIMNF.'�";
ED HARRIGAN —=s.'. ="'..;
46 NEW OCEAN STREET�i'Kc'-''
SWAMPSCOTf,MA 01907 Undersecretary Not valid without signature
r moons tt
.: Uo Per,£, Da"
„ram �� �ikedsp ES-1t1�61 , .
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'T e�G/ xej i
•i
The Commonwealth of Massachusetts
Department of Industrial Accidents t
Office of Investigations
u,p 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organiz tion/Individuap: 21 st-.t ee-R
Address: r Fjpr Q-27
City/State/Zip:S/i��u�St ,m14 QA?�7 Phone #: j! /.
Are you an employer'?Check theappropriate box: Type of project(required):
l�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.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t ?• ❑ 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' camp. 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'
comp. insurance required.] 13.❑ Other
*Any applicant that checks box dI must also fiitI out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name or the sub-contracturs and their workers'comp,policy information.
I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site
information. / / J
Insurance Company Name: lD�rr'yl/t �j/(,t„ec�Q
Policy#or Self-ins. Lic. #: UX-013( S 3 S l S lO pZ2 Expiration Date: S a O_[�
Job Site Address: (Vie—a-) i4ye City/State/Zip:__S� , rUA (S/q-7Q
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$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$250.00 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 cerrti�fy�u-n-(der the pains and penalties of perjury that the information provided above is true and correct.
Signatu Date o�/Oz
Phone#: r f/!' .57172• 233 3
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: _ Phone#:
_ Prop,9&jNs
Sweet Contracting Corp. dba AND ESTIMATE
Billy Sweet Chimney Swee
PROPOSAL SUBMITTED TO: DATE:
Ann Leaver 1122/16
STREET PHONE
55 Bayview Ave. 978-741-1872
MA CSl.:s106W CITY,STATE,ZIP CODE PHONE
MAa1C:a 125W
P.O.BOX 2e7 Salem, MA 01970 978-758-1728
6713ram�t,MA os� EMAIL
800s48 aano annm52@ claol.com
7arsysruasu
• Pull a building permit with the city of Salem.
• Remove the chimney cap on top of the chimney.
• Install a stainless steel liner in the heating system flue of the chimney,terminated at the top and
bottom.The liner will include a tee on the bottom and a top plate and collar at the top.
• Reinstall the chimney cap on top of the chimney.
• TOTAL(includes scaffolding,labor, materials,waste removal and cleanup):$5,500.00
Cost for permit application, permit,time to acquire permit and final inspection of work added to the final
payment(see payment schedule below).
The installation of a-new stainless-steelchimney.finer comes with a lifetime warranty as long as Billy Sweet
Chimney Sweep inspects and sweeps the chimney annually. Billy Sweet Chimney Sweep guarantees all labor
and installations for one year. If we come back each year to do a sweep and inspection of the chimney, the
material warranty and the company guarantee stays intact. Take advantage of our annual20%Spring Discount
for inspecting and sweeping your chimneys during the months of February and March. The f/rst annual sweep
and Inspection Is free,N done during the months of February and March 201 Z
The National Fire Protection Association, the Chimney Safety Institute of America, the U.S. Consumer Product
Safety Commission, the U.S. Environmental Protection Association and the American Lung Association
recommend annual inspections of your heatin system chimneys, flues and fireplaces.
WE PROPOSE hereby to fumish materials and labor-complete in accordance with above specifications,for the sum of:
................. .....+..+...
Five thousand five hundred and 00/100 Dollars ($) 5,500.00
PAYMEM TO BE MADE AS FOIL 5
1/3 deposit in advance ($1,800.00, paid by check#2627- 1/20/16), 1/3 payment at the start of work
($1,850.00), balance due when the work is complete plus permit cost ($1,850.00 +$309.00-
$2,159.00).
Advance de 'ts are non-refundable in case of cancellation bY customer.
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waes,asidmisadtlela 6syaW aaeoimcl Otewlmram/ae,amaftatM ante cecessay This proposal may be
withdrawn by us H not accepted within 30 days.
ACCEPTANCE On PROPOSAL: Tce above OM tD do the
WO and
mndnons ae aetlafaLTa,y entl n hereby accepted You are authadma m do the sah r Signature: 6T�—
spetlAed Papnentvabemaeasoo"adabm
Signature:
Date of Acceptance: r b S -t e r 4
CADocs\Cwtomer Reports 20I6U-mU eaver 55 Bayview Ave Proposal 160122.docx