60 BAY VIEW AVE - BPA-14-218 REPLACE WINDOWS The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
vu � Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Family Duelling
This Section For Official Use Only
Building Permit Number: Date plied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
I.1 Property Address: 1.2 Assessors Map& Parcel Numbers
6o 13�,, VI&, Ata
1.1 a Is this an accepted treet?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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Own e 'of Record:
cz+� VY" I a t h 5a�2vn ✓Y1/� of �t 7
Name(Print) City,State,ZIP
6D &L t U1flw ASP. 617- 31`f�122
No. and Street f Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other U Specify:
Brief Description of Proposed Work':
CC ( wth owl
IO Y Ya titd '�t ice; ( any
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building $ .9.03, i 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ / ❑ Standard City/Town Application Fee
❑Total Project Costs(Item 6)x multiplier x
3. Plumbing $ Other Fees: $L
4. Mechanical (HVAC) $ / List
5. Mechanical (Fire $Suppression) Total All Fees: $
_ Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ �)I �� 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES -
5.1 Construction Supervisor License(CSL)
b'�t 14�� 16 3 t3
A� Ve1 ���"I;I f o License Number Expiration Date
Name of CST,Holder W
-eTIS List CSL Type(see below)
No.and Street Type Description
<- �� ����� U Unrestricted(Buildings u to 35.000 cu. ft.)
✓4 R Restricted 1&2 Family Dwelling
City/Town.Stat .ZIP M Masomv
RC RoofinWindow
Covering
di
WS Window and Siding
SF Solid Fuel Burning Appliances
1 J Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Lo WC) ('10M t? (ae )W's- H . Rc istrati i N mb�' Expiration Date
HIC Company Name or HIC f�egtstrant Name
13G -rUMID, �t1
No.and Stree
T,,,-,,,, b Email addressl`77�- 6t7-�9-ovy6
City/Town, State,ZAP t 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 7a: OWNER UTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property, hereby authorize
to a t on my be alf, in all matters relative to work authorized by this building permit application.
�Ua I � M bon 4-u.t rl � 3413,
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
c tained in thus appli�anon is true and accurate to the best of my knowledge and understanding.
l�Ml (''` 1�i� d C(n41�r2 3,> i3
rint Owner's or Authorized 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
wwm/.mass.t_,ov/oca Information on the Construction Supervisor License can be found at www.mass.eov dps
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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Orgaanizatioln/Individn y�at): iMiClael eMiIle
-
Address: 5 56
6Ty1 Rd.
City/State/Zip: 01 D Phone* 573— 53o-717Y
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2# 1 am a sole proprietor or listed on the attached sheet. 7. ❑Remodeling
(((��- partner-
shipand have no employees These sub-contractors have 8 _
❑ Demolition
working for me in any capacity. employees and have workers'
insurance 9. ❑ Building addition
comp.[No workers' comp.insurance R
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such.
- 'Contractors that check this box most attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer drat is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: //o^^ View
Expiration Date:
b
Job Site Address: 8&V U('w &. City/State/'Lip: 5a I'e m 1 111A O 1 r/7d
Attach a copy of the workers' compensation Alicy 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. _
I do hereby certift-onder the pai=Xpenalties 2Lpedury that the i e ormation provided above is true and correct.
Signature' Date
Phone
Official use only. Do not write in this area,to be completed by city or town gp4ciaL
City or Town: Permit/License# _
Issuing A uthority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other It
Contact Person: ____ Phone#:
07-�
�s&B o tress regulatiY08rr6
Office of Consumer Affairs&Business Regulation
. IMPROVEMENT CONTRACTOR "
Registrafion,;�: 88 Type
E 13 Supplement
LOWE'S HOIME0"
� r � 1
RICHARD CHAL .�r •
136 TURNPIK€R
SOUTH BOROUGH,` 92
Undersecretary
Yp
L
fl'hi€ns F�tr At tat t Ott
�
u .
e
t
�� ��fe �Cz"??2�??'t.TZ?2"LL1gCr�L�I2- CL�C'G'LCC:I�.GCl2itL%1G�i�rl"
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
_ Registration: 162722
Type: Individual
Expiration: 4/6/2015 Tr# 238965
MICHAEL THOMAS DEMILLE
MICHAEL DEMILLE
5 BRISTOL ST
SALEM, MA 01970
Update Address and return card.Hark reason for change.
Address C Renewal Employment Lost Card
i SCA1 G 20V-35Ji1
14
>x-.� Office of Consumer Affairs&Busmess Regulation before
or registration valid for individul use only
before the expiration date. If found return to:
•� HOME IMPROVEMENT CONTRACTOR p
v• Office at Consumer Affairs and Business Regulation
A t�� egistraGon: 162722 TYPO
K .., acpim0on: 41612015 Individual
10 Park Plaza-Suite 5170
Boston,MA 02116
MICHAELTHOMAS DEMILLE
MICHAEL DEMILLE
5 BRISTOL ST
SALEM, MA 01970 Undersecretary Not valid without signature
d e9£ol, £L 6Z -IdV.�
i,
4
I
169 Q2 011,RF3DInTl*-.AlWg
7,
'm 13
1 A
3 1
'04
gEE
LV
i VS,�Mr T?
ll�',
110,IM-
-----------
DO �IITUJRAM�
WWI
to K
4q, pw, MY
IN
"M
s 7 SKIM
m- 9-9 W 5
ON
i5
W
.......... .
Im-
"0
's f
x' �'a.:- x� '"� ��-.✓E.. 3,..: �� �• -Sx r Sr; �-�^•t .�T s. :Y} l° _ - - �>L'�LfS.s "`•? „�2dP rs i
S 1 1 � 3rr' .� "� .a `S ap%§FY g t �i,•.=t -1 Tr%: a l 1-
u -
�.� y �+`TQt35L ' s •cP'n� .kq, xY-/� ;
G �,• f4f�`9:v s rAi�+ 2u,;},[ �9• 'i �+1:� # �'K1£- 8�'`
"" 'user
..� 9,111 a, ip"t ,eat x` `ewFy W k JA
Pf6f,51 navafe# ' e 'ontr ctr Caystdmev v
Alt t#Ve�
an "�iYlfh 6astot `., r a,Tka=rcf-
t
o `'`n
.. e•�3�v^ee n" �_ `#a ' sel ` t"tke�Ps relateto this
P � i sti`ta
..a�, sw
Y' .F r
IN
}14f-date n cpaatedffoh be.a+*s� _r
x X.
{
s x' ,y Y gen w -' agY ,
'fwn+ y sr` #s tessenc"c�f$s� •.e� sub iahs
¢z� i�i F t � F *n
ra - a �' 'rase`rta staBrentFofsr�€�i sonbrtg fi
R� t `E- � v� z roE � ?u''+•.+.+ '+?$?[d;'��{'e�YC 2x �€�`�� i'!-. S"� k 'tiI •u 5
$ a #�)?FC��toli3e[Ito=USeyf130p�Ilpvurg�paynaeFlEefi� ��rfc�-'.'�'r� 'rt�sf�" s..+a
•�Y•'a`•fi� 3-c�t.:' #a � .�.�t. -., 'x'�tu`�I ��z+r^'�t'a '..
{�C a4Q` ;stgmg GoptrdG' 1ePa'aSat�ttould.$e13e*totaksorahad e><�-finds-ate t,� r r - t -
t` f"DtFcdt4SE=. € .f3f3 „�.
tt�e#allowvag.,(ceek appiopnateTroatowgs �az �dbefore commenr�emegiAf utalla6oy I/We authorize Lowe s -
ryS'I� myFoar cE�fo tb aoaou[it oT{l e ment ind, ed atacxve antyhme after t1(b.date thlsCoFlh�.........
F 4 u �,b per 7 ✓ " rf� z u A,i a
a �agnf FtcM@tedabovve anyhme aftertt a date thI.sMM
CQniractas s ec�znd
4 ppY� ` o7=$F�@l��tabe�aton�mplebonzi€tbe-u�s�aAabon andabdih"Pa� `�-'daes sabsfaG6or>°--� %' s"�'"E'°"-�_ - -
,S AND''7SVC(fJE''R'- ERE$YrNtUTUgLLY AGREE JNA{)V. IGETHAT IN THE EVENT LOWE S - ')
0 Ow
z05eE7cEc
i4'SUBMkT 7OISUGHARBPTRgTION
e
� 2k
r �+#• ;, s'k x`r. s a ^e •. i1y45.. n*y ,gt. f}+ sy fit.+
1.4
-°DP1L�XT-O' F'E -
�'"'r * q�KfJf 'tS �, ,,,tS?UT£-RES,�OLUTIdN;INITIgTED
EU€Nx�NkiERE�T.?HE �
xqf EAAACIC HWCEDG[ t6 TF1AT TM tiAVWREAD;UNDEfZ$TA#D AND AGREE 70 THE
�UttDiTlE3iNNSEFD&TkF ON THE REVERS
SE E OF TkII PX►(,E AND fFtE'F(3 L®GIVING PAGES OF THIS
SID
dNT�tAGT YtATtS ENTITD TOACOPY OF TH(5 CUNTRdGV AT THE llNIE fJF 31GNATURE
sY` i _ dSy Yt Yt2.. H 2 l p
TNESS'OURW/:1ND S)AND SEALS)BELOW THIS DAY OF. Ucs r/s +T- •^ "� _ . ?. e s g
yre'sMortte ent lrac _ / '/
14
rattra�, Y t pforvto idn'j6ht Oft Ath rd bus'-e da aftetely"fiNeckm rio6 to,Gustoiner's execubon hereoY«.Xou tfie byyer may 4 ry
'egtdh7sfransacboa>cR-fth bme' or tormdd
an'explanabon.of thas dgh£ " y the date of thtstransacCibn See th@+attached notice of cancellatwn t -
FILE CQ�Y _ T'5:. t � .,�a�rt're!'�SfeT`ed"kaderrcar�s"nLFCgabla design° i ;(
60 BAY VIEW AVENUE 218-14
GIs#: ;,, 9304 COMMONWEALTH OF MASSACHUSETTS
Map: 44.
Block: CITY OF SALEM
Lot: a 0139
Category:"" � Replace Wmdows
Pera,t#- : 218.14 BUILDING PERMIT
Project# t , 4 JS-2014-000430
Est. Cost:', a $19,032 00 ,;
Fee Charged: „ $138.00
Balance Due: ,., $.00 °.s; PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License: Expires:
Use Group: - LOWE'S HOME CENTER
Lot Size(sq,8) 20799.9Owner: SCOTT MOUNTAIN
Zonmg PLI R11+ r y€. ` � .
Umts Gamed J` ""�' p Applicant: Lowes Home Improvement
Units Lost:' a' ' `i AT. 60 BAY VIEW AVENUE
Dig Safe#i
ISSUED ON: 05-Sep-2013 AMENDED ON. EXPIRES ON: 05-Mar-2014
TO PERFORM THE FOLLOWING WORK:
REMOVE/REPLACE 35 EXISTING WINDOWS***NO STRUCTURAL WORK TO BE DONE***
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
Underground: Underground: Underground: Excavation:
Service: Meter: Footings:
Rough: Rough: Rough: Foundation:
Final: Final: Final: Rough Frame:
Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oil:
Final:
House# Smoke:
Water: Alarm:
Assessor Treasury:
Sewer: Sprinklers: Final:
,THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING REC-2014-000469 04-Sep-I3 CASH $138,00
i
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.
4
i'