11 BEACH AVE - BPA-13-199 SIDING CJ-- 10 r
-71
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR Revised Mar SALEMdMar f
297/
14 I Building Permit Application To Construct,Repair,Renovate-Or-Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: D e plied: �ry
!J�
Building Official(Print Name) at Daze
SECTION 1:SITE ATION
1.1 P 1 pgrty Atddrpss:�l 1.2 Assessors Map&Parcel Numbers
ilQ(Jft (�V
l.l a Is this an accepted street?yes p 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:
Zone: _ Outside Flood Zone?
Public 8 Private❑ Check if yes❑ Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: L= 3 7'Y/ � �f+. lq\ m�f
2y-/N�R ✓ylr<IAUD
ame(Print) City,State,ZIP
S-)J ki
Noit No.andStreet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ ration(s) ❑ Addition ❑
Demolition ' ❑ Accessory Bldg.❑ Ngmber of Units Other ❑ Specify:
Brief Description of Proposed Work: `+ 'fin 1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Labor and Materials) Official Use Only
1.Building - $ I. Building Permit Fee:.$ Indicate how fee is determined:
2.Electrical $ O 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 - $ Total All Fees: $
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding,Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
�w�)l/:.mAt L`icens`e.NNlumbeerr fr Ex 'rmi Date
Name of CSL Holder
---11,
•,-, ,� �+� Y� List CSL'Type(see below)
dG Stree, Y Type Description
No. d Street
II�� t�r�1� b, U Unrestricted(Buildings u to 35,000 cu.ft.
(vl \� \�O� \a'� R Restricted 1&2 Family Dwelling -
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
pp SF Solid Fuel Burning Appliances
I bdw I Insulation
Tele hone Email a dress D Demolition
5.2 Rygrstered Rome Improvement Contractor(HIC) 1 1 1�
1'l9��_ _, \DA0. 4P/ HIC Registration Number E pint-a'o n Date
HIC Co y Na e o I egistram Name f.
N Q CamIR AN lkrnA1
No.an tie Era i ad ss
Ci /Town,State,ZIP Telephone b W
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 ..........hi No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize '�rp11Am\Q(;,�J\1�C!
to act on my.behalf,in all ma ers relative o work authorized by this building permit application.
1114
A o
rL
e'nt Owner's Nam lcctroni
c 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 acAleoest of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(E ) 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
www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/di)s
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"maybe substituted for"Total Project Cost"
�. CITY OF S�U.ENL 4 2ANSSACHUSETTS
BuILDINIG DEPiR- /ENT
• r 120 WASHINGTON STREET,3sn FLOOR
ej "ICI_ (978)745-9595
FAX(978)740-9846
KI5ffiERi FY DRLSCOIL
MAYOR -it�toetAs ST.P>FxRla
DIRECTOR OF PUBLIC PROPERTY/BL:RDD:G CM51ISSIONER
Workers' Compensation Insurance Affidavit: BuildersiContractors/Electricians/Plumbers
Applicant Information / Please Print Leeibly
Naive(Busines$,Drg�anization/inndiiviidual): Colwz�z c&Ekuck (o l tic.
, ' za
Address:�(}o `� a
City/State/Zip: 9XIPFORD NSA Q1q,1 l Phone#: 511-,3A3-%13dL
Are you an employer?Check the appropriate box: Type of project(required):
L❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the subcontractors
2_❑ I am a sole proprietor at partner- listed on the attached sheet 7• ❑Remodeling
ship and have no employees These subcontractors have 8. ❑Demolition
workingfor me in an capacity. workers'comp.insurance.
Y Pac tY• 9. ❑Building addition
[No workers comp.insurance S. We are a corporation and its
required.)
officers have exercised their 10.❑Electrical repairs or additions
3.❑ I 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' 13.❑Otha
comp.insurance required.)
'Any applicant that checks box 91 must also Fill out the section below showing their woken'comprnsation policy information.
*I iomama en who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such.
;C mtm•ton that check this box must anaclwd an additional short showing the mime of 1M subaonttaaas and their workers'comp,policy infamvios.
I am an employer that Fit providing workers'compensation insurance jar my employees. Below is the po/ley and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic..#: Expiration Dater:
Job Site Address: l Y�
1 /�l ,& City/State/Zip:Q D/V\
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
fine up to S1,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of
Invcstigalions of the DIA for insurance coverage verification.
f do/iereby ce 'y under the pains and Pena/ties of perjury that the information provided ove Is true and correct.
. i n t ire [)are! I TIL
Phone#
Official use only. Do not write in this area to be courpleted by city or town oJJiciaL
City or Town: Permit/I.feense#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
RES/DENTL4L AND COMMERCIAL CONSTRUCTION
(978)382-8132
ter, Ro. aN)?00&�s Rb
Be werti Ma 01929 � 15J1
70: ch 11 Be Ave ESTIMATE
11 Beach Ave
Salem Ma QUOTE#294
978-745-1344 . . Date: August 28, 2012
- - EXPIRATION DATE: 4/8/2012
SALESPERSON JOB PAYMENT TERMS PROJECTED START DATE
D.J. Genzler Vinyl siding
DESCRIPTION TOTAL
Install Tyvek house wrap on entire house.
Install new corner boards. Either color matched or wide white.
i
Install new vinyl siding. .044 thickness or greater.
Install new vinyl soffit on all eaves and overhangs.
Wrap all windows/doors using aluminum metal.Color to be chosen by customer.
Cover all other trim boards with metal.
Remove existing gutters to allow for proper metal installation,clean and re attach.
Clean up all debris from jobsite.
FULL CLAPBOARD $18,700.00
ULL CEDAR IMPRESSIONS �S
CEDAR FRONT/BACK. $21,400.00
ALL PERMIT FEES TO BE PAID FOR BY GENZLER CONSTRUCTION AND REIMBURSED BY CUSTOMER
All material is guaranteed to be as specified, and the above work to be performed in accordance with the.
drawings and specifications submitted for above work, and completed in a substantial workmanlike -
manner.
TOTAL Q)
To schedule the work or if you have any questions or comments, please call D.J. @ 978-382-8132
To accept this quotation, sign here and return:
THANK YOU FOR YOUR BUSINESS!
}� Massachusetts Department of Public Safety
Board of Build-ing,Regulations and Standards
C nstru.uon Supeni.ur`
License CS-093242
DONALD GE. ER
5 HANSON ROAD1
S
DANVERS#A 01923 - '
y 'o
J.�
1iQ�. - Expiration'
Commissioner_. - 01/23/2014
C//ze �panrFrreaiemeu�tfi-n�CYfla�aac'�u�ella
-Office of Co,ssumer.Affairs&Business:Regulation
p - 'ipOME IMPROVEMENT CONTRACTOR Type.
fiegislration 169712 . -
f - 'Expiration 8/2/2013 .y Individual _
DGNALD GENZLER,
DONALD GENZLER ',
q
SHANSON RD.
DANVERS, MA 01923' :�:` Undersecretary