7 BELLEVIEW AVE - BUILDING INSPECTION (2) The Commonwealth of Nassachusetts INSPECTIONA SERVICES
Board of Building Regulations and Standards CITY O
jMassachusetts State Building Code, 780 CNIR p'u SEP I k Pi M62011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This tionForOfficiaIUSCOWY
e 0
Building Permit Number: Date Appli r -1 -AQAY
Building Olticial(Print Name). Signature' - Date
SECTION 1:SITE INFORNIAT10N'
4Property Address: 1.2 Assessors Map& Parcel Numbers
3?I If vrc-,
II 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 III Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required F 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 es❑
SECTION2: PROPERTY OWNERSHIP!
2.1 Owner'of Record;
17'1 'U" rN �� k - �A
me(Print) City,Smte,ZI..P
•(�'i��Ije vlc� 92t a.lo 4�y�
No.a»d Slreal Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORfCi(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other 0-Specify: SYRn c,,,d 2 ame
Brief Description of Proposed Work-: C-fr._ ^- . e- (2o Q-xar-
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building $ D J I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Costa(item 6)x multiplier x
3. Plumbing $ ? Other Fees: S
4.Mechanical (HV,%C) S List:
5.Mechanical (Fire S Total All Fees:S
Suppression)
a Check No._Check Amount: Cash Amount:_
6.Total Project Cost: S U w 0 Paid in Full 11 Outstanding Balance Due:
I , SECTION 5: CONS"fRUCT1ON SERVICES
5.1 Construction SupervisorLicense(CSL) ycir��0 -iu -aoib
_�-liz'n��yfP.'. License Number Expiration Date
Name of CSL Holder V l�
List CSL'fype(see below)
;a / Vero��- S'>- Type - Description
No.;Hid Street
U Unrestricted(Buildings no to 35,000 cu. It.
R Restricted 1&2 Family Dwelling
City own,S ate,ZIP M Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address U Demolition
5.2 Registered Home Improvement Contractor(HIC) )&
HIC Registration Number Expiration Date
tIIC Company Name or HIC Registrant Name
VGwn� '1-
o.-and Street Email address
ar o �s5S �2N
CitVITJwn,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 Isluance of the building permit.
Signed Affidavit Attached? Yes ..........B� No...........❑
SECTION 7a:OWNER AUTHORIZATION:TO BE COMPLETED WHEN.'
.
OWNER'S AGENT Olt CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize ( •A,An -tQ is W r
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
!F_ ,/. err
Print Owner's Nance(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
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Dale
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�lLG.L.c. I42A.Other important information on the HIC Program can be found at
www.ntasS.eov!oca Information on the Construction Supervisor License can be found at ww�'dns _
2. When substantial work is planned,provide the information below:
'total floor area(sq. R.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. 11.) 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_
i. "foal Project Square Footage may be substituted tar"'total Project Cost" o
} - Page No. of Pages
WM. TRAHANT JR.-CONSTRUCTION, INC.
- 4TH GENERATION ROOFING..
L S '215 Verona Street
LYNN,,MASSACHUSETTS 01904 CSL #161220
(781) 599-1211 • (781)844-4551 • FAX: (781) 581-0855 H.I. LIC:#141778
PROPOSAL SUBMITTED TO '} / JJrrTTJJ��,,
.!`+D� PHONEv d,/O c/�t(� Dil-
STREET -7 JOB NAME f
- ✓f
C ,STATE and ZIP CODE JOB LOCATION
We hereby submit specifications and estimates for: We hereby submit specifications and�estimates.for:
SHIN_ GLE ROOF ELAT/ROBBER ROOF
.:
Strip
entire roofer ,=❑ Reshingle-- - ❑ Sweep entire roof clean
0- place any bad boards up to 100 linear feet ❑ Strip entire roof
cc:�r'.—'FIB,
nstall ice_and water_barrier first three feet,up roof ❑ Mechanically fasten down ISO board insulation
U stall ice and water barrier in all valleys and along dormers ❑ Install 060 Rubber Roofing on entire roof
fall 151b. felt paper on remainder of roof ❑ Install metal flashing around perimeter of building "
❑ Install eight inch drip edge ❑-White-❑ Black ❑-Mill ❑ Flash chimney(s), pipe(s) and wall(s)
❑ Install ridge vent _ _ _ ❑ Edge caulk all seams - —
_Jash or re-flash cNmney(s) - ❑ Install new copper center drain —
stall new pipe flanges -- x ---' -- - ❑ Other: ---_--- --_--� -
[;I-Ifistall lifetime shingle or c:r ❑ Clean up all debris
❑ Install gutters and downspouts ❑ Labor and materials guaranteed 100%for five years
❑Install trim coil mac'
_❑ Install new fascia boards
❑ Install new rake boards
❑ Install sky_light(s)
-L!rOther:,—
� � - —- - - --
52- can up all debris
ii, ab and matenals'guaranteed 1'00%for five years
II shingle roofs are nailed by hand. �— -
We rrapose hereby?to furnish material and labor- complete in accordance with above specifications, for the sum of:
" Total Price($ OC) ),
. ..
`CIF YOU ARE HAVING YOUR ROOFSTRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC, AS -
WE HAVE NO CONTROL.OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS."
All material is guaranteed to be as specified..All work to be completed in a workmanlike -
manner according to standard pracbces.Any alteration or deviation from above spec'dica- Authorized
tions involving extra costs will be executed only upon written orders, and willbecome an Signature I
extra charge over and above the estimate. All agreements contingent upon strikes,
accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary
insurance.Our workers are fully covered by Workman's Compensation Insurance.
> a t�p
. 1CCe,fta TCP of apXaporsa1—The above prices, specifications ^ _
and condi ions are satisfac y and are hereby accepted.You are authorized to Sigriatlwe, !L
do the work as specified.Payment will be made as outlined above. 0�
Date of Acceptance: Slgpatlue - -
Please ma I yellow copy to above address' - -
� � r
° C["I'Y OF SM.E.I, NfaNSS.ICHUSETI'S
V' BUILDING DEPART>I INT
t
3 4 • � a,�l 120 WASHNGTON STREET, 3w FLOOR
TEL (978) 745-9595
Fmv(978) 740-9846
Kl.\BF Rf FY DRISCOLL THOntjLs ST.FIERRE
",ILAYOR
DIRECTOR OF PUBLIC PROPERTY/BhII.DI\G CO\L\fiSSIONER
Workers' Compensation Insurance Amdavit: Builders/Contractors/Electricians/Plumbers
Ai)plicant Information Please Print Legibly
V;1111C(Busim /s Organiratiom'Indi victual): (,I )1['IAt' +I AWAr tr NaCaM 3FR cs•u�1
Address: r>_ c�_ `/r M()G Lr
City/State/Zip: LyNnJ I MA 019oy Phone if: 7C�e 5 SS Id-t/
Arc you at employer?Check the appropriate box: L
project(required):
I. 1 am a employer with / L( ;• ❑ 1 am a general contractor and tow eonsuuction
employees(roll and/or part-time).• have hired the sula•contractors
2.❑ lain a sole proprietor or partner•
listed on the attached sheet. t modeling
ship and have no employees These sub-contractors have molition
working for me in any capacity. workers'camp. insurance. ilding addition
INo workers'comp. insurance S. ❑ We are a corporation and its ectrical repairs or additions
required.) officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL mbing repairs or additions
myself. [No workers'comp. c. 152, §1(J),and we have no orrepairsinsurance required.) t employees.[No workers' hrr
camp. insurance required.)
-Any applirun slur chucks box 91 most also rill out tl,e scam W-ow showing their wotkos'cumpensaliun policy in6 mason.
'I b+munwn n who submit this 117lttnvit indicating they an doing all work and then hire outride mmracmn must submit a mw amdavil indinling ouch.
$eutrwton thin chuck this box must anachod an addidunal.hns showing the name of the sub•cunincion and their workers'camp.pulley information.
l ant an employer that is providing rvorkers'contpeusadon insuraned for my employees Boldly is tho policy and fob site
iuforntation. ' 1
Insurance Company
Policy it or Self-ins. Lie. 0: 151 33 3 Expiration Date: �-/O •ia1Qy�
fub Site Address; 9 'Relle✓ta,.a 4�y-f City/State/Zip; 5.e%er ,tea _
A tlach a copy of the worke n'cum ponsutloa pulley declaration page(showing the policy number and axplratlon date).
Failure to secure coverage as required under Suction 2JA of•MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S1.500.00 und/ar one-year imprisonment,as wall as civil penalties in the farm o f a STOP WORK ORDER and a lino
of up to S250.00 d day against the violator. Ile advised that a copy of this statement may be furwardcd to the 011ice of
htrestigmiuns ul'thc DIA for insurance coverage verification.
l du hereby terrify under the pains aad per 61rs dfd_fppeeriury that Ilse infunnutlun pro vided ubuve is true and corree
917
G
I):nu: 7-���t�rC�y
Phoned: 2y!
Official use duly. Do not write in thi.v area, to be cunrpleted by city or town official
CitynrTuwn:
Issuing Aut hurily (circle one):
I. Huard of Ilealth 2. Duildlnp Ucparrnnnt .V.City/faun Clerk 7. F.Icetrical Impactor i. Phuubiug Inspector
6. Other
I
C'un1uU I �fVrn. __ Phan t ,
CITY OF SALEK MASSAailJSEM
BUILDING DEPARTMENT
l� 120 WASHNGTON STREET,31D FLOOR
'ILL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THomAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUIMING CON14ISSIONER
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 c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
(name of facility)
( s�
(address of facility)
Signature of applicant
Date