47 BELLEVIEW AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts"---- �--
° Board of Building Regulations and Standards CITY OF
® Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number Date Ap lie
Building Official(Print Name) Signatu' D e
SECTION 1: SITE INFORMATION
1.1 PLr/np�ejrtyAddress: 1.2 Assessors Map&Parcel Numbers
7 / /I_3_ILItti! v t'
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 fl) 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?
Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner�ofRecord:
Name(Pont) City,State,ZIP
�/ 109'- 7 q'l-! 599
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building J$( Owner-Occupied Repairs(s) ,K Alteration(s) `1 Addition ❑
Demolition (:].I Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': i
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials) Official Use Only
1. Building $ 0 Y p d 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanic at (BVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $
q Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ � OS,Od ❑Paid in Full ❑ Outstanding Balance Due:
S EI.I i F0 CL-I Ets
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/j � ll c.s- o�. � z33 t/ -z - IS,
E-/o( e,1 F s w ,� �t License Number Expiration Date
Name of CSL Hooll�d/eer ). S / U
1 -1 Q/ 7 List CSL Type(sec below)
t't''k
No.and Street J7 Type Description
pp ,n n U Unrestricted(Buildings u to 35,000 cu.ft.
11 li✓t ✓ ? 'r 1 !� t'l It9 ��'2 R Restricted 1&2 Family Dwelling
iry/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
9PSwi,del(csve, Ir` SF Solid Fuel Burning Appliances
17C47Yy012- Ve J,'Z-v 1 ♦ ✓1 d 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Co tractor(HIC)
y�/ /' / /j� /S o
.jam (��✓1 \ UI� �, "/, I / HIC Registration Number xpi alion Date
HIC C�oompany Name or CRegsuant Name e �JS'W r,% ri� 111r4+�✓en
No.and Street Email address
oct.lvCis
City/Town,State,ZIP Teie hone
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 .......... W 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 i514 �e /I 42 �w -a i J-v I I
to act on my behalf, in all matters relative to work authorized by this building permit application.
COHee✓t C4114ka ✓t 1-7 —
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. -
�1d 14 t'Sw J el' (/ �� ,I�� z- 7-
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 M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca information on the Construction Supervisor License can be found at www.mass.guv/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"
CITY OF Sauxms 2AXSSACHUSETTS
• BUILDING DEPARTMENT
r p 120 WASHINGTON STREET, 3'a FLOOR
TEL. (978) 745-9595
FAx(978)740-9846
Kl\IIBFRiE Y DRISCOLL
MAYOR THows ST.PtEm
DIRECTOR OF PUBLIC PROPERTY/BUILDING CC%0,ftSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A i licant Information / t// Please Print Le ibl
Name (BusimNsiOrganizariontind/ivid�mi): E/rl6�t l� _� W_L d P I
Address: 2— ( l l�vi✓ l ec a la
City/State/Zip: 04 r) ,/ -e l l /Au Phone #:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or pan-time)' have hired the sub-contractors
2.W 1 am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers'comp.insurance. 9. ❑ Building addition
(No workers'comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their ID.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I i.❑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' [;,❑Other
comp. insurance required.]
•Anv applirani that checks box Bl most also fill out the section below showing their worked compensation policy information.
?I In' owners who submit this affidavit indicating they ate doing all work and then hire outside contractors main submit a new affidavit indicating such.
Cwumrxon that check this box most attached an additional sheet showing the name of the sub�com wmr,and their worker'enmls policy infornention.
lam an employer that is providing workers'compensation Insurance jar my employees. Below is the polity and fob site
information.
Insurance Company Name:
Policy b or SelLins.//LlIic.#: Expiration Date:
Job Site Address: % `7 Cll? t/.t,e w ljv e City/State/Zip: Su ✓ate Mu l y
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
.Failure to secure coverage as required under Scction 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 S250.00 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 certify under the pains and/penalties perjury that the information provided above is true and correct
Sigmttti 6�2 / n
��// [)are: 2—
Phone#: 2 1 2 L �J
Official use only. Do not write in this area,to be completed by city or town oJrciaL
City or Town: _ Permit/lAcense
Issuing Authority(circle one):
LkRuard of Health 2.Building Department 3.City/fown Clerk 4. Electrical inspector 5. Plumbing Inspector
6.Other
Contact Person: __ _ . _ _., Phone#:
CITY OF S�-II.&M, 1AXSSACHUSETTS
• BUILDING DEPARTMENT
F 120 WASHINGTON STREET, 31p FLOOR
TEL (978) 745-9595
FA.r(978) 740-9846
iQ�fBERLEY DRISCOLL
Tl
11TthYOR tOatAs ST.P[F_RRE
DIRECTOR OF PUBLIC PROPERTY/BUUMTNG CONLMSSIONER
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:
//.go>(4
(name of hauler)
S--73 - 13C)
The debris will be disposed of in
(name of facility)
(address of facility)
Signature of permit applicant
2 —
date
dcbrt,afcdm
1 Massachusetts - Department of Public Safety
Board of Building Regufations and Standards
Construction Supemsur
License: CS-027333
ELDEN P SWINDPLL '
217 MAPLE ST
DANVERS MA 01923
Commissioner 11/02/2015
_ - Office of Consumer Affairs&Business Regulation
li= HOME IMPROVEMENT CONTRACTOR
n Registration: 130419 Type:
• E;', ' Expiration: 3/7/2014 Individual _
ELDEN PETER SWINDELL
ELDEN SWINDELL
217 MAPLE ST. -
DANVERS, MA 01923 Undersecretary
i
i
IPROPOSAL
R ' C S. # 027333 E. PETER SWINDELL H. I.C. #110419
C'ARPI-N I RY&RFMHDI:I_liA'G
2I7 MAPL,G.SI_
DANVl-R.S MA.0023
(978)-774-402
Colleen Callahan 1/16/14
47 Belleview Ave.
Salem Ma. 01970
We propose hereby to furnish material and labor-complete in accordance with specification,
below, f'or the sum Of: S 19.405.00
Payment to be made as follows: I/I deposit. 1/3 after rough inspection or a mutually agreed upon time &
balance upon completion.
All nWlu ial a ui.vaniccd in be as.pccltmd.All work to be eomplcmA in a workman Lkc AU'r n ORIZED
manner xaconling to standard practices.Am ahclation or derialion from speclticalions he- SIGNA"I'URF
Imr he esecumA on I' upon wl'inen orders,mid will becunm an -
I'a er 'and ile clh c'limtl _All arecmcnucontingcnlipon trikesaceidcnrs NOIF:lhiepoptsal ni beithdrawi
rkJ I cue urcml'.I (a onevuy he lur edoadhcr'Ilk' rliro a�a Il net ee gtedr -tl 'IWFN'IYl VP DAYS
R � l:Irch .n r,Uln Od2
Set up necessary plastic barrier, gut kitchen area to the studs, ceiling & walls strip up flooring to
Sub floor. Hall walls. ceiling & floor to remain intact
Fxpand opening to dining room, install necessary header
Repair or replace any framing necessary. Re secure sub floor
Insulate exterior NvalIs to code, repair ceiling insulation as necessary
131ue board ksalls & ceiling. plaster as necessary (smooth coat)
Install new kitchen cabinets Supplied by Customer
Install appliances supplied by customer
Re trim kitchen windows & door
Install neces.sark base trim
file backsplash. file & grout to be supplied by customer
Supply dumpster
Plumber will install new fixtures supplied by customer in same location. connect ice maker
& vent pipe for kitchen sink
(continued)
Acceptance of proposal- The above prices. specifications Signature________
and conditions are satisfactory and are heiebs accepted
You are authorized to do the work as specified. Payment Signature r
will be made as outlined above. Acceptincedate:
Please si_n one copy & return it to me. Retain [he other for your records
IPROPOSAL
z C S. # 027333 E. PETER SWINDELL H. I.C. 4130419.
CARPEN"FRY&REMODI-:LING
217 MAPLE SI
DANVERS MA.01923
(978)-774-402'
Colleen Callahan 1/16/14
47 Belleview Ave.
Salem Ma. 01970
Install & vent micro wave or range hood
Supply & install pre finished oak hardwood flooring($1400.00 allowance)
Sink. faucet & garbage disposal not included in this estimate
Flecuician (not included in this estimate)
Countertops not included in this estimate
Painting or staining not included
This estimate may be subject to change depending on the final project design
Obtain building permit
Acceptance of proposal- The above prices. specifications Signature____
and conditions are satisfactory and are hereby accepted ---
You are authorized to do the work as specified. Payment Signature _
will be made as outlined above. Acceptance date:_
please sign one copy& return it to me. Retain the other
for Yourrecords