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47 BELLEVIEW AVE - BUILDING INSPECTION :z\ The Commonwealth of Massachusetts Board of Building Regulations ulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Heviscrl rL[nr 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only fff7-ff*0 ptied' atu -_ � I� SECTION l: SITE RMATION 1.1 1'rnperty Addess: 1 � IxJ � v,� 1.2 Assessors Map& Parcel Numbers l.la Is this an accepted street?yes_ uo MuP Numbcr Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: -----_-�. Zoning District Proposed-Use - P Lot Arca(sq tt) fro rage(IO 1.5 Building Setbacks (ft) front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (. G.J.c 40,§54) 1.7 Flood Zone Intbrmation: 1.8 Sewage Disposal System: Puhlic Private ❑ Zone. _ Outside flood Zone? MuninPal On site disposal eys[om Check if ye- ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ohcncr'of Rccmrd: - --- � di (�fln Ca(ia4�cr. dt SckteV" 3 � Name(Prnht) Qty,State,ZIP No and Street Tdchhone — I Finail Address SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that applt) Ncw C9nSVUCt1011 ❑ Exisun�� o BuildingX Owner-Occupied X Repairs(s) Alterations) � Additio-n-❑�{� Demolition ❑ Accessory Bldg. ❑ Numbcr of Units_ Other . ❑ SPecifv ___ Brief Desa iplion of Proposed Work': tytd — JJJ t t v'6 n P 1 tl <1 gr: < .t — SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: - —� (Labor and Materials) Official Use Only I. Building I. Building Permit Fee: S Indicate how fee is determined. 1. Electrical S ❑ Standard City/Towro Application Fee ❑Total Project Cosf (Item 6) x multiplier x Plumbing $ .S�r (7(� 2, plher Fees: $ 4. Mechanical (HVAC) $ List: 5. klechamcal (Fire _ S upprensionl . S Total All Fees: S 6. Total Project Cost: S ry Check No. Check Amount: Cash Amount:_- I D i0 ❑ Paid in Full ❑ Outstandinv Balance Due: _ ' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /� (' E � CX P n y�� n Gcensc Number Expirm,n Dam Name of CSL Holder �}1 a , List CSL Type(see helow) u No.and Street Type��qq WEAp Description nicted(Buildings up to J5,000 cu. fr.) Ciq•lPnwn,State,ZIP Y �� �� ` cted I&2 Fnmil Dwellin, r g Covering p �S 1✓r C6 V'�Ow and Siding9V/' 7/ 'Y02� Fuel Burning AppliancesIle �_ ��V! '�1 I v� _ tionTelephone Email address molition 5.2 Registered Home Improvement Contractor(I1IC) Ile ' (� f ( 13� �tiq E IBC P w 1 d46sC 1 1 HIC Re-, ��—___ Fll'ni nm Name or HiC Registrant Name y� istruuon Number Fspirauon Dale !d_ lCl �"7 �W"V, a�,i.° C I S ftl i A -f l r CqY W r,1 7'!N i No.an I StrCer I 2 1 Mk `^ Ei�l ad- ddnic� Clly/tewnl. State. ZIP Telc 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 Affidavi[ Amnchcd'? Yes ._..__. SECTION 7a: OWNER .4UTHCIRIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _ I. as Owner of the subject property,hereby authorize to act on my behalf, in/ell matters relative to work authoricd by this building permit application, P r� C 91t 1 CL .� Co Print Owner's Name(Blcctronic Signature) — DBIC SECTION 7b: OWNF,R' OR AUTHORIZED AGENT' DECLARATION 13y entering my panic below. I hereby attest under the pains and penalties ofperjury that all of the infoinr¢ion contained in this application isp true and accurate to the best of my k owledge and understanding. Prim Owner',9 nr Autho ized Agent's Name(Electrnnic Signaturc) —_ Laic NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (nor registered in the Home Improvement Contractor(HIC)Program),will not have access to [he arbitration P�og�em of ku uanry fund under M.G.L. a I42A. Other important information on the HIC Program can be found at v is�s.max bus/ocu information on the Construction Supervisor C iceme can be found at s+�vt� m tss rov/tJ'S Z Vile' sabot meal work rs planned, provide the information below: d hour n are r (sq Yt.) (including S n t�e, finished basement/auics, decks or porch) Giusti arcr ft) llabIlableroomcount Number of lireplaces Number of bedrooms Nmnber Uh 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 S.UEM, NLNSS ACHUSE-i-rs BUILDING DEPARTMENT • !< 120 WASHNGTON STREET, 3m FLOOR d� TEL (978) 745-9595 F.ax(978) 740-9846 KINtBF_RIEY DRISCOLL MAYOR THoNtAs ST.PiE.RRE DIRECTOR OF PUBLIC PROPERTY/BUMDNG COMMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/E►ectricians/Plumbers Applicant Information L Please Print Legibly Name (Busincss/Organizatiowindividual): L Address: 'P- i ell P •1 CL .P City/State/Zip: V (A l! el J Phone #:__� '7 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.�1 ran it sole proprietor or partner- listed on the attached sheet. I 7. [RRemodeling ship and havc no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9' ❑ Building addition required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I Plumbing repairs or additions myself. [No workers' romp. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. [No workers' comp. insurance required.] 13.0 Other 'nny applicant shut checks box ql mwt nlw ill out the section below 1howing Iheir wosken'compensation Policy mr rmation. 'I Inmeowrwzs who submit this affidavit indicating they am doing all twrk and then hire outside contractors most submit a new alridavn indicating such :Cummctms that check this box munt lane,h d an additional sheet showing the name of th,sub-camma m,and their workers'comp,pnliry information, l am Lou employer that is providing tvorkers'compenstrion insurance far my employees. Be information. low is the policy and jab site In,urancc Company Name:_ Policy#or Self-iris. Lic. #: ----- Expiration Date: - Job Site Address: City/State/Zip: —_ 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 Or. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and aline Of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Oftice of Investigations of the DIA for insurance coverage verification. /du hereby certify under tire painsgnd enullias ojP ry but the injunrralion provided above is rear and corrrec Siendn irc / ;Menu /V^' - - / 1 I q ry r-t Uatc: Pl:nne Y: 1 f F 1 t-( OJftcial use only. Do nor write in this area,to be completed by c7EIectrical i City or"fawn: -._ PermIssuing:\utimrity (circ)c one): -i. Board of Health 2. Building Department 3.City/rown Clernspector 5. Plumbing Inspector 6. Other CITY OF SM- E-M, tiL- sSACHUSETI-S BUILE)NG DEPARTMENT \ �! 130 WASHINGTON STREET, 3� FLoop TEL (978) 745-9595 Kl\fBERL.EY DRISCOLL FAX(978) 740-9846 MAYOR T omAs ST,PIERU DIRECTOR OF PUBLIC PROPERTY/Buumr`G CO\OfISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) 1n 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: .� ✓`( L � �tSrJ © S�C� (name of haul r) The debris will be disposed of in Yi (name of facility) V1 &r C a S7? h �� (address of facility) signature of permit applicant date Jcbnsait:Juc .��ae '�oOrv�uNreP�ertLl/L o�✓/�aaaacluoetla -� �� _� -� --. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Registration: 130419 Type: Office of Consumer Affairs and Business Regulation 7 Expiration: 3/7/2014 Individual 10 Park Plaza-Suite 5170 Boston,NIA 02116 ELDEN PETER SWINDELL ELDEN SWINDELL 217 MAPLE ST. - g _ DANVERS, MA 01923 Undersecretary Not valid without signature u Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-027333 ELDEN PSWllVDY,L 217 MAPLE IST A 5 DANVERS 111A tf1923Uje�' Expiration Commissioner 11/02/2015 PROPOSAL C S. # 027333 E. PETER SWINDELL H. I.C. 4130419 CAPLN-1RY&12FMODFUNG 217 MAPIJ.S"1. DANVGRS MA_01923 (978)a74-4022 Coleen Callahan 11/18/13 47 Belleview Ave. Salem Ma. 01970 We propose hereby to furnish material and labor-complete In accordance with specitications below,for the sum of: $10,457.00 + plumber $3650.00 + SP/DB $5703.26 = S 19810.26 Payment to be made as follows: IG deposit 1/3 upon rough inspection, balance upon comp etion. MI material is pua9nlecd Io be as specified.All work In be complueA in a workmanlike AM nORIZF.D -- aa t di E6 i i I dt'tp-i Ic s V tlwaion do iaYniho .pc ii mimube- SIGNAIURC Imp g, ,J-i of .illb .eea tut od p n rllcnorder adt 1lccumcan - '- - -- cxljcl Charg ei and a c the Mini ac. VI abacc nests contmtcul t ,,n sl i6 s necid,a, NOTF Thal proposal l" be eithdra vrn a' i I t..be vn J n c tl p rljc 101 ladoth Ifnot accepted within I kyi NN'I'yl'I yl DAY_5 Re: Bathroom remodel Obtain pennit - Gut bath down to frame-wails_ceiling-& sub floor Repair as necessary any framing or sub flooring, frame end wall to extend bath to hall wall Assist plumber & electrician as necessary Plumbers quote attached add to above $3650.00 his( quote is for more than just the bathroom) Salem Plumbing/ Designer Bath quote attached add to above $5703.2 6 Electrician not included in this quote Install new tuh, tub walls & window kit. Replace bottom window sash add obscure glass All'er rough inspection- insulate, wonder board, blue board & plaster Install mop base. Install 6 panel pine door entry & closet doors Install vanity, sink top & faucets Install- floor tile in a square simple pattern, complicated such as diagonal may be extra File & grout not included in this quote Install- towel bars, tp. holder, soap & toothbrush holder (supplied by customer) Dispose of job related debris. no painting or staining are included / . Acceptance oI'proposil-The above prices, specifications Signature and conditions are satisfactory and are hereby accepted - You are authori-red to do the work as specified. Payment Signature \vill be made as outlined above. Acceptance date: i �- L3