1 BLOCK HOUSE SQ - BPA-12-26 ROOF & STAIRS TO DECK The Commonwealth of Massachusetts
Department of Public Safety
•4 1 •,�f ;N Iass,;rhux'ns till tr RuiIIIIIIA Cudr(780 CTI R)
Building Permit Application for any Building other than a One-orTwo-Family Dvvelling
('Ibis Section For Official Use Only)
Building Permit Number Dalr Applied: Building Official:
SECTION I. LOCA7lON(Please indicate Block 8 and Lot 8 for locations for which a street address is not available)
No,and Street Cih' /Tuhvn Zip Code Name Of BUiltlinl;(it.;pplicable)
SECTION 2:PROPOSED WORK
Edition of NM Slate Code used If New Construction check here❑ or check all that apply in the two rows below —
Esisting; Building❑ Repair❑ Alteration ❑ 1 Addition❑ 1 Demolition Cl (Plydse fill Out Intl submil ;\ppentlix 1)
Change of Use Cl Change of Occupancy ❑ Other ❑ Sprcify:. _
Are building plans,md/orconstrucliun documents living supplied as part of this permit application? Yes ❑ No 8:--
Is an Independent Structural Engineering Peer Review requireyi? Yes ❑ NO�Pt
Brief Description of Proposed Work: .Ae2o MQOlr jig pip !jAwl
,STP, Inc —e-6 Nef2v/7c�c jCKyajee
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑
Existing Use Group(s): Proposed Use Group(S):
SECTION 4:BUILDING HEIGHT AND AREA
Existing . Proposed
No.of Floors/Stories(include basement levels)& Area Per Floor(sq. ft.)
Tota! Area(sqft)and Total Height(ft.)
SECTION 5:USE GROUP(Check as a licable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 11A40 A-5 11B: Business ❑ --T E: Educating v j
F: Facto F-I ❑ F2❑ I H: Hieh Hazard H-1 ❑ H-2❑ H-1 ❑ +!-4❑ ,]-
1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-+❑ M: Mercantile❑ R: Residential R-10 It--)❑ R -.{ ClS: Storage St❑ S2❑ U: Utility❑ 1 Special Use❑and please dos:riD, a:
Special Use .
SECTION 6:CONSTRUCTION TYPE(Check as applicable) _
IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ 1118 ❑ IV VA N111 ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Floud Zone Information: Sewage Disposal: French Permit: Debris Reulov if:
Public❑ Chrck if outside Flood Zone❑ Indicate numicip,hl ❑ A trerwh-will not be Licensed Disposal Site❑
Private❑ or indentifv Zuno:_ ar on site system ❑ required ❑or trench or
permit is encosetl ❑
Railroad right-of-way: Ilizards to Air Navigation: , .,:
Not Applicable❑ Is Slnhctu 1`01,11hin airport approach arra? Is Ihrir rrs'iehr rnnh),Ieh'tl.'
0r Consrnt f0 Build rnclusrd❑ Yes❑ nr No❑ Yrs❑ No ❑
SPC'I ION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: L'se Group(s) "I% peat ConSlrUct 1011' 1
f �___ _ _._ C.cru ,ant Lund per IlouC
Docs Ihr building;contain an Sprioklrr System?._..__ _Spacial St fill 1,11 tons:
SECTION 9: PROPERTY OWNER AUI11ORIZA"I'ION -
Naum.uul :\ddress ul Properly Owner e .
Vf1L� �EnL---� . Sf
City Town -- ---— — — Zip
N.u»e(Print) Nu.and Street /
I'roporty Owner Contact Information:
Title -- - o1cphone No. (business) Telephone No. (cell) a-mail address
1
It applicable, the property owner hereby authorizes
(oS Som �oSWasi�raltr�+� r�S4-
Name Street Address City/town Stale "Zip
to act on the pro crty owner's behalf,in all matters relative to work authorized by this buildin, enmit a t plication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If buildin•is less thaut 35,000 cu,ft.of enclosed s ace andor not tinder Constmction Control then check here O and ski section 10 1)
10.1 Registered Professional Responsible for Construction Control
C�d•�oS .Ss>,�S ��� 003.3 �SGOS
Nannc Registrant) Telephone No. a-mail address Registration Number 13
/S c.�asl,<r'OUtr:'an)S 6bil;x/�,�fna � IIJ$3q _
Street Address City/Town State Zip Discipline xpiration Daae
10.2 General Contractor
C S if S�fUc �1'V aJ CO .
Company Name `
�o�Incc S ILIS
Name of Person Responsible for Construction License No. and Type if Applicable
/6-7 1AJ,o.Sj4-tA) f1)ry S� �r �J1/ELisN O 183
Street Address City/Town State Zip
Tole phone No. business Tele shone No. cell a-mail address
SECTION IS lit q tier•;', ,wu I ` -urn I 1=tli.\�t'r..\iri]i-.. x`11. M.G.L.c.152.9 25C 6
A Workers'Compensation Inwnnce Affidavit from the MA Department of Industrial Accidents must he completed and
s affidavit will result in the denial of the issuance of the building permit.
submitted with this application. Failure to provide thi
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item ami Materials) Total Construction Cost(from Item 6) =S _
1. Building S s�3dG7 Building Permit FCr-Total Construction Cost x_(Imsert here
o. Electrical $ appropriate municipal factor)=S
.t. Plumbing $ Note: Minimum fee=Ii (contact nuunicip.'lily)
4. Mechanical (HVAC) S
5. �Ini hanical Other S Enclose ch,rk payable to - —
n.Total Cost S �ejp� (contact municipality)and write check number here— —---
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering n,% name below, I hereby attest under the pains 11141 penalties of perjury that all of the infornation Con tined in this
application is true and accurate toI the best of my knowledge and understanding.
CAr�c7,5 Sv-r���-�—�., -
Please print and sign name P� title 'cic hone 'o- Date
Strvl Address A;
tithed �CJ Sate Cilyi down/ S.te Z1� -
Municipal Inspector to fill out this section upon application approval: --
Nannu _
157 WashingtonSt_ Villarreal Luz
Groveland MA 01834 1 Block House Square
978 407 0033 Salem, MA
6/z7/zo11
- Estimate Amount
11. Remove and dispose existing roof shingles including
( front porch
2- Install ice/water shield around chimney and three feet
up from the dripedge
i
3. Cover remaining of roof with 15 Ib tar paper and nail
! aluminum-dripedge as needed
4. Install new roof shingles(35 year warranty)
� 5. Repoint chimney all the way around
j 6_ Build new second floor deck stairs to replace existing
Mr' i spirals using all pressure treated lumber !
k
i � #
i
i Payment Schedule
f r /
Start $20,000
_.
Qa Firnsh 45,300
Total Cost
$15.300
3