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132 BRIDGE ST - BUILDING INSPECTION -I y - 1 . 5 C-K 4 oao t 2-.3 s The Commonwealth of Massachusetts �a Board of Building Regulations and Standards RECEIVED CEIV S VICOTY OF Massachusetts State Building Code, 780 CWSPECIlkL SALEM Rev(sW1 Mar 2011 Building Permit Application To Construct, Repair, Renovat ts' ap l 3 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date pplied: /r 17 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 132 Ne"' c o- , 36 -610aocl 1.In Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Uis[rict Proposed Use Lot Area(sq R) Frontage(R) 1.5 Building Setbacks(It) 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 ffr Private❑ Zone: _ Outside Flood Zone? Municipal Va'On site disposal system ❑ Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: /Y/�cKEv " SdiR�eu Zcrt-)SOA) :;At-el , f-�1tri d l 970 Name(Print �� City,State,ZIP /-'g n/o2rH J i --,IV 1•-/I6V740 0(.00 No.and Street Telephone V Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) Er I Alteration(s) 15' Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specity: Brief Description of Proposed Work': ROC m ®,�. F.�,a,�_. �1_ Q l, —in rD Tdl S �(2 oo r-- ,—C'—t Hts kr SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ DDO�bt9 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cose(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (FIVAC) $ List: 5. Mechanical (Fire $ Su ression Total All Fees:$ Check No. Check Amount: Cash Amount 6. Total Project Cost: $ 3` . 000.00 ❑ paid in Full ❑Outstanding Balance Due: Nor owt, ri . occu.TL(Ep , Mn.tt_� alb �O ��vsc�t� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License um er E piration Date Name of CSL Holder " i' .S 9 .t_� List CSL Type(see below) rJ No.and Street Type Description l ' U Unrestricted(Buildings u to 35,000 cu.ft.) W1 t,,AA -)/I, A snA �� f R Restricted 1&2 FamilyDwelling Citylrown,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Tele hone Emad address D Demolition 5.2 Registered home Improvement Contractor(HIC) �� 7 � l _ paaD\ � ups �.� Cgra b Hf(`Company Name o�[Tegistrant Name No.and Street - - 'Email a-dress ASS i�, City/Town,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 Issuance of the building permit. Signed Affidavit Attached? Yes ...........V 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(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 contai ed in this application is true and accurate to the best of my knowledge and understanding. „ 's Cl..� MEIN Pr nt Owner's or Author d Agent's Name(Electronic Signature) .- Date 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.eov/dos 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 halt/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" 'jm o - IQ, IIER aa� e1s k i'. 9 }e' { y.. ,nJ L t 4N4N4N H 'ye ( t , �hif e,fy { ;s�„� j •y Iyl t 1 y tiv+� I t{.:Ft [L- ! 1 -3 }t sJ z k �I l a �� -r A C-+tlid s C V, ¢'iYa. l I Ji' �_ ilv { I 1 N y ���� � its sJtt-I�#�hF`"��"� � �`{xy� �.��M st�4d i ._ �.��` `s� r�•� �"7 a �"� #ill � �K' s y tY iy � • lr�t 7`s 'Nfi - �, (� Jay; �- �(' t i7f 7 i I all 3iN f t avv Mi �^ Ar Nit N # 1G Sea 1 e"9'F Yw t d1 ay-_t Jfi{ ra Ni b��.xlp�sl It,: aI if � ti t { Ki t�lr �t4n + < ( ( � tlr x1 i1MAl' V, TI,-.gfia s{ix, DO � - -_-. L IFT I Johnson and Rich Co. Invoice 16 Water St. Essex, MA 01929 Date Invoice# 9/2/2014 96 Bill To Skirley and Mickey Benson North St Salem,Ma.01970 P.O. No. Terms Project Quantity Description Rate Amount Exterior repairs to Bridge St.,Remove facade,strip roof,add new plywood,all new trim on three sides of building overhangs and crown on rakes,4 new marvin windows. one new entry door.New red cedar clapboards,new granite step at new entry. Permit 350.00 350.00 Demolition 2,400.00 2,400.00 Trash removal 675.00 675.00 Materials 9,392.00 9,392.00 Windows 4lntegretery by Marvin 6/6 SDL 2,600.00 2,600.00 Entry Door 6,500.00 6,509_@9 Granite steps 600.00 600.00 Labor 13,500.00 13,500.00 Overhead and Profit 3,601.70 3,601.70 ------------ I s-� 33 � -7 a Thank You any Questions Please call 978 815-6929 Total $39,618.70 CITY OF SM.EM, NLAiSSACHUSETTS / s BUILDING DEPART-NLE?iT ' 120 WASHINIGTON STREET, 3w FLOOR TEL (978) 745-9595 F.t`c(978) 740-9846 KI\LBERLEY DRISCOLL MAYOR T Hoz v s ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BCIIDDJG COAL ilSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly MUTIC(nusinessOrg�nization,'Individual): \s'� (�t�aa�•�� ✓/ 1 c Iz Address: t 1a�aTr,� ST. rC CitylStale/Zip: '(� s 5 YYI�r ['hone H: �1`!) g _ _<A .9 ?.9 Are you an employer?Check the appropriate box: Type of project(required): 1.911 am a employer with_1 4• Elm I a a general contractor and 1 6. ❑New construction (full and/or part-time)." have hired the sub-contractors 2.❑ 1 tuna sole proprietor or partner- listed on the attached sheet.' _ 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. y. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10;❑ ir Electrical repas or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 L❑ Plumbing repairs or additions myself.[No workers'cutup. C. 152, §1(4),and we have no 12.❑ Roorrepairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.) •Any applicant that checks box AI must also fill out the section below showing their workm'compensation policy inliarmution. 'I(omenwnen who suhmit this amklnvit indicating they arc doing all work and then hire outside commctots must suhmit a new afrdsvit indicating such. K'immcwn that chuck this box must anachtxl an additional shoel showing the mmne of the subtontncton and their workers'comp.policy infomution. I ask an employer that is providing workers'compeusaton insurance for my employees. Below Is the policy turd job site hrforanatian. Insurance Company Name: Policy 4orself-ins. Lie.n: Expiration Datc: !`j ����j1L Job Site Address: 1 ��2t City/State/Zip:Srit_Ja A�) MQ _ Q f9 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 iv1GL c. 152 can lead to the imposition orcriminel 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 a tine of up to S2S0.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the 0flice of Invesligwions-ol'[lie DIA for insurance coverage verification. I do hereby certify rn er lite punts card I�lties qfperjury that the infonnutlon provided above is true and c•orrecL I' nC1: Official use aatly. Do oar cadre iu rhic area,lobe completed by riry ut town official City or Town: .__ PermiNl.lcense 11 !+suing Aulhurity(circle one): 1. Board of Ilealth 2. Building Department 3.city/roan Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person:_ [ CITY OF S:UzNf, —kssAclius s ©t:IML\IG DEP.►m. LENT 120 WASHLNGTON STAEST, 310 FLOOR `.. T�iL (973) 745-9595 KIMBERL.EY DRISCOLL F-1LX(978) 740-9844 ibtma rNO.NLAS ST.PIEma DI..RECTOa OF PUBLIC PROPERTY/3LMDLNG1 CONIAUSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section l l 1.5 Debris, and the provisions of bIGL c 40, S 54; Building Permit it 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&lGL c l 11, S I50A. The debris will be transported by: (name ut hauler) I'he debris will be disposed orin p (natne ortacai y) (aJdress of racilil/) i - lure of permit.applicant CERTROATE OF LIABILITY INSURANCE, Tftj4-CEATIFlCAh U tS$UEp AS;A WTTER OE U&O7DIAT=jONLY AND CCWFW,MO RMH UPON THE;CERRFICATE HOLDER THS �'ERTIFeCATE[LOPS NOT AFFIRgNT1VELY Oh RELATIVELY A61END, EXTEND FOR-ALTEit THE COYERAOE AFFORDED 6K THE POLICIES 9E'.LOW: i199 CERfIFTCAI'E UF=INS[IRANCE DOES NOT CONSTITUTE A CONTRACT BEPIAIm1 THE:t66tN1IG INSUREWSL AVWLOR=D pEPRESEFPTATItIH�ORf+ROONCER,ANDTHE CERTIFlCATE HO[AER. IPIPORTANT:.McNe wrtgfuN hol0er ffi Pb AODRIONAL INSDRE4..Jha PWkYlNsF nlw/Da miduaed. N SOBROGATIdi WANM subled tu, efa teYW&'BacaawonpoimeiwilCy..w/ro1n,tL � Y:ro!PW aN ePebraa�renL Alfa nencalnls mr r ee dogs lrot Nar.flow to the p/BRCiK'IwIOHIn:SW o1.aMeNend :. ... Pa If6ulaYe . I - `PRODeI�t AaY<INixansurance Agenry,Inc. wio� �`� �'� " ---•- i rai '_ ..., Rochester.NY 14620 `. w .�.��pane., NAne 877-266-B 0 eYwtsL .. Bradley D.Johnson. wsB a C: Rich ET AL PTR'- moo: Essex. MA 01929'. NPu�Re- COVER= ," .` cmumATE.Numam REVISION NUMBER 7kKIS TO CERTIFY TMT THE POLICIES OF INSURANCE LISTED SELOW HAVE:BEEN:ISSUED TO TREINSURED NAMED ABOVE FOR THE;PCLICY PEWOp'. INDtCATM NG,T"THSTAxLNNG ANY REQUIREMENT.TERM OR CONDMON OF ANY CONTRACT OR OTHER DDOUMENT WIII RESPECT.TO;WHICH THIS:, CERTIFICATE MAY SE ISSUED OR MAY PERYAIR THE 1KSURM1NCE,AFFORDED BY THE POLICIES DESQ40W HEREIN WSU MELT TO"ALL THE TERM$, EJIOUIOONS AND LONDRIONSCF-SUCH POLICIES..UANTS SHOWNMFYHAVE-BEEN REDUCED BY PAID CLAM&: TYPE OFINSURRIICE'.. .... PDI:ICY MBEe' .. UNni R ;GEWAAEC1VEPaf/' PAf?I OLC UNCS S0.0 DOB- '-GM.IMeiCW.QFNH+01 WwUM :c®noo .. BRBP450075 D9mrzoia)U9H7014 MEQFAP PEIt>bNLL&AVVINPJW IaG GEtaPH MIE StiD]0.0CC :,;t£PILA(YNiEMiEIIMRAPPLIESPBt PPfiWC19-0011PWKG &zw=C; •'P6Ld- PRO. LOL S _ .m eyAgBIYY - n�^��. BOOiY1N4R1'{PWP�P1 >: . AM ®pwie& EDHR MIILffi:. � S .--- i IIeR14l M* i OIX%IR... .. . FiYd14CdIRR61L1: i. ,- E%CE83 WB n1ANii.1ADE. I STAiU+ LOTH. A ' PLQY�JfBLBIuw YINANY x .. . , k".iK 00 El HDH ACCDFHT i. BRWC560983 oarTerzma e9na'2uTs silaw ..N4ltlmgbNp _ E ELF�FFTICNS WOW -Ei d9EA5E'- UMIIy�50GKL ;�` i®N-0FLAEPAIIOxifIDC"LDNEIVHBCIL4(ANtlllmMtel.AiWtliOtlf�,19&4mTiRlfmna�nbrtPYwq CERTIFICATE'HOLDER - CANCELLATION �.L 5110UL ANYO- M1E AEOVE.DE SEL YIlIGE5BE4WNACEDeE(W5'"HE Ji1LFiBy.BCFISD(T• - EY.oIRATIOid DATETHEREOF N=iICE HALL BEDP311ERELiNAC.gRDAVLN M'fnITHE pbIJCV FRDYI_90N6 EVTFAIW RE i0 MAII'SI)r.fJ nIOTIiFSHALLJM�4 11D T 16ri09A Street. OELGAYIOHq UAE O AV p DUPSn aE" 14j,irs co svM Salem, MA'D1970 A iNON8DPE0.8ga'?MME ' ' _.._.. _.... '' -.' 1988�0TO ACORQ CORPORA :HgnF$reseTVeD. AC0RD.25 j2D10IDSi The ACORD name:aml WW are registered maths 0ACCAID - iiMassachusetts - Department of Public Safety zard of Budding Regulations and Standards Construction Supenisor - < License: CS-004679 BRADLEY D JOHNSO * I SEAVIEW LN NEWBURY MA 01951 3 ` w expiration Commissioner 09/29/2015 YT: .. vn .- ... r .. a ...n w:14^'a i :.Yx...n.c-n.�...-rr..v,_1P,e*^!+^+gnySPry_awJp}Pn• r 1 n i , ZOCr97W X/ - � � L= , l f're�a/--ed for ZS G& /98 O CED : REc B/s. L .5 MgSIP I HFlefoK e erIly Toi Ileff t/ NOR-0 S HM E s u2 ve y co2P• Ae,r Coc � /8/ eS-S CA .Sfieef SFle/ r?,/W n 4 r. . sr��ra ? sr - y��- C1 /