14 CLIFTON AVE - BUILDING INSPECTION (2) 11Zk The Commonwealth of Massachusetts
l
J ; Board ul'Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, T"edition Rv rFsl r.MtiA rJxLuA,FYp
M
Building Permit Application To Construct ReD r Renovate Or Demolish a ar r r
Onp4ir,Tivo-Family Dw llin
X
This «lion For OITt rd Use Only
Building Permit Nu m r: a Applied:
Signature:
/°)/.) J/o
Budding Currtmissioned Inspector u dings Date
SE ON 1:SITE INFORMATION
1.1 roperty Addrea: 1.2 Assessors Map d) Parcel Numbers
� -
I.1a Is this an accepted streen t. yes no Map Number Parcel Number
IJ Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building SetbacW(R)
From Yard I Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public Private❑ Zone: _ Outside Flood Zone' Municipal y,,.On site disposal system ❑
❑ /"`Check if es
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Rel?me—ZS. cURS= ILI GLI yE
Nome(Print) Addrcas for Service:
9—7 8 7 4,5 3 z 3
Signature Telephone -
SECTION 3: DESCRIPTION Of PROPOSED WORK'(cbeck all that apply)
New Construction❑ Existing Buildings Owner-Occupied IIx I Repairs(s) Alteration(s) ❑ AdditioJEO3
Demolition ❑ 1 Accessory Bldg.❑ I Number of Units Other ❑ Specify:
Brief Description of Proposed Work': I?r S/4, ill l P ] Sr�l�;ir 'r/l f FKiy S e
PA//l n Fn,->n,r PolLI to
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Labor and Materials 011ltlal Use Only
I. Building S - 1. Building Permit Fee: S Indicate how lee is determined:
2. Electrical S O Standard City/Town Application Fee
❑Total Project Cost'(11em 6)x multiplier x
). Plumbing S 2. Other Fen: S
4. Mechanical (iIVAC) S List:
S. Mechanical (Fire S
Su reseioe Total All Fees:S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S ❑Paid in Full O Outstanding Balance Due:
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SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) a
)j/U/A A lie/L ) ILI l4 ly t �_ ) lispi tiun ya a oVName 1l'SL• IIulJer ebelow)
� icteJ l0 73000 Cu Ft.ed IR2 Famil Uwellin
J K/ RC I Residential Routing Coverin
I'cicplrrmeI WS I Residential Window and Siding
SF Residential Solid Fuel Burning Appliance lostallJlion
D Residemial Demolition
S. Registered Home Improvement Contractor(HIC) / �3
I IIC Qwnpany Name or 111 'Registrant Name Reautrntion Number
*Addm3s
. !LI !4 Q 2
{ �7� �/� 6 ipipirEt iration Date
Telephsxre
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. ISL f 2SC(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 ..........O No...........O
SECTION 70:OWNER AUTHORIZATION TO 8E COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 'k j�3 -A cia4Api as Owner of the subject property hereby
authorize 1w/s6 tJ e4)(L PI 1J l4 1r t" to act on my behalf,in all matters
relative to ork autho zed this building permit application.
Ar '"
_ Ia' b �LUlo
Si u Data
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
I ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of[honer or Authorized Agent Date
(Sianed under the pains and penalties of 'u
NOTES:
Lof
Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
t registered in the Home Improvement Contractor(HIC)Program), will gg have access to the arbitration
gram or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and
nstruction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 MRS.respectively.
en substantial work is planned,provide the information below:
oors area(Sq. Ft.) (including garage. finished basemenUattics.decks or porch)
iving area(Sq.Ft.) Habitable room count
of fireplaces Number of bedrooms
of bathrooms Number of half/baths
heating system Number of decks/porches
cooling system Enclosed Open
tal Project Square Footage"may he substituted 1'or"Total Project Cost"
��y CITY OF SALEM
'4 PUBLIC PROPRERTY
DEPART'NIENT
Construction Debris Disposal Affidavit
(IC(ILIired li,r all demolition and renovation work)
In accordance ith the sixth edition of the State Building Code, 780 CNIR section 1 1 L5
Debris, and the provisiuns of MGL c 40, S 54;
Building Permit tt is issued with the condition that the debris resulting front
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
I 11. S 150A.
The debris will be transported by:
I name of hauler)
'I he debris will be disposed of in
t of A
(name ul la=they) -
IadJrres ut laciluy�
IX -
i
,ienu rc ut pe tut applicant
/
date
.,..
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
-,i\il::N:ry:)xISC IA
M,N) to WMH016 I ON Srxe6T • SAL F.M.MASSAUn :f:its 0197:
11,1.:978-1745-9593 • 1'.Ix: 978-740.9S46
`Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Al 1licant Information /7 (J Please Pririint_LeJcibly
dame (0usincss/Or-.oniratinrVindiviuluull: l` v 0N 7 a—eas Peow ett ��
City,State,Zip: aepn& n n /VI a OI/ jr_ Phone ''.': q f(: e)- 3
Arc you an employer?Check the appropriate box: 'Type of project(required):
1.X I am a employer with�,_ 4. El am a general contractor and 1 fi. ❑ New construction
employees(full and/or part-unte).• have hired the sub-contractors 7.''Remodeling
2.❑ I ❑m a sole proprietor or partner-
listed on the attached sheet. :
sliip and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers' comp. insurance. 9. ❑ Building addition
No wolicers' cum 5. ❑ We are a corporation and its
P insurance officers have exercised their 10.❑ Electrical repairs or additions
required.] 11. plumbing repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL ❑ b P'
myself. tNo workers' comp. C. 152,g 1(4),and we have no 12.❑ Roof repairs
insurance required.) t employees. (No workers' 13.0 Other
4 _ comp. insurance required.]
-Ally.ipplicAut thin chucks box ill must also lilt our the scclion Ix tow showing ihcir workms cumpen t ion pulicy inf loruioure
'I lommiwrtun whu subs it this aftidavit indicating ihuy ore doing awl work aiul then hire outside corlooeron must suhrra t new ordavir indicating such.
Cormtcturi that dtcck this box musl attwhcd an additional sh uI showing the nmtw of nee sub-contrWion and their wurkon'comp.policy information.
/urn an employer that it providing workers'compensation insurance for my employees. Bell is the policy and job site
information 7
Insurance Company Name: L ! __ CL-9 A 11 ---—---
Policy it or Self-ins. Lic..�ti: GU __4.Jr(7( . . _._...- Expiration Dal
1,_�
Job Site Address: /plL4'a-�� CityiStateyzip:�7/a
Attach it copy of 111e workers'compensation policy declaration page(showing rile policy number and expiration date).
Failure to secure coverage as required under Sectiun 25A ul'M61.c. 152 can lead to the imposition of criminal penalties of a
Fire 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 fine
0f up to S250.00 it day against the violator. Be advised that a copy of this statement may be forwarded to the 011ice of
Im cougaunm at the DIA for insur;u:cc covcrago vciincatiun.
71h,.,erchy certi under thpains rdpenaUic.' f perjury d 't onnadon provided above is true and correct..
()f/iciol use only. Do not write in this area, to be completed by city or/ovn official.
Citv or'fown: -. Permit/License b_._-------- _.
Issuing Authorily(circle one):
I. hoard of Health 2. 111ilding Dep:lrtineut 3. Cipdfowo Clerk 4. Llectrical lnspector 5. Plumbing Inspector
6. Other - - -
Contact Person: __ .-- Phoned:
Information and Instructions
.Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or inure
d the t0r"oing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an Individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
NtGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, hIGL clmapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence ol'compliance w ith the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial '
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the pennit/license number which will be used is a reference number. in addition,an applicant
that must submit multiple pennit/licetse applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write "all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit,not related to any business or commercial venture
(i.e. it dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Otficc of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Ucpartinau's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
OfRce of Investigations
600 Washington Street
Boston, MA 02111
Tel. N 617-727-4900 ext 406 or 1-877-MASSAFE
Itcoisea ;-w-us
Fax N 617-727-7749
www.mass.gov/dia
Xpress Restoration, Inc. Proposal
Mgies
s RE.S TO RA T/ON /NC.
NAT-723e6-1 Historical Restoration&Remodeling Services
PROPOSAL
August, 26 2010
Rebecca Curran Xpress Restoration Inc,
14 Clifton Ave 18 3`d ST
Salem MA Medford MA 02155
Dear: Rebecca:
Thank you for choosing Xpress Restoration, Inc,
We propose to furnish labor and materials for the following work.
Exterior project
North Side:
Remove temporally stairs
Demolish/rebuild front porch
Install new fir decking
Remove lattice
Install new wood lattice
Install new railing matching existing
Install new square baluster matching existing.
Rebuild left corner of the porch
Install PVC boards on all fascia that will be replaced
The deck will be build with pressure treated wood on the rough
And it will be covered with composite wood to give a nice finish, we will have to dig 4
feet into the ground and place 12" tube and fill with concrete we will secure the deck
with special bolts attached to the house, we will attach the 2x10 one to another with joist
hunger and screws, also it will have the 4x4 support holding the deck up with shoe plates
we will place metal brackets on comers to give more support to the deck. The stairs will
be constructed out of 2x12 they have to be handmade.
The entire project will meet all the requirements by the 7 h edition of the Massachusetts
State building codes.
Install new gutter on 2nd floor(front only)
Install new downspouts on front gutter
West side:
Strip all shingle
Page I of 3
Xpress Restoration, Inc. Proposal
Install home wrap
Install new window drip edges
Install ice water and shield around windows (where shingles will be striped)
Install 2 new window sills on basement windows
Install new red cedar first grade unprimed shingles
East side:
Strip all shingles
Install home wrap
Install new window drip edges
Install ice water and shield around windows(where shingles will be striped)
Install I new window sill on basement window
Install new red cedar first grade unprimed shingles
South side:
Install new window trim around 2 windows to match existing
Repair shingles around the window(where its needed for the installation of new trims)
Install new storm window(Harvey) matching existing
Prep and paint work: M
I Re-glaze exterior window sashes as needed where missing or loose
additional hand scraping of complete exterior of home as needed
caulking of all areas as needed
filling of all holes, cracks and rough areas as needed (exterior grade "ready patch" filler)
apply hand sand to smooth surfaces (where it's needed)
priming of all areas with an oil base primer
painting all areas including the body, trim, casings, fascia, soffits, exterior face of
window sashes,basement window frames,the foundation, the exterior face of all doors,
and the rear porches and decking with two coats of Benjamin Moore "Aura" exterior
latex paint.
Provide all city permits
Provide dumpster
Clean up daily
Please note:
Painting scheme includes one base color, one trim color and one accent color
Our price for performing this work is $31.500, 00.
*This estimate is valid for 30 days after the date it was issued*
The payments should be made as follows:
5 % when contract is signed
40%down payment
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Xpress Restoration, Inc. Proposal
35 when all the shingles is installed and prep work is done
20%when job is completed
FYI:
The scope of work being done in this property is for renovation purposes only and not to
bring the house into compliance with Mass lead law chapter I I 1
We are committed to providing you with the highest level of customer satisfaction
possible. If for any reason you have questions or comments. We are delighted to hear
from you. Call our toll-free number, 1800 331 6584, or send us e-mail by just visiting our
web site at www.xpressrestoration.com. You can expect us to respond to your e-mail
within 48 hours. Again, thank you for your patronage. We look forward to serving you.
Acceptance of proposal:
By signing this proposal you are committing to work with Xpress Restoration, Inc. and
the above prices and specifications are satisfactory and herby accepted.
Dated- 06T b , 20a1 O.
M AA
!�
Signature of Owner
.2:"'ELCh�- (JYK.PY-�
Printed Name of Owner
,Angieis list BBB-
Page SUPER SERVICE
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