61 COLUMBUS AVE - BUILDING INSPECTION �- i � ���'
- �n 5— t � t�s °n' � c� g--�
�, The Commonwealth of Massachusetts
� Boazd of Building Regulations and Standatds IN5 ECTI�EtAFav!'sERV CE5
Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a�� NAR 24 A IZ� Oq
' One-or Two-Family Dwelling
T'kiis Section For Official Use Only i
Building Peimit Number: Date Appli d:
� 3� 7 t
Building Officia((Print Nazne) Signature Date �
SECTION 1:SITE INFORMATION
11 Pro e Addr� �� 1.2 Assessors Map&Parcel Nnmbers
I.1 a Is this an accepted street?yes no Map Number Parcel Number �
13 Zoning Information: �� , 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) �
1.5 Building Setbacks(ft)
Fron[Yazd Side Yards Reaz Yazd
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 O Z°°e: _ Outside Flood Zone? Municipal On site disposal system ❑
CheckifyesO �
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Iiec �� ���� � y� , � � '� ��
O V1C9-�'U �Ce.c.o � , � �v�
�'�(R; c,ry,stace,zar
�o (u,� l� us A �/e _ �c�� ��� s�r4S e , sonnenb��Cd�C r�c�sk .
No.and Street Telephone Email Address �'��
SECTION 3:DESCRIPTION OF PROPOSED WORK�(check all that epply)
New Constcuction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteretion(s) Addition ❑
Demolition Accessory Bldg.O Number of Units Other ❑ Spuify:
B � Descrip6on of Proposed Worl�: ✓ � L � � O
e " Q � —1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Cosrs: Official Use Only
abor and Materials
1.Building $ !'�('j3C)•� 1. Building Peimit Fee:$ Indicate how fee is determined:
2.Electrical $ , �Cj o� ❑Standard Cityffown Application Fee
❑Total Project Cost�(Item 6)x muldplier x
3.Plumbing $ U(�G 2. Othet Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
S ression Total All Fees:$
�p Check No. Check Amount: Cash Amount:
6. Total ProjeM Cost: $,�j� ❑paid in Full ❑Outstanding Balance Due:
1"� A1 L� ��3 t° �, �.
SECTION 5: CONSTRUCTION SERVICES
5.1 ConstructionASupervisor License(CSL) ����� �;r����r j
� �y�J V Q� LicenseNumber ExpirafionDate !,
Name of CSL Holder , /
���G�' n ,_ '^ � i List CSL Type(see below) V
-I'77�`J
No.and Street Type Description
��/1,�,i/Y� ..../,Q Ql c� a� Unrestricted Buildin u to 35,000 cu.ft.
r•�v �r� ( v �� , R Restricted i&2 Famil Dwellin
City/Town,State,ZIP M Maso
� RC Roofin Coverin
WS Window and Sidin
� � Q i��^ ^�� ����r SF Solid Fuel Buming AppGaaces
� Gi 7{ G�f� T� h�,C�-� L I [�sulation
�� Tele hone Email address D Demolidon
5.2 Re�tstered/� Home'I�ryp�ovementContractor(HIC) `�Zl�3� �7�f_(S"
J { 1 �� �� aS
9Z-�C q�7't�v V� HIC Regisvafion Number Expirafion Date
HIC �P�n y Name or ffiC Registcant Name
/�1/y ,/��G�Q/v�l��R�STN�-I
No.and S Email address
Ci /Town State,ZIP Tel hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.c.152.g 25C(�)
Workers Compensafion Iusurance 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 .......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONT'RACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize � ���� ��
to act on my be6alf,in all matters relative to work au orized by this bu�lding permit application.
�c�,i r e S� n h �n b�rc� CGc.c-�J � � 3 — i � — � �
Pn¢t Owner's Name(Electrouic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penal6es of peijury that all of the information
contained in Hus application is tcue and accurate to the best of my Imowledge and understanding.
I �L-�.-Q 3-2.2-�y
Priut Owner's or Authoriud AgenYs Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building pemut to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Progrem),will not have access to the azbilration
program or guaranty fund under M.G.L.a 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca InfonnaGon on the Construction Supervisor License can be found at www.mass.�ps
2. When substantial work is planned,provide the informadon below:
Total floor area(sq.ft.) (including garage,finished basemenUattics,decks or poreh)
Gross living azea(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 CosP'
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`.� '° Ethan Dow General Contracting MA.66844,HIC. 132456.
; ,�
95 Rockland St 781-631-0016
. SwampscottMA. 01907 �78�'S95�i33
.,�
CAWLEY RESIDENCE 3/16/2014 PG.2 of 2
61 COLUMBUS AVE. ..
SALEM,MA w "��:
��, a:,� .._. ..,. ._ .. .. PROPOSAL
�.v� rr ,r .w.�,,t�� � � .� F .
...Y )� . �d� rviT . . ... .i.11 , '
WE HEREBY SUBMIT'SPECIFICATIONS AND ESTIMATES FOR;
... ` � ��... .. �� a:r . • ' . ' .e.'....i .
QUOTB TO DEMOLISH AND INSTALL BATHROOM AND FINISHES AT 61 COLUMBUS AVE
TffiS QUOTE INCLUDES;
ALL WORK SPECIFIED IN ARCHITECHTURAL PLANS SUBMITTED BY FAMILY KITCHENS �
k • NOT TO INCLUDE COSTS FOR CABINETS, COUNTERS,TILE AND FIXT[JRES�:' '°4�
. �.,
. PLUMBING, ELECTRICAL AND TILING CONTRACTORS TO BE PAID DIRECTLY BY Tf�
OWNERS
• OR AS SPECIFIED ON PAGE 2 OF THIS CONTRACT .
. . o � �. . <,:;
' �i �V�. ,`.
WE PROPOSE HEREBY TO FURN[SH MATERIAL AND LABOR-COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFI-
CAT[OIYS,FORTHESUMOF;TWENTY-F[VE'fIIOUSAND,FIVEHIJNDREDANDI'WENTY-FOURDOLtiARS ($25,SZ4.00)
._. , . : , ,,:
PAYMENTS SHALL BE'AS FOLLOWS; 1�3 UPON ACCEPTANCE AND�TI�N PROGRESSIVE AS I
PROGRESS PAYMENTS
- . N �,- ,; ..� .
ALL`MATERIAL IS GUARANTEED TO BE AS SPECIFIED:ALL WORK TO BE COMI'LETED 1N A PROFESSIONAL MANNER AC—
CORDING TO STANDARD PRACTICE3:ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EX-
TRA COSTS WR.L BE EXECUTED ONLY UPON WRITfEN ORDERS,AND WII,L BECOME AN EXTRA CHARGE OVER AND
ABOVE TF�ESTA4ATE."ALI;'AGREEMENTS CONTINGENT UPON ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER
TO CARRY FIRE,TORNADO,ANp OTf�R NECESSARY INSURANCE.OUR SUB-CONTRACTORS ARE FULLY COVERED BY
WORKER'S�COIviPENSATION RVSURANCE.��. a � �, ��;� � . ,
CONTRACTOR SIGNATURE, �
� ..��._.,� �t
���� � --�
----__..
ACCEPTANCE OF PROPOSAL;
OWNER�AGENT SIGNATURE; (���� /a'
y
DATE OF ACCEPTANCE;
� - ! � - 1�f
� CITY OF S��LE:�I, �'I�1SS.�ICHL'SETTS
• • BLnnu�c Deraxr¢rrr
`� 130 W.♦SHINCCON$7REEP,3'D FLOOR
T�L (97�745-9595
FaX(97�740-9846
(CI�tgERI.EY DRLSCOLL
MAYOR 'I�iOMAs ST.P[F�tRB
DIRE(.TOA OF PI:BUG PROPEATY/Hl'II�CJG CO�L�(ISSIO�iER
Workers' Compensallon [nsurance Affidevit: Builders/Contractors/Electricians/Plumbero
A 1lcant Intormation � g9e p� �
�laII1C lBusimxs:OrganintioNlndividual): ��-�ft'�`�' ��
Address: /S l�-�'G ��JkvvD� ��
City/State/Zip:.L���(�o� /<tl� �!`ID J Phone M:_I�lI���r` ����
�ou an employv?Chee approprfate boi: Type o►projeet(require�:
1. I am a cmploya with 4. Q 1 am a general conhacWc aud I 6. ❑New constcuction
employees(full aad/or part-rime).• have hired the sub�contractors
2.� 1 am a sole proprieror or partner- listed on che attached sheet: 7. �emodeling
ship and have no cmpioyees 1'heae subconhactors have 8. ❑Demolidon
working for me in any capaciry. worke�s'�o�r.i�euraaa. 9. �Huildiag addi[ion
[No workets'comp.insurance 5. � We are a co�poration and its 10.0 Electriwl rc irs or additions
required.] officers Aave exercised the'v �
3.0 1 am a homeowner doing all work right of exemption per MCL 11.�Plumbing rcpairs or additiony
myself.(No workers'rnmp. c. 152,§I(4),and we have no �2,0(�f repaira
insurance rcquired.j f employa:.s.[Aio worhecs' I3.0 Ot6a
comp.insurance required.J
•nny opplicuq tAat chocks bpt sl mtW also fill uu1�he sectim 6c1ow�owies their vqkrn'oompmaarion policy infu,mattoa
t I lmxowms aho submit Mb affl�v6 ind'mting thry aie doc�g all wak wd then 6iro ouaide eonaactois muy mhmn a nm allidavit i�ing au�.
=Cuntm�.wn tMt ch�ck iEis bmc m�t anxhed an aJdi�iad chen showiag tM awe otMe abcwu�edo'e aod ihdr wokne'wmV•Duliry infamwiw.
I um an rmployarlhet&prnviding worken'compensadon tnsurance for my eraployeex Below ls fha pollcy arud/ab slfe
injormatioa //�
Inwrance Company�lame: � 'u-�.I�� ¢.�� ,���
Policy H or Self-ine.Lic.p: Il IJ'.���,l�� �� Expiration Date: S l�!� ;
JobSireAddress: � ���MaU� (�y� Ciry/S�atNZip:�T.iW't�//"[N ���
Attac6 a copy of the worken•wmpensadoa poliey dectaratlon page(cAowing t6e Qolky aom6er snd e:pinNon date�.
Failure to secute covewge as required under Scceion 25A of MGL c. I52 can lead W the imposidon of uiminal penaltiee of a
fine up ro S I,500.00 and/or one-year imprisonment,as welt as civil pemltirs in the form of a STOP WORK ORDER and a fina
of up to 5250.00 a day agains�the violator. lie advised that a copy af this statemcnt may be forwsuded to the Ot'fice of
Invcstiy��iune uf'the DIA for insuruna covcrage vcrific•rtion.
1 da hereby cenlfy uxAer tha pnlns aiid penalNer ojperjury rhat rlu ii�jormadon provldrd ubove ls nue end correeR
Si�nature � I/ �--- Dnte J ���'�/�
,
OJJicrd ust only; Do not wrile in dr6 anq m be completed 6y city w mwn oJjlciaL
City or Town• Permitll.fcense#
Issuing.�whority(clrcle one):
I. Uoard uf 1(eallh 2.Building Departmcat 3.Cily/fown Clerk 4.Electrlcnl Inspector 5.Plumbing Inspector
6.Other
Conlact Person• _ Phaae#•
� �� _ _ . - — - - - ---- ��
Jun 7 2013 05�09am P002/002
Received:31 Jun 7 2013 05:08am P002
Rightfax N3-1 6/7/2013 6: 09: 41 AM PAGE 2/002 Fax Server
''� � CERTIFICATE OF LIABILITY INSURANCE DATE(RAIWDD/YYYY
IFICATE IS ISSUE�AS A PAATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT DE .
CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONiRACT BETWEEN THE ISSUING INSURER�S),AUTHORIZED
REPRESENTATNE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subjeet to
he terms and eonditions oT the poliey,certain policies may require and entlorsement. A statement on this certifieate does not conier rights to
he certificate holder in lieu of such endorsement s .
PRODUCH2 CONTACT
NAN�:
THOMAS GREGORY ASSOC INS PHONE Fnx
� 401 EDGEWATER DR (AIC,No,Ezry: IaC,No�:
E#7AIL
WAKEFIELD,MA O1880 ADDRESS:
73DJJ INSURE72�S�AFFORDINGCOVERAGE NAU
�N�� INSURQ2A: TRAVELERSINDIIvINITYCOMPANYOFAMf?RICA
DOW,ETHAN DBA ETHAN DOW GENERAI.CONTRACTING INSURER e:
INSURER C:
INSURFR D:
95 ROCHI.AND STREET INSURQ2 E:
SWAMPSCOTT,MA O1907 �NSURERF:
COVERAGES CERTIFICA7E NUMBER: ftEVISION NUMBEIi:
H65 O TH O NGE EB TOTHEINSUREOMA1.ffDABOVEFORTHEPOLICVPFR1000101GATED.
MOiN7TH5TAN01NG AMV REQUIRFAIEIIT,TERM OR CONDI710M OF ANY LONTRALT OR OTHER OOGUMdT WITN RESPELT TO WXICH TH5 GFItTffILATE MAY BE ISSUED OR MAY
PE7tTAllL iNEINSUMNCEAFFOROmBYTHEPOLIGIES0E5GR�mHFAEIDISSU&IEGTTOALL7XETERhLS.E%LLUSIONSANOLONDITIONSOFSUGXPOLICIES IIMVi55XOWMMAY
HAVE B@I REDUGm 6Y PAm CLAQeS. .
MSR ADD SUB POLICY EFF OATE POLIGV E%P OATE
L�R TYPEOFINSURANCE L R POLILVNUAIDER �h4YA0D1YYYY) (ROd��O1YYYY� LIMTS
GENERAL LUIBILITY ACH OCCURRENCE g
COMMERCIAI GENERAL LIABI�ITY AMAGE TO REMED $
CLAIMSMADE �OCCUR_ EMISES(Eaoccurterce)
ED EXP(AM one person) $
� RSONALB ADVINJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $
POLICY �PROJECT �LOC ODUCTS-COMP/OP AGG $
AU70MOBILELIABILITY COMBINEDSINGLE $
�,�y p�p LIMIT(Ea aceiderd)
ALL OWNED AUTOS BODILY INJURY S
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY S
{Peraccident) �r..
NON�VJNED A1f�05 PROPERTY DAMAGE $ "
(Per accident)
UMBRELLALIAB OCCUR EACHOCCURRENCE S
EXCESSLIAB CLAIMS-MADE AGGREGATE $
$
DEDUCTIBLE
$
RETEMION $
A WORKQ2'SCOMPENSATIONAND WCSTAMORY oTHER
EN�LOYQ2'SLIABILI7Y YM �-58284199-13 05/182013 05/182�'14 X LIMITS
AM'PROPERf�oR/PaRTNEwExECUtNE � N�A E L EACH ACCI�ENT $ 100,000
OFFlCER/MEMBER EXCLUDEO?
(MantlatorylnMH� E.L.DISEASE-EAEMPLOYEE $ 100,000
rcyes,describeunder E.L.DISEASE-POLICYLIMfT S 500,000
�ESCRIPrION OF OPERATIONS below
DESCRIPTON OF OPERATIONSiLOCATIONSNE}IICLES/RESTRICTIONSfSPECIAL IlEMS
THIS REPLACES ANY PRIOR CERTIFICATE I3SUFD TO THE CERTIFLCATE HOLDER AFFECTIN6 WORKERS COMP COVII2A6E_
THE W ORKERS'COMPINSAT[ON POLICY DOES NOT PROVIDE COVERACIE FOR DOW,ETFIAN.
� CITY OF S��LE:�1, 1�I.�SS.�ICHL'SETTS
• • BtiII.D4�IGDEPARI'��,v"f
` 130 W:ISHINGTON STREET.3'O F1.00R
�� T1PL (97� 745-9595
F.uc(97� 740-9846
IQ\(gERLEY DRISCOLL
i1�fAYOR 'Il{ot►us ST.P�ERxs
DIREGTOA OF Pl:BI1C PROPERTY/BI:II.DQBG CO�L�IISSIO�iEA
Construction Debris Disposal Affidavit
(required for all demolition and renovarion work)
In accordance with the sixth edirion 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
ttris work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
I 1 I, S 150A.
The debris will be transpoRed by:
��16�`�l�-S� S t�-.-1 �
(name of hauler)
The debris will be disposed of in :
�r �' U �
(name of facility)
/�l�12-�S�9o�'�c �D, �kJG�S
(address of facility)
�� _ '�
signature of permit applicant
3 --� `z-��-
date
debriul7.Jce �
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ETHAN E `�1 ��Y � �'
� 95 HOCKLAND ST
t SWAMPSCOn,MA ' � /�f� �
. . e' 01907-2523 .. , 'a?cs�� ' +�� `._�, . \ r��;.�+�..
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1� Massachusetts -Department of Public Safety .
Board of Building Regulations and Standards
. � ConstructionSupen�isur .:��-�.
License: CS-066844
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ETHAIY E DOW - b`' �': �
. 95 ROCK[.AND S'I' '�� t � .
SWADiPSCOTT AZA 0190�� � -
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� '� ' �� Oftice of Consumer Affairs&Businesa Regulatioo . i ,
��I MEIMPROVEMENTCONTRACTOR. �
. eg�stration 132456 :� TYPe�- �.
� � piration:. 2/8I201b DBA .
� ETHAN DOW GENERAL CONTRACTING
, �. ' � i � � � �
( ETHAN DOW . V�+ -
� � - 95 ROCKLAND ST. ' - ���__
i ' SWAMPSCOIT.MA 01907'� - Unde— ��rc� .
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ALL DIMENSIONS AND � DESIGN PLANSARE PROVIDED FORTHE FAIR DESIGNEDFOR � BY '�'T BY SCALE DWG
SIZE DESIGNATIONS � USE BY THE CLIENT OR HIS AGENT IN Crl,�`����y' �\�rG��L�����:L /��-{-� ���LY� C�1�yTDf°1=FZ /�pc�p\juj RE�N `�� ' � „ ; NO.
GIVEfY ARE SUBJECT 70 � COMPLETING THE PROJECT AS LISTED WITHIN� Z--_�— __ � __—_-__ I/L / � � �
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VERIFICATION ON JOB �THIS CONTRACi. DESIGN PLANS REMAIN THE 6Ro�t�Np�JEn� % EGGEi�ionl"� REG�SSED
� .SITE AND ADJUSTMENT TO- PROPERTY OF THIS FlRM AND CAN NOT BE : "�v ' _ I-!r' 1.�: � F
F/N:SH h��R.i." W�-41Tz' ✓V ' �_' . ' W (� 20 llt
'��, �PIT JOB CONDITIONS. National Kitchen & Bath Association USED OH REUSED WITHOUT PERMISSION. ON M�..PLE ���r,,.ioe �-01 Pu� �
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