173 FEDERAL ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Rt , ,y Board of Building Regulations and Standards
Massachusetts State Building Code 780 CMR 7°i edition CITY
, , OF SALEM
Revised January
Building Permit Application To Construct, Repair, Renovate Or Demolish a /, 2008
One-or Two-Fancily Dwelling
This Section For Official Use Only
Building Permi umber: Date Appli d:
Signature:
Building Come ssioner/Inspector of uil Date
SECT N TE INFORMATION
1.1 ;ro l2erty ddress: 1.2 Assessors Map & Parcel Numbers
�-1--� �'zn�
I.I a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 "Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.Q L,c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal Systenc
Public❑ Priv:ne❑ "Zone: Outside Flood Zone?
Check it yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP' _
2.1 Ownerl of Record.
Nome r int) Address for Service:
�A- Ito - 3AN
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(,) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Q(� W3
j ---- -------------jam -- ---
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ Ja a- -(Djr 1. Building Permit Fee: $ Indicate how fee is determined:
FElectrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees:
4. Mechanical (HVAC) $ List: 1��/,
�+'
>. Mechanical (Fire
Suppressions - _ $ Total All Fees: $
�p- Check No. Check Amount: Cash Amount:6. Total Project Cost .$ ��id-o S rat 0 Paid in Full 0 Outstanding
Balance Due- /t
f �
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 13030 1 'h
5TQSJ eA YQ1 J-A 0n License Number Ex iralion Date V
N me if CSl_- Holder
�`� M� List CSL Type(see below)
Addres Type Description
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 Family Dwelling
Sti nature�7Q e`��z M Mason Onl
!111-uk,` -M-3 - RC Residential Rootin Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel BuminE Appliance Installation
D 1 Residential Demolition
5.2 Reg i steretf llo��t9ge tIyiprovernent Contractor (HIC) � C 9
ST21� K.LIMQn J `1 V
F IC mpany Name o I11C gistrant Na Regist ation Number
Addr s
1 `�' w 3 Zo t 1
E irati n Date
Sienature 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 Issuttapeof 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
I, y0(�, lrxa kam uil as Owner of the subject property hereby
authorize K-G to act on my behalf, in all matters
relative t o work authorized by this building permit application.
e I7 k e?
Signature of Otiner Date ' r
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
I, sx-elogn kcelw , ,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 N, ��- t/ ' Z-I t0 oq
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of a du
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectively.
2. When substantial work is planned, provide the information below:
Total floors 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 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"
IEastern Construction Estimate
Date Estimate#
"f tOi &e I MProvemewt speo'WLIstsa 10/19/2009 1410
PO Box 2057
Woburn MA 01888-0157
visit us at: www.easternconstruction.net
Name t Address e-mail me at: easternconstruction@comcast.net
Joanna Dellamonica
173 Federal St. Phone: 781-938-5229
Salem,MA 978-740.3264 Fax: 781-854-0206
AL +cA-9- (oo � 3I 2 5
Description Total
I---Tarp off house and yard as needed for protection against falling debris
2---Remove all existing shingles from entire roof of house
3--Remove and replace up to 75 linear feet of roof decking at no extra charge
*additional charges of$5.00 per linear foot will apply after the fist 75 linear feet
4--Resecure all exposed roof decking as needed
5---Repair and or replace all fleshings as needed
6—Install 6 feet of new ice and water shield on all lower edges,around all fleshings,and in all valleys
7--Install new 15 lb felt paper over all exposed roof decking
8--Install new 8 inch white aluminum drip edge on all edges of all roofs
9--Install new 30 year 3 tab roofing shingles on entire roof of house
*valleys are to be woven
10--Cut roof boards at peak of roof as needed to ensure proper ventilation
1 I--install new Cobra Ridge Vent on peak of roof
12--install new ridging on peaks and hips
13--Seal all flashings using fibmted roof cement and asphalt membrane,and or Geocel Tripolymer Sealant
14--Remove all loose dirt,dust,and mortar from both chimneys on the left side of the house
15—Wash and prepare same to chimneys as needed for repair
16--Apply Weldabond adhesive to rear larger chimney as needed for stucco
17--Stucco rear larger chimney as needed using Weldabond treated mortar
18--Spot point smaller front chimney as needed using Weldabond treated mortar
19--Install new mortar crowns on same 2 chimneys as needed using Weldabond treated mortar
20--Remove all job related debris
21—Eastern Construction is responsible for all necessary permits
22--Workmanship on new roof is warranted for 10 yrs under normal conditions
23'•All of the above work is only to be performed on the main house only.No work is to be performed on the
garage or shed roofs
12,285.00
i°'Mail to 102 Bayview Ave. Salem MA
Total $12,285.00
*Add 3%for Mastercard,Visa,and American Express transactions
*All roofing estimates are based on removing up to two(2)layers,unless stated otherwise �-Z� o Q
4When your roof is being removed,please remember to cover and or move any valuables i Date n 1
your attic ^•
*Workmanship is warranteed on new roofs for 5 years under normal conditions ,
*All estimates are based on current product pricing and are subject to change without notice Signature �' ,.L� ; �
*Any changes,variations,or alterations to this estimate will result in additional charges
A Division of AA&K Construction, Inc.
6�1� �✓d
S� Board of Building Regulations and Standards Licenl:e or registration valid for Individul use Only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registration: 130307 One Ashburton Place Rm 1301
Expiration: 2/162010 Tr# 262927 Boston,Ms.02108
Type: DBA
1 � JJJ
EASTERN STEV
STEVEN KALMAN`t
A HEWLETT ST.
SAUGUS,MA 01906 Administrator Not valid without signature
Nlasaehu,etts-Department ui Public Sdfeq
Board of Building Re-uiatinn,and Standard.
Construction Supervisor License
e License: CS 759Q
I Restneted to: 00
i
STEVEN R KALMAN
PO BOX 1266 `I
SAUGUS, MA 01906
i
Expiration: 3ffiMll
{ f nmmi c4m�.r' Tr#: 11543
I t
NOTICE a NOTICE
TO o TO
EMPLOYEES 4 EMPLOYEES
V
OEM S�6
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 — http://www.mass.gov/dia
As required by Mmmacbusetts General Law, Chapter 152,Sections 21, 22 8c 30, this will give you notice that
(we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
P.O. BOX 1450
MIDDLEBORO MA 02344-1450
ADDRESS OF INSURANCE COMPANY
(7PJU6-0536N39-2-09) 05-22-09 TO 05-22-10
POLICY NUMBER EFFECTIVE DATES
JOSEPH 0 DANCA JR INS 182A HIGHLAND AVE
MALDEN MA 02148
NAME OF INSURANCE AGENT ADDRESS PHONE #
A A & K CONSTRUCTION, INC DBA 4 HEWLETT STREET
EASTERN CONSTRUCTION CO
SAUGUS
MA 01906
EMPLOYER ADDRESS
e—
EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to ftwnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Worker%' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee_ the employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
connected to the Rork related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPFFAL ADDRESS
wiew W20PIG02 TO BE POSTED BY EMPLOYER