175 FEDERAL ST - BUILDING INSPECTION (3) LJ
IZ, The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
O
Massachusetts State Building Code,780 CMR SALEM
Q) Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Only
Building Permit Number: Date A lied: FF
4&"�r
Building Official(Print Name) Signature $ate rn
SECTION 1:SITE INFORMATION o
1.1 Property Address: 0194C 1.2 Assessors Map&Parcel Numbers t Z'
I 5 I"�gr� wl Si- sok1 Mfg �
L l a Is this an accepted street?yes no Map Number Parcel Number try.
1.3 Zoning Information: 1.4 Property Dimensions:
5o Q
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) ..40 -
1.5 Building Setbacks(ft)
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 qv Private❑ Zone: _ Outside Flood Zone? Municipal Von site disposal system ❑
Check if vesv
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:K Sal Pml �A A o I
�ptw► Kraut * N i col2 p�eruman 1"'rS o
Name(Print) City,State,ZIP ll 1 ggmc .f0
n 1
1�+5 FedtMi St *a bil-T?45-550 a rAuA OLAM i I.to
No.and Street haaM Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied V( I Repairs(s) �( Alteration(s) ❑ 1 Addition ❑
Demolition AAccessory Bldg.❑ 1 Number of Units I Other ❑ Specify:
Brief Description of Proposed Work'':
e.Jvdak
n
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Of Use Only
Labor and Materials
1.Building $%00 t 4 3 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $
❑Standard City/Town Application Fee
❑Total Project Cost'(item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 10] a(0 3 ❑Paid in Full ❑Outstanding Balance Due:
M fN tuizo 4U Zia" l I h
7 A.;4) Y� �7�LlhX r C=t3 i�`
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Su erviisso'r License(C,SL)
License Number Espir• on Dat (o
N;mie ofCSL Holder
List CSL Type(ste below) C
*Y- _ Type -, Description
No.;md Suect '
- Z ��� _ U Unrestricted 2 Family
s u el ing cu. Il.
R Restricted I&2 F:unil Dwelling
City/rows,State,ZIP M Masonry
RC RantingCovering
WS Window and Siding
/ SF Solid Fuel Burning Appliances
� /7 jZ�l�� 9 Lf'Pf^�i/lP, CQ�9� 1 Insulation
Telephone Email address •.Yi D Demolition
5.2 Registered Home Im/provement Contractor(HIC) � �?�Zz� O
HIC Registration Number rpuuuon Date
HI Company N or HIC Reglsimnl tine
Ng.and Ste/ 9 Email address
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 ...,SQL No...........❑ t
SECTION 7a:OWNER AUTHORRATION TO Bt .COMPLETED.WHEN,
OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Narne(Electronic Signature) Dale -
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my nam low,I reby attest under the pains and penalties of perjury that all of the information
containeJ in this, caticirKsAfue accurate to the best of my knowledge and understanding.
IYJ ds ��
Print rarer' or o e r 's Nmnc(Electronic Signature) ate
NOTES:
I. An Owr r who obtains a building permit to do his/her awn 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.m;tss.eov:'oat Information on the Construction Supervisor License can be found at www�os
2. When substantial work is planned,provide the information below:
Total four area(sq. R.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. R.) 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 ofcoolingsystem Enclosed Open
3. "rotal Project Square Footage"may be substituted for`Total Project Cost"
V '
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Massachusetts -Department of Public Safety
Board ofBuilding Regulations and Standards
Construction Supervkor
License: CS-090403
g1.I'TX ,.,.
FIOROTIRONAIfiO S
102 MYRTLE ST s
MEDFORD MA b215
F
Expiration
Commissioner 03/20/2016
.� Cl�ie.�'omvrreareeiea/,l�a� uoellb
Rice of Consujner Affairs&Business Regu�l8iiorq�_
ME INI PROVEMENT CONTRACTOR' "�'r.• -
rRegistritio.m -'7
176220
Expiration _7n9/2015a Supplement
�d
ZION?AINTING INC -
RONALDO. FIOROTI"
! 31 GUILD ST "? v 4�
!STOUGHTONMA 02072 .
Undersecretary
�3
• CONTRACT
Date: 10/21/2014 INVOICE# [100]
Expiration Date: [Enter date]
L
f
TO NICOLE BERGMAN�
` 175 FEDERAL ST APT 02
SALEM MA 01970
401-524-2412
Customer ID [ABC12345)
Salesperson Job—__ __-- _ Payment Terms--I Due Date a
L---------------- 1 Due on receipt I
Qty Description u it
Price i Line Total
--- ---- -------..--------------------------._--— -'-----�-------,-----------�
EXTERIOR
LEFT SIDE OF THE HOUSE j
REMOVE AND REPLACE CROWN MOLDING 29' FEET
WITH SIMILAR MOLDING
i
RIGHT SIDE OF THE HOUSE
REMOVE AND REPLACE LOW TRIM
REMOVE AND REPLACE LEFT CORNER BOARD
REMOVE AND REPLACE RIGHT CORNER BOARD
REPAIR SIDING WHERE NEED 3 BUNDLE ESTIMATE
1
LABOR FOR EXTERIOR CARPENTRY 1850.00 1 1850.00 1
MATERIAL COST ESTIMATE 1300.00 1300.00
TOTAL 3150.00
1
t
I
,I
DECKING
! DEMO FIRST AND SECOND FLOOR DECK I
BUILD PRESSURE TREATED FRAMING 10' X 17' j
! INSTAL 5 % TREX DECKING
INSTAL PRESSURE TREATED RAILING j
I ! I
! I ;
MATERIAL COST ESTIMATE 3900.00 3900.00
LABOR ESTIMATE 6600.00 6600.00
TRASH REMOVAL 600.00 600.00
ALL LABOR AND MATERIAL ARE INCLUDED
THE COST ESTIMATE DOES NOT INCLUDE
i
j PERMIT OR INSPECTION FEES
I BATHROOM TILE
I i I
PAINTING
ELETRIC
I
j ; I
TOTAL 11 ,100.00 j
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I
i I
I i '
Subtotal j
Sales Tax
Total 14250.00- !
Quotation prepared by:
This is a quotation on the goods named,subject to the,eortditions noted bllpw(Describe any conditions pertaining to these prices
and any additional terms of the agreement.You my wane Winn/£I d 'on g ncies hat ill a to quotation.)
To accept this quotation,sign here and return: (/(..'� v
Thank you for yoUrbuSISS!
BEST TEAM CORP 31 STEVENSON AVE APT 01, EVERETT MA 02149 Phone 781-864-4006
Fax(000-000-0000] ANDERSON-BG@HOTMAIL.COM