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10 FLINT ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF 1 ' Massachusetts State Building Code, 780 CNIR SALEM X11 Revised Alar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Family Dtivelling this Section ForOfficia[Use Only Building Permit Number. Dat pplred; Building Official(Print Name) "Signature, - SECTION 1: SITE INFORINIATION LL P/roperty Add-rress: 1.2 Assessors Map& Parcel Numbers / 6 11^# S � l.1 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 ft) Frontage(ft) 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2 PROP..ERTY'OWNERSHIPy 2.1 Owners of Record: / nIC,'/a l C�/1if/l+l f JP41�—°M !yI/� 6/ Pl Name(Print) City,State,ZIP Ia r-)1N \ s7` -)1 ;0 y901tS� No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF.PROPOSED WORK''(check.all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': ,LOO SECTION 4: ESTINL&TED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only, Labor and btaterials L Building $ $O^ I. Building Permit Fee 5indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical S is ❑Total project Cost,(Item.6)x multiplier x 3. Plumbing 5 2. Other Fees: S � \ I Mechanical (IIVAC) S List:- (J 5. Mechanical (Fire S . Sn cession) "total All Foes:.S q Check No. Check Amount: Cash Ainouut: 6 1'otal Project Oust S / 3 0 Paid in [Full 11 Outstanding Balance Due:_—___-- T ' SECTIONS: CONSTRUC'T'ION SERVICES 5.1 Cow trut•tion Supervisor License(CSL) �3 /13 �, 2�• 13 A) C//m-! fd D RIJA.,, J`f' License Number --- Expiration Date Name of CSL f folder --lid-�s�-- �f Q n eiP !D/f-- //�.11 List CSL Type(sae below)_n_ Ll No. and'Street 1� Y 'type Description �� Z� U Unrestricted 2 Family s u ento ing 00 ca R. /v R IZcstric(cd 13c_Famil Dwelling Cityaown, State, ZIP bl Nlasonr RC Roofing Covering NS Window and Siding /tJ tidy Ik @ Og-�( J� �" I InsSolulation tionFueBurning Appliances 9 24Pe [ Insulation "I'de hone Email address D Demolition 5.2 Registered Home Improvement Conyactor(HIC) /2 7 3 tl,/,1"i �y MDA C�� T s //h1c- 4e1 FIIC Registration Number Expiration Date I IIC Company Name ur("TIC Registrant Name y T►�8rr�„ ` tl `/�l0 Gs�J'1� •� No.and Street — -mail address tVve4t-1, MSI 0/r'L-3 Ci /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 ......... 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 ny behalf, in all t tters rell tive to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained i ap 'cation is t e and accurate to the best of my knowledge and understanding. 'rint vn� Authori , mna(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 [ionic 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 FITC Program can be found at www.m:us.<,uv�%ora Information on the Construction Supervisor License can be found at www.nrtss.tu�'dL When substantial work is planned, provide the information below: rota) floor area(sq. R.) _ _(including garage, finished basement/attics, decks or porch) Gross living arca(sq. ft.) Habitable room count_ dumber of fireplaces. .—_-- Number 0f bedr0oms ---------_-- Number of bathrooms Number of halt baths I vpc of heating system -- I)pe of cooping ryuem _ Fnclosed- ._ -- Open i. '"I"ot.il 111')ject Syu:re Fonua,e" miry be iubititut.d t0r'.Fot:d Project Co,t" u , 4 ' IVY CITY OF S:UzNf, tiLksSACHUSETI'S t, 8UU-DL\G DEPARTMENT 130 WASHLNGTON STREET, 3"°FLOOR TFL (978) 745-9595 KI.NMERLEY DRISCOLL F•L`t(978) 740-9846 i+L4YOR THOSW ST.PIERRs DIRECTOR OF PUBLIC PROPERTY/13Uan04G CONWISSIO:i ER 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 1 l L5 Debris, and the provisions of MOL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this worts shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: W4-1 Psi Ow _ h� P� Geti� 7 (nunte ut hauler) The debris will be disposed of in (name of facility) --(address of facility gnature Of pet tit applicant elate tdxiair'd.i< 1 i CITY OF SM EANI, NLA SSACHUSETTS BUILDING DEPARTNIE.NT 3 j " • '� r 120 WASHCVGTON STREET, 3-FLOOR TEL (978) 745-9595 F fix(918) 740.9816 KniBPRL.EY DRlSCOLL MAYOR TTtontAS Sr.PtFxRs DIRECTOR OF PUBLIC PROPERTY/BUILDING CONDIISSIONER - Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Amilleant information Please Print LeeibiX VBmC(Business.Organiratiarulndividual): 44 D(3 Cab ILI gK7 F, 17 Address: '/ / City/State/Zip: JSZ�hone Al: 2204 d I'J Are you an employer?Check the appropriate box: Type of project(required): l. m a employer with L 4. 0 I am a general contractor and 1 6. 0 New construction VV employees(Atli and/or part-time).• have hired the sul►comractors 2.0 I am a sole proprietor or partner• listed on the attached sheet t 7. 0 Remodeling ship and have no employees These subcontractors have S. (]Demolition working fur me in any capacity. workers'camp. Insurance. 9. 0 Building addition (No workers'comp, insurance 5. 0 We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself.(No workers'cump. c. 152,$1(4),and we have no 12.0 Roof repairs insurance required.)t employees.LNo workers' 13.0 Other, cump.insurance rcquired.) •Any appllcam that chocks box sl mutt also 011 out the scctiva below showing their workan'compenradon policy inlurmatlan. !I hanuuwmw who suhmit this alidavir indicating they am doing all worksod then him uuliide commctan must submit a new amdavit indicting such :Cammton thal chuck this box must attachedan additluwl shat.showing the name of the subeonlr ctan and Ihclr workers'comp.policy infotmagoe. I um an employer that Isprovlding workers'competrradon LilluraneeJor my empluyeam Below Is dorpolicy and fab site injormudolL Insurance Company Name. Lig N Policy 4 or Sclf--im.Lic. 0: A41 142 C— C2 �/O Expiration Data('`9, /,f— job ,flob Sita Address: r/ CitylState/2ip: Attach 2 copy of the workers'compensatloe policy declaration page(showing the policy number and expiration date). Failure to sceuru coverage as required under Section 25A of`VJGL c. 152 can lead to the imposition of criminal penalties of a line up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a line of up to SM.00 a day against the violator. lie advised that a copy of this statement may be furwardcd to the Off ice of Investigations ul'tho DIA fur insurance covcrago verification. /c/o hereby ceMiaidlit and pen s ajperJury drat the Lrfannudan provided above is true and correct S',. . Iit13lard• yr � '° 3 phoncd, UJJic ial use un/y. Do nor write in this arro,to he completed by city or town n/Jleiu6 City ar Town: Permit[License Nsuing Aulhorily(circle one): 1. Board of health E. Building Department .1.City/town Clerk 4. Electrical inspector S. Plumbing lnapecror 6.Other _. --_--- Contact Person:__... _.._. _. Phone th 11'-6 5/16". 5'-9 7/16„ 6., Ceramic tile walls Wainscoting(all remaing walls) . " Replace tub f 5'-0IxT-6"W Q Interior window trim M (water resistant) Tub/Shower Shorten wall 1'-0" M rble threshold Bathroom t vanity accomodaty cm _ — a p N Tile floor ¢ oo`hre-used N .4 closet or° J MDB Construction Replace toilet Proposed bathroom renovation 4 Tibbetts Ave. Melanie Charles Danvers, Ma 01923 Unit#1 Bedroom Replace vanity 10 Flint St. Salem, Ma 01970 5'-6 5/16" 11'-65/16" MTB Construction PRI,( �)Imo© A 4 Tibbetts Ave PROP OSA Ma 01923.3914 LICENSED & INSURED WEB SITE H.I.C. #100273 C O N S T R U C T 10 N www.MDB-Construction.com ESTABLISHED 1986 TO PHONE DATE Melanie Charles Unit 41 JOB NAME/LOCATION 10 Flint St. Same Salem MA 01970 Bathroom renovation Laundry fit un Kitchen repairs. JOB NUMBER JOBPHONE A We Hereby Submit Specifications And Estimates For: Renovations to existing bathroom/ laundry and kitchen area to consist of the following items: BATHROOM: 1. Demolition of remaining bathroom walls and floor. Debris to be placed in owners dumpster. 2. Removal of closet wall framing to extend bathr000m l'-0" (will be shown on drawing) . 3. Installation of new tub wall and reframe closet to extend bathr000m 1'-0". 4. Installation of R-13 wall insulation in exterior wall and R-11 in all remaining exposed walls. 5. Installation of 1/2" blueboard and plaster on all walls except shower. 6. Installation of 1/2" dura board on shower walls. 7. Installation of subway style tile and border strip on shower walls. 8. Installation of ceramic tile on floor. Note: A tile/grout allowance of $300.00 as been included in this cost. 9. Installation of vanity and vanity top. (materials allowance of $200.00) 10. Install new baseboard and window moldings to match existing as close as possible. 11. Installation of owner supplied wainscoting to a height of 42" above finish floor. 12. Installation of owner supplied shower curtain. 13. Installation of owner suppled bath accesories. 14. Installation of 1 new GFCI, 2 wall sconces and relocate one fan switch. (owner to supply lighting) LAUNDRY: 1. installation ?f owner supplied wainscoting and minor repair to top rail of trim. (as per discussion) KITCHEN/CLOSET 1. Installation of owner supplied wainscoting height of 42" above finish floor on 7' of wall in kitchen. 2. Installation of framing, plastering as necessay to close of old closet door opening. 3. Installation of repairs on closet to existing walls and hardwood floor. Note: walls and flooring to be patched only. MISC: MDB to procure all building ermits. EXCLUSIONS: Plumbing, heating, painting and any unforseen conditions. We Propose hereby to fumish material and labor—complete in accordance with the above specifications,for the sum of: Fi ftv and nn/inn not t ars dollars ($ 9 350.00 �• Payment to be made as follows: Payment 41: $500.00 upon signing (for permit and drawings) . Payment #2: $3,000.00 upon start. Payment #3: $2,000.00 upon rough inspection by City. Payment #4: $2,000.00 upon all walls plastered. Pavinent 5: $1,000.00 u on wainscoting start. Payment 46: $650.00 upon completio . All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications Authorize involving extra costs will be executed only upon written orders, and will become an extra Signa charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tomado and other necessary insurance, Our NThi o workers are fully covered by worker's Compensation Insurance. Note pr posal ma e withdrawn by us If not accepted within 1 s. Acceptance of Proposal -- The above prices, specifications �l and conditions are satisfactory and are hereby accepted.You are authorized Signa to do the work as specified,Payment will be made as outlined above. Date of Acceptance: -f- <QSignature: '-