40 FLINT ST - BUILDING INSPECTION (2) Z ! 01= Z
a The Commonwealth of Massachusetts CI"fY OF
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CNIR SALEM
Revived Slur 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fmnily Dwelling
This Section For Official Use Only .
Building Permit Number: Date Ap le : j i —O ram— t 3
Building Official(Print Name). Sigitalure' Date
SECTION Ik SITE INFORMATION
I.I Proper Address: 1.2 Assessors Map&Parcel Numbers
46 F Il wTi S1"
I.1a 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 Il) Frontage(11)
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:
Zone: _ Outside Flood Zone'?
Public❑ Private❑ Check ifyes❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTYOWNERSRIPI
2.1 pwnert of Record:
One(Print) Cily,Slate,ZIP
40 'FI or s T ?B33 S- 7sf
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) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Specify: 4yn e..d P�,Dmr'
Brief Description of Proposed Worke: S'-/r-;p -n6 Re• Rwr
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor and Materials
I. Building ;$ vi) o0 1. Building Permit Fee:S Indicate how fee is determined:
Electrical S ❑Standard Cityfrown Application Fee
2. ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S L Other Fees: S
4. Mechanical (FIVAC) S List:
5. Mechanical (Fire S
Su ression) Total All Fees: S
,'` Check No._Check Amount: Cash Amount:_
6, Total Project Cost: S a r)00 OJ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /40(9-0ioa
(Li0 1 r!4/`. License Number Expiration Date
Name of CS Holder /�
List CSL Type(see below) ICF
�o.and Street Type Description
U Unrestricted(Buildings tip to 35,000 cu. It.)
I-• R Restricted 1&2 Family Dwelling
Citylrown,State,-ZIP wl Ntasonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
'.�,O( SS 5 1 Insulation
Talc hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) J Y1 228
in C,:;04Skr---Fro,l HIC Registration Number Expiration Date
FIIC Company Name or HIC Registrant Name
Nr and Street Email address
LY�Q,*) , me-3, 7)els5fraI
Cit —State,ZIP 'tole hone
SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.C.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"
I,as Owner of the subject property,hereby authorize Cbt`i S Comer, 3 L"/lw...—)
t9 act on my behalf, in all matters relative to work authorized by this building permitjifpplication.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW 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 in this application is true and accurate to the best of my knowledge and understanding.
Print( wner's or Authorized Agent's Namc(Electronic Signature) Dale
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 Florae Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under bLG.L.c. I42A.Other important information on the HIC Program can be found at
www.niass.eov'oc:t Information on the Construction Supervisor License can be found at w%aw.nass.aoc'dns
2. When substantial work is planned,provide the information below•.
Total floor area(sq. It.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. tt.) 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
1 "Total Project Square Footage"may be substihrtcd for"Total Project Cost"
%4 CITY OF SZUEIri, lL3SSACHUSETTS
BUILOLNG DEPARTMENT
f it• 120 WASHINGTON STREET, 3}a FLOOR
TEL- (978) 745-9595
F.A.Y(978) 740.9846
KINIBERL-EY DR.ISCOLL T imw STTIE.¢RK
MAYOR DIRECTOR OF PUBLIC PROPERTY/BUILDING CO%0'iISSIONER
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
A i li ant Information Please Print Legibly
s t l 2 LL r..T `e� 2 (ttn�r. .LnJL
V alnL' (ItusincvvOrganization'Individual): r�ir„s
Address:
City/State/Zip: L)�.y/y n& 000 Y Phone H:7ef Ski 5 /a-t f
—r
7-asolc
mployer?Check the appropriate box: Type of project(required):
mployer with add 4, ❑ 1 am a general contractor and 1 6. ❑New construction
ees full and/or art-time)." have hired the sub-contractors
( p 7. El Remodeling
ole propr suer or partm r- listed on the attachedsheet.d have no employeesThese sub-contractors haveS. ❑ Demolition
g for me in any capacity. workers' comp.insurance. 9. Building addition
rkers•'comp. insurance 5. ❑ We are a corporation mid its 10 ❑ Electrical repairs or additions
required.] officers have exercised their
right of exemption r MGL I I.❑ Plumbing repairs or additions
3.❑ I am a.(No workers'
doing all work c y152,§1(4),and we have no 12. aof repairs
myself.[No workers' comp.
insurance required.] t employees. [No workers' 13.❑ Other
comp. insurance required.)
-Any applicant slut checks box 9 t most all,lilt out the seaian below showing their worker'compensation policy inlnrmution.
'I lomatwrors who submit this afrktavit indicating Ihey are doing ail work and then hire outride contractors most submit a new a fr.davit indicating such.
:c trwtun,that check this box must anached an additional.hota showing the mmne of the subeantrctors and their workers'comp.policy information.
i um an employer that is providing workers'conipeasarlon insurance for my employees. Below is the policy and fob site
information.
Policy a or Self-ins. Lic. 1): S SOf U b T_1n _6 Expiration Date:��.-,J-40/3
ya Fliwr A
y
Job Site Address:__ �S alle, City/State/Zip: 9Lr+ ?- -
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration data}.
Failure to secure covemge as required under Section 25A of yfGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.0o and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line
of up to S250.00 a day against file violator. Be advised that a copy of this statement may be forwarded to the Office of
In vest igutions of the DIA For insurance coverage verification.
i do hereby certify under due pains and penalties of perjury that the information provided above is true and correcL
i' n t
Phoned* A�S�l_L/oe-�
Official use aiily. Do not write in this area,m be completed by City or town official
City nr'1'uwn: Permitil.lcenseA----.___—_._.-------.---...--
Issuing Authority(circle one):
1. Board of health 2. Building Department 3.Cityfrown Clerk 4. Electrical lspector 5. Plumbing Inspector
6.Other . ......_— ---...___.. ..
C(intact Person: .__ .__-- Phone B:`_
1
CITY OF 5t1I.EM. UXSSACHUSETTS
t . 8LimL\,G DEPARTMENT
120%VIASHLNGTON STREET, 311D FLOOR
� + TEL (978) 745-9595
F.tu(978) 740-9846
KI1tBERL.EY DRISCOLL
tiLNYOR THOsw ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/KULD NG COXNISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section I 11.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit t# is issued with the condition that the debris resulting from
this work 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:
y -Do (VGY—
(namepf hauler)
The debris will be disposed of in
(name of facility)
G(address"
signature of permit applicant
date
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jt Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Cunstruction Sullen'isor Special,,
License: CSSL 101220
st i is
WILL R Y92A[igNT JR v
215 VERON4 STREET a:
I YNN MA 0J 904 t
Commissioner Expiration
02/110/20114
Techevolution Fax:7814595988r Oct, 7 2013 12;54pm P001 �a
TRAHANT JR. CONSTRUCTION INC,
4TH GENERATION ROOFING
J�JJ 215 Verona Street
LYNN, MASSACHUSE-M 01904 CSL u101220
(781) 599-1211 •(781)844-4551 • FAX: (781) 581-0855 H.I. LIC. #141778
'?ROFOSAL.Su@ramEO To Mow
J '115
.M, WE aP WOE A8 LpC,TM
sia r/
We hereby submit sbecficabons and estimates for: We hereby submit specifications and estimates for:
SHINGLE ROOF FL"UBBER ROOF
� mp entire roof Rv;*f8.,r ❑ Reshingle ❑ Sweep entire roof clean
Re ce any bad boards up to 100 linear feet ❑ Stsip entire roof
Ins If ice and water barrier firstthree feet up roof_ '. r`j" Mechanically fasten down ISO board insulation
to and along dormers ❑Install 060 Rubber Roofing on entire roof
In II ice and water barrier m all valleysµ -_�
Install 151b. felt paper on rernalrlder of roof roof ❑ InstaN metal flashing around perimeter of building
s I eight Inch drip edge CylWhite ❑ Black C Mill - p flash chimneys), pipe(s)and wall(s) -M m
�'.Iri— ridge vent --_— _- [I Edge.caulk all seams
�r re-flash ehimney(s) ❑ Nistall new copper center drain
in new pipe flanges _ O Other.
nstall lifetime shingle i olor . C
- _- S p Clean up all debris
0 install gutters and downspouts - w❑ Labor and materials guaranteed 100%for five years y
Instal(trim coil _....-_...._ ., ------
.L7 Install new fascia boards
❑_)nstall new rake boards -
J
; 7 Nistall sky light(s)
.❑ -r
C- n up all debris �-���-~,-`----------�~ ��
Ca r and materials guaranteed 100%for five years
NI.Shingle roofs are nailed by hafid. - w ..-` — ------ ---- -
'ATz PrDynoo hereby to furnish material and labor - comblete in accordance wi above specifications, for me sum of
Total Price($r ,fir.C30 ).
•'IF YOU ARE HAVING YOUR ROOF STRIPPED PLEASE COVER ALL VALUABLES IN ATTIC, AS
WE HAVE NO CONTROL OVER DEBRfS 7HA MAY FALL THROUCsH ROOF BOARDS.`°
All material Is auaranaeed to be as specredd.all work m be comolelea In a workmanlike
manner according to standard prat oes.Any alteration or dedmzon trim above specftea AuMori2e8'� l
dons erra"extra costs win be.eaecutad only upon w tmen orders,and wet bacoma an Signature
extra charge Oyer add above the estimate.All agreements contingent upon scribes,
'ScCldallts or delays beyond our control,owner to carry fire,tornado,and Other mcessary
L;"Qur wodmrs am fully covered by Workonnn's compensation lftv9 ce.
2T rzy0oal-The above pNces,specihcat onsns are sabsfa ory and are hereby accepted.You are authorized to as specified.Peymenmade as outlined above.
eptanCpu Cagy t0 Bo0.9 etl�tiv. /