14 FORRESTER ST - BUILDING INSPECTION (3) ICA _ I S3`� 7 ZS
1 2. The Commonwealth of Massachusetts REC
INSP E VEOCITY OF
Board of Building Regulations and StandardsECrIQN
L Q) Massachusetts State Building Code,780 CMR ReE111 doll
vised
Building Permit Application To Construct,Repair,Renovate Or19"M
One-or Two-Family Dwelling �b A A >
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 P1 6 pg d W �,4 t \ z 1.2 Assessors Map&Parcel Numbers
1.1 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(It)
Front Yard Side Yards Rear 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❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
�
2w`ner-'q(Rec
y /'3(�1�»' �^( � r' D �I S h n 0�� v s
Nam e Print City,State,ZIP /
)�A
No.and Street Te� Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other Specify:
Brief Des ription of ProV,Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 3 1 1 O 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: $
�1 Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 3 ���d: ❑Paid in Full ❑Outstanding Balance Due:
Psi tit L-li5o ('0 l A-
SECTION 5: CONSTRUCTION SERVICES
^5.1 Construction Supervisor License(CSL) mber n (a�2_ �ff5
_ 1)t t 1 1 $A Licen`se'1 Nu Ex 'ra[i Date
m Naeof CSL older bbb �
List CSL Type(see below)
N Street
c Type Description
c U Unrestricted(Buildings u to 35,000 cu.ft.
v,0 A J ` �rc` S 0 1R�3 R Restricted 1&2 FamilyDwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
13 I Insulation
Telex Email address D Demolition
5.2 Registered Home Improve t Co't actor(HIC)
d`Zr �'�/'�t'O HIC Register E pir io
HIC oomp Name Q�HIC Regis e
t�rr 1�1.ti�
MCI Street Emai addre
0.
own,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 AU HORIZATION 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 my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNERS 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 Owner's or Authorized Agent's game(Electronic Signature) Date
NOTES:
1. 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 can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dys
2. When substantial work is planned,provide the information below:
Total floor 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"
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Office of consumer Affairs&Business Regulation License or registration valid for indiVidul Use only
f� ME IMPROVEMENT CONTRACTOR
egfstration before the expiration date. If found return to:
128691
apiration 5/5/2015- Type: Office of Consumer Affairs and Business Regulation
�CYY DBA - {_ 10 Park Plaza-Suite 5170
NORTH SHORE ROOFING ' ++iI Boston,MA 02116
PETER MILLER
281 ANDOVER ST I.
DANVERS,MA 01923 — �D-
Undersecretary y
M....:.uuyvttuout signature
NORTH SHORE ROOFING
281 Andover St. Danvers, MA 01923
(978)977-3816 Fax: (978)762-4667
Mr. Mark Berube 03/20/14
14 Forrester St. Unit 2
Salem , MA.
The following is a proposal to apply a single -ply EPDM rubber roof system on the upper level
balcony roof at the above address .
1) Remove the existing roof systems down to the bare roof decking and legally dispose of the debris .
2) Remove a several courses of the existing exterior clapboard siding in order to properly temunate the
new membrane .
3)Replace any deteriorated or damaged roof decking if and where needed .
4) Install 1/2-in. cdx plywood sheathing over the existing roof decking .
s
5) Install 1-in. polyisocyanurate insulation which will be mechanically fastened into the roof decking .
6) Install a 1X4 pressure treated nailer board along the entire perimeter of the roof.
7)Apply EPDM rubber membrane .060 60 in]. which will be fully adhered over the insulation,
membrane will be brought up and terminated on the exterior wall where the exterior siding was
removed as well as under the below the slider door .
8)Re-install the exterior siding that had been removed .
9) Install pvc trim below the slider door in order to terminate the membrane .
10) Install heavy gauge aluminum flashing .032 along the entire perimeter of the roof color : bronze as
chosen by the home owner .
11) Install aluminum gutter guards (3) 10 ft. sections in the existing gutters .
12) All roof related debris will be legally disposed of by North Shore Roofing .
13) Quote includes a permit .
14)All roof related debris is packed on a daily basis .
15)Ten year warranty on labor and material .
16) If we are contracted for this project we will work with your carpenter prior to the roof being
installed, we will come out and peel back the membrane and cut an opening in the roof so the
carpenter can exam the supports and determine whether it is structurally safe to support a deck .
TOTAL PRICE ROOF: $3,350.00
-5%ANGIE'S LIST DISCOUNT: $168.00
NEW TOTAL PRICE ROOF: $3,182.00
PAYMENT TERMS
1/3 DEPOSIT REQUIRED: $1,000.00
BALANCE DUE UPON COMPLETION: $2,182.00
Remove all debris from the gutter and downspout . $75.00
*Note-If we are contracted for the roof project the gutter and downspout cleaning will be done free
of charge .
Acceptance of Proposal- By signing this proposal you have accepted all of the terms as stated above.
Date of Acceptance 3 ' / Home owner . 1
N.S.R.
Peter Mil er
*Member of the Better Business Bureau*
*Voted "Best of Boston-2010" by Boston Home Magazine*
*North Shore Roofing carries liability insurance as well as workmen compensation*
*Mass. Construction Supervisor License#99622* *Mass. Reg. #128691*
CITY OF SOU EN1, NIASSACHUSE=
• BUILDING DEPARTNEENT
130 W ASHINGTON STREET,3'n FLOOR
�j TE1_ (978)745-9595
FAX(978)740-9846
KImmd.EY DRISCOLL
MAYOR THoma ST.PtEm
DIRECTOR OF PUBLIC PROPERTY/BUILDING CON12\tISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
1
Name(Busim%siorganization/Individual):
Address: a-6
City/State/Zip: [ Phone#: en Ss C 7 LL_
Are you an employer?Check the appropriate box:
1�m a employer with k 4. ❑ 1 am a general contractor and 1 6.Pe ofproject(r :
employees(full and/or part-time).
• have hired the subcontractors 6. ❑Neew construcctionoon
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9• ❑Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.) officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof re its
insurance required.]t employees.[No workers' 13.�Other
comp. insurance required.]
Any applicant that checks box B1 most also fill out the section below showing their worker'compensation policy infum mion.
!I Irrmeowrxrs who submit this affidavit indicating they are doing all work and then him ouride contractor most submit a new affidavit indicating such,
-Comm am,that check this box must attached an additional sheet showing the none,of she mb•wntractan and their worker'comp,policy infomution.
I am an employer that it providing workers'compensation tnsumnce far my employees. Below is the policy and Job site
information. _ _
Insurance Company Name:_ C3_YT17f
Policy#or Self-ins.Lie.#: U e) L'22 COD Expiration Date:
Job Site Address: Ew-C.P_S12 &A: City/StatdZip: S�
Attach a copy of the workers'compensation policy declaration page(showing the policy numbor and exptradon date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to SI,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
!do hereby c under llte !n m penalties ojperfury that the information provided above 1 true and correce
SiLn l t e'- Date:
Phon
Official use only. Do not write in this area,to be completed by city or town oJficiaL
City or Town: PermiMceuse#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: