51 FORRESTER ST - BUILDING INSPECTION \VET CES
The Commonwealth of Massachusetts CT10NP ITY OF
Board of Building Regulations and Sta C,0F tiI
Massachusetts State Building Code, 780 Cb��IIRrr�� , 1 P Revised Uir 2011
Building Permit Application To Construct, Repair, RenovlAr Demolish a
One-or Two-Family Dwelling
This Section For OfficiaP4a Only
Building Permit Number: Date ppliedt
Building ollicial(Print Name), Signature, Date
( SECTION 1:SITE INFORNIATIOIV.'
1.1 Propertygress: 1.2 Assessors Map&Parcel Numbers
^� 1.1 a Is this an accepted street?yes no Map Number Parcel Number
U1.3 'Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Arca Is R) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) t.7 Flood Zone Information: t.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if es❑ P
SECTION2: PROPERTY OWNERSHIP,'
2.1 O�wye..l[t of Record;
%
1'0
✓/i7hv J 2 AOR D�
Name(PrA city,State,ZIP
57 L 33 37!
No.and Strect Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building Cl Owner-Occupied ❑ 1 Repairs(s) ❑ Altemtion(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief scrip .o of Proposed W/oW:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cosh(Item 6)x multiplier x
3. Plumbing S 2'?Qther Fees: .S
t.Mcchuiical (HVAC) S List:
5.Mechanical (Fire S Total All Fees:S
Suppression)
r•r P Check No._Check Amount:—Cash Amount:_
6. Total Project Cost: $ �p 7 7� ❑paid in Full ❑Outstanding Balance Due:
5r— 5 1 S
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Dale
Name ofCSL Holder
List CSL'fype(see below)
Type Description
No. :mdStreet
--
U Unrestricted Buildin a to 35,000 cu.J11
R Restricted 1&2 Family Dwelling
Citylfown,State,ZIP M I Mason
RC I Roolhar Coverin
WS Window and Siding
SF Solid Fuel Burning Appliances
I I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Dale
HIC Company Name or HIC Registrant Name
No.acid Street Email address
Cityfrown,State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL;a 151.12$Q15)}
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
t9 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: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
contain 't this application is true d accurate to the best of my knowledge and understanding.
z
Tint 0% s or Authorized Agent's Nano(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 Home Improvement Contractor(HIC)Program);will not have access to the arbitration
program or guaranty, fund under M.G.L.c. 1 d2A. Other important information on the HIC Program can be found at
%cww masS :ov'oca Information on the Construction Supervisor License can be found at www.mass.��os%Sh .
2. When substantial work is planned,provide the information below:
'total floor area(sq. ft.) 4 .(including garage,finished basement/attics,decks or porch)
Gross living area(sq. R.) Habitable room court
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 substiluted for"Total Project Cost"
I
aCITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT120 WASHNGTONSTREET,3" FLOOR
TEL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THOMAS STTIERRE
DIRECTOR OF PUBLIC PROPE RTY/BUILDING COMMIISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date J �S II II
Job Location Ale"" 44
Home Owner Address L
Present Mailing Address
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one•or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable
to the Building Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner" certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INS
KICK ALEX HOME REPAIR Estimate
94 Foster Rd
Swampscott, MA 01907 Date Estimate#
3/4/2015 454
Name/Address
James Testa
51 Forrester Ave.
Salem, MA 01970
Project
2nd floor kitchen
Description Qty Rate Total
Demolition of existing cabinets, ceiling as needed, 500.00 500.00
counters, soffit, wall oven box and wall materials.
Disposal of demo materials. 300.00 300.00
Install drywall on all kitchen walls and finish 560.00 560.00
except where cabinets will cover.
Labor and materials to provide and install new 1,960.00 1,960.00
kitchen cabinets per homeowner sketch.
_ land -46
Labor and materials to install new drywall ceiling . 460.00 460.00
Screws and seams finished to be paint-ready.
Quarter-round trim will be installed where ceiling
and wall meet.
Total
Phone# E-mail Web Site
781-268-3030 rick@rickalex.com ww ,.rickalexhomerepair.com
Page t
IM94FosterRd
Swampscott, MA 01907 Date Estimate#
3/4/2015 454
Name/Address
James Testa
51 Forrester Ave.
Salem, MA 01970
Project
2nd floor kitchen
Description Qty Rate Total
Labor and materials to install new countertop over 775.00 775.00
base cabinets per homeowner sketch.
Includes new 25" single bowl stainless sink and
basic faucet. Includes new water lines and drain
connection.
Countertop product quoted is Hampton Bay Tempo
Laminate Countertop in Milano Brown.
ing 250 00 459A
P--_.__ P•
Provide and install 720.00 720.00
12-ft-Wide-Bristol-Haven-Oak-Gunstock-Vinyl-Sh
eet-Flooring(wood look). Based on Product cost of
$1.17/sq. ft.
Dishwasher Installation. Includes mechanical 200.00 200.00
installation, electrical hookup, water line and drain
connections.
Labor and materials to paint kitchen walls, ceiling 350.00 350.00
and trim.
Total $6,475.00
Phone# E-mail Web Site
781-268-3030 rickRrickalex.com www.rickalexhomerepair.com
PagT2
CITY OF SALE4 MASSACHUSEM
} BDA.DiNG DEPAR4MEP&Nr
120 WASHMTON STREET,YO FLOOR
TEL.(978)745-9595
FAX(978)740-9846
KIIvIBERLEYDRISOOIL
MAYOR THomm ST.PIERRE
DmEcroR OF PUBMPROPERTY/BuIILDING a)AanssioNER
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 111.5 Debris,
and the provisions of MGL 00, S 54; Building Permit# is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be/ transported by:
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
ature of applicant
- 7 /S
ate