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14 GLOVER ST - BUILDING INSPECTION (3) t One or Two-Family Dwellin;; The Commonwealth of Massachusetts Board of Building Regulations and Standards�`, Massachusetts State Building Code- 7 (Et�41t�ED Marblehead Building DeparbrIMII �SERVICES This Section For Official TTUppse Only Building Permit Number Date of`3 io q (.� Signature Gam_4� v J Building Commissioner/Local Inspector Date ' SECTION 1: SITE INFORMATION 1.1 Property Address 1.2 Assessors Map& Parcel Numbers �-- //G"_E1J 17-- 5 32t !�{�0�97o Is this an accepted street? Yes C9' No ❑ Map Number(s) Parcel Number(s) 1.3 Zoning Information 1.4 Property Dimensions Zoning District Proposed Use _Lot Area(sq:ft) Frontage(R) 1.5 Building Setbacks(feet) Front Yard Side Yard Rear Yard Required Provided Required Provided Required Provided 1.6 Water and Sewer Municipal ❑ 1.7 Flood Zone Information 1.8 Conservation Commission Private ❑ On site disposal ❑ Flood Zone N/A❑ DFP Number 40- N/A ❑ 1.9 Old& Historic Commission 1.10 Site Plan Review 1.11 ZBA Special Permit COA Number N/A❑ Date filed N/A❑ Date filed N/A❑ SECTION 2: PROPERTY OWNERSHIP 2.1 Owner of Record Nam it Add s fo ry c x2- �> Sign ur o � ter Tele o� r SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) Existing Building New Construction ❑ 1 Accessory Bldg. ❑ Addition ❑ Alteration(s) Repair(s) Fr Demolition EdOwner-Occupied Number of Units °J Other ❑ Specify: Description of Proposed Work: SECTION 4: ESTIMATED CONSTRUCTION COST _ BUILDING PERMIT FEE Item Estimated Cost abor and materials) This Section For Official Use Only (l 1. Building $ 1110 019 L� 11_b' .� Building: $10/$1000 2. Electrical $ Building+Plumbing: $12/$1000 Buildin ectrical: $13/$10 3. Plumbing $ Building+ Electrical+ Plumbing comb' ed: $151$1000 4. Mechanical (HVAC) $ Total project cost(labor and materia )$ QL•� 5. Fire Suppression $ Fee multiplier from above$ 1000 6. Total Project Cost $ !f Z;S�yJ/0-0 Permit Fee$ Receipt Number SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) '1#0 #5 License G5'/O15&9 Expiration Date 7-1z7'/� Name of CSL Ty e Description Unrestricted(up to 35,000 Cu.Ft.) AddL _ R Restricted 1&2 Family Dwelling .1U ��, r M Masonry Only Signature RC Residential Rooting Covering O WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Telephone f D Residential Demolition 5.2 Home Improvement Contractor Registration (HIC) Registration � Expiration Date HICCI`owmpany/Na!NAR7trant Name Address Signature ri17• -/9/ •OL 7 Telephone SECTION 6: WORKER'S COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c, 152:§ 25C(6)) Worker's Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide an insurance affidavit may result in the denial of a building permit. Signed affidavit attached? Yes ❑ No ❑ .SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CO RA TOR APPLIES FOR BUILDING PERMIT 1,--j9flft , as Owner of the subject property, hereby authorize l(-FJ*45 5�,16 to act on my behalf in all matters relevant to work authorized by this ermit p lic ion. Signatur o dwner Date SECTION 7b: OW R OR AUTHORIZED AGENT DECLARATION 1, as Owner or Authorized Agent,hereby declare that the statements and ' f ion on the fore oing application are true and accurate,to the best of m nowl ge ann�elief. x X (,VIA-L� Signa[ re of ter or Au orized Agent (Signed under the pains and penalties of perjury) Date' SECTION 8: DEBRIS DISPOSAL - All dumpsters of six(6)cubic yards or more are required to have a permit from the d Fire department: call 784 6t9 41AIr�. In accordance with the provisions of 780 CMR and MGL c40,§ 54 a condition of issuance of this building permit is that debris resulting from any work performed shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL el 11,§ 150a. DEBRIS DISPOSAL LOCATION SIGNATURE OF APPLICANT NOTE 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El lectricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): /j���j (�f eLMY Address: YJ 0,eW City/State/Zip: - / Phone #: Yo/7DO � Are you an employer?Check the appropriate box: L❑ I am a employer with 4• ❑ I am a general contractor and If project(required): 2.�employees(full and/or part-time).* have hired the sub-contractorsNew construction I am a sole proprietor or partner- listed on the attached sheet. emodeling Ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' emolition[No workers'comp. insurance comp. insurance.t uilding additionrequired.] 5. ❑ We are a corporation and itslectrical repairs or additions3.❑ I am a homeowner doing all work officers have exercised theirm self. lumbing repairs or additions y [No workers' comp. right of exemption per MGLinsurance required.]t c. 152, §1(4),and we have n000f repairsemployees. [No workers' ther comp. insurance required,] 'Any applicant that checks box#1 most also fill out the section below showing then workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:-X-MC 7 y ")pf Policy#or Self-ins.Lic. #: J7j D)� / UtLSI � Expiration Date: /. rj,/4 Job Site Address: l YC3/Y/VSI sr l3 tn.. 4/�9,1-70� City/State/Zip:�%hjjrAy yG1/d-nG?� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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$1,500.00 and/or one-year imprisonment,as well as civil penalties.in the form of a STOP WORK ORDER and a fine of up to$250.00 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. I do nereay c' / and r the ably mad penalties ofperjury that the information provided above is true and correct. Si pure: Phone#: 617' 7�/' Official use only. Do not write in this area,to be completed by city or town ofcial City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/I'own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: L Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the Service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual, partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged hr a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating ctment policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/din i Page 1 of 1 Brian•Brinkers From: thomas shilling [tshilling@comcast.net] Sent: Tuesday, October 06, 2015 9:04 AM To: brian@acmesigncorp.com Subject: Revised Contract for Permit Shilling Carpentry 47 Orne Street Marblehead, MA 01945 617-791-0227 Client Proposal/Contract October 6,2015 Brinker Residence 14 Glover Street Salem,MA 01970 SCOPE OF WORK: All work to be completed in compliance with Mass building codes and architectural specifications as agreed to. Exterior: House: 1)Stage&demo existing sidewall trim elements-clapboards,aluminum flashing,and window trim. Labor:$6,000.00 2)Apply new pvc exterior trim elements,corner-boards,comices,rakes,flashing: Materials:$4,200.00 Labor:$5,500.00 3)Apply new clapboards: Materials:$16,200.00 Labor:$18,000.00 4)2 Front porches,additional framing new decking($3.50 LF),stairs,and railing systems: Materials:$3,920.00 Labor:$6000.00 Garage: 5) Remove existing garage floor,excavate soil to add 4"crushed stone and 910 gage wire mesh,pour 4 new support footings install 4 new lolly columns,porn 4"of 4000psi concrete with power trowel smooth finish. Labor&Materials:$10,720.00 Labor:$35,500.00 Materials:$24,320.00 Material Disposal:$1,500.00 Masonry Labor&Materials:$10,720.00 Electrical:$500.00 Total:$72,540.00 Building permit not included in estimate. , Note:Final payment due upon completion. Scheduline:The above work will led once a signed contract is returned and agreed upon deposit is received unless prior arrangements have been made.Unless otherwise agreed,all specified work areas are to be do furnishings before work begins.Any areas not ready are subject to an additional charge of$50.00 per hour. Other: y CI_eanine: miles will "b t"clean. �Apr-N kl� Any dis tes no sen ct to b� tion. e, / Homeowner' Shilling Currently:Thomas S illine r 10/6/2015 I _ Massachusetts -Department of Public Safety Board of Building Regulations and Standards - Construction Supervisor License: CS 101569 . THOMAS E SHRON 160 JERSEY ST _ MARBLEHEAD MA Expiration Commissioner 02/27/2046 c�TTe4v ,,ea/chic 71T/�t '1 Office of Consumer Affairs&Business Regul9tioo t OME:IMPROVEMENT CONTRACTOR Type: egistration A60856 OBA Expiration F71 TIM SHILLING CARPNTRY ' kr i € 1 THOMAS SHILLING 41 ORNE ST '` u F:. — — 'MARBLEHEAb,MA 01945 Undersecretary OONarT�� Commonwealth of Massachusetts 3 q Citv of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 \, Return card to Building Division for Certificate of Occupancy Permit No. B-15-1111 PERMIT TO BUILD FEE PAID: $792.00 DATE ISSUED: 10/15/2015 This certifies that BRINKERS BRIAN has permission to erect, alter, or demolish a_building,14.GLOVER_S_TREET Map/Lot: 330557-0 as follows: Repair/Replace HOUSE: STRIP EXTERIOR TRIM; APPLY NEW TRIM & CLAPBOARDS. ALTER FRONT PROCHES; ADD NEW RAILINGS & DECKING. GARAGE: DEMO EXISTING FLOOR & PREP FOR CONCRETE FLOOR'S ***06/15/2016 Contractor, Thomas E. Shilling came in with letter TERMINATING his involvement in this project*** ` letter placed in street file. Contractor Name: THOMAS SHILLING `I } DBA: SHILLING CARPENTRY t Contractor License No: CS101569 k I � 10/15/2015 I` -Building Off icial i Date i This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. 'y I All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. f I j All construction,alterations and changes of use of any,building and structures shall be in compliance with the I cal zoning by-laws and codes. I -� This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspech'on for the entire duration of the work until the completion of the same. I The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided bn this permit. i HIC#: 160856 'Persons contracting with unregistered contractors do not have access to the guarantyfund'(as set forth in MGL c.142A). Restrictions: Shilling Carpentry 47 Orne Street Marblehead, MA 01945 Tel: 617-791-0227 Re: 14 Glover Street,Salem, MA 01970 To Whom It May Concern, Please be advised that I,as contractor,have terminated my involvement in the project at the above captioned address with effect from June 15, 2016. The building permit is attached hereto. Thomas E. Shillin June, 15, 2016 The Commonwealth of Massachusetts RECEIVED CITY OF Board of Building Regulations and St 8CTIONAL SERVICESSALENI Q� Massachusetts State Building Code, 78 1� Revised,Nur2011 Building Permit Application To Construct, Repair, RenoMj ffeflliska 10 35 One-or Tivo-Family Divelling f This Section For Official Use Only Building Permit Number: Date Applied: 1 Building 011icial(Print Name). . Siytature• . . Date 1 SECTION 1:SITE INFOR,NIATION I.1 roper Address: CC__ a I.2 Assessors Alap&Parcel Numbers / l�fy�T 5� .xrl�2 v✓I �pl I.I a is this an accepted street? es no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy tl) Frontage(11) L5 Building Setbacks(D) Front Yard Side Yards pear Yard Reyuimd Provide) Reyuired Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if es❑ r SECTION 2: PROPERT V OWNERSH10: 2.1 Owner of Recor Sy 1e M Fvll�elt�� 1/al(t° ;me(Print) City,state,ZIP ! � Willa U Sfi G e 38a)1/ e �t •CD,r� No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction[3, Existing Building❑ Owner-Occupied ❑ Repairs(s) O Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: —� Brief Description of Proposed 1Vork2: e.I IL _� h c �/ 22X SECTION a: ESTINIATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials - I. Building $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $' 2 Patter Fees: $ �)"` x � 4.�Nlechanical (HVAC) $ LisC 66 5.Mechanical (Fire $ Total All Fees:S Suppression) Check No._Check Amount: Cash Amount: Project Cust: S ❑Paid in Full ❑Outstanding Balance Due: �60 i SECTION 5: CONSTRUCTION SERVICES 5.1 Constructimt Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL'fype(see below) Type - Description No. uhd Street U Unrestricted((Buildinp u2 to 35,000 cu. It. R Restricted I&2 F:unil Dwellin City/Town,State,ZIP M Masonry RC Rooting Covering WS Window and Sidin SF Solid Fuel Burning Appliances I I Insulation Telephone Email;nJJress D Demolition 5.2 Registered dome Improvement Contractor(HIC) HIC Registration Number Expiration Date 1IIC Company Name or HIC Registrant Name No. and Street 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 Isluance of the building permit. Signed Affidavit Attached? Yes ..........❑ No...........El 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:OWNEIii ORAUTHORIZED AGENT DECLARATION By entering my name below, 1 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. 1/oi/I:F 119-/ 3- / T Print Owner's or Authorized Agent's Name(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 nut have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at w vwv nhass.cov:'oea Information on the Construction Supervisor License can be found at ytjlA�s . 2. When substantial work is planned,provide the intormation below: 'total floor area(sq. R.) '� .(including garage, finished basement/attics,decks or porch) Gross living area(sq. it.) - Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms dumber of half/baths Type of heating system Number of decks/porches Type ol'coolingsystem Enclosed Open 3. "Total Project Square Footage'may be substituted for"TuLd Project Cost" ��� j�-� , �.1� s ��pC�E (zvo�z. oF- P.p��� per-��? L �25��� s�-sz � C'-�z �t � .� CITY OF SALEM, MASSACHUSETTS BUILDING INSPECTOR 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 Enkeleida Valle 18 May St Salem, MA 01970 I QTY OF SALEM, MASSACME TTS BUILDING DEPARTMENT 120,WASHNGTONSTREET,3" FLOOR 7�L. 978( )745-9595 KIMBERLEY DRISCOLL FAX(978)740-9846 MAYOR TrIOMAS STTIERRE DIRECTOR OF PUBLICPROPERTY/BUILDING COMMISSIONER HOMEOWNER LICENSE,EXEMPTION PLEASE PRINT: 2 Date Job Location / q der y S7� r Home Owner Address 5 7 VI-! Present Mailing Address /?3 AlAV -sr / Solew fql 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 INSPECTOR � YY osoo-qz - may l50 SL Le c o-sz Y 1 esao-9z