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25 GRANT RD - BUILDING INSPECTION (2) The Commonwealth of Massachusetts / Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section ForPKcial Use Onl Building Permit Number: Date Applied, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1a Pro er ,5p�i>^aty Addres 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(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 Zane? Municipal ❑ On site disposal system ❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Reco d: 7-'Z7-yLe �Ie.jw /4� Name(Print) City,State,ZIP 27R�ht5 7J// �Imrre No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied X Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description f Proposed Work': / r- o SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $,,s �J®, O 0 Paid in Full /�0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (soo_ 34 )one, Are A i fe License Number Expiration Date Name of CSL Holder 3 a tyc)0-1•1 Sf-- YAS*hTT71`, List CSL Type(see below) No.and Street Type Description M Q'g I U Unrestricted(Buildings u to 35,000 cu.ft.) e rh din/ /�/ R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC J Covering Windoc7f1_SGMC.c� .loc"`� WS Window andSiding l/5 SF Solid Fuel Burning Appliances I Insulation -Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC A 1 )ySto ehG1lirnn Sw 1� 33B �l 5 HIC Registration Number ExpfrationoDate HIC Co pany Name or HIC Registrant It /I 9t �; ►f���; I 5 xlr!C7tL�J% /loy N/r� , N and Street rmail address �wa pS�ort-�f�i o/1�7 7B/-S9'3•�33 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 ..........�c 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 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, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to t e best f nowledge and understanding. NA-rk ti/ tvwc e 4-�I Print Owner's or Authorized Agent's Name(Electr wSignature) Date NOTES: l. 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" 12/01/2010 17:03 FAX 781 314 3286 Waltham Building Deft. Q 001 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Please Print Le¢ib11 ,Applicant Information -- • Name(Business/Organization/individual): Address: 4 5 N)eu.J © cep- Sfi p: SWcinn 5c.olrV Ak(k Olgo' Ph7sbe7. S - a333 City/State/Zip: Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general nd I 6 New construction 1 Al am a employer with__ have hired the tors employees(full and/or part-time).* ]fisted on the att . 7. ❑Remodeling 2.❑.I am a sole proprietor or partner- These sub-cone 8. ❑Demolition ship and have no employees employees anders' . y. Building addition working for me in any capacity. comp.insuranc [No workers' comp.insurance 5 We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their I l.❑Plumbing repairs or additions 3.❑ J am a homeowner doing all work right of exemption per MGL - 12.El goof repairs myself.[No workers'comp. - c. 152,§1(4),and we have no insurance required.]> 13.0 Other employees.[No workers' comp.insurance re uired.] 77--applicant that checks box NI must also fill out the Gwh.o below showing their workers'compensation policy intbrmation. �Anyi Homeowners who submit this affidavit indicating they are doing ell work and then hire outside eonbactors must submit anew not those entities have asidivit iedicating ouch. tConh'aotors that check this box must attached an additional sheet showing the name of the subcontractors ead state whether,or not those ampleyees. Iftheeub-contractors have empicI airy most provide their workers'comp.policy number. policy and job site �PY I am an employer that is providing workers'compensation insurance for my employers. BeTaw is the information. �. Y�s ,�_ jYb4/�'�. Insurance Company Name: h11 y �J�'( Jr ._L S S Q M �� Z Policy#or Self-bus.Lit.#: Expiration Date: / ,t,�. ��� City/Smte/Zip: �-je, `_I Job Site Address: iY 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 nt;as well as civil penalties in the form of a STOP WORK ORDER and a fine lineup to$1,500.00 and/or one-year imprisonme 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. fP I ry I do hereby car under Fe airs ar renalttes a er u that the Tnformahan provided above is Vile an e tare: � hoe 7 3a3 � FAutb only. Do not write in this area,to be completed by eery or town official - Per tit/License# ! n: . ority(circle one):Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: i i I Prop p,Psals t AND ESTIMATE i r PROPOSAL SUBMITTED TO: DATE: Iloilo June Richards August 16, 2011 STREET PHONE MAHIC:N125338 25 Grant St. (978)745-7711 MA CSL:989583 ' CITY,STATE,ZIP CODE PHONE P.O Bo.287 Salem, MA 01970 (978)317-5684 Sua...p.cac MA 01907 EMAIL 781-59781,59 or 140 t 48R9(Xl S 781.595.11gO t:ax We propose the following: • Stage the chimney. • Rebuild the chimney from the roofline - up. • Re-flash chimney with new lead flashing. • Install a stainless steel chimney liner in the furnace flue of the chimney. • Re-install current stainless steel chimney cap on top of the chimney. • Remove woodstove pipe from heating flue and seal opening with brick and mortar. Cost: $8,200.00 Cost in getting permits: $63.00 (cost included on balance due payment) The installation of new stainless steel chimney liners comes with a lifetime warranty as long as Billy Sweet Chimney Sweep inspects and sweeps the chimney annually. Take advantage of our annual 20% Spring Discount for inspecting and sweeping your chimneys during the months of February and March. WE PROPOSE hereby to furnish material and labor—complete in accordance with above specifications,for the sum of. ***** Eight thousand two hundred and 00/100 ***** Dollars ($) 8,200.00 PAYMENT TO BE MADE AS FOLLOWS 1/3 ($2,734.00) deposit in advance, 1/3 ($2,734.00) payment at the start of work, balance ($2,732.00+$63.00=$2,795.00) due upon completion. Advance deposits are non-nefundrable in case of cancellation bY customer All material is guaranteed to be as specified. All work is to be completed in a substantial workman- --- like mannfr m according to specificationsinvolving h cper osts ill se practices.only upon wfionor Any deviation from above specifications involving ext2 costs will be executed onlyupon wntlen orders, AUthoflied and will become extra charge over and above the estimate. All agreements contingent upon $I nature ` strikes,accidents or delays beyond our control Owner to carry fire,tornado and other necessary Note:This proposal may be insurance. withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL: The above prices, specifications and /F'.t.2a—�`J conditions are satisfactory and are hereby accepted. You are authorized to do the work as Signature:�.�L<-�- specified, Payment will be made as outlined above. (j_ P Signature: Date of Acceptance: j �� ' / 08/23/2011 04:23 7815951140 BILLY SWEET CHIMNEY - PAGE 02/03 .11a>vtchuartt.- Dcp:u�mcnt of PubFic�;d'ct� Board of Buildin_ Rc_ulatinm and �,rmdard> Construction Supervisor License License: CS 105348 JONATHAN WHITE 33 NORTH ST METHUEN, MA 01844 Expiration: WIM13 ( •..... Tr-.•: 105348 Failure to possess a currant edition of the Massachusetts state Buildittg Code is cause for revocation of this license 'afar to: W W W.Mass.Gov/DPS . d k Office of Consumer Affairs and usiness Regulation 10 Park Plaza- Suite 5170 Boston, Massaebusetts 02116 Home Improvement;Groritractor Registration Registration: 125338 - Type: DBA Expiration: 1124/2011 TrA 2M915 BILLY SWEET CHIMNEY SWEEIy WILLIAM SWEET PO BOX 287 - SWAMPSCOTT, MA 01907 Update Address and return eard.Mark reason for change. .. ._- Address Renewal n Employment Lost Car OPSCAl 0 SUMW04-G101216 OT �orzrrearurea�� o�.�aaoac%uaelA Office of Coosvmer Affairs&Business Regulation or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 11 Registration .�25338 Office of Consumer Affairs and Business Regulation Expuaticip. -ONZWO11 Tr* 290915 10 Park Plaza-Suite 5170 f3Bfd Boston,MA 02116 Type BILLY SWEET CH WILLIAM SWEET -" 45 NEW OCEAN STREB.T SWAMPSCOTT,MA01507 . Undersecretary N valid without sig nature gnatnre 00/23/2011 04:23 7815951140 BILLY SWEET CHIMNEY PAGE 01/03 a r r i • 1 P.O.Box 287 Swamp.aorr MA 01907 781-593.23.33 or 800-2484900 F 781-595-li fax AX danLUillysveetc6imimoeysweep.com To: Salem Inspectional Services Fax: 978-740-9846 From: Dan Junkins phone 781 -593-2333 fax 781-595-1140 Date: 8/29/ 2011 Pages Following: 2