9 GREENWAY RD - BUILDING INSPECTION (4) - � 4 -'X
-7 94 - � � L� s3 � 3 2-s
j The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR �1qq Srly �$Building Permit Application To Construct,Repair,Renovate Or De U[i0 a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
�b )1
Building Official(Print Name) Signature Oak
SECTION 1:SITE INFORMATION
1. Pro erty Address: 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?les 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 Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
Name(Print) C �t2'1P � � ,C� I
(91-) 3,,5 3 - t
No.and Street I Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other . Speci :
Brief De do of Propos d Work :
XA
SECTION 4:ESTIMUTED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ '�t� 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: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $Z 0 ❑Paid in Full ❑Outstanding Balance Due:
M
�kl�s
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
���Q �(- YA: � CzR 9 (o 22
License Number E iratio Date
Name of CSL Holder
List CSL Type(see below)t�,_�
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
S ..Q.)D CC� Z R Restricted 1&2 Family Dwelling
CityMwfi,Sttate,ZIP) M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 1p I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Im roveme t Contractor(HIC)
HIC Registration Number E pir on Date
Hie om an ame orolC Re istrant Nine it
�$ I l--k Y\"p%J D I� J l C O
Oo.and Street Email ress
VWQ�M:ss .nl9t? 3
r /Town State,Z 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 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,I hereby attest under the pains and penalties of pedury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
� 14 A
Print Owner's or Authorized Agent Agenr s Name(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/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basemenUattics,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"
CITY OF SOU EM, NIASSACHL'SEM
• BUILDING DEPARTNEENT
a 120 WASHINGTON STREET,Yee FLOOR
dj TT L (978)745-9595
FAX(978) 740-9846
Ki%(BERLEY DRISCOLL
,ML AYOR THoi us ST.Pmm
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumben
Applicant Information Please Print Legibly
Name(BusumaOrganization/In(diividu l):
Address: '), � I Y 0 t 1 0 A
City/State/Zi;- to a)9—NC 'V \Q C S b lQ 7,7� Phone #: C.)�T c[^1 —.�g L
Are you an employer?Cheek the appropriate box: Ty
pe of project(required):
1 am a employer with I 4. 111 am a general contractor and 1 6. ❑New construction
employees(full and/or pan-time).' have hired the subcontractors
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, [1Building addition
[No workers'comp.insurance 5. ElWe are a corporation and its 10❑Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,91(4),and we have no 12.❑ Roof repairs
insurance required.]t employees.[No workers' 13 (Other
comp.insurance required.]
•Any applicant that checks bon el most also rill out the section below showing their workon'wmpem im policy infurmmion
t I lomeowren who submit this affdavit indicating they am doing all work and then hire outside watmcton must submit a new affidavit indicating such
-Contmmors rhos check this box most attached an additional sheet showing the name of the sub�wmmcuxs and their workers,comp.policy information.
film as employer that it providing workers'compensaton Insurancefor my employees. Below Is the policy and fob site
information ` _
Insurance Company Name: L,� 1�C"TT ��6a ��
Policy 4 or Self-ins.Lic.#: 2 __ Expiration Date;1 [
Job Site Address: c City/State/Zip:
Attach a copy of the workers'compensation pddy declaratlon 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 S1,500.00 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.
i do hereby cerr jy under ike pains and penalties ojperjury that the htronnalon provided above is true and correct.
• t ere• [)are, G '(-
Phone — 3
Ofriciat use only. Do not write in this area,to he completed by city or town official
City or Town: Permitil.icense#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.CilyfTown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:— Phone#:
i CITY OF SiU.&Nll NU SSACHUSETTS
• BLII.DIINGDEPARnI NT
120 W ASHINGTON STREET,r FLOOR
TEL (978) 745-9595
PAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THonus ST.Pmm
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONWSSIONER
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 c 40, 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 disposal facility as defined by MGL c
I 11, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed
- n
oof in :
pp sp
(name of facility)
LrN Y`rl acS .
(address of facility)
signature 6f permit applicant
date e — --
a�n„�trax
APR.09.2014 08:41 1 - 82228 P.001 /001
NORTH SHORE ROOFING
281 Andover St. Danvers , MA.01923
(978)977-3816 Fax: (978)762-4667.
Mr. Douglas Frye 04/09/14
9 Greenway Rd.
Salem , MA.
The following is a proposal to apply a new asphalt shingle roof on the garage roof at the above
address.
1) Remove the existing multiple layers of asphalt roof shingles down to the barb roof decking and
legally dispose of the debris .
2)Replace any deteriorated roof decking if and where needed .
3) Re-nail any loose roof decking if and where needed .
4)Apply 6-ft.of ice and water barrier around the entire perimeter of the roof .
5)Remaining exposed roof decking will be covered with 15 lb. asphalt rool'paper.
6) Apply 8-in. aluminum drip-tdge flashing around the entire perimeter of the roof.
7)Apply a 30 year architectural asphalt roof shingle,color to be chosen by the home owner.
8)All roof related debris will be legally disposed of by North Shore Roofing .
9) Exterior siding and shrubbery will be protected as best as possible with tarps during construction .
10)Five year warranty on labor, manufacturers limited lifetime warranty on asphalt roof shingles .
TOTAL PRICE : $2,950.00
5%ANGIE'S LIST DISCOUNT: $150.00
NEW TOTAL PRICE: $2,800.00
PAYMENT TERMS
1/3 DEPOSIT REQUIRF,D: $900.00
BALANCE DUE UPON COMPLETION: $1,900.00
Acceptance of Proposal-By signing this proposal you have accepted all of the terms as stated above,
Date of Acceptance 9 ( Home own
Peter"Miner
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor Specialh
License: CSSL-099622y.:
PETER MILLER
281 ANDOVER STREET f^. i
Danvers MA 01953sl
ov Expiration
Commissioner 0 9/0 612 01 5 F
it
`(%/FO rP6�JL�R6JLLOC(L�/O�U�CfIvJ!/C�(eir/O
Office o(Consumer Affairs&Business Regulation License f found return to:
or registration valid for iodividul use only
before the expiration date. I
N �gOME IMPROVEMENT CONTRACTOR ` Office of Consumer Affairs and Business Regulation_
registration 128691 Type:
. 10 Park Plaza-Suite 5170
xpiration:• 5I5/2075 DBA - Boston,MA 02116
NORTH SHORE ROOFING -
PETER MILLER - f
281 ANDOVER ST
DANVERS,MA 01923 Undersecretary Not valid ithout signature