0007 HARDY STREET, U1 - BPA-16-3 The Commonwealth of Massachusetts
TY OF
W Board of Building Regulations and Standards RE 'IV
Massachusetts State Building Code, 780 CMR sNSPECTIO AL �i�Rq a
Revise Mar 2 11
g Permit Application To Construct,Repair, Renovate Or Demolish a
One-or Avo-Fancily Dtvelling Z015 DEC 0 A 5 9
This Section ForOflicial Use Only
ber.° Date. plied,
t Name). - Signaturo.5 Date
SECTION I SITE INFORMATION
jI.1 Property Ad Jres`� 1 1 c� I� 'M4 1.2 Assessors hlap.4 Parcel NumbersL la Is this an accepted strreee�t? es' �n^o"� btap Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
ooD o(7
Zuning Drsmct Proposed Use� - Lot A {sq fl� Frontage(R)
1.5 Building Setbacks(It)
. . - Front Yard . .. - Sole Yam.- Rear Yard'
Required Provides! Required Provided .Requbed' ' Provided
1.6 Water Sypply:(M.G.L c.40,§54) 1 7 Fkad Zone Information: 1.8 Sewage D 1 System:
Zone: _ Outside Flood Zo9e7 Muniei On site d'u sal system Q '
Public Private O. (y/ pid P°
3EC"f[OrI'S::AROPE�ta?YOWN6RSIfIPt.':,' '
2.1 Ow r of
thhme(Print) Cay,Slate,ZIP `-
LAl di - qP-L%71 Mlexi- �yW-Glo �, cow .
No.and Street Telephone Emait Address
SECTION 3:DESCRIPTION OF PROPOSED WORle(cheek all that apply)`
New Constmction O E.'c isting Building Otvoer-Occupied Repairs(s) E3 I Alteration(s) O Addition O
Demolition G Accessory Bldg.O. Number of Units. 9 Other O Specify:
Brief Descripti n of Proposed Work': : o�rt o L K, C�n vi 14ro�
SECTION a:ESTIMATED CONSTRUCTION COSTS
It¢m Estimated Costs: Official Use Only
Labor and Materials
I. Building S ®p 0 I. Building Permit Fee:S Indicate how fee is determined:
O Standard City/town Application Fee
2. ElectricalS 2 CO " O Total Project.Cost'(Item 6)x multiplier x
3. Plumbing Is 5 00 2' QlherFees: S
4.Mcchanical (HVAC) S List:
5.Xlechanic:d (Fire S
Su ressiun) Total All Fees:S
Check No. 'Check Amount: Cash Amount:
6.Total Project Cost $ 2 s) o oo — p Paid in Full ❑Outstanding Balance Due:
rnAt�� se C�tto� t / ib
SECTIONS: CONSTRUCTION SERVICES
5.1. Construction Supervisor License(CSL) (25FA -05612Z5 2 /
License Number Esptrat on Uate-
Name/ofCSp[laid
�, o List CSLType(see below)_Jk -
;�U / ✓v � ��' �'v TYPg . . Descrtplioa .
]Nu.and Street
L U Unrestricted Buildin u to 35 Of10 cu. tl.
4, R Resuicted 1&2Famil Dwellin
Cityfrus� M M
RC Raotin Covcrin
WS Window and Siding
SF Solid Fuel Burning Appliances
�SCGuSf� 1 Insulation
Tele hotx Email address D Demolition �/
5.2 Registered Home Improvement Contractor(HIC) —� "ruf
iP,.a C 6,,( / - 111 Registrution Number E:tpt ton Date
HIC Company N e o HIC Rcgis an Name
/� /-LT 7 �� �t IJ C 6+'i
No.at Street ( Email address
Ci own Stat ZIP Tel ore
SECTION 6:WORKERS'.COMPENSATION 1NSUWCE AFFIDAVIT(M.G.L:a 152 g 2SC(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 Whence o .the building permit.
Signed Affidavit Attached? Yes.......... No...........O
SECTION 7a.OWNER AUTHORIZATION:TO BE COMPLETED WHEW.
OWNER'S AGENT OR CONTRACTOR/AAPPPLi)E3 FOR BUILDING.PERMIT'
I,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.
Prinl Owner's Name(Electronic Signature) - D
ian
SECTION 7b:OWNER RAUTHORIZE GENT 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.
Prir t Owtxr's or Authorized AgcWs Name(Electronic Si Date
NOTE :
I. An Owner who obtains a building permit to do his/her o work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program):will fMJ have access to the arbitration
program or guaranty fund under M.G.
c. 142A.OtherimportiH n orma ton—f—on the HICI'rogram can e o t a "—
wwvv rnass.eov/oca Information on the Construction Supervisor License can be-found at wwvv.roass.eov;dns
2. When substantial work is planned,provide the information below:
Total fluor area(sq. R.) N .(including garage, finished basetnendattics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of htdf/batlts
'type of heating system Number of decks/porches
Type ufcooling system Enclosed Open
j. '•Total Project Square Footage"may be,ubstituled Im"Total Project Cost"
From: Daniel Wallace [mailto:danjwallace@hotmail.com]
Sent: Thursday, December 17, 2015 9:40 AM
To: mariapl04l4@gmail.com; katstauner@aol.com
Cc: sdkennedy84@yahoo.com; arciep@gmail.com; sgdetails@comcast.net
Subject: Re: Home update
Kathy,
You have the approval of Sara and I.
Thanks,
Dan Wallace
7 Hardy Street, Unit#2
Salem, ma 01970
Sent from Outlook Mobile
On Thu, Dee 17, 2015 at 5:57 AM -0800, "Maria Petty" <marian10414na gmail.com> wrote:
Thanks Kathy! Sounds good to us(not sure if you needed our approval also,but you have it).
Arcie and Maria
Sent from my iPhone
>On Dec 17,2015,at 8:35 AM,Katherine Stauner<katstauner@aol.com>wrote:
>Good morning Dan and Sara,
> I have decided to update my kitchen and appliances in my kitchen to save on home energy. 1 have discussed with
Steve and will be pulling a building permit with the city of Salem to install.I will be working with licensed and
insured contractors and plumbers. Work should commence at the beginning of January.
>I will need an email at your convenience just saying you are aware that I am making home improvements on my
unit.
>Again many thanks and wishing everyone a very Happy Holiday!
>Kathy
>Sent from my iPhone
Massachusetts,79epa►tm9rd of Purr Safat;t ."
Board of Building RegulaUens and St6atts, k
Constructlon,Supervisor l &.2 FatniW, n �
License: CSFA4)88122
' aJSETT:S �FA
WRPHEN GLEAON 'p
159 HALE ST ''
BEVERLY MA 0191 i
Expiration ,
Commissioner 08/Z8IZ017 i
C/26e 1p97Hmt0'rst�18¢[C1c 0�(%N.Q4daL/tetde�d1 .
Office of Consumer Affairs&Business Regulation {
ME IMPROVEMENT CONTRACTOR
egistration 1h201 Type:
xpiratlon:i7 3W.T- DBA
DETAILS
STEPHEN 158 HALE,SGTLRE EAESTO 0
BEVERLY MA01915 tU.ute, ra_y —.:
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158 Hale Street, Beverly, MA 01915
Mobile: 617-899-6176 Fax 978-922-0764
Sgdetails(a)comcast.net
Contractor Reg #:Cs#88122
Home Improvement Lic#:138201
Contract for Services
THIS AGREEMENT is made this day 18th of Dec, 2015 by and between Details, hereinafter
called Contractor, and Kathy Stauner hereinafter called the Owner.
Witnesseth, that the Contractor and the Owner for the considerations named herein agree as
follows:
Article 1 Scope of the work
The Contractor shall perform all of the work described in the Proposal of Services entitled Exhibit
A, (Detailed in spreadsheet) as it pertains to work to be performed on property at:
_7 hardy street, Unit 1, Salem, ma
(The Property)
Project summation: Remove old kitchen, appliances, floor: Install new cabinets, counters, fixtures,
appliances, and floor. Paint and trim.
Article 2 Special Orders
All fixtures, lights, cabinets, as outlined in Exhibit A. All other special orders must be approved by
owner in advance. Int( )
Article 3 Time of Completion
The work to be performed under this contract shall be commenced on or before Jan 5,2016 and
shall be substantially completed on or before Feb14, `"2016
The work shall be deemed to be substantially complete upon the following:
1. Completion of all work described in Proposal of Services entitled Exhibit A:
2. Completion of any add-ons not included in Exhibit A, (may change completion date).
3. Any additional Add-ons to be in writing either by fax or email, including a description of
costs, services, start date and completion date.
Article 4 The Contract Price
The Owner shall pay and the Contractor agrees to perform the work, furnish the materials and
labor under this Contract as specified in the proposal of services entitled exhibit A for the total
sum of$28000. Any additional add-ons not part of the contract will be agreed to in writing by the
parties. Any materials supplied by owner will be deducted from the contract price. CS= Customer
Supplied.
Materials, not stated in proposal, must be approved by Owner in advance and will be invoiced
separately in addition to the contract price. Contract price is subject to additions and deductions
pursuant to authorized chafe orders. Materials ordered and/or picked-up by Details have a 20%
service charge. Initials: V/S )
Page 1 of 3 Details and Kathy Stauner
r
Article 5. Subcontractors
The Contractor agrees to solely responsible for the completion of the work described regardless
of the actions of any third party/subcontractor utilized by the Contractor. The Contractor further
agrees to be solely responsible for all payments to all subcontractors for materials and labor
under the agreement. The Contractor may direct the payment under the Contract be made
directly to the subcontractor. Any such payment will be considered satisfaction of the Owner's
obligation under the contract.
Article 6 Progress Payments
Payments of the Contract Price shall be paid in the manner following:
DATE: Contact signing Sum: 10,000.00
DATE: Jan 15th Sum 5,000
Balance Due: Upon satisfactory completion of the Contract and the work described in Exhibit A
If payment is not made when due, Contractor may suspend work on the job until such time as all
payments due have been made. A failure to make a payment for a period in excess of 3 business
days from the due date of payment shall be deemed a material breach of this contract
Article 7: Collection Fees
A$100.00 late fee will be charged for all past due accounts over 10 days. Should legal
proceedings be instituted for breach of the terms of the contract, the breaching party agrees to
pay reasonable attorney's fees, court costs, and other costs incurred by the non-breaching party.
There will be a $30.00 charge for all returned checks.
Article 8: Evaluation of Work
One Final punch list of items should be in writing and given to contractor at end of construction.
Customer understands what a punch list is OInitials
Article 9: Permits and Parking
The following building or construction related permits are required and will be secured by the
contractor as the homeowner's agent, and be adhered to unless circumstances beyond the
contractor's control arise:
All fees for special permits, are considered expenses for the job and are billable weekly.
Page 2 of 3 Details & Kathy Stauner
DO NOT SIGN THIS CONTRACT IF THEREAREANY BLANK SPACES
Acceptance of Contract
THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE
HEREBY ACCEPTED. I have fully read, understand, and agree to all terms and conditions as
described in this contract. You are authorized to do work as specified.When contract is signed on
location, State law provides that the customer may rescind contract acceptance by notifying
Details, Ltd. in writing and delivering the notification to our office within 3 days of signing.
Signed this / 2` " day of � +✓ 2015
Signed in the presence of: 'bil7 -G0`^i
Witness
Aod
s '
Owner Signature
Owner Address
Apt or Suite# �
City WlState MIQ. Zip
Phone ' 710- 6 Fax e-mail G( vif jzCG 4—
Contractor Signature &Li
a Dac
Page 3 of 3 Details & Kathy Stauner
The Commenwealth ofMassachusetls
Department oflisdnsoialAcezdents
I Congressstyeey smile Joe
B.oston,M4 021I41017
www.mascgov/dia
Workers'Compensation Insurance Affidavit Bollders/Contractors/Elecvicians/Plumbers.
TO BE FUM WITH THE PERMTITJNG AUTHORITY.
0
Name(BusioessAMpnirationandividual):.
Address l' �C
City/Siate/7ap: one#: . d"
__.
Are you ao amproyerr Oak the appreprOft bur: - Type of project(rtigoired):
1.01am a emp7oYer w .ei�kyees(full end/mP�- )•� ` 7. ❑WeW ccrostroction
2�1am a,mk}aopQiemrmparlamslup�dbave oo empbygos-wo4pop formem
r+P�ty 1Nowadcas"COMP i *e9 •1 9: Demolition,
3.p lam a hoemowaa doimg all work m)wV..(No wakca o®P:'"^�=re9uited]1
4.p l am a bomeownc and MR be hiring camhaetms m conduct all wink on my property. I will to p Building eddllltia. .
enure that all conbaams aid=have wmkets'mmpeaamon msuuam cane=le I i.0 Electrical repairs or additions
pmprstms withnomopyae. bin ro 12.L3 Pm : of additions
. , s i+epama
5.01 magmemleoMaaorsad these hfied&a sub-ttimuaef®s lured on the attachedAeet:
wodrab•COmp.�..a...,.t . .� tepaiis_
'. 7beoe mb-contractamhm®pkyee and have .'. - - .. .
6.❑Wearer COrporaa 'sod its officers have eaeicieed theaiigW ofeeempbm per.MQ.a 14.QtNhci
I., ls2,gl(4),end�kavem employes-[No wmlds•campcerequeedl � ,:....
•Airy applkaattlmt eheeb 6uoi sl men oleo fla�>be sect cm bekwabov.3og�eawnrkas eompmsanm pohry mlwttaoam: .
t Homeow>cs who subIDif effderit fudieelmg they me doing all work Poedkv!mdeide COS ins anrat'sulndhanew affidavit iodinfing inck
tConhscbte that check thiitim jai atterLed so-addibCOal abaci eboiwmBnamtl;ofttie'sub- lihOma mtlamtevutiePocaraot ttiosee�ues kve .
employes..Hf6eaubcmnagaabegeemployceq that'MrstPtwak>1�aa'm}ms'..e�Rpoltry-aU? -
I am an enyFloyer tbatisprori&W Wrhers'comPeseagon inrWWWWfor my empl ryeea Below is thepaNey anoiabShi-
injoimadon.
Insurance Company Name:
Policy p or Self-ins.Lic.# Eapaation Date:
Job Site Address: CityfP- -
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under A4GL c. 152,¢25A is a anal vioMon punishable by a fine up to$1,500.00
and/or one-year impos t,as well an civil penalties in the farm of a STOP WORK ORDER and a fine of Rp to S250.00 a
day against the violator.A copy offliis statement may be foTwerded to$e Office of Investigations of the.DIA far insurance
coverase verification.
I do hereby eerdfy under the altres ofperjary that the Information provided above rs a and earred
Phone N;
r.
Qjo&al use only. Do not write in this area,to be eoarplded by *Y or sown offleia1
City or Town: Fermlt/Lkense#
Issuing Am ority(circleone):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Phone B
Contact Person:
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 ofhire,
express or implied,oral or writtep."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in 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. Howeverthe
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 bean 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 suffionty."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),addresses)and pbone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(I.I.P)with no®ployees other then the
members or partners,are not required to carry 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 Deparnnent of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be retuned 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 permittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permi"cemse applications in any given year,need only submit one affidavit indicating current
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 proofthat a valid affidavit is on file for fitdme 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 dqg license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017.
Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dtia
OTY OF SALEA MASSAML SEM
Buamw DEPAR7mw
120 WAutmcTmS7mT,3IDFLODIt
UL(978)745-9393
FAX(978)74Q9846
%IIv�ERLEYDRISQ7LL
MAYOR TrEmms STYIIEM
Dzimcrox cFPuaucPRcrERTY/BuuDmocaaawcmR
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 M, S 54; Building Permit g 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 /d�e�bris will be transported by:
C�GfiL t c �1 C2S�G
(name of haul r)
The debris will be disposed of in:
(name of facility)
(address lot facility)
Sig u e of applicant
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