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24 HATHORNE ST - BUILDING INSPECTION (2) 25 cks �A The Commonwealth of Massachusetts t'( 1 €D CITY OF ° Board of Building Regulations and Standards .� FECjIQ#AL $1=ft���M Massachusetts State Building Code, 780 CMRje Revised Mar 2011 Building Permit Application To Construct,Repair, Renovate OrjQ��rti�a� q $: 48 One- or Two-Family Dwelling 1 � This Section For Official Use Only Building Permit Number: Date Applied: 1 Building Official(Print Name) Signature Date ( SECTION 1: SITE INFORMATION 11..1 Property Address: 1.2 Assessors Map&Parcel Numbers Ga of_ S I 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 Er Private❑ Zone: _ Outside Flood Zone? Municipal Check if yes❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: C�rvr McM��-\J. r—ib ,. (Ji11iGm5 SGIem 'Me, 01�1G Name(Print) City,State,ZIP QL1 Hc,YhOrr\e 5} G,1: -a18�1-Q 2 S}C�Cmcdst�a�r�lUOf`OS „��. Grp. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ±1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work': Re n_ � .2(�o q -1- G t—IAp bw, -S Sidi o S . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ cm ° 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: $ QOO. — ❑ Paid in Full ❑ Outstanding Balance Due: s(2� CL C C-f\UtA—�'o�i YLEisSv N � R^^'t' � � �j(•L�''T/��t � roatLe5;D 5 [ t-) SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) G�-/b3(3)F C SxP n f,1Q r• License Number Expiration Date Name of CSL Holder List CSL Type(see below) Un ne5-6 44• -I 14<hhY 5-1- No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) SOs'f(h ry,, 0 ko\ R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances �pI-y"U'rscicotl ��/ .�0 S'f C✓<Y�(�i 1�•G© I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /76/yam 7 'q�f, 71�)f l Vt (— HIC Registration Number Expiration Date HIC p ppany Name or HIC Registrant Name / L1 Wr.>`y SI J' lV Cow. No.and Str et Email address -s I<rV, mo. 010no 77&I-H/-/3 J 1 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 Issuance of the building permit. Signed Affidavit Attached? Yes ..........YY�' 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 'Aepp \er, �hrer to act on my behalf,in all matters relative to work authorized by this building permit application. 4� ri<r, Print Owner's Name( lectromc 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 contained in this application is true and accurate to the best of my knowledge and understanding. Print Owners or Authorized Agent'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.ttov/dus 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" CITY OF Sau.E,\1, 2N LXSSACHL'SETTS • BUILDING DEPARTN1LNT 120 WASHINGTON STREET, 3w FLOOR T EL (978) 745-9595 FAX(978) 7404846 KI«FAi FY DRISCOLI MAYOR DIRECTOR ST.P[ERRE DIRECTOR OF PUBLIC PROPERTY/BU DLNG CO%MISSIONER Workers' Compensation Insurance Affidavit: Builders!Contractors/Electricians/Plumbers Applicant Information 1 II Please Print Legibly Name(Busine-WOrpni:atiordindividualy 5_14h n �f1 ram« Address: y Pmnr�/ S-� City/State/Zip: .54A�f m (YOGI 01616 Phone #: _7 k I- yy3 -- �9 1 Are you an employer?Check the appropriate box: Type of project(requiref: 1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors BlVe 2. 1 am a sole proprietor or partner- listed on the attached sheet.- �• I I Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9• ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers'comp. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant that cheeks box ill most aim all out the section Most showing their wexkemi compensation policy information. t I lnmcowneta who submit this affidavit indicating they ane doing all work and then hire outside contractors most submit a new affidavit indicating such. =Contmeton that check this box must attached an additional sheet showing the name or tha sub- nstacunv and their wotken'comp,policy information. I um an employer that Ls providing workers'compensation insurance far my employees. Below Is the policy and Jab site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/Slate/Zip: 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 S1,500.00 and/or one-year imprisonment,as wall as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. He advised that a copy of this statement may be: forwarded to the Office of Investigations of the DIA for insurance coverages verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true/and tarred Sjgnaiure: -[�� Dote• Phone Official use ordy. Do not write in this urea,to be completed by city or town afrc1aL City or Town: Permit/License# Issuing.►ulhority(circle one): I.Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other . Contact Person: _ Phone#• 9� m - 3 9��rMMF t'P��'i Salem Historical Commission 120 WASHINGTCN STREET. .SALEM; MASSACHUSETTS 01970 (976)619-5685 FAX(978) 740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction ❑ . Alteration ❑ Demolition ✓ Painting ❑ Signa e LJ Other Work as described below does not involve an exterior architectural 'feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Mchrtire District Address of Property: 24 Hathorne Street Nau1c of Record Owner. Steven MacDonald Description of Work Proposed: Repair andlor replace mood clapboard.siding and repaint to match existing paint color. New replacement siding to be 4" cedar clapboard. No changes in color, material, design, iCcatiOn or outward appearance. Non-applicable due to being in- kind replaceineni. Dated: May 2. 2016 SALEM HISTORICAL COMMISSION By: L The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. Once completed,please submit a pholograph(s) gftlie final resatlh(maximum offour- i.e. one pholograph of each affectcr/frtCade). THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. STEVEBUILT CONSTRUCTION Construction Contract Homeowner Information Name: Steven McDonald and Fiona Williams Street Address: 24 Hathorne St City/Town State Zip Code Salem MA 02152 Contractor Information Company Name: STEVEBUILT Contractor/Owner Name: Stephen J. Driver Business Street Address: 4 henry St. City/Town State Zip Code Salem MA 01970 t WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor agrees to do the following work for homeowner: Repair or replace 200 sq ft of cedar clapboard siding. Materials Expected to be used: 4" Western red cedar clapboard Work Scheduled To Begin: May 12, 2016 Expected Date of Completion: May 30, 2016 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to provide the work, furnish the material and labor specified above for the sum of$ 2,000.00 Payments will be made according to the following SCHEDULE: $1,000 upon signing the contract. $500.00 by 05/13/2016 or upon completion of $500.00 upon completion of the contract. In order to meet the completion schedule, the following material/equipment must be special ordered before the contracted work begins: NA 2 - - 1 Homeowner's Signature Contractor's Signature Date Date You may cancel this agreement if it has been signed by a party thereto at a place other than at the address of the seller,which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. REQUIRED PERMITS The following building permits are required: Building, Plumbing and Gas, Electrical. It is the obligation of the contractor to secure such permits as the homeowner's agent and any costs which contractor will incur in doing so are included in the price for this job as set forth above. Please note that homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL C. 142A. Is an EXPRESS WARRANTY being provided by the contractor? No Yes X The following warranty will be provided by the contractor under this contract: STEVEBUILT warrants all labor and materials (excluding owner supplied) installed at the above mentioned jobsite address for a period of(2) TWO years. (see attached letter of warranty). 3 Please note that all home improvement contractors and subcontractor shall be registered and any inquiries about a contractor or subcontractor relating to registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1310, Boston, MA 02108, 617-727-8598. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided for in MGL C. 142A. Contractor: Homeowner: LL/ Date: _//�& Date: NOTICE: the signatures of the parties above apply only to the agreement of the parties to alternative dispute settlement initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not separately signed by the parties. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity. A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity. In instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require the signatures of both parties. 4