3 HAYES RD - BUILDING INSPECTION (3) S 9Ec-r 4A3 S29.�
The Commonwealth of Massachusetts RECEIVED OTYBoard of Building Regulations and Stand PECTIONAL SE VIC-5AL OF
Massachusetts State Building Code,780 CMR
Revisedd Mar Mar 2011
Building Permit Application To Construct,Repair, RenovaJJ JqrgfmVrTh A 1: 20
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Ln 4 3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1�y 1 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
� f/Avis 2aflct'
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 Zone? Municipal❑ On site disposal system ❑
Check if yes[]
SECTION 2: PROPERTY OWNERSHIP[
2.1 Owner of Record: -
TAnFT L. S7'OP7F— �A�Cm�,w,4 l7/970
Name(Print) CityCity,State,ZIP �—
2 ffAu _t Rc/ 978 7`/S ?G2 f 'f!S'//ROS (9,f 01- Cora
No.and Street - Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Acce! Other ❑ Specify:
Brief Description of Proposed Work':
rAl�A?b 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:
2.Electrical g ❑ 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: $ Z3 ❑Paid in Full ❑ Outstanding Balance Due:
9 /7,3 j Lo
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC 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 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
I,as Owner of the subject property,hereby authorize 2ceh i2ag a SAcds
to act on my behalf,in all matters relative to work authorized by this buildirAg permit application.
Pri wner's Name(E ectronic Signature) Date
SECTION 7b:OWNEW 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.
Pri wner's ortXuthorized 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.!,ov/oca Information on the Construction Supervisor License can be found at www.mass.my/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 halfibaths
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"
— -- — — -- - —— - Page 1 of 1
Subj: Proposal for 3 Hayes Rd. Salem, MA
Date: 6/24/2015 8:08:28 P.M. Eastern Daylight Time
From: flynnpropertyservice(agmail com
To: jlshaus6a aol.com
Hi Janet,
The proposed cost for your shed site preparation is $1628. Included in this cost is labor to excavate the soil from
the shed site and its disposal. Also included is construction of a retaining wall using 6"x6" pressure treated
landscape timbers and delivery of the 3/4" crushed stone to be spread, leveled and compacted making the site
shed ready. Let me know if you have any questions or would like me to schedule any work to be done.
Thanks,
Jeff
Wednesday, July 01, 2015 AOL: JLSHaus
d
CUSTOMER NAME uq r T0A) L'
Sq—
ADDRESS
3 Tracy Lane,Hudson NH 03051 CITY STATE (,�A ZIP
i.WV�l TGII Free:($$$)85-SHEDS HOME PFrONE O 7S/� R/!J S� ORDER DATE
Tel:(603)883-1362 I Fax:(603)882-9566 CELL PHON . (hl'A n v2 ff DELIVERY DATE
Swww.reedsferry.com EMAIL �' /1 ,7 r® "1 Ccr+ p
SIZE: $ I
Ramp4'x�_______________________________________________________________________________ QTY. x$ _ ea.$
SHEr Ramp 4'x _______________________________________________________________________________ QTY. x$ ea.$
American Classic ❑Victorian Cottage 5/8"PT Plywood Flooring Per Sq.Ft.of Floor------------------------------------NO OF SO.FT. x$ 2.00 ea.$
2x6 PT Floor Joists 12"On Center------------------------------------------------ NO OF SO.FT. x$ 0.35 ea.$
❑Antique Saltbox ❑Victorian Cottage w/Shed Dormer Additional Wall HT Per Lin.Ft.------------------------------------------------ NO OF LINEAR FT. x$ ea.$
❑Historic Colonial ❑Victorian Cottage w/A Frame Dormer Additional Window(s)'------------------------------------------------------------------------ CITY. x$ ea.$
❑Country Carriage ❑Grand Victorian w/Shed Donner Change Standard Window to Medium or Large---------------------------------------------- QTY.. _ x$ 65.00 ea.$
— —
Window Box- ----- ------------------------`F7f- N6`-------�j»tF1_l - OTY. x$ $ _
❑Traditional Gambrel ❑Grand Victorian w/A Frame Dormer Additional Transom Window------------------------------------------------------------------ QTY. x$ ea.$
r I Additional Fiberglass Door____________________________________________________________________ OTY. x$ ea.$
O Pine ❑Cedar T&G Change_Door to_Door-------------------------------------------------------------- CITY. x$ ea.$
Additional Overhead or Roll-Up Door-------------------------------------------------------- QTY. x$ W.$
linyl ❑Vinyl Shake - Change 5'Fiberglass Door to Overhead or Roll-Up Door---------------------------------- QTY. x$ ea.$
❑Cedar Clapboard ❑Plywood Upgrade to Lite Door________________________________________--___________________`___________ OTY - x$ 100.00 ea.$
Sill Plate _______________________________________________________________________ NO OF LINEAR.FT - x$ 5.00 ea.$
ROOFCr r• Loft 4'x ____,_________________________________________________________________------------- QTY. x$ ea.$
El White ❑Lt Brown ❑Lt Gray Cupola 21"with Glass Arches&Copper Roof---------------------------------------------- nr_v .... __... ... __$ 535.00 ea.$
Copper Weathervane----------------------- $ ea.$
LiWeathered Wood`Olack - ❑Dk Brown Architectural Roof Shingles---------------- $ 1.00 ea.$
❑Slate Gray JJL3 Brick Red ❑Custom Rubbermaid Kit----------------------------- $ ea.$
Other_________________________________________ $ ea.$
• r r• Other_______________________________________: $ ea.$
❑Almond lack ❑Blue hT SUBTOTALS
❑Clay ❑White ❑Red �y. $ qq
Y y ❑Green ❑Brown WINDOW TAXABLE SALES
%� n
Shutters included on all Windows ❑Burgundy
. QQ _ ------ SALESTAX$ � f7
r r• W
SINGLE DOOR � - _ SHED REMOVAL S
❑White Gray - ❑Blue a- --' _ TOTAL$ z.
❑Almond ❑Flint Gray ❑Cream
❑Tan El Pearl ❑ ro Sagebok DOUBLE DOOR
25%DEPOSITS(-)
❑Reads Red - ❑Beige O Clay —TOTALAMOUNT DUE
❑Olive ❑Wedgewood ❑Custom UPON DELIVERY
AMOUNT RECEIVED$
❑CREDIT CARD ❑CHECK ❑CASH ❑TYPE
NO.
" CUSTOMER SIGNATURE Date
. i
22-0010
zz-ooas �
22-0169CD
ti
�y
22-0170 R4.'
22-0171
,Y 31-0001
22-0172
STICK OrF ,� CO .
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QT'Y OF SALEM, MASSACHUSEM
' BUILDING DEPARThmNr
120 WASHINGTONSTREET 3" FLOOR
ter TEL. (978)745-9595
F
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THOMAS ST.PIERRE
DIRECTOROFPUBLICPROPERTY/BUILDING CONMSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
7
Job Location f� < S /21-2
Home Owner Address 3 S /?,✓�,
Present Mailing Address 2 hi Ze.
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