21 HEMENWAY RD - BUILDING INSPECTION (2) 1
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7°i edition OF SALEM
I Revised January
n n Building Permit Application To Construct, Repair,Renovate Or Demolish a /, 2008
One or Two Family Dwelling
This Section For fficial Use Only
Building Permit No ber: Da e Ap i
J
Signature: "Oeol
5 I'
Building CommissionepysTleoYor of Buildings Date
SECTION 1:SI ORMATION.' ry`'
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
Ql IkAen W&Y RRj
1.la 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 R) 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?
Check ifyesO Municipal ❑ On site disposal system ❑
2.1 Owner'of Record: _ SECTION 2:1 PROPERTY OWNERSHIP[�„
1 Ca Ay 21 NRmenwn R
Name(I' int) // Address
�for Service:
l 7/i 1
Signature Telephone
�1 7G
�
. ' SECTION 3:DESCRIPTION OF PROPOSED'WORK 2(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ I Repairs(s) Alteration(s) ❑ Addition "❑
Demolition 11 Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': 5X-1c j nieAond M r
SECTION 4:ESTIMATED CONSTRUCTION COSTS '
Item Estimated Costs: Official Use Ord
Labor and Materials y
1. Building $ 1.- Building Permit Fee $ Indicate how fee"is determined:
2. Electrical $ ,❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)z multiplier x
3. Plumbing $ 2.`„OtherF'ees: $
4. Mechanical (HVAC) $ List
5.Mechanical (Fire '
Su ression $ Total All Fees.
9 995 Check No. Check Amount Cash Amount:
6. Total Project Cost: $ / ❑Paid in Full " ❑ Outstanding Balance Due:
1
"SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
T CS S L 1O1O173
1GVYn S Mnu7so�r� s License Number Expiration Date
Name of CSL-Holder List CSL Type(see below)
/ l W;/stun sfi SGIe J MA
Address Ty Description a'
XU Unrestricted(u to 35,000 Cu.Ft.)
Spig¢g¢nature R Restricted 1&2 FamilyDwelling
/7t� �.7 1PO M Mason Only
/ .JO i RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
/�Lnin19ro6--r7r —:V-j-yicec l -'4
HIC Company Narfie or KIC Registrant Name Registration Number
P/ 4-1- C�1e /MA a/,? ,2/27/JJ
Addres
1&-S87- 5 Y 7(7 Expiration Date
Zia 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 .......... l/ No ........... ❑
SECTION 7af 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.
Signature of Owner Date
11'��s< � /",SECTION 7b:OWNEW OR AUTHORIZED'AGENT:DECLARATION !V-
P `
1, 2//!B �"OOe r ,,, ,Sef w PS , as Owner or Authorized Agent hereby declare
that the statements and inf rmation on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
19 e - v �7y Scar y c
Print N e
-20- /D
ture o O er Authori gent Date
(Si ne on er the pains and penalties ofperjury)
NOTES:'!
I. 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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I HLR5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"maybe substituted for"Total Project Cost'
i
ttsse LEIN#
54326
Roofing [• Siding • Painting 2615812
Sally Jo Cody
21 Hememvay Rd.
Salem.MA 01970
(978)741-1179 March 29.2010
Dear Sally Jo,
The following estimate is for the roof installation for the property located at the above address. The following paragraphs describe the
work that will be performed. GAF-Elk Corporation Weather Stopper System Plus Limited Warranty offers you a full coverage warranty
on defective shingles—to be obtained directly from the manufacturer (see enclosed brochure). To view the benefits of Stripping vs.
Going Over the existing roof,please visit our website Q www.olympicroofing.com
Installation Procedure
A. Strip existing roof on the main house&front porch down to the roof deck
4. Install an 8 inch drip edge on all leading edges(rakes&fascia)
3 Install ice&water on all leading edges&valleys
d Transitional walls are optional and incur an additional cost for the siding repair
d Install new vent pipe flanges
-k Replace any rotten or damaged decking(we allow 32SF aQ no charge,$80.00/sheet thereafter)
+1 Replace any rotten or damaged ledger board(we allow 3011.at no charge,$3.00/ft.thereafter)
46 Install 15 pound felt paper on all areas that is not covered by ice&water shield
4 Install new GAF 30-yr Architectural shingles
d Install new ridge vent system
• Remove existing wood gutters on main house and replace with new white aluminum seamless gutters
Ad not Soecirrcattons
4. Homeowner to choose color of shingles COLOR: fir-// EJri Sr//(/Cj G°erGU' -
Our dumpsters are sent to a recycling facility:therefore no additional trash may be placed in them. The transfer station will
.charge us a fee for additional trash which will be passed on to the homeowner.
..,4. Chimney.ce-pointing and,re-leading is not part of the roofing contract and will be quoted separately.
6 Tratisitioti walls are.an option,and if the existing flashing is in good,shape,usually do not require replacement
-- _.� Durinig a-robfjob,-the nails could_breek the sheathing during the nailing of the shingles
46 :We are not responsible for any of the cracks that may arise in any walls orceilings-_... ._.. . ..._......__.. ....._
4 Please cover all your floors in your attic to protect from dust and debris
.. We will remove all ofthe36b related debris
,� Permit costs vary from to to'towh and ate not included in:this bid '
/nitia!the notions you are choastne below:- $9,995 00 9995'- UO
Cost for Labor&Material for Roof: -
Cost for GAF-Elk Weather Stopper System s Ltd.Warranty: $ sso•o 3�
��33/, V3 work In progress $ od 1/3 upon completion S
Payment Terms: 1(3 deposit upon signing con P g
Remit to. Alpine Property Services Company,Inc.,P.O.Box 365, Topsfield,MA 01983
Total Amount Agreed To Be Paid: $ 47 V9137 OO
The following schedule will be adhered to unless circumstances beyond Alpine's control arise:
. —Work Scheduled to Begin: - TBD Expected Date of Completion:
Warranty:: Alpine Property Services Inc.guaranteevall work performed for a period of one year. If any problems occur we will cover
the cost of al l:tabor and.material-to correct.the problem and meet the customer's satisfaction. -
- Do not sign this contract if there are any Many spaces.
in nl provisionsfollow and are incorporates her9bn by this reference)
r r
i
Stav Cleno anger ', a Jo .:ody ff
me erty.Sern ompany Inc ' ,.Homeowner
d/b/a Olympic b
:. �3�c Pd-r'/T �, o•,�o',e7 /fie���
Tel: (800) 535-4312 9 Fax: (978)887-5875 • 239 Boston Street is Tops to ,N A 0 83
A•lacsachuectts- Dcpartmcntof Puhlic saletc ___... ... ... .... _—..
Bn:u-d of Building Rcwhrtions and Snuldartls
Construction Supervisor Specialty License License or registration valid mrindividul use only
License: CS sL 7010o3 -" IU'efore-thc-expiratlon date. 9f found return to:
Restricted to.' RF,WS Board of Building Regulations and Standards
One Ashburton Place Ran 1301
STAVROS MOUTSOULAS Boston _
11 WILSON STREET.
SALEM, MA 01970
-----� Expiration: 12%4/2011 f'nnunlxzbmer I Netv., with., signature
Tr-": 101003'
Boar o ui mg eguI ions�a tan
jOil One Ashburton Place - Room 1301
Boston_ Massachusetts 02108
Home ImprovemeE Contractor Registration
Registration: 154326
Type: Private Corporation
."•=`': "- _� Expiration: 2127/2011 Tr# 279846
ALPINE PROPERTY SERVICES C'IO �iC:,• .._ °r,
STARROS MOUTSOULAS =`=F
11 WILSON STREET
SALEM, MA 01970
Update Address and return card.Mark reason for change.
Address O Renewal n Employment I] Lost Card
oPs-wa 6 50M-071V-PC8450 .-_.—...
._... '�ommrmuue¢/,l/a o�✓ a°°a�urde°h
Board of Building Regulefidns and Standards License or registration valid for individal use only ,
HOME IMPROVEMENT CONTRACTOR Board
the expiration date. If found return to:
Board of Building Regulations and Standards
RegisTLP,I n, 154326 One Ashburton Place" 1301 "
Ex i 8prr-_2/272011 Tr# 279846 Boston,Ma-02108
P
."F---1CWA-. Private Corporation -
ALPINE PROPE._ EfZt l�r-ES CO,INC. .
STAR MOIs•Y":` �
11 WILSON Not valid without signature "
SALEM,MA 01970 Administrator "- '
CITY OF S.U.E.1(, ILliSS.kcHUSETI'S
9CaDcrG ou.tim.w i r
120 W.%iHCVGTOM STMW. )"FLOOa
TM (9711) 1499599
Fxx(978) 14496N
lu.'%®F.ALZY ORISCOL1a 711bswST.Pafaai
J4AY0R 01"Croa of rt euc Ptlo/eaTtf/K aZING CON"MIO.vER
Wurkers' Coreepeesatlon Insurance AlVdaeit: Ouildors/Contrseters/EI«triclons/Pfrmbers
>,unlleant Informatlo■ Pforaw Prlet-Lcsidit
Vatrle l /9 Lnt'no //fOn y� �'oWVt r of -
Address: 93,01 8 as 1b✓t ge4
Cily/Statdzip Tom_ -1J lam/O/IY3 PNone
\re ye.as ewpbyt!Ctrssb 1M sIM�MMaa teat Type of proises Iragttdradk
I.G �am a"RPM VW wits z�� b. 0 1 ate a pnawl contactor sad 1 6 ❑Now coosertanioo
.mpl.yeea(nr1 and/or pseo-do a1.• have hired the r►estYactott/
1.❑ 1 are a sob proprietor•r prtna• listed as low attachd shaea i f. 0 Mm "a's
.hip ad have no amp oyem Them su►eenttsaars have K O rim. lid"
.art
::Ices is any capaeiry, wettre'comp.lnstraaaat. 9. O DuiWing ackwon
1 No worlears'coop insurance S. I] We am a cosparadan and it 10.0 ebcaical repaint or.ediriorr
rtvpoiowLl oPMa haw arotelasd IheY
1.❑ I am a harneowew deine ad work riab of oaaanprion Pr ht01. I I.Q Phunbbe repaint or addition
myslt(Ye worlters'comp. c. IA 11(4).and we haw no 12.Q Rearrepsire
inaddrarere repaired l r `mp'm)- - iN*warlears' I J.❑Otbor
tomµirnantenceregaire .1
•A•y atgrwr dba aver sea Ofrar.. e AN WA ser a.o a seder.booty 'atee W ra�a.r+a Pettey iwawedaaaa,
•obaa.+wew der duime wb a e"indl aYq obey we dried de seek ad"beer adediiaawaadaae a aw aJra a am arltdwb Wilboo et ar►.
tc —MdererdYr.bwt ebb bell awe adderwaw3"Wwd so"Jwlme low seraadAea►aerdesae aed ddeb wellins'awnpd patty iefte ndee,
law arw amp/ers rAer b pwe/dbrt rderRM'cear/awsadda fwaaaeaeefir aq cnpbjtw+ ONYrIa b Peke pdfq sr//W slur
inform dde+ a.
insurance Company Nome: M
4 CO✓t UI(04
Policy s or calf-ina. Lis.JP 'S C/00 Q Eaphatioa Dab. 3/lv 1 It
Job sito Addbcss: .9-1 H rnP.rl v✓nti City/staurr pc <�TA"� 21�
.\nub a cop of elm werters'compsa a pallor decbraelN pop(she wh o tM ooft aawbw and stphrylM dirt).
KdilUM to securri coverep a repaired under lecelao 7JA of NOL s. 132 can teed to ohs imposielotr of criminal peroaltloo of a
rend up to s I,J00.00 and/or one-yew impriasnmone.a well as civil penally in do fans of a STOP WORK ORDER and a Alow
Afrup to s350.00 a Jay iWinse the violator. old adviaod that espy of this slatomrns maybe furwurded to dhs Ol17eo of
I n...0 dariutr of tthw nIA for insa+raddce covcrap varilkaliaL
/Jr homey rrrd/}•4nJN/AI •all and prna/r/re of pr/edq rAer Me,in/rwor/oar provided ubve is row rod:dr►o'a
Dare: 2� /Q
P` d ,!• — o5l 70
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City or ruwn: PrrmiNl.leenae 1__ _, ___ j
Iswang.\uthoruy ltircta nnel:
I nand ui uratob 1. 9udding ir.•paromvne I. Ciry/rows Clerk s. EletoricA [,dtpttlor 1. Plumbing Inapeetor
6. thher
l•.dU ad Peron: _ _ - Phan**
CITY OF SALEM
PUBLIC PROPRERTY
a DEPARTMENT
.1111: M I Y l "Mlr .'I
\I .1.'M t!Q � NI11.\L.�!v)1'MtLr ��•111\/.�1.\+i.\� III +I I.•.I't
I'rt:v t•N}7;ry P.�r:17s•7+SIs+a
Construction Debris Disposal Affldavit
(required lur all demolition :old 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 p is issued with the condition that the debris resulting rrom
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris will be transported by:
Inarne of�r►
The debris will be disposed of,in
1-9(9
(n:uneul au tly
I addre++of tacilily)
— 1
+ snalure of Iwrnut applicant
.late
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CERTIFICATE OF LIABILITY INSURANCEa °Ao 1d°o'
PRODUGM THIS CERTIFICATE 13 ISSUED AS A 1AATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Doorley Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEN0.EXTEND OR
17 Sixth Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELONL
East Greenwich RI 02818
Phone: 401-886-9600 Fax:401-886-9622 INSURERS AFFORDING COVERAGE NAIC9
INSURED �— DURNMA: Beacon Mutual Ins Cc
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MAY PERTAIN.THE INSURANCE aMRDW BY THE POLICIES DESCRIBED MERED/93SUBJECTTOALLTHETERMS.EJICulaom AND CONDITIONS OF SUCH
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DESCRIPTIONCPDPLU-AOONBt LOCATIONS/VEHICLESIRXC UrJ=SADDEDaY'-'o-'u••EMTIePECInL PROVSIONa
Fax to 222-1940, 'fax to 978+887-5875
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THEABOVE DEECRIBED POLICES BB L•ANGELLED OWIMMTME®IPULATIOM
RICONM DATETHEREOF.THEIUWNG OMRERWRL ENOEIWORTO MAR 10 DANSWRRT@1
NOTICE TO THE CERnPIGAM HGLOER MIMED 7DTNS LEFT.BUT PAIWRBTO DO SD#H/LLL
RI Contractors' Regietratien MPOBE NO OBLIGATION OR UILSUTYGPANY 1062 UPOd TNB INSUREIL IMAOENIM OR
S Licensing Hoard
One Capitol Hill REP/DnolrwTTves.'
Providence RI 02908 RED A
ACORD 25129M011 019811.2009 ACORD CORPORATION. All Tights Teaorvad,
Tho ACORD name and logo aroJaglaterad marks of ACORO' -