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3 HENRY ST - BUILDING INSPECTION (4) r' C pod The Commonwealth of Massachusetts OF Board of Building Regulations and Standards CITY M � Massachusetts State Building Code, 780 CMR SdMar/1 Revised Mar 2011 1 Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Offic' 1 Use Only Building Permit Number: I Dat Applied: Building Official(Print Name) _ Signature =:rSECTION 1:SITE INFORMATION 1.1 Property Address. 1.2 Assessors Map&Pa Numbers ,. 1.1 a is this an accepted street?yes ✓ no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq In Frontage(11) 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❑ ECTION 2: ROPERTY OWNERSHIP' 2.1 Owners of R cord: )C A Ian �a1em mA 0)9�0 Name(Print) City,Stale,ZIP "ervir q_U5915M No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Constructio:n:0fl Existing Building❑ Owner-Occupied L9T Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work : Trx Q 11- Ifs/L. QJea nc) I st 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: ❑Standard City/TownApplication Fee 2. Electrical $ ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (ITVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$- Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: 3 �I,A S Qe wood driveway gates - Google Search t Page 9 of 11 , http://www.google.com/s6arch?q=wood+driveway+gates&tbm=isch&tbo=u&source=univ... 6/30/2013 SECTION 5: CONSTRUCTION SERVICES /- ' 5.1 Construction Supervisor License(CSL) (20 9194 to� 8 • I lox-vo`1 C1 p n pa License Number Expiration Date Name of CSL Holder ^ � _ List CSL Type(see below) �) Po , J� � Ty Description No.and Street n o l �� U Unrestricted2 Family (Buildings u el ing cu.ft. ` `( \ (1 "1 R Restricted 1&2 Famil Dwelling City/Town,State ZIP M Masonry RC Roofing Covering �(X�/M�l�� WS Window and Sidin 9 1 U -k boo I I Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered It ete Improvement Contractor(HIC) , 115 1`� 10,'lAt ,' n n HIC Registration Number Expiration Date Coin N e o C e istrant Name © p �[ O g YU n. and Street Email address Wol s-1 rn ci9logq� oo I City/Town, t te,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 Issuan 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 authoriz e rYelkaNec G e�` Grr r(-)6 n to act on my behalf,in all matters relativ to work thorized by this building p fmit applic tion. 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 perjury that all of the information contained in this application is true and curate to a best of my knowledge and understanding. A1,1#to- I- hlv�7 4 Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 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 basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number ofhalf/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" wood driveway gates - Google Search Page 8 of l l http://www.google.com/searih?q=wood+driveway+gates&tbm=isch&tbo=u&source==univ... 6/30/2013 TTIE COIvIIviONWEALTi-1 OF?ASSAGFIUSETTS r ' DERARTI•IE\T OF LABOR i1 DIVISION OF OCCUPATIONAL �APETY ' �..=�� 19 STA1,TFORn STREET,Bosio�,!%ILassacHusETTs 02114 LEAD-SAFE RE\OVATION CONTR-kCTOR LICENSE GONY-EA CONSTRUCTION 105 FENNiO DRIVE ROWLEY VIA 01969 LICENSE: LR000031 EXPIRES: Tuesday,September 01,2015 IN'ACCORDANCE r+�ITIi I.G:L:C. 11?.§ 19T3(b)_av—El45 C��2 r 4-=c LICENSE IS ISSUED BY THE MASSACHUSETTS DIV.OF OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR TIIE PURPOSE OF ENGAGIDIG IN LEAD-SAFE RENOVATION AND VI ODERATE-RISK DELEADhNG WORE. TFIIS LICENSE IS VAT ID FOR A PERIOD OF FI-i17E(5)YEARS. THIS LICENSE TMUST BE MAINTAEgED BY THE CONTRACTOR-IN ACCORDANCE�MH M.GT.C. i 111,§ 197B(b)(2)AND 454 CMDZ 22.04 WHENT ENGAGED IN LEAD-SAFE RENOVATION AN'D MODERAT&RISK DELE ADLti G WORK I HEATHER E.R OWE:-Acf\G CO\•NIISSION"ER -` t� '!i t _ et:!. ccis 02;"•a-me coa ��:� T �� O�ce.YLonsumer:i._.:irs&`"Bui auoa .�poMEIMPROVEMENT CONTRACTOR 3oa,au �Gane =qul. 2ws -+..c Type: Crrstrucri.:+,$u„ne.or - bg- 's—,Registration:- 117575 _tes,sa CS-029124 ,. --,ram-ExPiratton 10120/2014 - -DBA � ? - DaRI2ELL 3 GON1 EA.. G CONST PO BOX 504 = Rortlep MA 01969 _� DARRELL GONYEA _ _ - 105 FENNO DRIVE - - ROWLEY.MA 01969 Undersecretary 0 610 81201 4 +L•r �x1 .�v 1 CITY OF S.U.&M, NWSACHLSETTS BUILDING DEPAR11t&N-Ir • 120 WASHINGTON STREET,3w FLOOR TEL. (978) 745-9595 FAX(978) 740-9946 lCl\fBt:RLEY DRISCOLL THOMAS ST.P[ERRE MAYOR DmEC[OA OF PUBLIC PROPERTY/BUILDING COMMSIONER Workers' Compensation Insurance Affidavit: BuildersiContractors/Electricians/Plumbers Applicant Information Please Print Le ibl Maine(BusioessOrganizatioNindividual): Address: • 0• U q ' t ,l City/State/Zip: i hone I/: -O Q'lR (O I Are u an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with�_ 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ 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 11.❑Plumbing repairs or additions myself.(No workers'comp. C. 152,§1(4),and we have no 12.❑Roof repairs r� insurance required.]r employees. [No workers' 13 dOth M t Of ke comp. insurance required.] •Any applicant thin Checks box#1 most also rill out the section below showing their workers'compensation policy infunnation 'I lomeowners who submit this affidavit indicting they are doing all work and then hire outside contractors most submit a new affidavit indicating such, =Comrxwts that check this box must attached an additional short showing the name of the subcomractcrs and their worko s'comp.policy Infattnation. l am an employer that is providing workers'compensadon Insurance for my employees. Below Is the policy and fob site information 1 J ".insurance Company Name: ' �P_ Hark�� C., Policy H or Self-ins.Lie.#: Expiration Date: Job Site Address:�� NPIII'�j rPe City/State/Zip. ' 0 jq-�Q Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to suture coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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 he forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify under thepains and penalties ofperjury that the informaion provided above is true and correct Signature• ['�1 Date' Phone ; 9 S 4S b0c) Official use only. Do not write in this area,to he completed by city or town offic'iat City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Ileallh 2.Building Department 3.City/town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other_ Contact Person: __ Phone#: wood driveway gates - Google Search Page 7 of l l http://www.google.com/search?gwood+driveway+gates&tbm=isch&tbo=u&source=univ... 6/30/2013 00 (Policy Provisions: WC 00 00 00 B) ,7 LJ INFORMATION PAGE wr-.c WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ., INSURER::HARTFORD FIRE INSURANCE COMPANY ODJE HARTFORD PLAZA, HARTFORD, CONNECTICUT 06155 NCCi Company Number: 13269 �gaH� E Company Code: TFORD m (V C Sufi LARS RENEWAL POLICY NUMBER: 08 TATEC LJ2700 02 o Previous Policy Number: 108 WEC LJ2700 HOUSING CODE: SB h, 1. Named Insured and Mailing Address: nARREL GONYEA W (No., Street; Town,State, Zip Code) (SEE EVDT) 0 N p a O BOX 50^_ FEIN Number: 042790276 ROl^lS,EY, MA 01969 State identification Number(s): DIN: The Named Insured is: INDIVIDUAL DUAL Business of Named Insured: PLL?ffiiNG - RESIDENTIAL Other workplaces not shown above: 105 FENNO DRIVE, ROWT1,EY MA ROWLEV MA 01969 2. Policy Period: From 03/13/13 To 03/13/14 ® 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: PR-SCOTT & SON INSURANCE AGCY IPiC ® - 963 EASTERN A`VE1RjE MAIDEN, KA 02148 Producer's Code: 088914 Issuing Office: THE HARTFORD _® 301 WOODS PAR_-K DRIVE CLINTON NY 13323 (800) 962-6170 Audit Period: ANNUAL Installment Term: The policy is not binding unless countersigned by our authorized.representative: f ® Countersigned by Authdrized Representative / Date Form V'1C o0 0o 01 A (1) Printed in U.S.A. Page ! (continued on next page) Process Date: 02/02/13 Policy Expiration Date: 03/13/14 ORIGINAL CITY OF S.u.Etii, TN'LA sSACHUSETTS BUa DING DEPIR-rmENT • P 120 W 1SHIINGTON STREET, 3'°FLOOR Tkr- (978) 745-9595 FAX(978) 740-9846 ��FRr F.Y DRISCOLL ,MAYOR THoMAs ST.PmRRE DIRECTOR OF PUBLIC PROPERTY/BUIIDIIQG CONMUSSIONER 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 111, S 150A. The debris will be transported by: / l lm,m Can oc�i rl r) (name of hauler) The debris will be disposed of in (Y1e-l101.�� ram► Q� re .SCIIDfl (name of facility) (address of acility) signature of permit applicant date debrivffd(w r wood driveway gates - Google Search Page 11 of 11 Goodie Images Home Switch to basic version Help Send feedback Ganglia Home Advertising Programs Business Solutions Privacy&Terms About Gargle http://www.google.com/search?gwood+driveway+gates&tbm=isch&tbo=u&source==univ... 6/30/2013 Gonyea Construction Building & Remodeling P.O. Box 504 Rowley, Ma 01969 Phone & Fax 978-948-6001 www.gonyeaconstruction.com gonyeaconstruction@verizon.net Proposal July 1, 2013 Mr. Anhui Ang 3 Henry Street Salem, Ma 01970 978-594-5746 ', Supply and install materials and labor. Remove existing trim work in the sagging wall area in the living room Install temporary support to ceiling. 4 "n Remove 2x4 cut off from previous wall frame. ,y Install two 1 '/d'x 12" LVL support beams bolted together to factory spec sheet. Recover beam with drywall. ' £max„ Install 2x4 support jacks under new beam chased down to basement center beam. Reinstall existing trim work, caulk and compound as needed to complete job. Apply on coat of paint to drywall and trim work: (Owner is to supply paint for the trim work and walls. Paint needs to be ready at the time of installation of the beam work.) Pricing is subject to change if something out of the ordinary if found in the existing wall cavity were beam is to be installed, but does not seem likely,at this time. Gonyea Construction will dispose of all construction debris pertaining to this job from job site. Estimate does not include building permit. ' w $1,825.00 I Accept the Te of is Proposal: Signature: Date: E � t r � i E �I IF j � + i i