Loading...
10 HERBERT ST - BUILDING INSPECTION 55( The Commonwealth of Massachusetts ° Board of Building Regulations and Standards RECFI�®F Massachusetts State Building Code, 780 CMR INSPEI TIOkd�IMIC S Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish IJ One-or Two-Family Dwelling N AY 13 A $ 3 This Section For Official Use Only Building Permit Number: Date App' d: Budding Official(Print Namc) - Signatures 3�Dat' SECTION 1:SITE INFORMATION ` 1.1 Prope Add ss�rvA 1.2 Assessors Map&Parcel Numbers l.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 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? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' I 2.1 �/ of d:J'&, �, / h� U p I Name(Print) City,State, IP la 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)16 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Nujnber of Units Other pecify: BriefD criptionofPro dWork: 71 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 $ 13Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Su ression Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ �J � 13 Paid in Full ❑Outstanding Balance Due: TD �( .0 . o GI 1113be TIS Nc- SECTION 5: CONSTRUCTION SERVICES 5 ruction Supervise Lice (CSL) /' Q (' G 1- / �J �1 License umOber Fxploation Date Name of CSLHoI er , p List CSL Type(see below) No.and Sir t \ T Description i/1 Unrestricted(Buildings u to 35,000 cu.ft. 1 U Restricted 1&2 Family Dwelling Cityfrown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF I Solid Fuel Burning Appliances / I 1 Insulation Telephone Email address D Demolition 5.2 Regist d eme proveme C ntractor(HIC) r HIC Registration Number Expiration Date HI©oru �N re Name No.and ,e t' y7� 1/l/ /0LFA /1 Email address /��/ _ ) V 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 BWLDINQ PERMIT 1,as Owner of the subject property,hereby authorize 51' ✓ 0 74/ VC ✓1 �l to act on my behalf,in I matters relative to work authorized by this building permit application. 0� ) T o / 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 d acc ,to Jmy knowledge and understanding. y Print Owner's 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 xvi"v.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 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 SALEK MASSAMUSE M a BUILDING DEPARTMENT 120 WASHINGTONSTREET,YOFLOOR TtL.(978)745-9595 KRaERLEYDRISCOI-L FAX(978)740-9846 MAYOR TrIOMAS ST rmRRE DIRECTOR OF PUBLIC PROPERTY/BuaDwG COMHSSIOMR 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 c40, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transp rted by: (name of hauler) The debris will be dis osed of i : �Gl) V (name of facility) 0 cSf � (address off it Y) Signature of ap licant ''� , Date The Commonwealth of Massachusetts Department of Industrial Accidents t 1 Congress Street, Suite 100 to Boston, MA 02114-2017 — www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TIM PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Nalna (Business/Orgat �di idual): Address: J (— City/State/Zip: r / Phone#: C% O U A e you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 3 employees(full and/or part-time).' 7. ❑New construction 2.❑lam a sole proprietor or partnership and have no employees working for mein 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.7 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I l.❑Electrical repairs of additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.7 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insumnce.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensate it insurance for my employees. Below is the policy and jab site information. Insurance Company Name: / ) > Policy#or Self-ins.Lic.#: r /1/Y Expiration Date: Job Site Address: t1 City/State/Zip: C� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. pp�����ttttn��us�aaaat I do hereby eetYify under the '�penalti perjury th the information provided abo e i e and correct. J/ Si ature: � �� Date: Phone#: 640 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions i 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 of hire, express or implied,oral or written." 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. However the 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 be an 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." s 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 authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than 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 Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned 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 pemrit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 proof that a valid affidavit is on file for future 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 dog 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. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia .14 The Commonwealth of Massachusetts Board of Building Regulations and Standards RECE_JWPF Massachusetts State Building Code,780 CMR INSPE TION�-�LfiMVIC `S Revised Mar 1011 Building Permit Application To Construct,Repair,Renovate Or Demoli t'�a AY 3 A One-or Two-Family Dwelling This SeWon For Official Uso Building Permit- Number: Date Applied: .tltulding Official(Prim Name] SECTION;1:SITE1NPOItMATION, . 1.1 Pro pe Add ss:rj�e1.2 Assessors Map&Parcel Numbers 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 11) Frontage(It) 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 syst Check if yes❑ em ❑ • SECTION 2:,PTiOPBItT'i'�OWN'ERSI�r ��•` _ _ 2.1 •E� 167/�1�C'�` t�' No•an� �— Telephone Email Address SECTION 3t DESCft][P 1`1 OF PI;i4POSED W401W(Aheckall that apply)' New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ N ber of Units Other pecify: Brief cription of Pro dWorl�: a ' C SECTION 4.E8TIMATED'CONST'RWTI01y COSTS Item Estimated Costs: (Labor and Materials)OCia1 iJse Unly 1.Building $ '—� 1. Building Permit Peet$ Iadirpte how fee is dotelmined: ❑Stautdard City/own Applloa ftn 2.Electrical $ b ❑.Total F. of Cost,ate'm 6)x mulEipHer x 3.Plumbing $ 2.,Otlrcai Fees'$ " 4.Mechanical (HVAC) $ List; 5.Mechanical (Fire n6l siou $ Total All Fees:$ �� Check No. Check Amount- Cash A oiurt: Project Cost: $ `� �J p p in Full 0 Outstmt&ingBalatttsreDae i Pcr ur- ` IO�IOgAC 8�8_8 A.C. CASTLE CONSTRUCTION CO. INC. P to 5 } w iMEMBER Telephone(800)505-LEAK(5325)•Fax(978)777-7750 Brian LeBlanc,President Please mail accepted proposal to the office located at: 9 Tibbetts Avenue-Danvers,MA 01923 Unrestricted Mass Builders License No.054882 Contractors Registration No.166.565 PROPOSALSUBM �f P ao Or! DATE/2 / STREET �/ �� p JOB NAME r_/" oD / CITY,STATE ANPOP CQIDE ` JOB LOCATION � zP>7 o� DATE WORK IS SCHEDULED TO BEGIN DATE WORK IS SCHEDULED TO BE COMPLETED JOB PHONE 01 19e prOpoS/eLhe by to fur (m?aterii II andlala�bor- mplete In ccordance with specifications below for me sum of: (,)/iO) / J_ y" y/�/tl l� dollars I$ C�� ., ayment to be as to d�N (� S NOTICE: Al home improvement contractors and subcontractors engaged in home Authorized improvement contracting unless specifically exempt from registration by Signature: provisions of Chapter 142A of the General Laws,must be registered With - '. Agent lire Commonwealth of Massachusetts.Inquiries about registration and Note:This proposal may be status should W made to the ollka of Consumer Affairs and Business Regulation,Ten Park Plaza,Sum 5170,Boston,MA 02116. Withdrawn by us it not accepted within days. WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: A ROOF STRIP We will cover the siding,bushes,and grasses with Blue Tarps in order to protect the property during stripping. We will strip up to 2 layers of roofing and remove all nails,screws and staples down to the bare wood.The ice and water shield will then be installed at the bottom of all edges,under all step fleshings,under all roll flashing,around all chimneys,skylights,and into all valleys,in heated areas only. We will install 15 pound underlayment onto all other areas of the rootdeck.The 8"aluminum dripedge will then be installed to all root edges. Any existing pipes will be covered with new urnjnuln rubber f n e .� 6frl, 62 The roofing material to be used will be �'• /I We will cleanout all gutters and downspouts.All the debris will be cleaned and dumped by us on a daily basis.Magnetic brooms will be used to extract all nails from your property.We will protect your property as best we can,however some foliage matting,breakage,or marring could occur. We cannot accept responsibility for possessions inside of the house,or debris falling into attic areas.Customer should protect personal belongings. EXTRA WORK IN WHICH A COST WILL BE ADD D TO HE ABOVE PRICE. Replace Rotted Roolfboardscs,Ua Install Aluminum Gutters e, Raised Chimney(s) Install Aluminum Downspouts Replace Facia BoaWs Install Skylight(s) Install Ridgevent !' .yes— �n�)a lv.� e-S' Rotted Roof To Well Flashings Install Roof Louvers Gutter Repairs NOTES: N r C11/M/✓L'—Y g .(/D r t�S „ li " efrm.,. -�r yr 1i and TAr a banrd d rr" .1, m .rn S, ' k X7Sa r.7aY Ao/er a5' tyro a 0 E.S %fEaf Warr n y manufacturer be as of defects for ye r , ee manufacturer's warranty for exact warranty performance. All r dorfn under tract shall be of good quality and free from defects not inherent in the quality required or permitted for a do f years$ hi Brandy excludes remedy for damage or defect caused by abuse,modification,improper or insufficient m menance,improper op ion,or normal wear and tear under normal usage.This warranty shall be limited to the work performed by A. Castle Constructi o.,Inc.and limited to either repair or replacement by A.C.Castle Construction Co.,Inc.at its'sole discretion and Lion. d all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the Occurence o the event giving rise to such claim.This warranty shall not extend beyond any limits imposed by applicable law. It is our obligation to obtain any and all necessary related permits.PLEASE NOTE:owners who secure their own construction-related permits shall be excluded from access to the Guarantee Fund. Payment and Penalties-Upon substantial completion of all work under this contract,customer shall within 3 days make final and full payment of the contract price.Any and all unpaid balances shall accrue with interest at 5%interest per month.You agree to pay all court costs and collection expenses incurred by A.C.Castle Construction Go.,Inc.in the collection of any amount you owe under this contract,including without limitation reasonable attorney's fees.Please note:any illegal layers of roofing beyond a second layer will be an extra cost of 35 cents per square foot. Arbitration-Any controversy or claim arising out of or related to this contract,or the breach thereof,shall be settled by arbitration with the American Arbitration Association or a mutually agreed upon third-party.Any judgment upon an award entered in arbitration may be entered in any court having jurisdiction thereof.This section shall not apply to claims of A.C.Castle Construction Co.,Inc.for collection of past due accounts owed by the customer. The homeowner's three day cancellation rights under MGL c 93 s 48;MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. Attelrtante of Airopom( -Signing this proposal means you have accepted all the terms as stated and us as a ' g agent for permitting. Y!a Date of Acceptance '3!/S Signature l