34 HILLSIDE AVE - BUILDING INSPECTION 4-1 r
`t R Commonwealth of Massachusetts
rdo C The
RVICES BoafBuildingRegulationsandStandards FOR
INSPECT[ Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
2015 MA I l -A W2'191Dg Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mm•2011
One-or Two-Family Dwelling
This Section For Official Use Only ` '
BuildingPekmitNumb, DateA ed` '
Budding Official(Prinmame) sigeahae [�w aData 5—
SECTION 1:SITE INFORMATION
1 n 1.13�ertyA$tJressj� � 1.2 Assessors Map&Parcel Numbers
1.1alsthisan cceptedC dstreW.yes no Map Number PkrdNumber ...
13 Zoning Information: 1.4 Property Dimensions:
c.r -
Zonivg District Proposed Use . ..- - Lot Area(sq 8) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards ' Rear Yard
Required Provided Required Provided R:e ed Provided
1.6 Water Supply-(KQL c.40,§54) 1.7 blood Zoos Infurmatiori: 1.8,Sewage Disposal System:
Public❑ Private Zone: _ OutsideF1oodZone?
Checkifyes❑ ! Muni i ❑ On site Disposal
disposal system ❑
SECTION2: PROPERTYOWNERSffiPl
21 Owner'of Record:
177 r- Leta,-f e �ev►, iN�l O/970
Name(Pnnt) Crty,State,ZIP
3LI
No.and Sheet Telephone Email Address
SECTION 3:DESCRIDMON OF PROPOSED WORKS(check all that apply)
New Construction❑ I Existing Building❑ 1 Owner-0 led E3 Repaits(s) ❑ Wation(s) ❑ Addition ❑
Demolition _ ❑ 'Accessory Bldg.❑ Number of Units- Other Specify
BriefDescription of Proposed Work2
SECTION 4:ESTBUTED CONSTRUCTION COSTS .
Item Estimated Costs:
(Labor and Materials Official Use Only,
1.Building $ 5 g9 j, - 1. Building Pemrit Fee S Indicate how fee is determined:
2.Electrical $ ❑Standard Citylfown Application Fee
❑Total Project Cnstr(Item 6)x multiplier . x
3.Plumbing $ 2. Other Fees: $
4:Mechawcal (HVACj .$ Lisf
5:Meebanical (Fire
Su ressioa $ " , Total All Fees:$
6'1 Total Project Cost: $ � CherkNo. Check Amount Cash Amount
T ❑Paid in Full: ❑Outstanding Balance Due:
SENT
I 1 :
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 1 �y 7(�r —7
8
IicenseNlnober Expiration Date .,
Name of CSL Holder
' I,ist.(SL Type(am below)
�
Eric W.Palm Type Description
No.and Street - 3 Hilton Stmet
U Unrestricted ml W 3 000 cn.>t
Calem MA 01970' R Restricted M-2 FamilyDwelling
City/rown,Statc,ZIP {' M
RC Rooting Covering
G r,I�,/ ry WS Window and Si
ft
701 a tl IF S0WFUnlBummgAppVaaces'
Tel hone EmaU address - -D -I Demolition -
5.2 Registered Home Improvement Contractor(1119 Iq 20 k 3 Z (Q
Atlantic WCittilCnGtUviyi .. MCItc&tranon amber Expiration Date
HiccompanyNarecorElloffleMWARKM AVenUe
*-
No.and Street Seim nar 007e Email address
Cityfrown.Statc6 ZIP Tet hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(hLGJL c.is,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fail=to provide
this affidavit will result in the denial ofthe issuance a building permit
Signed Affidavit Attached? Yes.......... I No..........13
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTORAPPLIES FORBUHAING PERMIT
1,as Owner ofthe subject property.hereby aafhorize &t G Y aI rn
to act on mybeh4 in all matters relative to wont authorized by this buildingpemritapplication.
Pdntbwnees Name(EI moS,ignatrae) j Date
SECTION 7W OWNERt OR AUTHORIZED AGENT DECLARATION
By enteringmy name below,I hereby attest under the pains and penalties of perjury that all ofthe information
contained in ' applica is to*a best ofmy knowledge and understanding.
Print Owner's orAathorized Agent's Name(Electronic Sigaatme). Data
NOTES:
1. An Owner who obtains a building permit to do his/her ownwork,or an ownerwho bites an unregistered contractor
(not registered in the Home improvement Contractor(FIIC)Program),will not have access to the arbitration
program or guaranty fund under MG.L.c.142A.OWer important information on the HIC Program can be found at
ass.www.maov/boa Infomration on the Construction Supervisor License can be found atwww.mass.eov/dos
2 When substantial work is planned,provide the information below:
Total floor area(sq.fQ (including garage,finished bmatent/attics,decks orporch)
Gross livingavea(sq.R) Habitable mom count
Number of fireplaces Number of bedrooms
-Number-of bathrooms Number-of-half/baths -
Type ofheating system Number of decks/porches
Type of cooling system Enclosed - Open
3. "total Project Square Footage"maybe substituted for"Total Project Cost».
roo,�
61 R Jefferson Avenue Salem, MA 01970 • (978) 744-8143
November 3, 2014
PROPOSAL SUBMITTED TO: Mr. Letarte
3q 33'Hillside Avenue
Salem, MA 01970_- — - — --- — — _ ---- --
We hereby submit specifications and estimates for: Main Roof-Pitched
1. Pull building department
2. Strip and dispose of existing shingles
3. Install up to 100SF sheathing as needed
4. Install ice/water shield
5. Install roof paper
6. Install 30-year architectural shingle
WE PROPOSE HEREBY TO FUNISH MATERIAL AND LABOR COMPLETE IN ACCORDANCE WITH
ABOVE SPECIFICATIONS FOR THE SUM OF: $5,995.00
..................................................................................................................................................................................
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner
according to standard practices. Any alteration or deviation from above specifications involving
extra costs will be executed only upon written orders,and will become an extra charge over and
__above the estimate.-All-agreements contingent upon strikes-accidents,-or delays are-beyond-our----- - - ------
control. Our workers are fully covered by Workman's Compensation Insurance.
The above specifications and conditions are satisfactory and are hereby accepted. You are
authorized to do the work as specified. Payment will be made upon completion of work as
outlined above.
Please sign and return one copy to the
ea�above address. ATLANTI E-ATHERIZ�ATION, LLC
ACCEPTED: � a cr r'Is?� By: ' _—
` Eric Palm
DATE: ///��✓i�'/.�
BPI Certified • EPA and Mass. Lead-Safe Certified
Authorized Honeywell and NGRID/NSTAR Contractor
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�J Board of Building Regulations and Standards
Construction Supen Nor -
License: CS-087977 a;
F.RIC W PALM =
S
3 H ILTON ST t
Salem MA 019707
- Jam„� ,,. ` Expiration
Commissioner 0412312016
'e�arirrirourocrr(!��C�il�atinc�nle(h _;
_ Office of Consumer Affairs&Business Regulefiou
MEIMPROVEMENTCONTRA-TOR -
istra0on: 142089 TYpa- n
piration. WiW2016: Ltd Liability C po:
ATLANTIC WEATHERIZATIOI&L.C. .;
ERIC PALM
61R JEFFERSON AVE
SALEM,MA 01970. - .Undersecretary