16-16 1-2 HOLLY ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CCCY OF
t1v` bfassach S Building d 780 C usetts State ung Coe, MR SALEb(
Ravised tLtnr ]1/
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family avelling
This Section For Official Use Only.
Building Permit Number: ; Date Applied:`
Building Official(Print Name Signature - Date
SECTION L SITE INFORMATION
1.1 Pro ty Ad r ss� 1.2 Assessors Map& Parcel Numbers
—0#4 6-r 1
I.1a is this an accepted street?yes_ a 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 (It)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal O On site disposal system ❑
Check if yesCI
ECTION2:; PROPERTY'OWNERSHIPL
2.1 erto irecord:
Name(P ' t) City,State,ZIP
e V,r ��3j-ez sr� vk
o.and Street I zTelephone E it Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use 11 Only. .
Labor and Materials
1. Building $ I. Building Permit Fee:S indicate how fee is determined:
?. Elcctriatl $ ❑ Standard,.City/Cown Application Fee.
❑'Cotai Project Cost (Item 6)s multiplier x
3. Plumbing $ ?- Other Fzes: S
L L
cal (IIVAQ S List:
5. cal (Piro —�
Sn � S Total All Fees: $
--
T Ch ck No. _Check Amount: _ Cash Amount:
I'Mal 1'tn'eet Cost $l � 6 V
l I [3Paid in Full ❑ Outstandmy Il rluue Dim;
SECTION 5: Co:Ns-rRUCI'ION SERVICES
5.1 Construction Supervisur License(CSL) I
LicenszNumber Expiration atz
Name or
I List CSL Type(see below)
z Description
No. ai trezt
U Unrestricted
Du u to cu R.
Restricted 3c7 PamilyDwelling
City/ro%vn,State, ZIP Masonr
RC Rootin Covcrin
WS Window and Sidin
7 SF Solid Fuel Burning Appliances
7 6� I Insulation
l'elz onz Email address D I Demolition
S tered Home [nip ement Contractor(tIIC) it
N[C zgistration tnnbzr E.rpiratiun D to
1IIC Company [II ' Ragu>n wee
7 10
No.and Stre /' Ile) L Email address
Ci ITuwn, State, ZIP Tile hone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. t52. 1 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 APP IES FOR BUILDING PERMIT
I, as Owner of the subject property, hereby authorize
to act on my behal7inal nr tiers relative to work authorized by this building permit application.
a n �
Print Owner's Name(Electronic Signature) Date
SECTION 7h: 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 ' n e to the best of my knowledge and understanding..
P7WIlen
int Owner's or Authorized Avia's Name(Electronic Signature) Datz
NOTES:
ho obtains a building permit to do his/her own work,or an owner who hiresan unregistered contractor
ed in the Houte Improvement Contractor(HIC) Program), will not have access to the arbitration
uaranty rund under M.G.L. c. 1d2A. Other important information on the H1C Program can be found at
uv; Information on the Construction Supervisor License can be found atantial work is planned,provide the information below:
Total floor area(Sq+ R.) (including gunge, finished b:asetnenVattios,decks or porch)
aro;; living mca(iy. tt.) ILibitable room count
Ntimberoffireplaeci----_---_-- Numberofbethooms -_---__-_--
Number ofbadirooitis Niumberofh:dt'baths -- --
I'vpu of he:uinq iyiiem Number of decks;purdms _
I'}peofConlin" 'Y:tciu Enclosed.- PPell _--_-_-- -.-
1. '-I',rLd 14nlret Syu,irc Ennl.ige" ut.t he iib;nrta d r;)r hd.il I'ru'Itd Coit"
y
(46BIP
Vropos'al
A.C. CASTLE CONSTRUCTION CO. INC.
MEMtR Telephone(800)505-LEAK(5325) • Fax (978) 777-7750 ra
Brian LeBlanc, President
Please mail accepted proposal to the office located at C� 7 6 6 � ��
9 Tibbetts Avenue • Danvers, MA 01923 Unrestricted Mass Builders License No. 054882 Contractors Registration No. 166565
PROPOSAL MITTEDT /
/ ,p1 11, 11 P PHONE
STREET ^ f• 1 DATE J /
t /V`• re � JOB NAME `
CITY, aTAT J ZIpO01� _ /s �y ` /'� ,
!lam JOB LOCATION Vf. � V
4RCHITECT W
DATE OF PLANS
JO PHONE
F_ TO�Ia hereby to fur r-..: ate"i - t
material and latter-co pleteIn'a cc orda ewith specifications below for the sum of: "�*�...,...,. .,,.
avme t r n ra n
lows:
--- dollars($
p )
t ,
OTICE: All home improvement contractors and subcontractors engaged in home
improvement contracting unless specifically exempt from registration by
Provisions of Chapter 742A of the General Laws,must be registered with Signature:
the Commonwealth of Massachusetts. Inquiries about registration and Signature:
status should be made to the Director, Note:This proposal may be Home Improvement Contract
Registration,One Ashburton Place,Room 1301,Boston,MA 02108. Agent
:HE
withdrawn by us if not accepted within
days.
REBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
ROOF STRIP
e will Cover the siding, bushes, and grasses with Blue Tarps in order to protect the property during stripping.
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
tailed at the bottom of all edges, under all step flashings, under all roll flashing,around all chimneys, skylights, and into all valleys.
will install 15 pound underlayment onto all other areas of the roofdeck. The 8"aluminum dripedge will then be installed to all roof edges.
✓existing pipes will be covered with n w
roofing material to be used will be ml rubb Lem
the debris wiii-De-cleaned and-durnpeci by-us on a daiiy basis-Maagneiie br0oris v•ii{u us d to axtr.ct all Waits
will Protect Your Property as best we can, however some foliage matting,breakage, or marring could occur. We cannot accept
yourproperty.)onsibility for Possessions inside of the house,or debris falling into attic areas. Customer should protect personal belongings.
RA WORK IN WHICH A COST WILL BE AD ED T THE ABOv IC
lace Rotted Roofboards �� /
ad Chimney(s) tall luminum Gutters
Install Aluminum Downspouts
ace Facia Boards
II Ridgevent y Install Skylight(s) ,
II Roof Louvers (,I R tied Roof To Wall Fleshings
=S: 7f ggrrQpairs
'anty by anufacturer b free of defects for
or pe r ed under Is ontract shall be of good quality and free from defects not inherent in the quality required or permitted for
ye Is, see manufacturer's warranty for exact warranty performance.
1dyearst warranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient
'n ce, Improper ration, or normal wear and tear under normal usage. This warranty shall be limited to the work performed by
a tie Constru n Co., Inc. and limited to either repair or replacement by A.C. Castle Construction iced Inc. at its'sole discretion
ec and all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after ion
once of the event giving rise to such claim. This warranty shall not extend beyond any limits imposed by applicable law. the
lent and Penalties - Upon substantial completion of all work under this contract, customer shall within 3 days make final and full
nt of the contract price. Any and all unpaid balances shall accrue with interest at 5% interest per month. You agree to l pay all
aosts and collection expenses incurred by A.C. Castle Construction Co., Inc. in the collection of any amount you owe under this
including without limitation reasonable attorneys fees. Please note:any illegal layers of roofing beyond a second layer will be
a cost of 35 cents per square foot.
ttion-Any controversy or claim arising out of or related to this contract, or the breach thereof, shall be settled by arbitration with
erican Arbitration Association or a mutually agreed upon third-party.
u any court having jurisdiction thereof. This section shall not ap yy to clams of A.C. Castle Conment upon an struction Co., Inc.rfor collection
due accounts owed by the customer.
Bte of i3ropDSd1 - Signing this
/Proposal means you have accepted all the t rms as stated.
lcceptance
Signature