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16 HORTON ST - BUILDING INSPECTION (2)
-- _-- -- I he (',unnnn\\alllh ,d \Ll„aehu,ett, -- -- — ---.. . Board ill ButldmL: Regul,ruun, and Stand,rrds t y %j:jsNd%.husrnS State 13MILIML: Code. 'SO ( MR. cdnl,n III Ali ;ii \III 1 13uildin ' 1'ernul :Apph.,ul,m To Construct. Repair. Reno%ate h I)enl,Ji,h .r This tie nun Fur Itma \e Unly ------_--_-- - , 1 l3uildin_, Perinll :.'ut few/rn. - - lle . plied' /1_ � Rulldw� Cninnu�.netn _mpr.im ,d 13 ilJmc. U.tic SF1'T ON 16 TE INFORMA I ION 1.1 Properh /\ddrTtss: - -- — —� 1 1,se,sors Nlup & Plrtel NiAnlillrs , .'t : .toss .It..tl ..I.. 1-3 Zoning Infonna lion: 1.4 Property V;,-.t rn,;ams: -------- iZmm�g Dutnct Pnq seal I\. I a :\rea(,y it) F_uutakgc IU r j 1.5 Building Setbacks (fU -- —;------...------ Fnnn Yard Side Yards Rcar Y ;u,l ' Rryun cJ L--n,,.ulcJ_ ! r3;yu.rcd — Pr„tdcd 1.6 %Vater Supply: tM G L� 1U g :.11 + r r ioox, GUcc tn[ matron. 1.8 Seevage "r.pc sal S+,lt,rrr`•`nl �i III i , ..__ Uu srJ,. Fh.>u Lnnc' Puhlic ❑ Pmatc❑ ,Skm. '- dl l) JI,>u:ul...____ r� -- —SF:L'f;(t�: ?: PROP[iRTY O\+\ ?iERSfdlP' rI.1 Owaert<r R•-ord: 2 s, r,n1, Addres, lu, Scr,i,.c: I slgnrn Telephone SECTION 3: DFSC'al:°';'ION Of PROPOSED WORK= !check nit that apply) .--------_--"" Neu' C ;nvrructnm ❑ 1 Existing Budding LJ O„ner Oecupted ❑ T ❑ \den;:.n n y — --- -.--. _. L um Pem,niti, n Cl \:eu„n} B.dk 0 , .r, her uI C%nti, h trC Sri u s i — -- — -- - I SECTION J: ESTI\tATEU CONSTRUCTION COSTS j Esumated Cults: Item t l.ahur .Lnd Millenalst official Use Only l I 13utlJrttu+ i L Building Penns Fee: 'S _ Ind leate h,,,, tee �, detrl nt,ncd ' ❑ Standard City'/Trnvn Apphcanun Fee Flee steal 4 --a ❑ Tula) Pnryect Cusl' (Item G) x multiplier x .___.. } Plumhing 'S _'. Other Fees: 'S 1 Mechanical 1 MAC) S Luc .— -- —- �i ,�teihante.d tFire' 1nL „t, nt f:-1,11 All Fee,' S_. -- � ~ ( heck No _ ('I1eLA .\m .n \ount _ (' h nt,nutl ..h rotal Project Cost '�` �/a p ❑ Paid to Full --- ❑ ()ul,l.tndtng f3.tl.t n.e I)ue �011 e ()une Z/ �� ll SECTION5: CONSTRUcr1ONSER% ICES -- S.I Licensed Cunslruclion lupenisur IC'SL1 \,rnr sill Sl. IhllJct I.1,11 S1. I pe ,\ee hilowl UI( u_ I�1 K Ri,luil:J F' fam;l, Ilnl, anal I'i lrpin�ate \\S Hip;'j, oil \% I'd"„ ;;J _n`_ ,...—_ ;it IStu Il n; 1_—\I•L-�n.-1_n;.a - /V 5.2 Registered llfAAAAAfoml Otpruy•rl Contractor (111Ct dp HIC (•Innp.uty Na111C or fIIC Rceutrant Nmne Kegntrauun Nuuther Z - F,puauon Date Signature relephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (NI.G.L. c. 152. § 25C16)) \Yorkers Compensation Insurance affidavit must be completed ad .,ubmttted with this application Failure to pro,Ide this alfidavi( will result in the denial of the Issuance of the budding permit. .. . . Signed Affidavit Attached? Yes .......... ❑ No -... ❑ - SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT - as Owner of the subject property hereby I .. authorize - li act on my hehalt. ut all nl.ltlel:s i relative to w..,I k authorized by this budding permit application. Slenature ul Owner - Date SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION I. as Owner or Authorized Agent herchy Jecl:Ire that the statements and information on the foregoing application are true and accurate, to the best of my knowledge :Ind nenalrt�"under Ci ri�r Aulh ize :\gent Date1.' and valuesut (u 1NOTES:obtains a building permit to dot his/her own work, ur an owner s,ho hors an unregt,l<•reJ c�nur:I. oar(nut registere in the Home Impro.emen( Contraclor (1110 progrtm)• will ant hale acccs, to one mbimauon - j - program or guarimy fund under M.G.L. c. 112A. Other important inhlrmauon on the I II' Program .Ind Construction Supervisor Llrensmg WSL)can he found in 780( NIR Regul:utnns I I0.R6 end 1 10 R5, re,pecrlscle I When ,uhsomual work is planned, preside the Inloimanin below: -- r,Ital flours area (Sy. 1:I.1 1including garage. fint,hed ha,entent/attics. deck, Ia" p,lnh, (iro,s living area I Sy. Fr.I Habitable r<,om c,,on( .. Number of fuepluces— `'umber it hednllnn, Number,d 't,alhlinms _ Number of h,1111,uh, - I %pe of he.utne ,s,tcm ._ Numher ,d Jc.k,r p„i.hr, - I\pe IIf "„Ihn,e ,s,ic rn_.— Ir.nJn'cd - 7, rmal project Syu.Ire Foulage" mas he ,ub,tituled h-I r,,r•J Prtgcct ('I I,I'• CITY OF SALEM ^. 64 PUBLIC: PROPRERTY DEPAR"I' �IENT I III 'I'Y.'{ X. ',-g.V:'I]L, Construction Debris Disposal Affidavit (required l6r all demolition and icnovation work) In accordance ith the sixth edition of the State Building Code, 780 ChIR section 1 1 L5 Debris, and the provisions of MGL c 40, S 54; Building Permit it is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal lacility as defined by MGL c I11. S 150A. The debris will be Iran;)orted by: I name of9rauler) I he debris will be disposed of in (name of!'acdity) (address of I]ctloyl VL'Ilal Ole hefll llt .11)I)lll alll 2- ,late CITY OF SALEM PUBLIC PROPRERTY 0 DEPARTMENT NInlRiI 't DxuCOII. VIsron l20W.%SIuNG1' NS-rnl:r:r0Snl_[Nt, 1L\ss:vauDerr,OIv70 THL: 978-745-959j ♦ F:kx: 978-740-7836 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anplit ant Information Please Print Legibly Nanie (Bu;intssioiganizatiomindividual): �O ✓ r Address: �— 1< C ��Ce ti Phone f# 7� City/State/Zip: J Are Non an employer? Check the appropriate box: Type of project(required): 1.1 }4 am a employer with © 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).` have hired the sub-contractors ❑ Remodeling 2.❑ I atti a sole proprietor or partner- listed on the attached sheet. 7. 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 [ p� 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I a n a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] f employees. [No workers' 13.0 Other comp. insurance required.] `Any applicant that checks box NI must also till out the section below showing their workers'compensation policy information. f I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I um an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: J,a,, Policy #or Self-ins. Lic. #: ] W� A' rL-i? Expiration Date: ` 2 �3• J, Job Site Address: �+ , ST City/State/Zip: v(1r4he �19 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby verb un er t pairs and penalties of perjury that the information provided above is true and correct. St n lur ? S Date: e � U (� phone Official use only. Do not write in this area, to be completed by city or town ofjiciaL Citv or Town: Permit/License # Issuing Authoritv (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: R Information and Instructions %I ZISSa C h LISCus General Laws chapter 152 «quires all employers to provide workers' compensation for their employees. Pursuant to this statute, an eutplgree is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An en+plover 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. I lowever 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." Additionally, NIGL 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 theircertificate(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 Deparnnent 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 permit/license number which will be used as a reference number. In addition,an applicant that titust submit multiple permib'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 burn leaves etc.)said person is NOT required to complete this affidavit. The Otfice of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and tax number: y ; , The Commonwealth of Massachusetts ' Department of Industrial Accidents _� f Office of Investigations ) 5 i 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-'_(i-OS , www.mass.gov/dia ,.7z.11-15-2008 02 : 15 PM BAX Global Boston 6663924090 1/ 7/15/' 08 TUE 14 : 28 ( ) 16175676338 U , 00� t 23 KETTLE COVE LANE p GLOUCESTERTER MA 0193© , "% PHONE: (978)526-8560 LICENSED & INSURED I WEB SITE FAX: ( li2B^R682 N.I.C. #100273 ,,.., d-Q S T R U C T 10 N www.MDB-Construction.com ESTABLISHED 1986 TO PHONE GATE Michele Barling 617.693-5113 7/15/2008 lb Horton St. JOB NAME i LOCATION Belem MA 01910 Same JOB NUMBER JOB pHONB 02U04BAN We tieroby Submit flpaadlead0ns Amd Eadmotes For; ..". };.Installation of pressure treated stair unit On existing deck LO conmisL of Lhe following iLemn; 1. Demolition of existing straight ...Lion of rolling at 90 deg 1604110n. Notnc This section to be reused for gate_ g, installation of now top 40d boLLom POOL Lo MALoh existing as close as possible. NOLot'-XL an add.xtlona.l post is necessary due to rai l Ing length a,aij.bil.ity it will he at no-extra_charge- ;_ Tnnta}latd0n of 2x12 pressure treated stringers (16" o.C.) so as to create 4'0" wide stair unit. 4c installation of matching slate grey Fibron decking to be 'used as stair treada_ Installation of concrete pad fox lower step and stringer support. 6. Installation of one side stair railing aeption in Vinyl to matnh AxJ.anlnh an cleae as passible_ 1. installation of additional framing materials (pressure treated) as necessary to strengthen existing lattice. B. Installation of one fir handrail on lattico o:Ldo so as to meet or exceed local codes. 9, tnatallotion ml prepMpre LsusLad x•ipara. 10. Installatlon oP one gate at the top of the stairs fabricated from the exisiing railing section. -.. - 11. 71,71 job related debrin to be removed by MnB 12. Building permit to be by MDn. NOTFS: Any plot plans, varience and or special permits required to be supplied by owner. . We PPDpOse hereby to furnish material and labor—complete In accordance With tho above®poolneatlone,for the sum o1: One Thou6and roux Hundred and 00/100 Dollars dollars 1,400,00 ) Payment to be made as IOpnwa- Une CASH payment .f $700-.00 upon projact permitting and start. One CASH payment of $350.OD upon framed one CAS11 payment of $350_00 upon Completion. All matador is guaranteed to be es specMad-Allwork to be complalad m a pmFsMk r a1 marftr W"WInp to standard pracgcae- Any ekwalian ar deviation from above Wohlomlons AuMadzed Involving gmrn ooma wig bn ekerAded only upon m1nan orders, and wig hQoomo an once 3ignatwe- dlorga aver OM above the eagelele. Ail a gowns mrllingant 147611 6trM, 9oaldams ar dalayg beyond mlr rnnvaI.Owner 1P carry ills,tomado:Old oilier goof aary 111s1pag�4, Qar Ng This 1 m be worke are Mlycovemd by Wommin dompormadan Inaurnnea. wehunnm ey us rr not acoepnd wlolln 1 0]ays. Acceptance of Proposal — The above prices, specs icadons Q and conditions are satisfactory and are hereby accepted.You are aWwdzed S��m;_ t6 do fho work as specs lad,Payment will be made as outlined above. Dale ofAcoeptance: Slgnaturo: