17 HORTON ST - BUILDING INSPECTION The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One or two Family Dwelling� Section
:� '7.77.77
Building Per
This Sectioii'�60fficial'U§e ��
t NumbeS, r Date plied
Building Official(Print Name). S �Date',
Signatures
SITE INV-ORMATI
1.1 Proper. ress, 1.2 Assessors ap&Parcel Numbers
Eop 1.1a 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
I I I
1.6 Water Supply: (M.G.L c.40,§54) - 1.7—Flood Zone Information: 1.8 Sewage Disposal System:
Public El Private D Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yesEl
T
2.1 e'if ro Reco cl: �
r /I ./)/- Y) P.,/— —
Name(Print) City, p
No.and trect el State,ZIP
t7 j� e Email Address
SECTION 1,DESCRIPTIONRK (eb k all fiiat-apply)
OF, PROPOSEDWO ec
New Addition Construction 13 1 El
_ struction El Existing Building 0 Owner-Occupied El Repairs(s) Alteration(s)
Demolition El I Accessory Bldg. El Number of Units Other 10 Specify:
Brief Description of Propose or
VV U
SECTION 4:,,ESTI tONSTR TFD UJCTION COSTS
Estimated 7—
Costs:
Item 6 Only
1
A
0
(Labor and Materials)
:
1. Building L:`Building Permit,F66-�$-9,- Indicate how fee is detenri
❑ �i:an'dai'dCity/T6'wii.Application Fed,',
2. Electrical
TQtaNPfqJ,c6,t Cost',(Item 6).x ftmltipl
3. Plumbing $ 2 Other trees
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
$ Total"Al Fees*,
Suppression)
Check No -Chick Aruount-' Cash Amount'
6. Total Project Cost: $ 0 V 0 Paid in Full DOutstanding Balance Due�
SECTION 5: CONSTRUCTION SERVICES
rName
uction Supervisor f se(CSL)) �l
✓ t/�'' ji \�.✓ License Number Expiration Date
SL Holder
List CSL Type(see below)
Ai&ereet -Description
Unrestricted(Buildings up to 35,000 cu. ft
Restricted 1&2 Family Dwelling
Qty/Town, State,ZIP M Masonr
RC Roofin Covering
WS Window and Siding
.� G. 75 J /� SF Solid Fuel Burning Appliances
V ` V I Insulation
Telephone Email address D Demolition
5.2 RegistA Hre Im ovemen o 'tractor(HIC) T—'
HIC Registration Number Expiration Da
HIC Co any e o HI Regi [ e
sY
No. and Street _ L O Email address
�o �j -
Ci /Town, State, Z'115 Telephone
SECTION 6: WORKERS' COMPENSATI,ON INSURANCE AFFIDAVIT(M.G";L.c.152.g 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 BUILDING PERMIT.;,
1, as Owner of the subject property, hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
rSECTION 7b OWNEW OR AUTHORIZED AGENT DECLARATION'
enterin,,ge below, I hereby attest under the pains and penalties of perjury that all of the information
lication is true and accur te. the best of my knowledge and understanding.
orized Agent's Name( ectronic 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
www.rmtss.govi"oca Information on the Construction Supervisor License can be found at www.mass.govalns
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"
t
CITY OF S.U..EtiI, TAxsSACHUSETTS
BEING DEPARTNtENT
N 130 WASHNGTON STREET, 3° FLOOR
TEL (978) 745-9595
FA..c(978) 740-9846
(q.NIBFRt FY DRISCOLL
MAYOR THO;•LiS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BuILDDJG CONWISSIONER
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 It 1.5
Debris, and the provisions of MGL e 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:
(name of haul r)
The debris will be disposed of in
e o face ity)--
'4 11)
(address of facility) -70
signature of permit applicant
date
:`✓ � �`� �Jl� �CD�1D$AC
BBrB E / G1��
A.C. CASTLE CONSTRUCTION CO. INC. yi ) 17 �
MEMBER �� Telephone (800)505-LEAK(5325) • Fax (978) 777-7750 fy/!
Brian LeBlanc, President
Please mail accepted proposal to the office located at:
9 Tibbetts Avenue • Danvers, MA 01923
Unrestricted Mass Builders License No.054882 Contractors Registration No. 166565
PR Sql, �ITT�D T PHONE DATE
BEET{ JOB NAME / L
CITY, STATE ANDCP CO EE JOB LOCATION
d '
ARCHITECT DATE OF PLANS JOB PHONE
)M r here�b °furnish maori� labo -co ple in accordance with specifications below for therm of:
7e flOUIC Adollars($ I
Payment to be s follows: 1
1
NOTICE: All home improvement contractors and subcontractors gaged in home
9 9 Authorized /improvement contracting unless specifically exempt from registration by Signature: fi
provisions of Chapter 142A of the General Laws,must be registered with
the Commonwealth of Massachusetts. Inquiries about registration and Agent
status should be made to the Director, Home Improvement Contract Note:This proposal may be
Registration,One Ashburton Place,Roam 1301,Boston,MA 02108. withdrawn by us if 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 flashings, under all roll flashing,around all chimneys, skylights, and into all valleys.
We will install 15 pound underlayment onto all other areas of the roordeck.The 8"aluminum dripedge will then be installed to all roof edges.
Any existing pipes will be covered with �w mi urp rub be f �g/gS�j
The roofing material to be used will bell C'� i �-
- All debris will be cleaned and dumped by us on a daily basis. Magnetic brooms will be us t extract all nails from y_our_property_._
We will protect your property as best we can, however some foilage 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 ADDED TP THE ABOVE PRICE.
Replace Rotted Roofboards LoQ F O 0 1 Install Aluminum Gutters
Relead Chimney(s) J4 Install Aluminum Downspouts
Replace Facia Boards Install Skylight(s)
Install Ridgevent, Rotted Roof To Wall Flashings
Install Roof Louvers Gutter Repairs
NOTES: I Ilea I— I o.
rc
WarraF� ilv
nufacture t e free oty Tor exact warrant erformance.
YPAlllabogd and hi 0ntractrent in the quality required or permitted for
a patio _year T warrantbuse, modification, improper or insufficient
mainteproper o ration, or normal wear and=tear under normal usae This warranty shall be limited to the work performed by
A.CCstru Co., Incandonstruction Co., Inc. a[its'sole discretion
and ely and alt claims are waived unless made in writin to AC Castl Ctruction Co., Inc. within 21 days after the
occurrea event giving risetos
imits im sed b li
a cable law.
.. Po Y PPPaymenalties - 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 Co., 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.
01treptante of Jaropo5af -Signing this proposal means you have accepted all the terms a 31ated.
Date of Acceptance Z d Z Signature
E Z � 9
:2 i ,