30 JACKSON ST - BUILDING INSPECTION (� The Commonwealth of Massachusetts
CITY OF
Board of Building Regulations and Standards
1 Massachusetts State Building Code, 730 CMR S
' �77 Revisedd Mar
2011
nr
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family Dwelling
This Section For'Official Use Only
Building Permit Number:; Date , pplied>;
Building Official(PrintName) :'Signature Date
SECTION I: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
30 <rAcwo/j 01-R_8;_r
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 SetbacIts (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 system ❑
Check if yes❑
SECTION2:; PROPERTY'OWNERSHIP
2.1 Ownert of Record:
�D �F,atct2ttv6? oN -45 C)
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORIC''6heck all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Iteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other Specify: 4 (9Fl& 9
Brief Description of Proposed Work': F S'ffrSLO 1 9
X0, 0"Le-
.41—ilip CAP
SECTION 4: ESTIMATED CONSTRUCTION COSTS-
Item Estimated Costs: Official Use Only
Labor and Nfaterials
1. Building ; 1. Building.PermitFee S Indicate how fee is determined:
❑ Standaid City/•PotvnApplication Fee
2. Electrical S .. ; - -
❑Total Project Cost ,(Item 6)x multiplier x
3. Plumbing S 2 Other Fees: $ i_
1. Mechanical (IIVAQ S List: / iU
5. Mechanical (Fire $
Slip ression) _ rotalAll Fees: .S
S(Q pC� 00
Check No. Check Amount: Cash Amount:
6 fatal Project Cost: S
i � � 0 I nid in Full Cl Outatnudin, 13nl;tnca I'Ttc:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CS[,) 01/04/9, Aai
Sr,/ � Licensa Number E Date
Name of�CSL FI Idea
List CSL Type(see below) 61
2 y � JET' _ TV lie Description
No. nn— d Street T
A (� �)p U Unrestricted Buildin s u to 35,000 cu. ft.
'J C�`� Restricted 1&2 Family Dwelling
L
own, [P RC�( Roofinr
ng Covering
lVS WindowundS'idin•
/ SF Solid Fuel Burning Appliances
I Insulation
Email address D Demolition
5.2 Registered Home Improvement Contractor(11IC) /� ci(f6 3 Z7 .2A/
�41)(9� CQ H[C Registration Number Esp' .tion Date
I `l'-J 1 ny,Utm r FI&2gj;tt.'tnt Name
No. an5� ��-eC � pi/g70 9?F9 7�Dr0�� Email address
CityjTown, State, ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be c pleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issua of the building permit.
Signed Affidavit Attached? Yes ..........16 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
SECTION 7b: 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 is true and accurate to the best of my knowledge and understanding.
G7Y`ri� S 7 d�ly{c� rz , Cm y� s< f/® 20%-?
Print Owner's or Authorized Agent's Nwttc(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty tund under M,G.L. c. 142A. Other important information on the HIC Program can be found at
w ww m:us.�,uvr'oca Information on the Construction Supervisor License can be found at
2. When substantial work is planned,provide the information below:
Total floor area(sq. tt.) (including garage, finished basement/attics, decks or porch)
Gross living area(sq. 12.) _ Habitable room count
Munber of fireplaces _ Number of bedrooms --- __—_--
Number ofbathroonts Numberofh;flubatlts
Type otlta:uing system _ Number of,lecks/porchcs ------_----
FN PC of cooling iyirout _ ,----"—"_--- F.ncloscd ----
}. -Total Pf ojecr Squnro Footngo" finny be iubitituted f)l 'I ntal Project Colt" -
CITY OF S:1 zm) ANSSACHUSETTS
1 BUILDING DEp,1RT-NL&NT
,'t } ' '-• 120 WASHIINGTON STREET, Ye FLOOR
TEL (978) 745-9595
Rux(978) 740.98.16
(V\(BFRf EY DUSCOLL
MAYOR Tr{OF4\S ST.FIERAS
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO\f\IISSIONER -
Workers' Compensation insurance Affidavit: Builders/Contractors/Electr(c(ans/Ptumbers
Amilieant Information Please Print Legibly
Naliic(Busiaeiis,Oryni:atiotvIndividual): Ole . doS"" ./2g
i
Address:
City/State/Zip: Phone#: ZLI -7�
Are u an employer?Cheek the appropriate boat Type of project(required):
1. 1 am a employer with J~ 4. C] 1 am a general contractor and I 6. ❑Now construction
employees(full and/or part-lime).• have hired the sub-contractors
2.0 1 am a sole proprietor or partner• listed on the attached.sheet I I. ❑remodeling
ship and have no employees These sub-contractors have V. C]Demolition
working for me in any capacity. workers'comp.insurance. q• C]Building addition
[No workers comp.insurance 5. (] We are a corporation and its
required.] 0Mccrs have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plu ng repairs or additions
myself.(No workers'cutup. c. 152, 01(4),and we have no 12. roof rupairs
insurance required)r employees. (No workers' 13 ❑Otter
sump,insuranco required.)
;Any applic:ud tint checks bax tt moo afsu fill out the seaioo MmAhming thair wmkm'eompenudun punry inibrmatlon,
1 hvnvuwm"who tuhmit Ihls aflldavit indicating thcy ate doing all work and Ihee h!ro oaUide commctps must submit a now atiidavit indicating suck,
:Conimcton that chick fhb box muat vlachodan addiaanal ahoy thawing the nurno of the misgostru"and 1hok wdAms'wrap,policy Inrenndiion.
l tun tin employer that Is providing workers'rompearadets Insuraneo jot my employees Below Is rho policy and Job site
infororallon.
Insurance Company Names (�of-evg ,=��y4s
Policy .or Self its. Lie. N: 6r-� 1"1458 7 / /p,38-0 —/ � Expiration Date:�2 2,6
Job Site Address: � Ul?aee51e V 7'l City/StatdZip• C !G
Attach a copy of the workers'compensation pulley declaration page(showing the policy numb.,and axplrotloe data).
Failuru to sccuru coveraga as required under Section 23A of MGL c. 152 can lead to the imposition of criminal penalties of a,
fine up to S 1,500.00 undlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and if line
of up to$230.00 a day against ilia violator. Ile advised that a copy of this siatcmunl may bo forwarded to the Off ice of
Investigudons ut'the DIA for insurance coverage verification.
/Jac hereby i fy it ter the Cable oad penalNer ofper/urythat the befornmllon provided above i err Ie turd correct
Dllfc iol use wdy. Do not write in thlr area; to be compheted by city or town gjIduL
i
city nr'fuwn: Permit/l.lcensep
Lssuing,%uihoriiy(circle one):
1. Uuurd of health 2.Building Uepartntelo .1.Citylfawn CI
4. Electrical inspector S. Plumbing inspector
6.00ter
Cunlact Person
t
^r Vr
Y CITY OF SiUI ENf, ,AuSACHUSETTS
BULLOLNG DEPAR-M&NT
., 130 WASHLNGTON STREET, 3" FLOOR
TEL (978) 745-9595
!CI\MERI Y DRISCOLL F•LC(978) 740-93446
i+ AYOR '1110sw ST.PIERRH
DrtECTOR OF PUBLIC PROPERTY/BCILDLYG CONNISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section I 1 L5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed ofinerly licensed waste disposal facility as defined by dfGL c
111, S 150A.
The debris will be transported by:
6 I,15m
(name of hauler)
The debris will be disposed of in
/c,f')oZSTrfS/l�e� �grZ��j
(name of facility) _
(address of facility)
signaru of permit applicant L
dvbn,.n� Lw
l
11
- -RAPID ROOFING
GENERAL CONTRACTING CO.
P.O. BOX 605 SALEM , MASS. 01970
978-531 -6111 / 978-740-0101
MASS LIC # 128253/144946/CS101965
WWW. GORAPIDTODAY.COM
RAPID ROOFING IS A DIVISION OF COYNE&SONS CONTRACTING COMPANY
ARCHITECTURAL ROOFING ESTIMATE
TO. 4/4/2013
ED HARRINGTON
30 JACKSON STREET.
SALEM , MASS. 01970
978-836-2502
JOB SITE ADDRESS.
SAME
RE; ROOF ESTIMATE #2013-012
COMPLETE STRIP OF 25 YR. 3-TAB ROOFING SHINGLES ON THE COMPLETE
HOUSE ROOFS & RIGHT SIDE PORCH ROOF OF THE PROPERTY.
INSTALLATION OF 30 YR ARCHITECTURAL ASPHALT ROOFING SHINGLES -
AND CAP ON ENTIRE HOUSE ROOFS & RIGHT SIDE PORCH ROOF OF THE
PROPERTY..
WE AGREE TO.
1. COMPLETELY STRIP THE ENTIRE HOUSE ROOFS & RIGHT SIDE PORCH
ROOF OF THE PROPERTY, OF ALL THE EXISTING LAYERS OF SHINGLES
ON THE ROOF OF THE BUILDING AT THE PRESENT TIME.
2. REMOVE ANY ROTTED ROOF DECKING BOARDS OR SHEATHING ON
THE ROOFS OF THE BUILDING, AND INSTALL UP TO 100 FT.OF EITHIER
ROOF BOARDS OR SHEATHING- FREE OF CHARGE ( ONLY IF ROTTED
AREAS ARE PRESENT).
r`
3. INSTALL NEW WATER& ICE SHIELD ON THE COMPLETE THE HOUSE
ROOF, VALLEYS, DORMERS, ECT. AND THE RIGHT SIDE PORCH ROOF OF
THE PROPERTY.
4. INSTALL NEW 15 LB. ASPHALT FELT ROOFING PAPER ON THE
ENTIRE HOUSE ROOFS & SIDE PORCH ROOF OF THE PROPERTY..
5. INSTALL NEW 8 INCH WHITE ALUMINUM DRIP EDGE ON THE
ENTIRE HOUSE ROOFS & RIGHT SIDE PORCH ROOF OF THE PROPERTY.
6. INSTALL ALL NEW VENT PIPE BOOTS ON THE MAIN ROOF OF THE
BUILDING AS NEEDED.
7. INSTALL NEW ALUMINUM STEP FLASHING ON ALL AREAS OF THE
COMPLETE JOB AS NEEDED.
8. INSTALL NEW 30 YR.. GAF TIMBERLINE ARCHITECTURAL ASPHALT
ROOFING SHINGLES AND CAP ON THE ENTIRE HOUSE ROOFS & SIDE
ROOF OF THE PROPERTY. tic SSi� ✓ W
9. CUT& INSTALL NEW COBRA VENT RIDGEVENT MATERIAL ON RIDGE
AREA OF MAIN HOUSE ROOF OF THE PROPERTY.
10. WE AGREE TO REMOVE ALL ROOFING DEBRIS FROM THE PROPERTY
AND OBTAIN ALL BUILDING PERMITS AS REQUIRED BY LAW.
11. NOTE.. ALL NEW ROOF INSTALLATIONS HAVE A LIFETIME WARRANTY.
TOTAL COST OF JOB... $ 5,600.00
WE HEREBY PROPOSE TO FURNISH ALL MATERIALS AND LABOR-COMPLETE IN
ACCORDANCE WITH THE ABOVE SPECIFICATIONS FOR THE SUM OF....
$ FIVE THOUSAND SIX HUNDRED DOLLARS-$ 5,600.00
WITH PAYMENTS TO BE MADE AS FOLLOWS....................
$ 2,800.00 DOLLARS DOWN TO COVER MATERIALS/ $ 2,800.00 TO BE PAID IN
FULL UPON THE COMPLETION OF THE WORK....
RESPECTFULLY SUBMITTED BY.
RAPID ROOFING CONTRACTING COMPANY
ROBOX 605.. SALEM ,MASS. 01970
978-531-6111/ 978-740-0101/ 978-223-7740/ 978-531-1141 FAX
OWNER.. CHRISTOPHER R. COYNE SR.
NOTE-THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN---21 DAYS.
ANY ALTERATION OR DEVIATION FROM THE ABOVE SPECIFICATIONS
INVOLVING EXTRA COSTS,WILL BE EXECUTED ONLY UPON WRITTEN ORDER,
AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.
ALL AGREEMENTS ARE CONTINGENT UPON STRIKES,ACCIDENTS,OR
DELAYS BEYOND OUR CONTROL.
NOTE.1,AGREE THAT COYNE&SONS CONTRACTING COMPANY,OR ANY PARTIES HEREIN..ARE NOT LIABLE IN
ANY WAY,AND CANNOT BE HELD LIABLE IN ANY WAY IN THE EVENT OF A ACT OF GOD OR NATURE..
WHICH INCLUDES STORM DAMAGE,WIND DAMAGE,WATER DAMAGE,FIRE DAMAGE,LIGHTNING DAMAGE
HURRICANES,ECT. '
WHILE WORKING ON ANY PROPERTY OR ANY PROJECT IN THE EVENT OF ANY SUCH DAMAGE SHOULD HAPPEN,
AS STATED ABOVE.
i
NOTE;ROOFING...
WE CANNOT ACCEPT ANY RESPONSIBILITY FOR ANY DAMAGES.OR DEBRIS FALLING INTO ATTIC AREAS,
CUSTOMERS SHOULD COVER VALUABLES,GREAT CARE WILL BE USED TO PROTECT THE EXTERIOR STRUCTURE
BY COVERING THE EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENT ANY DAMAGES
DURING THE STRIPPING OF THE ROOF,HOWEVER SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR
CONTROL,
HOMEOWNERS MUST MOVE ANY VALUABLES AWAY FROM THE BUILDING,PRIOR TO THE STRIPPING OF THE
ROOF.
NOTE; IF MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE IN THE ESTIMATE,THE
OWNER OF THE PROPERTY WILL BE IMMEDIATELY NOTIFIED,-THE OWNER ACCEPTS ALL RESPONSIBILITY,AND
(AGREES)THAT,ANY EXTRA CHARGES WILL BE ADDED FOR THE LABOR AND THE REMOVAL OF THE EXTRA
DEBRIS,OVER AND ABOVE THE PRICE OF THE ESTIMATE....
NOTE. IF FINAL PAYMENT HAS NOT BEEN RECEIVED OR PAID IN FULL AT THE TIME OF
THE COMPLETION OF THE WORK, AS OUTLINED IN THE CONTRACT,AND RESULTS IN ANY
TYPE OF COURT ACTION.. THE OWNER OF THE PROPERTY OR CONTRACTOR OF SAID JOB.
OTHER THAN RAPID COMPANY... AGREES TO PAY ALL COURT FEES,ANY ATTORNEY
FEES,AND INTEREST OF 12%COMPOUNDED EACH MONTH., ON THE FINAL BALANCE
OWED TO RAPID COMPANY
ACCEPTANCE OF PROPOSAL
THE ABOVE PRICES;SPECIFICATIONS AND CONDITIONS
ARE SATISFACTORY AND ARE HEREBY ACCEPTED.
YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.
PAYMENTS WILL BE MADE ASOUTLINED ABOVE..
DATE OF ACCEPTANCE
/��/pT
SIGNATURE
SIGNATURE_
SIGNATUR
PLEASE MAKE ALL CHECKS PAYABLE TO
CHRISTOPHER R. COYNE SR. THANK YOU!!