28 JAPONICA ST - BUILDING INSPECTION (4) y The Commonwealth of Mas achuse
Department ofPublicSif ty
Slab BuillJing L�tJr 1:8U C'SI i)Sa•rent ",It a !
City of Salem
Building Permit Application for an Buildin other than a I- r 2-Family Dwell'n
I Ihle'*• lion For Official U,e Only)
Building Permit Number'. Date Applied: Building In.pectur:
SECTION t: LOCATION (Please indicate Block a and Lot s for locations for which a street addr ss is not available)
X7+,and titrrrl 51 `a�City /ivavn Zip Code 0/9 Name of Building UI apphc A,10
SECTION 2:PROPOSED WORK
If New Construction check here Qau check all that apply m the two rows below
fxrling-9udding 0--Repair-❑--Alteratiun-0:- Addilmn-O -0emulilion-❑-(-('-Irasr-(ill-eul-and-submit-A}+prndix-y
Changeof Use ❑ Changeuf Occupancy ❑ Other 16-Specify:
Are building plans and/ur cunstructiun documents being supplied as part of this permit applica[tun? Yes ❑ No III
Nan Independent Structural Engineering Peer Review required? Yes ❑ No 0
Brief Descnptiun of Proposed Work:
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here it an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑
Existing Use Group(s): Proposed Use Croup(s): P
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) ..
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as app licabte)
A: Assembly A-1 O A-2r ❑ A-2nc❑ A-3 ❑ A4❑ A-5❑ B. Business ❑ E: Educational ❑
F. Facto F-I ❑ F2 O' H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I.- ❑ I-4❑ M Institutional 1-I ❑ 1.2 ❑ 1.3 : Mercantile❑ R: Residential R-140 R-2❑ R-3❑ R-4❑
S: Storage S-1 Cl S2 ❑ U: Utility❑ Specie! Use O and (rase describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IBO IIAO 118 ❑ JIIA ❑ I11B ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CJIR 111.0 fordetails on each item)
Water Supply: I Flood Zone Information: Sewage Disposals Trench Permit:
. Debris Removal:
❑
I'ublii O Check J,ndade PL,•J Lana❑ InJicalr muntal•al❑
Trench will not he\ Lrcrmed Unp,�.ul cur
rtrluucJ❑or trcneh .a.I•ced c.
I'nv.nc❑. �r mdenlilr Zone:_ nr��n air,c.trm O hermit"endu.ed ❑ TY&I -
I 11ailroad right-of-way: Hazards to Air.Navigation: M I Inl, n, l ..,,,,u., fir„•.-.:
\, I \I•idi.,tl•IvD L`Irwlulrt ,illn.1.11. rl.q•pu�.tih an•a' Lthcu tca lca. :,nnl•I.I.J• i
.nl , .rnl n•Ihul.iamL .c,l❑ I ),-,0 •r XuO )" 0 V, 0
SECTION 8:CONTENT OF CF.RTIFICA TE OF OCCUPANCY -�
I .t,linn•d l ..lc L-vinntl•nt fCl•c.•1 l• n.lrU,n,nt t4iul•anl l t,11'cr I !. •o
i
Ilur�the hwlJuq, nn.tm en �I•nnklcr N�Irm' �I•ri tat�upulau,•n. �
�icKa( t i
SECTION 9: PROPERTY OWNER AUTHORIZATION
N, nr l .\.1.1 rs.ul I'n,perlr Owner
rr�- !z �R'�l�Pefut�fi �GILm� /f7f�al9 �o __
1
\anu•(Pnnt) \'o.aunt tilrerl llh, Lnvn Gp
I'n+lvrlc 0,tier Contact Information:
Inlr relephune No.(business) relephone No. (cell) e mod .rddr,"
If applicable: the properly oe ner herebs•.nuhonres
Name Mrert Addre>., Cily/Tim n Stole l.Ip
lo.+cl on the j1rtli,vrt% any ner%behalf, m all matters relative it,work authorized by this budding arnut i + iir,twn.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(1)Nid.hn•is his thin 3i.tXm Ici.It.tit encloxJ.ice and/or ntit mulvr C.notnic lion Conlml then check here O and>ki +Sv bml Ill II
10.1 Registered Professional Responsible for Construction Control
.Ndmv ),.>rant) eltiphrunte No. a-mat a ress rgistration Number
Strut Address City/Town State Lip Discipline Expiration Date
10.2 General Contractor -
Co ny Name:
/r?i1llrn C,/V-t4► U l A,5 L's
Na a of Pe n Res�=Iy fur Cun..Wuchun ft,,icense�Nv� and Type if Applicable
J)�3 /1Jr Jot n S� r, O18XD _
Street Address City/Town State - Zip
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS•COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? - Yes 40 No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(LaFEnclowch�k
and Materials) struction Cost(from Item 6)=f �OQ
1. Building -§
mit Fee=Total Construction Cost x_(insert here
2. Electrical f propriate municipal(actor)=f
3. Plumbing § -
J.Mechanical (HVAQ f inimum fee=f (contact municipality)
5. Mechanical (Other) f
payable to
6. Total Cost f a.•0 d alit )and write check number here
SEcrybN 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penallle,of perjury that all of the information c, rit,ilred in this
epplicahon Is true and accurate to the bent of my knowlvdgeand underntandtng.
C1Tn�rm �a l o�n
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I'I i not.Ind •i 11 O:uIj'U� rate "
ole relcph.me
�tl++ a1, rxZU szA 54.
c t r l I
O j
Municipal Inspector to fill out this section upon application approval: J!
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jh,'pi,tpmemomwealib of 44assachmselpiN
I)epartmeni ol Industrial 4cridents
p5)ftke of Investigations
1,00 w(I.Villifingloo Street
Boston, 41A 02111
www"Mass.govIdia
Workers'Compensation Insurance Affidavit Unilders/11
Applicant Information -------
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Addi,em 3 AfPb-
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Are Von an cloploye"!Ch' k t c appropriate bim Type of Projet-t(required)
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mriployees f filil 11TI(Il"I pars lllflklf Remodeling
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Policytiors'111 Ins. 1i'llf
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Allack a coley ot Ille workers'loolpeo.motlon tioliry declaration paile(Skowing the policy Iminitip., and extorfilicio date).
�;'ifioc to Secure coutrage as Sccimi, Pi A of M(V!.c I"A ifad Io the uxawsnuu ofu"Ilmal 1w,11.111e,of a
file up pip$1.500,00 mid/or""e vl;., imptisop...i"';'a,-,It cml J" in ilk., lo, s I Oil WORK 01O)WK and I-me
fit ripe lirad,fuqcd Ohm a Copy may he lomfmic']lollic Otficcol
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_+•.� _ _CE_RTIFICAT_E OF_L_I_A_BIL" INSURANCEHEDER
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j TFIIS CERTIFICATE IS ISSUED AS p MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THECERTIFICATE HO9DE6R THIS
1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E%TEND NF ALTER TH-�—�--E S SPONGE ABY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUIN {BI, AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
the
ItheMPORTANT: II ndi i ort of to holder is an ADDITIONAL
INSURED. the pulicy{ies) must be endorsed. If SUBROISA1VED,subject to
Certificate
terms and conditions of the policy. certain policies may require an endorsement A statement on this certificateonfer rights to the
certifl cats holder in lieu of s((cry endOSoment{s).
PRODUCER
MassPay Insurance Sm'Vices,LLC 978-998-5896 NAMfq
27 Garden Street Unit 16 978-998-6897 Gilow
Boverly, MA 01915 Inc(, NP 1 xll -"-- -----
Sharlene Hilda Wulleman f[F MAK usioi, RYANSONCUSTOMEP IDp. --
Ryan&Son ROOfing IncINSURER(S)AFFORDING COVERAG93 New Salem St INs11REP A Ace American InsuranceCoNAlcn
1 Wakefield.MA 01880 -
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CERTIFICATE HOLDER -
_'--'-- ------..._ CANCELLATION
R'Wderl��dWnlYe e1 l��rYnOe SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ce 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE ACCORDANCE WITH ME POLICY PROVISIONS. DELIVERED IN
For bidding purposes only — — _
PUTVORl2[O RFPRESENTA TIVE —'— -
ACORD 25 2009109 (G11988-206 ACORD CORPORATION. All rights roserved e ACORD name and logo are registered marks of ACORD
The,
PDF created with pdfF'actory trial version www.Odtfactor r,.cJm
Proposal
C•
93 New Salem Street. Wakefield MA 01880
TeL617-571-9056 BIYdiI:Rva1AndSonS((4Mc.com
www.RvanAndSonRooling.com
Submitted To: lob Location:
Bruce Daigle
25 Japonica Street 25 Japonica Street
Salem,MA 01970 Salem,MA 01970
Phonet�
Email:
Proposal date: January 30,2012
WeBre pleased to hereby submit this proposal to furnish materials and labor,completely In accordance with the below specifications:
(Additional charges may applyfor any change's not included below in proposal either by request ofowner,or ifRyan and Son Roofingffnds unforeseen
cireumstances that will affect the performance,quality or integrity of this job)./n the event legal action is taken to enforce any provision of this
agfeement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorneys fees. Not responsible for
debris in attic.
THIS PROPOSAL Is TO.-
Ship realm bare wood and re-shingle[Do NOT doMesunroom porch man:$3,600.00
• Strip existing shingles down to bare wood
• Check for rotted wood and replace as needed
• Nail down any loose wood
• Install ice&water shield to first 6',which is 2-rows and in all valleys
• Install 301b felt paper to remainder of roof
• Install all new 8"white drip edge on perimeter and step flashing,where needed
• Install GAF Lifetime/30-year architectural shingles in color of your choice
• Install ridge vent and hip&ridge cap,to match
• Properly flash any protrusions and all new pipe flanges,if any on roof
• Re-lead chimney
Clean up:
• Will cover area with tarps to minimize debris
• Remove debris related to work
• NOTE: Please cover any belongings in the attic,as they will get dusty,fapplicahle
Payment Terms made as follows: (This includes labor, dump&materials)
Strip a shingle roof price: $3,600.00 K/*P4y 2EWr.P&4&W 7-0
Total Cost:dfno changes] $3,600.00 aPeter Ivan"
In payment due upon signing: $1,000.00 TH. VK Y&V!
Balance due upon completion: S2,600.00
1
RespectfullYSubmitt6dbC10�--,',ms,,�tdl
- - -� accepted bv:All work is 100%guarancra tat Kp. All other arms ees are through the manufacturer.All warrantees will be null&void if
job is not paid in full.Thank you for letting us serve you!!!Ryan And Son Roofing,Inc.is fully licensed(#159797)&insured.