314 JEFFERSON - BUILDING INSPECTION _ 7 I'lie C'onlnwmvr;lllh ul�1;u�;trhuselu
t; Hoard of lluilding Regulations and Standards ( rrl OF
tl M3M1chusctts State Building Code, 780 CTIR S,\Lli\I
Building Permit vocation To Construct, Repair. Renovate Or Demolish a
(ble-or Tu'u•furn!lI' D,rdllin,ur
This Section Fur 01)icial Use Onl
Building Permit Number: ate A plied:
lluilding Official(Ill iune) . i DaIL•
SECTION 1:SITE INFORMATION
L 1 P party Addrt(�T O 1.2 Assessors Nap& Parcel Numbers
I.1, Is th f an acee ted siree0 •es Map Number Parcel Number
1.3 laning Information: 1.4 Property Dimensions:
Zoning District Proposed Use LIII Ana Isy Iq Fromaga ill)
1.5 Building Setbacks(R)
Front Yard SiJu Yards Hcor Yard
Required 1'roviJcd Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40.§Ja) 1.7 Flood lone Inrormatlon: 1.8 Sewage Disposal System:
Public❑ Pris ale O Zane: _ Outside Flood Zone? Municipal O On site disposal s rCheck em ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 03Ajrl a(Rlecord.
Name(Pnnti,z"y/S�'-�1 () .
C'igt 'ula,ZIP
Nu.m,J Sired rclephune Fntait Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ E.risting Building O Owner
New ❑ 1 Repairsls) A1te4111:1:1IM ❑ Addition O
Demolition ❑ 1 Accessory Bldg,O Nwnbero-Units_ Othe ipccily:
Brief Description of Proposed Work-:
SECTION a: ESTIMATED CONSTRUCTION COSTS
lent Estimated Costs:
ILahurand Materials I Official Use Only
I. Building S I. Building Permit Fee: f Indicate how tae is determined:
2. Electrical 5 O Standard City'Tuwn Application Fee
❑Total Project Cost'l Item 6)s multiplier
2 _ _ r 1 I'lumhing S
. Usher Fees: S
J. \ledl.utic.d ill\ \( 1 $ Lisl:
\Iccllauicdi Illre
11u+,ressionl 5 rotalAllFccs: S .__ .._ . .. ._
0 1'utul Project CuN ) Clivck \'o. ( 11"k:Luomie l'.i,h \motml:
- -- _. .._ .
❑P.Iid in Full Uulslauding 11.11.mcc Due:
I
I
SE(`I ION S: ('ONSI'R11C F10N SF'RN'1('Es
S.I ('onitructiul tiupcnisor License St.)
I icen,c.Vwnhcr I �pirat ism Dale
X.111c11 C\
N.+. .mJ\reel� - - v 11 l�nre,IridcJ IIIuIIJin s li l0 14,Illlll.n IL1
f',/`.�/i�Y1 /•n i 11e,Iricled l&' 1'a0111) lnw" n
Cil)i f+nul,.\Idle./.II'
RC Rnldin Cn,airs
N'ti 11'indoe .mJ.slulo
- 5F solid fuel Burning:\ppliances
iS I lnslduliun
I'cle burs¢ ® V I'nulil aJJra.x D Dentulilian
5.2 Registered Ion Impru ¢intent Cudtractor( IC)
I IIC• cgutr:niun Numr Il�piruliun I)ulc
I IIC•CI w tuna o IC Reyiatmu Numo
Limail address
No. and t �—
Ci /Town, States ZIP
SECTION It WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C. 1S2. { 2SC(ti))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atfidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached? Yes ..........O No...........O
SECTION 7as OWNER AUTHORIZATION TOOL C0111PLETED WHEN
OWNER'S AGENT ORCONTRACTOR APPLIES FOR BUILDING PERMIT
I,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.
Dale
Print DNIIe�!Nwne Ifaccwnic Signature)
SECTION 7D:OWNERI 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 accur to the best of my knowledge and understanding.
PrintUancr•4or: IIIll,010iAUVII,'sNaoteIIfleclnmic.\iynaUuol
Dale
NOTES:
I. .\n Owner sshu obtains a building permit to da his her awn ssurk,ur an owner who hires an unregistered cunuaetur
I out registered in the Hone Improvement Contractor(HIC)Program),will no have access to the arbitration
program or guiranly fund under M.G.L. e. 1 J2A. Other important information on the HIC Program can be found at
I Inform Lion on the Construction Supervisor License can be found at
\I lien subswnlial+wrk is planned, provide the w6urmition bclolr
total flour area 1 iy. 11.1 - ____.._I including garage, finished bascmcllL allies. decks or porch I
Habitable rouni count
Grois lining area(iy. il.l .... - \;mnhcr of hedrooms
\anlheroflircllhces --- \unlberol'half hallta
\umber of hathrcowns .
I\pc of 1w.11ing i),loll qunhcr otJeeks porehci
I'
1\pe dcooling ,);tam
ncld,cJ _ItPen
1 "fnt.d Prow \Ihore fool-we-III•t\ I`e , lh,lilt1tCd ilor I'„i.tl Proycl
CITY OF S.gzNf, AkSS.+CH(:SETTS
OLLLONG OEP.IATtEVr
120 UO`LSHNGTON STMIr, jid ELOOA
� I1t. �978) 7�S-9S9S
KI313BALBY ORLSCOLL FAX(978) 149W
NCAYO)t Mo.1W Sr.FtzAAj
OIASCTO A OP PL SL1C PROP!ATY/8C MDOjG CO1131ISSION E A
COnstruction Debris Disposal Affidavit
(required for aU demolition and renovation work)
Ii a, and the provisiane of�4tCL accordance with the sixth
Oebri cdioNan40,o9ltheJ4;State Building Cade, 780 CaMR scctian 1
11Building permit a is issued with the condition that the debris resulting from
, 3 IJOA.work shall be
1 1 disposed of in a properly licemed waste dispose) facility as defined by NIGL e
The debris will be transported by:
(nama ut haulor)���
The debris will be disposed Grin :
(n�m�ar f cilily)
(,ddraroff,, ,I,iy)
�'In�n,ra vf;ermit
CITY0FS,ULE,%•It, NWSACHUSETTS
r. 1 OLlmNG OEP.kiji-N sT
1_O WASHLNGTON SHEET, 1 FLOOR
T'EL (978) 145-9595
FAX(978) 7)0.9846
:1)113 E UEY 0RISCO LL
UY0 2 TNOSL1s ST.PTERRB
DIRECTOR OF PL'OLIC PROPERTY/0L'R-DNC,CObOIIsstONER
Workers' Compensation Insurance ,%ITldavit: Builders/Contructuri/Electrlc(ans/PIUMberf
1 ) alicant Inrormatlnn ICa.4e Print Lealhf
Villnc tUuritusUrgintratiun Individual):
Address:
City/State/Zip:—
A c nu an emplayer!Check the appropriate boat
LI un a employer with - _ 4, ❑ I am a general eonlrsctor and 1WIM)"—deam
f project(required):
mnPloycrs U1111 and/or part-time).• have hired the sub•contractarsow construction
2.❑ 1•ain a role Mild-War or purinur. listed on the attached.rhdul temodeling
,hip and have no employees These subeontmetors hava emolition
working Ibr ma in any capacity. workdrs'camp,insurance.
(No workers'.comp• insurance 5• ❑ We are a corporation and its uilding addition
required.) officers have dxereised theft lectrical repairs or additions
I❑ I am a homcuwnor doing cis work right of oxempliun per MG(. lumbing rcptairs or odditfons
myself.(No workers'Gump, C. 152, 11(41,and we have no Root n pain insurance requfreJ.1 t employees. Elva workers'
comp,insurance rcyulmd.l heroy ap pllt MI dW rhrtYd box ri mwt she tilt uul the ue tivas below showing their rw kem•compsnsaduq pocym )end(on,
r I hvneuwwo who.uhmil this aIYIdsvit indlading ihey srs joins ail wore and then him"Hide contractors mtgl submit a new aindavil indicting.ugh.
Cmrytun that check'his Dux must aaaahed ag addtnuswl.hval ihuwiny Iho nwne at the IuO.eunlrsetun and Shall w,ullsrs'comp,policy Infamudoq.
fain on rrnpluya/hut b provlJlnX rvorkm'eumpeuar/un in/er . �
Insurunee�a pat/Iry andfob rile
In,urancu CompanyNmnr._Policy 4 or Self-ins. Lic, u: Expiration Dote• //
lub Sild Address: CityiState/Iip:
.litach a copy of the workers'compensatloa policy declaration pigs(Showing the Polley number and dapiratloo data).
F'.liluru to wcare euvernge as required under.Section MA of MGL c. 172 can frail to the imposirion ofcriminal penalties of a
ncu up rat SI,SCU,UU untl/ur one-year imprisonment,as well is civil penalties in that form of a STOP WORK ORDER and a line
to S'_SQUO a Jay r;ainst the viulamr. Ile.advised That a copy Of'hit.tatemenl may be lurwardcd io Ihd Qlticd of
I,rr r,Iigaliuns ti the 011 G)r insurance coverage verilic,aliun.
/du lrnrby crni/y/snJrr rhr point w"provider•s/perjury thal the True,nrJ correct.
IJara:
U/liciv!rue•rat ly, /J...r,q i,•rirr,in r/u;r:errs, Id St rump/N2J 5y city ur town nJflrivL —
City.Ir I'mvn:
1",.io�.\nlhorily (circla
I. :L)ard nl Ilrahh !. IIIIihlln•. Ucpsrinicnl i. f ;Iylfutrn llcrk J. i•:frctric it fn.pcclnr i, I'In�n6in4 lntpechar
fi. 1)Ih:r
L n,t Lt rt 1'.non:
01�...•r..k
B-TBP A.C. CASTLE CONSTRUCTION CO. INC. '���,Q
MEMBER Telephone (800) 505-LEAK(5325) • Fax (978) 777-7750 _ 1
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
PROPOSAL SU%VFTEP TO PHONF # DATE
STREET 1LV�• JOB NA
CITY,STAT AN0.2fP E JOB LOCATION
C P
ARCHITECT DAT OF PLANS OQ_PPH(Q
II)e 'P Top hereby to furnish m terial and labor-c plete in ac rdanc ith specifications below for the sum of:
rv�./�b/llows: J ✓ �` dollars($ -� )
Payment to be as follows:
7
roz, (lop
NOTICE: All home improvement contractors and subcontractors engaged in home Authorized
improvement contracting.unless specifically exempt from registration by Signature:
provisions of Chapter 142A of the General Laws,must be registered with A t
the Commonwealth of Massachusetts. Inquiries about registration and Note:This proposal may be
status should be made to the Director, Home Improvement Contract P P Y
Registration,One Ashburton Place,Room 1301,Boston,MA 02108. withdrawn by us it not accepted within days.
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
A ROOF STRIP
We will cover the siding, bushes, and grass with Blue Tarps in order to protect the property during stripping.
We will strip up to 2 layers of roofing and remove all nails down to the bare wood.The ice and water shield will then be installed
at the bottom of all edges, under all step(lashings, around all chimneys,skylights,and into all valleys.
We will install 15 pound underlayment onto all other areas of the roofdeck.The 8"aluminum dripIedge will then be installed o all roof edge .
Any existing pipes will be covered with new�alt1,m�In rubber flarl S ,
The roofing material to be used will be ZI( 1 WC
All the debris will be cleaned and dumped on a daily basis by us. Magnetic brooms will be used to extra aii nails from your property_
We will protect your property as besfwe can however.sorfle fo:;age malting,-breakage,or marring.could occur. We cannui 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 ADD TO HE ABOVq PR CE.�/n(a�
Replace Rotted Roofboards c f) Irlt&�GrYhfilrf 1 rs
Relead Chimney(s) p Install Aluminum Downspouts
Replace Facia Boards\ / Install Skylight(s)
Install Rid event C V �C/ o I
9 Rotted Roof To Wall Flashings
Install Roof Louvers � /� Gutter Repairs [i
NOTES: / C-7 la- G e
Warranty anufacturer to be ree of defect for )y s, see manufacturer's warranty for exact warranty performance.
Atli labor rf under Is tract shall be of good quality and free from defects not inherent in the quality required or permitted for
a peri f year t This arranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient
main nance, i proper ope ion, or normal wear and tear under normal usage.This warranty shall be limited to the work performed by
A.C. astle Construct o., Inc. and limited to either repair or replacement by A.C. Castle Construction Co., Inc. at its'sole discretion
and ele and all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the
occurrence of the event giving rise to such claim.This warranty shall not extend beyond any limits imposed by applicable law.
Payment and Penalties- 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 mutuallyagreed upon third-party. An ud ment u on an award entered in arbitration maybe
9 PY1 9 P
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.
_01[reptante of j0ropo5al - Signing this proposal means you have accepted all the terms as stated.
Date of Acceptance Signature �, 6xG ' '/%�