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406 JEFFERSON AVE - BUILDING INSPECTION f ew RECEIVED The commonwealth oti A t 1 CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building MjeFJE)g&RA q 10 ReviseJ,Nar1011 !Y1f Building Permit Application To Construct, Repair, Renovate Or Demolish a iOne-or Tivo-Family Diveldng This Section For Official Use Only Building Permit Number: FDate Apofied. Building Otticial(Print Name). -_ Signature Date SECTION t:SITE INFORMATION L 1 Property Address 1.2 Assessors Map&Parcel Numbers L/Q.6 �E{�eiSan ftl� Si'/�rr� �as1 I.I a Is this an accepted street?yeses no Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: `tuning District Proposed Use Lot Area(sq It) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard rWnter Provided Required Provided Required Provided (M.G.Lc.40,§54) 1.7 Flood Zone Information: 1.9 Sewage Disposal System: Zane: _ Outside Flood Zone? Munici nl On site dis sal s stem ❑❑ Check if es P Po ySECTION2: PROPERTYO�VNERSRIP!. � Mime(Print) Cit ,state, ZIP ,��� dl .ye�fl5n-vt eqy , �t3 9 No.and Sued Telephone- Email AJJresg SECTION.3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied A I Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units I Other ❑ Specify: Brief Description of Proposed)Work=: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building $ 3 OC96) I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cose(Item 6)z multiplier Ls 3. Plumbing S _5000; !?,QtherFees: S� 4.Mcchmtical (FIVAC) S �6lOC7 , — List 5. Mechanical (Fire Total All Fees:$ Su ression) -� Check No._Check Amount: Cash Amount:_ G.Total Project Cost: S 3 sO�, ❑raid in Full ❑Outstanding Balance Due: cp-AA-45'v 21 z 4 L,,mo►� -C SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License NumberEspimtiunDate Name of CSL Holder 41 List CSL'fype(see below) Type Description No.and Street L j7 Q / U Unrestricted(Buildings tip to 35,000 cu. tt.) Wr r�cLtGC{n, ��i 41y� R Restricted I&2 Family Dwelling Otyffown,State,ZIP f, N Masonry RC Rooting Covering WS Window and Siding / / SF Solid Fuel Burning Appliances � j8-- e� Insulation Telephone Email addr s D I Demolition 5.2 Registered Home Improvement Contractor(HIC) ra zll HIC Registration Number Expiration Date HIC Cu npany N;un•or IIIC Regislmn ;one ��G�/ ��nSer'yi� No.aid Su-e r Email address City/Town,State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.§ 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 ..........x No...........❑ SECTION 7a:OWNER AUTHORIZATION.TO BE COMPLETED WHEN. OWNER'S AGENT OR CONTRACTOR AAPP//LIES FOR BUMDING PERMIT' 1,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building pentf`t application. x To �n 6ar yn js 0,1 , &nymt,_tt= z /'0 Print Owner's Nmne(Electronic Sigr14ture) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 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. Print Owner's or Authorized i genl's Name: rlecoonic 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 (not registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty fund under Ni.G.L.c. Id?A.Other important information on the HIC Program can be found at wwhv.nmss.v� +:'Ola Information on the Construction Supervisor License can be found at w�r+v.mass.�ov!JLs 2. When substantial work is,pplanned,provide the information below: 'total fluor area(sq. R.) is lam N .(including garage, finished basement/attics,decks or porch) Gross living area(sq. It.) Habitable room count 3 Nnnhber of fireplaces n Number of bedrooms D Number of bathrooms O Number of half/baths / Type of heating system '�-h'All Number of decks/porches D "I'ypeofcoolingsymem N//4 Enclosed (/ Open_ 3. "Foial Project Square Footage"may be substituted for`Toted Project Cost" QTY OF SALEK MASSACHUSE M [S� 1 BUILDING DEPARTMENT -.., 120 WASHINGTONSTREET,3wFLOOR AL(978)745-9595 KIMBERLEYDRISOOLL FAX(978)740-9846 MAYOR Tifomm ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COM&SSIONER 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 111.5 Debris, and the provisions of MGL c40, 5 54; Building Permit# is with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: -76�?-Xlr Tinl (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) 7Signature of a plicant Date fThe Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P.lumbers Applicant Information Please Print Leeibiv Name (Business/organizati.on/Individual): Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): l.❑ I am a employer with 4.,yam 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors �tr�It 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7. Remodeling 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 required.] officers have exercised.their ME] Electrical repairs or additions 3 ❑ 1 am a homeowner doing all work right of exemption per MGL l l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box KI must also f II out the section below showing their workers'compensation policy information. Homeowners 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.pot icy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: /�G� �1Je//L6G/! Policy 9 or Self-ins. LiUUc.#: 4=2616 '02e5_5 y Expiration Date: 7�Z� Job Site Address: 7i�r� JCTfet ©/'1 �Ye City/State/Zip: //g /9f� 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$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$250.00 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 certify under the pains and penalties of perjury that the information provided above is true and correct. SSigna�turee G J Date PhoneN: OJficial use onlJ. Do no!write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: I I � , I I , Wit. ' I ' - _... . J.- I L o I I I I I I I I I I _ I I / I I I I ' /l Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-060149 PETER J BARBA(yVI WESTWARD CJRIY READING MA%018 Expiration Commissioner 10/31/2016 f — � Office of Consumer Affairs and Business Regulation � i 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 165538 Type: Corporation Expiration: 3/1/2016 TO 248873 C.J. & B CONSTRUCTION CORP. PETER BARBAGALLO 1 WESTWARD CIRCLE __—_— NO.READING, MA 01864 Update Address and return card.Mark reason for change. Address ❑ Renewal u Employment ❑ LA9 Card SGn i r, 20M-05111 c'`Te- honm:rv�,ueo/�./-n� aiaacf,.�aa,/ License or registration valid for individul use only A� f jee of consumer Affairs&Business Regulation before the expiration date. If found return to: - ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation -. f4gistration: 165538 Type: � 10 Park Plaza-Suite 5170 , xpirabon: 311/2016 Corporation Boston,MA 02116 s - C.J. & B CONSTRUCTIONCORP... . PETER BARBAGALLO 1 WESTWARD CIRCLE — NO.READING, MA 01864 - Undersecretary Not valid without signature `LL NORTH SHORE BUILDING SERVICES LLC 1 Westward Circle North Reading, MA 01864 1-800-564-4016 Licensed:CS-060149, HIC-165538, RRP Lead Certified PROPOSAL January 7,2015, Revised February 1,2015 Mr.John Barrows 406 Jefferson Ave. Salem, MA 01970. We hereby submit specifications and estimate for: Finished basement at above address. SCOPE OF WORK: • Install a french drain around the perimeter of basement to sump,and install sump pump and pipe to exterior. • Apply one coat of drylock to water seal;exterior walls. • Insta-ll..._ sub-floor,2" x 4" pressure treated and'/=" plywood. • Partition for full bathroom with laundry area, kitchen, office room,and family room.Close in furnace with two doors for access. Rebuild stair landing with steps to one side. • Replace all basement windows and re-trim exterior and interior. Home owner to supply windows, installation by contractor. • Plumbing—Plumb for full bath, laundry, kitchen and one zone of forced hot water heat. Contractor to custom build tiled shower,tile allowance$3.00 per s.f., all other fixtures to be supplied by Home owner.Shower door to be supplied by home owner,installation by contractor. • Electrical—Install plugs and switches to mass.Code. Install 100 amp sub panel for basement. Install 15 recessed lights with dimmer. Install outlet for dryer in laundry area. Install outlet for sump pump.Wire zone valve for FHW heat.Wire and install appliances in kitchen. Install light 7 fixtures. Install exhaust fan/tight in bath room. Home owner to supply all light fixtures and appliances. • Insulation—Spray foam exterior walls to seal and insulate, insulate basement ceiling for sound proofing. • Blue board and skim coat plaster walls. • Install kitchen cabinet, bathroom vanity and laminate tops per builder selections. Home owner may upgrade to granite at their expense,with a credit from contractor on laminate tops. • Interior doors and trim—Install six panel hollow core doors trimmed with 2-1/2"colonial casing. Install 5-1/2" baseboard.Trim basement window with pine. Install oak railing and spindles on stairs. • Apply two coats of paint on walls,doors and trim. • Install acoustical ceiling. • Flooring-Install ceramic tile on floor in bathroom and kitchen,$3.00 per square foot allowance for tile material. Install carpet on stairs and remainder of basement floor,$2.50 per square foot allowance for carpet, pad and installation. • Skim coat bulked walls with hydraulic cement and paint walls and steps. • Install bathroom accessories and vanity mirror, home owner to supply bath accessories and mirror. • Contractor to obtain all necessary permits. • Contractor to dispose of all debris. We propose hereby to furnish all material,except as noted, and labor—complete in accordance with the above specifications,for the sum of: $ 52,000.00 Fifty two thousand dollars. .Payment to-be Made as follows: 1. 1/4 upon acceptance of proposal. 2. 1/4 upon completion of interior partitions. 3. 1/4 upon completion of blue board and skim coat plaster. 4. 1/4 upon job completion. Acceptance of proposal—The above prices,specifications, and conditions are satisfactory and hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. I D f acceptan �_��—�� Customer signature) a (Contractors signature) All work is 100%guaranteed for one year on all craftsmanship.All other warrantees are through the manufacturer.All warrantees will be null and void if job is not paid in full. Thank you for letting us serve you North Shore Building Services LLC ��- J�N �/�l/�°�S j-e/� ;i✓at� /�2��1/Jal /.jR/,3/4�'A-LCO AlCe fjVo-/ PeroA <4 ,- G 'tom Z p ice', S {V �C FF7 yO G W 6 �,