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15 LAURENT ST - BUILDING INSPECTION z' The Commonwealth of blassachusetts RECEIV 0 Wilk/ Board of Building Regulations and StandardkNSPECT)CNAL ERW�rS)F SALE Massachusetts State Building Code, 780 CMR Revved, r12011 Building Permit Application To Construct, Repair, Renovate CUBM's-- IllfF [L One-or Two-Family Dwelling I This Section For Official Use Only ' Building Permit Number. Date Applied I )Z I} Building Official(Print Name). :. Signature . . Date SECTION 1:SITE INFORMATION 1.1 Property Address: ±Property Assessors Nlop& Parcel Number Is- Lt+u 12.on.fi ST I.1 a Is this an accepted street9 yes noNwnber Parcel Number 1.3 Zoning Information: Dimensions: _ Zoning District Proposed Use rea(sq R) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Munici al❑ On site dis sal s stem ❑ Public❑ Private❑ — Check if es❑ p Y SECTION2: PROPERTY OWNERSHIP!': 2.1 OwnertorRecord: 5 ��1_rn �/►s/ D�131i1a L'pz SiYJCr�-S J7 > the me(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: ' & 'L-&L o Grief Description of Proposed 1Vork=: IZ S I�r r�lv�' SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town own Application Fee 2. Electrical 5 ❑Total Project Cose(item 6)x multiplier x 3. Plumbing S 2%9ther Fees: S d.Nfechanicai (FIVAC) 5 List: 5. Mechanical (Fire 5 Total All Fees:S Suppression) Check No. Check Amount' Cash Amount: 6.Tutai Project Cost: S I d Q,. �f ❑Paid in Full ❑Outstanding Balance Due: jEDJ Tb �'l�bl rn NI LSD 12,111 1 SECTION 5: CONSTRUCT[ON SERVICES 5.1 Construction Supervisor License(CSL) A)r LT Nlv,^ t �. License Number Expiration Date Nano of CSL Holder -- � List CSL Type(see below) y E t j ---`d'/� -/, ' Type - Description No. and Street s 4 U Unrestricted BuilJin s u -to 35,000 cu. It. ( -111,IA- �� .SS ©� 0 1 R Restricted I&2 F:unil Dwellin Cityfrown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appl ianees Insulation Telephone E nail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) C04 , HIC Registration Number Expirution Date HIC Company Name or[IIC Registrant Name ZIS V2itr� No.,and Stf Email address i � �S9Cit /TowPTele hone SEWORKERS'COMPENSAT[ON 11 INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))Workers on insurance affidavit must be completed and submitted with this application. Failure to provide this affidault in the denial of the Isivance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No........... O SECTION 7a:OWNER AUTHORIZATIOI+ITO BE COMPLETED WHEN' OWNER'S AGENT OR CONTRAC r%APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Dote 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. Print Owner's or Authorized Agent's Name(Electronic Signature) Data 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 mix have access to the arbitration program or guaranty fund under I.G.L.c. 1 d2A.Other important information on the HIC Program can be found at +eww mass cov'oca information on the Construction Supervisor License can be found at www•.nmss.eov�'dus _ 2. When substantial work is planned,provide the information below-. 'total floor area(sq. R.) (including garage, finished basementlattics,decks or porch) Gross living area(sq. it.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of healing system Number of decks/porches Type or cooling system Enclosed Open J. "rotas Project Square Footage"may be utbstilutcd lox"'rutal Project Cost" v�� ��� aCITY OF SALEM, MASSACHUSET5 BLu DING DEPARTMENT 120 WASIENGTON STREET,3' FlooR nL(978)745-9595 KIMBERLEYDRIScoLL FAX(978)740-9846 MAYOR THomm ST131ERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING ODAsffssIONER 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, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: buw.j7 TlLael� (name of hauler) The debris will be disposed of in: "1'� -S ICI Ve► (name of facility) (address of facility) Signature of applicant Date ;T° Q-1-Y OF SALEM, 2ANSSACHUSE1TS t BU LLD LNIG DEPARTLEINT 120 WASHCVGTON STREET, 3aa FLOOR TEL (978) 745-9595 F.{x(978) 740-98.36 K[.NIBERt RY DRISCOLL THONULSST.PIFRAS - r'VLAYOR DIRECTOR OF PUBLIC PROPERTY/BCILDf\G CON IISSIONER lynrkers' Compensation Insurance Affidavit: Du[lders/Contractors/Electricians/Plumbers Applicant Information V;lint:(Ilusinuxs.Urganiratinru'Imlividual): Please Print Leelbly '` LLIYIS ` A }4K )A Address: �I S �—�Z �� S T o r City/State/Zip: Lyn /�— M4 0/goy Phone#: 0�'✓ � �' ZJ� Are you an employer!Check herppropriate Do:: Type of project(required): 1. [ I am a employer with 4. 1 am a general contractor and I . have hired the subcont r and 6. ❑New construction employees(full 7, Remodeling 2.❑ I am a sole proprietor or Banner- listed on the attached sheet. I g ship and have no employees These sub-contractors have S. 0 Demolition working for me in any capacity. workers'comp. insurance. 9. 0 Building addition I to workerY comp. insurance 5. El We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.0 1 ant a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself. (No workers'comp. c. 152, §1(4),and we have no l2.❑ Roof repairs insurance required.[ t employees. [No workers' 0 ,�2P-51-b to cmnp. insurance rcyuircd.J U. Other `F •Agv uppliram awl chocks bus rl must also fill out the section below showina their woikae'eompetandon pulley infurmation. 'I lomeuvsm"who submit this amcbtvit indicating they am doing all work and then hire outride contriteness most submit a new amdavit indicating such C.unrxwo that attack Ibis boa maul attached an addia,mal ohms showing the name of the subaontracton and their woken'comp.policy Infummlien. /unn ua durpluydr rbaf Tr pruvidlnK workers'cumptnrmlun/rrsuruued for my employers. lfelow is du policy and jub slid iujurmutinn' A �/( `�-P,64 .s � Insurance Company Name: C V 4—:r Y4Af- A-ce / ] Policy 8 car Self-itra.IILie. N: .d r- �J �y Expiration Date:-- `f'-1 0-1,(^ � Job Site Address: lJ'- �VT���r-� �J City/State/Zip:5A1s(1r/t'1 M/P25C Attach a copy of the workers'compensation pulley declaration page(showing the policy number and expiration data). vailun:to secure coverage as required under Section 25A of XIGL c. 152 can lead to the imposition of criminal penalties of a line up to SI.500.00 and/or one-year imprisnnmcn4 as well as civil penalties in that form of a STOP WORK ORDER and aline of up to 5250.00 a day against the violator. Ile advised that a copy of this statement may bu furwirded to the Office of li,veitlgatt°ns ofrbe DIA for insurance coverage verification. /du hereby certify under�//te pulps and p-e tal-dess of perjury that the iujunnurfmr provided above istrue turd correct. lien cure' �JA'��`•c- L4ea, "d(.OlY�1e• Uafa: 1-7/ � hone / �S , i ( P t Y: 4 official use only. 'Do nuf tvri/e in this area,to be cuurp/fired by city car sores o/jlriuL City or Town: _ _ Permidl.Icense p--._-.--- __---. Issuing Aulhurily (circle one): 1. Board cal'Ilcalih 2. Building Deparnncat .i.Cityfrnavn Clerk A. Electrical lospectur 5. Plnntbing Inspector 6. Other I Cunlact Person:..__._ ___ Phone T: � a '* Page No. of Pages as#txtg FxapasA,k WM. TRAHANT JR. CONSTRUCTION, INC. 4TH GENERATION ROOFING 215 Verona Street `t LYNN,MASSACHUSETTS 01,904 CSL #101220. (781) 599-1211 " (781) 844-4651 " FAX: (781) 581-0855 H.I. LIC. #141778 PROPOSAL SUBMITTED TO - - I PHONE DATE - s 7- i /c7 STR ETNAME - CITY, B L C STATE and ZIP CODE JOB 0111 - -- AQ 1 a 6% Cv«r t - oarvq We hereby submit specifications and estimates for: We hereby submit specifications and estimates for: , SHIN ROOF FLAT/RUBBER ROOF ElStri ntire roof _eshingle ❑ Sweep entire roof clean eplace any bad boards up to 100 linear feet ❑ Strip entire roof — ❑ Install ice and water barrier first three feet up roof ❑ Mechanically fasten down ISO board insulation Install ice and water barrier in all valleys and along dormers ❑ Install 060 Rubber Roofing on entire roof ❑ Install 151b. felt paper on remainder of roof ❑ Install metal flashing around perimeter of building UNnstall eight inch drip edge_ White ❑ Black ❑ Mill ❑ Flash chimney(s), pipe(s) and wall(s) v ns all 4 vents ❑ Edge caulk all seams Flash or re-flash chimney(s) N ( ❑ Install new copper center drain nstall new pipe flanges ❑ Other: stall lifetime shingle. U Color, v�L. 1,�4 —❑ Cleanup all debris _ Install gutters and downspouts ff �� ❑ Labor and materials guaranteed 100%for five years ❑ Install trim coil ---- — — ------ ' ---- - 1_ ❑ Install new fascia boards -- — ----/ ` � � � ❑ Install new rake boards — ❑ Install sky light(s) _❑.other: _ -- El Clean up all debris /Z7 ❑ Labor and materials guaranteed P00%for five yearsJz ---- --- .--- — ---— — ------ -- ---- j ❑ All shingle roofs are nailed by hand. - Pp p;Qppgp hereby.to furnish. material and labor - complete in accordance with above specifications, for.the sum of: Total Price($'z /OC .n '`"ff YOUARE-HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC, AS t. WE HAVE NO,.CONTROL OVER DEBRIS THAT MAY FALL THROUGH'ROOF-BOARDS." All material is guaranteed to be as specified. All work to be completed in a workmanlike - - - manner according to standard practices.Any alteration or devrabon from above speck& Authorized lions involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes,,- -accidents or delays beyond our control.Owner to carry fire,tomado, and other necessary - '.insurance.Our workers are fully covered by Workman's compensation Insurance - ' [Ind'concliTn II# TII�JII$FII—The above prices, spec'dications s are satisfaccory and are hereby accepted.You are alrth necl to Signs specified.Payment will be made as outlined above.ptance: Signature copy to above address. -