34-36 LEACH ST - BUILDING INSPECTION 1�11'heConunonwe:dlhofMassachusetts
i� Board of Building Regulations and Standards CI I Y OF
Massachusetts State Building Code, 780 CMR SALEM
emu+ Revised.t ar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
ti One-or Two-Fumilr Divellhuq
This Section For Official Use Onl
Building Permit Nu Date Applied: _
Building Official(Print N:une) Signature Date
SECTION I:SITE INFORMATION
1.1 Property Address: 1 1.2 Assessors Map& Parcel Numbers
I.1 a Is this an accepted street?yes_ no Map Numlwr Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(11)
1.5 Building Setbacks(R)
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.S Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if es❑
SECTION 2: PROPERTY OWNERSHIP'
1 Owner'of Record: (c��
Name(Print) City.State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Numberof Units_ Other ❑ Specify:
Brief Description of Proposed Work': r ° "S•v� a
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) y
I. Building S )� 1. Building Permit Fee: S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost(Item 6)x multiplier _ _x
1. Plumbing S 2. Other Fees: S
4. Mechanical Ili\':\CI S List:
IS. .\Iechanirtl tFire --- ----------
Su�trtssion) S Total :\llFees:S _------------------
Check No. Check Amount:
6: Total Project Cost: S \\ .^ I-) ❑P;6d in Full 0 Outstanding Bul:utce Due: -
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(C'SL)
License Number Date
N;une of C'SI. I lulder
List C'SI.1)Pe Isec below)
��le� � — - ------ Type Description
No. mtd Strcct
thircs(ricted(IhlildingS Up it)}5.000 cu. 11.)
-__ L1._. Restricted 1&? FamilyDwclling
Cityi ro„n..State.Z T' NI Nlasonry
RC Roolin g C'ovcrin
- - W'S Window and Siding
SF Solid Fuel Burning Appliances
1 I Insulation
'I'c1e hone Finail address D Demolition
5.2 R%Istcr£d Home Improvement Contractor(HIC)
IIIC Registration Numbur li.cpva' tir4t f)atc
111 C'oinpany Nunn ar I IIC Registrant Name
No td Sur Email address
_ ^`�ho1
City/Town,State,Z 'rdc hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 .......... ❑ No........... O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR 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.
Print Owner's Narne(Electronic Signature) Date
SECTION 7b:OWNEW 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 thisap?n9oljon is true and ac orate to the best of my knowledge and understanding.
Print Os,ner's or ahonzed Agcnt's Name(Flectronic Signaure) 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 no have access to the arbitration
program or guaranty fund under M.G.L. c. 1 q2A.Other important information on the HIC Program can be found at
",s„ nela.�;„t. ;, .i Information on the Construction Supervisor License can be found at lmmi<;,n dp.
2. When substantial%%ork is planned,provide the information below:
Total floor area(sq. ft.) I including garage, finished basement attics,decks or porch)
Gross licingarea(sq. 11.) Habitable room count
-- - ---------- ------ -
Numberoflireplaces_ _ Number of bedrooms
Number of bathrooms Number of half h;ulu
1\pe of heating s)stcnl Number of decks, porches._--
I'�pcufcuuling :y;mm Enclosed Open
1 .:frdal Project Square Footage- may be substituted for-l'ulal Project Cost"
CITY OF S.U..E.Nt, ,vLiSS.1CHusETTS
BLMDLNG DEP.IRTNONT
120 W.AsHLNGTON STREET, Yo FLOOR
T EL (978) 745-9595
FAX(978) 740-9846
Kll®ERLEY DROLL
NLAYOR T1{o+us ST.PtFm
DIRECTOR OP PLOLIC PROPERTY/9LILDNG CONNISSIONER
Construction Debris Disposal Affldavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 1 11.5
Debris, and the provisions of MGL a 40, S 54;
Building Permit Al is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
(name of facility)
(addre s of racii,ty) /
sig�nyamre of permit applicant
/ afC
I
t94
CITY OF SALEM
/' [PUBLIC PR(OPRERTY
DEPARTMENT
1,1114,•11
\111,M
Il:\dM1u.\,:pI.UI:tCkt' a $,hll•.Y1, h4m.1.14.111 V 1 JNJv z
Wurkers' Cumpenaatlon fn>urunce :ltllda�it
'll1 )Ilcan In nrinaflo ltullders/Cuntractur3/Ele tr►clana/P►umbers
\ 1 • .� In a 'hi
'h1117C 111uenc,yt7raaliirtlinrvind,YnlualE_ !f�\J,
111drusx: �.��
CiIY,SMrcZip- Phone
an vnlployer:'Cheek the aliproprlate boa:
I 1 1:uu J umpluyer with 4, ❑ I:on a general cauuaetor and I lyM atproJuet(rugYirYd):
2•❑
mnpluycex(full Jndfur Pitt"
have hired the.luh•eunlraclurs b• ❑new cunstrucliun
1.un J solo prnpricmr or partner• Noted on the anached..hcet : 7• ❑Retnodolin j
chip;situ Have no umpluyues Thess subcontractors have
working t)lr One in any eapieily. %vorkerv'comp,insurance. N. Q ntmolirion
I Na workrvLL) ra'cutup, insurance 1. Q Ws an a ca peralitNl and its 9• ❑ Dulwing addition
ruyuiMdJ ofTTcera have uwreived their 10•Q Electrical repairs or additions
7•Q I ant l hot is%var %: suing JII work right o/exemption per mcm I I.Q Plumbing npuirs or Jdditiotu
myself. (�'01�nrkdra'comp• C. 132,41(4).and we hnvo no
.11lvurunce mcluired.) t .Inpluyeus.Ilyo lvorkd' 12•0 Ruul'repuirs
14r") •ygd¢a,r lbol checks tim#I mum Jlw Till YIY 1M vruun Wool,do,o.'IiYran�y RyuinYt.J 1�•❑Udler
'1I.,m.„Ir.,rrr vhe„Arad Ohio amdowll Imnwlina"kilt Nr Jeil, a AY11 Wr"$ eue,pmuYluY must
N"itlllWi,Y�
f,Mincn.n thal check 1A,a boot mum Jifulloe an utuiliulyl AM
a rfl,vu,lly lkel AMi whits eurrlYmn m 1.
,Ilu,rin its naoty 0/Illa l w utw,Y r wYr tltl,lavil iMkylina�wk•
/mrt wl rnrp/oyer rhos/r prer/J/nX rvwAra'rutnprnrn/Ion GI.rY/nner�ttr a<ten tM IAeY rusk*"'cmv,n,lKy mrmman,ia
iltfurrltuthlrLL plI rlhq BdurY/i rAr pvt//ty ens//Y1.riro
Irt.urance Company Name: 16 '� p 7 T Z .
, CC ��rr...��___"��bbb---___ee,��\\`urn �• )
I'ulicy 4 ur SYIGintt. Lic.nl"\ - _.117---
Enpiralwn Dare alt
Job Site A,klrccs: ---�
.tttach it cuyy of 1114 ,workers eumpeatatleo ell• Y`0 C ily'slatelzip.
e duels P y rJllun u e.�
I•Jllu( page fahowln r \'u to,e• M
wro cweragt as re uired on g Polley numbYr and ux Iran y der Bootie P uo date).
♦ ui 1. 1 )ai.' GL •.
I �LSnp,rl/)Jnd/ur 1 v I37 eau lead to th ma n h oran
y r npri.runmcnr, Jr well Js civil •tale poalrion o(criminal penalripo/3
oVup ni i?JQ fM J Jay � Pv u m t
y guinvl qie v6NJmr. Ile 3dvi4cd thur J cu he 1'urm ol'a STOP IVUR)( URGER and a rrno
hn CNI�JII,a4 ul 111e Uhl lof rri.ucu'ee c„,crJgu 1,•1 ilic JUun. py ul'thlh.Iurcmem muy be Iurw J/dvd to the Ulliee of
/du hc'rrhy I crli/y nndrr rhY prim,old prat It u
/prr/:=fire//elr pNY%dtd YOY1'r%J r/YI mild varr .
Il1///l-ie/it, wily' /)d rant u•rifr in d,ia urve. fu Dr culny/rhd dy ci/y u►lo,rw,1//lciuL
I
Iwuiny \ulhuril - Pcrininl.Iccocel
y (circle nnul:
1. 111,.ird 1(IIvJIIh 2. Iluddlh� Mli.lrnocnl I. l;ili.'1u11n C'Ierk J. L•'Icefrie.tl In+lcv rut i,
G. 1)Ihcr
I 1 Pfumbin� In,ycctor
l%-'wict I',nuu: _
.. I'Aunc 1•
information and instructions `
turn is JetineJ as". every Pelson In the service of anolher un,let'lily cummct of hire.
hirir
\L1)),IN hUEen)taC OCl aI Law .hj let 132 lcqulres all engslo)ers to provide ,vorktr! WlnPenpJUu'l lot their CHIP eS.
111,r)uaall 10 till! p
)lituld. an!
�pre)s ur unphcd. Ural of written." or an two or more
urtnenhip,asstxlanu°•corporallun or other Icg,al entity. lu t.r or the
r is dctincd as"an Individual.p udiu the legal ropresenlatives of a deceased Cts. ) '
An ueplole rIss. and iltvl K to in ,.mployees Nowuvcr the
..I thu lotegoulg Cn0111: m a iwnt enlerp taboo Or other legal entity.emP y. g ant Of the
acerver It trollies ul'.al iudiv lJual, psltnenhlp, atone
owner of a dwelling houm having{not more than three aaialt rain and who resides therms,or lht Occupant
of such employment be deemed to be an elnpluyer."
dwelling huuia of analhar who employ!person w do maintenance,cunsuuction Ot repair work on such dwelling house
or,ill the grounds or building appurtenant thereto shall Ilot because
nSC 6 also slate!that"srtry state or local lictnslog agency shag withheld the Issuance or
�IGL chapter t32. 02 Oliegains ulrtd:
renswrI of s llcuass or permit to Operate a huslntss or to construct
with Ill buildings
rov041 n!><.lrtg111111 or any
Applies who has not produe+d ace+p
table tvldtacs of comp of iupolitical subdivisions+hall
ppali itiunully, �1GL clwpter I S_, a25C(1)slates"Neither the commonwealth not
any
w L %;1j for the partemtancs ufpubli. work until acceptable evidence of cunlpliasla with the insuranea
enter into any '
requirements of this chuptsr Itavt been presented to the contracting authority."
�yyacugs the boats that apply to your situation and, if
compensation atRdavit completely,by cheekings slang with thank cartiAcatlds)of
Please rill,tut the workers' comp ad�,lyes)and phone�'�ihips lt•t•P)with no employt•'es whey than Iht
nettle lay,supply sub-eontr4clot(s)n mails).' or LLP does have
insurance. Limited Liability Companies(LLC)or Limited Liability
ustrial
,nemban or partners, are not required to carry workers' eonlptnay be
submitted to the Milan insurance. if an LLC, a affidavit
employees,a policy is raquind 8s advised that it affidavit may wasted,ntsl the OePartrnent of
Accident for confirmation of insuraacs covurisge• AIW be sort to slgr and being she uMed,.n t ha st)idavlt show
Ilcation far the tannic a law or is being requested,uired to obtain s workers'
ha lclmmnled to Ills city or town that
have arty questions regarding the
low ur if you see rcy epics should enter their
Industrilll Accidents. Should y ent st the number listed below. Self-insured comp
compensation policy, pl+ass call the Depw=
sulf•insuranet liearue numbs,on the a Ora"Islas lino.
tom
('Iq or'I owe Officials Lit the
The Deportment hull provided u sPacOthe applicant•
Please be sure that the affidavit is complete and printed legibly.Investigations
Da
Of dla uifiJuvit for you to till out in the event the Oulu of investigations has to nee nut you regarding
applications in any given year,need only submit uno affidavit indicating current ty or
Oflll the be sure to 1111 in the purmit/licell"number which will be used as reference number• In addition,is applicant
Illat must submit multiple Pennio'lictlua apt s" h marked by tilt city ar town 'nay
bo provided to the
policy intormatiun lit necessary)and under"Job Sits Address"the applicant shnulJ write"all Iw:utiuns in Y
town)•"A copy of Iha ufitdavil that has been officially sump' business ur it be t tilled
out
applicant as proof That a valid affidavit is on file tar license permits or licenses. t now affidavit muss be tilled nut eat
entiy not related a any
nture
said erletl is NOT required to complete this affidavit.
When a home uwnu or citizen is obtaining a liens+er
t i.e. a Jug licenaa nr permit to burn leaves ate.). P y uesuoas.
1 he m Hli.e uI Invertiyatiuro Iwuld Iles w dwak you in aJvancu for your couparatiaa and+huuW you hal�.my 4
111ea)e du nut hasilnra ro gtvu us a call.
f he U.p.lninant's address, relephune and faa number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Iovestlgat'lons
600 Washington Street
Boston, MA 02111
'feu. M 617.727Fu00 ext 6174060774977-MASSAFE
www.mau.gov/dia
Shea. Roofing Co.
17 % Foster Street
Salem, MA 01970
(978) 745-7313
PROPOSAL May 31,2011 -
sueMi7TED To: Ryan and Laryessa White
34-36 Leach Street
Salem, Ma
We hereby submit specifications and estimates for., - -To remove all existing roof shingles from complete main roof and dormer
roofs and sidewalls.
To install ice and wafter shield along all roof edges up six feet aid along
all flashing points prior to re-roofing. '
To install asphalt saturated felt paper covering all roof board il prior to
re-roofing:
To install all new metal drip edge along all roof edges, both horizontal
and vertical.
To install architectural (GAF Timberline Lifetime High Definition) roof
shingles covering complete main roof and dormer roofs and sidewalls.
To install up to 100 linear feet of roof boarding as necessary
To install new roof flanges on roof vent pipes.
To counter flash, re-flash and /or reseal all sidewalls as necessary.
To install new roof bathroom vent on main roof.
To install five new roof air vents on main roof.
To counter flash and/or reseal the chimney flashings as necessary. If lead
flashing is too damaged on the chimney we will grind it out and re-lead at
an addition"l ; o 25Q 00
To install o ew Velux skylights on nveway side of building .
Skylights and flashing kits to be provided by homeowner.
To remove old existing skylight and board up area prior to re-roofing.
To clean up and remove all roofing debris from job site.
The new roof is guaranteed for five years against any problems created
by faulty workmanship.
We propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
Nine Thousand Three Hundred and Eighty-Five------Dollars $9,385.00
Payment to be made as follows;
Upon completion.
All material is guaranteed to be specified. All work to be completed in a workmanlike manner according to
standard practices. Any alteration or deviation from above specifications involving extra costs will be executed
only upon written orders,and will become an extra charge over the estimate. All agreements contingent upon
strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary Insurance.
Our workers are fully covered by Workman's Compensation Insurance.
Acceptance of Proposal—You are authorized to do the work as specified.
Authorized Signature:
Signature: -
Date of Acceptance:—
To install new seamless aluminum gutters around complete main roof. I1vL���sl�
1Dy�M� RNLI gIS(IvSE c cfS (tt�lo Wvo� buTtl � S $2400.0V