14 LEMON ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
F; I, Department of Public Safety
••J %IaS •tchusetts State Building Code(780 CNIR)Seventh Edition
City of Salem
Building Permit Application for any Building other than a 1- or 2-Family Dwelling
n (This Section For Official Use Only)
Building Permit Number: Date Applied: Building Inspector:
6ON 1: LOCATION IPlease indicate Block ll and Lot 11 for locations for which a street address is not available)
bd �0
eet City /Town Zip Code Name of Building (ifapplicable)
SECTION 2:PROPOSED WORK
If New Construction check here❑or checkall thatapply in the two rows below
ding❑ Repair❑ Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other 90 Specify: S
Are building plans and/or construction documents being supplied as part of this permit application? Yes W No ❑
Is an Independent Structural Engin��'rii g Peer Review required?C Yes ❑ No ❑
Brief Descriptio of Proposed Wu�!^'v r4 X /Z [e)l3rs� N!'L.- /J
/1-a 2�6N1 Y1 4ka
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑
Existing Use Group(s): Proposed Use Group(s): m•
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.) - //•fO f ` ,
SECTION 5:USE GROUP(Check as applicable) i7
A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2 ❑ R-3 ❑ R-4 ❑
S: Storage S-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE (Check as applicable)
IA IB ❑ IIA ❑ 116 ❑ IIIA ❑ 11180 IV ❑ VA VB ❑
SECTION 7: SITE INFORMATION (refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public ❑ Check if uutmde Flood Zone ❑ Indicate municipal ❑ A trench will not be Licemed Dr posal Site❑
Pri ca to ❑ ur incivrin_t Zone:_ or on site,i,tem ❑ required ❑ur trench ur .pecih:
permit k cndu,ed ❑
Railroad right-of-way'. Hazards to Air Navigation: \I:\ li>6 ai.l ....... i�ni K....... I'n•r,..;
\ul :\ppliiab e❑ k ti1rlVCILlie within airport apprn•idm urea..' I. their 1Qc' me Cinnpleled'
n Cumcnt lu Build 1'ncl111ud ❑ Yc. ❑ ur.No O Ye.❑ \o ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Eduiun nl C udr: C.e CruuppC rope of Gin>tnicuon: (.1CCup•1nt Lead per hour:
I)ur. the brnldin};innlain an Sprinkler Se,tum?: Special Stipulation,:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and 1 I Ire, )I Property Owner
Name(Print) No.and Street G pq City/Town !/ y�L}i/p,/{.
Pruprrty Owner Contact Information: ,�_
0 f�)an C7 K
Title Telephone No. (business) Telephone No. (cell) e-mail add ss
If applicable, the property uwmer hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION to:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less than 35,tR)0 nI. ft.of anclosed S pare a nd/or not under Construction Control then check here O and Skip Section I0.1)
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town .State Zip Discipline Expiration Date
10.2 General Contractor
Company Name:
Name of Person Responsible for Construction License No. and Type if Applicable
Street Address City/Town State Zip
Telephone No.(business) Telephone No. (cell) e-mail address
SECTION 11:WORKERS'COMPENSAIION 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❑ No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs: (Labor
Item and Materials) Total Construction Cost(from Item 6) _$
1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ appropriate municipal factor)=$
3. Plumbing $
Note: Minimum fee=$ (contact municipality)
4. Mechanical (HVAC) $
S. Mechanical (Other) $ Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under tho pains and penalties of perjury that all of the information contained in this
application is true and accurate to the st orny )w dge and understanding.
GGG/GL C1I)teL D-9--m' W 0
1'lui! 1 ae print and>in name Title Telephone No. Date
ice o,mus�l
,;Ireel Address Cit%,'Town State Zip
Municipal inspector to till out this section upon application approval:
Name Date
P
09/15/2009 00:44 5083981995 SALT SPRAY SHEDS PAGE 02/03
CITY OF S.U.Ems MASSACHUSETTS
• BUMDING DEPARTMENT
12O wasmiNGfON STREET.r FLOOR
TEL (978)745-9595 —- --
PAX(978)740-9846
1v�ffig[tiEY DRISCOLL
MAYOR TRomm Si.P1saR8
DIRECTOR OF PUBLIC PROPERTY/Bl:MDLNG CO%MISStONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciana/Plumbera
Ant liccant_Information PleasePrint Leeibiv
Name(eutincuorganizaeim/individuaq:
Address: 2-35 (.rtZZ41 1.6 &QUIT'EW 24M
City/State/Zip: So.lrld QnusLL4 h 4 MCI, Phone#:
Are you an emptayer7 Check the appropriate box_ Type orprofact(required):
1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 L�C1 e
6. New construction
aye=(full outlier put-time).• have hired the sub•ceutraceota
2. 1 am a sale proprietor or partner- listed on the attached sheet,t 7. ❑Remodeling
ship and have no employees These sub-contractors have $. []Demolition
working for me in any capacity.
workers'coop.insurance.
[No wotkets'comp.insurance S. ❑ We are a corporation and its 9' ❑Building addition
required.] oHicros have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'comp. c. 152,g 1(4),and we have no 12.❑Roof repairs
insurance required.]t anploycea[No workers' 13.❑Other SlurEO
comp.insurance required.]
;Any npplicma 1hA dredn hen[el must aM ail gut the seetim bdowehowhyl Ihelrwtxkafx'compomm�on pdiry infomwdon.
'I Inmeawoefa who oAfnit this nMdwk indkaina they aro doing all work and thin hire outside connm l m mart submit a new andtvir indiculeg swL
;Gommcron that cheek this bag n wt amehed on additional sheet chewing dre name oPtlro nAeorttn.mra grd'half workefs'comp,policy Inaxmmloo.
am an employer that is providhrg workers'comperrsudon hrsaroncefbr my employees. Below Is the pollcy and fob albs
information.
Insurance Company Name:
Policy 1/or Self-ins.Lie.0: Expiration Date:
Job Sire Address: __ City/StateJZip:
Attach a copy of the workers'compensation policy declaration pogo(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 15Z can lead to the imposition of criminal penalties of a
Roe up to S 1,500.00 and/or one-year imprisonment,as wall as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Iavextigations of the DIA for insurance coverage verification.
!do hereby crn6&ender ttronlns and penaides of perfrtry that the into rmarm provided above is true and correct
Sienalure !�+.�
Phones: 9'/N-09 Sa8�34'fi'—/QOo
Official use only. Da not write in this arse,to he completed by rigor town off eiai
City or Town: PcrmAHl lcense it
Issuing Authority(circle one):
1.Board of lleallh 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#t
II
M
i
m
M
m
L
c�
a
d
N
Q
L
co
}
Q
d'
N
H
J
Q
N
. 66�f♦Pai'64� i u s�io'3lsTaun Atx_u,"�sr
HOME IMPROVEMENTCONTRACIlj;
Registratilba: 153540 `
- Exp7YaSjoli;`,12/2012010 .Tits-7,75392
SALT SPRAYS4EQ$=---..'.. °
BRIAN WARBURTOI�00
235.GREAT WESTERN.AD. ,,y f
r_1
� SOUTH DENNIS,MA'&26$0`
m
uo _
Nlassechusctts-Dcpartmcnt of Public Safct%
Board of Building Regulations and Standards
Construction Supervisor License
m
m License: CS 62056 _
Restricted to: 00 _ -
m
m BRIAN E WARBURTON i
LO 1631 MAIN ST
Q BREWSTER, MA OA31
m Y
— - -�'� Expiration: &SWti
I :
WMRSa
eath
..°° erwood.Architectural Asphalt Shingles
71
White Cedar Shingles . White Cedar Shingles 5"Exposure
5"Exposure } 3
2 8'-0' ,' 12'-0"
r
.. ' 'Ridge Vent - -
12
12 -
r Weatherwood Architectural Asphalt Shingles
White Cedar Shingles.
5"Exposure
( le _ ItV
8-0" 2'-0" ^�
a - White Cedar Shingles 5"Exposure
i
tom,✓"��
Salt Spray Sheds Estimate
235 Great Western Road
South Dennis, MA 02660 Date Estimate#
4/23/2009 799
Name/Address Ship To
Delai Mary
14 Lemon street
Salem,Ma
mary.delai@gmail.com
gmail.com
978-979-8840
Terms Project
Description Qty Cost Total
8'x 12'Cape Cod Cottage 1 7,100.00 7,100.00
3'Transom Door.Acorn Hinges are recommended 1 0.00
Comes with Cape Cod Cottage
Doors must be primed and painted on all sides(front,
rear,top,bottom and sides or warranty on doors will be voided
Double Hung Window True Divided 24'x 41'without window box 1 0.00 0.00
or shutters
Comes with Cape Cod Cottage
Double Hung Window True Divided 24'x 41'without window box -1 207.00 -207.00
or shutters
Customer only wants one window with window box
Window Box and Brackets Custom.Scroll Brackets with Window -1 245.00 -245.00
Box with Molding
Customer only wants one window with window box - -
6'Transom Double Door.Acorn hinges are recommended for this -1 436.00 436.00
door Doors must be primed and painted on all sides(front.
rear,top,bottom and sides or warranty on doors will be voided
Acorn Door Handle -2 15.00 -30.00
Acorn Strap Hinge.Price is individual 4 26.00 -104.00
Total
Signature
Phone# Fax# E-mail Web Site
508-398-1900 508-398-1995 saltsprayshedsrycomcast.net www.saltspraysheds.com
Salt Spray Sheds Estimate
235 Great Western Road
South Dennis, MA 02660 Date Estimate#
4/23/2009 799
Name/Address Ship To
Delai Mary
14 Lemon street
Salem,Ma
mary.delai@gmail.com
gmail.com
978-979-8840
Terms Project
Description CRY Cost Total
4'x 8'Loft 1 98.00 98.00
Cape Cod Cottage with one 3'door on left front 2 feet off corner
with one double hung window and custom window box centered on .
front.4'x 8'loft on right gable
Delivery Charge per hour for truck and crew 4 109.00 436.00
Discounts allowed by Brian -550.00 -550.00
Delivery discount -436.00 436.00
Ebonywood Architecture Asphalt Roof Shingles 6.5 0.00 0.00
If you would like to order this building please a mail or call at one 0.00 0.00
of the numbers listed below to schedule an installation date and to -
confirm any specific details that are important to your particular
location or request. _
Thank You
Brian Warburton
Owner Salt Spray Sheds
508-280-3607 Cell call anytime
508-398.1900 Office
Total _71
Signature
Phone# Fax# E-mail Web Site
508-398-1900 508-398-1995 saltsprayshedsacomcast.net www.saltspraysheds.com
Salt Spray Sheds Estimate
235 Great Western Road
South Dennis, MA 02660 Date Estimate#
4/23/2009 799
Name/Address Ship To
Delai Mary
14 Lemon street
Salem,Ma
mary.delai@gmail.com
978-979-8840
Terms Project
Description Qty Cost Total
12" Cupola 1 152.60 152.60
October 1st ROUGH INSTALLATION DATE
0.00 0.00
Total $5,778.60
Signature
Phone# Fax# E-mail Web Site
508-398-1900 508-398-1995 saltsprayshedsacomeast.net w .saltspraysheds.com