The URL can be used to link to this page

14 LEMON ST - BUILDING INSPECTION (3) r The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF `\ Massachusetts State Building Code, 780 CMR SALEM. Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling This Section For Official Use Only j Building Permit Number: Date Applied: wilding Officia riot Name) Sign!! Date '- SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 14 Lemon Street,Salem,MA 01970 Lla Is this an accepted street?yes P no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Debra Kirchheimer Salem,MA 01970 Name(Print) City,Stale,ZIP 14 Lemon Street 978-979-6840(cell) dkmd@venzon.net 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 ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work: i MAI ArrcAewt o8,ke V � f r/�ra SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ 19 Soo 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 80t ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ �L S00 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ U ❑Paid in Full ❑Outstanding Balance Due: ON,a SECTION 5: CONSTRUCTION SERVICES 5.1(�Connstruction Supervisor License(CSL) 111 V/9 /Q, g 3 ( CAI✓ !R�16 ✓r� License Nbumber Ex iration Date Name of CSL Holder r S List CSL Type(see below)l? V No.and Street Type Description /',rlA �� AU O X7 U Unrestricted(Buildings u to 35,000 cu.ft. U/ R Restricted 1&2 Family Dwelling City/TowUState,ZIP M Masonry RC Roofing Covering WS Window and Siding 9�8 �S9-D��/6 Scotty ro6;ctiG✓o� w ve^Lei_per SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /0K US3 P7HIC Registration Number xpir lion Dale HIC Company " 'HIC Registrant Name S co'N"j rob;cha.rA © ye1;i-Zd& ,nrc-t No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATIONINSURANCE 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 .......... W No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUIL ING PERMIT I,as Owner of the subject property,hereby authorize scot J dl okl to act on my behalf, in all matte 1 rve to work an horized by this building permit application. 1 lt�rc. �trc�t�etm-f .��_ �� Print Owner's Name(Electronic Signamre) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information cont ' ed in this application is true and accurate to the best of my knowledge and understanding lcoft- �Jt,4 trhdv� II j /, Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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 M.G.L. c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dus 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" . [ faa��tr.nuuui�) -0SZ7 *U1 SL0ZBU0l . uogendX3 �T L88L0 dW N)16NIWIIM t "� * 2Ip.M3dNilO tl , 4 ,`•16f1VH H02i ( 110�S 1. .69b99 SO asuaat� asva�)ll iostAiadng udliRni;suoO ' vpar.pu115 Pun Sung1 In taa xrulpl!nfl .Itt Pit ug /:1 311Qnd pt lunulnulip • -- ��.y� d I Sieia�oasaapon ' ;,y, LOS 10 HW 'NOIDNIWIIM !, L1O 83d`di10 LL 'I pneppo'd 1100S v llOOS .-lenplAlpul KID U8 -�:uollendx� :od61 +�- 894806 uone21s16a FL a O.LD"IN001N3W3A011dW13W0 r T _ uolliji N esa Isng+g uIvi !"awnsuo0)o 330,{O s+ +7�ernJ.vnfeir�/v�n /fvamvGoatvuoorli aL� �J I -+ !�J r 01997-2010 Xerox Corporation.All Rights Reserved. XEROXO and the sphere of connettivlty design are trademarks of Xerox Corporation In the United States and/or other countries. SCOTT-1 OP ID: JD 4�JR0, CERTIFICATE OF LIABILITY INSURANCE DAr11/011 2vY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). >RODUCER Phone: 978-658-3805 CONTACT Vilmington Insurance Agency Fax: 978-657-5724 PHONE ive Middlesex Avenue Unit 14 All C No Earl I.O.BOX 1010 E MAIL Vilmington,MA 01887-0580 -- _------ ----- --- ------- Vilmington Insurance Agency —_ —_ ____INSURERS)AFFORDING COVERAGE _ NAIC M_ — INSURER A:Hartford Insurance Company NSURED Scott Robichaud INSURERS:Cornerstone 21 Draper Avenue — -_-- -- Wilmington, MA 01887 wsuRERc: INSURER_D: _ INSURERS: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE ADD UB POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 �S (aE�'(S B X COMMERCIAL GENERAL LIABILITY Q$103374 04122112 04122%3 AA A PREMISES(Ee occurrence) $ _ 10+00_ CLAIMS-MADE f X� OCCUR MED EXP(Any one person) S 1,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 1,000,00 POLICY PRO- LOC 1 $ — — AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Lam dent $ _ _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accitlent $ I AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accideng $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ E%CESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY YIN X_LTORVSIMISS___I-E A ANY PROPRIETOR/PARTNER/EXECUTIVE 6S60UB-0380N77412 02/22/12 02/22/13 E.L EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED' NI A — (MandatoryinNH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under — -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION KIRCDEB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Debra Kirchheimer ACCORDANCE WITH THE POLICY PROVISIONS. 14 Lemon Street Salem, MA 01970 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 12010/05) The ACORD name and logo are registered marks of ACORD 26V* 28¢" - 28;" t„ Site build4shelves around �6'-, 24" 8- 301=6' 9" boxed in vent stack ' (to replicate those on architects plan) WI W72301 WFLS630 WlVV,M24 N I[ OFI BC242484 1. 24E,. J812 430 GAS-RANGE2 BFLS3 � r 4_ TB9R-FH .W Remove walls from around existing brick chimney to expose brick and create more space for cabinetry I Leave existing half wall ° N same height-extend about 12" O w as needed for design N NOTE: = N remove existing bead board and The installation and location of install new drywall lighting fixtures,switches and outlets will be determined on site. - li w m III NOTE: 0 i III �—_-_ Change out existing octagon I ill window,and replace with transom style patch in clapboard siding w _ BC151284R o BCt ��84R - - m Wood wall canon top of half wall,and hutch unit _._n I,lI B36 LS3° i Iil _— I ry ' � .gyp p Sp ort column to be trimed out in pine II W4830 ready for paint I W3630"- 3 III _25 P,OST3 about 8"overhang POST3 O W u N I Built up crown to ceiling i m io I M n FSEP �284L A�imensions _size designations given are �® `?r`'�'q This is an original design and must not be Designed: 8/14/2012" subject to verification on job site and rec e,votoeles released or copied unless applicable fee has Printed: 11/l/2012 _ adjustment to fit job conditions. been paid or job order placed. J Deb and Mare !All .Drawing #: I 266" 28;' 28� c Site build shelves around -6" 24" 6 8" 1�� 3o s" 9" boxed in vent stack , (to replicate those on architects glen) VVI W12301 O/FLS630 WiWFL-24 r oi 16 - ____ 1 L - N OF[ 2 BC242484 t 24E JB12< BFLS33 1 .,, 30 GAS-RANGE2 T85R-FH ', to - - Remove walls from around existing N brick chimney to expose brick and create more space for cabinetry - N Leave existing half wall N same height-extend about 12" " w as needed for design NOTE: _ -. - - remove existing bead board and The installation and location of ° install new drywall lighting fixtures,switches and outlets will be determined on site. - s � u NOTE: --4 -- Change out existing octagon window,and replace with transom style patch in clapboard siding BC161284R m �", m i I Wood wall cap on top ! o m :BC161284RI of half wall,and hutch unit n m...._ 636 LS3° i .F r Spport column to be trimed out in pine W4830 , ready for paint m n n I __W3630_ POST3 about 8"overhang POST3 w i Built up crown to ceiling (Typical)��,.M FSEP 284L 'All dimensions size desi -nations given are '"`f, This is an of iginal design and must not be Designed: 014/20 2 subject to verification on job site and 4•"' ieleascd of copied unless applicable lee has Printed 9/10/2012 ad�justmnent to fit'iob conditions. been paid of job order placed. 1 Dcb and Mary _FA I Drawing 4: 1 \ ou� ij � I I I -1 'Note: This drawing is an artistic �?�'1 Designed: 8/14/2012 Lei' interpretation of the general appearance of ��n�t sir. � Printed: 9/10/2012 the design. It Is not meant to be an exact t " rendition. r li `Deb and Mary � All Drawing k: I li I I i F - � o oho 00 I m® a Sao, ' O I rNote: This drawing is an artistic �("� Designed 8/14/2012 interpretation of the general appearance of r . ccic .� Printed' 9/70/2072 the design. it is not meant to be an exact --- - rendition. 'Deb and Mary ,All Drawing 4: 1 I 1 � IQ d a � � i Note: This drawing is an artistic 2f-� - - Designed: 8/14/201 interpretation of the general appearance of iecenolo�re= Printed: 9/]0/2072 'the design. 1t is not meant to be an exact rendition. 'Deb and Mary All Drawing #: 1 i l� I I I i i Note: This drawing is an artistic 2PY " Designed: 8/14/201211 interpretation of the general appearance of ��,.•JJ icciEs � 'Printed: 9/10/2012 'the design. It is not meant to be an exact — ---1 rendition --------------------- � u Deb and Mary All Drawing #: 11 lsosr:,:, Vendor Ship To Purchase Order Dcsi .ns Scott J. Robichaud Debra Kirchheimer 215 South Main Street 17 Draper Drive 14 Lemon St. P.O. No. 4658-04 Middleton, MA 01949 Wilmington; MA 01887 Salem; MA 01970 Phone 978-750-1403 978-979-8840 Date 10/15/2012 Fax 978-642-9595 Ordered By Jim Due Date 10/15/2012 Item City Manufacturer Model & Description Job/Tag# Rate Date Received Amount Installation I Provide labor to remodel kitchen as KIRCHHEIMER-JH-104-4636 per approved plan. Remove existing kitchen and haul away all related debris obtain required building pen-nits Remove walls from around existing chimney exposing original brickwork patch in drywall as needed. rework right side of trim on existing bathroom door casing-using parts from removed closet door. Remove existing octagon window , and replace with transom / hopper unit -patch in clapboard siding as needed , as well as drywall , and interior trim - Homeowner will purchase new window unit. Remove beadboard from existing half wal 1, extend length as shown and drywall Repair/ patch in drywall as needed after PLEASE REFERENCE JOB/TAG# & PO# ON ALL CORRESPM� FNCE AND SHIPPING DOCUMENTS Total Boston Vendor Ship To itche® Purchase Order Designs Scott J. Robichaud Debra Kirchheimer 215 South Main Street 17 Draper Drive 14 Lemon St. P.O. No. 4658-04 Middleton, MA 01949 Wilmington, MA 01887 Salem; MA 01970 Phone 978-750-1403 978-979-8840 Date 10/15/2012 Fax 978-642-9595 Ordered By Jim Due Date 10/15/2012 Item Qty Manufacturer Model & Description Job/Tag # Rate Date Received Amount install of electrical and plumbing. Repaint ceiling- other painting of walls andtrim to be done by homeowner Box in existing support post with pine trim ready to be painted Sand - stain and refinish existing hardwood floors, stain color TBD. Install new kitchen cabinetry as per approved plan, including moldings and hardware. Install subway the backsplash behind range area approx. 10 so,.ft.exact tile TBD($]00) Note: Electrical and Plumbing labor and materials will be a separate agreement. NOTE: This agreement does not include any additional labor or materials which may be required should unforeseen or hidden issues arise after the work has started. PLEASE REFERENCE JOB/TAG# & PO# ON ALL CORRESPOWbiNCE AND SHIPPING DOCUMENTS Total iotito'i ItchelaVendor Ship To Purchase Order Dcsign.t Scott J. Robichaud Debra Kirchheimer 215 South Main Street 17 Draper Drive 14 Lemon St. P.O. No. 4658-04 Middleton, MA 01949 Wilmington, MA 01887 Salem; MA 01970 Date 10/15/2012 Phone 978-750-1403 978-979-8840 Fax 978-642-9595 Ordered By Jim Due Date 10/15/2012 Item Qty Manufacturer Model & Description Job/Tag # Rate Date Received Amount Any deviation from the above specifications involving cost or time will be done only upon a written separate agreement signed by all parties involved. PLEASE REFERENCE JOB/TAG# & PO# ON ALL CORRESP&ObD -NCE AND SHIPPING DOCUMENTS Total CITY OF S�1LEM, lL-1SSACHUSETTS r„ BL:ILDING DEPARTNIF-NT •��, � `_,,�t 120 WASHGVGTON STREET, 3'a FLOOR Ce�Oe TEL. (978) 745-9595 Rm<(978) 740-9846 KI\IBERLEY DRISCOLL MAYOR T3iOMAs ST.PtERRB DIRECTOR OF PUBLIC PROPERTY/BUMDLNG CONNISSIONER Workers' Compensation insurance Affidavit: Builders/Contractorv/Electricians/Ptumbers Applicant information Plcage Print Legibly 1 / NatnC(Businass.Organizatiurvindividunl): �� I'Otllr G//Q4 Address:_ )7 -0k4 ee/- _Dra City/State/Zip: 6,C l/y,F yv?" f�G(, Phone #: ?n S - SS7- 0 cyb� Are you an employer?Check the appropriate box: Type of project(required): I.a am a employer with o� 4. ❑ 1 am a general contractor and 1 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractars 2.0 1 am a sole proprietor Or partner. listed on the attached sheet.t ?• Remodeling ship and have no employees These sub-contractors have e. C] 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 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'comp. C. 152, 91(4),and we have no 12.❑ Raof repairs insurance required.) t employees.[No workers' 13,[] Other camp. insurance required.) •Any applicant nut chucks box el most also fill cut the section below showing their workers-compensation policy it,A) nalion. 'I l rneuwners who submit this affidavit indicating they are doing all work and then him outside contractors most submit a new anidavil indicating such. =Cnmrautor,that chuck this box must ntachvd an addiliotwl ahetl showing the narne of the subcontractors and their workers'comp,policy bootnution. !am an employer that it providing Ivorkert'compettsatlun insurance for my employees. Below/s die policy and Jab site ieforniation. 0 Insurance Company Name: Qlr_Av-d 11S- CB. Policy p or Scif-ins. Lic.4: C S 0L)/✓— 6 3S N Expiration Date: ,S�fy Job Site Address: l y emo4 cST. City state/zip: Sa/EA t M- 0/7�0 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration data). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S230.00 a day against the violator. Ile advised that a copy of this statement may be furwardud to the Ofrice of Investigations of the DIA for insurance coverage verification. /du hereby e•rrr/ij'y rgrdrr dnr p L and penaldes of perjury that the Grfurmullon provided above is true used correct siai;rnlrc: (� 64V oat 1/ l /�2 Phone 1: ?28 " Oflic•ial use uuly. Da nor write in t/dx area,to be cunrplered by city ur tows,njj1rlal City or'ruwn: Permit/f.lceme q Issuing Aulhorhy(circle one): 1. Board of Health 2. nuilding ilep in cunt 3.Cityrruwu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: ...___ ._._ Phone B: