9 LINDEN ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
> Board of Building Regulations and Standards CITY
OFSALEM
Massachusetts State Building Code, 780 CMR, 7's edition Revvise January
Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008
'l 11 One- or Two-Family Dwelling
^ry.� This Section For Official Use Only
Building Permit No her:: Date Applied:
Signature:
Buildin Commissioner nspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
G
Lla Is this an accepted street?yes 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 lowner'of Record: ' P� S7.L Sa leavt /l l n 1 f-
Narne(Prir AJ ress fur/S�ervwc: T
Signature Telephone
SEC ON 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building T1Owner-Occupied W Repairs(s) Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': -
00.n
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I.Building $ D 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: /+
4. Mechanical (HVAC) $ _ List: �[J, a
5.Mechanical (Fire $ /
Suppression) Total All Fees: $
l Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ U 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
�� ( �G License Number Expiration ate
Nan �f L o ( W List CSL Type(see below) L2
Address Tyne Description
t7143 gV Unrestricted(up to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwelling
Zignature M Masonry Only
11?�� 5= RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registere Home Improv ment ontrac[or(IIIC)
IC mp�ny m Nae r IC eg' rant Na me L _eegiisst'ration Number
_.
Addre (( _7,, I
— - � Expiration Date - _
ignature 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 .......... ❑ No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIESI FOR BUILDING PERMIT
I, 1O d A A-i"' g as Owner of the subject property hereby
authorize A (.o j�_ �t�3 64 -'UGS (A �C.. to act on my behalf, in all matters
relative to wo orLed this burldmg permitlaapplication.
JL
Signature of bwner Date
SE ION 7b: OWNER! 4R AUTHORIZED AGENT DECLARATION
I, A� I t
I i pz-- ( Qc r✓( , as Owner or Authorized Agent hereby declare
that the statemments and in ormatio on'the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Ls!! C L 1
Print Name
5 �K71
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
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 of guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"
�. Restricted to: 00
... 00- Unrestricted
1G-1 2 Family Homes
Massachusetts- Department of Public Sni'ety
Board of Building Regulations and standards
Construction Supervisor License Failure to possess a current edition of the
License: CS 80145 MassachusettsState Building Code
is causeusefor revocation of this license.
Restricted:ta,00,
GEORG61i.. SILIAftS Refer to: WWW.Maas.Gov/DPS
5 PITCAAAf gV(VAY s
IPSWICH, NCq.-:019W
Expiration: 10/282011
f'ommL+sLmer Tr#: 6238
I
Xe
J Band of Building Regulat onsJ dStan�e
One Ashburton Place - Room 1301
Boston. Massaphusetts 02108
Home Improvement'Contractor Registration
Registration: 154326
Type: Supplement Card '
Expiration: 2/27/2011
ALPINE PROPERTY SERVICESbsCt ; --
GEORGE VASILIADES -
11 WILSON STREET
SALEM 01970 < ..``
, MA �_':-�<�::�� Update Address and return card.Mark reason for change.
I] Address [I Renewal 0 Employment rj Lost Card
DPB-0Ai O 4oM-0&os oBBLF0RMCA10B2120W
�ia�owrmwo�uieal!/a�./�ceaac%ael0 .
Board of Building Regulntions and Standards License or registration valid for Individul use only
.I HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
• Board of Building Regulations and Standards
Registrdtfoti: 154326 One Ashburton Place Ran 1301
E-C—lfaflon';`PJ272011
P Boston,Ms.02108
;:Typed S,ii�iplemenl Car
ALPINEPROPERTY ER CCES..0
P
P.EBGE VASILIAD ,S'},�",:"
-
SALEM,MA 01970 Administrator Not valid without signature
i
tj
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
• 600 Washington Street
Boston, MA 02111
wwwanass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Orgmization/Inndividual):
Address: 63 CJ �i 54 4
City/State/Zip: G U Phone M
Are ou an employer? Check the appropriate box: Type of project(required):
I. I am a employer with 30 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
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 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, §1(4),and we have no 12.[Lj400f repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infrmation.
-t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
lain an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information. nn r 1_ /
Insurance Company Name: n ai✓�'LI
Policy#or Self ins. Lic. #: L0CM (Do �J: � IJ IO'� Expiration Date:
Job Site Address: Ld cld City/State/Zip:
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(if
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
Signature: �// I Date: /? a Ij'CJ
T
Phone#: 11�R ' $8 5 F?_Ol
Official use only. Do not 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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s) of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of •
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write "all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
600 Washington Street
Boston, MA 02111 •
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax# 617-727-7749
www.mass.gov/dia
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ONLY AND CONFERS NO RIGHTS UPON'DIE,.Qm7#ICATE., '•
H.J. Knight Intemational lnsurmlCc AgmCies,Irol HOLDER. THIS CERTIFICATE DOES MOT AMENC�-LX'7mMD OR:..
500 Victory Road-Marina Day ALTER YHE COVERAGE AFFORDED BY THEPOUFIES b�l•OW;
North Quincy,MA 02121 MPANI McOl B+G COVERAGE.
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A Allantic Charter Insurance Company VDAC
PIa1RQD COMPANY
Alpine Property Services Co.,Inc. 13
OOMPPNY
PO Box 365 C
... _Topsfieldl._ 01983. .. •_ .coMPANr-.- .. -... .... . . ..
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7JNjXC=ATED.
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EXPIRATIDN DATE THEREOF,THE ISSl COMPANY VOLL ENDEAVOR TO MML
DAYS VAUTTEN NOTICIll C9r7P¢ATl HOLDER+IA1l TO,7MELEFT.
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• AULROAtrADRQRRYSlHTATME
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HIC 054326
Roofing • Siding • Painting EIN#56-2618812
Todd Hannig Job#:
9 Linden St.
Salem,MA 01970
(978)930-4992(cell)
April 28.2010
Dear Todd,
The following estimate is for the roof installation for the property located at the above address.The following paragraphs describe the work that
will be performed. _
Installation Procedure -
J. Remove existing shingle roof on the entire house
4. Install an 8 inch drip edge on all leading edges
4 Install 3 feet of ice&water shield on front leading edges&valleys
J< Install 15 pound felt paper on all areas not covered by ice&water shield
d. Install new ridge vent
4 Install new vent pipe flanges
J, Replace any rotten or damaged roof decking plywood(we allow 32SF a.no charge,$65.00/sheet thereafter)
J. Replace any rotten or damaged roof decking ledger board(we allow 3011.at no charge,$5.00/ft. thereafter)
:k Replace any rotten or damaged fascia or rake boards @$10.50/ft
J, Install new GAF 30-yr Architectural shingles
1 OPTION 1: Chimney Lead Flashina-Remove existing lead flashing on(2)chimneys,install ice&water shield,step flashing,and
grind new lead flashing into both chimneys
4, OPTION 2: Transition walls will be stripped(at least 1'above roof line),ice&water shield applied,new step flashing.&install new
wood shingles
J= OPTION 3: Paint trim on(2)dormers
Additional S eci tcations
J, Homeowner to choose color of shingles COLOR: B I—A cy,
J. Our dumpsters are sent to a recycling facility;therefore no additional trash may be placed in them. The transfer station will charge us
a fee which will be passed on to the homeowner.
ak Transition walls are an option,and if the existing flashing is in good shape,usually do not require replacement
4. We are not responsible for any of the cracks that may arise in any walls or ceilings
J. Please cover all your floors in your attic to protect from dust and debris
- 4i, We will remove all of thejob related debris
Initial the options you are choosine below: .
Cost for Labor&Material for New Shingle Roof $5,100.00 +, .� W<r JV„y f 444 t(P-kr
Cost for Labor&Material to Rrlead&Re-flash(2)Chimneys: $ 700.00 "(}U J✓
Cost for Labor&Material for Transition Walls: $ 600.00�
Cost for Labor&Material to Paint Trim on(2)Dormers: $ 325.00_-- _
Payment Terms: 113 deposit upon signing contract $ZOQ ,1/3 work in progress $ Z�d O and 1/3 upon completion$
Remit to: Alpine Property Services Company,Inc.,P.O. Box 365,-Topsfield,MA 01983
Total Amount Agreed To Be Paid: $ 6 b Z5
The following schedule will be adhered to unless circumstances beyond Alpine's control arise: ,
Work Scheduled to Begin: TBD Expected Date of Completion: TBD
Warranty: Alpine Property Services Company Inc. guarantees all work performed for a period of two(2)years. If any problems occur we will
cover the cost of all labor and material to correct the problem and meet the customer's sattstaction.
Do not sign this contract if there are any blank spaces.
(additional provisions follow and are incorporated herein by this reference)
l Z
Ja
�'✓/v
nni Maniatis,Project Manager Todd Hannig
Alpine Property Svcs.Co.,Inc.d/b/a Olympic by(Name) Homeowner
Tel: (800) 535-4312 9 Fax: (978) 887-5875 • 239 Boston Street 0 Topsfield,MA 01983