Loading...
171 LORING AVE - BUILDING INSPECTION ------— ------------ The Commonwealth of Massachusetts iy1, Board of Building Regulations and Standards CITY OF G1',�1 Massachusetts State Building Code, 780 CMR SALEbt Revised.l far 2011 Building Pennit Application To Construct, Repair. Renovate Or Demolish a Otte-or Two-Fanuly Dmvelflikq This Section For Official se Ot Building Permit Number: Date pplied: Building Otticial(Print Name) Signature Date SECTION is SITE INFORMA ION 1.1 Property Address: 1.2 Assessors Nlap Parcel Numbers /-& 0�✓JG 4y—e 1.I a 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 It) Frontage(fi) 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: Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Ow erl of Re ord- �� � vOraale _ �lP,� , mass ne N;u (Print) City.State,ZIP /7/ LL1P,:�df .Rice- `17f16676Yf1 No.:md Street 'relephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ .Accessory Bldg. ❑ Number of Units Other*'Specifv:�i/ Brief Description of Proposed Workc: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building S ©� I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. [electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2, Other Fees: $ n 1 4—Mechanical (fl\':\C) S List: L.,{'�TG/n /Z• v/1 �(�,!'/ i. \Icchanical (Fire S — Su m mression) Total All Fees:S Check No. ('heck Amount: Crash:\m)unt:_____ 6. Total Project Cull: S 9366 Q Q ❑Paid in Full ❑Outstanding Balance Due: ! SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) —Jo1 L 2 o /0IZ— ��-_r1older License Number F iralio Date Name o(CSI. I folder C 4 List CSLI)pe(Scc hcluw) exin-oAyl 1}pe Description llnrc J 1 Uildings u to cu. Il.) nn fl YM_ „s1 i qlD, R Restricted IN2 Family Dwcllillg Ciq/I tit n.State,ZIP M Mason ry RC Rooling Cmerin WS Window and Siding SF Solid Fuel 13uming Appliances I Insulation Telephone Finail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1y/?7Via' 4/m —TIAAM / 3Q CDn r nn C HIC Registration Number Ispira ion Uutc I IIC'Company Nac or I IIC Registrant Name CV.� ue10 n s I-- o.and Street Email address Inn Me-ts e3 lqQ -, Grown, State,ZIP Telephone 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 .......... 0 No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,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 Name(Electronic Signature) Dale SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby atte nder the pains and penalties of perjury that all of the information contained in this application is true and a u to to the best of my knowledge and understanding. Print( ane 's err t�nhii6 Jar Agent's Name(Flectronic Signature) z�Datel 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 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 a3 s���yngp..goe te;t Information on the Construction Supervisor License can be found at t�o�a.ni;) >.gu�-'Jli_ ?. \khen 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. fl.) _ Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half baths 1)pe of healing system -----__-_-- -- Number of decks porches - ---- rypeofcoolingsystem-_ ------ ---_____-- Enclosed -----__-_-- Open 3. "ro1:d Project Square Footage-may be Snh,liltned for rotal project Cost' �+ CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT .our. M:1 Y:InIV ul1 �Ill,vl 12C WANif1Ais I u.%iIsCtT • inlrW, M.t».11.la u t Iv J197� I'c1. 774;IS'li'iS •I�yr 'I)e•'iC•'ISM Workers' Cumpensation Insurunce AiOdaviC Builden/Cuntractun/Electri♦')ansipiumben II 1 illcant Information /� case Print Leagibiv Villnalu114,Ie.YI)I�ylValinNlnJlYnlaall:�r/M T �zh 7'�" TP t City,.Alfc.lip. Ir�1_T—y—mac�$ _ Phone it: 7a 2- I \re%ru an eoyiloyar7 Chu�I( tho approprlute burr; I.❑ 1 am a employer with_?�L 4. ❑ I mn a ycncnl cuulraetor and t I>M urprn)ucl(ruyulrrd): cnlyluyccs(lull undYur port-lime).• have hire)the suh•cuntracwrs h' ❑New cwlstructiun ?.❑ 1 •un u sole prnpricntr fir punnar• tisrad on the anachcJ shceR : y. ❑Remodeling chip and hava no mnptuyeas, These subcontractor have lvorking firs Inc in any capacity, workers' comp• insurance �• Q Demolition IIYn woiltcn'cutup. insurance J. Q We an n cm 9• ❑ Owdin�addition n uired pontinn and its 1.O y J »Then have ceen:iscd their 10.Q Electrical repair or additions 1 :nn a holm owner doing all work riyhr of asamplion pur h1Ot, I I.Q plumbing repairs at additions mysalf.(Ko lrorkcn'comp. c. I3],¢Ili),and we hnva no 12.❑Rlnil'rrlwirs inauranco re r ;mpluyecs.(No worker' comb insumncwrcyuired,J 13•BOdter NG,i,� r(�� ^eq,,;gthcue Ih,Y.•hcb\ua of mop:Jw IIII,nrd Iho veu•rl Wow dntwule their Na\ui c,lntptnullun Ituliey maulttdniur\ 'Ilulnw,wrwth tt' ul this Ihie amdMIMI tl in1111i o ne They are auind ell.vur\and Iknt hip ulnitde Viar"' ham Innil.•Prod I ndnr alnd•eil indiulline (',Mlrpll,p that ahu\this heN TWI artaehld an aadlliuyl Aver.\,,,.ire the nape oflhe Sub clantouhm and IheN Mtr\ep'rplllp.ptllcy Inlhrllronue• /airs um vvrrpleyer thus Ir prlrvid/nx learAns'curnivenradon bisurnneo for my etnp/ilyera Br/aiv is Mr pu/ley unr//ul.vif� h1fareiudun, Insurance Company.Vmne: Policy Al or Svlr•ins. Lie. Er<piralloo Date: Job Site A41tlre1a;�7/ `�dI ; C1ty,State/ZIp: C Attack n copy of rhd worker'cumpensanon policy Juclarellan yoga(showlnp the policy nulubbr and esplratlun duce). Pal lure to sucurs culenye u required under Section?JA ul'.\IQL c. 132 eau lead faille imposition ofcriminal penalties ors lino rp hl it 300.00 und/ur one-year intpri.vomncnt, ar hell"civil)wnullics in the runn ufa STOP WORK ORDER and a ring ,ills fit i2sn.00 a Juy Idallge Idle vialahu. Ile advl.vcd Out is copy urihis sfutcalunt may be forwarded to the Office ul' I'm mig-Juoaa u1';II • IA for�mimircc alvcruyc la ificarum. /du/r.•rehy d vrlily it er the point mid pen,dricr uji"p rrJury that th nn r iu/uudow pruviJell u uve is true(food(foodcorrer4 Lo rue uldy, dy I' ma0o Cit�,'fa,uiC'Icrk J. Llectrical luvpcctur 3. Phnnbinyluvyceror'l Information and Instructions �LusaQtu.eus Gcnerrl Laws chapter I i2 tcqutres all employe:on in the acrvice of anotherc onler Illy c ntnctt flhire.a. I`ursu.utt to Mull.aatuw, an rrnplu)'ee is JetineJ as"...every De c%press or „nplicd, oral of written." oration of tither legal cnhry,or any two or more he �n c,nplu)•ar is JetineJ ss"an individual, partnership, ,,saclatloa-Cory tumerse' asaoetatiuo ar other legal entity,employs"{employees, However the t the too),et 1 g engaged n a)writ enterprise'and including the legal represenutives of a deceased employer,or t ecmver or d dwelling g .m se ha dual, p Woos w do maintenance.construction or repair work on such dwelling house owner of a Jwellint{house bout^y not tmOfO�0A three apartntenu and who resides therein•or the acupam of Iwelh IS Ituuie of another who employ person, or tin the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." sin agency shad withhold the Issuance or t cell d or local 1 d for as �IGL chapter 152, 425C(6) also states that"every business stau Is the ulrod. renewal of a license or Plot jolted d operatetable evidence of cumpdasee witb t construct be heslnsuof its Coverage ii subdivisions+hall npplicunt ehe has not produced acceptable \JJitinully, �IGL chapter l 5., j25Cly)states"Neither the commonwealth our any D Inter into any contract tot the perfomwnce of public work until acceptable evidence of cuntpliwtce w ith the insurance cling raquiremcnis of this chapter have been presented to the Contra Appdeaots to our situation and. if compensation atlldavit completely.by checking the boxes that apply Y addresses)and phone nuntber(s)along with their cartiflcate(s)of plc:tse fill out the workers' compe with no cm loyces other than the netcssary.supply.rub-eontractor(s)nsrne(s), ' naurmtcc: Limited Liability Companies(LLCworketa tcompema ed Liability n imurancel(if an)LLC or LLp does have members or partner, are u required to carry �w this affidavit may be submitted to the Department of Industrial employees,a policy is require Department of not the Dep Accidents for confirmation of insurance coverage. Also be sure to sl{a and Jute the ul'ltdavlt. Tile affidavit should uestioos regarding the law ar if you are required to obtain a workers' he rctttnted to die city or town that the application for the ponnie or license is being requested, should enter their Industrial ,\cciddnIs. Should you have any q let flu number listed below. Self'insured companies compensation policy,pleas call the Department self-insurance license number on the a r° riate line. City or Town Officials partment has provided a space at plensc be sure that the ou tupl�II outsi complettand printed n the oven the officelof Invy. The estigations estigatiDel ons has to contact you regarding the tapplicam of the affidavit for y in any given year,need only submit one affidavit indicating cuneu' I'I:use ba suro to till in the permit/licenaa number which will be used us s reference number. In addition,an applicant than must submit multiple pennio'l rid tin applications iu roviJaJ to the policy illl'ormati„f the ncccb via!that has been offle ullynder-job Site�'tameped or marrkedtbys tile city or townmay be p o Y Ito town). ' \cuPY applicant as proof that a valid afflduvit is on file tot future Da"^'nn of 1 it oat relate)to any business avit 1ur comst emerc al venOut ture year. \0'here a home owner or Citizen is obtainingi license ur p t i e. a Jug liccnsa or permit to burn leaves AM.)sail person is NOT required ro ramplete this till y uthatc'Ln uesuous, f he )tii:e tit Inveaigatiuns would Itke to thank you in aJvance fut your cooperation aoJ shuulJ y Y 4 plua,e Ju nut Itesitat¢ to give us a call. umber fhu U:panment's aJJre+a, telephone and Th Caii ommonwealth of Massachusil Department of industrial Accidents OMCS of Iavesdiladong 600 Washington Street Boston, MA 02111 f el. q 617-727.4900 ext 406 or 1-877-MASSAFE Fax to 617.727-7749 J ;.,,,.I s www.mass.gov/dia CITY OF S'UF-.4Nl, %WSACHUSETTS BLMDLNG DEPARTNONT 120 WASHLYGTON STRM, Y°FLOOR TEL (978) 745-9595 FAX(978) 740-98" KI\BERLBY DKIWOLL MAYOR THo.+us ST.Pmna DIRECTOti OF mat-IC PROPERTY/81L DLYG COMMISSIONER 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 l 11.5 Debris, and the provisions of MGL c 40, 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 disposal facility as defined by MGL c l 11. S 150A. The debris will be transported by: �ahc{ Z 7-2UG< (narni of hauler) The debris will be disposed of in (nafnc of facility) /9/) ct/st-r /—4 " -�? (address of facility) signature of permit applicant Z/ /i �—PalC I.M1n vl(bw _ • - Page No. Of Pages. �aafYxtg �rv�as�xX WM. TRAHANT JR. CONSTRUCTION, INC. 4TH GENERATION ROOFING 215 Verona Street LYNN, MASSACHUSETTS 01904 H.I. LIC. #141778 (781) 599-1211 • (781) 844-4551 e FAX: (781) 581-0855 PHONE J'� DATE - PnOPQSALSIUB EDTO , K !J-_ I66 01/ L1 3 JOB NAME STREET.` _t'� k � Lot'E I1V r' JOB LOCATION CITY,STATE and ZIP CODE ` / - p i 1, n-1 1. / We hereby submit specifications and estimates for: We hereby submit specifications and estimates for: __ SHINGLE ROOF —__.-_- _- ------ — - -- — — -- ❑ Sweep entire roof clean 0 Strip entire roof -- -- ❑ Strip entire roof L5'Replace any bad boards up to 100 linear feet -- -- - -- ❑ Mechanically fasten down ISO board insulation Install ice and water barrier first three feet up roof -- - Install 060 Rubber Roofing on entire roof ET-Install_ice and water barrier m all valleys and along dormers ❑ - — _ ___ - er Install 151b felt paper on remainder of roof — ❑ Install metal flashing around perimeter of building -- --- - -- ❑ Flash chlmney(s), pipe(s) and wall(s) 171 Instill eight inch drip edge --' _ - ---- -- [I Edge caulk all seams Install ridge vent - - - - --- El Install new copper center drain Flash or re-flash chimney(s) p, ;, _ — ---- -- -- - - -- — — « ,;c l ❑ Other: _ nstall new plpe flanges Cv1� r - — _ -- ❑ Clean up all debris p•lnstall 30year shingle ❑ other _ - __ -- --- — ❑ Labor and materials guaranteed 100% for five years ❑ Install gutters and downspouts -- ❑ Install trim toll - - - - - ❑ Install new fascia boards 1h�k �e- t_<_ '_. ___� '-`7 '�'J.h:,: �_a.___-. ❑ Install new rake boards -' ❑ Install sky Ilght(s) I ❑ Other _V)IJC tc_ts!'-s?!-: a .,,,-- - ` _ t ,J�I-Cean up all debris - lBeabor and materials guaranteed 100%for five years C] A1) shingle roofs are nailed by hand. ryernpuse — complete in accordance with above specifications, for the sum of: hereby to furnish material and labor Total Price($ •*IF YOU ARE HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC, AS 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 Authorized manner according to standard practices. Any alteration or deviadort ham above c c Signature - lions involving extra costs will be executed only upon written orders, and will become ome ann R extra charge over and above the estimate. All agreements conti genoNe�necerssary accidents or delays beyond our control. ownerto carry fire.tornado. insurance.Our workers are fully covered by workman's Compensation Insurance. / / The above prices, specifications ccetMttce (if11 rapasttl — g , and con Itions are satisfav ry and are hereby accepted.You are authorized to Signature do the work as specified. Payment will be made as outlined above.