496 LORING AVE - BUILDING INSPECTION 1 y The Commonwealth of\Massachusetts
�i Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code 780 CIVIR $dMar� Revised�Lfnr 2011
VV Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family avelling
This Section,For`Official Use Only
Building Permit Number: - Date pplied.>
Building Official(Print Name) S gn Lure : - Dat
SECTION 1: SITE INFOMATION.
1.1 Property r 5s: /� , " \J ll 1.2 Assessors Map& Parcel Numbers
1.la 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?Check ifes❑ Municipal❑ On site disposal system ❑
SECTIONZ:' PROPERTY'0WNERSHIPL 10
2.1 O r'of Record:
Name(Print) City,State,ZIP
Q Ozl' Vz q
No.an Street —Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORIO(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s)V I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Onl
Labor and Materials y"
1. Building 3 1. Building PermitFee S indicate how fee is determined:
❑ Standard City/"Down Application Fee.
2. Elxtrical ❑'rotal Project Cost'(Item.6)x multiplier x
3. Plumbing S 2. OtherFeeS: S
4. Mechanical (IIVAC) S List:
Meehnnical (hira $
SIT ressiim) _ Total:Ul Fees: .'S
Check No. Check Amount: Cash Amount:
6, I'utal Project Cost: S /��� (� ❑ Paid in lull ❑ Outstanding 13al:utce
SECTION 5: cONSTRUCI'ION SERVICES
5.1 ConsructionSupervisorLicense C L) �!� J
License Number E.epiruion atc
Namc of CSL I[oh
� List CSL Type(see below)
No. and Street
z �/� PUP
- Description
43rol Unrestricted2 Fin(Buildings u el ing cu. R.
Restricted ISc2 Famil Dwallin
Cityfro%vn, State, ZIP II blasonr
RC Roofing Covering
WS WindowandSiding
SF nsul Fuel Burning Appliances
'� L U �l ✓rl �) ( Insulation
'rely hone Email address D Demolition
SZ Registe ed Home Improvem nt Contractor(EIIC) f-
MC Registration Number Expiration Pate
I I[C Compan ame MC Re st a N ne
No. anM'n xc- 2 Email address
City/To ,State, ZIP 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 DE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
[, 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.
a
Print Owner's Nain (a tronic Signature) 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
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized:\gcnt'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 Hoine Improvement Contractor(HIC) Program),will not have access to the arbitration
program or guaranty time!tinder M.G.L. c. I42A. Other important information on the MC Program can be found at
w V%VAI SS.<'ovioca Information on the Construction Supervisor License can be found at www.mass.uo��!dL
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.) _ Ef,1bi[able room count
Number of tircplacas Number of bedrooms -- — _—_--
Number of bathrooms _ Number of haltibaths
Type of beating system - -- `'umber of decks/porches
I'ype of cooling syctent_-- Enclosed Open
i 3. rolal Pngect Square Fnnta e may be Sub;rnitcd fa' 1'n(zl I'roldct Cott"
ti 1
k
CITY OF S U ENf, NWSACHUSETTS
s� iG BI:MDLNGDEP.IR-M&NT
1 '0 WASHLNGTON S "'STREET, ] FLOOR
TEL (978) 745-9595
Kt\IBHRI Y DRISCOLL F•L`t(978) 740-9846
NLAYOR '1110m ,S ST.PtERAS
DmECTOR OF PLBLIC PROPERTY/BCILDLIIG CON(NUSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition ofti to Sta
te Building
Debris and g Coda, 730 CMR s d the provisions of t�iGL c 40, S 54; section l l I.5
Building Permit Ik is issued with the condition that the debris resulting from
this work shall be disposed ofinerly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transpolrtc/d by:
(name ut hauler)
The debris will be disposed Orin :
(name ofCaci/l%
--(addl"eSS et taClh )
i
signature ut permit applicant
!I
CITY OF Sau Em, uxssSaCHUSETTS
Bug-DING DEPiIiT.NtErT
) ' .�tr r.• 120 WASHINGTON STREET, 3i0 FLOOR
° TEL (978) 743-9595
F.'a(973) 140-9844
KIN
[BERL1r D Y RISCOLL
TH
1 tE Y DR O'%W ST.PtB.RRl3
DIRECTOR OF PUBLIC PROPERTY/BUILDLYG CO\Lt1ISSIONER
Workers' Compensation insurance AfITdavit: Builders/Contractors/Electricians/Plumbers
A a alicant information Pleane Print Le ibi
Mum tilusine4s.Organizati.3rvind ividual : .
Address:
City/State/Zip: 0121 4 i/0r--S 4�W-41iona M:
Are you an employer?Check the appropriate box: Type of project(required):
1.k7l am a cmploycr with / 4. 0 1 am a general contractor and 1 B. ❑New construction
employees(Nil and/or part-lime)." have hired the sub-contractors
2.0 1 am a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling
ship and have no employees These subcontractors have It. ❑Demolition
working for me in any capacity. workers'comp Insurance. 9. 0 Building addition
(No workers'comp.insurance 5. 0 We are a corporation and its
required.) officers have exercised their 10.0 Electrical repair or additions
3.0 I am a homeowner doing all work right of exemption per MOL I I.❑Plumbing rupture or additions
myself.(No workers'comp. c. 152,j 1(4),and we have no 12.0 Roof repairs
insurance required.)t employees.(No workers' 1l.❑Other
Gump.insurance required.)
'any upplit ue liwt cbwka box r l must sisal fill oil the mlim below showing their wm4an'compeneadun policy init nnallon,
'If."ouwm"who submit this aHtrravit indleatne they am dotne all writ and that him olntide cantramem mutt submit a new anidmit indicating WIL
=Cumracton that chalk this box meet attached an adranunal+hat showing the name of the mb,�co traetars and Ihalf workers'sump6 put icy informadoe.
fain ran eurpfuya rhaf/i provldlnR workers'compeoradon Luurnneejor my employers Bduw fr!Ae policy and Jab ske
IInrrnceC
Insurance Company Name:
v
Policy 4 or Scif•itts. Lic. n: � ) Expiration Date: JI l
lull Siid Address: LI Q K ! 6 P z (��A--`�6 City/SlatdZip:
attach a copy of the workers'componsatlon policy dechdalloa page(showing the policy numbor sod expiration data).
F`.liluru to secure coverage as required under Suction 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1.500.00 MVOs one-year impri3011mcnk as well as civil penalties in the farm of a STOP WORK ORDER and a line
orup to $2J0.00 a day against the violator. Ile advised that a copy of thisstatcment may be forwarded to the Office of
Investigutimts trflhd DIA fur insurmted coverage verification.
1,10 hereby certify r dnr pule drfury t/rut rile GrjunuaNar providrJubuve is true surd canree,
Daw: L/ l //
Phoned:
L d Z
i011trial nee airy. /la nor write in dell urra, ro be completed by city ur lawn aff/elut I
City orTuwO: _ Purmit/lJCCme,V
Issuing Authority (circlo unc):
1. Iluurd of Ilcullh 2. Iluildlnq Ilcpurtment I.Cifyffuwn Clerk 4. Cleetrical 6upectur J. Plumbing lospeetor i
6.Other
Phnno B•
NOV-13-2012 Tii1 02:29 FM �
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CERTIFICATE OF LIABILITY INSURANCE
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THE CERTtACATS HOLDER THIS
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PO Box 567 WSURERA. i105 Insurance Co 41360
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AC letructlon Co, Ilse R�ea�ca BOSH-m'10 � pORATH)N. AB rights reserved
ACORD 25 420101057 The ACORD name and logo are registered marks of ACORD
Office of Consumer Affairs and Efusiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Reclistration: 166565
Type: Corporation
�f;.l, Expiration: 6/9/2014 Tr# 228167
A.C. CASTLE CONSTRUCTION C IK10 ~ 1 �'.
BRIAN LEBLANC
9 TIBBETTS AVE 7 '
� 1
DANVERS, MA 01923
Update Address and return card Mark reason for change.
n Address n Renewal E] Employment Ej Lost Card
PS-CA1 0 50M-04/04-G101216 .._.....___.....:.__
�e eoopv�!g ✓Lli+mas/ui?elts License or registration valid for individul use only
,y— Office of Consumer Affairs&B siness Regulation before the expiration date. if found return to:
HOME IMPROVEMENT CONTRACTOR Typo office of Consumer Affairs and Business Regulation
WRegistration l66565 10 Park Plaza-Suite 5170
Expiration 6/9/2014 Expiration: ,..Boston,MA 02116
INN.
ACASTLE CON$TRUCTIONCQ INC. -
BRIAN LEBLANC, , ;y
9 TIBBE17S AVE
DANVERS, MA 01923.-, Undersecretary Not valid without signature
Massachusetts- Department of Puhlic Safcty
' Board of Building Rcg_ulations and Standards
Construction Supervisor License
License: CS 64882
BRIAN A LEBLANC
9 T113BElTS AVE
DANVERS, MA 01923
o��G- _df—tjE Expiration: 9/17/2013
('unuuixnbncr Tnr 1288
11-0026W46
This card admarladpeaMetfis rerun thMemaexk* a :w(i .•i-�,`a.
104rour �y mW Conshnnitton Heats
Brian LeBlanc
100 25782 4/20/l0l l
(fisher mine—PFW or rype) (Co+ian end date)
t .
V ropogal np
H>SB F A.C. CASTLE CONSTRUCTION CO. INC.
�IMEMBER Telephone(800)505-LEAK(5325) • Fax (978) 777-7750 v
Brian LeBlanc, President
Please mail accepted proposal to the office located at:
9 Tibbetts Avenue • Danvers, MA 01923
Unrestricted Mass Builders License No.054882 Contractors Registration No. 166565
PROPOSALSUBMI TO
PHONE - DATE I
STREET 7 k
JOB NAME
CITY,STATE AND COgE t
/ JOB LOCATION i
ARCHITECT DATE F PLANS 61
JOB PHONE
f hereby %nish m tonal and la - -com lete in accordance with specifications below for the sum of:
Pay nt to be follows: �� ( dollars is LJ ll�J�
VOTICE: All home improvement contractors and subcontractors engaged in hom
improvement contracting unless specifically exempt from registration by A horned `
Provisions of Chapter 142A of the General Laws,must be registered with Signature:
the Commonwealth of Massachusetts. Inquiries about registration and
status should be made to the Director, Home Improvement Contract Agent
Registration,One Ashburton Place,Room 1301,Boston,MA 02108, Note:This proposal may be
withdrawn by us if not accepted within_days.
IE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
ROOF STRIP
Ve will cover the siding, bushes, and grasses with Blue Tarps in order to protect the property during stripping.
Ve will strip up to 2 layers of roofing and remove all nails,screws and staples down to the bare wood. The ice and water shield will then be
Istalled at the bottom Of all edges, under all step(lashings, under all roll flashing,around all chimneys, skylights, and into all valleys.
Je will install 15 pound underlayment onto all other areas of the roofdeck. The 8"aluminum dripedge will then be installed to all roof edges.
ny existing pipes will be covered with n w In %rubber t,l�pe�, �
he roofing material to be used will be
11 the debris will be cleaned and dumped by us on a daily basis. Magnetic brooms will be used o ract all nails from your pro Vr
Its will protect your property as best we can, however some foliage matting,breakage, or marrin could occur. We cannot ac p Y
sponsibility for possessions inside of the house,or debris falling into attic areas. Customer should protect personal belonging
KTRA WORK IN WHICH A COST WILL BE ADDED TO
E ABOVE PRICE.
,place Rotted Roofboards D O VY `f
� Install Aluminum Gutters
dead Chimney(s)
Install Aluminum Downspouts
?place Facia Boards
Install Skylight(s)
;tall Ridgevent
Rotted Roof To Wall Flashings
;tall Root Louvers
)TES: Gutter Repairs
larranty by manufacturer to be free of defects a s manufacturer's warranty for exact warranty
labor performed) under this contract shall be of good quality and free from defects not inherent in the quality required or permitted for
orlon of__years. This warranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient
intenance, improper operation,or normal wear and tear under normal usage. This warranty shall be limited to the work performed by
Castle Construction Co., Inc. and limited to either repair or replacement by A.C. Castle Construction Co., Inc. at its'sole discretion
i election. Any and all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the
:urrence of the event giving rise to such claim.This warranty shall not extend beyond any ts imposed by applicable law.
3yment and Penalties - Upon substantial completion of all work under this contract, customer shall within 3 days make final and full
ment of the contract price. Any and all unpaid balances shall accrue with interest at 5% interest per month. You agree to pay all
rt costs and collection expenses incurred by A.C. Castle Construction Co., Inc. in the collection of any amount you owe under this
tract, including without limitation reasonable attorney's fees. Please note: any illegal layers of roofing beyond a second layer will be
extra cost of 35 cents per square foot.
bitration -Any controversy or claim arising out of or related to this contract,or the breach thereof, shall be settled by arbitration with
American Arbitration Association or a mutually agreed upon third-party. Any judgment upon an award entered in arbitration may be
:red in any court having jurisdiction thereof. This section shall not apply to claims of A.C. Castle Construction Co., Inc. for collection
ast due accounts owed by the customer.
ptant¢ Of VrOp05af -Signing this proposal means you have accepted all the terms as stated
of Acceptance
Signature