8 LORING HILLS AVE - BUILDING INSPECTION The Commonwealth of Massachusetts
Department of Public Safety
MasSa[hn9etl9 State Building Code(780 CMR)Seventh Edition
City of Salem
Building Permit Application for any Building other than a 1- or 2-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Inspector:
ECTION 1: LOCATION (Please indicate Block R and Lot B for locations for which a street address is not available)
No.and Street Citv /Town Zip Code Name of Building (if applicable)
SECTION 2: PROPOSED WORK
If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work:
L f\
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): r
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.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2r Cl A-2nc❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ 1-2 ❑ 1-3 ❑ 14 ❑ 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 ❑ IIB ❑ IIIA ❑- IIIB ❑ 1 IV 1 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: =Debrisoval:
Public❑ Check if outside Flood Zone❑ Indicate municipal ❑ A trench will nut beal Site ❑P1 iva to ❑ or indentily Zone: oron site system ❑ required ❑or trench
permit is enclosed ❑
Railroad right-of-way: Hazards to Air Navigation: MA I Ii.tnriU Cnnvnia+iim Rc,i,,, Pn n•..:
Nut Applicable❑ Is Structure within airport approach area? Is their review Completed?
ur C onsant to Bold eoCIOSCd ❑ Yes O or:No❑ Yes ❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Ldition of Code: Use G,ruup(.v): Type of Construction: Occupant Load per Fluor:
DoeS the building;contain an Sprinkler System?: Special Stipulations:
c
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No. (business) Telephone No (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address Citv/Town State Zip
to act on the pro perty owner's behalf, in all matters relative to work authorized by this building permit a p plica tion.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1)
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'COMPENSATION 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 ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
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 $
A. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality)
5. 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 Linder 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.
Please printand sign name Title Telephone.No. Dale
Street Address City/Town 'tote Zip
Municipal Inspector to fill out this section upon application approval: z -X,»
Name Date
II
The Commonwealth of Massachusetts
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 71h edition
d
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised
One-or Two-Family Dwelling A ri115, 2009
This Section For Official Use Only
Building Permit Number: Date Applied:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 rFerty Address: 1.2 Assessors Map& Parcel Numbers
70 a{1 '/.,n C� 1,
1.1a Is this an accipted 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:
Zone: _ Outside Flood Zone?
Public ❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2. PROPERTY OWNERSHIP'
2NOwnert of Record: _
Adv
T�ZaVe(P t) A dress for Service: '
(/7X` -7 qI -D
Signature felephone
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building ❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': n
+ n
F
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ 1
4.Mechanical (HVAC) $ List: / u
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 5 0 Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) CS SL 104
Y4s } \Qs License Number Expiranon 6ate
Name of CSLr Holder )�WS,
W List CSL Type see below
Address Type Description
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 Family Dwelling
i nature M Masonry Only
i7 RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D I Residential Demolition
5.2 a stered Home Improvement Contractor(HIC) I S &a
Ot Ne Imo_ S?rJ,Lc.-S
HIC Company y Name or HIC egistrant Name Registration Number
a /a'7 /(t
ddress
q-72-aV5-n�V ion 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 APPLIES FOR BUILDING PERMIT
I, , as Owner of the subject property hereby 'I
authorize to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date li
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
I, as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of a du )
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 and
Construction Supervisor Licensing(CSL) can be found in 780 CMR Regulations 110.R6 and l 10.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"
HIC#154326
OLYMPIC EIN#56-2618812
Painting,Roofing&Siding Office: 978-535-0943
515 Lowell Street—Peabody MA 01960 Fax: 978-535-2008
Cyndy,Anselmo
East Coast Properties
400 Highland Avenue
-
Salcm.MA 01970
978-741-2003(phone);978-745-9684(fax)
Email:c}9m1043in,agl,com castcoastproL@-gol.com
Property Location:
Loring Hill Condominiums-Unit A3,CU&H5 No Mansard
Salem,MA
July 8,2009
Dear Cyndy,
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
4 Strip existing roof on the entire house down to the roof deck
J: Install an 8 inch drip edge on all leading edges(rakes&fascia)
4 Install ice&water on all leading edges&valleys
J. Transitional walls are optional and incur an additional cost for the siding repair
-k Install new vent pipe Flanges
4 Replace any rotten or damaged decking(we allow 32SP a no charge,$80.00/sheet thereafter)
nb Replace any rotten or damaged ledger board(we allow 30ft.at no charge,$3.00/ft.thereafter)
4 Install 15 pound felt paper on all areas that is not covered by ice&water shield
4, Install new GAP 3-TAB shingles
4, Install new ridge vent system
Additional Specifications
,k Homeowner to choose color of shingles COLOR:
Our dumpsters are sent to a recycling facility;therefore no additional trash may be placed in them. The transfer station will charge us
a lee for additional trash which will be passed on to the homeowner.
4, Chimney re-pointing and re-leading is not part of the rooting contract and will be quoted separately.
4 Transition walls are an option,and if the existing Flashing is in good shape,usually do not require replacement
4, During a roof job,the nails could break the sheathing during the nailing of the shingles
k We are not responsible for any of the cracks that may arise in any walls or ceilings
9. Please cover all your Floors in your attic to protect from dust and debris
=4 We will remove all of thejob related debris
+k Permit costs vary from town to town and are not included in this bid
Initial the options von are choosing below:
Cost for Labor&Material for Roof: $1,995.00 /Per Unit
Cost for 30-yr Architectural Upgrade: $ 195.00 /Per Unit
Cost for 25 year GAF System Plus Warranty: $ 250.00 /Per Unit
Payment Terms: 1/3 deposit upon signing contract $ ,113 work in progress $ and 113 upon completion$
Remit to:Alpine Property Services Company,Inc.,515 Lowell St.,Peabody,MA 01960
Total Amount Agreed To Be Paid: $
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 [pine Pr erty Se ' s Inc.guarantees all work performed for a period of one year. If any problems occur we will cover the cost of
come e problem and meet the customer's satisfaction.
,
outso c[Manager Cyndy selmo
Alpine Property rviccs Company Inc., East Coast Properties m
d/b/a 01 y ' by(Name)
.CERTIFICATE OF LIABILITY INSURANCEv.
>RooucER (617)471-1220 FAX: (617)479-5147 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
a..I;ty Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON' THE .CERTIFICATE
HOLDER. THIS CERTIFICATE DOES 'NOT AMEND, EXTEND OR
500 Victory Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
`farina Bay -
orth Quincy MA 02171 INSURERS AFFORDING COVERAGE NAIC 0
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m$URM - INSUMAc F:Lrst Mercury Insurance' Co.
Alpine Property Services Co., Inc. , DMA: INSURER e:Safety Easuranee _ -
11 Nilson Street INSURER C:Atlantic Charter Ins. Group
INSURER Great-Americas - . ... _. _.
Salem I MA 01970 INSURER E: .
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOIU`1TEU.NOTWTRST/140ING
ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _
�'RT •- •. POLICY NYMBTR P FFFEC:TRIE POLICY FYPIRATION
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$MOULDANYOFTHEABOVEOES.CMI POUCM38GtPN6ELIEDB6CP.ETNEEXFWATION
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IMPOSE NO OBUGATN)N OR UF8IUTy/0F ANY"D UPdN THE IMM14DL nS AGENTS OR'
REPRE58NTATWES.
AUTHORI7EDREPRESENTATNE N
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ACORD 25(2009101) O 1988.200 ACORD CORPORATION.'All:fight$reserved.
INS025(20osoT) The ACORD name and 1090 am 1`091stered marks of ACORD ,
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CERTIFICATE OF LIABFINSURERS
INSURANCE 0T10512009
PROD TIER pmnw(61T1651-5110 FaC 161T)65T•5112 THIS CERTIFICATE IS ISSUED AS A NATTER OF INFORMATION - - -
KNIGHT INTERNATIONAL INSURANCE GROUP ONLY AND CONFERS NO RIOHIS UPON THE CERTIFICATE _
500 VICTORY ROAD HOLDER. THIS CERTIFICATE DOES P107-AMETLD, EXTEND OR
MARINA BAY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
RUINCY MA 02171
AFFORDING COVERAGE - NAIC 0
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11 WILSON STREE! R.SALEM MA 01970 Et
COVERAGES
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IMy PERTNN,THE MGURYWCE AFFCRCED BY THE POLICIES DESCRIBED NEREW ERMS IS SUBJECT TO ALLTHE T ,EXCUIGIONS AND COMMONS OF SUCH
POLICIES.AGGREGATE UNITS GROWN MAT HAYS BEEN REDUCED BY PAID CWMS,
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DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
_ CERTIFICATE HOLDER CANCELLATION
GROULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED REFORETHE
ERPWkMN CATE THEREOF,THE ISSUING INSURER LIILLERDEAVpRTO MAYto BAYS
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AUTHORID:O REPP,ESENTATNE
Attention: H2rold JLXtJgh
ACORD25(200%8) Cart7Dcata0 8149 0 ACORD CORPORATION 1.988
- ytartI lent of Public Safer1 _. ... . ..-
Bo:u•tl of Building Reguf Itions ;tnd St tndartls -. '--
Construction Supervisor Specialty License
-License or registration valid for-individul use only License: CS SL 101003 -" - --
-" I liefore-the-expiration date. If found return to:
Restricted to: Rp yyS iBoard of Building Regulations and Standards
STgVROS I One Ashburton Place Rm 1301
LAS
11 WILSON STREET iBoston
SALEM, MA 01970 � '
— ---� Expiration: 1204/Mil Not without signature
('„nunismner .
Tr$: 10,003,
AM u> mg egul ionsa�tan ar s
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Nntractor Registration
Registration: 154326
- Type: Private Corporation
- Expiration: Z/27/2011 Tr# 279846
ALPINE PROPERTY SERVICES."(�O
STARROS MOUTSOULAS
11 WILSON STREET
SALEM, MA 01970
Update Address and return card.Mark reason for change.
Address Renewal I] Employment ❑ Lost Card
nPS-CA1 0 SOM-07107-PCMB0
T1. �rwa . �a/
Board of Building Regulau ns and Standards License or registration valid for individul use only
UJHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registration 154326 One Ashburton Place Run 1301 .
Expiration -2/27/2011 Trk 279846 Bosto
Type:_:Private Corporation
ALPINE PROPE,_ 00,INC.
STARROS MOl11y-SQOLd$ __
tr
11 WILSON STREET t: � "�•'°"^- Not va id without signature
SALEM,MA 01970 -- Administrator