50 LOVETT ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only -
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
111_Prgperfy-A.,ddXe 1.2 Assessors Map&Parcel Numbers
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. w er of R co d: • �t� �� i/inn
\ b i
�lafne(Pr n�ty) (� City,State,Z 2/'� 3,�y� —7-
No.and Street Telephone ' Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building Owner-Occupied epairs(s) Alteration($) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units=== I Other ❑ Specify:
Brief Description of Proposed Work2: / —
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item 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: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $ 4
Suppression) Total All Fees: $
Check No. Check Amount: - Cash Amount:
6.Total Project Cost: $5'7,2Si -❑Paid in Full ❑Outstanding Balance Due:
Bf CXE77�
5. !fi>�rinru� 03SZ7 6
t y
SECTION 5: CONSTRUCTION SERVICES
5. Construction Supervisor License(CSL) off
-e�
` Liiccense Nurnber Ex iration ate
-Nne of CSL Holder /�,/�`/ List CSL Type(see below) - v�
No.and Sgrect Q Type Description
��/) � U Unrestricted(Buildings u to 35,000 cu.ft.
�' M I _LAy/�/ / 39X R Restricted 1&2 FamilyDwelling
City/Town,State,ZICJ///_��jL/l�P M Masonry
C,
✓ Z RC Window
Coin
�-�/ WS Window andd Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address- D Demolition
5.2 e,g'steredHome Impr vemeent Contractor(HIC) /5-6 930
ILA �Y/Ja/ HIC Registration D `�
Number xp' tion Date
!/l�-, p xe=om Namep_�CR tName
N treet "f� Emaill ress C
Ci /Town,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 f 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
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) 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
coM
d in this ap 'cation is true and accurate to the best of my knowledge and understanding.
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/dos
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"
l" •
The Commonwealth of Massachusetts
51\—
�— Department of Industrial Accidents
e = OffueofInvestigations
i --14y = 600 Washington Street
Briton,MA 02111
tjK✓ www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Conkractors/Electricions/Plumbers
Applicant Information p Please Print Legibly
Name(Business/OrganirationMdtvidaat)•
Z t
Address:
, 2l
CitylState/Zi--J F /V Phone#:
Are yo an employer?Checklhe appropriate box: Type of project(required):
1. . 1 am a employer with t! 4. 0 I am a general contractor and I
s have hired the sub-contractors 6. ❑New construction
employees(full and/or pact-time).
2.0 I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
shipand have no employees These subcontractors have g_ 0 Demolition
and have workers'
working forme in any capacity. employees 9. 0 Building addition
comp.insurance comp. insurance.;
required.]
workers' p . .
o m
required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑PI ing repairs or additions
myself(N coat m se o workers' . right of exemption per MGL
y P 12. oofrepairs
insurance required.]t c. 152, §1(4),and we have no
employees.[No workers' 13.0 Other
comp. insurance required.]
-Any applicant that cloaks box#1 must also fill out the,section below showing their workers'wmprnsat on policy infomtatioa
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. -
tContractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have
employees. If the sub�ontracmra have employees,they must proviQe their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. T
Instnance Company Name:
Policy#or Self-ins.Liic.J#�: �r1/ G (1 l Expiration Date:
Job Site Address: lU Ly/V� L1 CitylState/Zip: t Y/ vt
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 of
Investigations of the DIA for insurance coverage verification.
I do hereby ce nder the a an penahi ofperjary that the information provided ove is a and correct
Signature. ? / Date:
Phone#: �✓' �CC� l
Official use only. Do not write in this area,to be completed by city or town okral.
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#:
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
9 ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 156930 Type: Office of Consumer Affairs and Business Regulation
`�fxpiratlon: M012015 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
DAWN MELANSON CONSTRUCTION -
DAWN MELANSON
85 EXETER RD.
SOUTH HAMPTON,NH 03874 Undersecretary - - t14�• ll_ /VT--
Not v id without signature
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction SupenkorSpccialt% 1414.
License: CSSL4)99g91 '�1
DAWN MMEI.ADjSON
85 EXETER ROAL tl lit s
SOUTH HAMpfON Na 03M
i 'war/
i
Expiration
Commissioner 11/20/2015
Restricted
noted To: CSSL_W S-Windows and S.
d.
n8CSSL-RF-Roofing
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Ucensing Information visit: www.Msss,Gov/oPS
DM CONSTRUCTION
85 EXETER RD.
%) SOUTH HAMPTON, NH. 03827
603-394-9944 OFFICE
603-394-8004 FAX ;
11/17/14
ROSEMARY MROZ
50 LOVETT ST.
SALEM,MA.
STRIP&REROOF-HIP STYLE W/DORMER (2 LAYERS)
We hereby propose to famish all labor necessary for the completion of work at THE ABOVE
ADDRESS. Please see attached sheetifor job specifications.
All work performed by us is guaranteed against workmanship for a period of TWO(2)years from job
completion date. Any defects becoming evident during period of guarantee,uopn written notice of the
dwelling owner,shall be promptly repaired at no additional cost.
All material is guaranteed to be as specified,and the above mentioned work to be performed in accordance
with specifications submitted for above work and completed in a professional manner for the sum oL
$5,350.00-STRIP&REROOF
$375.00-GRIND&RELEAD CHIMNEY-NEEDS REPOINTING AT A LATER DATE
EXTRA: $600.00-2ND LAYER SHINGLES STRIPPED
INCLS LABOR,MATERIAL,& DEBRIS REMOVAL
*SEE ATTACHED SHEET FOR JOB SPECIFICATIONS& PRICE BREAKDOWN
Any alteration or deviation from above specifications involving extra costs,will be executed only upon
written request and will become an extra charge to the dwelling owner. Workers Compensation and
Liability Insurance to be supplied by DM ConstrtctiQQn upon request. A deposit of 1/2 the total cost is
required before lob start date. Balance due uponlcompletion
*Please remove all gardening and/or yard decorations from perimeter of dwelling. Please remove
any valuable decorations/hangings from inter' r walls and any valuables in the attic should be
covered or removed. DM Construction is no responsible for any damage to these items during the
work performed.
Respectfully submitted: Dawn Melanson-Owner
Note: This proposal may be withdrawn if not accepted within thirty(30)days. This proposal roust be
signed and dated before any work is uerformed.
ACCEPTANCE OF PROPOSAL
The above prices,specifications,&conditions are satisfactory and are hereby accepted. DM
Construction is authorized to do the work as specified by code. Payment will be made as outlined
above. PLEASE MAKE CHECK PAYABLE TO DAWN MELANSON
tl
Signature Q"� �--- Date
Signature
Date
DM CONSTRUCTION /
85 EXETER RD.
SOUTH HAMPTON,NH. 03827
603-394-9944 OFFICE -
603-394-8004 FAX
11/17/14 �/J
ROSEMARY MROZ //d(((///l/rl
50 LOYETT .
SALEM,MA.
STRIP&REROOF-HIP STYLE W/DORMER (2 LAYERS)
SET UP ROOF STAGING AS NEEDED
PROTECT LANDSCAPE&DWELLING
STRIP&REMOVE ALL ROOF MATERIALS DOWN TO ROOF DECK
REPLACE ROTTED ROOF DECK W/ 1/2"PLYWOOD IF NEEDED-$2.50 PER SQ FT
RENAIL ROOF DECK WHERE NECESSARY
INSTALL 8"DRIP EDGE,INCL FASCIA&RAKES
INSTALL 1ST 6'ICE/WATER SHIELD UP FROM EAVES
INSTALL SYNTHETIC ROOF GUARD ON REMAINING ROOF AREAS
INSTALL STARTER SHINGLES ON EAVES&UP RAKES
INSTALL ARCHITECTURAL SHINGLES
INSTALL RIDGE VENT
INSTALL CAP SHINGLES
REPLACE VENT PIPE FLANGE(S)
INCLS LABOR,MATERIALS,&DEBRIS REMOVAL
TOTA RIP&REROOF
$37 .00-G &RELEAD CHIMNEY-NEEDS REPOINTING AT A LATER DATE
D LAYER SHINGLES STRIPPED
..
— bl