194 MARLBOROUGH ROAD B-13-828 The Coin nionweaIth of Nfassachusetts ary Board of Building Regulations and Standards SALE NI
OF
QQ Building Code 730 C�IR 5 \L
�77 Revised Mar 201
Massachusetts State Bu g
Building Permit Application To Construct, Repair * e Or Dem a
One-or Two-Family D} ling
This Section:For f icial Use 0
Building Permit Number: Date Appli
wilding OfFicial(Print Natrit) -. tg lure �. . Date
SECTION I:Sl I ORNIATION
1.1 Pr etty Add s . �L .2 Assessors Map & Parcel Numbers
1.1 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 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.O.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 es❑
SECTION 2PROPERTY'OWNE IP
2.1yo rd\/R ), V \4 1 Oro r ,,- n
Name(Print) City,State,ZIP
No.and�Street Tea Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW((:back all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTINLaTED CONSTRUCTION COSTS-
Estimated Costs:
Item Official Use Only,
Labor and Materials
I. Building ; I. Building Permit Fee.- S Indicate how fee is determined:
Standard.City/Town Application Fee-
2. faactrical S ❑'Total Project Cost'(Item 6)x multiplier x
J. Plumbing S 2- Other Fees: $
i. Mechanical (fIV:\C) S List:
5. Mechanical (Fire S Total :\Il Fces: .S
5n > >resion) _
Check No. _Check Amount: Cash Amount:
r, Total Project Cost; S 0 Paid in Full ❑Outstanding llulnrtce 1)1ia:
SECTION 5: CONs-rRuc-rION SERVICES
5.1 Construction S ervisur License L) Q G l
License Number Expiration
Name of Cb I lulWdcr List CSL'rype(we below)
—�✓ - Description
No. and Street
D Unrestricted Duildin s up to 35,000 cu. ft.)
�/✓//7 Restricted 1&2 FamilyDwelling
City/" "f o`vn,State, ZIP �[ \-fasonr
RC Roofing Covering
WS Window and Siding
SF Solid Fuel [turning Appliances
O Insulation
l'ele hone Email address D Demolition
5.2 Registered Home Im ro agent Contractor(HIC) // 6 SKI C-1V Al
—
FIIC Registration Number E.epiratlon ate
t IIC Cum Nant r Ill ' egistrant Name
Nod "® /� '� ` (' �K—v IL Email address
. n
City/Town, State, ZIP L— 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 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: OWNEW 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 Autlwrited:\;cnt's Name(Electronic Signature) Date
NOTES:
7",
r who obtains a building permit to do his/her uwn work,or an owner who hires an unregistered contractor
ered in the Home Improvement Contractor(HIC) Program), will nor have access to the arbitration
r guaranty fird under NI.G.L. c. 142A. Other important inform;Lion on the HIC Program can be found at
s.�arv;'0ca Information on theConstruction Supervisor License canbe foundat www.m,tss.,nytv_IdIL.itantial work is planned,provide the information below:oaa(sy. R.) _(including garage, finished hasetnent attics,darks or porch)
Grosi living area('sq. ft.) —_ habitable room count
Number of tit epLiCes._--_.----— Number of bedrooms
Number of bathrooms `'umber oFhalCbatlis --_.---__-
f'cpe of he.uing sy,tCn . -- . _-- `umber of decks"pore te.i
F)lie of Cooling iyucm Enclosed __. _ � tpCit
t. I"ol it hojeet Sgmtla Foot i umv he siib;titu[.J t,r"1'"0 I'ioltd lost',
CLTY OF S:U.E:,I, A--1SSACHL"SETTS
13L'R.DING DEPAIMLENT
120 W."HIINGTON STREET, 3iO FLOOR
TEL (978) 745-9595
`- EL'c(978) 140-9844
M.NfBERLEY DRISCOLL
�{AYOR THOstAS ST.PtE.aRli
DIRELTOROF Pt:ULIC PROPERTY/Ut:ILDING COSL%IISSIONER
Workers' CmnpensatIon Insurance AMdavit: Builders/Contractors/Electricians/Plumbers
1 i tllcant Information Please Print Legibly
�1;It11C IUminv+aOryniraiorvin�ividual): •
Address: // J
City/State/Zip: a/6-4 y(J.a Phone#: /
Are you in employer?Ch the appropriate box: Type of project(required):
1.0 lam a employer with 4• 0 I am a general contractor and 1 6. Nov,construction
employees(full and/or part-time).• have hired the suGcontractors
2.0 lam a safe proprietor or partner• listed on the attached sheet t 7. ❑Remodeling
Chip and have no employees These sub-contractors have V. ❑Demolition
working for me In any capacity. workers'camp.Insurance. 9. 0 Building addition
(No workers'comp,insurance 5. 0 We are a corporation and its
required.) of icers have exercised their 10.❑Electrical repairs or additions
J.❑ 11
I airs a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.(\oworkers'cump. c. 152,01(4),and we have no 12.[ Roofrepsira
insurance required.) r employees.(No workers'
camp.insurance required,) 13.QGther.
Any appllcam that eh.ha box t l mtut aiso oil out the A'etiaa below showing that#wmken'mmpenaadun pulley inlbrmallon
'I I,vnvuwm"who,uhnnit this adl,twis indleming they an doing all want and then him twoideeontneton must submit a navr amdavil indimting such.
:C onuxwn that chtvit this box meal auaehod an additional short thawing the name orthe nlretintixWn and theft workitm,comp policy Infwmadon.
/urn un eurp/uyer rhuNs provldln,�tvorkns'rompeuadan Guarunn jar my employees; Below is the pollry and Job site
iujorinutloa
Insurance Company Name:
Yulicy A ur Self-its.Lic. N: v Expiration Date:
Job Silts AJJress: T� 0 _City/Slate/Zip:
\inset a copy of workers'compensation Bailey declaration page(:towing thapoflcy number and expiration to).
Failuru to sccuru coverage as required under Section 13Aof,%,(GL a. 152 can lead to the imposition ofcriminal penalties of a
line up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a lina
of up to S'_50.00 a Jay against ilia violatar. Ile advised that a copy of this statement may bo forwarded to the Ohica oe
Invcstigmims ui the DIA for insurance coveralls verification.
/du/rdreby verrljy truddr the pains uud penuhles u/per ur t/I the hrjwnmr/on provide eve ix true wtd cornett
�i �—
�icnantre' Dot
Phone,*
O/Jiciu/rue mdy. Dn nor write in 1/1/9 urea, ei be ruarp/rted by city of town n/JUal71illpector
City of'I'uwn: P'rmit/LlccnseIssuingAullmrily (circlo one):
I. Uuard of IIeAh 1. Iuilding UCpallntLit, .I.Cityffown Clerk -1. L•'teetrfcol Infpectur
! b. Other
Contact Perim): Phone'!:
I
/4J Yr'
CITY OF S:1Iam2 NL1SSACHUSE"ITS
BUILDLVGDEP.%RTJLENT
1 '0 \q-"HLYGTON STREET 3AO FLOOR
T EL (978) 745-9593
F.%.x(978) 740-9345
;<!J[DE1tf.EY DItISCOLL
NL-%YO,'l Dlou"ST.PiEAHS
DIRECTOR OF PUBUC PROP ERTY/BCtLDLYG CCILMISSIONER
Construction Debris Disposal Affldavit
(required for all demolition and renovation work)
fn accordance with the sixth edition Mile State Building Code, 730 CbiR section I 1 L5
Debris, and the provisions of tbfGL 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��fGL c
111, S 150A.
The debris will be transported by:
(name uniautur)
The
debris %vill be disposed or
oof in
� (j
(name ut•tacility)
(address of facility)
signature uipermit applicant
d.uc
i
W..
6�rh5 �I'D�Ogd� Y'FC %f *WY F..
TR A.C. CASTLE CONSTRUCTION CO. INC.
MEMBEti Telephone (800) 505-LEAK(5325) • Fax (978) 777-7790
se 'Brian LeBlanc, President a
Please mail accepted proposal to the office located at: s'
9 Tibbetts Avenue • Danvers, MA 01923 ;
a Unrestricted Mass Builders License N . 054882 Contractors Registration No. 166565WX, A. v
r PROPOSAL ITT�,QT
v fJ a�e PHON �j DATE
x STREET
` /y JOB N E -
e CITY, STATE AN PC E w .4,R1r ��'yr ,
a ` �� JOB LULA I IUN40
ARCHITECT DATE OF PLANS _ C? ✓ 'vr� *".�N "��
JOB PHONE
r TO 5C her o turn is material an labor- r�L'��.e±,y�R+ %rt{ / / I/- mplete in accordance with specifications below for the sum of: i
Payment to a as follows:
l/
dollars is t
s,k NOTICE: rrol
All home improvement contractors and subcontractors engaged in home
improvement contracting unless specifically exempt from registration by
s, t
Authorized ' •z provisions of Chapter 142A of the General Law must be registered with Signature:
vk the Commonwealth of Massachusetts. Inquiries about registration and _ 4F
,:. status should be made to the Director, Home Improvement Contract Note:This proposal may be
Registration,One Ashburton Place,Room 1301,Boston,MA 02108. nt
withdrawn by us if not accepted withindays,
5d t days ' -
"`� WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: # R
A ROOF STRIP
J �..
We will cover the siding,bushes, and grasses with Blue Tarps in order to protect the property during stripping.
We 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 4 �-
a«, 9 PPin9�installed at the bottom of all edges, under all step(lashings, under all roll flashing,around all chimneys, skylights,and into all valleys.
We will install 15 pound underlayment onto all other areas of the roofdeck.The 8"aluminum dripedge will then be installed to all roof edges.
Any existing pipes will be covered with new
w mix
The roofing material to be used will be !f3^rubber fl
u
All the debris will be cleaned and dumped by us on a daily basis. Magnetic[brooms will be s d to extract a.l n i om ourproperty.—, P
v t
We wsifl protect your property as best we can, however some foilage matting, breakage, or marring could occur. e cannot accept , ,
Y
responsibility for possessions inside of the house,or debris falling into attic areas. Customer should protect personal belongings. A # `
EXTRA WORK IN WHICH A COST WILL BE AD EDT
Replace Rotted Roofb rds v o / THE ABOVE PRICE. q
e9',utr fw A.
Install Aluminum G Relead Chimney(s) C utters
Install Aluminum Downspouts ' w"
Replace Facia Boards
Install Ridgevent Install Skylight(s)
W
Rotted Roof To all Flashings � ��
Install Roof Louvers
NOTE Gutter Repairspq
07
)-. F
S: - �t4
1
Warran anufacturer/�tto a free of defects for v` r All lab' dormed under R1is ontract shall be of good quality and free from defects not inherent in the quality required or permitted for
a see manufacturer's warranty for exact warrant § < �
a p tbd of� yearODTh' warranty excludes remedy for damage or defect caused by abuse, modification, improper oannsufficient
nance, N gAy M
A.
Castle C improper op .tins, or normal wear and tear under normal usage. This warran shall be limited to the work Performed b
A. Castle Constructi o., Inc. and limited to either repair or replacement by A.C. Castle Construction limited
Inc. at its'sole discretion
and n d all claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the
occurrence of the event giving rise to such claim. This warranty shall not extend beyond any limits imposed by applicable law. �� }�
Payment a the contract Price Any nd Penalties- Upon substantial completion of all work under this contract, customer shall within 3 days make final and full u fi ti.
shall accrue
ree to
payment
costsfand collection expensesansurred by A.Call unpaidlCastleances Construction with
interIn est
the interest
of Per
ry month. You amount you owe under thipay s
contract, including 5 without limitation reasonable attorneys feeC.
s. Please note:any illegal layers of roofing beyond a second layer will be
an extra cost 35 cents per square fool. #xF
Arbitration -Any controversy or claim arising out of or related to this contract, or the breach thereof, shall be settled by arbitration with a h��
the American Arbitration Association or a mutually agreed upon third-party. Any judgment upon an award entered in arbRration may be l a
entered u any court having jurisdiction thereof. This section shall not apply to claims of A.C. Castle Construction Co., Inc. for collection
of past due accounts owed by the customer. y d
,qttCptante of proposal -Signing this proposal means you have accepted all the ter as stated.
Date of Acceptance
Signatur � � *�•� � a i
y�.