42 MARCH ST - BUILDING INSPECTION (2) Zi) Otr
�\ The Commonwealth of Massachusetts CITY OF
4 _ Board of Building Regulations and Standards
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 Offi ' , se Only
Building Permit Number D Applied:
J/ / /
L16,
2 7J
SECTION 1: SITE INFORMATION v ='
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
42 F1A(LC�1 %- �
l.la Is this an accepted street?yes/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R2
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 El' Private❑ Check if yes❑ Municipal fd' On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 Owner of Record:
) w TiQ�Ck% OA4Ifw Trz 5 - SA�e rr� � o 0; o
Name(Print) City, State,ZIP
`{2 ''NIA(LC , �- g18.)yo - o4go q�;�FerSKin con c�sl .� f
No.and Street Q .q6 [)Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply)
New Construction ❑ Existing Building Owner-Occupied Repairs(s) k Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:
e A� o rl 00(L + Framc wor
J
SECTION 4: ESTIMATED CONSTRUCTION COSTS[
Item Estimated Costs: Official Use Only
Labor and Materials m
1. Building $ 1 ,Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $
❑ Standard City/Town Application Fee s❑Total Project Cost3, (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List%
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ goo O l 0 Paid in Full 0 Outstanding Balance Due:
,< CITY OF SA -Y--N1, iNDSSACHUSETTS
• BUI LDLNG DEPARTMENT
• P 130 W/ASHINGTON STREET, 3" FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KINIBFRt 'y DRISCOLL
MAYORTHObLRS ST.PtERRH
DIRECTOR OF PUBLIC PROPERTY/BUILDING CON5IISSIONER
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 111.5
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
111, S 150A.
The debris will be transported by:
�AkVi n DZ-5t511
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
<5
signature of permit applicant
date
dcbriwlr.d[x
CITY OF S UX.N1
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICLNS6 EXEMMON
:I
Please Frtnt 'I
Dam
Job Location 2 1tA2CU SAICKA
Home Owner Address
Home Owner Telephone 91t1f. r1q(2 - o e)
Present Mailing Address ,'
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allows such homeowners to engage an individual for
hire who.don not possess a license ,provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Persons) who owns a parcel of land on which he/she resides or intends to resides,on
which there is, or is intended to bs6 a one or two family dweilinl, attached or detached.
structures accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
stomeowner'sW submit to the Building Official,on a form acceptable to the Building
Official. that he/she be responsible for all such work performed under the Building
Permit.
The undersigned homeowner'assumes responsibility for compliance with the State
Building Code and other applicable by-laws and reguladonL
The undersigned "homeowner'certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and r uirements and that he/she
will comply with said procedures and requirements. 1
HOMEOWNERS SIGNATURE 5
APPROVAL OF 9UILDING NSPECTOR
See other side for state code
t
e
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
AC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No. and Street Email address
City/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 of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMALETED 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: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application accurate esto 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.eov/oca Information on the Construction Supervisor License can be found at www.mass. ov/dps
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"
I
Installation
ri Gallery by NSWS Quote
3ouih Main Street 978-762-0007
~Middleton, MA 01949 866-809-3136
CUSTOMER Sue and Rick Hallam REVISION DATE 02/25/12 Quote expires in 30 days
ADDRESS 42 March St. PROJECT NAME
CITY,STATE,ZIP Salem, Ma ADDRESS
DAY TIME TEL 978-578-4660 978-740-0440 h) CITY,STATE,ZIP
SALESPERSON Bob Desrosiers DAY TIME TEL email:
REV 03/10
LABEL QUANTITY DESCRIPTION PRICE TOTAL
1 1 Larson Storm-36 x 80 Hunter Green Full Lite Panel 1,761.70 1,761.70
Jeld Wyn-36 x 80
Full Tearout(Interior/exterior door)Pre-hung. 495.00
Full Tear out( Storm Door)-Full frame replacement 395.00
Miscellaneous Materials : caulk, insulation,fasteners
Interior and exterior trim-(Both Doors)=Azek exterior. $23 .00
1 Building Permit Fee
NOTE: Customer has assumed responsibility for Building Permit
1 Installation Flat Labor Charge 890.00 890.00
1 Miscellaneous Materials 125.00 125.00
1 Rubbish Removal Fee 76.00 76.00
All installations will be left broom clean at the end of the day.All painting is by others.Marvin Showcase warrantees the installation
labor only.All materials are covered under the Manufacturers warranty.Any rot found or extra work not specifically mentioned in this
work order will be billed at an hourly rate plus the cost of materials. Marvin Showcase will not be held responsible for the fit of existing
window treatments to the installed replacement windows. Interior trim included is BROSCO#8710,any change will be an additional
cost.Customer will supply electrical power and water when necessary.Customer will prepare the work area by removing all
furnishings and provide easy access to area.Massachusetts Home Improvement Contractor Registration#
TERMS DEPOSIT OF $1,055.19 REQUIRED PRIOR TO PLACING ORDER SUB TOTAL 2,852.70
$1,055.18 DUE WHEN MATERIALS TO BE INSTALLED ARE DELIVERED. DELV CHARGE 25.00
$890.00 FINAL BALANCE DUE ON THE LAST DAY OF INSTALLATION. 6.25% MA TAX 122.67
MAKE ALL CHECKS PAYABLE to Marvin Design Gallery By NSWS TOTALL__$3,000.37JI
CUSTOMER HAS RIGHT TO CANCEL ORDER WITHIN 3 DAYS FROM DATE AT TOP
ORDER ACCEPTED
AS WRITTEN X
NO RETURNS ARE ALLOWED ON WINDOWS,DOORS,AND SPECIAL ORDER MILLWORK.
IF YOU HAVE ANY QUESTIONS REGARDING YOUR INSTALLATION
PLEASE CALL BARRY GOVE AT 978.922-0921