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17 MOONEY RD - BUILDING INSPECTION (2) / I The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7 h edition R Ois SALEM M nua Viz evised Ja ry Building Permit Application To Construct, Repair,Renovate Or Demolish a 1, 2008 One-or Two-Family Dwelling This Section Use-Onlyr Att� Buildiii Petmu Numberi' � m" � - Date A liedi "' Signatreu . . ; wi.'4;//S rl✓._"i - Buddin Co missioner/ n e orofBuildm s =u ;Date , .i r, " >a., s ' SECTION 1:SITE INFORMATION. 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1, Mare M a SO IP M . MR l.l a Is this analcepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard y� Required Provided Required Provided Required Provided I 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'':.., 2.1 Owne of Record: <� TacarJ� FSsI,� IZ O-T.NP.n `P A ,4 m Nae(Pri — Address for Servib : CY27 z36; Sig re Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that- apply)" w* , New Construction❑ Existing Building❑ Owner-Occupied x Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of ProposedWork2: r U c ! 521���' P C� ;- 'SECTION4: ESTIMATED CONSTRUCTION COSTS 7r Estimated Costs: c "" Item *aL Official y(Labor and and Materials -�.�.....•., _ Use Onl 1.Building $ 1 Building Permit Fee $r Indicate how fee is determined ❑Standard City/Town Application Fee m 'a 2.Electrical $ ❑Total,Project Cost (Item 6)z multiplier _ 3. Plumbing $ 2 Other Fees $'M y� 4.Mechanical (HVAC) $ list.: 5.Mechanical (Fire $ Total All Fees $Suppression) Check.No. t Check Amount. Amount 6.Total Project Cost: $ �t�b� ppaidinFullr 'u '`❑OutstaridingBalanceDue: " -�-- SECTION 5:"CONSTRUCTION SERVICES '' 5.1 Licensed Construction Supervisor(CSL) 1, Can License Number Expiration Date Name of CSL-Holder �H List CSL Type(see below) Pd >< b �3QVe6_ MR p� m:-.Type Description �, a U Unrestricted(up to 35,000 Cu Ft �, ill 60.wv• — R Restricted 1&2 Family Dwelling Signature p M Masonry Only q1 g q2� UA�� RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Register_ ed o e1S �I@ip�gventent Contractor(HIC) boy .3-S Z HIC ompany Name r Hl Registr t Name Registration Number Mx 4q�� ^evet-V,4 . mA �/%3/-4 "b s'A dr s _ nU�TT t �15 971 ON-) &Q Expiration ation Date Signaa�re Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE'AFFIDAVIT(M.G.L. c 152.§25C(6)) G, 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 APPLIESFOR BUILDING PERMIT as Owner of the subject property hereby authorize �id1A.�f0. b 1: to act on my behalf,in all matters relative to work authorized by this building permit application. Sin re of Owner Date � f" SECTION 7bi OWNER`OR AUTHORIZED AGENT DECLARATION .m _;.' r_c 1, 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 N �wM- ntAL �/1� )^ ^ \ Signature or Authorized gent Da e W " (Signed under the pains and penalties of perjury) 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 110.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"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts Department oflndustrialAccidents office ofinuestigations g 600 Washington Street, 7a' Floor ace Boston,Mass. 02111 Workers' Compensation Insurance Affidavit: BuildinVPlumbing/Electrical Contractors [Al p�tcant/�inform�on•r}}��...- �: � .>!m r+, s� � �PloasePR�Tleelbly OR MT name: \N nn VdNi,% 1)lC_ LAIA'') \� 1 address P /�PO OX l�h �t (� p city & n,4Q- y� state nm'a zioM©�1'1 V J phone# �� '1�� C�•1�� work site location(full addressY �❑ �10�-m loll We M ( I°to V ❑ I am a homeowner performing all work mys f. Project Type: ❑New Construction ❑Remodel ❑ I am a sole proprietor and have no one working in any capaci ❑Building Addition g,I am an employer providing workers compensation for my employees working on this job r< NEs-M _xv e"A"'"I�v 'mxn c "u ae "rtu? t r _em [,^r m...enm nee*:rsav[vrxs.m r�...„�xrar aswaern yeu. a u!€..£ asn = .. -'i1 ,?!v^ u1 va�a r wr` '9Na zT Ez �a%se ink@rt�Y )r:' x `k` r2 company name r < y,v x "' ' c-- .. '�@ ` aL -m {wx tihi maC Hs. 9an+Thu.-2a h.f 4ry A »p! d x .3k. ns t zs IN+qtr k`s �: a : :� -3� ��`a'HstwO s n a7 ar uF;' "fl5C'Elargkt�,r��� address 57d- . 'm �2 5 r, 5 .. `* `"T , �. Lama es Ns:S i to ,m ,n e s._ _.y¢"' ,r vm ."i,�a tpl ' +� i i�4c s: it 'sn ss�®-Ne : skmnsv vm�w� , , s v`� a a-i,� .m:. ��ss t�s, tt��fj� r v^ sun eitV ; Qltec .a €' v u «r 't�;sG'f2fC.F,-DhOne# �' A'r"I as C)`I amti. act3sa'�_E '`f9 »,n,,x s r inn. fin. sn=.a e ^s' a,+. 8 s c-f1 s m t ry rc'` F :, i rm s sa ,ti aArm+e 4wr €'h7 :1' -9 �tSa,� """" S Q 'i insurance co. `:= It `:J }' `'`�=�xa�"G� µs olic#» ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers compensation polices ink awa mac it s d -,e I a av x rumEi: i ' ' ai se six._ aF: syin :1as c mr. n ss m r'm, s- 5,` i€a ea av a m. g x s P a rp.A' A.+ay49 ,coin an name.__=,...® E . . ,_ r,^.ur a :,�..,._-,.: _ ......di�._sc M a"_"' t TV, 'n:a arAa, A�'t' eme �e Trite usans -a. sn,:4x. ssr Av 39fv tix. is-e:'a w e ins " ' , rrw.. ®. gym v§L,r�k E .�i' iL Mw„{„. 0 a mF: U �-, .'' a= la^ L vt E +vux m' `7sSm Sin nsr rorv�n�;..5� a 3 r s -` am 'r r eddres9l ._su-P�anav+.fax rr_f m.:-�p',.m sir �A,3A;_.mH..aun a:.-s,r,, sms^m.=,,, ......,.....p.._..... _.. _E.:_ an 4. st �s r. .�,ima< ' - wl h--°Gush. w '° ' vVAs:iat vwa)<!. . 'fir" .� as L, A.. to m^v tae a-tis x i 3 a r fL: s..:nSLm-Oc gym" s i'4'iitm ia- e ',> )5at� ha -'fi, .)i " 7 �5re. - xe 'krso imty "�s. .r' f.w..F.z= as<,x xv'x7Am ' -sue " .`wL�9f"idAs a3 "sf.: "uVohone# Tr a uws a ux 6 zv"ccA xr .nsk?x, '� . tot. iv„ts-k. mas&.a,r: g r= :,& --o `s N, k 4 u_ s: -,r A 7 6{��i, m ur s%,m'Ai r Ss' .C+7,mu m -.n @ # m L. h?m s .7,.a ns a:'" !' a_* s"r _A sI £ .mr .a-'�sf" ..Pan yr Silt� sv'v}A 4„A M'�p"aAa90?' ice'3 ' AS s?Wh_ms c- mr5 insurance co oohcv# ' a aAays i . : nnrcaut m,.a.LxiSmcf mr.fie n.ra,i Ya c '� f,FE,ai 'f, 4m ,c: ^a s m :�i ,s: ,hi dsmF ,sn x.� s 2,01 1u.rafi :m hse remss. es ,� sum I},a ss r.ms s .- u,r, :,a a. . F s^"$q. " m'xkum,En a"4u ns;i;.,t. i 1 ia" n�-m W76i ih' .u4hi '#�s -'n's�'ea;�OMA com an name a r MM s: r.}ssa -- ns sr , r- of : sum �r as x R P r s m' - s s wLs+A`uA. Us M m aaeu x s evEstimms ta'ia E'ti'fl���a�n r' t� �.M '� +a. .asm;ea ite.w e min ,u ns .a R, a'_a rar m w s ue .z AMI€m`6res" EF PCt honed.dC.� amh�w"maa ae:ainr. r StEf?-_:;isNi r , in.ksm raen'.ePAeE'c.L1o5.*:7..`R i-...u._ m'� "FEm3FP: 4r lA #A re ' m m�m t xA. S 'vr.* rautt�in+*" -.a t Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify,under the paiins/land pe�naltiels of-perjury that the information provided above is true and correct. [ Signature .LJ K-� !V't V ACC\ Date Print name G l @.nip ('�ot11� LAo Phone# Cr)g (n7) IEl fficial use only do not write in this area to be completed by city or town official ity or town: permit/license# ❑Building Department ❑Licensing Board check if immediate response is required ❑Selectmen's Office ❑Health Department ontact person: phone 0; ❑Other evised Sept 2003) CITY OF S.U.FAI, TN'LNSSACHUSETTS BUU-DLNG DEPART%IENT M• 120 WASHLNGTON STREET, 3" FLOOR -0� TEL. (978) 745-9595 FA.e(978) 740-9846 KINfBFRi FY DRISCOLL MAYOR THonu �s ST.PRRe DIRECTOR OF PLBLIC PROPERTY/BUMDLNG CO\L\IISSIONER 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 l 11, S 150A. The debris will be transported by: Grv.�t.+� �nlvStp� (name of hauler) The debris will be disposed of in : k�n (name of facifity) `7\ �O,cJ 1}S-t &rGGk�d n (address of facility) signature of permit applicant date JcbrisafT.Jtx MAY-17-2010 02:52P FROM: TO: 19789219202 P.2 ACORD CERTIFICATE OF LIABILITY INSURANCE OAT/172010 os (M /DD010 PRODUCER (978) 922-6600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sterling Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 306 Cabot Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 493 Beverly, MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A SOOttE Cla16 Insurance Glenn Battistelli LLC INSURER O: 11 Broadway INSURER C. INSURER D' 136ver1 MA 01915- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILT R ADO'L Type OF INSURANCE POLICY NUMBER PDATEE(MIUFDO%W E PDATE EXPIRATION LIMITS A GENERAL LIABILITY CPS1172209 02/26/2010 02/26/2011 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PAREMISES Ea oa 110) S 50,000 CLAIMS MADE a OCCUR MED EXP one pemon S 5,000 PERSONAL a ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY F128y LOO I I I I AUTOMOBILE LIABILITY COMBINED SINGLE LIMB S ANY AUTO (Es accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Pemoa) S HIRED AUTOS BODILY INJURY (Pet axidem) S NON-OWNED AUTOS PROPERTY DAMAGE y (Per e=idenl) GARAGE UABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA AGO $ AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S 3 DEDUCTIBLE S RETENTION S T S WORKERS COMPENSATION AND / 5 ER EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNEMEXECUTIVE E.L.EACHACCIDENT S OFFICERMIEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S If yes,desnibe under SPECIAL PROVISIONS helwv E.L.DISEASE-POLICY LIMIT 3 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (978) 921-9202 FAX ( ) — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INBURER WALL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SHALL IMPOSE NO OBUQATION OR LLA131UTY OF ANY KIND UPON THE Mrs. Ercha INSURER ITS AGENTS OR REPRESENTATIVES. 17 Mooney Rd. AUTHORIZED REPRESENTATIVE Salem MA 01970- ACORD 28(2001108) 10 A ORD CORPORATION 1988 �,,;INS026(moa).o5 ELECTRONIC LASER FORMS,INC.-(800)327.05e5 Page I of 2 GLENN BATTISTELLI: PAINTING-ROOFING-SIDING-CARPENTRY-VINYL REPLACEMENT WINDOWS - KITCHENS-BATHROOMS-PORCHES-DORMERS-ADDITIONS ' P.O. BOX 496 BEVERLY;:MASSACHUSETTS 01915, (978):922-6338 (978)777-4499 DIRECT LINE (978)927-8956 FAX(978)921-9202 CELL(617)962-1235 ESTABGSHED 1974 GLENN BATTISTELLI CO., hereby agrees to perform the following services for: Home Phone: Business Phone qL� Sealer applied to all vent pipes and chimneys.All Flashing will be inspected. / Roofing Nails will be Z./ y inches. Grounds will be cleaned of all roofing materials. All workmen are covered with Public Liability and Workmen's Compensation. All',work willbe continuous and will be performed in a;Workman,like manner. Chalk lines will be used to line-up the shingles Roofing Shingles are self Sealing. While installing the new roof, we'wilYprotect your home antl plantings from debris: Roofing Shingles to be delive'red Install new fiberglass:paper to.roof boards when stripping of shingles is required: All shingles will be secured With four nails. State and local building codes, along With manufacturers specifications will be adhered to at all times. Color of Roof to be All work is riced as specific. The possible occurrence of rotted roof boards or poorflash ing w Will arrant an additional cost of � i ih. The homeowner is responsible for covering their articles within the attic. Work is to be commenced on Payment is to be delivered Apply inch aluminum drip edge to the following areas: Year Workmanship Guarantee. Year Material.Guarantee f/Q Roofing shingles to be —r�'7 /QA P 7 z 'e'/ r __Y7 Qc4 i,{ariZA c Agr �d by Homeowner Kgreed by Contractor Ref. Page Date 3 Day Cancellation Notice Required a!+ax'l� �r �..r ,� ors, t -•`.;:ta"st'ir. � ,a' r 3;, s� ,+,�. Wes, v 'y, •�,a f? � 'W� r''=`�fr" t"�" a + '?P � �lu+" iv.'trtarta�esx�ls/i 4f✓ udek$�, z 'Board of Building Regulations and Standards A. _ ,Construction Supervisor Licensea - e.. License: CS 2123. Expiration `51242010 - �' �. "Restriction; 00 - GLENN R BATTISTELLI ., i o. 4 4 1,1 BROADWAY R/PO 66X496 z BEVERLY MA01915 .R... Commissioner - , p� �e l00'YiUtlNd/GOP�� o�.�i!ae:uac�ueall4 �\ Board of Building Regulations and Standards License or registration valid for indlvldul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 11 Board of Building Regulations and Standards Registration: 104352 One Ashburton Place Rot 1301 Expiration: -7/.13/2010 Tr# 270077 Boston,Mo.02108 j9pe DBA- GLENN BATTISTELU CONSTRUCTION Glenn Battistelli 11 BROAD WAY REAR /P,:O:'BOX � -- rNerly, MA 01915 Administrator Not valid without signature Unofficial Property Record Card Page 1 of 1 Unofficial Property Record Card - Salem, MA General Property Data Parcel ID 14-0004-0 Account Number Prior Parcel ID 42-- Property Owner NOT AVAILABLE Property Location 17 MOONEY ROAD Property Use One Family Mailing Address Most Recent Sale Date 1/4/2007 Legal Reference 26450-349 City Grantor ERCHA ANN, Mailing State Zip Sale Price 0 ParcelZoning R1 Land Area 0.258 acres Current Property Assessment Xtra Features Card 1 Value Building Value 184,600 Value 0 Land Value 145,700 Total Value 330,300 Building Description Building Style SPLIT ENTRY Foundation Type Concrete Flooring Type Hardwood #of Living Units 1 Frame Type Wood Basement Floor Carpet Year Built 1973 Roof Structure Gable Heating Type Elec Base/B Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Electric Building Condition Avg-Good Siding Vinyl Air Conditioning 0% Finished Area(SF)1914 Interior Walls Drywall #of Bsmt Garages 1 Number Rooms 5 #of Bedrooms 2 #of Full Baths 1 #of 314 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 0.258 acres of land mainly classified as One Family with a(n)SPLIT ENTRY style building,built about 1973,having Vinyl exterior and Asphalt Shgl roof cover,with 1 unit(s),5 room(s),2 bedroom(s),1 bath(s),0 half bath(s). Property Images MIREa,. o.� w E Disclaimer:This information is believed to be correct but is subject to change and is not warranteed. http://salem.patriotproperties.con/RecordCard.asp 5/18/2010