The URL can be used to link to this page

18 NAPLES RD - BUILDING INSPECTION (3) (� V The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY t) Massachusetts State Building Code, 780 CMR, 7ih edition OF SALEM 'w Revised Jurrnury Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 2008 One-or Two-Family Dwelling This Section For Official Use Onl Building Pe it N bar Date Applied: Signature: r 2 •[ dding Cummissi e' for of Buildings Date VSECTION 1:SITE INFORMATION 1.1 Pr arty Address: 1.2 Assessors Map& Parcel Numbers 1.la 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 11) Frontage(d) 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' 2.1 Owner'of Record: C en e LLY Name(Print) Address for Service: Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building Owner-Occupied epairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': P4, 5= SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building S 9 � rna 1. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S 9 a Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: S / r 3�5 13 Paid in Full 0 Outstanding Balance Due: r SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) O 9 L4-7 6-z-, �5 / C/— i O OsD 6 ^i C License Number Expiration Date Name of CSL•I]older List CSL'rype(see below) C1 M A t.J S) P (hrvR� T Description Addm U Unrestricted(up to 35.000 Cu.Ft. R Restricted 1 @2 Family Dwelling Signature M Masonry Only `T� S3� ga3y RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 F{egistered Home Jmprovemeontraetor(HIC) I ©� I L- a J Gt 5 iY gA HIC C mpany Name or HIC Registrant Nam Registration Number 9ygrnGltn� s� ��ap ��go� - 23- i ® Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 2SC(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...........O 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. Signature of Owner Date SECTION 7b: OWNjjEW ORR AUTHORIZED AGENT DECLARATION LO (mot b.AY as Owner o Authorized Agen ereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. �bfLJi Print Names Signature of Owner or(Authorize Ag Date (Signed under the pains and penalties ofperjury) NOTES: I. 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�Uo have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115, 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' f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly r Name(Business/OrganizatiotJlndividual): L Q N 1 bo L �� n i 2 4 1 liv/ l...C p Address: I t{ 9 M At ST City/State/Zip: q 1,D Phone#: 19 8 5 3 1 $ a Are you an employer?Check the appropriate box: Type of project(required): . am a general contractor and I 1.� I am a employer with�_ 4 ❑ I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.Y I required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box k 1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide thew 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. Insurance Company Name: _�_/� _ M MI AL r4 z,3 c o Policy#or Self-ins.Lic.#: 4 to I O 9 7 9 ® j� O O q Expiration Date: 3 ( d Job Site Address:_I A Z.a 62 szf 1?,o City/State/Zip S A ! p n, MA I7 N 0)`I 0 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 certify under theeppaiinns and penalties ofperjury that the information provided above is true and correct. Sitmature: � �J Date: 3 — Z .- 10 Phone#: S 3 Official use only. Do not write in this area, to be completed by city or town official 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#: KQUL-LtK��„ I 1 N ly.,. ISSIJZD.4TL• 07131/3009 •d\vard F Sennett Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTB4CATE HOLDER.THIS CERTIFICATE 4Rency Inc DOES NOT AMEND.EVEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 16 South Alain Street ops6cltL NIA 019S3 CONIPAINES AFFORDING COVERAGE usuRED — -- en Glbely Contracpng Company Inc comPANY A ALM,Mutual Insurance Co r THIS IS 70 CERTff1'THAT THE POOCffS OF INSURANCE LISTED BELOIV HAVE BEEN ISSUE__T THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WDICAT'ID.N01WI7HSTANDPIa ANY REQUIREMENT,TERM OR CONDITION OF ANY'CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR\LAY PERTAIN.THE INSURANCE AFFORDED BY Tiff POLICIESOTHER DESCRIBEDDOCUMHEREIN H SUBJECT 70 ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POOCTE LIMITS SHOWN MAY PIAV,BEEN REDUCED BY PAID CLAIMS. Co LIX nl[Df LV[URAHR POLICY"UMBER P°LILY LriFCTl1'F PDTIP.LT cart wwD@m DAn o4mArz IIAMIDIYTnYI u[un L:utRA L uneulrY curtnu Ac°a ECArz OcLwmL.v' ,GVILYALUAbIL1T1 FROMM CUNFPY ALG. Q OE'W IRS MAC[OUNR FER'JEYIAL C AUV IHAIRY I �G WIL'fi'a[°!Ii:ARCi'S WIT. CACF.UIYU:i DICE I _ RIS DA G:Uw:a:iil:l AUiUfI°tlILE L41tlILli1' IIEU CSEII.[I:nr>u COMB111LO?INfiLC IIN.R 1 I :11y A1.9L ' N.L OWED AV7M S•LILI'IIU UY.1 i eGKDL'LED AUTOS V.pmlo) I XISD AUTOS II 1101,MIR,Altos -EC DILr iluDP.\' ' I�cuacrlAecm v1.�:1.M1 FF.OFan DWAM !]Ct3e LIABILITY EACH UCCL'EA!Ir,S ',Me:.ttu TavaA AOOM W Tr rriEE PW l UNDPSL:TORV —F�O, JSRS COMPENSATION AND LOMU LJABILETY TAT LDOTE STATE LG'� MV.7Cun'+E11.C, �c:a fi01097901�0U9 OS/03i1009 OSl03/7010 EL DLSEAS F"POLICI-LDSR 500,000 500,000 EL DREA.S FFACN I i i CA,�`� BOULD ANY OF TILE.iBO`TE DESCROED POLICIES BE CAVCEL 1 m BEFORE THE EYP@ATION DATE THEREOF.THE ISSUQJO CON@ANY wILL EMJEAVOR TD ARIL A%?XrrEN NOTICE TO TIff CERT@ICATE OLDER NMED TO n ELEFT,BUT FAILURE TO aLla STICH NOTICE SRAD,p@OSE NO OBLIGATION R LIIIBIITY OFAKY JTgD UPON TIDE CO\@ANY,TrS AGENTS OR RDRESENTATIVFS. Ir0 WHOM IT MAY CONCERN 111TNo417.ED REPRESENTATIVE 6169 III or CO3TLl.-occurs arvla I-ma mne.ur own,I.laverea .Li 111vvn wuvanawmni nd l.,ri s11el J II L Page No. of I Pages . LEN GIBELY CONTRACTING CO., INC. 31Z2,(ore"�`�)� 149 Main Street 31zq XL"Jbf, l PROPOSAL PEABODY, MASSACHUSETTS 01960 All home improvement contractors and subcontractors (978)531-8234 engaged in home improvement contracting, unless FAX(978)531-9304 specifically exempt from registration by Provisions of _ Chapter 142A of the general laws,must be registered Submittedwith the Commonwealth of Massachusetts. Inquiries ea. r, y ,5 L /1 nC r /y00'^oI I�- - about registration and status should be made to the [� I/ Director, Home Improvement Contract Registration, /V Ly 1\[� One Ashburton Place, Room 1301, Boston, MA 02108 ( / ) (617) 727-8598. Owners who secure their own nr� n - J Q �v l LI ( Q7 0 construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE G<TE REGISTRATION NO. /6 MA.REG.100811 'On rvamE/rvo. J JOB LOCATION s,4N+ r eby b t p s rase m forwalk t b pay roamed and materials m be used l ion pr{ - — e.PCr9C - � . I— S4rx f�PC� �o/cam �—o/C J /p2C �pW r l I��ZC C�fell o C' � C�-- -'J n 2e P-I �s (� \ /Gt 4,o J J411 Cfr ey. kir V - _(,✓_'1 [ I�I —d1r!� C',C1�p-�i `��_��e/ �^-1 t�/'P cJ�liJ. /Ur�c� Df._ Cl c 1-7'Ti.�Jj�16 I / We �_. 6 '/C� If . Construction related perrtlts: Q • II �9375, 0�� - � 137S��d re ��Oc4, ,c ' �vP �/o� // J �1 6l drrort Jac k wORBSOleou E C II t g orN or oNe,rM1e cooler als babre rM1e rM1 N tlay follow ng tM1a a going of IM1's Agaeament unless spead led Here n w II begin to k or b t (date) earring delay caused by circumstances beyond Contractors control,the work ry II be completed by oP41 vactorwor t.The0 hereby k gr the M1e scnedul ng dares are appaoti mare and tM1a sate delays that are Rol avoaable by the contractor shall Rol bge^considered� [as rruurone of this Agreement, TY ThenCourepor warrants that the work furnished hereunder shall be free from detects in material and workmanship too a per.off following spardedan and shalt comply wtm the requirements of this Agreement.In the event any defecr In workmanship or materials,or damage caused by the Contractor his subcoN'actors,employees or agents,is discovered Within one year after completion of any lob,including clean up,the Contractor shall,at his own expense,forthwith remedy repair,correct,replace,or cause to be remedied,repaired,o replaced, such damage or such detect in materials or workmanship.The foregoing warranties shall survive any inspection pedmmed in connection with the agreed upon work. We Propose hereby to furnish faterial and labor—complete in accordance with above specifications,for the sum of: �} d� ' Payment to o'maae as co n dollars($ ). s' / GIf 6664 I$ // )uponnlracl:9 es co 3 Nam, t�nonoeay alaK n nayklan� C _ %f$. )upon completion or S„et Add Cpon bempdefrof Rn^It Blm, shall bematle look ilM1upon omplotion of work under this contract. pnono Eeae,almeyl Notice. No agreement for home improvement contracting work shall require a down yae,rorfAlesmay / Payment (advance deposit)of more than one third of me total contrad price or the mml amount of all deposits or payments which tha cont racmrmust make.Inadvance, ,nzed s,gnemre a order and/or otherwise obtain delivery of special order materials and equipment, ' yegir ova 'agar to, Note:This proof may be wtthdmwn by us if cot arrested wilnin days. k { Acceptance Of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated.I understand ' that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above - You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after -. -s the date of this transaction.Cancellation must be done in writing. 0 N�T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. �l'IYn� 2�p sanctum n k1 halo `—�'/�'� cone,, cot, IMPORTANT INFORMATION ON BACK l 'l " "` ✓/te�l�olitinaiu[�rzt'��. o` .��JJacl[Ude�b I �b ; BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 094763 Blrthdate: 05/14/1943 - Expires:05/14/2010 Tr,no: 94763 Restricted: 00 THOMAS R DOBBINS 19 CEDAR HILL DRIVE G-� ' DANVERS, MA 01923 Commissioner rt� �iEe 1°io-.x�rro,uoea�i o�✓l�aaac/araelA Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registratigm. 100811 Expiration:_6/23/2010 7rp 268971 Typef'PSiyate Corporation LEN GIBELY CONTRA CT IN '.;l,'INC. Brian Dobbins 149 Main Street Peabody,MA 01960 ------- Administrator