202 NORTH ST - BUILDING INSPECTION (4) 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
w - .This Section For Official Us Only ar
Building Permit Number: �. DateApp ek"..' law
',-'!Building Official(Print Name) "r",,,.Ixiu��t,r- ,a rp -T,�?. .Signature..., --ra.may +, • n._^*„�, ..._I?Date__ ....
SECTION 1:SITE INFORMATION,,V'
1.1 Property Addres : 1.2 Assessors Map&Parcel Numbers
IWL (\jprlh S
l.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 ft) Frontage(it)
1.5 Building Setbacks(it)
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:PROPERLY OWNERSHH`
2.1 Owner of Reclolyd:n 1
Name(Pr m) - '-'-City,State,ZIP
r 41, Ncxik '�t aLl% A-Toi ! sV43 p�
No.and Street Telephone Ffliail Address
, ,„ `�• -SECTION 3c DESCRIPTION OF PROPOSED WORKZE(check all ttiat apply)
New Construction❑ FExisting Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other EL Specify:_ St
Brief Description of Proposed Work2:
e V in � C•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs: s
Item "Official Use Only
Labor and Materials)
.,.� . .,' :.•���., ....:, ,:" n, tr.. _ . .•=r-s,�..�.:
1.Building $ I Budding Permit Fee $ a. Indicate how fee is determined
2.Electrical $ ❑Standard City/Town-A I— Fee
❑Total reject Costa(Item 6)x multiplieraLT,
3.Plumbing $ 2 Other Fees $
4.Mechanical (HVAC) $ List ` °s .�r IS75
5.Mechanical (Fire
Suppression) $ Total All Fees
Check No.",,.'•m Check Amount: •••• Cash Amount:
6. Total Project Cost: S S 3 O ri O p Paid in Full ':. ...W
. ❑Outstanding Balance Due
c
��' Q A
0 0 Z Z
` "SECTION Sc CONSTRUC I
O�N SERVICES v
5.1 Construction Supervisor License(CSL)
U Z�\ I
U 2y
61p n n lb „l License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
11 �t,a Iyati K/PC) N L-kq
No.and Street J :Type'>'- - . Descnpt�on--' 3 -' a �•._
p q Q`` 0_ Olq 1 U Unrestricted(Buildings u to 35,000 cu.ft.
� `t lh� R Restricted 1&2 FamilyDwelling
City/Town, ate,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.22 Registered Home{-Improvement Contractor(HIC)
l2�Cn(\ Q ( SIN��A ^l LC 1�Z Syb
HIC Co a Nam r HIC Reg[strant Name HIC Registrat ber Expiration Date
N�and StIeet— Ema address
Ci�tate,ZIP Telephone
�....om....., _:.
i-,O 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...........❑
'a'„=-, SECTION 7a: OWNER AUTHORIZATION TO BE.COMPLETED WHEN'"'=` , iF 7� `
». • -
v
OWNER'S AGENT OR CONTRACTORtAPPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters rel to work th tzed by this building permit application.
�gnU<P R �e Rt�c� = slll I
Print O' ner's Name(Electronic Signature) Date
. .,. . , R 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
contMv—
this application is true and accurate to the best of my knowledge and understanding.
�� (\ t
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
";NOTES:PTPt "-
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.>ovt. /oca Information on the Construction Supervisor License can be found at www.mass.eov/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"
CITY OF S.0 .1N1, i xSSACHLSETTS
BUILDING DEp.kxnt&-T
• ` 120 WASHLNGTON STREET,Sae FLOOR
sarat�r TEL (978) 745-9595
FAK(978) 740-9846
KImBERIEY DRISCOLL
MAYOR THODIAs ST.PiFm
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Annlicant Information Please Print Le ibiv
VaMe(BusittesiOrganizationilndividwp: ltile nf, UG 16t Q\`\ w�—
Address:__
City/State/Zip: &yerL��Qf-)IL t9 iS Phone #: 91� gQ-77 ?,9S(1
Are you an employer?Check the appropriate box: Type of project(required):
I.B.1 am a employer with t 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-cortbactors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling
ship and have no employees These sub-contractors have S. [] Demolition
working for me in any capacity, workers'comp.insurance. 9. [:]Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL I l D Plumbing repairs or additions
myself.[No workers'comp. c. 152,41(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers' l3 Other s ta\rw
comp.insurance required.] ,�
*Any applicant that checks bon a I mast also fill out the section below showing their workets'compensation policy infomtation.
I ILvrxowtxas who submit this affidavit indicating they arc doing all work and then him outside contractors muat submit a tow affidavit indicating such
'Contractors that check this box must attached an additional sheet showing Tito name of the subcontractor;and their workors'comp.policy infotmution.
/um an employer that is providing workers'compensadon Insurance for my employees. Below is the policy and Job she
information, \\ \\ J
Insurance Company NameL—[V&Y2lt'.cS
Policy#or Self-ins.Lic. #: �9, vote-i 3 Expiration Date:--(
{ —T—
Job Site Address: City/State/Zip: �6 ,/ft)fJlA n-7 n
Attach a copy or 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 S1,500.00 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 orthe DIA for insurance coverage verification.
/do hereby tend adelli0ins ant enalties ojpuJury that the in arm flan provided above Is true and correm
Sienature �fAvf Da[ 1 s
Phone#:
OJTcied use only. Donor write in this area,tube completed by city ar town official
City or Town: PermitILIcense# __
Issuing Authority(circle one):
I.Board of health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Plume#:
GLENN BATTISTELLI P.O. BOX 496
BEVERLY, MASSACHUSETTS 01915
PAINTING-ROOFING-SIDING-INSULATION-CARPENTRY (978) 922-6338 (978)927-8956
I/we,the owners of the premise ned below,hereby contract with and authorize you as contractor,to furnish all necessary materials and
labbr and to irletall im-f vements on - pre ses ac i g to the following specifications:
Owner's Name.:!4t-.r.•••kT"! .....' :....................... .................................Tel.. .. .... ........................ a�
Job Address....:.... .. - ..l..I< .�.-i..... ...................... City.....: Vim-✓ -:.............State..�..y�/..
,/2�' y y .......................
1. Secure Building Permit with the Town of -
2.All necessary electrical work will be done by a licensed Electrician. �1� 1� - �'dA
3.All work is to be continuous.
4.A clean job site will be reasonably maintained at all times.
5.All necessary strapping is included 6.Secure loose wood to obtain an even surface. /y eL
7.Allow proper space as to allow for expansion and contraction.
8.Galvanized nails to be used to apply siding.
9.Contractor has all necessary Public Liability.and Workmen's Compensation.
10. Install....... ...........
.......�.�. 47
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4-e..4�^. /�/ /"7''/�...G7.,.f-!.^..I'J....J.... �1�,../�F?, "( .....� i y'!",?:rlf 2 �`r., ...............
...!........ !s«[L ....................
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:.-...�../�.....�iw.1.....-.. .. %..A. .l...... `' .. ..f.-�i ram..... '� G x..C7.....................
y....r.:..:..�...}. �if r.: %r/..1........�rr:.:. �..:/./....... S ..u.ff..:.:'/........-....... ......(
..../�.E-+ .l `.::�L...C✓..a6:4:.....x....... .......::.f. '....E.'./S r_.e......i?1. ....`.'..ri.:'7... :.t? ...�+.. ..::
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........(li ^...,l..G•••....d.'�-"'�:%,/�! / �.L. � r7....f4.......C.'t.�....r'G'C�.../.�.:....�.1�...........................
..... .. ...e..��P�z..: G l/....h.:r I e.............4 �....
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iy v2 onb� 7yG: �i/-
n consideratif the labor an materials supplied by,the Contractor,the Owner(s)�agree(s)to pay to the Contractor the sum of
...............................................................................:.........................:....................................................Dollars................................................,
Payable.......................................................:.................M.::..::.......................................................................................................................................I............
The contractor shall be liable for any,defect of,insist!abor`labor only if it fails to repair same within thirty days after receipt of written notice,but not
otherwise and in no event shall the contractor be liable,b6yond the cost to it of the labor and material required.
The contractor shall be paid by the owner(s);all cost,attorney fees and expenses,in addition to the amount unpaid,that shall be incurred in enforcing
the terms and conditions of this contract and/or any liemin connection therewith. -
Owner agrees that in event of cancellation of this contractbefore work is started,but after expiration of recession period,owner shall pay to contractor
on demand all costs incurred by the contractor.plus twentolve percent of the face amount of the contract.
No work to be done on this property other than thafspecifled herein without additional charge.All parties by their signatures hereto covenant and agree
with each other that there are no representations or promises of work of any nature:other than what appears within the four comers of this instrument.
Receipt of a copy of this contract is hereby acknowledged.Company agrees to furnish guarantee upon request at completion of contract.
INSURANCE COVERAGE -
This contract is subject to strikes,accidents,or other delays beyond our control.
Glenn Battistelll Co:hereby agrees to perform all work In a workmanlike manner.Workmanship is guaranteed to be of the highest quality.
RECESSION NOTICE:You may cancel this agreement if it has been consummated by a party thereto at a place other than
the address of the seller which may be his main office or branch thereof, by written notice directed to the seller at his main
or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third day following the
signing of this agreement. See the attached notice of cancellation for an explanation of this right.
IN IT S HEREOF,the arties hav reunto signed their names this day of 20
:. ........................I.................. ..............................................................
Representative
Accepted: \
J'� Signed........ .. .. ...... ...................................................
OW ER
By....................................................................................................................Signed............................................................................................................
OWNER
MAR-11-2014 14:35 FROM: TO:19789219202 P.1/1
OATA(LIWDDMYY)
CERTIFICATE OF LIABILITY INSURANCE 3/11/2014
THIS CERTIFICATE IB ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS). AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, 11
IMPORTANT; It the ceri floato holder Is an ADDITIONAL INSURED,the pDllcy(les)must be sndoread. If SUBROGATION IS WAIVED, subject to
the terms and condit)ons of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the
certlflcate holder in lieu of such andomeme a .
PRODUCER
PHONE (978)922-6600 Fa (R)51922-74E0
Sterling Insurance agency, Inc. A
306 Cabot Street NF10a
P.O. Box d93 NRIIRERe DSDIN000vERADe
IRQVerly MA 01915 INAURERAXS Brokers Insurance anc
INSURED IN NO.
INOURER C
Glenn Satttistelli LLC INSURER
11 Broadway N useR
Severly MA 01915 R '
COVERAGES CERTIFICATE NUMBER:Ct,1311700056 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW WAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR INC POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMCNT, 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.LIMITS SHOWN MAY HAVE BEEN REDUCED P BY PAID CLAIMS.
R TYPEOPIXSURANCE POLICY LIMITSa DeNaRAL LIAaILrrY 8B1656891 /'261201A' 26/2015 EACH OCCURRENCE S 2,000,000
PA Dcr nL Nda�� S SO 000
$ COMMERCML GCNERAI LWSarcY 5,000
CLAIMS MADE � OCCUR PEN An one a
PERSOUALAaOV INJURY a 1 000,000
GENERAL AGGREGATE $ 2,000,000
ff:'� PRODUCTS.COMPIOP AGO 3 2,000,000'
GSN'L AGGREGATE LIMIT APPLIES PER S
POLICY PRO LOC .0 SINGLE LIMIT
AUTOMODILI UANUTY IAA_
e006Y INJURY(Par penm) S
ANY AUTO
ecD
BODILY INJURY(
ALL OWNED SCHEDULED - (I'maa+1) f
AUTOS NN=LNED R S
HIRED AUTOS AUTOS S
VMORELLA LIM OCCUR EACH OCCURRENCE S
IMCEas Lwe CLAIMs.L1aUE AGDREOATP $
S
DED FTENTIO A U.
WORKERS COMPENSATION
ANO EMPLOYERS'LIAINUTY H.L.EACH ACCIDENT
OFMCGRI,1EuMEE�xCCUJOEEDDTRE ISO NIA
(Mandalay In NH)
E.L DISEASE-LA EMPLOYE $
tt yypo�e ."Da MYIa• E.I DISEASE-POLICYLIMR 3
DE6LIRIP N OE OPERATIONS NAlew
DESCRIPTION OF OPERATIONS I LOCATIONS I VINCL98 IAUCn ACORD 101,M01101M1 Raaal.a sahaa•da,if men apaas 1a m*d. d)
Worker's Compensation to IPe sent undar separate cover.
CERTIFICATE HOLDER CANCELLATION
SHOTHEULD ANY OF EXPIRA EXPIRATION DATE VTHERE F. NOTICE E DESCRIBED I VALES B CANCELLED L BE DELIVERED N
ACCORDANCE WITH THE POLICY PROVISIONS,
Denyse DeROChe
202 North Street AUTHORIZED REPRESENTATIVE
Salem, MA 01970
Risk eaconey/TANYA �,-"^"'""\�r ' •"Y—•'��'1
ACORD 26(2010106) 01988.2010 ACORD CORPORATION. All rights reserved.
INS026(2oiow).w The ACORO name and logo are regietered marks of ACORD
3/11/2014 Unofficial Property Record Card
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 17-021" Account Number 0
Prior Parcel ID 61 —
Property Owner DEROCHE DENYCE A Property Location 202 NORTH STREET
Property Use Two Family
Mailing Address 202 NORTH ST Most Recent Sale Date 918/2003
Legal Reference 21704-05
City SALEM Grantor DIISSO ROSEMARY L,
Mailing State MA Zip 01970 Sale Price 150,000
ParcelZoning R2 Land Area 0.160 acres
Current Property Assessment
Card 1 Value Building Value 192,300 Xtra Features 500 Land Value 69,300 Total Value 262,100
Value
Building Description
Building Style Muiti-Garden Foundation Type Brick/Stone Flooring Type Hardwood
#of Living Units 2 Frame Type Wood Basement Floor Concrete
Year Built 1890 Roof Structure Gable Heating Type Forced H/W
Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil
Building Condition Avg-Good Siding Clapboard Air Conditioning 0%
Finished Area (SF)2567 Interior Walls Plaster #of Bsmt Garages 0
Number Rooms 12 #of Bedrooms 4 #of Full Baths 3
#of 314 Baths 0 #of 112 Baths 0 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.160 acres of land mainly classified as Two Family with a(n)Muiti-Garden style building, built about 1890, having
Clapboard exterior and Asphalt Shgl roof cover,with 2 unit(s), 12 room(s),4 bedroom(s), 3 bath(s),0 half bath(s).
Property Images
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i� art" I
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Disclaimer.This information is believed to be correct but is subject to change and is not warranteed.
http://salem.patriotproperties.rorrVRecordCard.asp 1/1