16 OSBORNE ST - BUILDING INSPECTION * 5¢ cr a
The Commonwealth of Massachusetts CITY OF
U16
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 730 CMR Revise Mar 2011
Building Permit Application To Construct, Repair, Renovate emolish a
I One or Two-Family Dwelling
f 1 This Sec#ion For Offrctal Use QAly,
YI Budding Permit Number ,Date Applied f r
'T' Date
Building OniciaL(Pnnt Name) ignat
SECTION 1: SITE,INFORMATd
1.1 Property Address: 1.2 Assessors M, arcel Numbers
d G Otsy N''m '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(ft)
1.5 Building Setbacks(ft)
Side Yards Rear Yard
Front Yard
ffEE!E
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? Municipal ❑ On site disposal system El
Public El Private ❑ Check if yes❑
SECTION2 PROPERTYOWNERSHIP':
2.1 Owner'of Record: ���•�
y'mE Sr» fi'�iE, SAL ,6rn 1;17y
Name(Print) City, State,ZIP oe
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF A
,PROPOSED RK'(check all that apply)
New Construction❑ Existing Building ❑ Owner Occupied Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units f Other ❑ Specify:
Brief Description of Proposed Work': aj 69 R gek
SECTION 4; ESTIMA:LED;CONSTRUCTION COSTS
Estimated Costs: Official Use Only ;
Item Labor and Materials -
1. Building $ 1 Building PermiE.Fee $ Indicate how feeds determined: .
❑_Standard Ctty%'Cown Application Fec
2. Electrical $ ❑Total,Project Cost'(Item 6)xmultiplter x
3. Plumbing $ 2"Other Fees: $.
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire Total All Fees: $
Suppression)
Check.No Check Amca nt. Cash Amount..
6. 'rota) Project Cost: $ OVn 0 ❑ Paid in Full ❑ Outstanding Balance.Due
4r-,UD -7-0
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
--,y�^,p } 0803g3 1 -I
! Mt I t AN License Number Expiration Date
Name of CSL Folder
t List CSL Type(see below)
�y cJEN/U,N�S- Gi Z
No. and Street Type, Description.
U Unrestricted(Buildings up to 35,000 cu. ft.
074 R Restricted 1&2 Family Dwelling
City/Town, State IP M Masonr
RC Roof" Coverin i
y( // WS Window and Sidi-
18SrJ/ l/ SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Horne Improvement Contr. for(HIC)
M1£Los C.9nZ5r^[ tfGTrp�1/ LLG tD� 453
FIIC Registration Number Expiration Date
HIC Compa�y�Name o HIC Registrant Name nn
'��/ 'r s2�Ur✓ a/C24 G:`,t? "rinl D owzo c/� �✓
No and Street P Email address i }BDa 0 /960 97 .S3/OS !I
Ct /Town, late, 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 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.
Print Owner's Name(Electronic Signature) Date
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
contained in this application is true and accurate to the best of my knowledge and understanding.
FAusTl� MOLLo [/ -R_ i z
Phi ft Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
FTota:lfloor
n Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
ot registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
ogram or guaranty fund under bLG.L. c. 142A. Other important information on the HIC Program can be found at
ww.tnass gov/oca Information on the Construction Supervisor License can be found at www.mass ,iv:ilL
hen substantial work is planned,provide the information below:
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 SM EI4, NL1SSACHUSETTS
BUILDING DEPAIMLENT
; ) 130%V.,sHiNGTON STREETS 3se FLOOR
sax TEL (978)745-9595
F.{x(978) 730-9846
KIJtBERLaY DRISCOLL
MAYORTrL06tAS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO'.WMISSIONER
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information Please Print Leeibiv
Namt:(Business.Organizmiorulndividuaq: lnLLa S Yiza;e rr`o LLC.
Address: 3 'Y G; g
City/State/Zip: v Phone #: /7&S.3I— d ;'/
Are u an employer?Check the appropriate box: 'type of project(required):
1.QI am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑Now construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner. listed on the attached sheet.t 7. ❑Remodeling
ship and have no employees These sub-contractors have V. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9. E30uilding addition
(No workers'comp.insurance S. ❑ We are a corporation and its
required.)
officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or udditions
myself. (No workers'comp. c. 152,$1(4),and we have no 12.❑ Roof repairs
insurance required.)t employees.iNo workers 13.E] Other
comp.insurance requircd.J
;Any applicant that chucks box el must also M1 out the section Most,showing thou workers'compensation m polity inforation.
r I hvneuwners who submit this affidavit indicating they am doing all work and then hire obtsidecontmcton mass submit a new amdavil indicting such.
�Comrxton that chuck this box mustatlachod an additianot shoot showing tho name,of the subcontractor and their worker'comp.policy infortwdon.
l um an employer that Is providing workers'compensadon Laurance for my employees Below Is dte policy and fob site
informalion.insurance Company Name: C�ZOSS VV,%J12AAJ6,__
Policy q or Self-iffy.Lie,. H: 71OUB 78 j Expiration Date: J 2-- 2—
Job Site Address: 16 Q'SB17RA1F- S 7- City/State/Zip:..SA-L e-ln d!22A
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
line up to S1,500.00 unddor one-year imprisonment,as well as civil penalties in the form of it STOP WORK ORDER and a fine
of up to SM.00 a day against the violator. Ile advised that a copy of this statement may be furwardcd to the Off ice of
Investigations of the DIA fur insurance coverage verification.
l do hereby e e l rider the p ns umd pear of perJury that the h1furmallon provided ubuve/s true and correct,
Sien;aure: Ua_te: /Z— S— Z 2_
P o ;J•
OJJiciul use arty. Do not write in this urea,to be completed by city ad-town aJJiriral
City or Town: PermittlAense
Issuing Aulhority(circle one):
1. Board of Iieailh 2. Building Deparlotent J.Cityffown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:—-- -_---.-.._ Phone 4:
i I
CITY OF S. .F—M, UxsSACHUSETTS
BLILDL\G DEPAR-M&NT
d 1+ 120 WASHCYGTON STREET, 3° FLOOR
TLL (978) 745-9595
F.+x(978) 740-9846
KIJtBER.L.EY DRISCOLL
I
�ir1YOR �-IO�tAS ST.PIERRs
DIRECTOR OF PUBLIC PROPERTY/BUILDIING COSLMIISSIONER
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:
011,4 f9Ti2vG[t
(name of hauler)
The debris will be disposed of in
—MAAil1SFt= tZ _
(name of facility)
— crz�cr�7- ZyAIV
(address of facility)
signature of permit applicant
date
acbrc;ait'.d.x
. CERTIFICATE OF LIABILITY INSU NCE i2�s/Zoii'�'
C A TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG UPON THE-CERTIFICATE HOLDER. THIS-
TEDOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TH COVERAGE AFFORDED BY THE POLICIES
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWE THE ISSUING INSURERIS►, AUTHORIZED
' E'NTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. -
'._ r -TANT: 8 the eeNflcate holder Is an ADDITIONAL INSURED,the polleylles►must be end0 R SUBROGATION I8 WAIVED, subject to
B Esr-ns and cc of the policy,certain policies may require an endorsement. A statement n thb CerBBcate does not confer rights to the
zerifteaft holder In Ilea of such endotsemen s - -
- - Lanren QoldmjImt
4-roas insurance-Peabody- - PNose (978) $-545 (97i)332-22a7
1391.Lpa ield Street .lgoldmancy.comINsu0 COVERAGE NAIC e
embody MA 01960 INSURERA3'fain Srica Assur. 9939
Nat:ionMutual Ina Co 4788
■+ YAS CONSTRUCTION LLC C/O FAUSTINO MEIA msumec:The Ch Fire Ina Co 25615
34 JENNZNGS CIR INSURER*:
34 Jennings Circle INSURER
E2ASODY MA 01960-3568 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL1112557650 REVISION NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN URED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTI ER DOCUMENT NTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCI HIED HEREIN IS SUBJECT TO ALL THE TERMS,.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL INS. -
L TYMOFINSURANCE - POLICY ADO POLICY EFF Pout LIMITS
GEMPRf L LIABILITY - It EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY 0AMAOh TO R 0f 500,000
A clnlMs-NnoE QX OCCUR 3e62 a/26/2011 a/26/2 az LIM EXP f 10,00
PERSONAL 6 ADV INJURY f 1,000,000
GENERAL AGGREGATE - f - 2,000,000
GEMI AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPAP AGO f 2,000,000
X POLICY PRO- - LOC f
AUTOM68ILELuu3n Y I 3 11000,000
.� ANY AUTO - - BODILY RWURY(PW pm " f
ALL 0ANEO X W4MWLED H43926 /21/2011 /21/20 2
AUTOS AUTOS BODILY INJURY(PW aoddot) f
X HWEO AUTOS X AU�WNW.TOS PR 7
SAOB f
UMBRELiALU1e OCCUR EACH OCCURRENCE f
E(CESS UAB CWM6-YAOE AGGREGATE f
CED I I RETIN
C AORKERSCOMPENSATION
1111C AlU-2XDEMPLD7ERS UABIDiY - YIN 07
' E.L EACH ACCEIENi. f 1 OOO 000
ffiWaZO18at EX(%J1DEOi . MIA
Tamtw;'IMNN) COU87814M46511 - 2/4/2011 2/4/20 2 EL DISEASE-EA EMPLO f 1 OOO 000
47sA esuab uMv _
�'=CRIDnO OF OPERATIONS Eabr EL DISEASE-POLICY LIMB f 1 O00 000
OESCAIPTION'Of OPERATIONS I LOCATIONS I VEHICLES (At bACORDIOI.AdMI WRnu,INSeMdoN.ff ro spLwlsmgAmdI
Refer to :policy for exclusionary endorsements and special provisions.
CERTIFICATE HOLDER CANCELLATION
i
6
- SHOULD ANY OF THE ASOV DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE -HEREOF, NOTICE WILL BE DELIVERED IN
Fc� Insured Purpose - ACCORDANCE WITH THE PC LICY PROVISIONS.
AUTHOROM REPRESENTATIVE
Timothy Tramonte/AID �Y/rJ'b jf• d- LtiA�rr/a->✓1Z�P.�
ACORD 25(2010/OS) - - O 1988-2010 ICORD CORPORATION. All rights reserved.
INS025;zav�')Oi The ACORD name and logo are registered marks of ACOIID
A .r re9''I'F r *h r r w Y* � tI �j I!1�4mcj '' n 9�9`SIY r �'�iN'�a'' �71Y 4 i'w '4jl'@Yi
t`ns�� N 4 � ., 1± °�"P
ro-y.`.� „fiv„se,m ��KN ?✓Ilfhramxtul�ak�rW�albrIV wl�fki�iu��it�I�tVIVtl�i IY�d�i'iE� �14Vi'g���li�ll�V1'iPR�'���.IVB9��5
w ,
i'11,1k nl
11irs A. nuslaem Regalnlion License or registration valid for iudividul use only
l� OME I14 ROVEMCNT CONTRACTORi before the expiration date. If hound return to
��f s Rltih 6
0lalratlon: 108963 Type: i- Office of Consumer Affairs and Business Regulation
xPlratlon: 60,612614 Lid Liability C rR 10 Park plaza-suite 51^O
4 C?
.a'
Boston MA 0211
6
MEL64CCNS1RU6TION
� .Paustlno main
34 JENNINGS CIR � � -
Peabody,MA 01960 Undersecretar
y .Not vali without signature
Failure to possess a current edition of the . �^; �n:'-
Massachusetts State Building CodelhuPa!rt!ntf_At ,S�fet)
is cause for revocation of this license. B6gt!of Buitilmg Regitlattuhg und Standards
+yx 'Construc`tjon SuperJisor License
Refer to: WWW.Mass.Gov/DPS k
Ucense: CS. 80393
FAUSTINO N``MELO
34 JENNINGS CIRCLE
PEABODY, MA 01980 '
Expiration: 3/112U13
o.
ti. ftommis+inner w:. Trk: 11740
CC>LOIt SLR7F
Melo's Construction LLC
1313S 34 Jennings Circle Peabody,MA 01960 x�=$
Telephone: 978-531-0811 - E-mail: FaustinoMeloAmsmcont n.wa ds..a
1iN11SMB6R Faustino Melo,General Manager
Unrestricted Mass Builders License No. 80393 Contractors Registration No. 108953
Proposal Submitted to: Phone Number:
tME So - D- t
Address- City,State,and Zip Code
Job Description: Job location: Job Phone:
��� 5R ✓t7�
We Proposed hmeby to fiuniah materib and labor-complete in aawdence with the specifications listed below,far Ne smm of.
S ,- XT4C)iI S w t'jh Six &O-A /RE/1
Installation of Payments:
Payments will be paid in thirds.The fast installment will be paid before the job begins.The second payment will be obtained in the middle
of the job.The last payment will be obtained after the job is completed Note:This proposal may be withdrawn by us Authorized Signature: /. !�'j //i
if not accepted within 20 days. Date: 10--1L a _
e Hereby Sabmh Speenleatiaas and radinata r n
THE INSTALLATION OF A NEW ROOF
To protect the homeowner's property,Blue Tarps will be used to cover the siding,bushes,and grass during stripping.
All of the layers of roofing will be stripped,and all protruding n9k screws,and/or staples will be removed. Ice and water shield
Will then be installed at the bottom of all edges,around all chineys,skylighta,and into all valleys.
Fifteen(15)pounds of felt paper will be installed 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 rubber flanges.
The roofing material to be used will be
The homeowner is responsible for the selection of the roof color.
Also,the homeowner may select either hand or pneumatic o filers for the nailing application of the new roof.
All the debris will be cleaned and properly dsmmW oroo a d2&hasio.Magnetic brooms will be used to extract all nails from
your property.
We will protect your property as best as we can,however,some foil a matting,b
accept responst for ag attic
breakage,or marring could occur.We cannot
�bihy possessions inside of the house,or debris falling into attic areas.
The customer should oroted versotW bebntri 25.
ExtM work in which an additional cost will be added to the above price.
Replace Rotted Roolboards Gutter Repairs Remove Aluminum Siding
Relead Chimney(a) y 0,00 Install Skylight(s) Remove Old/Rotted Wood
Replace Facia Boards Repoint chimney GE Install Garage Roof
Install Ridgevem Install Azek Board Install Insulation
Install RoofLouvers Install Window Trim Install Tyvek Paper
Install Aluminum Gutters Install Shutters Cover Aluminum Windows
Install Aluminum Downspouts Remove Vinyl Siding Repair Vinyl Siding
Install chimney cap Porch Repairs Rebuild Chimney
Additional Notes:
P� 'nl 6 + , r-Y'-�
Total Amount for Additional Work:
Warranty by manufacturer to be free of defects for'a 0 years, see manufacturers warranty for details. All labor performed
under this contract shall be of good quality and free from defects not inherent in the quality required or permitted for a period
of years. This warranty excludes remedy for damage or defect caused by abuse,modification,improper or inaufficent
maitenance,improper operation,or normal wear and tear under normal usage. This warranty shall be limited to the work
performed by Melds Construction,LLC and limited to either repair or replacement by Melds Construction,LLC at as sole
descreton and election.Any and all claims are waived unless made in writing to Melds Construction,LLC 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 and Penalties-Upon substantial completion of all work under this contract,customer shall-within 3 days-make the
final and full payment of the contract price. Any and all unpaid balances shall accrue with interest at 5%interest per month.
You agree to pay all court costs and collection expenses incurred by Melds Construction,LLC in the collection amount you
of any amount you owe under this contract,including and without any limitation of reasonable attorney fees.
Acceptance of the Proposal:
The above prices, specifications and conditions are satisfactory and are hereby accepted.
You are authorized to do the work as specified,payment will be made as outlined above.
Payments are to made as per reluisittion and or invoice.
The proposal may be withdrawn within 20 days. f
Date of Acceptance: 6F Q 1 2' Signature
,r� 1