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4 PHELPS ST - BUILDING INSPECTION t C The Commonwealth of Massachusetts "< Ia C ''1 -'IRYKI¢-7 IT ' Board of Building Regulations and Standards SL�0I .Massachusetts State Building Code, 780 CMR 101b OCT lsvist�Sir J011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section ForOfficial Use Only Building Permit Number: Date.Applied,. 1� Building Official(Print Name) _ Signature . . - Date SECTION L•SITE INFORNIAT1OW 1.1 Property Address: P'NESP.S S,T 1.2 Assessors Map&Parcel Numbers I.la Is this an accepted street?yes_ nu Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: "Coning District Proposed Use Lot Area(sq 11) Frontage(11) 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? Municipal O On site disposal system O Public O Private O Check if esCl P P y SECTIONI: PROPERTY OWNERSHIP" 2.1 Owner of Record: RnB St RE.pRr MA 70 ame(Print) City,State,ZIP 4 &EM 9-79-52o-559Z No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction O Existing Building❑ owner Occupied Repairs(s) Alterntion(s) ❑ 1 Addition ❑ Demolition O Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work-: ✓ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Oflleial Use Only Labor and Materials) I. Building S 1. Building Permit Fee:S Indicate how fee is determined: O Standard CityiTown Application Fee ?. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S ?. Other Fees: S 4.Mechanical (FIVAC) S List: 5. Mechanical (Fire S Total All Fees:S Su ressiun) /-� Check No._Check Amount; Cash Amount:cc 6. 'total Project Cost: S r QO 0 Paid in Full ❑Outstanding Balance Due: ►"Y1 f-N t LfETD u SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) p9'039 A L� License Number spi/rati`un Date Name 6ff CSL Holder / list CSL'rype(see below) <J � �/U" ✓!/L�s G�2 �Type. . Description No.and trect n yy U Unrestricted Ouildin s tip-to 35,000 U. tl. /��g0/J //6� �� 6D R Restricted IM2 F:unil Dwelling Ci*,Stator,Stale, P M Masonry RC Rooting Covering WS Window and Sidin SF Solid Fuel Burning Appliances Afxw, I Insulation Telephone Email address - D I Demolition, 5.2 Registered Home Improvement Contractor(HIC) 1094753 M9 Ld r5 �NS'i r-7j,a 4 LG �, HIC Regislmtion Number Expiration Dale 111c coontpan Name or IIIC Registrant Name r �'� _ r ,��✓/UilV G,=,e ?!�J'S7l`nID/J7r'CDediN?erl/�Ldrs�r Nu. @Street ` 01960 ��/ Email address Ci /Town Stat IP , 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...........13 SECTION 7a:OWNER AUTHORIZATION TO BE.COMPLETED WHEN: OWNEWS AGENT OR CONTRACTOR APPLIES FOR BUILDING.PERMIT 1,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Nome(Electronic Signature) Date SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION By entering my name below,)hereby attest under the pains and penalties of perjury that all of the information contai ' this appli ation is true and accurate to the best of my knowledge and understanding. /©--, 3i,- Prin Owner's or Autimrtzed Agents Rnme(Electronic Signature) Dale NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (tot registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under 1M.G.L.c. I42A.Other important information on the HIC Program can be found at www mass l:ov:'oca Information on the Construction Supervisor License can be found at wta�! 2. When substantial work is planned,provide the information below: 'total floor area(sq. ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq. It.) Habitable room count Number of fireplaces Number of bedrooms Nuutbcr of bathrooms Number of halflballts Type of healing system Number of decks/porches rype ofcooling system Enclosed Open .i. Total Project Square Footage"may be substituted for-rural Project Cost" (byCFSALEA4 MAZAami &nmrcl>�ata�rr �WatSnt�f;3'°]oLoox ]>r 7�-99Rf. SD�BRt8Y1 Z97#9f16 MAI= DnresSrP� CPA817CPB�l7]'/dlIIl�1GD�Ov Construction Debris Dispose►►/Affjdh* (required forall demolition andrenovation work) In acm a wkb the abth edltbn of the State BuBdhg Code,7800^Secdon 11LS Debi and the provisions of MGL c1o,S 54;8uilg penult N ls the condition thetthe debris resultfng from tills wark doff be&Posed of in a properly Bceosed wed depw*be ty as delked by MGL c ill,S ISat The debris will be transported by: (name of hauler) The debris"I be disposed of in: (name of facility) (address of fadlity) Signature of applicant /0- Date The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le¢ibly Business/Organization Name: /yf/Loy J GoNSr/ZI!(T�'a�t/ L Li Address: 3 City/State/Zip:. L /`P'0 Phone#: 17 e- Are y an employer?Check t/e�appropriate box: Business Type(required): I am a employer with employees(full and/ 5. ❑Retail orpart-time).* 6. ❑Restaurant/Bar/EatingEstablishment 2.❑ I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate, auto,etc.) employees working for me in any capacity. [No workers'comp. insurance required] 8• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]** 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#l. I am an employer that is providin,g/workers'compensation insurance for my employees. Below is the policy informadom Insurance Company Name: /yOis'TV SAP Insurer's Address: /I / rarT.E/2 .ST City/State/Zip: a06012�Z Oef L7 C/ 6 0 Policy#or Self-ins.Lic.#;a&// d 7,f/%&7 G S jL Expiration Date: I — Lf— 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 ceerti der the pains and pen/aldeses offpperjury that the information provided above is true and correct. Signature Date q A9 — ;j — Phone#: / � c�'' 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Form Revised 02-23-15 r Melo's Construction LLC BBB 34 Jennings Circle Peabody, MA 01960 Telephone: 978-531-0811 - E-mail: FaustinoMeloCamsn.com n.wedr..tt MEMBER Faustino Melo,General Manager Unrestricted Mass Builders License No. 80393 Contractors Registration No. 108953 Proposal u mt to: Phone r: . R F 8- - ld- / - 6 Address: City,State,and Zip Code 0Y417o Job on: Job Location: Job Phone: We Propoaad tsaeby[o fumiab materials and labor•eomplate is w wdh dw Tmifimuam hsW below,for the sum of. S ►1�+.) TJ�aus�1 nrn ®�� _aauan ($ 7,CM 00i Installation of Payments: Payments will be paid in thirds.The first 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 Sigmtme: l6LiA if not accepted within 20 days. Date: t[(tJ- 17 -//_ e Hereby Sebmit Speeatods and Eatmuta ear. 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 nails,screws,"or staples will be removed. Ice and water shield will then be installed at the bottom of all edges,around all chmeys,skylights,and into all valleys. 6 F9E7 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 30 Yin t?��2L%fllr Gig The homeowner is responsible for the selection of the roof color. Also,the homeowner may select der hand or pneumatic niters for the nailing application of the new roof All the debris will be cleaned and property disposed of on a daily beats.Magnetic brooms will be used to extract all nails from your property. We will protect your property as best as we can,however,some foilage matting, breakage,or marring could occur. We cannot accept responsibilty for possessions inside of the house,or debris falling into attic areas. The customer shoald protect personal belousdnas. Extra work in which an additional cost will be added to the above line. Replace Rotted Roofboards Gutter Repairs Remove Aluminum Siding Relead Chimney(s) Install Skyligbt(s) Remove Old/Rotted Wood Replace Facia Boards Repoint chimney Install Garage Roof Install Ridgevem � Install Azek Board Install Insulation Install Roof Louvers W VEA)Z pera 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 Additomal Notes: RE)Yi ayF ota ,c'opF7v zjgza/ 449,tf fibyR de 000 64F 7.D'y i3rmvue r n _7-A 57 I L L A' A/� �S k &ffA H 1 r 50 " J in0L7 i4n�/l 'T'A15'TR t 11,4I2/ PcQV1AA5, S,nE ffijQ�1,/ i 0011*11 Total Amount for Additional Work: Warranty by manufacturer to be free of defects for�Q years, see manufacturer's 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_� 0 years. This warranty excludes remedy for damage or defect caused by abuse,modification,improper or insuf scent 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 its sole descretion 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 shell 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 foes. 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 requisittion and or invoice. The proposal may be withdrawn within 20 days. Date of Acceptance: 101 a-5,11(o Signature: woP��`�c$1900, noj n [Tc- tz+p °-P- $ 7 00 , 00 a no� Si�Q,