55 PINE ST - BUILDING INSPECTION 1
The Commonwealth of Massachusetts
� Board of Building Regulations and Standards Town of
Massachusetts State Building Code, 780 CMR, T"edition Building Dept
BuildingPermit Ap
plication To Construct Repair, Renovate r Demolish a
PP P •
One- or Tu'a-Fmr qc Dwelling
This Section forofficial Use Onl
Building Permit Nu erA�: A at A i
Signature: -,tf, ��/�/0 /c
Building Commission6f Inspector of Buildings Date
SECTION 1: 111ft INFORMATION
1.1 Property Address: VJ 1.2 Assessors Map At Parcel Numbers
5 : P't n�
I.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 fl) Frontage(it)
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?
Public Private ❑ Check if es❑ Municipal�On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
P t n
Name nt) Address for Service:
4,twSignarurn Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(,) ❑ Alteration(,) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': 1�,--Fcba fl Rci rrti-�r��l
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical S ❑ Total Project Cost(Item 6) x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. :Mechanical (Fire S
Su ression Total All Fees: S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S03 Lo50 ❑ Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
l(vr�• n 1 r�mt� Licence Number Expiration Date
N�mc of CSL-- HyIJ
a -OI9G0 List CSL Type(scc below)
Address ' T' Deseri lion
U Unrestricted u to 35,000 Cu. — ,
Signature R Restricted 1&2 Earn,,., Dwellin
478-C 7 3 91 M Slason Onl
Telephone RC Residential Roofin Coverin
WS Residential Window and Sidin
SF Residential Solid Fuel Bumin A liance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Narriqlor HIC Registrant Name Registration Number
Address
Expiration Sur r QdoG-+9ri� (�A Q)9/ - .
97£t-977-315 I Expiration Date
ignatu're Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. !i 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 .......... IT No .......... O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work authorized b this building permit application.
ESi nature of Owner "Date,
/� SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
1, —��C_la nn-G-i r, I I ' m i+ rt A , as Owner or Authorized Agent hereby declare
that the statements and i formation on the foregoing application are true and accurate, to the best of my knowledge and
behalf.I
Pa_t a �� rt
Print Name
jr,Signamre ofOxvner or A'uihorized`A gent] Date
Si ned under the 2ains and penalties of oedunD
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�oj 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 I IO.RS, 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 he substituted for 'Total Project Cost"
Pumuc PROPERTY DEPARTMENT
120 WASH1 6TON "KWr, 3RD FLDOR .
SAL[M,MA O1970
TEL (878)7454595 EXT.390
FAX (574) 74OD846
STANL[Y J. Uuovlcz, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of M($,c 40,S34,I
ofBuilding Pennit itE aclmowledge isat as a condition
governed by this Building Permit sba$ disp�in �,ft� ang
disposal facrWW.as defined by M(3L c IIi.S 1SOA.
The debris will be disposed of at: IIIa
Location of'FaI
Applicaat CDaiq�
(PLEASE PRINT CLEARLY)
Name..a r AppIIc" i �^
Fina Name. if say
,01 Co.l � SF _. no RGC�
Addt'w.City dt State
The above statute requires that debris fiom the demolition, renovation rehab or other
ahemdon of bailding or structure be disposed in a
properly-licensed
&6&y as defined by MM-cIM S150A, and the b ���or Osoli m are disposal
indicate the location of the bity. licenses are to
L
11/04/2008 TUE 14:17 FAX 781 581 7200 BENEVENTO INS AGENCY Z 001/002
70ATE YY
ACORD CERTIFICATE OF LIABILITY INSURANCE OPAI PM
CN-1 Ds 0 8
-RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3enevento Ins . Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
197 Humphrey Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
3waapscott, MA 01907-
Phone: 781-599-3411 Fax:781-581-7200 INSURERS AFFORDING COVERAGE NAIL#
NSURED INSURER A: Han[Yord Unexvxi teea Ine_ co-
11JSURER 6: TRAVELERS INSURANCE CO. AIC
Cabinetry Unlimited Enterprise FNSER c:
P ter Ba$arella President -
1 2 Rear Main g�. RDPeabody MA 01960 R 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.NSURANCE 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 CLAIM&. „
LTNSR I1 SRO TYPE OF INSURANCE POLICY NUMBER OATS E�/D/YY DATE w"ww=
LIMITSGENERAL LIABILITY URRENCE S1,000, 000
rvRE S 300000X COMMERCIAL GENERAL LIABILITY I-680-4753B409-TCT-0810/21/08 10s(Ee occurcnc=CIAIMS MADE OCCUR (Any ono pereonl $ 5,000
L 8 AOV INJURY S 1,D OO , O0O
AGGREGATE S 2,GOO, 000
OEN'L AGGREGATE'LIMIT APPLIES PER. S-COMP/OP AGG $ 2,000, DOO
I POLICY F JEoOT17 LOG
1 AUTOMOBILE LIABILITY CO BINEDISINGLE LIMIT $
(ESI ANY AUTO ) -
ALL OWNED AUTOS BODILY INJURY S
I� (Per pemon)
SCHEDULED AUTOS
I HIRED AUTOS BODILY INJURY 5
NON-OWNED AUTOS (Per acclnent)
1
PRO PERTY DMMGE S
(Per 6CCidGn)
GARAGE LIABILITY AUTFOCCURRENCJES
S
u ANY AUTO OTHEA AGO $
AUT S
EXCESS/UMBRELLA LIABILITY EACSOCCURCLAIM$MADE AGGS vSDEDUCTIBLE $
RETENTION S S
WORKERS COMPENSATION AND X TORY LIMIA
IT$ Eft
'LIABILITY
B 636OUB-58070BO-3-0 10/27/08 10/27/09 E.L.EACH ACCIDENT SSOOO
EMPLOYERS 7 O0
ANY PROPRIETOFJPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S100000
lr yac doalDe under EL DISEASE-POLICY LIMIT $
5000O0
SPECIAL PROV15IONG bClw
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
C,+ CITYDFp SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EIIPIRATION
1 V'Y Jd''a-fn DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHO�JZE70RESEN TIVE
ACORO 25(2001/08) ®ACORD CORPORATION 1968
9-7g
r
Massachusetts - Deltaitntent of' Puhlic Safct�
Bo:u•d of Building Re- ulations and standards
Construction Supervisor License
License: CS 87554
Restricted to: 00
PETER BAGARELLA
28 MARLBOROUGH RD
SALEM, MA 01970
Expiration: 4/28/2011
< ,nuni i,uior Tr#: 14975
Y\ fie � Q��i�1�GGCf'2Le!QP�d
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 156191
Type: Private Corporation
Expiration: 6/12/2009 Tr# 255742
CABINETRY UNLIMITED ENT, INC.
PETER BAGARELLA
21 CALLER ST STE 2
PEABODY, MA 01960
Update Address and return card. Mark reason for change.
�_ c• z�ti,.�=�=.o�Aaa� n Address n Renewal n Employment n Lost Card
_ ,,
�\ �Bo r o ui mg egula�i'ons an an ar s�
F
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 156191
Type: Private Corporation
Expiration: 6/1 212 01 1 Tr# 285271
CABINETRY UNLIMITED ENT, INC.
PETER BAGARELLA -
21 CALLER ST STE 2 - -
PEABODY, MA 01960
Update Address and return card. Mark reason for change.
❑ Address Renewal 0 Employment ❑ Lost Card
0 P S C O 40M 08/08 DBS L I FORM CA 108212008
; � Bo� of$ui� ggufa�tioii;•a`nd 'andar "
License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
M Registration: 156191
'= Expiration: 6/12/2011 Tr# 285271 One Ashburton Place Rm 1301
Boston, Ms.02108
Type: Private Corporation
CABINETRY UNLIMITED ENT, INC.
PETER BAGARELLA
21 CALLER ST STE 2
PEABODY, MA 01960 Administrator Not valid without signature
-fit foK�3 `;
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