15 POPE ST - BUILDING INSPECTION Cam- 34,�;3 -
The Commonwealth of Massachusetts
Board of Building Regulations and Standards RECEIVE CITY OF
Massachusetts State Building Code,780CMRNSPECT10HAl_ E%VISKEEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Dew i 2
One-or Two-Family Dwelling 1��5 J� �
This Section For Official Use;Only
Building Permit Number. F <<- pp Da Led
N
Building Official(PnntName) ''Signature
•-,
SEC%19*1.SITE INFORMATION
1.1 Property Address* 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
13 Zoning Information: 1A Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
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 13 Private Q — Check if yesQ Municipal❑ On site disposal system 13
SECTION;2 PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name(Print City,State,ZIP
No.and Street I Telephone Email Address
SECTION 3•DESCRIPI'IONOF PROPOSED WORK'(check all that apply)
New Construction 13 Existing Building❑ Owner-Occupied ❑ Repairs(s) '@� Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': -t— 5 4 S
OA YYl A i N 1-knl IS
� . « .. -
i SECTION 4 ESTIMATED'CONSTRUGTIONCOSTS
Item Estimated Costs:
OffictatUse Only= a _,>
(Labor and Materials m> M
1.Building $ — 1 Btrildiiig Permit Fee $ Indtcatehow fee is determined:
2.Electrical $
❑Standard City/Town Appltcatton Fee `'
❑Total Pralect Cosr'.(Item 6)x multtpher ' x
3.Plumbing $ 2 Other Fees $ ' _
4.Mechanical (HVAC) $ Ltst
5.Mechanical (Fire n
Suppression) $ Total Ali Fees $ }
Check No , + Check Amount• Cash pmou
6.Total Project Cost: $ p pmdiu Full ❑Outstanding Balance Due i
sty zg CNot j .
eo W t_ n cl
s ` SECTION 5 CONSTRUCTION;SERYICES: ` fi, ,.z a
5.1 Construction `Supervisor License(CSL)
t
Z r�
r- � �-�e e Licens N mrber Expiration Date
Name of CSL Holder
List CSL Type(see below)
""'C Tt'1K!( t�_(Cl J1 Type , Desmpnon
No.�^d Street
I✓ D �p� 1 Imo, U Unrestricted -di to 35,000 cu fQ
i\\\ y R Restricted 1&2 Family Dwelling
City(rown,State,ZIP Masonry
Roofing Covering
WS Window and Siding
SF i Solid Fuel Burning Appliances
1 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(IHQ
t c -1 I-:F / �D L/
HI�Registration Number Expiration Date
HIC Co qmy Name or HIC egis t Name
Sr"
No .�Strce -1--0 Email address
City/Town,State,ZIP Telephone
SECTION 6 WORI�RS'COMPEPiSATION'INSURANCE AFFIDAVIT(M G L ;g i52.§ 25C(q)
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 ..........hK No...........O
SECTION 7ac,OWNER`AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACT012'APPLIESFOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Y t
to act on my/behalf,in all matters relative to work authorized by this building permit application.
�9. l 6)- rcL 4 '� �
Print Owner's Name(Electronic Signature) Date
`-* ',:SECTION.7b:OWNEIti OR AUTHORiZED'A6ENT 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.
i
ZZ ( 5
Print Owner's uthorized Agent' ame(Electronic Signature) Date
NOTES .
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(MC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the H1C Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
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.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 Cosy' ��
wV'//ViiW'/�/IA/�l �/WN l�
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston,Massachusetts 02116
Home.jmprovement CQ"tor Registration
ReiiiiWa6w. 16DM
-:� # .' ` - Type: q8/►
Expba9on: 4MO16 TWO aaaM
ERIC A TEEL —.—.---
ERIC TEEL
672 WETHERSEIELD ST — —^— ——
ROWLEY, MA 01969 ---- —
Update AddrM and rrJare 0w&Mark reaoo for cbnq e.
L i Admms ❑ Reeesal O EMpkya wu O LAM card
3G1 O 2Cwmi
�a�ara.�g/ u
olrae orGIL`ler 8a�s Limm er M- UM&
for brd "aee only ---
IMPROVEtlIfd!Ii CONTRAGT'OM before the toned retard im
TYM 0116"of Cati Busiam Regulation
19 Park Pb 70 r'
Donbas MA 02116 J;
EMICATEEL
ERIC TEEL
OnWETHERSFURMST
ROWLEY,MA 0190 UedaeearY4 / valid w algaatae
Massachusetts-Department or Public safe:,•
Board of Building Regulations and Standards
- Z:uvciarvciiuz �i'nea r•+n7 irmC�aeis �
S
License:CSSL-099509
SRIC A TEEL
672we1hm-Mdsiire� =_
Rowley MA 01969
J.f:.-�ll,fita�.7rrn`� Expiration
Ca;ninissioner 0623/2017
ROOFING EST AMTE E R 1 C A. T E E L CSL. 99509
ROOFING HIC. 150452
Commercial and Residential • Fully Insured
P.O. Box 648
Rowley, MA 01969 978-479-7420 ericteel@hotmail.com
f ESTIMATE SUBMITTED TO: JOB NAME JOB i
1
�I ADDRESS - - I
I JOB LOCATION
I �-
CITYlSTATE/ZIP
PHONE i 6)I)qn� FAX M CELLO
WE HEREBY AGREE TO SUPPLYTHE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW...
NOTE:ONLY THE MARKED BOXES/PERTAIN TO YOUR ESTIMATE.
WE AGREE TO:
jK I. COMPLETELY STRIP TH ENTIRE �'1 F^ � ROOF(S)
OF THE EXISTING�_LAYERS OF SHIN LES.
O 2. INSTALL A NEW LAYER OF SHINGLES OVER THE
EXISTING ONE LAYER OF SHINGLES ON ROOFS.
3. INSTALL A N W DRUB JiOOF(S), USING ALL NEW RUBBER ROOFING MATERIALS ON THE
ff 4. INSTALL NEW ICE&WATER SHIELD ON_�_ ROOF(S),
ROOFS EDGE,RAKES,VALLEYS,DORMERS,SKYLIGHTS,CHIMNEYS,&FLAT ROOF AREAS.
O S. INSTALL NEW LB.A PHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE
i
6. INSTALL NEW 81NCH_R ALUMINUM DRIP EDGE ON THE ENTIRE'
ROOF(S).
II O 7. INSTALL NEW ALUMINUM STEP FLASHING ON ROOF(S).
IJR 8 INSTALL NEW(VENT PIPE BOOTS)ON ROOF(S).
GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE BY COVERING EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH
TARPS TO HELP PREVENT ANY DAMAGE DURING THE STRIPPING OF THE ROOF.HOWEVER SOME DAMAGE AND MARRING
COULD OCCUR BEYOND OUR CONTROL...
NOTE: (IF)MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE,AN EXTRA CHARGE WILL BEARDED FOR THE
LABOR&THE REMOVAL OF DEBRIS OVER AND ABOVE THE PRICE OF THE ESTIMATE.
We propose hereby to fumish^aterial and I r-comp' accordarNe with the atw the sum of
$ G1i Of O-0 Dollars
with payments to be made as follows:
Any allendow or deviation tram the above spec rzations involvim extra costs Respectfully
will be executed ordy upon written order,and will become an extra charge over submitted
and above the estansle.All agmeme O Contingent upon strikes,agents,or
delays beyond our control. Note—of be wfiMrawn by us t not accepted wtgtn days
,I
91tceptance of jkopogl6l
The above Prices,specifications and conditions a satiate ry and are hereby Signature
accepted.You am authorized to do the wo ecifted. ymen 'll be
made as cotkted above.
�� Date of Acceptance J f ignatur /
A6 ve CERTIFICATE OF LIABILITY INSURANCE °"�`""9°8 15
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CFJfTIRCATE 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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIRCATE HOLDER
IMPORTANT: ti the certificate holder is an ADDITIONAL INSURED,the polirypas) must be endorsed B SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on IN a certificate does net cantor ruts to the
certisca>te holder In lieu of such erdorsemen
PRODUCER
Paula Hellas
Circle Business Insurance PnoNE 978 777-5619 N
247 Newbury Street AD ulahalas@circleinsurance-net
Danvers, NA 01923
wsulE s AFFOROINGcovEwoE xace
IMURERA:SafetV Indemnit
INSURED ImsuREt B:Seneca Insurance
Eric A Teel Roofing LLC INSURETC:
Pc Boa 46
INSURER D
Rowley, NA 01969 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICES 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 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 BY PAID CLAIMS
LLTTR TYPE OF INSURANCE J POUCY NUMBER P DO D YYY IDd YY Lam
8 GENEtALLIABILI Y BAG-1009822 12/20/14 12/20/15 EACH OCCURRENCE $ 1 000 000
X COMAERCIALGEIERALLIABWTY DAbWGETORENM $ 100,000
cLAMMADE D OCCUR NED E)W(Aryore pesal) $ 5,000
PERSOIWLa ADVINA)RY $ 1.000.000
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LSAT APPLES PER PRODUCES-CDNPDP AGG $ 2,000,000
POLICY X PRO- LOC $
A AUTOMOBILE L'A8°rE'' 6219821 9/10/14 9/10/11 aaorOKSINEDSVIGLaaanl E $ 1,000'000
ANYAUTO BODILY INJURY(Per Person) $
ALLOWNED SCHEDULED BODILY INJURY(Per aeddenl) $
ALTOS X AUTOS
X HIREDAUTOS X AUTOS eraodaen NON-OWNED PRO $
E
UIBREUAUAB OCCUR EACHOCCURRENCE E
EXCESS LIAB CLAMS4AADE AGGREGATE E
DED RETENTION$ $
WORKERS COMPENSATION I WC STATU- OTH-
AND EMPLOYERS'LIABILITY YIN
ANY PROFREIORPARTHERIEXFLUINE NIA EL.EACHACOCENE
OFFx1.FeMEMBET EXCLUDED?
(Mantle"In NIa E.L.DISEASE-EA EMPLOY
eyyeess describe under
DESCRIP ION OF OPERATIONS below E.L.DSEASE-POLICYLBNR
DESCPoPTWMOFOPEATOMILOCATIONSIVBHCIES (ACxb ACORDIOI,AdBBorel RemdmSdmdM.1t espambmgdred)
Michael Allen 15 Pope St Salem, NA 01970
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Salem ACCORDANCE WITH THE POLICY PROVISIONS.
44 Lafayette Street
Salem, NA 01970 AUTHOR REPRESENTATIVE
Paula Balas
®19sa2oto ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
Phone: Fax: (978) 745-4638 E-Mail:
A`& CERTIFICATE OF LIABILITY INSURANCE DAB„en`YMAD�,S '
THIS CERTIFICATE IS 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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N the certlHeate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. B SUBROGATION IS WANED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorseme s.
PRODUCER xAra Paula Haws
CIRCLE BUSINESS INS AGENCY INC (AIC
NONE 976)7n-5619 INC.FA" N„
ADDRESS, paulahalas@cirdeinsurance.net
247 NEWBURY ST. INSUREast AFFORDING COVERAGE RAICO
DANVERS MA 01923 INSURER A: AIM MUTUAL INS CO 33758
INSURED
INSURER B:
ERIC A TEEL ROOFING LLC INSURER c:
INSURER D:
P O BOX 46 INSURER E:
ROWLEY MA 01969 INSURER F:
COVERAGES CERTIFICATE NUMBER: 843 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 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 BY PAID CLAIMS.
am TYPEOFINSURANCE ADDL UaR POLICY NUMBER POLICY EFF POLICY EIP LIMITS
COMMERCMLGENERALLULBRJTY EACH OCCURRENCEDAMAGE TO RENTED
$
CLAIMSIMDE ❑OCCUR PREJAISES $—_
MED EXP one $
N/A PERSONAL AADV INJURY $
GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $
POLICY ElJEC LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUmYOBILELU1&llfY COMBINED SINGLE LIMIT S
(Ea aV tlenl
ANY AUTO BODILY INJURY(Per person) S
ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per eccitleM) $
NON-OWNED PROPERTY DAMAGE $
HIREDAUTOS AUTOS PerERTe t
$
UMBRELIALU1a OCCUR EACH OCCURRENCE S
EXCESS LING C1AIMS4MDE N/A AGGREGATE S
DED I I RETENTIONS S
WORIORSCOMPENSATION X I
STATUTE ER
AND EYPLOYEW LIABILITY
A ICERRIETORNARTNEREEXECUTNE YIN EL EACH ACCIDENT $ 100,000
A (MandaRAIEMBEREXCLUDED7 wA wA MIA AWC40070318742014A 71/19/2014 11/19/2015
(YAntlatmlrhl NN) EL DISEASE-FA EMPLOYE $ 100,000
eyyee'9 d antler
DESORPTIONamON OF OPERATIONS helmv EL.DISEASE-POLICY LIMIT I S 500,000
N/A
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACORD 101,Additional Rmrmrks SchaduN.may Ire alLachetl U nmm sperm Is repuharN
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside Of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.gov/lwdMrorkerscompensabonfrnvestigabonst-
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Salem ACCORDANCE WIfH THE POLICY PROVISIONS.
44 Lafayette Street AUrdORI ED REPRESENTATIVE
Salem MA 01970 L
Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA
(91988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD