Loading...
6 PRESTON RD - BUILDING INSPECTIONf IP -I �k1 � 3 1 q The Commonwealth of Massachusetts REC Boaz I of Building Regulations and Standards INSPEC rl6NMVICE Mass ichusetts State Building Code, 780 CMR RevisedMar2011 Building Pei it Application To Construct,Repair,Renovate Or DemolMkAlIG21 A W Q One-or Two-Family Dwelling This Section For Offi ial Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Prope Address: 1.2 Assessors Map&Parcel Numbers 1.la Is this an accepted s4eet?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Us Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks({) Front Yard Side Yards Rear Yard Required P,ovided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§ 4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ I Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSMV 2.1 O nerr of Record oavr n -e- Bert-t, --_ Su���r r 019 70 Name(Print City,State,ZIP 6 �reS 7YW-.26 k 2- No.and Street ( Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing B filding❑ Owner-Occupied ❑ Repairs(s) ❑ eration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Idg.❑ Number of Units_ Other Specify: Brief Description of Proposed Wo k2: S 8s I - SECTION 4:ESTIMATED CONSTRUCTION COSTS . Item I Est mated Costs: Official Use Only Labo and Materials 1.Building I $ i- 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cos?(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 6 5.Mechanical (Fire I $ Total All Fees:$ Suppression) Check No:' Check Amount: Cash Amount: 6.Total Project Cost: $ 9 Ys, ❑Paid in Full ❑Outstanding Balance Due: ,v -� nVL__ �,OEP"T-" , �slzq L SECTION 5: CONSTRUCTION SERVICES a 5.1 Construction So ervisor License(CSL) 15 iro License Number Expiration Date Name of CSL Holder = EIIC W. P81B1 Hilton Short List CSL Type(see below) L1. No.and Street S km 1A 01970 WDe Description tricted Buildings s u to 35,000 cu.ft. City/Pown,State,ZIP cted 1&2 Famil Dwelling Coven.n w and Sidin t -ilk .7W4-31 - Fuel Burning Appliances tionTele hone Email address lition 5.2 Registered Homel Improvement Contractor(HIC) HIC Company Name or C eggs ` p�gte , IBC Registration Number Expiration Date Oj JG[ICLSbIIAYCIWe No.and.Street I ' CM 01970 '71 (_�/tf 3 Email address Ci /Town,State,ZIP Tele hone SECTION 6:WORKS )'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insuran affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the d ial of the Issuan of the building permit. Signed Affidavit Attached? es .......... No...........❑ i SE 1 TION 7 :OWNER AUTHORIZATION TO BE COMPLETED WHEN OW1 R'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject proper ,hereby authorize Fr i:C I"/,-) to act on my behalf,in all matter relative to work authorized by this building permit application. �f Print Owner's Nam lecironic Sig ature) D 1 9 "/ Date SECTION b:OWNEWOR AUTHORIZED AGENT DECLARATION By entering my name billow,I h by attest under the pains and penalties of perjury that all of the information contained in this application is p ie and accurate to the best of my knowledge and understanding. / Print Owner's or Authorized Agent' Name(Electronic Signature) o `Date ` NOTES: 1. An Owner who obtains a bui ding permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in th�Home I riprovement ContractorI IIC)( Program),will not have access to the arbitration program or guaranty fund un let M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.-ov/ocaInformal on on the Construction Supervisor License can be found at www ma ss eov/drams 2. When substantial work is pla tried,provide the information below: Total floor area(sq.ft.) I (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 Squaze Footage"may be substituted for"Total Project Cost" 61 R Jefferson Avenue Salem, MA 01970 • (978) 744-8143 August 1, 2014 PROPOSAL SUBMITTED TO: NSCAP/Chuck JOB SITE: Joanne Berube 6 Preston Rd Salem, MA 978 744 2682 We hereby submit specifications and estimates for: Roof 18sq 1. Pull building permit. 2. Remove and dispose of existing shingles. 3. Install up to 100 sf sheathing as needed. 4. Install ice and water shield 3 ft. up at perimeter of roof and at valleys 5. Install 151b felt paper 6. Install flashing/pipe boots at chimney, pipes, skylights, etc. 7. Install drip edge. 8. Install 30 year architectural roof shingles. 9. Clean and remove debris. WE PROPOSAL HEREBY TO FURNISH MATERIAL AND LABOR COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS FOR THE SUM OF: ($6995.00) .................................................................................................................................................................... All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviation from specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate.All agreements contingent upon strikes, accidents, or delays are beyond our control. Our workers are fully covered by Workman's Compensation Insurance. ......................................................................................................................................................................... BPI Certified • EPA and Mass. Lead-Safe Certified Authorized Honeywell and NGRID/NSTAR Contractor The Cordmonwealth ofllMassachusetts ` (;1W— w-, DeparmentoflndustrialAccidentsOffice oflnvestigations 1 Conoo ess Streets Suite 100 Boston, ?� 02114 2017 Workers' Compensation Insurance Affidavit. Builders/ContractOrs/Electricians/Pl A licant Information umbers L.Please Print Leeibly slue (Business/Organization/individual): "Uill!ii^ 'Wedjvt128itOD, Address: 6i - Je rsar Avenue Sale 0 7 City/State4c Are you employer? Check the a Phone#; q7� I•L I am a employer with 2 J� PPt0p4ate bos: employees(full and/or I a general contractor and I Type of Project(required): part-time). have hired the sub-contractors 6, ❑New construction 2•❑ I am a sole proprietor or partner- listed on the attache sheet. Shhave ip and have no employees �• ❑Remodeling working for me in any capacity. employes and have rwo workers, 8- ❑Demolition [No workers' comp.insurance COMP. ins required.) P urance-` 9• ❑Building addition 5• ❑ We are a corporation and its 10-El Electrical repairs or additions '• I ys a homeowner doing all work officers have exercised their myself. [No workers'comp. right ofexempfion per MGL 11 Plumbing repairs or additions insurance required.)t c. 152 §1(4), and we have no 12•�Roo airs employees. [No workers' 13. . then �JS Any hacks box 4§1 must comp,insurance required.) wly out the t Homeoplvnersiwhosubmit this affidavitindilso caating they care d ning all Work and then hire outside contractors must submit a new'Contractors that check this box must attached an additional sheet showing the name of the sub•contnt acts and state submit newaot those entities have employees. If the subcontractor,have em to aotthosettle p yees,they must provide their workers,comp.policy number indicating such. information.inn a employer that is providing workers'compensation insurance far my employees Below rs the policy and job site Insurance Company Name: 2ut�, u; Policy r or Self ins.Lic.#: —•��7 Job Site Address: p Expiration Date:_ity —�O t'�S�rt ✓ Attach a copy of the workers compensation policy declaration page(showing thetpol Zip: S G/2/v/ A Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impositionhofc and expiration date), fine up to S I,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WO Of up to$250.00 a day against the violator. Be advised that a co o f criminal Penalties of a Investigations Of the DIA for insurance coverage verification. py thus statement may be forwarded to the RK OVER and a fine Office of I do lrereby cent! u r the a !ties of er'ar that the in ormation provided above is true and correct iienatwe: 'hone Date: . / ! d: C/ 7� 7G//i/- t�� 3 Official use only. Do xot write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License 1.Board of Health 2. Building Department 3.City/Town Clerk �.Electrical Inspector 5. 6 Other P Plumbing Contact Person: Inspector Phone"• iugaa A.A.an aw-i or J_cr cvltY r :cr : �r tu•! rnvc JVr V00 ram OGL VGl • 14 II a CERTIFICATE OF LIABILITY INSURANCE [.)ArL D,4 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: If the certificate holder is an ADDITIONAL INSURED,the poficy(es)must be endorsed. If SUBROGATION IS WAIVED, 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 Reu of such endorsement(s). I PRODUCER CONTACT EASTERN INS GROUP LLC PHONE 233 WEST CENTRAL ST i ar No u: 'FAX Nm: NATICK.MA 01760 I MWL WSURERIS)AFFORDMOCOVERAGE NAIC9 i INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURED I INSURER B: ATLANTIC WEATHERIZATION LLC { INSURER C: 61 REAR JEFFERSON AVE f SALEM,MA GIS70 INSURER D: t INSURERE: INSURER F: CQVFRAnES REVISION MUM BER- 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. WSR TYPE OF INSURANCE AWL SYIUVG pOLLCY NUMBFJi POLICY EFP POLICY EXPft UMW LTR MWDOMTYY MM!WIYYYY GENERAL LL40JUTY RENCE 5 COMMERCIAL GENERAL LIABILITY ENTED S CLAIMS-MADE❑ OCCUR i 0 .1ADVIWURY REGATE S GENL AGGREGATE LIMIT APPLIES PER: COMNOP AGO S POLICY JEGT LOC S AUTOMOBaEUABLITY i aMaBIINNeD SINGLE UMIT S ANY AUTOAU I BODILY NUURY(Pal Pttaon) S A TOS OWNED SCHEDULED AUTOS I BODILY IWURY(Par aceEttl) S HIRED AUTOS ANQNO-OSNWEO OP Y AMAGE a II S UMBRELLA LIIB OL IMS ' EACH OCCURRENCE S EXCESS UAB OCcuR MADE AGGREGATE S IcEol IRETENTIONS , S WORKERS COMPENSATION WCSTATU- I CITH- AND EMPLOYERS!UABIUTYR YM f X TORYLIMITS ER ANY PROPRIETOmARTNSIVEXECUTrv� ELEACHACCIDENT $500.000 OFFICERIMEMSER EXCLUDED? INtI NIA I 6ZZU6 03.20-2014 03.20.2015 (alendalttYm NF) 1 1 58270121 E.L.DISEASE-EA EMPLOYEE $500,000 11 desnLe under DESCRIPTION OF OPERATIONS I I EL-06EASE-POLICY LIMB $500,000 tl f DESCRIPTION OF OPERATIONS!LOCATIOUSI VEHICLES(Apeeh ACGRD 101,Additlenal Remarks ScW W Y,H more apace Is regWmd) i I I CERTIFICATE OLOCANCELLATION CITY OF SALEM - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 93 WASHINGTON ST CANCELLED BEFORE THE EXPIRATION DATE THEREOF, SALEM,MA01970 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR¢®REPRESENTATIYE � � Adf�w_ P�•A'' I 01988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010103) The ACOIRD name and logo are registered marks of ACORD •F, V CERTIFICATE ER 8 IFICA 8 E OF LIABILITY 0 INSURANCE DATE lMM100/yyyyJ THIS CERTIFICATE Is ISSUED IqS q MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE c6RTIFlCATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY E NEGATIVELY'AMEND, EKZND OR. ALTER THE COVERAGE AFFORDED TE HOLDER THIS BELOW. THIS CERTIFICATE PR TE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORDERINSURE By THE AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the lic es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require an endorsement A statement on this certificate does not confer rights to the PD yf eerti6cate holder in lieu of such endorsemeM(s). PRODUCER Eastern Insurance Group LiNONNTgOT Construction 233 West Central Street PHONE . (508)651-7700 FAX O No AD R S: INSURED Natick E.MAII Mill01760 INSURER S AFFORDING COVERAGE INSURER A Arbella ProtaCtiOII Ins. Co. RAICR 1:tlnti ac Weatherization INSUREReArYlella Ind 1360 61 Rear on Avenue INSURER al Llus InsurancelCo Co 0017 INSURER D- Salem MA! 01970 INSURERS; OVERAGE$ INSURER F: ICERTIFICATE NUMBER 3raster 2014 FX LUSHCAT IN51AND ISSUEING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ICY P THIS IS IS r0 CERTIFY THAT THE POLICIES UI INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WHI REVISION NUMBER: CERTIFICATE MAY BE ISSUES OR MAY PERTAIN, THE INSURANCE AFFORDED BY HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L TYPEOFINSURANCE GENERAL LIABILITY POUCYNUMBER M pCY EFF pCY EXP LIMITS X COMMERCIAL GENERAL Ug81LRY I EACH OCCURRENCE A D $ 11000,000 CLAIMS-MADE X OCCUR t 500042826 PRE IS t /zD/zo14 /zo/2o15 "" S 50,000 MEDEXP(An one Pension) S 51000 PERSONAL S ADV INJURY S 1,0001000 GENT AGGREGATE LIMIT APPUES PER:! GENERAL POLI PRO- AGGREGATE S 2,000,000 CY X LOC I PRODUCTS-C AUTOMOBI UA UTy OMP/Op qGG S 21000,000 LE BI S $ ANY AUTO COMBINED SINGLE LIMIT ALLOWNED as 14w1 S 1 OOO 000 AUTOS X AUTOSSULE0 020015871 BODILY INJURY(perpsrson) S X HIRE D AUTOS X A��WNEDi /20/2014 /20/2015 BODILY INJURY(wereccitlenp S PROPEaIRtlan�AMAGE S X UMBRELLA LIAR X OCCUR PIP-Basic p S e 000 EXC UqB ESS CLAIM .UADE EACH OCCURRENCE S 11000,000 DED RETENTIONS I 600058654 AGGREGATE WORKERS COMPENSATION /20/2014 /20/20 S 11000,000 15 AND EMPLOYERS'UASILM I S OFRjANY PROPRIEmR/PARTNERIEXECUTIVE YIN WC STATU- OTH- Olandia MEIAaER EXCLUDED? O NIA(Men4Sloc in NHJ EL EACH ACCIDENT II es.tlesmba antler j S DESCRIPTION OF OPERATIONS belmx I E.I.DISEASE-EA EMPLOYE S C POLLUTION LIABILITY EL DISEASE-POLICY UNIT S PL200378602 0/1/2013 0/1/2014 GENERAL AGGREGATE i EgPOLLUTIONCONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VENICIES I0.Nach ACORD 107,g4tll6ono]Rem dM Schedule,Ir more specs is requi $1,000,000 { i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SALEM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 93 WASHINGTON 3TREETi ACCORDANCE WITH THE POLICY PROVISIONS. BEM, MA 01970 I AUTHORIZED REPRESENTATIVE i ACORD 25(2010105) Ronald Cleavesl INS025mm�rtsl m I Tha Annon namganrl Innn aro ronia}aroei mar688- 010 ACORD CORPORATION. All rights reserved. lKh Massachusetts -Department,ef Public Safety �[ Board of Building Regulations and Standards Construction Supervisor License: CS-087977 ERIC W PALM 3 H MTON ST S Salem MA 01976 Expiration t Commissioner 04/23/2016 4-J�e�oJ�uuOurlM[r�l�1����Y?ifnc�ttie!!J X . *ME oCoosumerAffairs&Basmess RegaladooIMPROVEMENT CONTRACTORIstration142089 Type:iration: 3112/2016 Ltd Liability Cotpo: ATLANTIC WEATHERIZATION L.L.C. i ERIC PALM _ - 61RJEFFERSON AVE � . SALEM,MA 01970- -Undersecretary ` ffi.