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12 PURITAN RD - BUILDING INSPECTION (2)
�o U= 3,q 3 E ' falnAl SER�tI��:. The Commonwealth of Massachusetts 3TY OF ^n =,p Board of Building Regulations and Stand iu% 39 P f_ , i Massachusetts State Building Code,780 C Ste' /� Revised Mar 2011 l N 1 Building Permit Application To Construct,Repair,Renovate Or Demolish a rOne-or Two-Family Dwelling This Section For;Official UseOnly Building Pemtit Number: Date Applied:' 1 Budding Official(Print Name) Signature Date - SECTION 1:SITE;INFORMATION 1 1.1 Pr erty Addr 1.2 Assessors Map&Parcel Numbers {I_ 1r2 rnzur^' L l 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ t. --SECTION2: PROPERTY OWNERSHIP` kt`tf RAJ a4>,.� ! 4gr1 nQ 0 U Name(Print) City,State,ZIP (,n 690 995� li�YIPR ruFSII �4R�,no cat' No.and Street Telephone Email Addrbn SECTION 3:DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(,) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ city: Brief Description of Proposed Work": t �itH tt ATe1C rif-rr c SECTION*ESTIMATED'CONSTRUCTION COSTS Item Estimated Costs' Of5cialUse Only (Labor and Materials) 1.Building $ I S-- y-S L Building Permit Fee:$ Indicate how fee is determined: 2.Electrical Eln App Standard City/Fowlication Fee " $ ' ❑Total Project Cost"(Item 6)x multiplier" x 3.Plumbing $ 2. Other.Fees:4.Mechanical (HVAC) $ List: c 5.Mechanical (Fire $ Suppression) Total All Fees:$ + Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ Gls t-f-�i "❑Paid in Full ❑Outstanding Balance Due: GLN/S TOpp.,J� `7 l s 1 ' L SECTION 5: CONSTRUCTION SERVICES 5.1 AColnstr ictiron•supe!rv-isyor License(CSL) p r o'7 3 L4 c,J�J��C ✓t ✓ i I �— License Number xpm j Name 6Y°CSL Holder n.. ;3 X List CSL Type(see below) fd No.and Street - Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mmonry - RC Roofing Covering �oC Window and Siding SFF Solid Fuel Burning Appliances �n IasWation Telephone Email address D Demolition 5.2`Registered Home Improvement Contractor(HIC) t a J S Q V-NI'N 5✓ 4A44(bh Jq 'jt *-t -rAti HIC Registration umber Expiration Date HIC Com an.p y Narpe or C e u Nq.and�trpr �w` �I� Email address Ciity/Town, State,ZIP SCE y 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 pemut. Signed Affidavit Attached? Yes ....... No........ 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T I,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. X 1 �--1 4 Z(wA bi Print Owner's Name(Electronic Signature) I I Date SECTION 7b:OWNEW 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 C d in this application is true and accurate to the best of my knowledge and understanding. L�t' > �v(1ti1 (O ^ I o Print is or Authorized Agent's Name(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(FIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.a. 142A.Other important infornation on the HIC Program can be found at Information on the Construction Supervisor License can be found at 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,fmished basemenUattics,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" ` Massachusetts Department of Public Safety, Board of Building Regulations and Standards License: CS-073424 Construction Supervisor iF r+; JEFF A SCHULTZ PO BOX 665 r MIDDLETON MA 019499 - , Expiration: Commissioner 02/08/2018 w 611ut'� /Is Office of Consumer Affairs&Business RegulaHou-JPo - OME IMPROVEMENT CONTRACTOR egistiato, 8.1294 Type: xpiration 01 Corporation -7) 1' J&S CARPENTRY N -- CRION,INC. - rd JEFF SCHULTZ Ir 22 FOREST ST _ ..� MIDDLETON,MA 01949 . Undersecretary 5 L ;F iyyj 5 x I� fr (ti y'4- afrY L t H Sx t - - "� � � �`V i r r 1 r a L`pg s Y '_�" ! ?t x .�� ✓y w' k � �"�� - �,.'S'SE'...4"v ''1" .-t r1q 2 r�#C+ ,ts_a�*n :e-_ -{e v.S' ,�''..: ..,xc`�,.0 ='�`r�"�" -'� n:`r*..'t Y.s9�.`t'�`��-.......�' r�<. •.� .�? Vs 10 - -- --I- -- -- I -I�L- -I -I--� I-- --- I � '-I —I C—`- - 1 'I -'sl_�— - ij �I I � � TT a s Y ha 1 ? e i8i J&S Carpentry and Construction, Inc. 22 Forest Street P.O. Box 655 Middleton,MA 01949 License#CS 073424 /HIC 181294 CONTRUCTION CONTRACT Agreement entered into this 15 day of June, 2016, by and between Bobby and Lisa of 12 Puritan Rd, Salem Massachusetts 01970, hereinafter called the "Owners" and J&S Carpentry and Construction, Inc., and its authorized representative, Jeffrey A. Schultz, President, hereinafter called the "Contractor". Witnessed, that the "Owners" and the "Contractor", for the consideration hereinafter named, agree as follows: Scope of the Work—The"Contractor" shall furnish all of the materials (except as noted) and perform all of the work necessary for the following job: Build deck • Remove old deck. • Construct deck measuring approximately 8 feet x 13 feet. • Deck footings 12" diameter x 48" deep filled with concrete. • Deck ledger will be fastened to the house structure with bolts. • Deck frame will have proper flashing. • Deck frame will be 2x8 pressure treated lumber. • Deck beam will be double 2x8 supported by 6x6 pressure treated posts. • Joists will be supported with proper Simpson joist hangers. • Decking is AZEK Slate Gray square edge. • Deck board fasteners will be Cortex or an equivalent screw type with color matched plugs. • Decking will be laid out in a picture frame. • Rail posts will be 4x4 pressure treated with a composite sleeve covering the post. • Post caps white Island style or equivalent. • Railings are white AZEK Premier or equivalent with 2x2 balusters color white. • All hardware used will be Zink and or galvanized coated. • Area of work will be kept neat and safe during the construction duration. • Work area swept end of each day. • Trash and building permit in addition, billed separately. • Warranty on labor is 5 years. • Material warranty by manufactures. J&S Carpentry and Construction, Inc. 22 Forest Street P.O. Box 655 Middleton, MA 01949 License#CS 073424 /HIC 181294 1. Time of Completion—The work to be performed under this Agreement shall be commenced on or about TBD once building permit is obtained, and shall be completed within a reasonable time, weather permitting. 2. Contract Sum—The "Owners" shall pay to the "Contractor" for the performance of this Agreement, the sum of Fifteen Thousand Four Hundred Fifty Dollars and 00/100 Dollars, ($15,450.00). This price includes the following: See scope of work. The "Owners" are responsible for paying any amounts due for plans, drawings, architectural work, permits, and any other related fees. 3. Impossibility of Performance—In the event that any contingencies beyond the control of the "Contractor", now unforeseen, including but not limited to Acts of God, shall arise which shall render temporarily impossible the performance of this Agreement by the "Contractor", the performance hereof shall be suspended temporarily until such impossibility is removed: and if such impossibility of performance by the "Contractor" shall continue for more than thirty (30) days,then it shall excuse performance by the "Contractor" and shall discharge both parties from all obligations under this Agreement. 4. "Or Equal" Clause—Whenever any item in this Agreement, defined by describing a proprietary product or by using the name of a manufacturer or vendor, the terms term "or- equal", if not inserted shall be implied. The specific article, material, or equipment mentioned shall be understood as indicating the type, function, standard of design, efficiency, and quality desired, and shall not be construed in such a manner as to exclude manufacturers' products of comparable quality, design, and efficiency. 5. Extra Work or Changes—No extra work or changes shall be done except upon a written order signed by the"Owners" and the "Contractor". Such order shall state the cost of such work and the time allowance for same, if any. 6. Settlement of Disputes—If payments are not made by the "Owners" and received by the "Contractor"by the due date se t forth in this Agreement, the "Contractor" shall charge interest on the balance overdue at an annual interest rate of twelve percent(12%). In addition, if said payments are not paid when they become due, the"Owners" agree to pay all costs and expenses of collection, including reasonable attorneys' fees. 7. Entire Agreement—Except as otherwise stated expressly herein, this Agreement constitutes the entire agreement among the parties hereto. This Agreement supersedes any prior agreement or understanding and may not be modified or amended in any manner other than as set forth herein. 8. Miscellaneous—The covenants and agreements contained within this agreement shall be joint and several obligations of all parties, and shall be binding upon the successors and assigns of all parties. 9. Governing Law—This agreement and all the rights of the parties hereunder shall be governed by the laws of the Commonwealth of Massachusetts. IN WITNESS WHEREOF, the parties hereto have exec d this Agreement the day and year first written. Witness Owner Witness Owne* L UCV\A— Witness Authorized Rep. Jeffrey A. Schultz, r ide J% J&S Carpentry an Construction Inc. i �r•j, i i CfS 2 3 si X § L it # F } 1 y k 4A CITY OF S.UI EM. NL-�sSACHL"SETTS BuimING DEP\RTNW-NT p 120 WASHINGTON STREET, 3'c FLOOR TEL_ (978) 745-9595 F.,m(978) 740-9846 KIMBERLEY DRISCOLL NLNYOR THomAsST.PI>mE DIRECTOR OF PUBLIC PROPERTY/BI'A.DLVG CONLMSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busim7Org nizatiowIndividual): `�CY:J�' �.1 el,s C.Git ,p/W Address: ► a'x tp s:r �F 0, City/State/Zip: IA ;w n t W_e i , VA Lk o )q hone ill: C)-n 7Sjp 9,-7-4Lk,1 Are you an employer?Check the appropriate box: Type of project(required): LA I am a employer with 7/ 4. El am a general contractor and 1 6. ❑New 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 ❑Remodeling ship and have no employees These subcontractors have 8. ❑ Demolition working for true in any capacity, workers'comp. insurance. 9. ❑Building addition INo workers'comp. insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ t am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself[No workers' camp. C. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' !3.❑Other comp. insurance required.] 'Any applmaA that cheeks box AI must also fill our the section below showing their worken'compensation policy information. t Ihowners who submit this affidavit indicating they are doing all work and then hire outside contracts,most submit a tte,,affidavit indicting suck tlua check this box mu t attached m additiord shoes showing the name of the subcontractors and their workers'comp,policy information. I am an employer that is providing workers'compensatlon insurance for my employees. Below is the policy and job site information. Insurance Company Vattrt� i �>rt/S , Policy it or Self-ins. Lie.#: SU 3 _50 2U ) Expiration Date: 7—)to Job Site Address:_ �� City/State/Zip: 5,&ke4,K WA& b)g 76 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 certify nut r thr a'ns m enalrfr ]perjury that the information provided above is rue and carrect Si•�nat ar pate: _Z� Phone A: Ojlicial use only. Do nor write in tins area,to he completed by city or town a iciui City orTow•n: Issuing Authority(circle one): 1. Board of health 2_Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: __. Phone tt: 1 n CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDIYYYY) 6128116 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 policy(ies) 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 lieu of such endorsement(s). PRODUCER CONTHAMEgCT Larry Cowan Cowan Insurance Agency,Inc. PHONE Eau.978 372.1451 F'ix . 978 521.4669 359 Main Street 6-MAIL : la cowaninsurance.com _SS _ Haverhill MA 01830 INSURER(SJ AFFORDING COVERAGE NAIC# INSURER A, Associated Employers Insurance Company INSURED INSURER B J&S Carpentry 8 Construction Inc. INSURER C POB 655 INSURER D: Middleton MA 01949 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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. INTR7 TYPE OF INSURANCE AODL SUBR POLICY EFF POLICY E%P 1 POLICY NUMBER I LIMITS GENERAL LIABILITY EACH OCCURRENCE s COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED SE $ CLAIMS-MADE OCCUR MED EXP IArn,one eraon is PERSONALS ADV INJURY_IS GENERAL AGGREGATE •$ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY I I PRO- I LOC $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT —� .swJUauU_ ANY AUTO BODILY INJURY(Par person) S ALL OS SCHEDULED .BODILY INJURY Per amdeni $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE f, HIREDAUTOS AUTOS �) S 4 !S UMBRELLA DAB OCCUR I EACH OCCURRENCE S EXCESS LIAB CLAIMSMADE AGGREGATE $ D 0 ETENTI N S a WORKERS COMPENSATION X WC STATU- I JOTH. 9 AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOMPARTNEWEXECUTIV� E 1.EACH ACCIDENT $10O 000 A OFFICERIMEMDEREXCLUDEDT N , NIA WCC50050136502015 IO7116(2015 D711612016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $100,000 q Ir ea,dos ua uM P NO -OPERATIONSE.L.DISEASE-POLICY LIMIT s500,000 � � h M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks schedule,if more space Is required) Carpentry contractor. CERTIFICATE HOLDER CANCELLATION City Of Salem Mass SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE +Jy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN { ACCORDANCE WITH THE POLICY PROVISIONS. } 120 Washington Street 3rd Floor / Salem,MA 07970 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. { ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD - n CITY OF SALEM, AXSSAC1 USETTS u' BUMDLNG DEPaRT\LENT 120 _0 WASHINGTON STREET, 3" FLOOR T I- (978) 745-9595 F.ux(978) 740-9846 KI*%{BERLEY DRISCOLL MAYOR T7to�w ST.PtERRE DIRECTOR OF PUBLIC PROPERTY/auaDr-7G COXL%IISSIONER 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: (name of hauler) The debris will be disposed of in I�(name of facility) addr sot facility) ature of perrxiit applica/� nt date r CITY OF SALEM ROUTING SLIP New Construction Certificate of OccupancR LOCATION DATE ASSESSORS DATE 93 Washington St. CITY CLERK DATE 93 Washington St. PUBLIC SERVICES DATE 120 Washington St. _ x WATER DATE j 120 Washington St. CROSS CONNECTION DATE 5 Jefferson Ave PLANNING DATE 120 Washington St. z { CONSERVATION DATE 120 Washington St. ELECTRICAL DATE 48 Lafayette St. FIRE PREVENTION DATE 29 Fort Avenue HEALTH DATE 120 Washington St. BUILDING INSPECTOR DATE f 120 Washington St. s a i z S