14 RAYMOND RD - BUILDING INSPECTION f I"he Commonwealth of Massachusetts
Y11 r,i� Board of Building Regulations and Standards CI"I'Y OF
'i•�;. Massachusetts State Building Code, 780 C•NIR SALLM
Building Permit Application To Construct, Repair. Renovate Or Demoli• a vis
One-or Tivo-Falpoilv Dn elling
This Section For Official-We Onl
Building Permit Number: Oat ;\pplied: /-
DwlJing Olticial(Print Nrunc) Signature Dale
SECTION 1:SITE INFORIIIATION
1.1 Property
Address'
t3 A Ad dress: `l' ey 1.2 Assessors blap& Parcel Numbers#siF- L , PJ
1,la Is this an accepted street?yes no blap Munher Parcel Nunther
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Propuscd(Jsc Lot Area(sq It) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear.Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:( - I-c.JU.§S4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check fifes❑ Municipal ❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
aAA fat;_7 7 f9 L l/i
Name I Pant) Uty.State,
A Vn4 c ���1 9 2g co "1- /S
No. and Ctreet—T y
Telephone Email AJdress
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ Owner•Occupied ❑ Repairs(s) Alterations) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specily:
Brie •Deseripnon or roposed \Vork-: ' 4,t iIZ
SECTION 4: ESTIDIATED CONSTRUCTION COSTS
licm Estimated Costs:
(Labor and .Materials) Official Use Only
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
'_. Flectrical S ❑Standard City/Town Application Fee
❑Total Project Cost'(item 6)x multiplier _ r
i. Plumbing S 1.. Other Fees: S T
4. \lech;mical 111\':1('1 S List:_
5 \lechanieal (Fire ---- - - --
S - " ---. tiup ucuionl Tutul :\IlFces: S
is. Total Project Cost S C Beck No. ('heck :\nunut: _ -- "- C,uh Amount:
O ❑Paid in Full ❑Outst ❑ding Bal:rice Due:
a � el�
� G
bl�
SECTION 5: CONS'MUCriON SERVICES
5.1 Construction Supervisor License(C'SL)
DffQ3_9 3-- - -]-_M
License Number Fcpiralion Dane
N:une ul'CSI. I lolder
7 � �j I iu CSI. I'�pu(see bolo+v)
�I��t luu-6--5 C/i_J_l r--.--- 1�PC Description
No .utJruet
li I inrestricluJ I Iluildin9s Up to 35,1110 cu. It.l
R Restricted I l3 Pwnil Dodlin'
C'ilei fo-i I�o+l n.Slate.LI Nt hlasun
.. RC Rooting Covering
W'S Window:old Siding
SF Solid Fucl lhlrning Appliances
I Inxdution
'felt hone h]nuil address D Demolition C/
5.2 Registered Home Improvement Contractor(,HIC) / iC 9 s 3 o��
M7z g5{� A 'y��/ �% %i�/(� C/ I IIIC('1ReeSguvation Number Fspiratiun Date
I IIC'Cumpan,,]],,Name or I ItC' Ite1 i�umnt Names f
my
No. Street Email address
Ci /Town,State,ZIP 'fdu hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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.
Print Owner's Name(Electronic Signature) Dale
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
cont ,ut his appli tion is tr e a accurate to the best of my knowledge and understanding. j
I'rint s O+tner' or Autht red Agunt-s Nance(Hectnnuc Signature) Date
NOTES:
I. :\n Owner Whu obtains a building permit to do his:her own work,or an owner who hires an unregistered contractor
(nut registered in the Hume Improvement Contractor(HIC) Program),will rru have access to the arbitration
program or guaranty fund under M.G.L. c. I42A.Other important information on the HIC Program can be found at
tact% m.r•. •.•, + ,y i Information on the Construction Supervisor License can be found at
2. %\lien substantial work is planned,provide the information below:
Total dour area(sq. R.) I including garage, finished basenlcnt'attics.decks or porch)
Gross living area i sq. lit I _ Habitable room count
\umber of fireplaces Number of bedrooms
Nuntherufbathrt,otns \umberufhalfhaths
1)pc of heating s)slenl Number of decks, porches
1')peofcoolhtg s)stenl -- ._ _ Fnclosed
1, "Itn;ll Project Square footage" nllt) he Substituted lir''I'olul Project Cost"
CITY OF SALEM
PUBLIC PROPRERTY
S° DEPARTMENT
,w:.4I1 Y',nIN.-it
12Z IVe Hu,\tl I%^Sla ttl• a j,\Irvl. MIp,In V I
loYurkers' Cumpensatlon lnsurunce :lfOdavit: UulldervCuntractursiCle triclrnilPlum
� I Ilicunt In unnutlo ben
_ PI Le 'hl
V;IIT1OIlluu,k,ytlrganvjli ntIndsv,,Iuull: �tLO I�
/c
Cily,SlamZip• �� Phonell%
I • e.1 ou an c q/loyer7 Check the approyrlme boll:
1. a cmpluyur with 4, 0 c r) t'rpro)ecl(rwlulrvd):
culpluyvcs(full und/ur part•lime).I lluvu hired Ihv.uh�c eua�unt and l M
h• ❑New curs°Irucliue
2.0 1,1111 a sold proprit:lar or purincr• fisted on the attached sheet t 7. Cl Re/noddins
.vhip and have no empluyec's These sub-contractors haw
,wrkiny titr Ind in any capacity, nvrkers'comp, insurance. d' 0 Demolifion
I NO workers'cutup. insurance J. 0 We are a emporelinn and its q• ❑014114111119 addition
rcquircd,j 'Orders haw c�ureiecd their It1.0 Electrical repairs or additions
7.❑ I and a homwwnur duin(l all work fight ofu.eemption put hICL 11.0 Plumbing repairs myself.jNa,vnrkers'cum ' Y pairs or addilitina
p• C. 1 J2,4I(4),and we hove no insurance rcqulred.j r :Irlployco:4. tNo workers' l2❑Ruufrepuin
.mop, insurance required.J 13.0 all,
4 ny.ppLraa Ih,r ehceb bunt mum.dw fill wl the„Ichml tn:aim,dalwul ,
11.,m,,,,v,nera wtw Vii this
thisb"o111davll inJiulin t e heir wwlua'eynrpeeyelyp nWiey,uGnlrwriwa
'f..nlewb,n Ihm allecY IAu Eae mtrt aaahell„n aJY�+u driae oil
wu,he 1IMm oft a Side ewrnle
,dial•tuwr Jlulvin IM naaMW IN,Ubt O'er lore mwl.uhnY a now m.1,,il indlwline%Ne,
/ara un velployer/huNr prvvlr/lnr werArra'rurnprnrmlrn hl.runueee/ur my rrnp/v,r�their
Bdu�/+
Iy
irr�urnrw&rs (�
Insurance Company Name:
I'ulicy 4 ur Sulf•ins. Cic.M:�>t}L/�r/,��y5t� _
7 � ^ Eapiralwn Data:
lul> Sitd Aildress:_�`�1 �/t} �/�'J�f/L/Y/1 /•� l7 c, �L�
.lttacA n cagy of the Yorkers'cumpemation pollc-y declaration p' a— ye_ (showing num�virplrst��te).
Palluro w,adore cuseroye as required uodcr Seuiun c. 132 eau lead to the imposition of criminal penalties of a
tiI'u up ri S 1.04.1 q y 1juil uue•year impri.v.Inmunt, as well as civil Ilenalhcs in the lunn ura STOP 1VORK ORDER and a rind
alup rn i?St3 fM,I Jay.truinat 16e")"llnr Ile adviiiI that a copy urlhrs dafcmcnt may be lurwarded to the Otlicd,If
In,:nn�au,nu uY:hc DIA for alsnall'cc IIivera,u \.v a,41;41n. -
/du/r,•rrh y nn,/cr illr pnini•r ull"prr/nry rhw Nrr iu urinar/dn.T.L/ /• prvriJr�u0uw is true nn,/i•orrerR
I I , �co,
S
7nh-u,,.,,'tyy
rnr un/ . )Y / ourrd, to Ar ru,rrylelyd by city ur town n///,'toil
b,rn: _ufhurity (circlenuclfIvrinit/1Icvn,e e
(Ilv�hll ! vintc,It 1 Citt.'1a„n CIcrk J. A'Iccfric.Il ht,Ice/ur t,1 (`lumping nun;
- Phone• y
j
information and Instructions
v et+on to the rarvue of anuihcr%lodct any :unlrict of hire.
�Lu;achu;eus l.icncral Laws chayar I i2 Iegwres all cnytlo)e,s a provide workers wmpensauun for their enlp Jyees.
I'iir:uailt to gills .latula, an empluYre is delined as". .e cry P'
:.press of unphed, oral If wnuen." Of an two of more
lu m vnl loyces. However the
�n .vnpluycr I t defined IS..an Individual. Partnenhip.assuctauuo,CafpJratlJn Ur Jlief legal cOmty,
I IN: I�lregwng engu�cd In a lumt enterprise. Ind
,nAsliocialloo or other ICS41 enaty,empl yrescillatives of a g�e PeJ employer,ur the
IecmverJrdwelli of.ouindividual. p
v0 resides
owner it's Dwelling house having not pployn pe rhea three not because of sup3runents Ind ch employmcntibe deemed to be an elnployer."
.Iwelilnd huu;a of anolhar who a i the eto shallinaimenunce,construction ur repair work on such dwelling house
or,ul the grounds Jr building Appurtenantshad withhold the Issuance of
>IGL chapter 151. 423C(6) also states that 'wary slaw or local licensing dingKelley
compliance wills the insurance coverage required:
renewal of a license or porn to operate•business or se eoutruet buildings In the commoawwltb or an
1pplle in, "Ile has not producdd alreeptable evidence of camp of iv political subdivisions shill
Wditiunally, `IGL chapter 151, i'-SC(l).rates"Neither the commonwealth not any
entnr into any contract for the Perfomtance ut'publi. work until acceptable evidence of"110iaruce with the insuranea
requirements of this chapter have been pfaented to the cantncting auhority."
Applicants checking the boxer that apply to your situation and.if
compensation alltdavit completely.by hecking th°bond with thou emtiflcate(s)of
Plew,te r,11 Jut the workers' comp es)sad p LLwi with i clnployl es other Ill=the
meccas try,supply aub•contruclor(s) na rrii . addreasl Partnerships
workers' eompetuati submitted a the Deputtmmtt off atrial
insurance. Limited Liability Campanict(LLC)or Limttcd Liability insurance. if an LLC or LLP does have
members or paMers, are not required to carry
enlpinyeas.a policy is require& Ile advised that this affidavit lnsy davit should
of
or town that the application for the ponnit or licersae is being requ to obtain u workers'
\ccidantt for confirmation of inturamcaD overage. Also be sure to sign and Jute the uflldevlt.al the The),partm s a f
he Iculmild to Ile city you have any 4uestioms regarding the law or if you eta required
I ndusrial.\ecidents. Should Y li went at the number listed below. Self-insured companies should enter their
compensation policy,please call the oep
seif•insurance license number on the a fo flute lino.
City or-rows Omr:ials
please he surd that the affidavit is complete and printed Of bly.
The ons had t c hug provided u space h rho liC cant
of the afrtduvit fur you to lilt out in the event the C hie Jf investigations
l be ugd all has to contact you regarding the applicant.
v e•r, need old submit one atildsvit indicating c`eeuf
I'I:asc be sure co rill in the pvrmiNlicmise nwnb:r which will be used ❑s a reference number. In addition,an upp
flat inust submit multiple Ilenniu'licaitsa applications in any given y roviJJd to
(hit
policy iut'ormmion I if necessary) And under"lob Sita Address"ihe applicant should write"all buvuti town knay e p o (' Y
tusvnl•"�\copy Jf the utTlduvit that has been officially stain min to of pud or ark nset ad byhill
new s111davit ,just be filled out each
I license Jr Permit not related to any business or commarcial venture
Applicant as proof that a valid aiflduvit is on fib far More P
your• Whirs A hum°owner Jr citizen is obtaining
t i.e. a dug license Jr Pcrmil to burn leaves 410 said person is NOT required to complete this Afflda uthasa.uly quwuuus,
111. i)tll�e ql t11vCN114atiuns would IIAe IJ dlallk YOU ill a.lvallce for your CooperanJlt alld should y
lease du not hesitara to gtvc us A call.
fhc U.pApmcnt s addre's, telcphuna and fax number.
The Cotnmonwealdt of M=achusetts
pepactment of Industrial Accidents
Oftice of lavesdgsdons
Epp Washington Street
Boston, MA 02111
re1. 9617-727-0 72 of 1-877-MASSAFE
Fax617.
wwWrtlan.gov/din
CITY OF S,U-F.Nf, i�L�SSACHL'SETrS
8L'tLONG OEP.IATIE,`r
120 W'kS-4LNGTON STURT, J a FtOQA
W' d nL (978) 145-9595
K!J®ER1 sy ORMOLL FAX(978) 740-921./6
,tiL4YOR THawU ST.F[ElAa
DIAECTOA OP PLBL C PKOPLrA7Y/8CIIDLN(;;coumISSIONE)t
Construction Debris Disposal Atttdavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 1 l
Debris, and the provisions of MGL a 40, S 54;
Building Permit # is issued with the condition that
This work shall be disposed of in a properly
111, S I SOA. licensed waste disposal fac lity as defincdsby MGLoc
The debris will be transported by:
U N I i l�u� K
(niune of hauler)
The debris will be disposed of in
(name of facdily)
S
(�ddm� or r�riL�Y)
e'yn+mro of pecmrt ipphcmf
O ,)jig
Melo's Construction LLC ,
BBB 34 Jennings Circle Peabody,MA 01960 Krim
Telephone: 978-531-0811 - E-mail: FaustinoMelo )jnsn.c4 n.w.orsw
MEMBER Faustino Melo,General Manager
Unrestricted Mass Builders license No. 80393 Contractors Registration No. 108953
Proposal Submitted to: Phone um
/ a M A /' 9
ddress: City,State,and Zip Code
I. 1 On/o GALL ni nl Iq7
Job/kscription: Job Location: Job Phone:
to ® r; SA ni P
We proposed hezeby to ftamsh meftruds®d labm-eomplea in emixiaooe wins the apamficaticna listed bat�ow,,€ar We `of. G 5�
<7: x `�1—xL ra 0 S,.a J1/Y7 a7d�iZ — m�it..-'�� (S /1�1 OFVI��
Installation of Payments:
Payments will be paid in thuds.The fast 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 alter the job is completed. /
Note:This proposal may be withdrawn by us Authorized Signature: ,y/ �(i
if not accepted within 20 days. Date: J(�q— J•�
e Hereby Selin t Speelffadisa and EsdasaW for. '
THE INSTALLATION OF A NEW ROOF
To protect the homeowners property,Blue Tarps will be used to cover the siding,bushes,and grays during stripping.
All of the layers of roofing will be stripped,and all protruding nails,strews,and/or staples will be removed. Ice and water shield
Will then be installed at the bottom of all edges,around all chu eys,skylights,and into all valleys_
Fifteen(IS)pounds of felt papa will be installed onto all other areas of the roofdeck. The s"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 'Z rn v/7 el/
The homeowner
ownerhomeo s responsible
select eta erd�nd or pneumatic roof c f o-r.Als .
Y _ for the nailing application of the new roof.
All the debris will be dened and properiv disposed of on a dA&bads.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 should protect personal belongings.
Extra work in witicli an additional cost win Fe added to the above price.
Replace Rotted Rooiboards Gutter Repairs Remove Ahu mum Siding
Relead Chimney(a) Install Skylights) Remove Old/Rotted Wood
Replace Facts Boards Repaint chimney Install Garage Roof
Install Ridgevent Install Azek Board Install Insulation
Install Roof Louvers Install Window Trim Install Tyvek Papa
Install Aluminum Gutters Install Shutters Cover Aluminum Windows
lustall Aluminum Downspouts V '
you Remove myl Siding Repair Vinyl Siding
Install chimney cap Porch Repairs Rebuild Chimney
Additional Notes:
�Y'M!]I�F J RCc /i�inl�li 9/w� LN4YALi T11R�� �d�il1/�Pf1-_ t Q75 fl(7
r
Total Amount for Additional Work:
Warranty by manufacturer to be free of defects for '3 O years, we manufacturers 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 to years.This warranty excludes remedy for damage or defect caused by abuse,modification,improper or insulficent
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 wont under this contract, customer shall-within 3 days-make the
final and full payment of the contract price.Any and all unpaid balances shall 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 fees.
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 raquisittion and or invoice.
The proposal may be withdrawn within 26 days j�
Date of Acceptance: I ` Signature: r�/�`� i