Loading...
14 ROCKDALE AVE - BUILDING INSPECTION ary The Commonwealth of Nfassachusetts SAL �., Board of Building Regulations and Standards OF Massachusetts State Building Code, 730 CMR SAL OF ^ Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a / One or Tivv Family Divelling l This section For Official UsiOfily. ` Building Permit Numbet: .: D3�e A lied: Building Official(Print Name) gna ore Data SECTION 1:SITE INFORIVEATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers /e( eoe rlmIlr- St, 1.1 a is this an accepted street?yes_ no bfap Number Parcel Number 1.3 Zoning Information: 1.4 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:(KO.I,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private O Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesC3 " SECTIONZc; PROPERTIi'OWNERSHD'( 2.1 Owneri of Record: 0A?V1D 5-4CCM ML) Name(Print) City,State,ZIP - /tl �eCJC Ing.9(E No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction ❑ Existing Building Or Owner-Occupied ❑ Repairs(s) A I Alteration(s) 19 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': 979/19 /9%,0 12 rO[ 4r,- 041/AiG( 1 SECTION 4: ESTIMATED CONSTRUCTION COSTS- Estimated Costs: OfQclai Use Only. Labor and Materials 1. Building g 3,5 3,(' L,Building PermitFeer S rndicate how fee is determined: El Standard.City/town Application Fee 2. Electrical S p .` ❑'CatalPiojectCost (Item 6)smultiplier x ). Plumbing i U o- Other Foes:•S t. Mechanical (11VAQ 3 p List: . Mechaoic.il (Fire $ - p . 5ii , tression) _ fetal All Fees: S_ Check No. Check Autount: Cash AI!. I'n r:11 I'i-niect ('u.i t: $ , --- n -- 53G f L7I id in Fill- - - ❑ Outstaudim, Il_d:mcc I)ue: sm'rION 5: CO:VsrRUCrION SERVICES 5.1 Construction Supervisor Liecuse(CSL) —y4A1GF6UJ _ (—/ _ License Nutnbcr Gepiratimt ate Name of CSL I lolder [! Z� U List CSL Type(see below) G(47CI? %1V pas Description No. and/Street Unrestricted Building u to 35,000 cu. R. �A ����G d 13c2 F:unil Dwellin City/Town,State,ZIP and Sidi ouel Bunting Appliances Insulation 'I'cle hunt Email address U I Demolition . 5.2 Registered Home Improvement Contractor(1111C) 16 f 6'7 Z 3 Z /T (!�014 C2U11 712 r✓e-l/0— HIC Registration Number Expiration Date I IIC Company Name or IIIC Registrant Name 2� rw47E/I Si No.and Street Email address CitviTbwn.State, ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. 5 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.......... ........9 No........... O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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. I�A� I w 1 N.7� rZ Print Owner's Name(Electronic Signature) Date 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 contained in this application is true and accurate to the best of my knowledge and understanding. _ CV[ NGCC—) u 'VI ) G j7 brit Owner's or Authurieed Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or am owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty tend under M.O.L. c. 142A. Other important information on the HIC Program can be found at www m:u.:.euvii,eu Information on the Construction Supervisor License can be found at ww'w.otas .,n�:'�IL 2 When sub.itantiad work is planned,provide the information below: Total floor area(iq. (including garage, finished basemrnVattici,decks or porch) t7Ni; living: -ea(sq. (t.) -_ Habitable room count _ Nand+eroftireplaces_—_—__,----- Numberofbedrooms -----------__--_-- Number ofbathroomi Numberofhalf'baths _ Npe of Iteming iyileIII - .. _ - -_'-_'—_— `umber ot'decks/porches Fncloied -- _ -- ()Pell t. '"I', r.11 I'ny.et �yuaro Pnnt.lge" way he albitinit.d t:,r"I',�rA I'ioiQct Coy t" '✓ '• sk' � Avd � � � a �r y�era^ '4 i 'b.�T3r 'K Wx' as fx..k'N x in "Y� a u��'-� u. b CITY OF &UE.M. MASSACHUSETTS BL'ILDLNIG DEP ART\IEDiT 120 WASHINIGTON STREET,3i°FLOOR ' TM (978)745-95915 FAX(978) 740.9846 KIMBERLEY DRISCOLL MAYOR THObtAs ST.FMM DIRECTOR OF PI ILIC PR6PERTY/BU1'MINIG COJLUISSIONER Workers' Compensation insurance Affidavit: Builders/Contractors!Electricians/Piumbers Applicant information _ _ Please Print Leiiijb,y VainC(0usinesslOrganiratioNindividuap: �l)/T ��r1�f %e (/�7/CJr Address: 2 G✓�T�/1 S 7/1 i rI i. City/State/Zipz lE'�F/�(/) M� Phone H: � �� 9D0p •�� (I� Are you an employer?Cheek the appropriate box: Type ype of project(required): 1.91 1 am a cmpfoyer with,' S 3. 0 1 Nn a genera(contractor and 1 6• 0 New construction employees(tLll and/or part-timis).• have hired the sub-contractors 2.0 I tun a hole proprietor or partner- listed on theattached sheet•{ 7. ®2emodeling ship and have no tomploycmi These su!}contractors have . S 0 Demolition working,_formain any capacity: workers':comp msurariae . 9 building addition [No workers comp:,insurance.,- 5. 0 We area corporation and required.) otYicers Have.exercised ihetr 10•0 Eiecnical repairs or additions 3.0 i am a'homeowner doing all work eight of exemption per MGL l L0 Plumping repairs or additions myself..[No workers'comp. C. 152;§1(4)and we halve no 12•0]Ruof repairs insurancerequiied.11 employees: [No workers',,. l3.❑0thu comp insutancerequired:). I imneuwnera whotuhmit this offidavn indieatng th' um doing all"attd then hero ounidaeantroetors must -Any applicum that chocks box#1 muitalyu rill out ihuxcctiwbalowshowingtheiiwwkea'wmpanwIon Policy mfurmationr r ' a ry a submit a now affidavit indicating ouch ._ -Controoton(fiat chaklhistwx mint anachod an aJdiaurod shxtthawiny tho naaite oftM supaomrMon dndthe4'werken'_eomy,policy in(omunae:.. !ant as employe►that lrprav/ding workers'comprtisadoIa htrrirtitteejor miy employeesiBelaw!is the policy aqd/ob site iujorinattam i insurance Company Name: Lrt 6 C12%% M (114 . • - Policy 4 or Self-ins.Lic.q:.. f/"`� /3/ S 3J/ V,7 00 17 Expiration Date:. Job Site Address: l f lzoc/e.041-r A-�y City/State/Zip: S4(CM MA ,1teach a copy,o(the stockers'compensation policy declaration page(show till,the policy number and expiration date). Failure to wecuro coverage as required under Section 23A ofMGG c. 152 can lead to thdimpositton of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment,ax well'as,civil penalties in the form 'of a STOP WORK ORDER and rine crop to S250.00 a day against the violator.-13e advised that a copyof this 3tatcmcnt may be forwaidyd.to the Office of - Investigations of tilt:DIA for insurance'cov�raba veritiwhon. - !do hereby certify cinder the p lid (let ojperJury that the hi/ormadon Provided above is rrruuj, /�ode' and correct. t / � / Data 3/ T OJJtcia/use only Do not write in tblr area,robe completed by city or totvq nf/!cl21 City or Town• Permit/Llccnse# Issuing Aulhorily(circle one): 1. Uourd of liealth 2.Building Department 3.Cilyfl own Clerk 4. Elect=lnspcctor5. pector 6.OtherContact Person: —.__...----- Phone# Df A� CERTIFICATE OF LIABILITY INSURANCE � ID6%/)13 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 NAMEACT Carmen Cocca Cocoa Insurance Associates Inc PHONE (781) 245-0888 rt'X N (791) 246-3926 dba Water Street Insurance Age ADDRESS: carmen@getinsurancehere.com 27 Water Street INSURER(S) AFFORDING COVERAGE NAIC# Wakefield, MA 01880 INSURERA:Commerce Insurance Company INSURED INSURERB:Essex Insurance Eda Construction Inc 1NSURMC:Liberty Mutual 27 Water St Ste 116 USURER D: Wakefield, MA 01880-3032 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 CONCITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AWL SUER POLICY EFF POUCY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDY MMMD'YYYY LIMITS B GENERALLIABILITY X 3DN9884 4/7/13 4/7/14 EACH OCCURRENCE $ 1,000 000 X COMMERCIAL GENERAL LIABILITY DAMA GE TO RENTED $ 50,000 CLAIMS-MADE FXIOCCUR MEDEXP(AMonepersm) $ 1 000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN LAGGREGATE LNITAPPLIES PER PRODUCTS-WMPIOP AGG $ 1,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY X BBLQ47 4/6/13 4/6/14 COMBINED SINGLE LIMB(Ea amident) $ 300,000 ANYAUTO BODILY INJURY(Per Person) $ ALLOWPED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS eraccitlent $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ L. WORKERS COMPENSATION WC131S381490013 4/6/13 4/6/14 X I WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE YIN NIA E.L.EACH ACG DENT $ 100,000 OFFICE RMIE MEEK EXCLUDED? (MandaWry in NH) EL DISEASE-EA EMPLOYEE $ 1QQ,000 If ves describe under DE SCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OFOPERAMONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rerrerla Schedde,if rnore space is regd red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W City of Salem ACCORDANCE WITH THE POLICY PROVISIONS. 93 Washington St Salem, MA 01970 AUTHORIZED REPRESENTAWE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Cin of S.uzNf, LbW&wHusErrs `� BI.'ILDLYC DEP.sgntgvr 120 W-UHNGTON ST Ujr Jw FT.T EL(978) 745-9595 ao '<d1t0ERLSY DRISCOLL FAUX(978) 7•t0-9344 ,� L1vaZ T�tosc�Sr.Ptsuts 01. ECTOR of Puouc PR0PEATy/8t:MDLYG CWLMISSIONEA Construction Debris Disposal Af'ftdavit (required for aU demolition and renovation work) In accordance with the sixth edition of the State Building Cade, 730 C�b1R section l 11.5 Dcbris, aid the provisions of MGL c 40, S i4; Building Permit N is issued with the condition that the debris resulting from this work shall be dispuscd of in a properly licensed waste disposal 111. S I SQA. facility a9 defined by ltilGL u The debris will be transported by; �C UL,,^J �4 t-9 n r (clime of llaulur) The debris will be disposed of in : (nanta et t'iclhly) ig ta prit; e cm •Im .I uc -- t ve Office ofCooso9Me IMP OVEMENT CONusi"�eglhonTRACTOR pirahon 468672 i 3&4412b15 TYPet EDA CONSTRUCTION IN' -��,;�A Corporation - i 2IV TERNSBERGER t WA ER ST S KEFI UITE118`=- t ELD,Mq 01880�- `S="'' I Uade Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-084795 t EVANGELOS # 12 STONE STREET IS a, DAn'VERS MA 0192 Commissioner Expiration 05113f2015 Y z ',LY.. '" `£d`* a a Mx #r s M fi v2ft � Y d3 *. a. ` �,i r } } z rs " # -w. �tiw.8rt,r'C st:3F�9 fr,'"x4 fr#+ c•. �Yi�3C5"`Y+ w. Y, # ) ... rv4b" � "Y i.. �YC ' F,k� "f}.€ �•� + Y �5 ^a>`#; '�'r vx �' {"ka rjJ n"i >=> +r^. '�k.`'k t'4 MASSACHUSETTS EXTERIOR SOLUTIONS`INSTALLED SALES ROOFING/SIDING CONTRACT :x% INSTALLED SA11LES SPECIALIST + NUMBER „� .h CUSTOMER, w S STORE NO STREET AQbRE55 ySF '�- STREET AODRE55 Y! e�"� CITY_ STATE ZIP -: � ��`g� Cln .. )/� STATE� -.. - zIP - - ..-TELEPHONEr me{µ >P Y TELEPHONE � ,-DATE I LOWE'S r / 0Z, HOME CENTERS INC S MA NIC NO NSGa8 lA9X ai ' CBpP�RNDK Z LCC REG Y � FEIN 5"748358 I cHAeG[ j � i " al3 h 'i .7 �Th5 0 only,a quoleBir Na mergnaxtl�aad sances pneredbalow This I�ecornessra�eement.atnm PaY!ma!1 tlport PaYmaPL tlm emwe agregtnan4 aItl Winghw gpetlaCBWy mnIe[ed Pages of aaa ,}; auivmenL Ne,TePns sad CwWwansmcruasd aMh�4Kiloumiamtandmy WhHaatlesdaaattaG)menu teremasllali bsreteriea`tyherwn. . ,PC�FjI$F,,READy LL;(EAMSANDrMDFTIONSONTHEREVERSESIDEOi:''rHLS AGE/A ND "AOES BEFORESIGtIiNG .s+ fin:..- `._._�, .....- `� '�...r` wt" "�'§.'IF°� • _ �a, r a; _. ., #`+5' .Z�a.. , r — '� .% �'# "', . .:. '.. -. INSTALLATION STREET ADDRESS Cm f STATE ZIP Color style: Accessories: 'Show drawing where shingles or siding will be installed. Contract Total Are permits required for this installation.: D�, Yes ( ]No *applicable tax included NOTICE TO CUSTOMER:Federal law requires Lowe's to provide you with the pamplet Renovate Right:Important Lead Hazard Information for Fa ma- les,Child Care Providers and Schools.By signing this Contract.Customer acknowledges having received a copy of this pamphlet before work began Informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. 1 _ j r WAIVER OF LIEN and ONE.YEAR WARRANTY(TO BE SIGNED BY JN�STALLER) I,the undersigned(netalleAt"ridependent Contractor,having been employed by the Customer whose name aplie"in^f bontract do hereby cedify that the work referred to in this - Contract will be or has been completed to the Customers satisfaction.In Consideration of the receipt of one dollar and other good and valuable consideration,and to the extent permitted by law,I hereby waive and relinquish all liens and all nhtear{d claims of liens which 1,the undersigned,now have or may hereafter have for labor or material furnished.I,the undersigned,caddy that all the work performed and metenfals'f6ielied,il arry,by any other party or parties upon the order of the undersigned,has been fully paid for-Further,I the undersigned,agree to cause the prompt release of any mechanics lien which Trey be filed against the premises retaned to In this Contract by any subContiador,laborer,mechanic or material supplier claiming the right to to file such a lien through work related to this Contract I further agree to hold harmless and indemnify-the Customer whose name appears in this Contract and/or Lowe's,from and against all costs and expenses arising from or by reason of such hen or the release or discharge of such liens. The undersigned,an Independent Contractor andlor supplier for the construction and improvement of real estate pursuant to this Contract,represents that any materials furnished on said p1�Ofect are fit and appropriate for the purpose for which they were used and that any labor performed by the undersigned and/or its agents or servants was accomplished in a workmanlike manner. In addition to any warranties specified elsewhere or provided by law,the undersigned for$5.00 and other valuable consideration the receipt and sufficiency of which is hereby acknowledged warrants that all work furnished under its Contiad shag be free from defects eitherin material or workmanship,and shah be suited in all respects both for the purposes for which it was specified and for all other uses for which it is intended to be used or for which it may be represented in writing by the undersigned to be suited. If any defects in material or workmanship shall be discovered in the work furnished or matedal used during the course of the work or within one year from the date of the certification of completion,or if such defects are latent within a reasonable time after which said latent defects are discovered,the undersigned shah forthwith replace or correct such defective work or material,bee from all expense to Lowe's In a manner satisfactory to the Customer.If the undersigned shaft fail to replace or coned any defective work or materials after reasonable notice, Lowe's may,at its option,muse such defective work or materials to be replaced or Corrected,and all costs and expenses honed in connection therewith shall be borne by the undersigned. Signed and delivered this day of f� (seat) Installer �� f pri a is az 'CFR�IFICATE I,the tiuyer herabyCdrif(y that" elnstelYer,arihex assigned subcarrbaetors havedumis`hed all goods hndla{eervid�s„fhai in5talia(ion`;rPpa(ra and aNera}IOITor ltnp ern shave tieen.. In ter as setfodliineo'r sales.Go1'ibad Kart LowA'siy a• .� , 'v� ' � sW Date � 0 era= 'hfedName ° i* ,� ''