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37 ROES ST - BUILDING INSPECTION ,� � ur���l +•� 94wealthofMassachusetts � rF$3ildmg Regulations and Standards FOR 77pp nnVVMassacphhusetts''ttState Building Code, 780 CMR MUNICIPALITY Bui1d4H�A9XUSE it��pllcatiAn 1 o4Construct,Repair,Renovate Or Demolish a Revised Mar 2011 t One-or Two-Family Dwelling This Section For Official Use Only -Building Permit Number: Date plied: Building Official(Print Name) Signature Date SECTION 1.SITE INFORMATION 1.1 Pr e$y Ad •ess: ` 1.2 Assessors Map&Parcel Numbers _ 5� 1.1 a Is this an accepted street?yes no Map 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: (M.G.L c.40,4 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes[] Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O �e��eco�: ��//`���� n Name(Print) YY`"' Cny,State,ZIPS v Nfo.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Buildin Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:_ Brief Description of Proposed Work': c_ A2 on 01 r. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 2 11LI2, 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Applrca 'on Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees: $ UUO v Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: 11 (2>0 N 4t L>=,p -I-D C O tsI Yt SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Yam i a/� �) License u Expiration'ate Nafhe of CSL Hoolderlder 750� �, P� n List CSL Type(see below) No.and Street d/ Type Description � U Unrestricted(Buildings u to 35,000 cu.ft. IV Restricted 1&2 Family Dwelling Cuy/Town,State,ZIP Z— M Masonry RC Roofing Covering WS Window and Siding d SF Solid Fuel Buming Appliances v ',ZY7/ 1 Insulation —Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor zto/ (HIC) � � ,� l 8 lF `�// I"✓— Mt " ;s,,,� HIC Registration Number Expiration Date IC Company Name or HIC Reg strant amN me�AA— PAh No.and Sire t I e Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 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 e_ 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. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNERi OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information co fain is ap is i u d accurate to the best of my knowledge and understanding. L F atPint Owner's or Authorized Agent's Name(Electronic Signature) Date' NOTES: L 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(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (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 Square Footage"may be substituted for"Total Project Cost" Proposal AB Carnes Roofing,Inc. 30 Arrowhead farm Rd Page 1 of I Boxford,Ma:01921 978-887-1431 MA.CS-000230 and HIC Reg.176928 PMPosal Submitted To: LIKA&GJYLE SINAN Date November 16,2016 37 BOW ST Project Nam SAME SALEM,MA 01970 Address 617-620-9716 We propose to furnish material and labor-in accordance with the specifications below: Sixty Five Hundred Dollars($6,500.00) Payment to be made as follows:$300.00 Deposit,Balance Upon Completion Nonce:All home improvement conaaclors and subcontractors engaged in home Improvement contracting,unless specifically exempt from redseatlon by provisions of Chapter 142A of the General Laws,must be registered with the Commomveafth of Massachusetts.Inquiries about registration and status should be made to the Mass.govAirenses missile. ROOF PROPOSAL ® STRIP ROOF FSLATE S OF ASPHALT SHINGLES.COVER ROOF DECK WITH THE UPGRADED RHINOROOF TITANIUM U20 HIGH PERFORMANCES THET1C1d ERLAYMENT MEMBRANE.COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. ® ICE DAM PROTECTIONo1NSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVERALL HEATED AREAS SIX FEETI WIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEV(S)AND SKYLIGHT CURBS WITH AND WATER BARRIER. -® COVER ALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. ® INSTALL GAF COBRA RIDG_EVENT;ANDIOR❑ ROOF LOUVERS FOR ADDED ATTIC VENTILATION, ED COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. -❑ REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF PLFT.WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK AND YOU MAY NEED TO HAVE A CARPENTER REINSTALL OR REPLACE THE SIDING THAT WAS REMOVED. ID CHIMNEY FLASHING:REMOVE EXISTING FLASHING FROM ONE CHIMNEY(S).CUT NEW REGLET INTO THE BRICK AND SECURE THE NEW LEAD WITH—METAL ANCHORS AND SEAL. PLEASE ADD$450.00 TO ABOVE PRICE.(BLACK TAR USED BY OTHERS IS NOT FLASHING) ® COVER ROOF SURFACE WITH CERTAINTEED LANDMARK 235LB LIFETIME WARRANTY DESIGNER SHINGLES. ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH I X8 SPRUCE BOARDS AT AN ADDITIONAL COST OF$4.50PLFT. ❑ COVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF ®NAILING SECURE SHINGLES WITH EIGHT IN TOTAL COATED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS. ❑BKYLIGHTS'REPLACE EXISTING SKYLIGHTS WITH NEW VELUX OR WASCO UNITS.WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.OUR LABOR CHARGE IS$90.00 EACH IF THEY ARE THE SAME SIZE.INTERIOR WORK IS EXCLUDED. ❑ REPLACE DEFECTIVE TRIM BOARDS WITH CUSTOMERS APPROVAL USING NO,2 PRIMED PINE,ADD$15.00PLFT TO THE ABOVE PROPOSAL, CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA. THE PROPERTY OWNER AUTHORIZES AS CARNES TO OBTAIN THE ROOFING PERMIT.WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE.HOWEVER,SOME MARRING AND OR MINOR DAMAGE COULD OCCUR, IN ADDITION,WE CANNOT BE RESPONSIBLE FOR ITEMS FALLING FROM WALLS,SHELVES OR CEILINGS DURING THE ROOFING PROCESS. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES ALL SLATE ROOF SECTIONS ONLY. WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WRt 4N UPGRADE TO THE CERTAINTEED HIGH PERFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YES,y() EMAILADDRESSr Warranty;All work warranted against installation defects for 5 years;this warranty is limited to the installed item(a)and its repair only.Material is warranted by the manufacturer against defects for 50 years;see the manufacturers warranty for select warranty performance. Cancellation:Customer has legal right under fedeml In to cancel this contract without penalty or obligation within three business days from the date of signing this agreement via Priority Mail Delivery ConPomation. Please see reverse side. Dispute Resolution:All parties agree that any and all disputes relating to this proposal shall be settled by arbitration as provided by the AAA.This forum is user friendly and does not requl/re. wyers.Please see reverse side. Signing this Proposal means,yo have accepted all the terms as stated on the front and bafthisgreent. Please see reverse side. Date ofAcceplance 2 — b SignaSignatur Signa �arry Carnes A PLEASE SEE REVERSE SIDE rpm V/eo q/ObuvllYiY(p¢[LLL/G b�llR2Rf0¢G[aJCG(d -1. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration. —176928 Type: Expiration 10/10/2017 Corporation AB CARNES ROOF1140,14c. BARRY CARNES 30 ARROWHEAD FARM RD` BOXFORD,MA 01921 Undersecretary Massachusetts Department of Public Safety Y Board of Building Regulations and Standards License: CS-000230 Construction Supervisor BARRY S CARNES ° 30 ARROWHEAD FARM RD BOXFORD MA 01921 . Expiration: Commissioner 0 3/0712 018 CITY OF SALEM WASTE AFFIDAVIT As a result of the provisions of MGL Ch.40-sS4, I acknowledge that as a condition of building permit# all debris resulting from the construction activity governed by this building permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL Ch.111-s1SOA. Waste Disposal or Solid Waste Facility: ALLIED WASTE Address: 300 FOREST ST Town/City, State, Zip: PEABODY, MA 01960 NAME OF HAULER: AB CARNES ROOFING, INC. DUMP TRUCKS DATE: 11-28-2016 SIGNATURE OF APPLICANT: The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 8( www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Orgmization/Individual):AB CARNES ROOFING INC Address:30 ARROWHEAD FARM RD City/State/Zip:BOXFORD, MA 01921 Phone#:978-887-1431 Are you an employer?Check the appropriate box: Type of project(required): I.E I am a employer with SOrrbe employees(full and/or part-time).* 7. D New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8, ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.❑1 am a homeowner doing all work myself.[No workers'comp,insurance required.]t 9. ❑Demolition 4. I am a homeowner and will be hiring contractors to conduct all work on m 10❑Building addition ❑ g y Property. I will ensure drat all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 not,a general contractor and 1 have hired are sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.[ 13.F,/]Roof repairs 6.r]We are a corporation and its officers have exercised their right of exemption per MGL C. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If dre sub-contractors have employees,they must provide their workers'comp.policy number. - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:TRAVELERS INDEMNITY CO OF AMERICA Policy#or Self-ins.Lic.#:6HUB-7H68075A-16 Expiration Date: 10/15/2017 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby c un r the pains and allies o r'u�he information provided above is true and correct. Si nature: j Date: Phone#:978-887- 1 Offuial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 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#: CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 11/2812/28/2016 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 CONTACT NAME: Lori Cote CIRCLE BUSINESS INS AGENCY INC PHONE FAX 247 NEWB URY ST E-MAIL Alt No: ADDRESS: DANVERS MA 01923---------" INSURI AFFORDING COVERAGE NAICR 7 INSURER A: Travelers Indemnity Company of America INSURED AB CARNES.ROOFING INC INSURER B 30 ARROWHEAD FARM RD INSURER C: BOXFORD,MA 01921 INSURER D 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. I ADDL SUER UT POLICY EFF POLICY EXP UT TYPE OF INSURANCE lNqR rl POLICY NUMBER MMIDDIYYYYI (MMIDD"Wi LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY �II�r_ I IA. ETO NTED I� PREMISES Ea occurrence $ CWMS-MADE !J� MED EXP(Any one person) $ N/A PERSONAL B ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PEO LOC AUTOMOBILE LIABILITY �I Ee aocIN tleDISINGLE LIMIT $ ANYAUTO I� BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Par accitlenp $ HIRED AUTOS AUTOSWNED PROPERTY DAMAGE $ Per accoenf $ UMBRELLA LIAR OCCUREl F-1 EAR ENCE $ EXCESS LIAR CLAIMS-MADE N/A AG $ DED RETENTION$ $ WORKERS COMPENSATION - OTH- ANO EMPLOYERS'LIABILITY Y/N RA ANY PROPRIETORIPARTNERJEXECUTIVEE:L. DENTOFFICEIMEMBER EXCLUDED? N❑ N/(J 6HUB-7H68075-4-16 10/15/2016 10/15/2017 $ 100000fyes,dncrisandatory NH) / E.L. EA EMPLOYE $ iQQ QQQIf yes,tlesrnlx un0er E.L. POLICY LIMIT $500,000 IJ F] N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ANach ACORD 101,Addldonal Remarks Schedule,If more space is required) ROOFING CONTRACTOR CERTIFICA.T151HOLDER ,.� CANCELLATION L1337 AN LIKA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN OW STACCORDANCE WITH THE POLICY PROVISIONS. EM,MA 0197 AUTHORIZED REPRESENTATIVE Daniel M Crowley,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NOTICE N NOTICE TO a TO EMPLOYEES 4 = EMPLOYEES 7 �e i�,M s�gv The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-7274900 — http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152,Sections 21,22&30,this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MI DLEBORO MA 02344-145 ADDRESS OF INSURANCE COMP r�(ISHUB-7H68075-4-16�,' 10-15-16 TO 10-15-17 Y NUMBER EFFECTIVE DATES CIRCLBUSINESS INS AGCY 247 NEWBURY ST DANVERS MA 01923 NAME OF INSURANCE AGENT ADDRESS PHONE# ,F—= AB CARNES ROOFING INC 30 ARROWHEAD FARM RD , e BOXFORD MA 01921 e= EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE e= MEDICAL TREATMENT �= The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services Ld provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS o,o"z W20PIG16 TO BE POSTED BY EMPLOYER