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100 SCHOOL ST - BUILDING INSPECTION The Commonwealth of Massachusetts J I s OF Board of Building Regulations and Standards CITY l�l r' Massachusetts State Building Code,780 CMR S M dMar Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use only Building Permit Number: D e Applied: Building Official(Print Name) > Signature'. a Da SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers �Uf) )ot if Lla Is this an accepted street?yeL_,X= no Map Number Parcel Number 13 Zoning Information: -- ' 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(it) 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal stem ❑ Public❑ Private O Check if yes❑ P Po system %SECTION 2: PROPERTY OWNERSHIP' 2.1 O�ynerr of Reco��qq: (7j-, � /Tin/('�/x'y �/1�/ivt iGfl4 ©/�7a Name(Print) City,State,ZIP /D 4 .I`c��o o c� �OF6 No.and Street lephooe Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work : C—f JfC- Ffl� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ _ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application 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:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ �/ j��— ❑Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /0 26 ! Age, License Number Expiration ate Name of CSL Holder 9P ) ®/�CMXN List CSL Type(see below _ c/- TYPe Description No.and Street D t±!2�� U Unrestricted(Buildings u to 35,000 cu.ft. (f I R Restricted 1&2 Family Dwelling City/Town,State,ZIP M snry RC Roofing Covering WS Window and Siding /c SF Solid Fuel Burning Appliances 7� �7.J p70 I Insulation Tele hone Email address D Demolition 5.2 Registered Home Impprovementt Contractor(HIC) f7 5'6 7 7Z/A 6-cy-t Noti � e K HIC Registration Number EpA D!a te HIC Company e„or Hl egistrant Name No.=/ //�i ®�,�9 �i ,d7 �8 Email address City/Town, State,ZIP 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 permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION lac 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) Date SECTION 7bt OWNEW OR AUTHORiZED AGENT DECLARATION By entering my tame low,I hereby attest under the pains and penalties of petjury that all of the information contained in this ap ' to is true and accurate to the best of my knowledge and understanding. 1.17 Print Own 's Authm A ctrmac Signature) I gate 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(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. ovg /dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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" Unrestricted-Buildings of any use group which l�f Massachusetts -Department of Public Safety contain less than 35,000 cubic feet(991m')of Lid Board of Building Regulations and Standards S enclosed space. Conztructiva 5upers lent License:CS-080145 GEORGE VA$iLiADES 5PTTCAEPN*AV , IPSWICHM,4 69125: Failure to possess a current edition of the Massachusetts State Building Code Is cause for re•rocatfon of this license. For DPS Licensing information visit: www.Mass,Gov/DPS Commissioner 10j2W013 1 ��0feee of�Cons mer ai and�esss Re n 10 Park Plaza- Suite 5170 Boston, sachusetts 02116 Home Improve ontractor Registration Reglstration:. 167567 m TYOe: Supplement Card EXplrallow .10142012 TURNPIKE GENERAL CONTRA w GEORGE VASILIADES M 239 BOSTON STREET BOX 365 TOPSFIELD, MA 01983 �r �e spa Update Address and return curd.Mark reason for change. JPSCq+ a aou44aaae1012+e ❑ Address Renewal Employment ❑Lost Card r' 'Poomw»taa+tneclUe a�� � _ Office of Coammer Again&:BasImss Regulaton License or registration valid for fudividul use only OME IMPROV MENT CONTRACTOR before the expiration date. IPfound return to: Office of Consumer Affairs sad Business Regulation ReBistmtlon 587 Type: 10Park.Plara-Suite M70 E'xP re 1 Supplement Card Boston,MA 02116 Wr GE ING INC. GEORGE VAST 239 BOSTON 4-ra4 TOPSFIELD.MA 01 Undersecretary Not valid without signature A TURNP-3 OP ID:CA a`oizo CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) 02/27//27/12 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 endorsements. PRODUCER 978-462-4434 CONTACT Chase&Lunt LLC NAME: P G Box 590 978-465-6204 A/CN N. FAX C No 47 State Street E-MAIL DRESS: Newburyport,MA 01960 Marcos W.Shaner INSURER(S)AFFORDING COVERAGE NAIC0 INSURER A:Scottsdale Insurance Co. INSURED Turnpike General Contracting 239 Boston Street INsuRERB:Commerce Insurance Company Topsfield,MA 01983 INSURERC:Peerless Insurance Co. INSURER D:Hanover Insurance Company 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, TERI! 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. IPOLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER MM,DD LICY EF MMM LIMITS GENERAL UABIUTY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY BCS0026080 10/21fl1 10/21fl2 PREMISES Ee ocmnance $ 50,00 CLAIMS-MADE OOCCUR MED EXP(AM one ps,son) $ 5,00 PERSONAL B AOV INJURY $ 1,000,00C - GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE UNIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POUCV X JFCTPRO, LOC E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E 1,000,00 B ANY AUTO BDBRJM 10/20111 10/20/12 BODILY INJURY(Per Person) $ AU OS SCHEDULED AUTOS BODILY INJURY(Psracddan0 S AUTOS SCHEDULED X HIRED AUTOS X NOI*OMED PROPERTY DAMAG $ AUTOS Pat aw"nl E UMBRELLA UAS X OCCUR EACH OCCURRENCE S 5,000,00 A X EXCESSUAM CLAJ:MADE XLS0077698 10/21/11 10/21/12 AGGREGATE $ 5,000,00 DED X RETENTION$ 0 $ WORKERSCOMPENSATION WO-STATU- FOR' AND UABILnY ANY PROPRIETORIPARTNERIEXECUTNE YIN O BE ISSUED FROM CO E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) EL.DISEASE-EA EMPLOYE $ If yes tlescAhe under DE SCRIPTION OF OPERATIONS W. E.L DISEASE-POUCY UMIT $ C. Inland Marine IM8883151 12/01111 12/01/12 Materials 250,00 D Commercial Crime 13200939 01M7/12 01117113 Limit 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mom space Is required) CERTIFICATE HOLDER CANCELLATION - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ALrrHHHOOOR"2�E0 REPRESENTATIVE V ©1988-2010 ACORD CORPORATION. All rights reserved. --ACORD-25(2010105) - The ACORD-name-and-logo-are-registered marks-of-ACORD -- -_-- - Y ACORD. CERTIFICATE OF LIABILITY INSURANCE 01109/2012 THIS CERTUICATE 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 ism ADDITIONAL INSURED,the policy(ies)must be endorsed. It SURROGATION IS WAIVED,subjeclto the terns end conditions of the policy,certain policies may require and endorsement. A statement an this emUficate does not confer rights to the certificate holder in lieu of such erdorsemmt(s). PRODUCER CONTACT NAME: PHONE FAX CHASE&LUNT LLC (ANC,No,Ed): FAX (MC,No): POB 590 EMAIL ADDRESS: PRODUCER NEWBCRYPORT,MA 01950 CUSTOMER ID M. 77BPK INSURER(S)AFFORDING COVERAGE NAICN INSURED INSURER A: TRAVELERS DIRECT ASSIGNMENT INSURER B: TURNPIKE GENERAL CONTRACTING INC INSURER C: INSURER O: 239 BOSTON STREET INSURER E: TOPSPELD,MA 01983 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERDFYTHATTHE 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 W HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS,EXCLUSIONS AND CONOITIONS OF SUCH POLICIES UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUSR POLCY EFF DATE POLCY EXP DATE TYPE OF INSURANCE POUCYNUMBER (MMOO1YYYY) (MMDOIYYYY) UNITS LTR Well WVO GENERAL LIABILITYEACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ - POLICY PROTECT LOC PRODUCTS-COMP/OP ADS $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accidsm) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ $ WC STATUTORY LIMITS OrhI WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN UB4939PI55-11 1012212011 102Z2012 E.L EACH ACCIDENT $ 1.000,000 ANY PROPERITORIPARTNEWEXECUTIVE N E.L.DISEASE-EA EMPLOYEE $ 1,00D,000 OFWdolor, mit EXCUJDE01 E.L.DISEASE-POLICY LIMIT $ 1,000,000 (y.o.d aryln NH) DESCRIPTION WEB( DESCmPTON OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSNEWCLESIRESTRICTIONSISPECIAL ITEMS TIO REI?ACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFPECITNG WORIO?RS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Charles J Clark ACORD 25(2009/09) - 1988-2009 ACORD CORPORATION. All rights reserved. The Commonwealth ofMassachuse#s Department oflndustrialAccidents Office oflnvestigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly/ Name(Business/orgamzationandividuat): Address: City/State/Zip:' /,J',/-/- % &k D/9fs Phone#: [2.0 re you an employer?Check the appropriate box: Type of project(required): I am a employer with (� 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)? have hired the sub-contractors Remodeling la m a sole proprietor or partner listed on the attached sheet x � ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. ,�,(,w�orkers' comp.inc,ranee. g, Building addition [No workers'comp.insurance S. j ,off are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3. I am a homeowner doing all work right of exemption per MOL 1 LEI Plumbing repairs or additions myself[No workers'comp; c. 152, §1(4),and we have no 12.XRoofrepairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box ill must also Rl out the section below showing their workers'compensation policy information tHomeowners who submit this affidavit indicating they ape doing ell work and then him outside contractors must submit a new affidavit indicating such. ;contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information lam an employer that isproviding workers'compensation insurancefor my employees: Below Is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: U/3 r/ �j CJ/" / S� -j/�` Expiration Date: U ZZ Job Site Address: /00 S'Cl(-o a L Sr- City/State/Zip: _D1h_e?,A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration .date xP ) Failure to secure coverage as required under Section 25A ofMOL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy ofthis statement maybe forwarded to the Office of Investigations Of the DIA for ins once coverage verification. I do hereby certify under the ins an pen hi ofPerr'ury that the information provided above is true and correct. Signature, Date, Phone#: -7 K7 - `0 O F only. Do not write in this area,to be completed by city or town official n Permit/License# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.ElectricalInspector 5.Plumbing Inspector son: Phone#: ' Markeang Gmup 167567 Roofing • Siding • Painting • Masonry E IC#IN#27-3477-3470462 Job#: Chris Hinchey - 100 School St. Salem, MA 01970 (978)745-8096 March 9,2012 Dear Chris, 1 have prepared the following estimate for the installation of the vinyl siding at the above location. This will be a full coveragejob with no maintenance required and lifetime warranty. All work will be performed to the manufacturer's specifications to ensure a lifetime warranty. Below is a brief description of the work that will be performed. Vinyl Siding: • Go over existing clapboard siding on left,rear,and right sides of house • Price includes(4)dormers on upper main roof of house - • Price does not include existing soffit and fascia on main house • Install 3/8 insulation board over all areas prior to vinyl installation • Install CertainTeed MainStreet Double 4"vinyl siding • All overhang and eaves will be dressed with soffit panel • All trims will be wrapped with aluminum coil stock • We will install new vinyl comer,j-channels and casements throughout - • The soffit and face boards will be done to match the windows • You may choose to have the vinyl match the color of the soffit • Foundation will not be covered • Job will be started and completed without any interruption • Vinyl permits vary from town to town and are not included in this estimate • COLOR: ? Cost for Labor&Material for Vinyl Siding(Go-Over): $11,895.00 Payment Terms: �. 113 deposit due upon signing contract: $ 54,v 113 payment due upon start of job: $ 113 payment due upon completion of job: - $ Total Amount Agreed to Be Paid: $ I( (� col nt) Please sign and date all pages. Remit to: Turnpike General Contracting Inc-P.O. Box 365, Topsfiefd,MA 01983 The following schedule will be adhered to unless circumstances beyond Turnpike's control arise: Work Scheduled to Begin: TBD Job expected to be completed within 60 days of actual start date. Warranty: Turnpike General Contracting Inc,guarantees all work performed for a period of one year. If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. Terms and Conditions: This ct is subject to t ter s and conditions of paragraphs 1 through 14 attached hereto incorporated herein by reference n ,c 4A L1 ahcti 1-n ]0 1 Mic Connors,Project anage Chris Hinchey pike General Contracting nc. Date Homeowner Date Tel: (800) 535-4312 • Fax: (978) 887-5875 • 239 Boston Street • Topsfield,MA 01983 1-888-5-OLYWIC • www.olymnicroofing com