2 SOPHIA RD - BUILDING INSPECTION ? a
--� i
The Commonwealth ut Massachusetts t Board of Building RCgu I (tR
lations and Standards MI N1(l)R I'I 1 ;
L ' Massachusetts State Building Code. 780('MR, 7"' edition I 'SIT
Building Permit Application To('onstrurt. Repair. RCno%ate Or Demolish a
N One- ar T(rn-Fumih• Duelling, 1, 2f) 4`'
This Section For Official Use Only -- — -
Budding Permit Number: Date Applied: f
Signature: -
13 tg('ouunts,wool l voor o(Buddwgs Datc -
�y
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Nlup & Parcel Numbers
a S�nh�r( 2 n
1.la Is this an accepted street'! yCs_._ nu_ Map Nmnher Parral Number- f
1.3 Zoning Information: 1.4 Properly Dimensions: 1
Zoning District Proposed Use Lot Area(sq 11) Fnmtage ot)
1.5 Building Setbacks(it) I
Front Yard Side Yards Rear Yard f(
I Required Provided Required Provided Required Pnwidcd
f
1.6 Water Supply: (M.G.L c.40. 494) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone'? Municipal ❑ On.site disposal sys(em ❑ I
Public Private❑ Check if yes❑ +
SECTION 2: PROPERTY OWNERSHIP'
2.1 QwnerCt\ ecord: Qhtft
a Name((Print) Address for Service: l
$" r7 U CE-Sg9 r -
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) - Alteration(s) ❑ Addition ❑
Demolition. ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ I Other ❑ Spedty:
Brief Descrip ton of Proposed Work'': A- SidRE: .I `--
tZ�Se- , ,X\ fig
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Ofricial Use Only f
item (Labor and Materials)
1. Building $ 1 )(4266,06 t. Building Permit Fee: $ Indicate how fee is deternuned: '
❑Standard Citylrown Application Fee
2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x
3. Plumbing $ 2. Other Fees: $ x
4. Mechanical (HVAC) $ List: 7
5. Mechanical (Fire $ 'total All Fees:
Suppression)
Check No. Check Amount: ''ash Amount:
b. Total Project Cost $ ❑ Paid in Full ❑ Outstanding Balame Due:.___,_,.. _ 1
a SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number livpoanon Date f
Name tit C'SL- I folder -
List{'SI. 1v i see heimt) _
.9 \JJress Tv. • [hscnl rium
F Unrestricted i tip to 35.00t)Cu. Fr t
{ R. Restncted 1&2 Fanuh D%%elhng
11g11alnrC At %lasers Onto
11 Rcsidcnual Rooting C mering
--11
TelephoneItasWriniA \Tonto% .md SiJmc
e SF Rc,idential Sohd Fuel liurnme \ i th:mec ln,ialiaiwn
' D Residential Dcuwhuun ---
5.2 gv�n Re istered 1 om -improverr nt C,untvuctpr(HICf
-2�
i•Name Re tstiation Numb er111cCompan Na or ist•fm
Address -e-Q F ration Date
Signature Telephone
I
f
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 pros ide
this affidavit will result in the denial of the Issuance of the building permit.
P
Signed Affidavit Attached? Yes ......... . No........... ❑
' SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. ::Sal - ` , as Owner of the subject property hereby
authorize I to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
e
s SECTION 7b: OWNERi OR AUTHORIZED AGENT DECLARATION
t
1
I, �--r+--•• , as Owner or Authorized Agent hereby feel;oc f
that the statements and information on the foregoing application are true and
JJ accurate. to the best of my knowledge and ff{
behalf. 7 l 4(1 Z �Ab t�i'1'I � ISf t'i')C� ,� f/-
Print Name Signature of Owner or Authorized Agent Date
(Si ned under the pains and ppenalties of perjury)
1 NOTES:
L An Owner who obtains a building permit to do his/her own work.or an owner who hires in urn egntered contrachtr
1 (nut 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 and
Construction Supervisor Licensing(CSL)can be found in 730 C'MR Regulations 110.R6 and 110.115. respectively.
# i - When substantial work is planned, provide the information below:
Ttnal floors area l Sq. Ft.) (including garage. finished hasement/;1ni". decks or pt achl
Cross living area tSq. Ft.) Habitable rtxtm count
Number of fireplaces Number of bedrooms
Number of h;uhrooms ?lumber of halt/baths
-rypc of heating systern Number of decks/porches
-rype of cooling system Enclosed _open
3. 'Toad Project Square Footage' maybe substituted for "Total Project Cost"
� t i
CITY
OF
SALEM
PUBLIC PROPRERTY
DEPARTMENT
N ti I Ill.f f • A.NI I-)I,
)-8-'i5-;,q; • F ins, 9-8-74_'184u
Workers' Compensation insurance :Utidasit: Builders/Contractors/Electricians/Plumbers
m lic lot Information PleasePrint LetibfV
:IIl1C JSuelncs ltrg.uucturm:InJis i.lu.dl:_�YV1 � f��1�
cadre;,:
City,State'Zip: 1120aPhone
tire on an employer'.' Check the appropriate box: "Type of project (required):
�-4 1 :un a general contractor and 1 6. New construction
ith
1,am a employer w ❑
111 employees (fall undlor part-time).' have hired the sub-contractors
7. ❑ Remodeling
_'.❑ I :uu a sole proprietor or partner- listed on the attached sheet. *1
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for time in any capacity. workers' comp. insurance. q. ❑ Building addition
No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
required.) officers have exercised their
i ht of exemption per MGL 11.❑ Plumbing repairs or additions
3.El inn a homeowner d w r
doing all ork g p p e.
myself. [No workers' comp. c. 152, yl(d), and we have no 1-sp oof repairs
insurance required.] employees. [No workers' 13.0 Other
comp. insurance required.]
'Any appIt can Ihot checks bon 01 moat also till out the section below showing their workers'compensation policy infoma 'On
.
' I lonnvwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$'ontraclors that check this box must attached an additional sheet showing the name of the sub-cuntractors and their workers'comp.policy information. f
L.'
..g
I am an employer drat is providing workers'comrpensation insurance for mry employees. Below is the policy and job site
information. l )n
Insurance Company Nine:. l A,� tip nn�L�"`"'�� /�-�Cl—
Policy # or Self=ins. Lic. #: Expiration Date:�lyQ
nn I Q- 7
.lob Site ,\ddrcss: 2 � r� IZ(SC`xe� .. City/State/Zip: T'� m -0070
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
f:ailurc to secure coverage as required tinder Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a
tint up to S I,Soo.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 Jay against the violator. Be advised that a copy of this statement may be forwarded to the Office of
I mrestiu;uions ot'dic DIA for insurance comerage cerificalion. -
/do hereby ccrtijj-under the pains and penahiev of perjtr that the injorniation provided abot a is trite andcorrect.
p Dale
;i en.Iture:
Ph I
--official use only. Do not write in this area, to be completed by city or tonvt ofjiciaL
City or llre n: _ -___ ------ Pennitil.icense #------ ---
Issuing .Iuthorily (circle one):
1. Board of Health 2. Building Qeparhnent 3. Cih/'Town Clerk 3. Electrical Inspector 5. Plumbing Inspector
6. other _— - —
Contact 1'crson: _ _ _—-_ Phone #:— — -
l .
Information and Instructions
\I.t»:nc l:uscus Grncral Lncvs chapter I�' rcquirez all cinp Io�crs to pros idc workers' camgtensanon for their emploccc s.
I'm su.mi to [Ills >t:mde, all enr rloree is dctincd .is "...CN cry person ", the
/ _ I n hs sere ice of;uo[her under:ury contract of Itirc.
:\press or [milli icti. oral or wri[Icn...
.\n :tnph,ter is defined as "':m inJih:dual. p.[rntcr>hip, axsoci:uion, corporation or other legal entity. of any two or more
of(he Imegoing engaged in a joint cn[crprise. and including the legal representalk es of a deceased employer. or the
rrceit cr or trustee of an individual, flartncr>hip, association or )[her legal entav, cnfplo�In,, employees. I love%er file
,rt%ner ota dwelling house ha%inc not ;pore than three ;[p:trtmcnts Lund who residcs [herein, or the ocCupant of the
dht clling house of another who employs persons to do nnaintrnanre, construction or repair work on such dwelling house
Ire on [he _rounds or builJing appuncn:mt thereto Shall not beCause of such cnfplo,%ment be deemed to be an employer."
\I(il- chapter 152, �s'SC'(h) also States that "crcry state or local licensing agency shall withhold the issuance or
renewal of a license or perrnit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.-
.\dditionally, MOL chapter 152, §250 ij states 'Neither [he commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public Mork until acceptable eh idence of compliance with the insurance
rcquirenhents of this chapter have been presented to the contracting authority."
Applicants
Please till out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, Supply sub-contractor(s) nane(s), address(es) Lind phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requeSted, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of [Ile affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple penniulicense applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) Lind under"Job Site Address"the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
Year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e, a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give his a call.
the Deparuncnt'.S address, telephone and bt.x number:The Commonwealth of Massachusetts
Department of industrial Accidents
OfIIce of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
1 ,:'. scd <-'0-05 Fax # 617-727-7749
www.mass.gov/dia
CITY OF SALEM
'PUBLIC PROPRERTY
' �. DEPARTMENT
•l
rFI 1)78-743-')545 t�\-'v: ')"S-14C-9946
Construction Debris Disposal affidavit
(required Cur all demolition :utd renovation work)
In accordance with the six[h edition of the State Building Code, 730 CNIR section 111.5
Debris, and the provisions of MGL c 30, S 54;
Building Permit _ is issued with the condition that the debris resulting from
;his work shall be disposed of in a properly Licensed waste disposal facility as defined by NIGL c
l 11, S 150A.
The debris will be transported by:
v
S� 1 uume t haular)
I he debris will bedispOsed Orin
C� �r.:r Si i::clllry)
Proposal# 4142008
Page # 1 of 2
April 14, 2008
From: Steven Lamonde
SML Roofing & Roof Repairs, LLC
6 Felton Street Job Name: Del Campo
Peabody, Ma. 01960
(978) 531-9557
To: Mr. & Mrs. Armando Del Campo
2 Sophia Road Job Address: Same
Salem, Ma. 01970
(978) 744-5899
I hereby submit specifications and estimates for: Approximately 4 Squares of a strip
& a re-roof of shingles including the roofs cap.
I will first begin by stripping the 1 old existing layer of shingles from the
front side of the Main roof only. Then I will denail the roof as well as nailing off any
loose boards. I will replace any rotted roof boards up to 32' for free, any additional
board replacements after 32' will become an extra charge on the final payment with
prior notice. Board replacements after 32' will cost $4.00 a foot plus the charge per
each board. Then I will apply an ice & water shield 3' up from the roofs bottom
edges, in any valleys, around the base of the existing chimney. Then I will cover the
remaining opened areas of the roof with rolls of 15 felt paper. Then I will nail down
8" White drip-edge to all of the roofs perimeters and I will begin to re-roof with new
3-Tab shingles By Sovereign in the color of White to match the existing. I will tie in
the new shingles around the base of the existing chimney after I re-lead it while
using new karnak for a water tight seal. Then I will put 1 new 4" Aluminum flange
on the 1 existing stack pipe and I will change any old or broken down step flashing.
Then I will install the roots cap where needed.
Apr 14 08 03: 47p .l Del Campo 978-744-5839 p. 1
.yrn-ircv�o•t�..+c., rrtan i.a'� nar., a.wv •"-� �••�--•w�� ••
Page#2 of 2
Prior to receiving written permission to do the dob we can not pysieaft remove
shingles during an estimate to know how many layers are currently on the root
This could contribute to more water damage to the interior or it may cause new
leaking. Therefore we will use our professional judgment to price accordingly,if
any additional layers are encountered when stripping the roof you the Home Owner
will be supplied with photos if,your not available to view the addditierral layers. We
will add the additional charge per square to the invoice.
All material and debii pertaining to this Job will be supplied by and removed by
SML Roofing&Roof ltepairs,U C. This Job comes with a 5 year guarantee to
Mr. &Mrs.Armando Del Campo. These terms above to be voided in the event of
new Ownership,and or if any future work is to be done to or on the above areas
mentioned in this proposal, unless done by the said Contractor.
I hereby propose to furnish labor& materials-complete in accordance with the
above specifications for the sm®of S1,600.00 One Thousand.Six MMdral Dadars.
With payments to be made as follows,a deposit in the amount of%SM.00 for the
stock and the permit will be required in advance along with the suing of this
proposal in order for us to start this Job. The balance$800.00 to be paid in full
upon the completion of the proposal with any extras,if any.
If this proposal is to your satisfaction and you are accepting these specifcations and
conditions along with the payments to be made as follows,please sign and date.
That return Our signed copy with the deposit to schedule.
X Accepted Signature:
X hate:
Contractors Authoraation to do the work as specified.
Steven IAmonde
Please return this signed copy with the deposit for Our records
Thank you is advance,
Skeveu Iamonde
SML/tdl
03/26/2008 00:56 9787778415 rHl ez
AMR& CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
THIS CERTIFICATE M ISSUED AS A MATTER OF INFORMATION.
County Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON 7HE CERTIFICATE
123 Sylvan St. MOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
Danvers, MA 01923 ALTER THE COVERAt# AFFORDED BY THE POLICIES "LOW.
` INSURERS AFFORDING COVERAGE
wSIJRE� SML ROO£iR S
g Repairs LLC INSURER a:
INSURER B
6 Felton street: Ir SURER C:
Peabody, MA 01960 INSURER 0. '
COVERAGES IIBURER e
THE POLICIES OF W3URANCE LISTED BELOW HAVE BEEN ISSUEO TD THE VISORED NAMEp ABOVE FOR TTiE POLICY PERIOD 87Dl 11 11 NOTWITHSTANDING
NAIALI PERTAIN,THE 511RAN E AAFFFORDDEED BY THE POUGE 6S ESCRi�NON S NT WfTHCT TO 1 THIS CERTIFICATE MAY BE SUBJECT TKO AL,L THE TERMS,EXCLU6pN3 AND CONpi'fIpNB OF SDjlp1
POLICIES OR
.AOGRE6ATE LIMBS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAW.
8R TYPE OF
POUCY NUMBER
OEENGRAI LIABBJTY LMtlY3
COMMERCIAL GENERAL UNBILITY EACH OCCURRP4E s 1 0 00
mume WOE d QWUR RRE DAMAGE(Arr/ %v) S
c MED EX#1(AM o.r� S
113700007752 1/12/00 1/12/09 PERSONALAADv INJURY s
GEML AGGREGATE LOAT APPLIES PER: GENERAL AGGREGATE s
POLICY PM LOC PRODUCTS-COMMOP AGO s 0 0
AUTOMOBILE LIABILITY
ANY AUTO IHEONSINGLELIMIT $1,GOO,OOO
ALL OWNED AUTOS
SCHEDULED AUTOS SWgLY(INJURY S
1
HIREDAUTOS 07144LQ3940 3/14/09 3/14/09
NON-OWNED AUTOS B�OOIL�Y iNJs
AG PN �
PROPERTY DAMAGE S
GARAGE LIAMAM
ANY AUTO AUTO ONLY•EA ACCIGENT S
OTHER TIWro EA ACC s
EZCEss LIMILATY
Pro OMLY: AGO S
EACH OCCURRENCE s
OCCUR CLAIMS MACE AGGREGATE S .
DEDUCTIBLE Is
RETENTION s s
wORH@RS COMPENSATION AND
EMPLOYERS'UAMUTY TORYLMUS ER
00243054 2/24/08 2124/09 E.I.EACH ACCIDENT 5100,0
L E.L.MgASE-EA EMPLOY S
OTHER ELDISFAE-E-POLICYUMIT S
'
NOPWMN OF ADDEO BY ENOOFOUM USPECIAL PRMSWNS
,00fing
ATI ICATE HOLDER I JACCITIONALINSUREMMUMERLETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BECANCELLED REFORETHE 004MTM
City of Peabody DATE THERWF.THE BSUING MWR@i WILL MMMMMALL 2.0-_CA"WIwrTEN
Building InspeCt'.or NOTICE TO THE GEYMMATE HOLOM NAMED TO THE LEFT,BUT FAS.URETO DD SO SHALL
Peabody, Ma 01960 MPOEE NO oealrAe OR UABILRY OF AMv KIND UPON ri1E NS REfL rrs AGENTS OR
REPRESENTAT
AUTROQUEsRlTA71YE
Ili ORD 25S(7w) O ACORD CORPORATION IWO
Board of Building Regulations and Standards 1Y,(t
HOME IMPROVEMENT CONTRACTOR License or registration valid for indivldul use only
before the expiration date. 1f found return to:
Registration: 136605
Board of Building Regulations and Standards
Expiration: 4/23/2009 Trp 129039 One Ashburton Place Rua 1301
Type: DBA Boston,Ma.02108
SML ROOFING&ROOF REPAIRS
STEVEN LAMONDE
6 Felton sl
PEABODY,MA 01960 �'k1
Administrator
Not valid without signature