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55 SUMMER ST - BUILDING INSPECTION (3) $ze K [ 123 The Commonwealth of Massachusetts NSPEC CEIVED /ICE Board of Building Regulations and Standards 1 C I Massachusetts State Building Code, 780 CMR SALLEMi Building Permit Application To Construct, Repair, Renovate Or Demo[�tf�N -v1Ted 2(ar0�( One-or Two-Family Dwelling D A `L This Section For Official Use Only Building Permit Number: Date A I' d: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: L2 Assessors Map& Parcel Numbers f I:la 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 It) 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Ale//5, Shy fo F Name(Print) City,State,ZIP 's- Sd nt. <?5 -7-- 2Z-S-bnt-( No.and Street - Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specity: Brief Description of Proposed Work': f /i/'tt4 a �4r / o e SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ 3.-2od I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (FLVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 3 z 0-0 Check Paid in Full ❑Outstanding Balance Due: MN>.kAa;n To �l .O . Sly 14AV& (4/ST02r, ( w s f, L,,T2 SECTION 5: CONSTRUCTION SERVICES .5.1 Constrn`ction,Supemisor License(CSL) 4 �01'' �2r (?/ License Number Expiration Date �N me of CSL Holder, jiff List CSL Type(see below) No.and Street T Description �/f 0/ U Unrestricted(Buildings u to 35,000 cu.ft. 91.� Restricted 1&2 Family Dwelling flown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ��,� SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Ikei 4'/i' J vk lam, e7ll�? Z /�, Expiration HIC,,//C��ompan,7yl�N me m-1-IIC Regi/g rant Name HIC Registration Number Expiration Date All 7)?Csc `6NC / 1/ CO-�— No.and Street Email address .3� 7a 92yZJ 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 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_ /+eis to act on my behalf,in all matters relative to work authorized by this building permit application. k� uRy '0-lell r- s /y Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW 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. P t Owner's or Author ed Agent's Name(Electronic Signature) Date NOTES: I. 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.eov/dys 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 hal0baths Type of heating system Number of decks/porches Type ofcwoling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Roofing propo0aY Page No. of Pages John Hersey All Phase Roofing 39 Chase Street Beverly, MA 01915 978-304-6967 MACS# 82262 PROPOSAL SUBMITTED TO PHONE DATE I 2 STREET JOBNAME .t�i�1 , '22_fa �Q 5 SJr `SUM�9[r 3 G CITY,STATE //AND ZIP CODE JOB LOCATION �1FlCr+ 'EJJ S a ✓N'L2— We hereby submit specifications and estimates for: We hereby submit specifications and estimates for: SHINGLE ROOF FLAT/RUBBER ROOF Strip entire roof ❑ Sweep entire roof clean ff Replace any bad boards up to 100 linear feet ❑ Strip entire roof 'ETInstall ice and water barrier first three feet up roof ❑ Mechanically fasten down ISO board insulation ❑ Install ice and water barrier in all valleys and along dormers ❑ Install 060 Rubber Roofing on entire roof Install 151b.felt paper on remainder of roof S�N/�v�e ❑ Install metal flashing around perimeter of building E17Install eight inch drip edge ❑Flash chimney(s),pipe(s)and wall(s) ❑ Install ridge vent ❑ Edge caulk all seams ❑ Install or re-flash chimney(s) ❑ Install new copper center drain OfFlash new pipe flanges ❑ Other: Install 30 year shingle ❑Other L,L T7Ma ❑ Clean up all debris ❑ Install gutters and downspouts ❑ Labor and materials guaranteed 100%for five years ❑ Install trim coil ❑ Install new fascia boards ❑ Install new rake boards ❑ Install sky light(s) Other: Clean up all debris ETfabor and materials guaranteed 100%for five years We $Jropoa hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: 3 2 oa 0� Total Price($ 3iJoe) ). **IF YOU ARE HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC,AS WE HAVE NO CONTROL OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS`* All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will Authorized become an extra charge over and above the estimate.All agreements contingent upon Signature strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Zirteptat tt of Vropooal — The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature work as specified.Payments will be made as outlined above. Date of Acceptance 5. 90 , 9f in^D l q Signature Plesse mail yellow c.,y m above edJ .DDfi.ltg �O�ID�aY Page No. of Pages t -John Hersey All Phase Roofing �. a 39 Chase Street Beverly, MA 01915 978-304-6967 MACS# 82262 PROPOSAL SUBMITTED TO PHONE y-a64 ��� DATE I LI I L) TR SEET,/ JOB NAME 12 2_S . C)O l t 5 SS So .o er ° S� L CITY,STATE AND ZIP CODE JOB LOCATION - We hereby submit specifications and estimates for: We hereby submit specifications and estimates for: SHINGLE ROOF FLAT/RUBBER ROOF ... _._� .Cyj Step entife<roof s,: �..,,,,.. ,-1,.___ ❑ Sweep entire roof clean T1 Replace any bad boards up to 100 linear feet ❑ Strip entire roof - ]Install ice and water barrier first three feet up roof ❑ Mechanically fasten down ISO board insulation ❑ Install ice and water barrier in all valleys and along dormers ❑ Install 060 Rubber Roofing on entire roof Install 15lb. felt paper on remainder of roof S,rN{n ha ❑ Install metal flashing around perimeter of building Install eight inch drip edge ❑Flash chimney(s),pipe(s)and wall(s) ❑ Install ridge vent ❑ Edge caulk all seams ❑Install or re-flash chimney(s) ❑ Install new copper center drain tFfl�Flash new pipe flanges ❑ Other: t©Install 30 year shingle ❑Other ❑ Clean up all debris Qilnstall gutters and downspouts ❑ Labor and materials guaranteed 100%for five years 1�;$nstall trim coil ❑ Install new fascia boards ❑Install.new rake boards ❑ Install sky light(s) Z Other: {� ErClean up all debris ©Labor and materials-guaranteed100%for-five-years `- - - _ - --- - - •,.* -------- We jlrnpo5e hereby to_furnish /material and labor—complete in accordance with the above specifications for the sum of: Total Price($ **IF YOU ARE HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC,AS 3 WE HAVE NO CONTROL OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS.** All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will Authorized become an extra charge over and above the estimate.All agreements contingent upon Signature strikes, accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation 4.Insurance. 4 (� /.,� 4 r tt lueptante of P oplogdl 5-" The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature .+work'as specified.Payments will be made as outlined above %� Date of Acceptance / / w l 1 Signature 2 r' , Pi—mil nnoq copy to ab—aamc.:. t r . "1 Massachusetts'-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor u; License: CS-082262 JOHN T HERSEY;-` s 39 CHASE ST BEVERLY MA 6191 ss Expiration ' Commissioner 1�1fQ412015 r V/te.tponuNcoruue[&lF�i.o�V�Laalnf�ueJe�a Office of Consumer Affairs&Business Regulation "- .', F _ ME IMPROVEMENT CONTRACTOR "egistrafion 171107 Type: xpiration: r 2I13%201 Individual JOHN HERSEY • JOHN HERSEY � "� l 39 CHASE ST e BEVERLY,MA 01915 Undersecretary': ,4ca�iea' CERTIFICATE OF LIABILITY INSURANCE s DATE(MMDD YYY) s 2014 THIS CERTIFICATE IS [$SUED AS A MATTER Of INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES',NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the policy(iec)must be endorsed. If SUBROGATION I$WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement an this certificate does not confer rights to the certificate holder In lieu of such endorserm ntis). PRODUCER NAMNTACT E: LEWIS CLARK & BROWN INSURANCE PHONE t; 781 944-0427 ac ND 781 42-2654 22 Woburn Street Suite 25 AODR�ss,lewisdarkbrown cornc s m Reading, MA 01867 INSURER(s) AFFORDNG cOVtrnoe NAiCI INSURER A;COMMERCE INSURANCE COMPANY INSURED JOHN HERSEY INSURER B: ALL PHASE CONSTRUCTION INSURER C: 39 CHASE,ST INSURER D: BEVERLY, MA 01915 INSURER E INSURER F: COVERAGES CERTIFICATE (NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LASTED 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. ILTR TYPE OF INSURANCE IN50 a b POLICY NUMBER M / M M LIMITS COMMMOIAL GENERAL UASIUTY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea accunence S X BUSINESS OWNERS MED EXP(Any one parson) 3 A POLICY BDDKZT 2/2/14 2/2/15 PERSONAL&ADV INJURY $ INCL GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 1,000,000 POLICY❑JECO (rt T U LOC PRODUCTS-COMP/OP AGG S INCL OTHER: e AUTOMOBILE LIABILITY Ea aoddentINGLE LIMIT ! ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per acciderR) ! NOWOHIRED AUTOS AUTOS Porpddart $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION! Ig WORKERS COMPENSATION -AND EMPLOYERS'LIABILITY STATUTE ER QFF RROPRIIN 5ER eXCLVDED%ecUTIVE ANYY- TO BE ISSUED BY EL EACH ACCIDENT $ OfFICERIMESBE4 @%CLUGEp? �N/A tMa^eacrv1.NW COMPANY E.L.DISEASE-EA EMPLOYE S If yes,describe under DESCRIPTION OF OPERATIONS belmv EA-OISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS I VEHIGLES (ACORD 101,AddlWnel Remathe SWeduie,may be etteohed itmme space Ie Roused) CERTIFICATE HOLDER CANCELLATION CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSPECTIONAL SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 120 WASHINGTON 5T- 3RD FLOOR SALEM, MA 01970 AUTHOR ENTATIVE FAX #1-978-740-9846 , 0 662014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD �hvr CITY OF S•1lZNf1 )% ASSACRUSE-rTS ©U'ILDIING DEP.1RT 0NT 120 WASHCYGTON STREET, Y°FLOOR T8L (978) 745-9595 KIMBERT Y D(LISCOLL F.L%(978) 7-W-9944 NLAYOtt TrtO'%vU ST.PmAjm D"UCTOR OF PUBLIC PROPERTY/Stmom<;CO.NumsSIONER Construction Debris Disposal Aff7davit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CUR section 111.5 Debris, wid the provisions of NIM c 40, S 54; Building permit y is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c l l 1. S 150A. The debris will be transported by: f/f(e- TAPI ." jl c- ,a.4 (fume ut'Iteuler) The debris wi 11 be disposed of in (name o ttacdily) - --J �"` ,e�J kluuress of facility) c-9? sigrtatureofpermitapplicant —