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59 SUMMER ST - BUILDING INSPECTION (3) /1 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7ih edition OF SALEM Revised January Building Permit Application To Construct, Repair, Renovate Or Demolish a 1, 1008 One-or Two-Fami/v Dwelling This Section For OfTtcia se Only Building Permit Number: ate Appli d: Signature: /✓C✓p J �� Building Commissl ner/Inspector dRuildings D ic SECTION 1:SITE INFOOATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 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 B) Frontage(11) 1.5 Building Setbacks(D) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check ifyes❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 16.0 wner ppf Record: '71 \ �;nq dwvore. �j�l StAmoie—y Name(Print) Address for Service: Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building P,I Owner-Occupied JX I Repairs(s) ❑ I Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other P Specify: a4a Brief Description of Proposed Work': t r o M SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Oliicial Use Only Labor and Materials y 1. Building S �Q- () 1. Building Permit Fee:S Indicate how tee is determined: �.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing $ a 2. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire $ f1 Suppression) Total All Fees:S /� Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: S bid 9U ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Lice en—sed Construction Su ervls 17 or(CSL) saq 3/ZLJ/ 12 1 g t/ License Number Expiration Date Name of CSL•I folder YPe List CSL T (see below) Cj / 0]eJ e11 1LI YT rype Descr iption Lion U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling ' ature M Masonry Only Q 0(6 -7231 g RC Residential Roofing Covering relephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 egbtered Home IrrtErovement Contractor(HIC) ` b b- �CYcf 191Ca� FIIC tom an Name or III 'Re ist t Name yj� p Registration Number L/ Y t )� g tS 0 t"s rT" 7 1 /© A res Expiration Date -6'3ov P nature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 ..........o. No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Pe�'G,/ 1Ptv 4✓� , as Owner of the subject property hereby authorize %A S 4�,oD h to act on my behalf, in all matters relative to rk authorized by this building permit application. S' ature Owner Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of 'u 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 jol have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115,respectively. 2. When substantial work is planned,provide the information below: Total floors 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" Massachusetts Dcpitrunent.ut Public S itctg , ? . Board ofBuildin Rc�ul uiibts and St Indat tts,. Construction Supervisor License License: CS 99551 Restricted to: 00 PETER ALLARD �. 2 CARVER ST. , BEVERW Mp+A1915 ,� ��e-- Expiration: 3125r2012. - - f'uniniidviPnrr' V Ba:' �atHiiifAifrdifai4�d8SrfH8SrHff ' HOME IMPROVEMENT CONTRACTOR - 3 Regiatra l 137887 3 Eggta n_ 12/17f2010 Tri 277800, • ( i = :tvte CorporaWn BUILDING MAI - PETER ALL4R 14.15 WILLARQ ..... '. PEABODY,MA 0198, Administrator E CITY OF S.UEM. 1tLASSACHL;SETTS BLI[M G DEPAIMMST I'_0 W.►sHL%iGTON SiTitm. 340 FLOOR TEL (978) 745-9595 F.ut(978) 740695M KI.,,tBEy. EY DRISCOU Tliomu ST.P12aug HAYOt D1kt$croa or vt gtic PROPERTY/It:ttatYo coSMnss1oNER Workers' Compensation Insurance Aflhdavit: Builders/ContractorslElectrlclansiPlumben > e lieant Information Please Print Val17e I tluaidw+r 4rynuuion In hvO fmd1: \-A � Ron 'M ; S'C Address: AI 1 j55_ L4, \\of City/StateiZip: Ala: 61 CiM phone#. o �; $- Are you an employer'Cheek the appropriate box: Type of protest(requtred): I.� I pia cmployr:with ]Len 6. Q New coustnstioo employees(full and/or pan-eime).• have hired the atb•cantraetors 2.❑ I am a sole proprietor or partner• listed on the attached sheaf 7. ❑Remodeling ship and have no employees Thess sub-contractors have 8. Q Demolition working for me in any capacity. workers'comp.ins iniam 9. Q Buidling addition INo workers'comp insurance S. Q We an a corporation and its 10.❑Electrical repairs or atWitiore rcquired.l ofters have exercised their ).Cl 1 am a homeowner doing all work right of exemption par MOL 1 I.0 Plumbing repairs or additions myself.LNo workers'comp. c. 152,f 10),and we have no 121,gRoof repairs insurance required.]t employees.LNG workers' 11.❑Other comp insurance required.) -Any appmran this ddreb 10411101 mop atop no.err 1114131111101411111 baler.loaiy their war 'cwnraarwr panty in itrma sou, I t I.mwrwnwa who subate this aM6vir inilkwing they,an doles YI work are thin him aursib csnmoson Onus rahne a now arlhYvit indicating"k <r.musYww that cheek Ohio ban dtawiry dlte rate rt!rlra wlaeaarnrrpe gad the#rwbna'taOOrOp.policy iafwrtWiOa /sae an anp/oystr that boreviding workers'roaroer►tadon/nswrsiwn for s it resp/rryees: Slow/s fAe pellep awd/eI s/Ir information, ^ ` Insurance Company Name:\V eQf cS CO)\ Policy 0 or Self-ire. Lie.M: t- "r 5 5i S 1(°I Expiration Date: 1212—3 T Job Site Address: 9Cf S40+-Ne C/ Z City/StatriZip: GlcrAexd .\teach a copy of the workers'compensation policy deelarstlou pap(showing Ike policy number and expiration dab), Failure to secure coverage as requited under Section 25A of MGL 6. 152 can Ind to the imposition of criminal penalties of fine up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Roe of up to S250.00 a day against the violator. Ile advisdxl that a copy of this statement maybe forwarded to the OIYTce of Inccaugatiuru ul'dta OIA for insurance coverage verification. 1,10 hereby eartif under the pains un/d�hex ojper/ury that Ike inforwodow provided ubeveJis true and rarpre& Phu ,t: ga Lg 0/07cia1 use onir Do not write in this urea,to be.mnp/erd by city or town,t//Jc•iaL City or ruwn: PcrmiUl.lcensr M—_. Nsuing Aulhurily (circle une): I. Itwrd of MAN 2. Huilding Department J.City/fawn Clerk 4. Electrical Inspector 5. Plumbing Impactor 6. Other COntact Pcnan: _ ._ _. Phone#: ,S CITY OF SALEM PUBLIC PROPRERTY VA. // DEPARTMENT 110%X.wIh[t.;0N5fXhfT0SA %MAN"' nlaIn:I'h 7'FI;97B•N.+•7i9s 1'.%X:978.140-9446 Construction .Debris Disposal Affidavit (required liar all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40,S 54; Building Permit _ is issued with the condition that the dcbris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c l 11. S 150A. The debris will be transported by: (name ofhauler) The debris will be disposed of in (name ut acl Itylty"I y) Vl lV1017 � (address of facility) ip;nature of permit applicant date Icln Half,:•w mud" U.S. Roofing ® ® v a division of Building Maintenance Corp. NNL �� m P.O. Box3118 � sus Peabody, MA 01961-3118 ROOFING Telephone: (978)532-6300 Fax: (978)977-0803 CONTRACT The Owner(s) of the premises described below ("Job Address"), hereby contract with and authorize U.S. Roofing, a division of Building Maintenance Corp. ("Contractor"), to furnish all necessary materials, supplies, labor and workmanship, and to install, construct and place improvements at said Job Address, according to the following specifications, terms and conditions: 1. Owner's Name: Daniel Finamore 59 Summer Street Salem, MA 01970 2. Job Addresses: 59 Summer Street Salem, MA 01970 3. Specifications: - Remove all existing shingle layers down to exposed roof boards - Dispose of all debris in a legal landfill - Install Ice and Water Shield at all gutter edges; including all valleys and roof penetrations - Nail 15-lb. felt underlayment over remaining roof surfaces - Install 8" white aluminum drip edge to all roof perimeters - Cut away opening in ridge boards (to allow ventilation) - Install Certainteed`' 30-year Three-Tab shingles to all roof surfaces; storm nailing each (six nails per shingle) - Install coil ridge vent at roof peaks - Flash all roof penetrations according to National Roofing Standards - Cap ridge with Certainteed`°' 30-Yr cap shingles - Repair existing rubber roof located above front door - Clean all gutters at completion of project COST OF WORK: $ 6,750.00 4. Extras: ' Any rotted board replacement cost would be an additional $3.00/sq. ft. 5. Warranties: The above work comes with Certainteedm,Inc. 30-year limited warranty (furnished to Owner from Certainteed°1n directly)for materials and a two-year warranty (furnished by Contractor)for labor. 6. Payment Terms: The total cost of the contract is $ 6,750.00 Payment shall be rendered in the following manner. - 100%due upon successful completion of all work 7. Attorney's Fees: In the event of default,the Owner shall pay costs for collecting amounts owing including, without limitation,court costs, expenses and reasonable attorney's fees, in addition to any sum that the member may be called on to pay. U.S. Roofing ® a division of Building Maintenance Corp. vnn_�` P.O. Box 3118 ROOFING Peabody, MA 01961-3118 Telephone: (978)532-6300 Fax: (978) 977-0803 S. Entire Agreement: This contract constitutes the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. The Owner agrees that Contractor has made no statements, promises, commitments or representations not contained herein. 9. Modification: Other than that required as a result of paragraph 4 above, any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if evidenced in writing signed by each party or an authorized representative of each party. 10. Unforseen Circumstances: Contractor is not liable for delays due to weather, strikes, accidents, acts of God or other circumstances arising out of causes beyond its reasonable control and without its fault or negligence. 11. Governing Law: It is agreed that this agreement shall be governed by, construed,and enforced in accordance with the laws of the Commonwealth of Massachusetts. IN WITNESS WHEREOF, the parties have signed their names hereto: Date: 10-19-2009 Date: 1 I O`, S. Roofing, by its agent Homeowner an or Homeowner's agent: Willard H. Murray List desired shingle color: � 1t(Please Print) iC.�— - e, E'X,J7 " 2 _ . ACORD,w CERTIFICATE OF LIABILITY INSURANCE 12 292009 DATE /20/09 PRODUCER Phone: 781-681-6656 Fax: 781-681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Driscoll Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 93 Longwater Circle HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . P.O. Box 9120 Norwell MA 02061 INSURERS AFFORDING COVERAGE _ NAIC# . INSURED - INSURERA:Star Indemnity_ & Liability COm Building Maintenance Corp. INSURER B:Peerless Insurance Company 4198 58 R Pulaski Street Peabody MA 01961 INSURERc:Everest National Insurance Co INSURERD:ACE Property & Casualty Insur INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY NUMBER POLICYEFFECTIVE POUCYEXPIRATION LTR D MM DD A MM D LIMITS A GENERALLWBILRY WCSICON30006109 12/23/2009 12/23/2010 EACHAGECURRENCE $ 1000000 X COMMERCIALGENERAL LIABILITY PREMISES Ea occumnce $100000 CLAIMS MADE OCCUR MED EXP(Any one Person) $5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GENIAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $2000000 JECT POLICY X PRO- LOC B AUTOMOBILE LIABILITY BA 8730382 12/23/2009 12/23/2010 COMBINED SINGLE LIMIT ANY AUTO (Eaaccident) $1000000 ALLOWNEDAUTOS BODILY INJURY $ X SCHEDULEDAUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTYDAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHERTHAN EAACC $ 1 AUTOONLV: AGG $ C EXCESSIUMBRELLA LIABILITY 71CB000264-091 12/23/2009 12/23/20 10 EACHOCCURRENCE $5 00Q 000 X I OCCUR CLAIMS MADE AGGREGATE $5 000 000 $ DEDUCTIBLE $ RETENTION $ $ D WORKERS COMPENSATION AND - C458SS119 12/23/2009 12/23/2010 X WC STATU- O R EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500000 ANY PROPRIETORIPARTNER/EXECUTNE OFFICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500000 Ryes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 B OTHER CBP 8732S82 12/23/2009 12/23/20 10 Job Site Limit $100,000 Installation Floater DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS E: Latitude Condominiums, 281 Essex Street, Salem, MA & all other projects in the city. otice of cancellation provision is 30 days, except 10 days applies for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION.DATE THEREOF, THE ISSUING INSURER City Of Salem Massachusetts WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE Attn: Public Properties Dept. CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 120 Washington Street, 3rd Floor SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Salem MA 01970 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORRED REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988