1 TEDESCO POND PL - BUILDING INSPECTION . G K 3�J c� �-I � 3 z°z �
� g� The Commonwealth of Massachusetts CITY OF
>� Boazd of Building Regulations and Standards RECEIVED v`�E�EM
^ MassachusettsStateBuildingCode,7801N�ECTIONALSE RevisedMar20L
�
Building Permit Application To Construct, Repair,Renovate Or Demolish a S
O One-or Two-Family Dwe[ling _ p. �' �
� Tlus SecEion For Officia Use Only
� 1 � Building Permit Number: Date pplied:
�,� , 3
iBuilding O�cial(Print 7Vame) Sig�at�ue . . � �0
� _ SECTION 1:SITE INFORMATION
1.1 Prope Add ess: 1.2 Assessors Map&Parcel Numbers
\ ' GS5 �
` 11 a Is this an accepted street?yes no Map Number Pazcel Number
. 1.3 Zoning Information: 1.4 Property Dimensions:
. Zoning DisVict Proposed Use Lot Mea(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yazd Side Yazds Reaz 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? Munici a]O On site dis sai s stem ❑
Public❑ Private❑ Check if yes� p � Y
SECTION 2: PROPERTY OWNERSHIP'
2,.�j Owner�of Record• � ��/�
K R'�/hl �TK1 � D�/ S✓1'/ )'7`7-k ��"� vv//E}• O'/c1�CJ
Nazne rint) City,State,ZIP
/ �',�r�k-� Oa�,o �i-�-.�� (,-� .�,�-�3yi
� No.and SVeet Telephone Email Address
SECTION 3:DESCItIPTION OF PROP03ED WQRIC'(eheck all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: ' �
Brief Description of Proposed Wod�: f� �%�//�s7 J r/T/FFJ�-t]'� ���Q-/�/�l�E'7'—'� �
,•
S - e P .
SECT[ON 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use On1y
Labor and Materials
1.Building $ d� �• 8����8 P���t Fee:$ Tndicate how fee is determined:
� ❑Standard City/Town Appldcation Fee
2.Electrical $ - p -
❑Total Project Cost�(liem 6)x multiptier x
3.Plumbing S 2. OtherFees: $
4.Mechanical (I-IVAC) $ � �d� .List: . -
5.Mechanical (Fire $ Total All Fees:$ �
Su ression
Check No. Chesk Arnount: Cash Amount
6.Total Project Cost: $ O Paidin Fut1 ❑Outstand'mg Balance Due:
ft�f���K17 Fs�l'� ��('i'j �JBC� �
K�,Q =�S Ca�.-�����✓L
SECTION 5: CONSTitUCTION SERYICES
5.1 Construction Supervisor License(CSL) �
l S C�l'�(�7�'— a � !S�"
�-{J���r}� /�,[�(�-(�G LicenseNumber Expin onDa �
Name of CSL Ho]der
List CSL Type(see below) �
� L�ZWI Ph�4G�3—
No.and Street - , � TYPe � � � Description. .
������ y�� D/C7(� U Uarestricted uildin u to 35,000 cu.ft.
��� � R Restric[ed 1&2 Fami] Dwellin
City/Town,State,ZIP M Maso
RC RooSn Coverin
WS Window aud Sidin
/� ���, �� SF Solid Fuel Buming Appliances
l0/77� 9O�yqh !�/T1r" '���)C�{'Y/�i� I Insulation
Tele hone Email addr�� - D Demolition
5.2 Registered Home Improvement Contractor(HIC) ��
�/'/D�(./a�D �b/Y�/St�i{ ��p� r�_ HICRegistration umber p ation ate
HIC Com any Name or HIC RegisVant Name
.� �'�.-n P�c�- f'�i�-r it.�r,n�/; �
No.��q�,Street �+e�'dress �A�,
_//"/�4/�LL�f}}C�� �li�-. (�,'7J/, �5�?
Ci /Town State,ZIP Tele hone
5ECTT01V 6:WORICERS'COMPENSATION INSI7RANCT AFP'IDAVIT(M.G.L.c.152.§25C(6�j
Workers Compensation Insurance affidavit must be completed and submitted with this applicafion. Failure to provide�
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No........... ❑
SECTIOPT 7a:OWN'ER AUTHORtZATiON T0 SE COMPLETED WHEN
QWNER'S AG$NT OR CON'1'RACTOR AP�LIES FOR BUII,pING PERM►T " -
I,as Cwner cf thz subject property,hereby aull;orize�g-j,z,/,p..�^'�i���'-,�jg2C+!1
to ac[on my behalf,in alt matters relative to work authorized by this building permit applica[ion. jh
1��kL.�vw r�- ���/l S
Print Ownets Narne(Electronic Si�ature) a�
SECTION 76:OWNER' O�t AUTHOI€IZED AGENT DECI.ARATION
By en[ering my name below,I hereby attest under the pains and penalties of pequry that all of the information
contained in this application is true and accurate to the best of my Imowiedge and understanding.
�d�-t2-(S�7L�bk FS{? �il_.td-!� �
Print Owner's or Au[horiud AgenYs Name(Electronic Signature) Date
,. .. . . . . . . .
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 azbitration �
program or guazanry fund under M.G.L.c. 142A.Other important information on the HIC Progam can be found at
w�v�v.mus.eov..%oca Informa6on on the Construction Supervisor License can be found at ww�i�.mass.eov/dos
. 2. When substantial work is planned,provide the information below:
Total floor azea(sq.ft.) (including garage,finished basemenUattics,decks or porch)
Gross living azea(sq.fr.) 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 E�closed Open
. 3. "Total Project Squaze Footage"may be substituted for"Total Project CosP'
Client#:65359 MONACOJONN
� ACORD�. CERTIFICATE OF LIABILITY INSURANCE �,nvzo""�S��Y'
.THIS CERTIFICATE IS ISSUED AS A MATTER OF INFONMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER.THIS
CEflTIFiCATE DOES NOT AFFlRMATVELY OR NEGAT7VELY AMENO,EXTEND OR AL7ER THE COVERAGE AFFOHDED BY THE POLICIES
BELOW.THIS CEHTIFICA7E OF INSURANCE DOES NOT CONSTITUTE A CONiAACT BEfWEEN THE ISSUING INSURER(S),AUTHOpIZED �
� REPRESENTATIVE OR PRODUCEH,AND 7HE CERTIFICATE HOLDER.
IMPORTANT:If ihe certificate holder is an ADDITIONAL INSUHED,the policy(ies)must be enCorsed.M SUBROGA710N IS WAIVED,su6jeet to
the terms and condRians W the policy,certain poiicies may require an aidoreemeM.A statemeM on this certificate does not confer rights to the
certificate holder in lieu of such enAorsement(s).
VROOUCEN - N�Ep� C�[IFICB���t
HUB International New England P��N �,978 657-5700 � x,:866 475 5959
299 Ballardvale St �1°� nee.certificates@hubinternatlonal.com
AUONESS:
Wilmington,MA 01867 INSUNEX(S)AFFONOWGCOVEIIAGE NAIC8
978 657-5100 ixsuwew n:Travelers Indemnity 25658
msuneo ixwxex e:
Monaco Johnson Group LLC
INSUPFA C:
C/O Christopher A.Monaco
ixwxFn o:
3 Elm Place
MSUXFA E'
Marbteheatl,MA 01945 �
INSUPEN F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBEH:
THIS IS TO CEfl77FY T}IAT 7HE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUE�TOTHE iNSVRED NAME�ABOVE F-0RTHE POLICYPERIOD
INDICATED. NOTNITHSTANDING ANV RE�UIREMENT, TERM OR CANDITIONOF ANY CONTRACTOR OhiER DOCUMENT WITH RESPECT TO WHICH THIS
CEflTIFICATE MAV BE ISSUED OR MAY PERTAIN, THE INSURANCE APFORDE� BV 7HE POLICIES DESCRBED HEREIN IS SUBJECT TO ALL TiE TERMS,
EXClU510N$ AND CONDIiIONS OF SUCH POLICIES. LIMIT$ SHOWN MAV HAVE BEEN RE�UCED BV PAID CLAIMS.
INSIi AU IIB POLICY EFF POLICY IXP U��
�Tp TYPEOFWSIIflANCE �q �yyp POLICYNUM6EP WD
p ��+E�-�a+�' - 68p3647N8847542 �����$ ��d2�� EICHOCWRflENCE S� 00���
X COMMEflCNLGENERALLIR9ILRV ' PPEM°�EST�Oea�� s300000
ClAIMS-M�DE �OCCUfi MEDIXP� oneperson) ESOOO
� PEfl50NNL8�lUVINRIflV $� �Q��O�
GENEMLAGGHEGAIE $ZOOO�OOO
GENLAGGNEGATELIMITAPPUESPEfl: PflOOUCTS-COMP/OPAGG $T�OOO�OOO
X POLICV PRa LOC =
A AUTOMOBILELWBILIT'/ BA3649N64475 4/10/201504/10/207 Ee�e�d�SINGLELIMR
BODILVIWURY(Petperson) $SOO.00O
FNYAlITO ' . �
ALLOWNEO X SCHE�ULEU � � � �� BODILVINJORY(PereUitlenl) &SOD�OOO
X MREpSAlJ�0.5 X NON-0WNEO . Per�a¢fltlenOAMAGE S�Q��OOO
PUTOS
S
q X UMBXFLLAWB X occua CUP3038T6601542 N201504lIOP201 FACNOCCUHHENCE s2000000
E%CE55IJAB CfAIMSMFDE AGGREGATE EZ OOO OOO
�ED X REfEM10NSSOOO $
A WOPKEXSCOMPBISATION IOUB3667N32115 0/2015 04/10/201 X WCSTPTU- OTH-
ANU EMPLOYEPS`LIABILRY
ANYPROPPIEfOP?MTNEflIF.XECUIiVET�N E.LEACNACCIOENT $SOOOOO
OFFlCERrt.1EMBEREXGLUOEOi � N/A
(Ma�Matory in NX) E.L UISEASE-EA EMPLOYEE SSOO OOO
If yes.desn'be untler
�ESCRIPt10N OF OPEflPT10N5 Eelow E.L DISEASE-POLICY L�MR ESOO OOO
OESCRIPIION OF OPEH4TON5/LOCATONS/VEIIICLES(Atlae�ACONO lUl,NdEltloiul Peme,ka Sc�MWe,M mare apam is reqWre�
� "Workere Comp Infortnation" �
. Proprietors/Partners/Executive Officers/Memb�s F�ccluded:Chdsopher Monaeo,Member 8 Peter Johnson,Member
� Blanket Additional Insured status applies to certificate holder only when required by written contract and .
� prior to any loss/claim.
CEHTIFICATE HOLDER CANCELLATION -
Jon Sillman SNOULD ANY OFTHE ABOVE DESCRIBED POLJCIES BE CANCELLED BEFORE
TXE EXPIRAiION DATE TXEREOF, NOTCE WILL BE DELIVEpED IN
359 Tappan Street,Unit 3 ACCOfiDANCE wnn+ n�e roucr PNOV1510NS.
Brooldine,MA 02445
AUMORQm REPNESFMAIrvE �
O t98H-2010 ACOHD CORPOHATON.All rights reserved.
ACORD 25(2010/05) � p{7 The ACORD name and logo are regis[ered marks of ACORD
�S7425000/M1360749 ' CW007
QTY OF SALEA MASSAaiLNETIS
Bu a DING DEPARTMENT
120 WAUM4GTONSMMT, 3'ORDOR
L (978) 745-9595.
F
KIMBERLEYDRISOL7LL FAX (978) 740.9846
MAYOR IhC UAS ST.P EM
DIRECTOR OF PUBLiCPROPERTY/BI 1 DAC OOSSIONER
Construction Debris Disposal Affidavit
(required for 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 c40, S 54; Building Permit # is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
1'40
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address o(facility)
Signature of applicant
ate
-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 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 state whether or not those entities have
employees. If the subcontractors 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. -T
Insurance Company Name: / /Lt4 a'�✓3YJ S. /!J/rx-s�7'J �t sfi lf.
Policy 4 or Self -ins. Lic. M /,:2 A 3 ig A7��_�/V ?moi �/' �_ Expiration Dater
Job Site Address: / `7KI7/SS7se lairn,1J r
//, — • . - City/State/Zip:.7aa--y.frs�., �J� W
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
coveraee verification.
I do hereby
Phone M G (7 719
the information provided above is true
Official 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
Phone
The Commonwealth ofMassaehusetts
'
Department oflndustrfalAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Wworkers'
www massgov/dia
Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers-
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
Please Print Legibly
Name (Business/Orgartization/Individual):
p
Address: `� C5� 712 T l,�-%
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit 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."
Additionally, MGL chapter 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and 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 be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the 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 permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and 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 dqg license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
`--! .CnrCl C' o:. 1: C.19 .0 a�71 i,:0 .3 f, C! .til c
"flW1,11cri,111 S1111vin km' t „I,y
CS -013075
CEWSTOPHER A -MONACO
3 ELM PLACE _
MARBLEBEAD MA 01945:
1012612015
I
C7-
-072GO/1??/J?24�d2G(lPCYr%1F2 0���LJ-CLCidGG/r1�
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 110147
Type: Partnership
Expiration: 10/912016 Trk 259048
MONACO JOHNSON GROUP
CHRISTOPHER MONACO
3 ELM PL
MARBLEHEAD, MA 01945
SCA 1 0 20M -05M
(•'_��e (!gin Neuin/rrOro�/� f�nrllilJJrrc�uAn//1
�.
office of Consumer Affairs & Business Regulation
OME IMPROVEMENT CONTRACTOR
egistration: 110147 Type'
.Expiration 10/9/2016 Partnership
MONACO JOHNS ON,GROUP
= r'i
CHRISTOPHER MONACO
3ELM PIL
MARBLEHEAD, MA 01945 Undersecretary
Update Address and return curd. Mark reason for change.
n Address r] Renewal rj Employment I_, Lost Cord
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
CNot valid without signature
63�o
3y v6;)
c Marcia Kirkpatrick
From: Bobbi Smith <bobbiwsmith@comcast.net>
Sent: Monday, August 10, 2015 2:13 PM
To: Marcia Kirkpatrick
Cc: Bobbi Smith
Subject: Fwd: building permit for 1 Tedesco Pond Place
Hi Marcia
Following please acknowledgement of interior construction by Steve Curley on behalf of the association trustees.
All best,
Bobbi Smith
Sent from my Whone
Begin forwarded message:
From: "Steve Curley" <steve@sunrisemkt.com>
Date: August 10, 2015 at 1:41:06 PM EDT
To: "Bobbi Smith" <bobbiwsmith@comcast.net>
Subject: building permit
The Trustees are agreeable to any interior alterations to your unit. Any exterior alterations would need
to be reviewed in advance.
Regards,
Steve Curley, As Trustee
1