94 TREMONT ST - BUILDING INSPECTION Q The Commonwealth of Massachusctts
Board of Building Regulations and Standards Town of
Massachusetts State Building Code, 780 CMR. 7'"edition loomm000
�. Building Dept
t
Building Permit Application To Construct, Repair, Renovate Or Demolish a thlitl►
One- or Tivo-Fumilt DtrrlGng
ecfon orOticialUseOnl
Building Permit Number: Date Applied: 72 (J
Signature:
Building Co tssioner/ Ins torn I Date
S ION I:SITE INFORMATION
1.1 Pro eZ Address: 1.2 Assessors Map& Parcel Numbers
1 CM r)IU�
1.1 a Is this an accepted street'?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Propoxd Ux Lot Area(sq fl) Frontage(n)
1.5 Building Setbacks(11)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.6 Sewage Disposal System: -
Public❑ Private❑ Zone: — Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: C� —r
Name(Print) Address for Service:
Signature Telephone
SECTION J: DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ 1 Alteration(slWAddition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work": A4 i ll vt cab ®A=r .F '0 sit`
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building = I. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Ite s multiplier a
J. Plumbing S 2. Other Fees: S
4. Mechanical tHVAC) IS List:
5 Mechanical (Fire S
Suppression) Total All Fees: S
Check No. _Check Amount: Cash Amount:_
6. Total Project Cost: S Q 0 Paid in Full 13 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) ax
Liccroe Number Evpuation we
N;lme of f.SL-liplder _ < Lnt CSL T
YPe late below)
a Tvve Description
AJdrrss� U Unrestricted(up to 35,000 Cu. Ft.)
R Rcsuicted 1&2 Family Dwellin
Signature � �. \1 Mason Only
? y
4 J> < �y I r RC Residential Rooftn Covering
Telephone WS Rtvdential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D I Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) !D G J
HIC Company Name or HIC Registrant Name „ / Registration Number
Address'
h--1
Expiration Dam
Signamrc—` //� I/ 7elephjone�. 1
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 2SC(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
1 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.
Si nature of Owner Date
F
ECTION 7b:OWNEWOR AUTHORIZED AGENT DECLARATION
, as Owner orAuthorized Agent hereby declare
the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
lf.Nameture of Owner or Authorized Agent Date
ed under the sins and nalties of (uNOTES:
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 ng have access to the arbitration
rogram or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
onstruction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115. respectively.
hen substantial work is planned, provide the information below:
floors area(Sq. Ft.) (including garage, finished basement/attics, decks or porch)
living area(Sq. Ft.) Habitable room count
r of fireplaces Number of bedrooms
er of bathrooms Number of halfbaths
of hearing .system Number of decks/porches
of cooling system Enclosed Open
1. ' Total Project Square Footage"may he subsntuted for 'Total Project Cost"
CITY OF SALEM
PUBLIC: PROPRERTY
DEPARTMENT
.I . . I.. \1r, r.•.,. .l..alt • �Vl vl. \I�•.�, .I'r .
Construction Debris Disposal AIlidasit
(rcyuired li)r all demolition and rcno%auun work)
In accordance 11 ith the sixth edition of'the State building Code, 7S0 C NIR section 1 1 15
Dcbris, and the provisions of.)AGL c 40, S 54;
Building Permit N is issued with the condition that the debris resulting from
This work shall he disposed of in a pruperly licensed waste disposal lacility as defined by MGL c
I11. S 150A.
The debris will be it by:
Iname tit hauler)
I he debris will be disposed ot•in
owine uI Isu Ilv)
4 <B.v
LIJJre+. .d'I]nluvl
.a�nalwc nt p:nnrt .ggrhi�nl
.Idle
CITY OE S.U.Em, , xSSACHUSETTS
BUILDING DEPART IUNT
6. o
120 W.45HINGTON STREET. )as FLOOR,
TEL (978) 745-9595
FAX(978) 740-984
KI,BERIEY DRISCOLL
MAYOR I14oaW ST.PIERAt
DIRECTO R OF PUBLIC PROPERTY/gU D.DDIG CO%L%RSSION ER
Workers' Compensation Insurance AMdawit: Builders/Contractors/Electricians/Plumben
-%oplicant Information Please Print Leaiblr
_ �
Vatlrt (tlusimuOr{mu+afionlnJrvtdual)[ /'/A�/I[.- LGO., C(i///J7-/"4-6i'�-�/�l? � Z-1
Address: '�L/ �I luytU A)a c, K
City/Statc/Zip: F-f BO 1)�-/ ./14 A + Phone N: � 7 'i�
%re you to employer!Cheek the appropriate box: Type of project(required):
1.(Tam a employer with 4. ❑ t am a general contractor and 1 6. ❑New construction
employees(full and/or pan-rime).• have hired the subcontractors
2.❑ 1 am a sole proprietor err partner- listed on the attached sheet : 7. ❑Remodeling
,hip and have mu employee{ These subcontractors have {. ❑ Demolition
Workingfor me in an capacity. workers'comp.insunu ca
Y P tY• 9. ❑Building addition
[No workers'comp. insurance S. ❑ We are a corporation and its
required.)
officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.(No workers'comp. c. 152.41(4),and we have no 12.0 Roof repairs
insurance required.) t employees. LNo workers'
comp. insurance required.) I3.0 Other
-Any applicant bo thO chocb a of must alai fill out the saaim l clow showing their workee'wrnPais, tot policy infuntutdoa
't Lvncuwscra who subant this aflldi vg indicating they ate doing all work and thm hits outside centrtuoe,~submit a now anldavit indicating sOsei
<'.vOsrston Ohio cheek this hose must anwhad an additiusal sheet showing she eserw of tht arb4oxoratlole ad slick wortora'comp.policy infonwiaa.
1 um eA employer that is providlnE workers'compensedaa lnsuroaer for my employers i3dow/a rbr polity an//oI sire
informurion. /
Insurance Company Name: I� It ✓YJCC�i$IrI/
Policy r or Self-ins. LLiic. a: Ti 7 � 14'/V) Lf G a Expiration Date: / �1
Job Site Address: / / -)//1 S7— City/State/Zip:. ��1���� �t
,%hack a copy of the workers'compensation policy declaration pop(showing the policy number and espirades date).
Failure to secure coverage as required under Section 23A of MGL e. 132 can lead to the imposition of criminal penalties of a
fine up to S 1,300.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDEA and a find
of up to S230.00 a day against the violator. Ile advi.*x1 that a COPY of this statement may be furwarded to the Office of
Investtdalionn ol'the DIA for insurance coverage verification.
1 do hire certi y under the prim used Penalties ofaIrrJOIFY that the infArmadon provided above is true and carrecs
Ofriciul use only. Da not write in this area, to be.uwpleted by city or taws gfla'idil
City or futon: _ . __ ecrenit/l.icente I_
Iuuing.%whonty (circle une): i
I. Guard of fleallh 2. Ruilding Deparlmcnt 3. City/town Clerk 4. Electrical lnrpector 5. Plumbing Inspector
6. Other
l ..nCacl Perron: Phone
Melo's Construction LLC
$$B 34 Jennings Circle Peabody,MA 01960 xri=S
Telephone: 978-531-0811 - E-mail: FaustinoMeloArrisn.com
MEMBER Faustino Melo,General Manager
Unrestricted Mass Builders License No. 80393 Contractors Registration No. 108953
Proposal �u to: Phone .
E/ - ' N a A I S 97 '7 - Cl AY,3l 4 - t 7 - DPI
Address: City,State,and Zip Code
1 M0 /U7- i S Le- M /'0,4 . t) o
Job Description: Job Location: Job Phme:
{? 00%:-UG 9 H T Rzr1o,ur Sr 1 9 7 Sr 113/
We Proposed hereby to fiunish mahmIs and habar-oomplete m eocardeme mtb the specificab=hsted below,far the sum of.
TW o -THO b-, A tUn 006- /tU1VDRE0 Di9�/ a—Ulsrs (S . /DO• °rl
Installation of Payments:
Payments will be paid in thirds.The foot installment will be paid before the job begins.The second payment will be obtaimd in the middle
of the job.The ha payment will be obtained after the job is completed
Now;This proposal may be witlukawn by us Authorized Sigmune:�f�,.0
if not accepted within 20 days. Date: 6 ' J y-O 9
We Meshy Subs t Sredt4eadaw and Eseisaars tar.
THE INSTALLATION OF A NEW ROOF
To protect the homeowner's property,Blue Tarps will be used to cover the siding, bushes,and grass during stripping.
All of the layers of roofing will be stripped,and all protruding nails,strews,and/or staples will be removed. lee and water shield
will then be installed at the bottom of all edges,around all chineys,skylights,and into all valleys.
Fifteen(15)pounds of felt paper will be installed onto all other areas of the roofdeck. The 8"aluminum dripedge will then be
installed to all roof edges.
Any existing pipes will be covered with new rubber flanges.
The roofing material to be used will be 3 o y/� /�oo`i 1JG
The homeowner is responsible for the selectioa of the roof color.
Also,the homeowner may select eiler hand or pneumatic tail rs for the nailing application of the new roof.
All the debris will be dented and proneAv disposed of on a a&bask .Magnetic brooms will be used to extract all nails from
your property.
We will protect your property as best as we call,however,some foilage matting,breakage,or marting could occur.We cannot
accept responsibilty for possessions inside of the house,or debris falling into attic areas.
The customer should protect personal helpnoinoa_
Extra work tow an additional cost Will be added to the above price.
Replace Rotted Roof ioards t f, o O Fvor Gutter Repairs Remove Aluminwn Siding
Relead Chutney(s) Install Skylight(s) Remove Old/Rotted Wood
Replace Facia Boards Repoint chimney Install Garage Roof
Install Ridgevent Install Azek Board Install Insulation
Install Roof Louvers Install Window Trim Install Tyvek Paper
Install Aluminum Gutters Install Shutters Cover Aluminum Windows
f Install Aluminum Downspouts Remove Vinyl Siding Repair Vinyl Siding
Install chimney cap Porch Repairs Rebuild Chimney
Additional Notes: (4°osE
Nis t?, GE r'S {`D)Z or .c: 0AJz -5,', c O 7`,Y, /Coo ,`A1
RZPcACC iy w l3oo NG 3� VI? t DAi oA/,E .S/DC OG7/rri
Total Amount for Additional Work:
Warranty by manufacturer to be flee of defects for _3 years, see manufacwrees warranty for details. All labor performed
under this contract shall be of good quality and five from defects not inherent in the quality required or permitted for a period
of /V years. This wanianty excludes remedy for damage or defect caused by abuse,modification,improper or insufficent
maitenance,improper operation,or normal wear and tear under normal usage. This warranty shall be limited to the work
performed by Melds Construction,LLC and limited to either repair or replacement by Melds Construction,LLC at its sole
descreton and election. Any and all claims are waived unless made in writing to Melds Construction,LLC within 21 days after
the occurrence of the event giving rise to such claim. This warranty shall not extend beyond any limits imposed by applicable
law.
Payment and Penalties-Upon substantial completion of all work under this contract,customer shall-within 3 days-make the
final and full payment of the contract price.Any and all unpaid balances shall accrue with interest at 5%interest per month.
You agree to pay all court costs and collection expenses incurred by Melds Construction;LLC in the collection amount you
of any amount you owe under this contract,including and without any limitation of reasonable attorney fees.
Acceptance of the Proposal:
The above prices, specifications and conditions are satisfactory and are hereby accepted.
You are authorized to do the work as specified,payment will be made as outlined above.
Payments are to made as per requisition and or invoice.
The proposal may be withdrawn within 20 days.
Date of Acceptance: Sigpature
;n1rU nt`-IPi(Iltiid�'R�illiiliops•In0 4tniiiPlf fi-'�;
HOME IMPROVEMENT CONTRACTOR
z._ Registration: 108953
Expiration: 8/28/2010 Tr# 2738,'18
Type: Ltd Liability Corpor
CONSTRUCTION
s.'.snrzo f0elo -
JENNINGSCIR �,0-Z.L• �•"-•-=
Pcabody.P6A 01960 Admiuistr;ilar .
.• %l ssa hu.ul. Ucp trll Vill ul Public "afet)
9S Rnud uP Ruildill Re it Itiurls Ind Standards
License: CS 80393 _
Restricted to: 00
FAUSTINO N MELO y T
34 JENNINGS CIRCLE
PEABODY, MA 01960
Expiration: 311/2011
12192
G•CTRD CERTIFICATE OF LIABILITY INSURANCE 2/23/20O9"
FAX: (978)532-2217 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
--- _ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
01960 INSURERS AFFORDING COVERAGE NAIC#
INSURER A:National Grange Ins Co
T.TC INSURER B:Travelers Ins. Co.
34-lle. 34 Jennings INSURER
INSURER D:
P e�'L-' _ MA 01960 INSURERS
OY.'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
v L- `nM :17 OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
5 'O?;LIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
It =N'RaDUCED BY PAID CLAIMS,
k I POLICY EFFECTIVE POLICY EXPIRATION LIMITS
POLICY NUMBER DATE MMIDD DATE MM(DDN
EACH OCCURRENCE $ 500,000
DAMAGE TO RENTED SOD,OOO
PREMISE a oowrt $
��;�- y, x i R�MPB23862 11/26/2008 11/26/2009 MEDEXP Aa oae rson $ 10,000
PERSONAL&AD INJURY $ 500,000
GENERAL AGGREGATE $ 1,000,000
--R PROD UCTS-COM P S 1,000,000
COMBINED SINGLE LIMIT
I (Ea accident) S
M9H43926 9/21/2008 9/21/2009 BODILY INJURY
`. (Per Person) $ 250,000
._ BODILY INJURY $ 500,000
(Per aeeidam)
_ PROPERTY DAMAGE S 100,000
(Peraccident)
AUTO ONLY-EA ACCIDENT $
OTHER THAN
AUTO ONLY: AGO $
-T_+4 —W-vz, EACH OCCURRENCE S
1
_-_-. iaL'.'.S MADE AGGREGATE $
= z $
LND WC STATU- OTH-
- EA ?
E.L.EACH ACCIDENT S 1,000,000
- ° IH7814M46508 12/4/2008 12/4/2009 E.L.DISEASE-EA EMPLOYEE$ 1,000,000
-- �' E.L.DISEASE-POLICY LIMIT S 1,000,000
OF O:2RATIOKSitO ATIOHSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Or i.nsured's Purposes EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER.ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
9 John McCarthy/LG9
ACORD 25(2001108) O ACORD CORPORATION 1988