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98 TREMONT ST - BUILDING INSPECTION The Commonwealth of Massachusetts f Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 20/1 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Buildi tuber: Date Applied: }y 'Iding O (P ' ame) Signature Oate SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers CIS Tccmnn� S�- Lla 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 ft) Frontage(ft) 1.5 Building Setbacks(R) 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 wn�'of Re ord• 6 CA ��, `` t } '(� t �� C�-'F l)P(`l V n C'�-� r� Name Print �_ I ' City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction Existing Building❑ 1 Owner-Occupied Repairs(s) ❑ Alteration(s) Addition Demolition OfAccessory Bldg.❑ 1 Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work : "AnrN I1�(IvZ�n3 c InA rtl0m M Wh--' w:AV� r xsh� tclrvc-r SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ S =0 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town.Application Fee _ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ n< Check No. Check Amount: -Cash Amount: 6.Total Project Cost: $ O 0 Paid in Full 0 Outstanding Balance Due: t SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Cg-I0306� w r&acr © 1 n(f 1 - License Number E ma on Date Name000f CiSL Holder 9 O )L--3)0 ' Gt.UG Lis[CSL Type(see below) (s No.and Street n ` Type Description C`) Y1 Y/ !y�Q ©I l O J U Unrestricted(Buildings u to 35,000 cu.ft. R Restricted 1&2 Famil Dwelling CiYfrowrf,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ep - /13� y�.(�� SF Solid Fuel Burning Appliances 0 ��(��I v0t,9 Y1"1ad m L Insulation Telephone Email adds ss D Demolition 5.2 Registered Home Improvement Contractor(HIC) ��563 a ebbq (')ne—O- �At1�rno-A .7a V,c g (.JOB � V`I 0.�� / HIC Registration Number ExpirAtion Date Inc Com any Name or HIC R� egistrant Nam AR I avL OM �51�atiy Cs � o and Street 978-64i 09 9 Email address Ci /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 FOR1 BUILDING PERMIT 1,as Owner of the subject property,hereby authorizeW0.1 ©tints�? 0�1C t I$`>o�w4 7Y1R11 to act on my behalf,in all matters relative to work authorized by this building permit application! XPrint Owners Name(Elee4onic 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. _ Print Owner's or Authorized Agent's 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 arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. oov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 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 half/baths -+-r Type of heating system Number of decks/porches `''" Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" - 08/08/2013 14:50 Lauranzanolnsurance 4gency OW) P.001I001 Name of Insurance Co.: Liberty Mutual Fax/Email: 603-334-8162 Date: 08/08/2013 MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE Use this form to request a Certificate of insurance from an Assigned Risk Pool Carrier. Please provide all of the requested information, including the email address(es) or facsimile number(s) of the person or persons to whom the Certificate of Insurance should be issued. If this form is fully and accurately completed and if the policy to be listed on the certificate has been issued, the Certificate of Insurance will be issued and distributed by email or facsimile to each contact provided below,within two(2)business days of the carrier's receipt. This Form may be emaiied, rnailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrier's contact information refer to the Certificates of Insurance section located in the Producer Community section of the Bureau's website,(www.wcribmo.ora). 1. Name,address,telephone number and facsimile number or emall address of the INSURED: Name: Walter O'Neil DBA O'Neils Handyman Service Mailing Address: 98 Kesler Avenue Lynn MA 01905 Physical Address: 98 Kesler Avenue Lynn MA 01905 Phone: 976-697-0973 Fax or Email: 2. Name, address,telephone number and facsimile number or email address of the CERTIFICATE HOLDER: Name: City of Salem ATTN:Tom St. Pierre Mailing Address: One Salem Green Salem, MA 01970 Physical Address: SAME Phone: Fax or Email: 976-740-9846 3. Nome,address,contact person,telephone number and facsimile number or email address of the PRODUCER: Name: Lauranzano Insurance Agency Mailing Address: 107 Dodge Street Beverly MA 01915 Contact Person: Renee Phone: 978-927-8420 Fax or Email: 978-522-8481 4. Policy Numbep Policy Effective Date and Policy Expiration Date If a Certificate of Insurance is needed for more than one policy term,provide the Policy Number, Effective Date and Expiration Date for each polity term. If the policy has not yet been issued,you must attach a copy of the Notice of Assignment. Policy Number: WCS-31S-372123-022 . Effective Date: 10/12/12 Expiration Date: 10/12/13 S. List any special requests for optional coverages/endorsements(see Page 2 for listing of coverages available in the pool and the conditions of availability)or additional information (including changes in exposure not yet reported to the carrier) that will assist the carrier in the issuance of the Certificate of Insurance. NOTE:An additional insured(s)shall not be listed on any Certificate of Insurance unless such additional insured(s)is a named insured an the policy. , of s 1 FAX COVER SHEET TO Tom St.Pierre COMPANY FAX NUMBER 19787409846 FROM Larry Lauranzano DATE 2013-08-08 18 : 55 : 16 GMT RE O'Neils Handyman Service COVER MESSAGE The worker' s comp certifacte will arrive seperately. ww .efax.com Tu.T m St.Piorre Paye 2 or 9 1 ZO'I - _08 '18.55:35(GMT) La uanivno Inauianav Ayancy From. Larry Lvuianza no 31 8 ACORD OB/08/2B/2,M CERTIFICATE OF LIABILITY INSURANCE DATEI 013 PRODUCER (978) 927-8420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lauranzano Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Dodge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A'.Western Heritage O'Neil's Handyman Service INSURER B'. 98 Keslar Avenue INSURER C INSURER 0: Lynn MA 01905- 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 AODD POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPEOFINSURANCE POLICYNUMSER DATE (MMIDDNY) DATE(MMIDDIYY) LIMITS A GENERAL LIABILITY BOP 0071436 06/14/2013 06/14/2014 EACH OCCURRENCE d 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ee occvDnce S 100,000 CLAIMS MADE F—IOCCUR / / / / MED EXP(Any one person) A 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-OOMOOP AGG A 1,000,000 POLICY 7EC°1 E LOG AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO E.ao(ident) & ALL OWNED AUTOS / / / / BODILY INJURY S SCHEDULED AUTOS (Per per HIRED AUTOS / / / / BODILY INJURY 8 NONOWNED AUTOS (Per acci(lent) PROPERTYDAMAGE (Per accidenq GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 8 ANYAUT, / / / / OTHER THAN EAACC 8 AUTO ONLY AGG S EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ _ OCCUR CLAIMS MADE AGGREGATE b R DEDUCTIBLE RETENTION A $ WORKERS COMPENSATION AND WCS-HAT G °ER EMPLOYERS'LIABILITY ANY PROPR I ETORIP ARTNERIEXEC UTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED'i / / / / EL DISEASE-EA EMPLOYEE$ Ifyes describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES)EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job at: 98 Tremont Street Salem, MA 01970 CERTIFICATE HOLDER CANCELLATION ( ) — (978) 740-9846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City of Salem; Building Inspector FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ATTN: Tom Pierre INSURER,ITS AGENTS OR REPRESENTATIVES. 120 Washington Street AUTHORIZED REPRESENTATIVE Salem MA 01970- C _ ACORD 25(2001108) ---1 O ACORD CORPORATION 1988 �,._-IN S025(01081 OS ELECTRONIC LASER FORMS,INC.-(800)327 0545 Page 1 w 2 To. Tom St.Pler',a Page 3 p13 20'13-08-08'18.55:35(GMT) Louranza no Insurance Agency From. Larry Lauianzanu IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) �,.,-INS025 io 1 oa7.o5 Page 2 or 2 j t Oc ._ .^.-.,..._..,._..-...._..nay �. DCO / 30 insul SCCA�b� f . Ir�b i� �4U(1n�a� iCv\ i i I . C bo i C FjUn�al (on /-1aJ� I �;.��5��� �-��� e i i I + I ` 3 , _ b ' � a —1 ,�1� _ � � � - � �� � � � � � , I \\ � � -�.. � � �- � �� i ," � � � � �" � � ttt NandmrLC -98 KeslarAvenue, Lynn, MA 01905 (978) 697-0973 oneilshandy@gmaii.com www.oneilshandy.com CONTRACT July 20, 2013 Stefan and Niki Celo ` 98 Tremont Street Salem, MA 01970 Dear Stefan and Niki: As requested, I am submitting the Contract for work to be done on your home. Scope: 9 x 14 Addition with bathroom and mudroom. Demo • Remove existing 8 x 8 mudroom and deposit into on-site dumpster. Excavation Remove old foundations and prep for the new foundation 9 x 14. Foundation and Footing • 9 x 14 footing and foundation will be poured to MA codes. 3/4 gravel inside. Framing • Frame with new addition to building codes. • Build new entry stairs. Roofing • To match existing roofing as close as possible. Siding • To match existing siding as close as possible. Windows • One reuse and one new. Insulation • All walls, ceilings and floors will be insulated to building codes. Stefan and Niki Celo July 20, 2013 Page Two Electric • All electric will be to building codes. There will be GFl outlet at sink and an exhaust fan will be installed. Plumbing • New plumbing,for shower, sink, toilet, washer and dryer will be installed to code. Allowances • 3' shower stall $400.00 • Shower Door $200.00 • 3' Vanity $200.00 • Vanity Top $150.00 Tile Floors • Tile will be medium grade. Finish Work • All work will match existing conditions. Plaster • All finish surfaces will be blue board and plastered. Paint • All finish surfaces will have one coat of primer and two coats of finish. Total Cost of Project $25.000.00 Thank you. Sincerely, Skip O'Neil Agre d t Walter O'Neil Stefah Celo Niki Celo 1 JVD O\ G QS 1lc G xYoJy � 30 l ns u lo�addn Scc�cor. l/ it I S«Ic bo i 1; I � q C � boondadVon Fla17 T � �` ,. � �- 9 I �' 1 � J o 1d ' � 1 �. v � J` , . _ � � , .. s c M �,�oy . , i � �,,�� � _ _ _`� _ . _ � � ___. ____�:E -y - �F%�- R .N S2aN KB�r�iNi.�-/6 wNGU zeoN �OVNcS (Srci� rj 0�0JrO.•O ,D,E60 : O r / S'TRY.ry � r a cn 4- Al PREPARED'- FOR. SCALE : I RURAL LAND SURVEYS /R/1 /'C AITDG �-7 raw n n/r roc . • . i CITY OF SlUEN11, U-IiSSACHUSETTS BUILDING DEP iRT\tENT • 120 WASHINGTON STREET,3"'FLOOR TEL (978)745=9595 FA.0(978) 740-9846 KIJfBFRLEY DKISCOLL iOR i1t1AYOR T� US ST.l?IERRB DIRECTOR OF PUBLIC PROPERTY/Bt:RDlTNG CONMIISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P.lumbers Applicant Information 1I_ � Please Print Leeiblr Name(BusitwssOrgtniratior✓individual): ,)001l 5 f'M1f��niay) UtC`C6 Address: Wiif 1oc raw C City/State/Zip: ( rhn Ma Phone lf: 9JR-(;q)-rfl)3 Ar!_XAaan employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 1 4• ❑ 1 am a general contractor and} 6. 0-ge—w construction employees(full and/or have hind the sub-contractors - 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees- These sub-contractors have S. ❑Demolition working_for me in any capacity. workers'comp.insurance. 9, ❑Building addition [No workers:comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL - I I.[]Plumbing repairs or additions myself.[No workers'comp. c.,152,41(4i.and we have no 12.0 Roof repairs insurance required.)t employees.[No workers'. 13.0 Other,- comp.insurance required.) 'Any appllc:ua that chocks era[x o fi l must alsll out the section below showing their workers'mmpenwiun peony infurmation. t I Itwneuw eni who submit this affidavit indiwing they ate doing all work and ihm hire outsidemntmcton matt submit a new atridavit indicting such =Commuters That check this box moat punched an addilionol ahmt showing Ih0 ttwne of the sutl mnlfadOra and theirwndcen'mmp,policy information. I am an employer that is pravlding tvorkert'compensadon insurance for my employers Below is the pollcy and fob site information. - Insurance Company Name: r� Policy 4 ur Scif-ins.Liic. H:�L"C S \3� \' 3,a. a�"- o as piration Date: Job Site Address: 7 0 l(C(J�f`Y`O^`� �'1' City/State/Zip:. 3:, e. racy V 17 /D ,Utach a copy.of the workers'compensation polity declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 23A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of tlic DIA for insurance coverage verification. [do hereby certify i aide the puins mid penalties ofperfury that the iitfonnallon provided above i^s�true and correct. iix=i �_y01_1� ) ate: ^ld`+�`3 Po d• - 9 -09 Official use only. Do not write in this urea,to be completed by city or town affle/al City or'ruwn: Permit/I.Icense Issuing Authority(circle one): 1. Board of health 2.Building Department J.Cilyffown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Otter.. �r Contact Person:. ------ __. Plioneth t CITY OF S'U.F- I, INLkSSACHUSETTS Bum .DNG DEPARTMENT N 120 WASHINGTON STREET, 3° FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KI.,fBER RY DRISCOLL MAYOR T HO,%AS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUHMING C0311MISSIONER 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 c 40, 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 disposal facility as defined by MGL c 111, S 150A. The debris wilt be transported by: Y1 I� AS (name of hauler) The debris will be disposed of in (name of facility) (address of facility) signature of permit applicant /a-avl3 date dcbri>alf doe