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13 UNION ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulat ous and Standards CITY OF Massachusetts State Building Code, 780 CIVIR SALEt Revised rLlnr201/ V , Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling ^n this Section For Official so Only Building Permit Number: Da(e pplied?' f � Building Official(Print Name) _ ; Signature 1te SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map & Parcel Numbers L I a Is this an accepted street?yes_ no Iv'ap Number Parcel Number 'J' n 1.3 Zoning Information: 14 Property Dimensions: :a CD _ W y Zoning District Proposed Use Lot Afea(sq It) Frontage(R) r 1,5 Building Setbacks (ft) r a Front Yard Side Yards Rear Yard Required Provided Required Provided Required ProvidQ¢ 1.6 Water Supply: (IM.O,L c.40,§54) 1,7 Flood Zone Information: 1.8 Sewage Disposal System: Public ❑ Private❑ Zone: _ Outsite Flood Zone? Municipal❑ On site disposal system ❑ Ched if es❑ SECTION 2; PROPFATY'OWNERSHIP! Name(- Ciq"State,ZI No, and Street Telephone Email Address SECTION 3: DESCRIPTION OF.PROPOSED WORK (check all that apply) New Construction ❑ Existing Buildirl Owner-Occupied epairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ NumberafUnits_ I Other ❑ Specify: Brief Description of Proposed Wor<r: �1 0 re Slw�c� SECTION 4: EST(VIATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor tnd Vfatcrials y 1. Building $ Q� I. Building PermitFee: S Tndicdte How fee is determined: 2 Bleetrical $ ❑ Standard,City/Town Application Fee ❑'total['reject Cost(Item.6)x multiplier x 3. Plumbing $ _ 2. Other Fees: S \tech...... (.IVAI:) $ -- List:__ i, \kchanical (FireS. -- Snppressiun) --- — lbtal All Fees:.$_-- ow— Check iNe. ---Check Amount: ---Clash ;\mount-----_-- � I'utal I'rnjupt Cost: �p✓mil 11 Paid in Pull 11 Out.tmntling B;ilance I")iic: ------ SECTION 5: CONFI RUCTION SERVICES — 5,I Consh•uclion Supervisor License (CSC,) F it9/-� •{1 ,�/ _r Expiration Date Name urCSL IIoIJcr r ,�/�, � List CSL Type(.tee below) No.and StreVet — Type _ Description U Unrestricted(Buildings up to 35,000 cu. 11 _ 'CL�Jw'.� R Restricted 1&2 Famil Dwellin Cit /Town State ZIP ' , y M b(asonr GC �aS� — RC RootingCovering 5VS Window and Siding SF Solid Pact Burning Appliances _ I Insulation 'fcle Iwne Email address D Demolition 5.2 Registered ,Mine Improvement Contractor(11IC) /� J —71 � t�1 r(� G(/x Uc—x^/1 `,��N� eHfC Registration Number ExpirationDate omp y one ur flfC cgistr tt Name No.and ere � � /, q Email address11No (S! 7 � 1 `,P Cr /Town,State, LIP 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 ......... �K— No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize G(A4 �'Wbv u to act on my behalf, in all matters relative to work authorizes by this building permit application. print Ownel sName(Electronic ,;ure) I Date SECTION 7h: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I liereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best ol'my knowledge and understanding. Print Owner's or AalherV.CJ Agent's Name(Clecreonic Signnturo) Data NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not r,istered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.01. c. I42A. Other important information on the HIC Program can be found at }�ww.mase, uy>'uca Information on the Construction Supervisor License can be found at wwcv.rnass..n dL 2. When substawiul work is planned, provide the informatics below: lbtal Floor area(sq. R.) (inclu,ling garage, finished basement/attics, decks or porch) Bros; living mca(sq. ti.) ---__ ___-- Habitable room count.— --,— Nmliber of lireplaccs Number o f bcdroomts Numhaulbudurounu ___ Numberofhult,'baths I\i;c of heating Sy,lem Number uFdecks/pulvhws I-5peol Cool in" SyAlun f:nclo;cd _...(tpcn i "I'a II hoject Squ u'a Pnnl-i c" nmy he SllhnllIRd tni I ,I.II 1541joLt Cost" Offices: 383(Rear)Lowell Street,Suite 2G �i t 140 1 Wakefield,MA 01880 '" PETER RYA Te1: 617-571-9056 e A ' ( p 352 Main Street,Suite 3C �s ( an�a � � Gloucester,MA 01930 Tel: 978-559-7333 1100FIN69 Inc. www.PeterRyanAndSonRoofing.com Submitted To: lob location: Stanley Burba 13 Union Street 13 Union Street Salem, MA 01970 Salem,MA 01910 Phone#: 978-744-7532 Email: None. Proposal date: April 29,2015 We are pleased to hereby submit this proposal to furnish materials and labor,completely in accordance with the below specifications: (Additional charges may apply far any change's not included below in proposal either by request of owner, or if Peter Ryan and Son Roofingfinds unforeseen circumstances that will affect the performance,quality or integrity of this job). In the event legal action is taken to enforce any provision of this agreement, the prevoilingparty shall be entitled to all its reasonable costs, including reasonable in-house or outside atiorney'sfees. Not responsible for debris in attic. SM, OFjW�t19 Strip entire roof to bare wood and re-shingle: $8,000.00 • Strip existing shingles down to bare wood • Check for rotted wood on roof decking,and replace as needed • Nail down any loose wood • Install ice&water shield to first 6-feet,and in all valleys and around any protrusions • Install premium synthetic underlayment(in place ofsvandard 301b.felt paper) BBB, • Install all new 8"white drip edge on perimeter and step flashing,where needed • Install manufacturer suggested starter course of shingles • Install IKO or GAF Lifetime/architectural shingles in color of your choice • Install ridge vent • Cap ridge vent properly with manufacturers suggested cap(GAF Timbertex®or IKO Hip&Ridge 12) • Properly flash any protrusions and all new pipe flanges,ifany on roof Clean Up: • Will cover area with tarps to minimize debris and remove debris related to work • NOTE: Please cover any belongings in the attic,as they will get dusty,ifapplicable PAVMENTITERMS' COSt deI81IS:`(includes cost of ermit,lab it dmu &iiatenal " .'. Payment Schedule:,'::r° rt payment due upon signing: $2,000.00 Total Cost: $8,000.00 Total balance due upon completion: $6,000.00 Kindly remit payment to"Peter Ryan". Thank you! aespectlully submitted by: / Accepted JdW— Our craftsmanship is 100%guaranteed C&10-years. A warrantees are through the manufacturer.All wa antees will be null4k vo ifjob is not paid in full. Peter Ryan and oofing,Inc.License♦t 178871 --Thank you for letting us serve you!!! cc: Leo/Peter Vie Ontrrtomi,ettltli (rmassaclittsetts —. - Delmidinen(ofAd ustrial-Acclydents 0/ftce ofltrrestigatiotrs i, 1 Congress .Street, SWIte 100 . . . Bostoit, 112 4 02114-2 01 7 Woi°kas' Cola[pellsatia[1I[[stivanceAffidavit: Btzildeis/C otltractvl'slE echtcians/Fttuniret's A i Atemit Lifoz'[natioal Ptease e lbt NOMe c$usiaesstargaraiaationllxrdivrdtralr Peter Ryan and Son Roofing, Inc. C Adch•ess: 383 [rear) Lowell Street,Suite 20 city/state/Zip Wakefield,MA 01880 p'holle #; 617-571.9056 Are goat an ernploye0 (heelcthe appvopM te'lros' T3pe of project (t•egulred): 1,❑ 1 nil a employer witil 4, ® 1 am a geuernl coatrnctov aad I zrrplo}zes (full.ruldforpsrt-time):• leave )tired the Sub-comrnctoa:s 6. ❑ Nevv construction 2,❑ 1 roll a sole ploprietor or partner•- listed oil the attached street, 7• ❑.Remodeling ship and have no employees These snly-coutractors have S. ❑ Demolition working for me in any capacity, employees And have Workers' 53. ❑ B'uilditlg addition [No vvorket:s' comp insulall" comp, insuralim! re}uirecl) 5. ❑ We are a eory3oratiou and its M[] Ele:err•icnl repairs or additions 3, ElI ant a homeowmer doing all Work officers have exercised their I❑ Plumbing repairs or aciclitiu'na myself No workers' corn right of exernlatiou per 1YfGTL Y [ A 12.❑ Roufs•elaaa•s Insurance recluived] t c. 152, y'1(4),and lire have no enmployees, [No vvoikeas' 13.❑ O'drer comp, hmitlince roquired.] *Amy appffieant that checks boa k.I must also till outtheseetion below showing Ill ell workers'campeatsntion policy ill fbralatrnn_ t Honreoumers v+Poo submit this affidavit ialdiratiagthey are doing all work lad hten.hire oil tside contractors muv submit a It ea affidavit htdicating such. CoatracIois that check tills box laust attached mr add'itional sheet:showila,the name of the sub-coutractors;mid state whetIm or nar those eenitles have employees. If the$ub-cootractors have:e lip]oyees, they nmst provida their workers con{p.policy n [al beI Inn+ an emplq)wr thar.is provlth'ng rooekerss'compertsarlon ntst+atttree,jor my employees. Below is thepo'licy rent!joh-site h1fortutrt1011, Insurance Company Name: N/A (I am not required to carryW,C,as I have no employees) Please see the Sub-Contractor's WC.Aldavit attach Policy#or Self-ins.Lic, 4, N/A Expiration Date; Job Site Address: ......13. `�` v 4_W� .v C it1'`StaterZip; l/ Attach a copy.of the vi,ovkevs' compensation policy d"larntiou page (showing file p'olicp ntumzlaer And exph'ation date). Pailctre to secure coverage as reguia ed under`+action 25A of MGL Q. 1.52 can lead to the unposition of crimirsai penalties of a tine up to $1500 tiD nrrclror one-yeal•imlvrisornnent. as well as civil pelidtics in the fonn of STOP \VORh ORDER and a foie (if up to$250.00 a.tiny ngainst the violator. Be advised that a copy of this statement may be fom arded to the Office of Investigations of the 'DIA for insttrance eoverage verification. I do herae;bv ct vl jj undiu the pahrs atidpeiraldes ofperjw:y that the Infopmatlon pmvr ded above rs ri ue and cm,mcr, `tii�nnnng.; 6115719056 Offclrr:l use only. Do not mrfte In this amil, ttt be completed'L,p elry-or tolor offrtt+l C'it •or Towrrt Permit/Uvense # IssmugAirthordt}(circle one): 1, Board or Health 2, Bufldhmg Department d, Uty/Tovvn Clerk 4, E:Iecti ical'lnspector 3,Plumbing Inspector 6,tither CorttnctPersom Phone #;. The C'ommot7rmilth ofMossrtchusetts 17e1rarlinent nJlradxes/rlul ceidersts Qfflce of hzvestl nutlons 1 C'ougress ,S'lreerl Sulte 100 Boston, MA 02114-2017 P� li'li,m In(Iss,govIdI(I Workers' Coin 1)eiimttou Insurim.ce.Affidilvit: Buildea siC:onh act. s/Eiectriri�risfPialnbers ApI)licxut Informiltion Pleitse Print Legfbly Nilliie (Bushreworganizationfindwidnal): Len3d Construction, Inc. Address: 71 Prospect Streat City/smte/Zip: Brockton, MA 02:301 Phone #: 508-232-1194 Are you an ernployer? Cheek the npproprlate.box' Tylxe of project (required): 1.❑■ 11111 a employer with 10 4. © I rim a general contractor arld I employees (full aardlux•Dart-tinge}, hnvO hired the sutMcorxtcactors 6. ❑ New comtmcdon 2.❑ I am a se'€e proprietor or partner- listed on the attached sheet. 7. ❑ Reulodeluxg ship=md have tro enip'loyeas Time styli-contra rtors have 8. ❑ Dertiolilion a,olking for me in any Qnpiwity, oriiAoyees and have workers' [No workers' comp. ursuramce comp tnstara iml J. ❑ Building addition required,) 5, ❑ We are a corPointiou arid its MEI Electrical repairs or additioru 3.❑ 1 am a honteottiler doing all work officer's have exercised their 1 I.❑ Plumbhrg repairs or additions myself [No tvorkers' comp, right of exemption per MCfL t c. 152, a 4- 12.❑ Roof neprs insluanee requiced.k $� O, anal we Iravt no employees. [No workers' 13.❑ Otlrer comp, insurance required:) °Any applicant that checks box#1 must ithio fdI out.the section below stowing their workers'compensation policy inf'onnation. t Homeottmers who.submil this affidavit indicaring they rife doing all worl;a rd then hire.outside.coaanNors must submit a t ew a7Yidawit indicating atloh, tC:ontra CIO rs that check this box anim Oticlied an additional sheet showing the❑wie of'Ilie sub-contractors and zhite whether or not hose entities have employees. if lire sab•c.ontractors have employees,they must provide their workers`comp.policy number. 1 pIH.fIY7 P'r71f)117yP1'rlidld ls'1)1'orldill� 11+OY144"1'.5"' CUntl)Bti,P{A#1Un ln.SbtYFf114'B fol'n7,1'Erkt[)tUyHP.E RPIArP 15 L17 E'(30llay 17rrd�Ob S'/df' 1•fl f0TIF7 Rf1017, Insurance CarnpatryNnrne: Insurer A: Northland Insurance, Insurer B: Arbella Protection, Insurer C; Travelers A/R Policy�or Self-ins. Lie. 9; 6S60UB-SB86069-2-15 03.01-2016 J� Expii•atiou Date Job Site Address:,. 0� �T [ity/State/Zip: Attach a copy of t166666le workers' compensatiwr policy declaration ilage,(sha))ing the polley raumbea' and e�xphmtiorr date), Failure to sectn-e coverage as required tinder Section 25A of lvILIL c. 15.2 can lead to the imposition of eriurinal penalties of n fine up to 4'1.500M mid/or ullc year imprisornnent, m well ns civil pertatties in the form of a.STOP WORK l:7RDER and a fine of up to$250,00 a tiny against the violator. Be advised that a Copy of this sinterimit may be fox—Amided to the Office of Investigations of the DIA for iar.stirance covemg,,t: verirication, I do haaebp rsrtlfy ands r 7larth�tn.r mr g „re �nrrfru y t3x t ike lnfarncatlolz prot�/dcd nLar�< !s hoze nrarl correct: Phcncd: 508.232-1194 Offclat use arily. Do not wpire in this area, to be cmnhlererd L,y city or rows afficial. City or Town; PermitlLicense 9 Issuing Authority(clrcle one): 1, Board of Health 2. Building Department 3, City/Town Clerh 4,Electrical Inspector 5, Phrrrxblug Inspector 6, Other Contact Person; Phone 9; CERTIFICATE OF LIABILITY INSURANCE °AT03/24/20 5Y THIS CERTIFICATE IS ISSUED 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: Ifthe certificate holder Is an ADDITIONAL INSURED, the poll°y(les)must be endorsed, If SUBROGATION 15 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 Ileu of such endorsements . PRODUCER CONTACT JO MassPayinsurence SerNces,LLC NAME: 1oe M Keller 27 Garden Street,Unit 1B PHONB . (978)774-4338 x115 �aC (978)774.1318 Danvers,MA01923 AnoRess: loyWe@phllrichardlnsurance.ccm INSURERS AFFORDING COVERAGE HAD 4 INSURER A: Northland Insurance NOR INSURED Lema Construction,Inc INSURER a: ArbellaProtectlon 41360 Jesus Loma 71 Prospect Street INSURER : TRAVELERSA/R TRC Brockon,MA 02301 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVIL SUBRI POLICY NUMBER MMIDDIYYYY MMIODIYYYY LIMITS LTft TYPE OF INSURANCE A GENERAL LIABILITY - WS236161 01/31/2015 01/31/2016 EACHOCCURRENCE $ 2,000,000 COMMERCIAL GENERAL LABILITY ° 100,000 E (Ea occ rents $ CLAIMS-WOE 7OCCUR MED EYP(A,,y ant eroar) $ 5,000 PERSONA.B AOV IMURY $ 2,000,000 GENERAL AGGREGATE $ 3,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO $ 3,000,000 POLICY 7 PRO LOC $ B AUTOMOBILE DABILITY 1020009274 11/28/2014 11/28/2015 COMBINED O BN R ED SINGLE $ 1,000.000 L^ ANYAUrO BODILY INIURY(Par person) $ ALL OWNED SCHE00.ED / AUTOS V AUrOS BODILY INJURY(Per ecddenp $ V HIRED AUTOS J AUTOS NEO PROPERTY DAMAGE $ $ UM BRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ DEO RETENTION E 1 1 $ O WORKERS COMPENSATION 6S60UB•5B86069-2.15 03/01/2015 03/01/2016V IWCSTATU• OTR AND EMPLOYERS'LIABILITY YIN LIM ANY PROPRETORPARTNEWE�CIRIVE OFFICER/MEMBEREYGLUCED7 a NIA E.L.EACH ACCIDENT $ 500,000 (Myondelory In NH) E,L.DISEASE-EA EMPLOYEE $ 500,000 DEundar SCRIPTION OF OPERATIONS below 500,000 E.L.DISEASE•POLICY LIMB $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Ntach ACORD 101,Additional Remarks Schedule,If more space Is re qulrad) Proof of Insurance EmElled to:evan.franWIm55@gmaI1,com CERTIFICATE HOLDER CANCELLATION SHOULDANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ryan and Son Roofing THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 413 Lowell Street ACCORDANCE WITH THE POLICY PROVISIONS, Wakefield,MA 01880 _ AUTHORIZED REPRESENTATIVE I`JJV`j�.1, f ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CS License: #CS-I04865, Expires 07-0I-20I6 Massachusetts-Department of Public Safety Board of Building.Rcgutntions.nnd Stnndards Comtraetlon SupmIsm. License: C>3 10g865 CLINTONACALiN. ;. 229 Vernon Street Wakefield MA 0IF880 i 2 ,Fr JI lit\1 „\ Expiration Commissioner 07/0112010 HIC/Clinton Galvin, #I752I3, Expires May I, 2015 —• �;/lt y'nJUJ+/eNrtUrtq!/�t jr/�Y(GJbtJ[IIJC�Iu OMeor0mumtr Affnlrs-&Busincftoluilon • � .• tlME1MPROVt:MENtCO.NTRAGtOT;. ' eglstradon, 176213 Type, �f4fExptration: 6M12015 Corporation EMPIRE 1 HOME IMPROVEMENTS CLINTON CALVIN 88 AUDU6ON'RD tJ315 WAKEFIELD,MA 01880 Undorsetrotsry HIC/Peter Ryan: #178871,Expires May 28,2016 (',t�+ ti'r{.JniJ(*>3xtrrcYtrl�>n(�C�l n;((c�umtflJ, *x'�l MIMPROVEECONtRACTORTypo-: 18trotion lration; 012812018� Corporation PETER RYAN 8 SON ROOPfNCa;:INC. 'PETER RYAN - 383(REAR)LOWELL ST 81117E 2. jg%" 9VAKEFIELD.MA 01'880 Urrdtcsnortbvy AVMORTZATION FROM CONTRACTORS FOR SECOTO'PARTM TO FULL PWUR I'S COP PANY DATE To whom it may ooni; m to:pa.pem its for the company m li Sfgrmture: (( i - PtintedName; Y d� Notary �P��-_-- Conin �,�