68 VALLEY ST - BUILDING INSPECTION (2) cy
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Ql�
y
Massachusetts State Building Code, 780 CMR J01h NO AelseAE+�l J
�- — Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fmnily Dwelling
^ This Section For Official Use Only
(V J Building Permit Number: Date Applied
Building Official(Print Name). Si6mature� - Date
1 SECTION fi SITE INFORNIATIOW
1.1 Property Address: Q 1.2 Assessors Map&Parcel Numbers
1(`) 1.la Is this an accepted street9 yes no Map Number Parcel Number
I 1.3 'Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tl) Frontage(11)
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:
L'�- Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public O Private❑ Check if es❑ p po y
SECTION2: PROPERTYOWNERSHIV'
2.l Q&09wlter'of Record:
IR�m(Prin �� City, ZIP
4 6' Ua/lesr (sT 71- 7c11_-gy/3 p!
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building Cl I Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other G-Specify: N-rtfi n F, t-OQ
Brief Description of Proposed Work`: — �F
�. ro Or6c.F Id
F n csrtE
2/
SAH E
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: - Official Use Only
Labor and Materials)
I. Building S I. Building Permit Fee:5 Indicate how Ice is determined:
❑Standard City/Town Application Fee
2. Electrical 5 ❑Total Project Cose(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: .S ��
I.Mechanical (FIVAC) S List:
5.MechonicuI (Fire S Total All Fees:S
Su ressiun)
Check No._Check Amount: Cash Amount:_
6.Tutal I'rnjcct Cost: 3 6 J /�fJr @� ❑Paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction,Supervisor License(CSL) 9 _ZA17
✓�L 9v ��f^ (C— License Numbers E.epiruu a ate
Warne`oofCSLHolder f List CSL'rype(see below)
pC CJ /c/t 12CA vt-a.a /�G1 -Type - - Description
No.and Street
C p D� U Unrcsiricted Buildin s u to 35,000 cu. Il.
_ d 7 6 V R Restricted 1&2 F;unil Dweilin
Cityfrown,Slate,ZIP M Masonry
Ro ing Covering
Window and Siding
SF Solid Fuel Burning Appliances
Insulation
Telephone Email address / D Demolition
5.2/�legister/ed�Home Improvement Contractor(HIC) /9 a3
tP/a'/!A f AAT& � � HIC Registration Number Espiruuon Dale
IIIC Comp%Niame or IIIC R rstmnt Nat e
/oa0 f�svt��� ��' 24 r aC sf _ zucr
No.and Street Email address
9,7,? 7 FO
City/Town, State ZIP Tel e hone
SECTION 6:WORKERS,COMPENSATION INSURANCE AFFIDAVIT(M.G.Em 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 Is3uance of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN,
OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING.PERMIT'
1,as Owner of the subject property,hereby authorize 1001n)A (�a ry- A,—/ T 0, of
t9 act on my behalf,in all matters relative to work authorized by this building ermit application.
/�" 7
"Tffnt Ownera(Electrorn Signal 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 an accurate to the st of my knowledge and understanding"."
i��CntBs L r.nnle9� .� _„� c�.l-L �/iro�alo/7
Print Owner's or Authorized Agent's N3me(Electromc Signature) Dote
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who(tires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will nut have access to the arbitration
program or guaranty fund under NI.G.L.c. I42A.Other important information on the HIC Program can be found at
www mass.cov'oca Information on the Construction Supervisor License can be found at AA .mass.eos:!dns
2. When substantial work is planned,provide the information below:
Total floor area(sq. R.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. 11.) 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. "lutai Project Square Footage'may be,ubstiluted for"f ut:d Project Cost"
f
'\ The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
�//+/
Business/Organization Name: &24 C (fr/1ss1, 6C Ae, C
Address: LeYL A4- d ontr Q of+r
City/State/Zip: d&Phone#: rj?f— 7 6V
Are you an employer?Check the appropriate box: Business Type(required):
1.❑ I am a employer with employees(full and/ 5. ❑Retail
or part-time).* 6: ❑Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) "
employees working for me in any capacity.
[No workers'comp.insurance required] 8• ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing
no employees. [No workers'comp.insurance required]' 11 ❑Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp.insurance req.] 12.❑Other
`My applicant that checks box N I most also fill out the section below showing their workers'compensation policy information.
-*If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box NI.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: Acc- e,19�i✓S�tIAI / /,
/Insurer's Address: / !9d c�'-t��n,4C 1 T/JA `ram Oc�C d iw t' gpj d y
City/State/Zip: A6
Policy#or Self-ins.Lie.# 56 2 CI Al Q 3-1 j 9(5-h Expiration Date: Z✓//d l a d/ 7
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c1"',
,ins and penalties ofperjury that the information provided above is true and correct
,m
Sil;nature: .Ua/5.4.�� Date: C41ZO `o iZ
Phone !J 7F naL CW/ '2
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
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 your insurance company's name,address and phone number along with a certificate 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). 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 dog license or permit to burn 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
Boston, MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-NMSSAFE
Fax# 617-727-7749
www.mass.gov/dia
Fom Revised 02-23-15
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cx��rcraa�/srnua�a�or�n
Construction Debris Disposa/Affidavit
(required forall demolition and.renovatibn work)
In accordance with the sbdh edition of the State BuWkwCode, 780a^ Sewn 111.5 Debra
and the provWM of MGL o40,S S4; Buddhg Permit B Is issued with the
condign that the debris resulting from this work shag be d&posed of in a p►operiy licensed
waste deposit facility as defined by MGL c ill,S isQA
The debris will be transported by.
(�2o
(name of hauler)
The
y�debris will be disposed of in:
(name of fadlity)
(address of facility) c/70
ignature of applicant
Date
Q
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Bonn Construction Co., Inc.
RoofingSpecialists
100 Femcmft Rd. Unit 204 Danvers, MA 01923
5252016 Ottice# (978)750-8881 Fax# (978)531-9202 Em.# (978)490-0181
PROPOSAL
Submitted to: Roberto Negron Phone#
68 Valleys Street Fax#
Salem Ma 01960 Cell#
Attn.:Roberto
Re:Two Sites: Project being done—68 Valley St Salem Ma 01970
Dear Sir,Or To Whom It Concem, ----Shingles Tear—off—Install new shingles.
We hereby propose to ftrmish materials and labor-complete accordance with specifications.
Below for the following sums: All porch or deck items will be removed or protected with great care,
Along with bushes,landscape and walkways as well
1.Remove the existing wood shingles dawn to bare wood,replace any rotted wood up to 50 lin-feet - -
2.Apply ice and water shield along the eaves,valleys,wails etc.of the house.(6-feet of ice&water shield)all mound from eave up.
Re-nail any loose deck sheathing,
3.Apply 30 If.felt paper to the rest of the roof deck for a vapor barrier.Clean all existing gutters and down spouts.
4.Install 8 inch aluminum drip edge to the eaves and the rakes of the house.The color Brown or White can be used.
5.Cut open the ridge of the house for proper ventilation.Install new Cobra Roll vent,Then cap-
6.Install new aluminum pipe flanges to all vent pipes,check all wall flashing-replace as needed.
7.Install new copper or lead to the existing chimney as needed Remove 3 courses of brick on the existing chimney-rebuild with
Correct mortar mix and new brick as needed-Install new cement cap pitched so-water does not sit up then:_ - -- - - -
8.Install New Life time CertainTeed Landmark Architect Asphalt style shingles—Install new asphalt cap over the mesh vent.
Re-install the existing slip metal falling oar-replace the shadow Ix2 boards as needled.-Replace any rake metal missing.
>All lower roofs are included,The back deck will be covered with''/l inch plywood for safety concerns,the stairs as well.
9.Clean all debris ban on site dumpster provided by Bom Co.Inc.A0 permits pulled by Bonn Co.Inc.
10.All workers will have safety harnesses and ropes for fall protection,other safety devices will be used
11.All workmanship is guaranteed for 5 years on leaks and blow-offs etc.The warranty is transferable to the new owners if the home v
Is sold or leased.................Install new fascia and take boards as needed -C
rn 12.Bo Co.Inc.reserves the right to add on any extra cost for changes that are made by others as the project Progresses forward— =r
Cost for materials and labor ...................:.....................................tf
Cost for the chimney fix.................................................................I...... .....
One third of the balance will be needed prior to the project start..................................Thank you
F.LD.#04-3336347-H.I.C.# 140520-Construction Supervisors License.#99357
All o workers are cov d by Wjuker's Compensmim Insurance &G
��Liabil Ins t -
Certif tesoflnsutance availableu m request. �r � it ��
] L Currier/Ovmer/President /Roberto e nf Horne Q40hm /
B Conswc[ion Co.Inc. - 68 Valley St Salem Ma 01970
bonncoinc1996(nlvahoo cam roams n msn com e
--------------
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9\. Office ofCoasomer Affairs&Badness Regulation I
05MOME
IMPROVEMENT CONTRACTOR
Certificate of Technical Pmficiency i Ott Reg' 1On: laoszo Type;
Expiration.. 1012 17 Private Corporation
JAMES L. CURRIER ,�(>
# BONN CONSTRUCTION:CO INC
hasBuccessfullycompleted-a two-daySarrafilt introductory a .
TraihingCourseforSamalp installers underthesupervision JAMES CURRIER 71
-
of a Sarneifil instructor. - - -
During the training session,the bearer showed aQrofutierty m 100 FERNCROFT ROAD UNIT 204
heat welding and demonstrated practical appficairon proce- -. - DANVERS,MA 01923 •. �
dues°sing SarnatB malg+ialsursimulated job site conditions. - - Uadersecre _ -
traze 4/s�i 3 ter WWA"IdE ArAININVAn
Massachusetts Department of Public Safety OSHA 002330883
i Board of Building Regulations and Standards
License:CSSL4)99357
Construction Supervisor Specialty r US.Department of Labor
Re. JAMES L CURRIEROczupatiorral Safety anio Health Admmnstr tm
20 KROCHMAL ROAD, James CUrfiOr
JA PEABODY MA 01990�
20 { ' has succosshAy=npleted a 10-hour Cnccupauonal Safety and Health
PE .r .,,,, r Traotmg Course In
Expiration:
ConstuGion Safety&Health
Commissioner 1121`1xpira o William Kershaw-NE01009 09/09/09
('Trainer) .. . (Date)
( nnmi..i °i•r Tr--: 99357 -_,............__...._ ., ._.. ... .... .__
BBB Accredited Business
Member in Good Standing of the Referral Card
p B np TR= ASSMTMM For free information on services
For Addihonalinformation and Veri6catiaR from Accredited Businesses in
-Caa TOM Free 1-8W32G7800 � your area
�p- Check Out a Business at:
BONN CONSTRUCTION,INC. BBQ
From 11/00 To 10l01
bbb.org
SAFETY _
EQUIPPED. INC. vj�t OSHA 10 e `< =_IIY OP.SALEM f1834
Trainilrig&consuking sw&m
Aerialffi BUILDING LICENSE
mx
Authorised OSHA FOf
Trainer This is to certify That
JAMES L. CURRIER
Bill Kershaw TCL 09-33124 59 276 NEWBURY STREET St., PFARt1T1Y Mass.
SafBtY CODSuhant 61 Eiwhgwa M'Sty MA 027T! Has been ranted a license by fhe Building inspector as
MembaofASSE �L� H SPECIAL /1WEEv r_c-r=
- OCTOBER 23, 1998 1 f ti--?s•r
(issued) Bull mg Inspeetoi