16 VICTORY RD - BUILDING INSPECTION n, The Commonwealth of Massachusetts
v\ Board of Building Regulations and Standards Town of
i
Massachusetts State Building Code, 780 CMR, 7'"edition Wilbraham
� Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a 413-596-2800
One- or Two-Family Dwelling Ext 118
This Section For Official Use Only
fY1 Building Permit N b/e/r: Date Applied: .p
Signature: `/hYi.�� 10 p� p _
Building Commissioi /In pector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I V S �7)r� �
I.1a Is this an accepted sttteet'?-yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq Q) Frontage(ft)
1.5 Building Setbacks(ft)
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:
Publi Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record• ('
Name(Print) ss for Service: —�
Signature Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ _ Owner-Occupied ❑ Repairs(s) Alterations) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ �d r
4. Mechanical (HVAC) $ List: /
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ q Q/100 C)6 0 Paid in Full 0 Outstanding Balance Due:
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
S �9 _ License NumberExpiration Date
Name of CSL- Holder List CSL Type(see below)
— (, t� )(A Type Description
Address U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 Family Dwelling
Signature q �^ M Mason Only
J J�'/.�J RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home 1�rprovement Contractor(HIC) �6y S
L 4-1. I C
HIC ompa y Name m HIC Regi trant Na a Registration Number
Address —
{ Expi anon Date
Signature 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 FOR BUILDING PERMIT _
1 rn (/) Q as Owner of the subject property hereby
authorize Y to act on my behalf,in all matters
relative to work authcrized by this
_balld�in'g�permit application. nn
Si nature of Owner Date -
SECTION 7b`: /OWNER[ OR AUTHORIZED AGENT DECLARATION
1 VV1 L J�0(�L.-i ,as Owner or Authorized Agent hereby declare
that the statements and information on the fo�egomg application are true and accurate,to the best of my knowledge and
behalf.
J-�-esz✓� a� �SL__
Print Na
,. ���A Icy-duo- D �
�ature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
NOTES:
I. 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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I IO.RS,respectively.
2. When substantial work is planned, provide the information below:
Total floors 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
Type of heating system Number of decks/porches
Type of cooling system Enclosed _Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF SALEM
PUBLIC PROPRERTY
DEPAR'1'�1ENT
('onstrurtion Debris Disposal Affidavit
(rryliired IiN all demolition and renovation N%'ork)
In accordance %%ith the sixth edition of the state Building Code, 780,CNIR section 111 .5
Debris, and the pro%isions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting front
this work shall he disposed of in a pruperly licensed waste disposal I'acility as defined by MGL c
111. S 150A.
The debris will be transported by:
manic of 11 tiler)
I he debris will bedisposed of in
tna irul tic hty)
�vn f �� oak (S�.
IadJrc.. urlh ihlvl
�IL'�WIW I' �d p:nnrt .q+phcant .,
0 - d�
,I�tr
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
J411:M'I N it
I'(I'll
%1 n 12C rxbtrr • SAtrsl, M.vssl. ll it-I IN 0197-
l',I: '778-.'-fi9545 it P.tx 978-?4CG7gi6
Workers' Compensation Insurance :%fftduvit: Builders/Contractors/Electricians/Plumbers
\ l tlicdnt Information Please Print Legibly
Nafnt: l0u.ulcrsil)r;;anv:uinNlndlvlduul):J� �. C''"'1
ddfess:
City,Stacc,7iP Phone '1: S7 �� � —15; 5; �
Are sou an employer?Chec4 the appropriate box: Type of project(required)'
a employer with 4. ❑ I :tin a general contractor and 1 fie ❑ New construction
enytloyces(full andlur part-time).• have hired the soh-contractors 7. ❑ Remodeling
2.❑ I dnt a sole prnpfll'Ittr or partner- listed ore the llnachctl sheet. '
ship and have proprietor
etor or par These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9, ❑ Building addition
INo workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
I required.] officers have exercised their
right of per NIGL 11.❑ Piumbing repairs or additions
3.❑ I inn a homeowner doing all work S exemption Pon P'
Myself. [No workers' comp. C. 152. ¢1(3),and we have no 12.❑ Ruuf repairs
insurance requiredl t anPloyces. LKo workers' 13.0 Other
comp. insurance required.]
\n0 aj),111calll thW checks box fit mud,AIpU till otlr the wc11J11 kKiuw ahUwinm aicir work,as'cunlpen"ion pulwy in1wrrratiom
' t Iomm,wnen whu subsoil this affidavit indicating they arc doing all work aIM dins,hire uutside cuturoerors must.uhmil a vew arrdavil indicating+nch.
-CbmrxU,h that check this box must atlxhld.In addition+I sheer+hawing ncC u:unc of the sub-contrxturs and'iheir workun'c m,p.policy mflamarion.
/,tin tin rurployer that ds providfnr wurkers'cumpensation in.surooce for•ray entpla}rees. Befnry is the policy and job site
iuJaruwtiun. (/'��_ ` ,
Imurancc Conlpauy Name: \\ ?L\ MM
1'olicv p or Self-ins. Lie. `/ nf�1 /�C ... d -- Expiration Date: J 6 9 ���-
Job Site Address: V i d 1���1 _ City;Surteizip:,a Jyy�1'1� �sY- Q ( s 76
Attach it copy of the workers'compensation policy declaration page (showing; the policy number and expiration date).
l;aiture to secure coverage as required under Section 25A of\1GL c. 152 eau lead to the imposition of criminal penalties of a
tine up to S1,500.00 and/or une-year imprisonment, as well as civil penalties in the furor of a STOP WORK ORDER and a fine
of kill to 5250.00 a Jay against file violator. He advised that a copy of this statement may be forwarded to the Office of
Inv,su�,a nuns ul the DIA :or insttr:n:cc ,atvcragc tcrilication.
I du her,-by terrify r ,ferrtth _e purrs a^d prn,Jtics ajperju ihut the infurrnution provided/above is true and correct.
D:114__— • V ��1./ �a �a
Official use tody. Do not nvite in thi.v area, to be completed by city or town ofjiciaL
(:itv or fawn: _ _ Permit/License 0_ _.
issuing Aulhurity (circle onc):
1. Board of llc:dtb ?. Dcparlmeol 1. City:foau Clerk i. L•'lectrical Inspector i, Plumbing Inspector
6. Other _. .
Contact Person; _ __ Phone IJ:
Information and Instructions
Massachusetts Gcneral Laws chapter 152 requires all employers to provide workers' compensation for their employees.
PILLI'M nt to (his statute, an empluree is defined as"...every person in the service of another under any Contract of hire,
express or Implied. oral or written."
An employer iK defined as"an individual,partnership, association, corporation or tither legal entity, or any two or more
,it the Kxegoing engaged in a Joint enterprise. and including the legal representatives of a deceased empluycr,or the
receiver or trustee of .or individual, paniterbitlp, 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, §23C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal or a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant "Ito has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MG1- chapter 152, §25C(7)states"Neither the conunonwealth 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 certificates)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 dale 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
,elf-insurance license number on the appropriate line.
City or Town Officials
Please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
or the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
I'loase be sure to fill in the pennit/license number which will be used as a reference number. In addition,an applicant
111at must submit multiple pennidliceuse 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 nmst be filled out each
year. Where a hume 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 bum leaves etc.)said person is NOT required to complete this affidavit.
t he i)I IKe kit IIIVCItlgatltins \%ould like to thank you in advance for your cooperation and should you have any questions,
please du not hesitate to give us a call
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
seat:. d 5-'o-u5 www.mass.gov/dia
Proposal # 1072008
Page# 1 of 2
From: Steven Lamonde October 16, 2008
SML Roofing & Roof Repairs, LLC
6 Felton Street
Peabody, Ma. 01960
(978) 531-9557 Job Name: Finley
To: Mr. & Mrs. Gary Finley
16 Victory Road Job Address: Same
Salem, Ma. 01970
(978) 744-9164
I hereby submit specifications and estimates for: Approximately 20 Squares of a
strip & a re-roof of shingles including the roofs cap.
I will first begin by stripping the 2 old existing layers of shingles from the
Main roof and then I will denail the roof as well as nailing off any loose boards. I
will replace any rotted roof boards up to 48' for free,any additional board
replacements after 48' will become an extra charge on the final payment with prior
notice. Board replacements after 48' will cost 54.00 a foot plus the charge per each
board. Then I will apply an ice & water shield 3' up from the roofs bottom edges, in
any valleys and around the base of the 1 existing chimney. Then I will cover the
remaining opened areas of the roof with rolls of 15 felt paper and nail down F-8"
White drip-edge to all of the roofs perimeters. Then I will begin to re-roof with new
30 year Architech shingles By Landmark in the color of Atlantic Blue. I will tie in
the new shingles around the base of the 1 existing chimney after I re-lead it with new
lead while using new karnak for a water tight seal. Then I will install 2 new
aluminum flanges on the 2 existing stack pipes and I will install new aluminum step
flashing where needed. Then I will install the roofs cap to match along with new
Cobra ridge vent where needed.
For free of charge
I will install new cobra ridge vent for free of charge where needed. Then I
will seal the corner of the gutter that is in question, after I clean the gutters out.
Page 4 2 of 2
Prior to receiving %%rirten permission to do the Job we can not pysically remove
shingles during an estimate to know how many layers are currently on the roof.
This could contribute to more water damage to the interior or it may cause new
leaking. Therefore we «ill use our professional judgment to price accordingly, if
any additional lavers are encountered when stripping the roof you the Home Owner
«"ill be supplied with photos if, your not available to view the addditional layers. We
will add the additional charge per square to the invoice.
All material and debris pertaining to this Job will be supplied by and removed by
SNIL Roofing & Roof Repairs, LLC. This Job comes with a 5 year guarantee to
Mr. & Mrs. Gary Finley. These terms above to be voided in the event of new
Ownership, and or if any future work is to be done to or on the above areas
mentioned in this proposal, unless done by the said Contractor.
I hereby propose to furnish labor& materials-complete in accordance with the
above specifications for the sum of$7,900.00 Seven Thousand, Nine Hundred
Dollars. With payments to be made as follows, a deposit in the amount of 1/3
$2,633.00 for the stock and the permit will be required in advance along with the
signing of this proposal in order for us to start this Job. When of the job has been
completed (_-Approximately 12 squares) another payment in the amount of$2,633.00
will be due. The balance 52,634.00 to be paid in full upon the completion of this
proposal.
If this proposal is to your satisfaction and you are accepting these specifications and
conditions along with the payments to be made as follows, please sign and date then
return Our signed copy with the deposit to schedule. (Week of October 20`h,
Weather permitting)
X Accepted Signature:
X Date: Zo
Contractors Authorization to do the work as specified,
Steven Lamonde.
Please return this signed copy with the deposit for Our records.
Thank you in advance,
Steven Lamonde
SML/tdl
03/26/2008 00:56 9787778415 PAGE 02
ACORQ. CERTIFICATE OF LIABILITY INSURANCE mra(MMMONY)
THIS�ROGVCER
county Insurance agency, Inc. ONL CEY ANp RTIFICATE IS ISSUED AS A BdATTER OF INFORMATN7N NL CONFERS No RIGHTS UPON THE CER71RCATE
123 Sylvan St. HOLDER. THIS CERTIFICATE DOW NOT AMEND, EXTEND OR
Danvers, MA 01923 ALTER THE COVERAGE AFFORDED BY THE PO BELOW.
` INSURERS AFFOROMG COVERAGE
IBUREO SML Roofingfi
Repairs LLC INSU REP A
INSURER 0:
6 FeltoTT Street INSURERC:
Peabody, Mk 01960 INSURERR Cdalty
OVERAGES M+euRER E:
THE POLICIES OF WSURAN O LISTED BELOW HAVE BEEN CONTRACT
R0 THE VN5UR�F NAANEO ABOVE FOR THE POLICY PERIOD WDICATED.NOTWITHSTAImm
ANY REQUIREMENT,TERM OR CONDITION OF ANY CON'RWCT OR OTHER DOCUMENT WITH MAY PERTAM,THE INSURANCE AFFORDED DY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL CTHE TEgMS.EXCLU6pNS AND ONMAY BE DtTIpN31 OF S"DUpI
POLICIES.A6GREOgTE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.x
TYPEOFlNBURANCE POLICY NUMBER
GENERAL LIABILITY LOTS
COMMERCIAL GENERAL UABIUT' EACH OCCURRENCE S1 O` 00
CLAW MADE ®OCCUR ` FIRE DAMAGE(AIya vm) S
MED OP(A. ply�) S
113700007752 1/12/08 1/12/09 PERSONAL A ALY INJURY I
GEN'L AGGREGATE LIMIT APPLIES PER-, OENERAL AGGREGATE S
POLICY PRO, LOC PRODUCTS-CoMPA�AGG S 0 O
AVTOMOEILE LIAOILTTY
ANY ALTO COMBINED S INGLE LIMIT Y 1,000,000
ALL OWNEO AUTO$
SCHEDULED AUTO$$ BODILY INJURY I
(Pw P.- n)
NON-OWNED O'7P44L03940
NON-OWNED AUTOS 3/14/08 3/14/D9 BOINLr INJURY
(E'er acaEplq S
MAGIi
�PROPERTY"
GARAGE LIABILITY -
ANY AUTO AUTO ONLY-EA ACCIDENT I
OTHER THAN EA ACC $
E%CESS uAEIUTY
AUTO ONLY: AGG S
EACH OOC{RiRENCE S
OCCUR CLAMS MADE
AGOREGA'IE I
S
DEWCTIOLE
S
RETENTION S S
WORKERS COMPENSATION AFID
EMPLOYERS LIABILITY TORY LSAE5 I ER
00243054 2/24/08 2/24/09 E.L EAGH ACCIDENT s
E.L.DISEASE-FA EMPLOYE S
EL.DISEASE-POLICY LIMIT S
OTHER
NPTION OF OPERATIONSAAOATIONSNE]K[CUI W=LU IONS ADDED BY WGORSEMEMT/SPECIAL PRDy1SIGN8
'Ofing
TIFICATE HOLDER ADDITIONAL INSURED;SISVRER UETTER CANCELLATION
SHOULD ANY OF THE ABOVE OESCRIHED POLICIES BE CANCELLED BEFORE THE ERPIRA
City of Peabody DATE THEREOF.THE M UINC INSURER WILL XMMRVW MAIL*_DAYS WfartEN
Building Inspector NOTICE TO THE CER7VICATE HOLDER NAMED TO THE LEFT,BUT FAS.URETO DO SO SHALL,
Peabody, Ma 01960 IMPOSE NO OBL.IGA OR LIABILITY OF ANY KNO UPON THE INSURER,rrS AGENTS OR
REPREBENTA
AUTH NTATNE
RD 25-S(7197) @ACORD CORPORATION iBBB
Board of Building Regnintlons and Standnrds
HOME IMPROVEMENT CONTRACTOR License or registration valid for iudividul use
Registration: 136605 before the expiration date. If found return to:
Explralion: q/23/2009 Board of Building Regulations and Standards
TrN 129039 One Ashburton Place Rm 1301
TYPO: DBA 13DdOn,Ma.02108
SML ROOFING&ROOF REPAIRS
STEVEN LAMONDE
6 Felton at
- /^J -PEABODy,MA 01960 `- --�-Q•� `�"J(( /i, �
Admin-'� CL /�
Not valid without signature
Restricted to: RF
IA- Masonry only
BF- Roof Covering
WS-Windows and Siding
SF- Solid Fuel Burning Devices
DM-Demolition only
Failure to possess a current edition of the
Massachusetts State Building Code -
is cause for revocation of this license.
Refer ta: W W W Mass.Gov/DPS
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