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14 VISTA AVE - BUILDING INSPECTION (2) �K I 98 7— The Commonwealth of Massachusetts } OF Board of Building Regulations and LE ERVICES CITYM Massachusetts State Building S RevrsedMdMar ar2011 Building Permit Application To Construct, Rep jt vate�Ope2iohsl a One-or Two-Family Dwc►Rt �1L This Section For Official Use Only C�— Building Permit Number: Date plied: /It, , Building Official(Print Name) Signature Date U / SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /�y/s� Ad c Sa�tM Mk 1.la 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(ft) From Yard Side Yards Rear Yard Required Provided Requved 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 Owner'ofW(ord: �� m� /y ,d f'H ha f 1 ft LS S i Name(Print) City,State,ZIP n )(,f V1 a We 33y d?--0153 ?/CSS: No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other PC Specify: R007� Brief Des rip0 pf proposed Work': SMA0 'f r S SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ 6. Total Project Cost: Qp�� d p Check No. Check Amount: Cash Amount: ❑Paid in Full ❑Outstanding Balance Due: rnaIL,(50 tat13 0�) 666k Ll SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 66 66 3 3 is 6 I bad; IU/00/;[�o License Number Expiration Date Name of CSL Holder Holder v w,?56 V List CSL Type(see below) No.and Street Type Description MU 4'par j M ff Dd 151� U Unrestricted(Buildings u to 35,000 cu.ft. 1' R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Maso RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Rot a Improvement Contractor(HIC) if V X S/ �< C d'Not, we-( 9 n f(ra it a-pt-C HIC Registration N, Expiration Date .FBI C C � N�eo gistmnt Name F l No d treet �j j�$ _M fhLik �L�`(� 7��9 jg, 07q Email address City/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 ...........0 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 fN�" �4 ft5 6 fee"Ck 5 XI'C to act on my behalf,in all matters relative ork ai orized by this building permit application. DNtfs --kbwq( ON Print Owner's Name(Electronic 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 co at d in I lication i tied accurate to the best of my knowledge and understanding. 1,411 Pri er's S_ n gent's Name(Electronic Signature) Date NOTES: L 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.Qov/des 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 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" i Serving Greater Boston for Over 2S Years! Dave Tomolillo HALLMARK CSL#: 064063 HIC#: 158936 HAI:IA f10AfS RFNOfIElK Standards & Quality are out Priority! Next Step Living Quote — Re-Roof September 30,2015 NS-011 Michael Alessi 14 Vista Ave Salem,MA 01970 339-227-0933 alessil4@aol.com Roofing Specification: MIPA,MPB,,MPC&M_PD Only; • Remove old comp shingles down to the existing roof sheathing • Remove all nails and replace up to 32 square FL of plywood if needed • Additional plywood will be charged at$55.00 per sheet • Apply 6'of Water Shield along the lower eaves • Apply 3'of Water Shield along the valleys • Install new vent pipe water diverters where needed • Apply 15 lb.felt underlayment as protective base • Install 8"aluminum drip edge along entire roofline perimeter • Includes [50'] roof ridge ventilation system and [SO'] color matching caps • Removal of roofing debris by dumpster • Total number of roof squares [211 • Owens Corning'TruDefinition®Duration®30-year Architectural shingles. • Providing all Insurances,Licenses and Permits Materials and Labor: $3780.00 Permits&Admin: $110.00 Quote_Tota : aS8Y0 u "A Hallmark Homes Associates,Inc.• P.O.Box 885,Medford,MA 02155• (781)838-0789• www.HallmarkHomesRemodeling.com The Commonwealth of Massachusetts . Department of IndustrialAceidents I Congress Street,Suite 100 Boston,MA 02114-2017 wwwatnass.gov/dia \Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/organization#Individutl):Hallmark Homes Associates, Inc. Address: 56 Wilson Street City/State/Zip: Medford, MA 02155 Phone#: (781) 838-0789 Are you an employer?Check the appropriate box: Type of project(required): L©I am a employer with 2 employees(full and/or part-time).' 7. ❑New construction 2.❑lam a sole proprietor or partnership and have no employees working For me in g. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]f 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. - 12.❑Plumbing repairs or additions 5.❑i am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.©Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.❑Other 6.E]We are a corporation and its officers have exercised they right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] - *Any applicant that checks box#I most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContiactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy numbm lam an employer that is providing workers'compensation insurancefor my employees Below is the policy and job site informadom Insurance Company Name: The Travelers Policy#or Self ins.Lic.#: 6KUB-5B29684-3-14 Expiration Date: 03/17/2016 Job Site Address: 14 Vista Ave city/stateizip: Salem Ma 01970 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificati I do hereby cer an r the and p es ojperjury that the information provided above is true and correct Siartature _ Date, 10/01/2015 Phone#: (781) 838-0789 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Hallmark Homes Associates, Inc. — David Tomolillo , ASACHUsETTs �111�11�1�1�11111��1111�1�1�11 - DRIVERS MA I LICENSE a,.r +.p'^u" www.mass.q�ovlrmv En f ( I - 1 4� Oa ExO bMYrEiI LUE9. .1 i( a 1111 02.2Q-20f3 NONE 58253§�7:. o sxaD wdnr x..9rn a,a9+ a` � y/�� Id are.p xeMol lvm m , 03,75, M 15- -20t8 yrwa ,�Igu,Sr�SYi pp or is six M +&Ilai"Fae xoxE xoxe rNONE TOMOLILLO _ 56 Wilson S[ttet [C cwxnf ore xEss.m eEEow.aExanxexr wx. Medford,MA 02155 f M - s Zf�Aassachusetts-Department of Pubtcu Safety Unrestricted-Buildings of any use group which Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m3)of Construction Supentsor r. enclosed space. License: CS-064063 a pl DAVID F TOMOLILLO 56 W ILSON ST ` _ t MEDFORD MA 021551 , Failure to possess a current edition of the Massachusetts �,,�•_�lj�6G . '"""'j ~a Expiration j j State Building Code is cause for revocation of this license. Commissloner 03/76/2076 i For DPS Licensing information visit www.Mus.Gov/DP8 .. _ _ .. L J fN�'jnerriiw[r rHttrf/�r rwhacdld License or registration valid for individul use only Office of Consumer Affairs&Business Regalaffpn before the expiration date. If found return to: AOME IMPROVEMENT CONTRACTOR Office of Consumer Affain and Business Regulation g, y Registration: 158936 Type- 10 Park Plan-Suite 5170 `'en—s��Explin tion: 3/18/2016 Private Coonoratic Boston,MA 02116 HALLMARK HOMES ASSOCIATES INC. DAVID TOMOLILLO ` 1 STONEHILL DR. 1F STONEHAM,MA 02180V li" undersecretary NOt valid wi out signature _y y [ ' w ..fR wmr»a.rJw ,xr ,4r+Miuw aeray+eraRWry V1.lL-1 .i�2. .'�2V}74 rn+rwt>'U exda[awrn rtaer'�,nmx[wrK mmDka�a[,eJJeo x.•w+t This card acknowledges that the recipient has suctessfulfy completed a. 30-hour Occupational Safety and Health Training Course in Construction Safety and Health Michael Arenella i'.e ar Ji.frimrinn M ibix nrJ fur rrxuJvknt Dury[.xcc in[IudinR fake tLirw ur Eati� navi.al erai,JnR.pa.rrwa in prwa,aun nMcr f81 LS.II IDIIi.Rpmtial Deaxairs ynt,tl<ua»oiluN[rnaw lino impnuwwul VD lV IM1e]'mra.nr Iw(R Jessie Vieira - _814/11_ w.rse 8 ((Rainer name—prim or type) (Course end date)