60 WEBB ST - BUILDING INSPECTION +� The Commonwealth of Massachusetts
OF
Board of Building Regulations and Standards CITY SALEM
Massachusetts State Building Code,780 CMR dMar
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Wcial Use Only/ t
Building Permit Number: ate Applied:
Building Official(Print Name) Signature D�
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
C00 VUE1613 IG i
l.la Is this an accepted street9 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)
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 Owner of Record:
Sllsmt._3 611j11ZdC ' tYWLEO✓i Amo4
Name(Print) City,State,ZIP
60 wtsg s,, yw-45N3 -Osao
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORIO(check all that apply)
New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other specify: t?oOt--iNL
Brief Description of Proposed Work':
s i teal Y d- �- Iz-ottT
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ /0 e_vo 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 $ Total All Fees: $
Su ression
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 101 i;Oo 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /Q/ 77S' Ith3he
Ro'9f.rLT Th't-4e1T License Number Expiration Date
Name of CSL Holder -
Lis[CSL Type(see below)
q0e,-fJ W-Z
No.and Street Type Description
I�1D5d)..! �1T� O 3bs I U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) N -&S- ?1 13
TV+wad i HIC Registration Number K xpiration Date
HIC any Name or HIC Registrant Name
R RVi_ 909 (2� 74,t� I A.k- , c
NoN / 3-7Q6 - yam 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 .........A No...........0
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 Ro9V41— dd`
to act on my behalf,in all matters relative to work authorized by this building permit application.
St)5rfi1—N ;- /Sci z
Print Owner's Name(Electronic Signature) Dau,
SECTION 7b:OWNER'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.
J209YnT- —9aT-- /y�3d//L
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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 can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass. ovg /dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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"
The Commonwealth of Massachusetts print Form
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
UV www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organization/Individual): {ZT TI rfT �00T I I J�, I- CCJ J 7>�9Ti' P kA6
Address: B 71 � A%&
City/State/Zip: }k So 9J N lq 03 01C- 1 Phone #: a03- ')C«' /63 S_
Are you an employer?Check the appropriate bo Type of project(required):
1.❑ I am a employer with 4. a a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must 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.
:Contractors 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 number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: LI gF,� M\ITI/PT1.- —
Policy#or Self-ins.Lic.#: WIZ 7- ' 3 I S - 3(0q 5-/8"0 t Z Expiration Date: `9
Job Site Address: (cd Vkk,'B9 g l City/State/Zip: Sirt.f'>-1 &W'T
Of
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.
7 do hereb certi under the Elms and eenaldeN o er'u that the in ormation provided above is true and correct
4;anature .�v a-�j- Date
Phone#: 664 -70T-- 6
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#:
`;o CERTIFICATE OF LIABILITY INSURANCE DATEIh4►iIDWYYYYI
os/la/zola
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: If the certificate holder is an ADDITIONAL INSURED,the Po11CATIES)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and Conditions of the policy,certain Policies may require an endorseneeM. A statement on this certificate does not Confer rights to the
Certificate holder in Ileu of such endorseme s.
PRODUCER
GLOBAL HELP CENTER INC NAME TATIANA SALES -
19 MILL ST2NDFLOOR PHONE E-M .(978)275-0997 FAX
AIL -
LOWELL MA 01M ADD GHCLOWELL@YArIUU&UM (978)275-0589
INS AFFORDING COVERAGE NAIL#
NNSURERA: N TS
INSURED
ROGERIO TRENTO INSURERS: LIBERTY MUTUAL
DBA ROYAL CONSTRUCTION&ROOFING INSURERC:
139 RIDGEWOOD DR InsuneR o:
LEOMINSTER MA 01453
INSURER E-
INSURER P
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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,
ILSB
TR I TYPE OF INSURANCE O IMM POLICY NUNS POLICY F PO
GENERALlJA81UTY
users
EACH OCCURRENCE S 1,000,000
X COLRdERCIAIOENERAL LIABILITY T T T PR p S SO,W6
CLNNM44ADE Q accuR �PP807d3-3 OJ_3P_012 OJ23/2013 -.
A MEDEXPLAn a,m parser] s 51000
PERSONAL a ADV MWURY S 1,000 000
GENERAL AGGREGATE S 2,000,000
X POLICY PRO-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COAPIOPAGG S INCLUDED
POLICY
AUTOAUTOMOBILELIABILdrY LOC IN St S
(99
11
ANY A enUTO S ------.__._.
ALL AUTOS
SCHEDULED O SODRY INIURY(Pm Parser) S
AOr03 BODILY INJURY(pm aaidm) S
HIRED AUI'QS NON-PLANED
AUTOS PR RTYD S
UMBRELLALWB OCCUR S
EACH OCCURRENCE S
EXCESS UAB DED RETENTIONS CLAIMS4A4DE
' AGGREGATE S
WORMERS CONPENSAr10N S
ANDEMPLOYERS'LIAe"ITY YIN X WC SrATU- OTH.
B CFE%RDTI RCZ-31S-361518-022 OJ/24P012 013 E .ECHOFFIRRIMBEER CUDD aYNIA DENT 3100.00000eodatm NH)
100;000
RYCa desCrIbe uMar E.L.DISEASE-EA EMPLO S
DESCRIPTION OF OPERATIONS bebw - E.L.LXSEAsr-POLICYmn- S500-000
DESCR7TIONOFOPERATWNSILOCATIONSIVEMCLES U1Dazh ACORDIM.Ad,ptlanal Ramada Sehaduh.1fm easmisrequw.M
ROOFING AND CONSTRUCTION
CERTIFICATE HOLDER CANCELLATION
RJ TALBOT ROOFING AND CONSTRUCTION
8 JOANr ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
HU'DSON J�Z-I 0305] ACCORDANCE VAT"THE POLICY PROVISIONS
AUTHORIZED REPRESENTATIVE
I
WORD 25(2010105) V O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ROBERT TALBOT
8 JOAN AVE. y�6
HUDSON.NH 03051 - -
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HUDSON, NH 03651
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lk �ooririzo�wrea�/i �yp��aaQ Office of Consumer Affairs and Husiness Regulation
10 Park Plaza-Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
naR191lB IM 157288
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https://mail-attachment.googleusercontent.com/attachmenVu/l/?ui=2&ik=055ccc64c9&vi... 10/30/2012
Page 1 of 1
https://mail-attachment.googleusercontent.com/attachment/u/l/?attid=O.I&disp=emb&vi... 10/30/2012
AB Bob Talbot
a..
' Ommer -
_ ROOFING CONTRACTING
OOT � G Main:: 603-755-1535
{,pt �yl Main: 888-755-1535
Residential, Commercial& Condominium Roofing Solutions E-mail: bobAtalbotroofiri i.wm
H:LC#157288
- CS SL#101775 -
Susan Quirk 10/8112
60 Webb St.Salem,MA
508-843-0580
MASTERING HOME IMPROVEMENTS.
1. .Devcription of work area:Entire Hon.a except front porch roof
2. House and landscape will be protected as needed from falling debris
3: Remove existing layer of asphalt shingles and properly dispose
4. Any looscor rotten wood will be re-nailed and replaced as needed.Any necessary,wood replacement will be
$2.25 per square foot for'h"plywood and$3.25 per lineal foot for dimensional lumber
S. Install 6 feet of water and ice shield to lowest roof edge,3 feet valleys,and around skylights
6. Install synthetic underlayment to remainder of roof deck
7. Install new 8"white drip edge to all roof edges-
8. Install a start starter course of shingles to the lowest edge
9. Install GAF Timberline HD Lifetime architectural shingles permanufacturer's specifications.All shingles "
will be nailed using 1 %4"nails.Color to be: Oyster Grey.
10. . Install.Shingle Vent 11 ridge vent with GAF Seal-A-Ridge caps
11. " All existing flashing kits at skylights will be removed and re-used
J2. Re-lead(1)chimney
13. Install.066 rubber roofing on flat roof bay windows on front of house
14. Remove crown molding on front-porch roof and install new edge metal and cover tape on existing rubber roof
15. Install 5"white seamless gutter with downspout at front porch fascia
16. Work site will be cleaned on a daily basis and all area will be gone over using,a magnet to pick up all the nails.
17. Talbot Roofing&Contracting will furnish manufacturer's 50 year material defect warranty,as well as a
10 year non_prorated workmanship warranty
18. Talbot Roofing& Contracting will supply customer with a Liability and Workers Compensation insurance
certificate prior to any work being performed.
19. Talbot Roofing is NOT responsible for debris that might fall into the attic. Please cover any valuable items.
20. Payment terms to be as follows' 1/3 deposit&balance on completion.
AR jobs to be started approximately 2-3 weeks after the signed contract and 113 deposit..
(Pending weather conditions)
Total Investment:$10,200.00 Complete roof system(price vand for 30 days)
Comments: Due to the proximity to the street there may be additional requirements by the city.Any -
associated costs from this are not included and will be an additional charge. "
Please call nre with any questions. Thank You,Rick Lundgren 978-361-6129
r ."t'ACC$PTANC[OF PROPOSAL:.Tb.abocu pd..,specifications and eanditions a v.satisfactory and hereeby accepaal.TalboLR.00fing is authur n:d to do-_ - -
(lie work as alnocified. Ira Deposit is due With a signed ctyty of this contract&hahowc is due uMv eornplctioun -
' Talbot Roofing Rep: Date:
Authorized Signature: Date: /O _F L -
Talbot Roofing&Contracting,LLC -
- A..Pn,,a•Hod_nn-NH 03051 `(6031.755-1535 or 888-755-1535