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9 WHEATLAND ST - BUILDING INSPECTION (3) The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF SALEM Massachusetts State Building Code, 780 CMR Revised.liar 2011 :Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Fan ilv Dwellinir This Section For Official Use Only Building Permit Number: Date)(pp Building Official(Print Name) Signature Date SECTION I:SITE INFORMATION I.I Property AJJress: 1.2 Assessors Nlap& P1mr el Numbers `� WHFIq'TLWn//h 5T 1.1 a Is this an accepted street?yes no Map Number V Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if)es0 Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: EDt/k1+20,0 iZF-kA/V7-UCLA �5AL-G: t1A M/N C� I Q! � O Name(Print) City,State,ZIP 9-)RJ -7 `'15-8t/95 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check 01 that apply) New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units I Other ❑ Specify: Brief Description of Proposed Work': D - ,� A/ .e- ,L li5 4 f SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building S I. Building Permit Fee: $ Indicate how fee is determined: 2. ❑Standard City/Town Application Fee Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. ,\Icchanital (111':\(') S List:_ s, ,Mechanical (Fire $Su mression) 'Total :\ll Fees: $ r ODD Check No. _Check Amount: _ Cash Anmuunt:______ G. Totrl Project Cost: S ❑paid in Full [3 Outstanding Balance Due: SECTION 5: CONSTRUcT1ON SERVICES 2 5.1 Construction Supervisor License(CSL) J ._� I IV � L'j7�L Q --_-- License Number Fspiration U:nc Name of('St. I[older List CSL Type(sec below) _ Ty Description Nu. and Street � U tlnres(ricted(Buildings u*p to 35,000 cu. 11.) R Restricted IX2 Family Dwdlin C'itylfoten.State.ZVP M Mason ry RC Roofing Covering WS I Window and Siding SF Solid Fuel Burning Appliances G78-S311)s/I �Au6TW0MEL W/Z(S%I,C I Insulation felt hone Email ad lr, D Demolition 5.2 Registered Home Improvement Contractor(HIC) _ �f tzGn is CryuS r2 ciG?,`o (/ GG C1 d1 IIIC Registration Number Fxpiratiun Date I IIC'Col n,g�n) Nant•or I IIC' lie�;istrant Name �l "J— �z 4,A."13 y GS C r`� .4V i;/✓Dir�l.�t 4J�I.t +✓, No.tarw Street ):mail address n1/���10� L1.fl/Q�ifJ 2�S)pr/0g/1 Ci /Town, Stag Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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, as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 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 ' curtained in this application is true and accurate to the best of my knowledge and understanding. AuST%1t/D .-�Ar-GO -�//- // 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 NLG.L. c. I42A.Other important information on the HIC Program can be found at y Nt\t.mp,.gat.-oul Information on the Construction Supervisor License can be found at o.yk w.ntai., 'off ]Ili, 2. When substantial work is planned, provide the information below: Total fluor area(sq. R.) (including garage, finished basement'attics,decks or porch) Gross living area(sq. It.) Habitable room count `umber of)/replaces Number of bedrooms Number of bathrooms Number of Inalfbaths 1'y pe of heating system - Number ot'decks,porches - ------ --- -- -- -------- l\pcofcouling system Enclosed Open 3. "Total Project Square Footage-may be substituted for"Total Project Cost„ TCITY OF SALEM [PUBLIC PROPRERTY DEPARTMENT N\1,w UC WASHINGIt^i1'MLT• 5,111•.N, M.111.\\.I11 V I tvJ1'17'. fla: •11F71Svi't3 •f\.v 971144C•'i816 Workers' Cumpensation Insurance .%rndaviC Builders/Contrac torsi Electriclan9/Plumbers %1)1)ilcjflt In urmrtion �p Plcrs Print Le 'hl �lil lTte llJuauN:�i1)rgrn�,rA7linrvinJmduull: ywn �4r�1S �'���1!�/�� r Sf / �' �1t.ldrt:ss:� rJ�N4Ji'hl a�S C.I Cily,.Starc%ip I'hunrif: 7 S 7, 1 nc1' /� 1Are\uu ' I,vinployer7 Check the appropriate box: 1. 1 am a cmpluyur with 4. Q I non a general c°Inraetot and 1 1 yM°/prn)eet(rcyulreJ): cnlpluycux(lull andlur part-time).• .Iiuvu hired the suh•cuntracturs rt' ❑New callstruction ?.❑ I Jm a sole pmpricnlr or partner• listed on the artachcal sheet 1 y ❑ Remodeling .hip and baud no mnpluy a•s These sub-contractors have \varking liar and in any capacity, workers'comp,insurance. g' C3 Ikmolition (Nn workers'cutup, insurance 5. ❑ We are a col 9. ❑ Ouilding addition n uircJ. corporation and its 3.❑ y ) on4cen have eser:ised their 10.[]Electrical repairs or additions 1 ;an a homeu\vncr doing all work right ofcaeniption par NIQL 11.0 PlumbinY repairs or additions myself.(No wnrkun'comp. c. 152,¢1(4),and% hoed no 12.�Rwl'npuin insurance required.)t cmployucs. (No worker' ctnnp, insurancdreyuircJ.J 13•QUther •4nr,yrphcua'hW chch bar el mum:aw Itll wu'be fecnw,"w aitivi'Mir wwkai eun,penuaiun Policy udormmitrlL 'I tvmwnw,wrs whir$linne this sn'IJevl,indli ming I",air jig f11 work a,it Ihax Al,e tw,side come f.M,ra.I,n.Ihm cMY'k this bet muu a1laYhgl a"aawitit f Avon%A-mine the"aN,o of tM rub•cemrxWn and Ace wuA 1e'v'Irtlaril inituuiny /ant Ulf errrpleyer,that fr pruvidfng rvarkers'rurrtperfradom hitaranee/br iffy ernpluytet, Ltelule!s thepfrll'y an%tr1 a - irllarmulhon. InsuranceCunlpauyVane:-, K . �_6-4z1" ,y .� �G lidicy If Sulf•ins. Lie.tel: -TN�1_fl7& 4MU(a 7 •5 I D Expiration Date: !ub Situ Address; I----- C1lpsWtelzip: ' / fJ/76� \ttach n ropy of the workan'emnpen.tuflun policy duclrrullun page(showing the policy number and e.tplrunua date). Pailutd to Nauru covetuye as required under Scctiun 251% ul'VIOL c. 152 eau lead 10 the imposition oferiminal penalties oral tin. up m.S 1.5110.IR)and/or uue•year irnprismuncnt, us wt:11 J.t civil pcnalllus in the 11unn ara STOP WORK ORDER and a fine orup to 12511.00 a Jay.Iguiml the vi'Aitor. lac advi.fcd that a copy ufthis slatctnent may be IurwarJaJ to the 011ice,rf lei\'�111�JIInnf J1 flea IIL\ for Io,uraluc cnvcn�c\etilicaaun. /du/r.•n•hy c crri nJer rh p,rinr all d pelf"/Net u/'per/nry that dIe in/br"'w"am provided above fs erne urn/rorrem U r 7 �f l � t7//friut use wily. no rtnt vFirr in Il#ft area, ru he runrplvred by vies of to fall,r//1rruL 'ire or 1'ntrn: t PcnnitrLlccnte st. h.uing.lwhurity (rirclo one); II. ) Il.r of IlrJldl 2. Ilutidu,g Ucp.,rnncut I. t:i1i:'1'ueu Clerk J. Electrical Infpccror :, plumbing Insycctar 6. Other l'„nlJ,a 1'cnw : — I ._� I'ha"c Y• . Information and Instructions �Llss.lchusctts lJcncral Laws chapter I i2 re4WreY all CI11ployesOn in II1e i to Cry�!Jf anJlhefe ul Iet'nlly ntract of h tor their ire. 1'llrsuarlt to this %latute.in ernplgs'ee Is detiried as"...every pe'. ♦press Jr IIr I1Cd. oral or written." ry I of ally two or .�n arnitiI 1+ds lined as"an Individual,partnenhip..tssaciauoa,corporationof es ufla deceased empl ycr,Jr the Jfa ,II the 1,1rcgjIn�engaged In a Joint enterprise.And including the Ic gal rCpr cnl Of owner of r dwelling. in In having not more than association apartments or other and whotresides therein,urnhel occupant w the aver the ction of repair wul .Iwelhng house of another h dwelling house who employs ehereto shall rions to do notnbecause of such employment be deemed tuit in ybe an employer." Or on fie grounds or building appurtenant �IGL chapter 152. 4'_SC(6)also states that"every state or local licensing agency shag.withhold the Issuance or renewal of A license or permit to operate a business or to coostruct wilif the building,In insurance ce coverage re fore . applicant wire has not Produced acceptable ibl eeevidence de'Incer the onunonwIalth not any of its political gsubdivisions shall Additionally, IIGL chapter l S_, a_ l t Jnter into any contract for the perfumwnce of public work until acceptable evidence of cunlpliarlca with the insurance requirements of this chapter have been presented to he contracting authority." APPIIcoM, applyins the boxcs that t our situation and.if Plcaif t rill%cat the workers' compensation affidavit Comp�aty-by numbers)along wi h thircerti8catels)Of necessary, supply sub contractors)n une(s),aJdreLimit P with insurance. Limited Liability Companies(LLCwair orkers'tcompensaed t onsinsurance..(If an)LLC oroLLP does have cimployces er than the members or partners,um not required to Carry be so to the Deporuent of industrial employees,o policy is required. Be advised that this affidavit may \ccidents for contlrmation of insurance coverage. ►Ise benureor IiC to anse is being reque ted.not he lhPartmCnt Of h� he rcnlmed to the city or town that the upplieation for the pe to obtain a workers' Industrial Accidents. Should you have any questions regarding the low ur it,you era required compensation policy,please call the Deportment at the number listed below. Self-insured companies should enter their self-insurance license number on the a ro riuto lino. rlry or Town omelah please be sure that the sffidavit is complete :tad printed legibly. The Department has provided a spaud Lithe bottom of tile affidavit for you to lilt out in the event the OlTce of investigations has to contact you regarding the applicant. I'I:aac be sure to till in than permit/licmise number which will be used as A reference nonlife; , In addition,an applicant cif Or Illat moat submit multiple panniVlicellse applications in any given year,need only submit one afidavit indicating Curren policy intormat o f ha necessaffidaary) and under"Job has,been officiallySite AY mcpcJ or markedlb s tile may bu proviJOd to the Y Y townca A cuPY applicant as proof that s valid affidavit is on file for tLturo permits of licenses. A new affidavit must be filled out each Where a hone Owner or citizen is obtaining a license or permit not related to any business or commercial venture t i,a. a dug licen a or permit to bum leaves ctc.) sail person is NOT required to complete this affi davit • year. cooperation and should you have:J,y yueauons, I he I)11icc ui Investigations would like to thank you in adv:ulec for your plane do nut hesitato to give us a call. fhc U.p:lrnncm's address. telephone and fan number: The Commonwealth of Massachusetts Department of Industrial Accidents 01IIee of Investigations 600 wasttington Street Boston, MA 02111 'Pei. q 617-727.4900 ext 406 or 1.877•MASSAFE Fax M 617-727-7749 t ,,, J :.+p.n5 www.mass.gov/din CITY OF S.�LE.�I, LPL-kSS.kaiUSETTS BI;IIDLVG DEPARTMENT 110 W.ISHLNGTON STREET, 3j1O FLOOR TEL (978) 745-959S FAX(978) 740.9W KIJ®ERLEY DRISCOLL MAYOR THomu ST.Pmus DIum&OF PLBLIC PROPERTY/BL'IIDNG COMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris,and the provisions of MGL c 40, S 54; Building Permit Al is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c l 11, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in (name of facility) n2�> 7-4 ef�er 6R 41 s (address of facility) signature of permit applicant 7--/l- /l Jim I.bnvl(Jw 7 ® DATE(MMIDD/YYYY) A�OR� CERTIFICATE OF LIABILITY INSURANCE 1 12/1/2010 THIS CERIjP.STF 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. IMPORTANY: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS 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 lieu of such endorsements . CT PRODUCER NAM Lauren Goldman B.R. McCarthy Insurance Agency, Inc. 1PAIC0.10,Sao. (978)532-5445 p/C No,(9]B7332-2217 E-MAIL 1 oldman@crosea enc com 10 Centennial Drive ADDRESS' g g y— West Entrance PRODUCER Peabody MA 01960 INSURERS AFFORDING COVERAGE NAICY INSURED INSURERA-,Main Street America Assur. 29939 INSURER e:National Grange Mutual Ins Co 14788 MELDS CONSTRUCTION LLC C/O FAUSTINO MELD INSURER C:Travelers Indemnity of America 25666 34 JENNINGS CIR INSURERD: 34 Jennings Circle - INSURERE: PEABODY MA 01960-3568 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1012139423 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVNTHSTANDING 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' POLICY EFF PODCY EXP LIMITS LTR I TYPE OF INSURANCE I POLICY NUMBER MM/DOIYYYY MM/DD I. GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,000 DAMAGERENTED 500,000 ? X I CC:SAERCiAL GENERAL LIABILITY PREMIS S(Ea occumeincel $ A i ' CLA4dS-MADE LOCCUR KP023862 11/26/201011/26/2011 MED EXP(Any one person) 3 10,000 ? i PERSONAL S ADV INJURY_ $ 1,000,000 j GENERAL AGGREGATE $.. 2,000,000 GEN'L AGGREGATE Ll,`.'IT APPLIES PER - PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY i Pgf: I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) �_ ANY AUTO BODILY INJURY(Perpems ) $ B ! AL OWNED r'.UTOS 9H43926 9/21/2010 /21/2011 _ .BODILY INJURY(Per eccide s) $ { X ' SCHEDULED AUT OS PROPERTY DAMAGE $ i X HIRED AUTOS (Per acoMerd) j X 'NC'N-DY':ED-UTOS -SA06 $ f—I Uninsured motorist 81 Spin limit $ 20,000 i UMBRELLA LAB CC EACH OCCURRENCE $ EXCESS LIAR y !CLAIMS-MADE AGGREGATE' S i DEDUCTSLE $ - ` RETENTION S $Q - WORKERS COMPENSATION i ( 2/4/2009 12/4/2030 WC STATU- DTH- AND EMPLOYERS'LIABILITY YIN - — — -�- ANY -rRO?RIETOPJPARTHERi=XECUTNE- E.L.EACH ACCIDENT 3 1000000 I OFRC_R!l.tcMdER EXCLUDED+ NIA HUB7814M46510 �2/4/2010 12/4/2011 E.L.DISEASE-EAENIPLOYE S 1.000.000 IMandatory m NH) I if yes,?e=_c [eon�e: E.I.DISEASE-POLICY LIMIT S 11000,000 i DESCRIPTION OF OPERATIONS beicw DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remanle Schedule,it more apace Is required) Refer to policy for exclusionary endorsements and special provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Insured's Purposes AUTHORIZED REPRESENTATIVE Timothy Tramonte/LG4 .L-Gr vc� rX• �/ ACORD 25(2009/09) ©'1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Sxfet.v Bo td of Building Rc ul ttions and St.mdai'ds Construction Supervisor License License: CS 80393 ' P FAUSTINO N MELO 34 JENNINGS CIRCLE PEABODY, MA 01960 `• ---15.c� Expiration: 3/1Y2013 Commis�iona�. Tr#: 11740 I i l 1 ItI Vf 1 .OM=.tA?ROVEh1ENT CONTRACTOR Type: 108-053 - , i2;ion oR82012 U"d Liability Co-'PO es—z _ 3 ..IIy.b1vA 01960 Underseeretarr Melo's Construction LLC $B$ 34 Jennings Circle Peabody,MA 01960 Telephone: 978-531-0811 - E-mail: FattstinoMelo(almsn corn n.wr.rr�a MiMIRiR Faustino Meld,General Manager Unrestricted Mass Builders Lic me No. 90393 Contractors Registration No. 108953 Proposal Subminad to: ne Number: Ew=LA 7 - 7— City,State,and Zip Code i 'IvaIV14, I 7 b Job Description: Job t outiaa Job We Proposed hmeby�m fimush m buials and labor-complaw in womdaoro with the spomficw m ' bolo*,for the min of U.#' IT'm�Scnn/ n SG/ernl {�/ //yR O�ydaan (S C J ImtaWtionOfPayments: / ,y7�i ) �F Payments will be paid in thuds.The fire[adalhueot will be paid before the job begins.The second payment will be obtained in the middle of the job.The last payoeat will be obtained after the job is compl tad Note:This proposal may be wi bdmvn by us Authorized Signimue: if not accepted wihin 20 clays. Date: , S^ 9741 e Heretry Subeeb Spedaeadma sad FA"an tar:THE INSTALLATION OF A NEW ROOF To protect the homeowner's property,Blue Tarps will be used to cover the siding,bushes,and grass during stripping. All of the layers of roofing will be stripped,and all protruding nails,screws,and/or staples will be removed. Ice and water shield will then be installed at the bottom of all edges,around all chmeys,skylights,and into all valleys. Fifteen(15)pounds of felt paper will be installed onto all other areas of the roofdeck. The 8"aluminum dripedge will then be installed to all roof edges. Any existing pipes will be covered with new rubber flanges. The roofing material to be used will be 7&Vj? The homeowner is responsible for the selection^to the roof color. Also, the homeowner may select Ca"hand or pneumatic nallm for the nadtrng application of the new roof. All the debris will be ckaned and pronesfv disposed of on a dailybUill.Magnetic brooms will be used to extract all nails from your property. We will protect your property as best as we can,however,some foilage matting,breakage,or marring could occur. We cannot accept responsibilry for possessions inside of the house,or debris falling into attic areas. The customer should orotect Extra work m which an additional cost will be added to the above price. Replace Rotted Rootboards Gutter Repairs Remove Aluminum Siding Relead Chimney(a) install Skylights) Remove Old/Rotted wood Replace Facia Boards Repoint chimney las call Garage Roof Install Ridgevent Install Azek Board htstall Insulation Install Roof Louvers Install Window Trim Install Tyvek Paper Install Aluminum Gutters htdall Shutters Cover Aluminum Windows Install Aluminum Downspouts Remove Vinyl Siding Repair Vinyl Siding Install chimney cap Porch Repairs Rebuild Chimney Add tiona Notes: Total Amount for Additional Work: Warranty by manufacturer to be free of defects for years,we manttf icwrees warranty for details.All labor performed under this contract shall be of good quality and free from defects not inherent in the quality required or permitted for a period of_years. This warranty excludes remedy for damage or defect caused by abuse,modification,improper or inettfficent mmtenence,improper•operation,or normal wear and tear under normal usage.This warranty shall be limited to the work performed by Melds Construction,LLC and limited to either repair or replacement by Melds Construction,LLC at its sole descretion and elation. Any and all dam are waived unless made in writing to Melds Construction,LLC within 21 days after the occurrence of the event giving rise to such claim. This warranty shall not extend beyond any hunts imposed by applicable law. Payment and Penalties-Upon substantial completion.ofdloork under this comrom customer shall-within 3 days-make the final and full payment of the contract price.Any and all unpaid balsams shall accrue with interest at 5%interest per month. You agree to pay all court costs and Collection expenses incurred by Melds Construction,LLC in the collection amount you of any amount you owe under this contract,including and without any limitation of reasonable attorney fees. Acceptance of the Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified,payment will be made as outlined above. Payments are to made as per requisitdon and or invoice. The proposal may be withdrawn within 20 days. Date of Acceptance: `?11`!I I Sipam r .