44-46 WINTHROP ST - BUILDING INSPECTION 1
The Commonwealth of Massachusetts CITY OF
y Board of Building Regulations and Standards SALEM
I Massachusetts State Building Code, 780 CNIR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One or Two-Family
ily Dwelling
Phis Section For Official U illy
Budding Permit Number Date plied
Building Official , ign re
<.. . Date.,: ..
SECTION 1: SITE INFORMATION, `-
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
H _y 6 �`� , � fLryp Parcel Number
l 1 a Is this an accepted street?yes_ no_ N[ap Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(f)
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:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system El
Public ❑ Private❑ Check if yes[]
$1 CTION'2, PROPERTY OWNERSHIP'
2.1 Owner'of Record: :Dgistd HwnL.o ��� � ( iA
1. oQ v(L A Re
S Y�c v City,State,ZIP
Name(Print)
L4 t4 - t-1 42(2 S-L 4Z1 7 jnf2�i 2 1
No. and Street
�— Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all thatapply)
New Construction ❑ Existing Buildin Owner-Occupie Repairs(s Iteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work: S T'fL e W Qen?n
SECTION 4: ESTIIVIATED,CONSTRUCTION COSTS
Estimated Costs: Official Use Only_
Item Labor and Materials
1. Building $ 6 d 1 Building Permit.Fee $ Indicate how feeds determined: .
❑.Standard;City/Town Application Feet/
2. Electrical $ ❑Total;Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2 Other Fees $
4. Mechanical (IIVAC) $ List
5. Mechanical (Fire $ Total All Fees: $
Suppression)
Check.No. Check Argotmt. .Cash Amount'.
6. Total Project Cost: $?( 0 O a O 0 Paid in Full . ❑ Outstanding Balanee:[yue
/ t
SECTION 5: CONSTRUCTION SERVICES
r��
on Supervisor License(CSL)
Ry-7t�3 � ice(D l..t License Number Espirntion DatelderList CSL Type(see below)
LtRIPA 6c>-
Type Description
o�� -JVI A .� 4 U Unrestricted Buildin s u to 35,000
O A � R Restricted 1&2 Family Dwelling
City/Town, State,ZIP - bl Masonry
IN
CoverinwtindSidin _uzl Burning AppliancesonTele hone Emailaddress ition5.27Registered/H�ome Improvement Contractor(HIC) 2T ' ( Z _IL—J& , l . k —I -t,- — �'� ation Number Expiration DateHIC Compan Name or HICRegistrant Nameo� �� cv i. f D ✓ 4 �a i[N Street Email addressBoaYNrg9-7RS31R
Ci /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 .......... ❑ 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: 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.
Lav G.S, wsr
-- ),!� — 3Z—
Print Owner's o 4uthorizcd Agent's i ame Electronic Signature) Date
NOTES:
rl. 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 arbitrationprogram or guaranty fund under iNI.G.L. c. 142A. Other important information on the HIC Program can be found atwww.nass.aov%oca Information on the Construction Supervisor License can be found at www.nass.eov dr,When substantial work is planned, provide the information below:l Floor area(sq. ft.) (including garage, finished basement/attics, (leeks 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 Footagc" may be substituted for"Total Project Cost"
1
` The Commonwealth of Massachusetts
— Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
"�- � www.mass.gov/dia
NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Len Gibely Contracting Company
;address 23R Winter Street
City/State/Zip:
Peabody, MA 01960 Phone.#: 978 531 -8234
Are you an employer? Check the appropriate box: Type of project(required).
1.L� 1 am a employer with 12 4. ❑ I am a general contractor and I
G. ❑ New constnwlion
employees (full and/or part-time).* have hired the sub-contractors'
listed on the attached sheet. 7. ❑ Remodeling
2.L] 1 am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[ p No workers' com insurance comp. insurances
e are a co d its 10.❑ Electrical repairs or
5. a !diGcn.::
required.] ❑ W corporation an
3.❑ 1 am a homeowner doing all work officers have exercised their 11,❑ Plumbing repairs of ad(liiiotts
MGL per exemption of let exem
myself. [No workers' comp. ri 5 P p 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other ___________.
- comp. insurance required.]
^Ally applicant that checks box NI must also fill out the section below showing their workers'compensation policy information,
t liouieo,mers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1C entractors that chock this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensatlon insurance for my employees. Below is the policy and job site _
infurnuiliaa.
lnsuiance Company Name: A. I .M. Mutual Insurance Company
Policy r! or Self-ins. Lic. #: 6010979012012 Expiration Date:08/03/2013
Job Site Address: a L-F -L{to L4S t.c�.l_+Jt, S'-�-- City/State/Zip: S _MA
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration datO.
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$250.00 a Clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct,
c...natute i .�7a �,p Date• _
Phone # L� O S Z+ �. lS �- 3 \ - --- -
Official use only. Do not write/it Ti i_s area, to a comp eted 5y city or town ofJlclaI
City or Town: Permit/License#
�I
it
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
G. Other
I
Contact Person: Phone#: ------
it
JUL-24-2012 10:42 Sennott Insurance 978 867 2404 P.01/01
nATE(b NV0D/YY Y)
CERTIFICATE OF LIABILITY INSURANCE a7i24/2012
THIS cERTIlIGTi Is IasVM M A NRTTia O! nllORBWTroW OWLY AIR/ CONFIRM NO RIaNTR UPON TNT C"OrnIrf 1 NOID[R. MX8 CfiITIRGTa
ME, NOT AT►rABATI x OR "mTrRany AlDitiD, ENIt1ND OR AAT[R THi I.W[RAOT. AT'lCRDNP BY TN[ 90I6ICI[6 Rumt TNTB MATIfICATE OE
ISSURRMIK was WIT cO1ISTITWIL A CONTRAt R[Tw[[N THE XSBUTm IWsiiA[Rlsl, AWHOR=EEL P[PPESYWTAiiV[ OR PRODUCER, FORD TEE
t9 aTiP'YCAT[ BOILER.
TIPOATANT. If Ciao oertiEioata mi4gr SF SH AOO17joBsE, INausm, the pellOTlles) must be endorsed. Yf 9URRORRTION is WATV[D, subJeeC
to the team. FnC Nondltion. OF the pPLluy, Gott VOILales Bay zequlra aN elfdOrlos t. A {tateaent on this Oertilloato doe. nat
OOOf et tights to the oartuitate hoiO r Sn lieu of ouch vidoYsment(e1
cs, w.f
Edward S Sennott Insurance
year, Tv,
Agency Inc AiL,a. t.Ll: uro. .al.
16 South Main Street ..w,R "h
m
Topsfield, MA 01983-- 99".. ,DI.
I"PPNDI"1 a/.p,Pai covuMD[ ua{
IHaMr.D t{Ruu: A.I.N. Mauna insurance; Co 33758
T.en cibely Contracting Company Inc
mvRt e
23 Winter Street Rear
Peabody, NA 01960-5941
,aNNI,{I
COVERAO88 CY3x1PICATE NVI03ER': R$VIEION NVNFSRR: �
tN C Is TO taiiirt THAT THE POLICIES OF IN LISTm sitov HAVE Rear issm To I= Msuam i"m Mon 6aa TIRE POLIET PIRIOO INOICwtm.
}NSMITHSSAIIDINN Ext TORK OR WWDITION or NH CONINPCI Oa OTHER,MUNPRP•T WITH RE9PGCT To"10 TNIa mitlPTCAI& MY 0E I9fiUm OR WT
N AIN, TNC INBUNN.Q Yt(ONDm by THE POLICIES OESCRIRtS P®1EM I9 S061ECT TO ME THE TIORES, LiCLVSMNP ANO CONDITIONS or SVCR POLICIES LII[IT6 SNOHN
kAT HA\2 St ERR, L BY DAM MAEOR.
POLICY IMIDIR DOLICT EPr 9OLICY END LMITB
TYPE or iasORasm ua'RmT mL'mnn^
Qdot LIABILITY {AV OOlmuw
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F1 ExFaTIVI nve uPY IC'60.5 ARE
❑ inCl ® coca 6010 97 9012 012 -IBLICT NHv a 500,000
OH/03/2012 OH/03/2013
P.I., DauuR• {.eaLot , 500,000
C8RTI6ICATE HOLDER CA3gCEMAT.ION
tNOVIL ANY or THE"S DESMUSID Mi.ICIG9 m CMCELIIT 1al"ORE THE
Evidence of Insurance "ImIDATIoN Oar, TNMIBRI, NOTId HILL BE MLN69DJ IN ACCOMaN¢WITH THE
MLILY OPdVIBIDAe.
TOTAL P.01
JHI4-d4-ewld 14;313 nennott Insurance 978 867 2404 F'.01
01/Z4/2012
PRODUCER 978.887,4900 FAX 979.897.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
` Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
P. 0. Box 4S7
TDpsfield, MA 01983 INSURERS AFFORDING COVERAGE NAtC H
INSURED Len Gi ely Contracting Co. , Inc. _ INSUREAA Catlin Specialty Insurance Co
23R Winter Street IN$uRERe. 19038
Peabody, MA 01960 IH$uREac:
INSUR_ER_0:
INSURER E.-___.___..
COVERAGES —THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWRHs rANDING
ANY REOUIREMENT,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 CONDI FIONS OF SUCH
POUCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
wTR N$R TYPE OF INSURANCE POLICY NUMBER P ICY EFFECTIVe POLICY EXPIRATION
DATE MMNOrrYVV DATE MMIDONYYY LIMITS
GENERAL UABILITY 370030101E 01/29/2012 01/29/2013 EACHOCCURRENCE i 1,000I9O
x COMMERGIKGENERALLIABIUTY PREMISES EAPttu,wo f 000
CLAIMS MADE FU OCCUR MEO EXP IAny pw PalaPn) f 51000
A PFA$ONAL a AOV INJURY S 11000,000
GENERAL AGGREGATE i 2,000.00
GEM%AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO 7 2 000 00
POLICY PEODT LOC •- _ .� t.,-_._L._�
�...._.W�.�._... ,.. ...,. .. __
AUTOMOBILE LIABILITY COMBINED
_ ANV AUTO ( SINGLE liMll
(Ed i Dom) 4
ALL OWNED AUTOS BODILY INJURY
B X SCHEOULEDAUTOS Tv Pel eon)
HIRED X_ AUTOS
BODILY INJURYf
X NON OWNED AUTOS (Per eeeldeyv)
^^ FROPERTYDAM1NGE f
(Pet]CddaMI
OARADE LIABILITY AUTO ONLY EA ACCIDENT r
ANY AUTO
OTHER THAN Eq ACG i
AUTO ONLY. AGO S
EXCESSIUMBRPI.LALLIMMU Y EACHOCCURRENCE b
OCCUR u CLAMS MADE AGGREGATE i _
DEDUCTIBLE f
f f
VIOftNERS COMFENSATM)N —.___._—..._.....- ,. 14
,._
AND EMPLOYFRV LIABILITY YIN rORY LIMITS ER
gNYPROPRIMDFA EXCLUDED?
E.L.EACH ACCIDENT i
C OFFM.de"I NH) FXCLUDED7
(m,detal um E.L DISEASE-EA EMPLOYEE i P-ary
8 ED ALPRO PROVISIONS
1
OTHER OROV191ON9 bMow E.L.DISEASE-POLICY LIMIT i
OTHER
DESCRIPTION OF OPERATIONS I LOCAnON8 I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVIMNS _--- --
VIDENCE OF 2012 RENEWAL COVERAGES.
1
CERTIFICATE HOLDER CANCELLATION �J
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1HE EXFIHAIION
DATE THEREOF,The ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRIIIEN
NOTICE TO THECERTIRCATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 80$HALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGEN f6 OR
REPRESENTATIVES.
AUIHORUM REPRESENTATIVE
Sennott Ins. Agency
ACORD 25(2009101) 9)1989-2009 ACORD CORPORATION. All rights reserved.
The ACORD memo and logo ore registered marks of ACORD
12 U2,2up Len Gibely Contracting 9785319304 p.2
LEN GIBELY CONTRACTING Co, INC. ) Page No Pay;
23R Winter Street `L42O7 PROPOSA!
P�A800V, MASSACHUSETiS 01960
(978)531-8234 Fax(975)531-9304 F
anigme Improvement contractors and subcontractor
weew.lengibelycontracting.com ngacally exempt ed in home Improvement
registration by Prlovlaions c' cc
S�Onues on
er 142A of the general laws,must be registers:
TO: _. Laura Br.C.c�stei.n. _.. he Commonwealth of Massachusens. Inquiric
registration and status should be made to in.
or, Home Improvement Contract Registralicr.
-...._...44.-!1.6._W1nthr.Op...Stxee..C..__. shburton Place, Room 1301, Boston, MA 02101
_ ......___ P
727.5598. Owners who securetheir.. Salem _MA..... 01.9,70 !"7T1� uction related ermlts or deal with unregistere..ctors will be excluded from the Guaranty Fum
f ax '}g.-} � ion of VIGIL C.142A.
WTE REGISTMTANNP
617-686-
.qs o 5381 B OB 12 MA.REG. 100811
David Hindle 609-306-9526 'aB 1OCB1%OH
we lb«g sl.cmil speclseue 'a brb esemaNa br,grt b be pprlornbe q,a meieriVG w ea vae¢REAR MAIN ROOF;
Strip id f existing roofing up to 2 layers,
RE-nail sheathing where necessary.to'32 LF--of-'sheaYhin 1- Inspect roof sheathing, replace up gover'32-tF -is--arr extra-oP--$9-.-95-:LF-._..._. .__.. ....
Install 6 'ftr-'-of-ice-'& -water-zhi'e2'd-Over-so£17itS-1-3-ft:'around chimney base -
and around skylights. 15p felt paper to the rest of the roof.
Grind out & re lead chimney ------
Install standard soil- pipe- falshing-.. . _
Replace 1 ex
istl,n RV `
4 on right side.
Install- Cer tainTeed-Landmark-Arch-:--shingles---- ----------- .-
Re-use existing cap at roof peak -- - - -
- . ... . .... ...._ li,1800.00. . .... .Permit
FRONT MAIN ROOF:.
Strip off. existing. slate._roofing s.Install 6 ft ice and water over offits --
Install 3f.t...i.ce.._5..water.around.._Chi rtney. .base.
..._....
Clean 6 inspect chimney flashing. -"-- ---
> nstall._C pIrml, teed._Landmark_ehi<..gl.es....__,_.__ _
Canslrradkn elated permts:
Install ridge vent to -'-`"
. . -. Pea $2800.00 + i
--- permit
If A d B done together --
$7000.00 + permit
,99R2$$uldob-trash . .. _
Cml'�G15[wYl in t qOd d ,do Na malanel c I _.• .... . .. .- _. _ . .. _.. ... ... .
�r l-1F tat By Ne all" rdbw,g lira Ne np IN4 .
wb°nva an o acts mar Inn C Delay Gayaetl Ey cirymalonesa eryo d Cons eaters cool pie the 1 kb II C°GrOm�Dbl�od a�elna.Co srciw wrl l:pn rlq wc,x x'r
/Afl.3gNTV rr amadtl rep daly yaepp Dp e.i Olb treat prM dpaN au...Ol avdddlW by rre Gdlllrad pt yl°Pu'w wgldp«d oa
TM Conbnor wamm«pre Vn ltlno).lea own.'heron
We.d;uYemoma pr lase w°rY rumbrwd nlMUMer slmt pe eae bwm v.ebNna Y ek/a(raCnNnl.
AgomponL Yr tree Wnla dabq In go,Engnaalpqm�ybsbbpprpoOalO wgammy:lp beparlop of+:o%ear elm,xanp:ulpndpry lcp.rrclr,dvq eban uD.IN ComnGaq alWl.al.lb pnn oa 9 G4usedbll,b CMvnroa na 9q:mvac:orslgcelna comobltcn an°g'e..ennCry'r.
:u[Il daTapo o,eygl Je'A¢I in malarbb olNgbnar6rlp.Av bl Dmio.'oraxvq«mppr,«pey.p yd Wa ppa o Iafl p'.M°°enL,gtl.ot.m°J wil' ,aea'np ygnantlq ylep aurHw MY Ine{b[lim paelmrnpd F O]Mocll�prr w N Ina aywJn�pun�Zs>d•'.:pY1jO'or mcl pr.
We Prop OSe here Gy la furnish material and IatGr-camplele in acco once with abcve specifications,far tta sum ol:
Payr[am,to be made as(dkws:
Io�aS�7� a ea�r a°orathcott
—°=1f )upoi<omplelbnd r°ebD flaeaam
�%I$ )upon c°+,plElbnd 4lrailYlirii
—`.Is�_)wnae ma4e rorawim Wan Clb�eO14 mmn. ..
mmpleliln IX wox uMw Me conwn.
P emanl ba Mmo impmaemenl com«cuno wds shall require a down
paymem ladvame Oepaslll d more Iaen�ImrO of lea but WnIIGG[Willie.,tb N°mad soumn _ -
10«0l amopnt d all depaats c peyme0b rah bn 111e esrnlrall-mr,l a, ddempp,
da°ad/e mlbmbo pplan Ealiwry d spacial ardor mbarlWs Yn0 Gay.pmanl, S�pwrwo _
[ml: MIelClladp
\ga;Tl,<rrcpYal mart wiltp«wn ey yil dal Kcp'gU'xaM r
Acceptance of Proposal have read both sides of this document and accept the prices,specifications area Condit ores stated.I untlersWntl
that upon signing,this proposal becomes a binding conbect.You Ore alnhonald to do the work as speciCed. Payment tall be node as outlined e,stan
You,the Buyer,may cancel this transaction at any tithe prior to midnighl of the third business day afteabove
r the
date of, this Iran.Can IlatiOn must be done In writing.
.. N IG T IS CONTRACT IF/T�H�ERE ARE NY LANK PACES.
Oab / $bnrVa e'K-
o:Ia 0 �
IMPORTA NFO ION ON BA��
' A. t Massachusetts - Department of Public Safety
R
Board of Building Regulations and Standards
ru.0 ,u Sup,r:i.ur
License: CS-094763 rA
THOMAS IL Ofl&BINS r.
19 Cedar HBLDrive, i
Danvers MA-01973
r
Expiration
Commissioner 05/14/2014
--/I'YI1111 NP/I...... I/ [�n-//LAin('�/LPI�' _.
�. Office of Consumer Affairs& Business Regulation License or registration valid for individul use only
IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
�= a Registration: 100811 Type: Office of Consumer Affairs and Business Regulation
rExpiration: 6/23/2014 Private Corporation 10 Park Plaza-Suite 5170
ors' Boston, MA 02116
LEN GIBELY CONTRACTING CO., INC.
Brian Dobbins
23 R WINTER ST. Zi
PEABODY, MA 01960Undersecretary Nul validalure
1