Loading...
96 NORTH ST - BUILDING INSPECTION IO5 c-- r— The Commonwealth of Massachusetts t Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Appli . co Building Official(Print Name) Signature Date SECTION l: SITE INFORMATION i 1.1 ProperAddress: 1.2 Assessors Map&Parcel Numbers c% S 4 l,n I.1a is this an accepted street?yes no Map Number Parcel Number 1 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) I 1.5 Building Setbacks(ft) rFront 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 wnrerr''of Rec rd:ICG 1 `��� ,�,� m A c x mi) Name(PrinN City,State,ZIP 46 1�L4 �— 918-4N3-691() ocl :fer:r��.0 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ 1 Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ,k Specify: -Q04.,� Brief Description of Proposed Work': 4 r., 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 s ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing S 2. Other Fees: $ 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Total All Fees: $ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ g�l 3 3 ❑Paid in Full ❑ Outstanding Balance Due: (YS7> 2.1 t-1 L SECTION 5: CONSTRUCTION SERVICES y 5.1 Construction Supervisor License(CSL) C4_07,�49S License Number Expiration Date Name of CS0 Holder �� 0 mb2 S�� List CSL Type(see below) No. and Street Type Description 9 U Unrestricted(Buildings up to 35,000 cu. ft.) b4 (XQYZ R Restricted 1&2 Family Dwelling City/Town,Stat ,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances O 6� aOK��v-HCC�V+ ��f c�C�-fowv I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 9/O/ ` / p J V l L— {{77 r r (6 O b � D 1� rQy�) C,e �0 J"ceS I I HIC Registration Number Expiration Date HIC Company Name or IHIC R HIC Na eSu,� No.an Street �0 Email address IJ Br, r� r,)o )S 9�fZ-99� NASI Cit /To ,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 ...........X. 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 I,C. ` 1/Jf,:4 �rOh(-[.5 t Lu. to act on my behalf,in all matters relative to work authorized by this building permit a plication. n/ICLM IA )QQ CC�C'Iz 12i�/ is Print Ownbc�ame(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 contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner' br Authorized Agent's Name(Electronic Signature) DatT e 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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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"may be substituted for"Total Project Cost" 7 Betterbuilt Construction Estimate E�RULTE 100 Cummings Center - - --- Suite 226 G - Beverly,MA 01915 t 19/23/2015 + EL 811 Phone# (978)998-4751 infb@betterbuiltcorp.com Fax# (978)998-4861 wow.Betterbuiltcorp.com Customer Name /Info Project Adress j Mary Woodcock /'G LA fe4l C.{-(A L (l:G%.iJZ- E 96 North Street 96 North StreetSalem,MA 01970 I Salem,MA 01470 2� N�e:t1 e..�; v fq\ USA USA y I i f i i 30%Deposit-40%-30%1 Roof Replacement i 801 -Roof StH... !Strip existing roof on entire house 0.001 0.00 1802-inspect D... j Inspect decking for any rotten or damaged areas(we allow 32SF @ no charge) 0.00 0.00 803- Replace/... (Replace any additional rotted or broken roofing boards at a cost of$4.00/1-F for ledger board 1 0.00! 0.00 and$70.00/sheet for 1/2"plywood i 804- Ice&Water Install six feet of ice&water on all leading edges, valleys&transitions 1 0.00 0.00 j 805-Low SlopeIlli Alt low slope roofs will be covered completely with ice£t water 0.00 0.06 806- 15 pound... `Install synthetic undertayment to cover the rest of the roof 0.00 0.00 :806-Drip Edge Install an 8-inch drip edge on alt eave and rake edges.Color:Brown 0.00 O.QO 809-Vent Pilo... Install new vent pipe flanges 0.001 0.00 810-Chimney... Install new lead flashing around one chimney 0-�j 0- i i 813 -HD Timb--. j Install new GAF HD Timberline Architectural shingles,fastened by nails(six nails per shingle- 4 0.00! 0.00 i hurricane nailing) ( 1 814-Shingle C. Home owner to choose color of shingles. Color: Charcoal 0.00 i 0.00 951 -Cover Be... V Homeowner will cover all belongings in attic to protect from debris, BetterBuilt is not I 0.001 0.00 responsible for any damage k 952•Cracks We are not responsible for any of the cracks that may arise in any waits or ceilings o.cot 0.06 1953 -Dumpster j Dumpster will be placed 1n the parking tot behind the house I 0.001 0.00 1954-Timety M... I All work will be done in a professional and tirnely manner f 0-00 i 0.00 I 1955-No Interr... i Job will be started and completed without any interruptions 0.00 0.00 956-Clean BetterBuitt vdll clean jobsite at the end of each day 0.00 om j !957-Debris BetterBuitt will dispose of all job related debris 0.00 0.00 958- Permit I Our price includes the cost of the building permit obtained at the Salem Building Department 0.00 0.00 t 1959-Payment... Payment ternu: 30%deposit, 30%work in progress and 40%due upon completion 0.00 0.00 1 960-Warranty Warranty: BetterBuilt Enterprises LLC Guarantees all work performed for a period of two years.' 0.001 0.00 i If arty problems with workmanship occur we will cover the cost of all tabor and materials to { I correct the problem and meet the customer's satisfaction. MA License#160616 1961 -Addition... Additional carpentry wiill be bitted at an hourly rate of$65/hr plus any necessary material 0.00! 0.00 1 950-ESTIMAT... ,Customer has three business days to cancel contract and receive a full refund 1 0.001 0.00 1800-ESTIMAT... (Total cost for all:tabor,Materials,Trash Removal,and Permit to complete job. 1 I 14,831.331 14,831.33 i 1 �I � l _. -------_i TOt'al RI4,831.33 1 Thank you for the opportunity and please call us with any questions Acceptance Signature I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �yI Please Print Le ibl Name (Business/Organization/Individual): //�'� Address: DO � � wt , .t � S ( e. r St3; L 2z6 C City/State/Zip: 1,e MA (S k S Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.a1 am a employer with 3 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. '* 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.aRoo£repairs insurance required.] t employees. [No workers' 13.El 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1l �y / Insurance Company Name: ��,/GI<pp.TpoS F� �wt"t to Policy# or Self-ins. Lic.#: ODO�p 0353 Expiration Date: f 2 Job Site Address: 96 J0(4 3L - City/State/Zip: TAA A 61946 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. I do hereby certify under the s and a 'e rjury that the information provided above is true and correct. Signature: q p Date: Phone 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#: r ® DATE(WIDDIYYYY) AU& CERTIFICATE OF LIABILITY INSURANCE 4i29i1s 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), AUfHORZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: 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 endorsement(s). PRODUCER CONTACT NAME: Carmen Cocca Cocca Insurance Associates Inc PHONE (781) 245-0666 1 FA% No: (181) 246-3926 dba Water Street Insurance Age Ef AIL ADDRESS: carmen@getinsurancehere.com 27 Water Street INSURE SAFFORDING COVERAGE NAICp Wakefield, MA 01880 1NMJRER A:Essex INSURED INSURERB:Travelers Indemnity Betterbuilt Enterprises LLC NsuRERc:Evanston 100 Cummings Ctr Ste 226-G INSURERD:Arbella Protection Beverly, MA 01915 INSURERE: NSURER F: 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 POLICY 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 OFSUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AWL SUER - POLICY EFF POUCY EYP LTR TYPE OF INSURANCE INSR WV0 POLICY NUMBER MMM f.4MwYYYY LIMITS A GENERALLIABIUW 3DX4274 1/11/15 1/11/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENE RAL LIABILITY PJiEMISES_(Easgw u' e)_ $ 50r000 CIAIMShMADE OCCUR MEDE%P(A,yoreprim) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPUES PER PRODUCTS-OOMP/OP AGG $ 2,000,000 X POLICY F-1 PROT LOC $ MBINED SINGLE LIMIT D AUTOMOBILE LIABILITY 1020038039 2/3/15 2/3/16 COaacciderrt $ 1,000,000 ANYAUTO BODILY INJURY(Per Perean) $ ALLOWNED X SCHEDULED BODILY INJURY(Per acddenp $ AUTOS NONAUTOWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS eramident $ CUh�RELLALIAs X OCCUR XONJ451415 1/11/15 1/11/16 EACH OCCURRENCE $ 1,000,000 x C = LIAR CLAIMS-MADE AGGREGATE $ S,000,OOO DED RETENTION$ $ B WORKERS COMPENSATION 000768353 4/28/15 4/28/16 We sTATu- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORPARTNER/EXECUTNE YIN N/A EL EACHACODENT is 1,000,000 (Mandatory in NHOFFICERVR EXCLIAED? ) E.L.DISEASE-EA EMPLOYED $ 1,000,000 fps,describe under DESCRIPTION OFOPERATIONSbelow E.L.DIS EASE-POLIOYLIMIT $ 1,000,000 DESCRIPTIONOF OPERATIONS I LOCATIONS/VEHICLES (A ch ACORD101,AdditionalRenedce Schedule,ifmomspmisregire ) The Workers Compensation policy does not provide coverage for DENNIS DROGGITIS & EVANGELOS LIAPIS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN "FOR BIDDING PURPOSES ONLY" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Carmen Cocca ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: r t Office ofConsumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR 4 ` 1 egistrati n:7 :6 16.6«.., Type, I �� kf xpir'ation �t?9 `�' Ltd Liability Cofpo.- E d :a:. � p`.. ., ' 'ABETTER BUILT ENTERPR1L ' a A EVANGELOS LIAPI 100 CUMMINGS CENTER,SUl +,r i,. - 9NERLY,MA.61915 ' Undersecretary Massachusetts-Department of Public Solely 1) Boast!of Building Regulations and Statldards Canstroctiam Sbneivtsas ' License: CS4384795 EVANGELOS UAJ S 12 STONE ME11T DAtMRS MA Ilt rY r b� t %2. 101- fob-iv Fte'a E*pifzfion Conrntssloner 0511912017.. {