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20 RAYMOND RD - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards F t IAF OR Massachusetts State Building Code, 780 CMR 15P,?LITY �' 101//,, Building Permit Application To Construct, Repair, Renovate Or D'eIT141 8 ( Re t7 iced Mar 2011 6�' + One- or Two-Fancily Dwelling >r 4 n n This Section For Officia se Only JQ Building Permit Number: _ Date Z q Building Official(Print Name) Signature g Date n SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers ^ 1.1a Is this an accepted street?yes_ no Map Number Parcel Number V \I 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lon 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.40.454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: "Lone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Awnerl of Record: AeA Namc(Print) y� ,.� Cit ,Stntc,LIP - No.and street, telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Buildin Owner-Occupied Repairs(s) ❑ 1 Alteration(s) Cl I Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units_ Other ❑ Spucil'y:__ Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) ea 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/'Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $_ 4. Mechanical (HVAC) $ 5.Mechanical (Fire $Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6, Total Project Cosi: $ u/�o 0 Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number --- Expiration Date Name ofCSL Holder/ List CSI.'I'ypc(sec below) X P fin tit jk1 Wo and Stwet MM Description i stricied(Buildm s u to 35,oUU cu. li.) ( j 2 - Pmnil U Cny/Town.State.LII' f -� icted 18t2 Y wcllinp nn Coverinow and Siding1Puel Burning Appliances— tionTele hone - Email address -_--- lition 5.2 Registered Horne Improvement Contactor(Inc) /, A.f� l /tNr.s k00�'!�Jf f IiIC Registmtiun Nunlbar Ex iration Date HIC Company Name or HIC Regis -mit Name �t p 3 u �— No.and Site ------ ._._ L2 0 �— A.17 X' /� 6 Ennuil:address Cit /Town, State,ZIP Telephone SEC'T'ION 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 Issuan,e-of the building peirnit. Signed Affidavit Attached? Yes ......... CT 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.g j �, k/t� L L9 Q�Lt✓., to act on ury behalf,in all unmers relative to work authorizer) by this building permit application. Prua Owner's Name(Electronic Signature)/ - Da11 SECI'ION 7b:OWNEIV OR AUTHORIZED AGENT DECLARATION By ei ;ingnrn nan below, Ihere.by attest under the pains and penalties o'Fpcl:i in that all of the ill formation -co noted in this app Ication is true and accurate to the best of my knnwledgc and understanding. P int Owner's ur Aullnori'ted Agent's Naos(lilectrunic Siguauu'c) 31, _-_--- _ NOTES: _ 1. An Owner who obtains it building permit to do his/her own work,or an owner who hires an unregistered contractor plot registered in.the]ionic Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty find under M.G.L. c. 142A.Other important inlbrmatiou un the HIC Prognini call be found at www mass nov/ool Information on the Consu'uctiun Supervisor License can be Found at vyww.nans.uov/dos. 2. When substantial work is planned,provide the informatiou below: -- Total floor arca(sit.ft.) (including gruagc, finished baseunent/attics, decks ur porch) Gross living area(sq.(t.)_--__ Habitable Town count -.—_-- Number of fireplaces Numbei o I'bedrooms Number of baduvoms __ Number ofhal0baths ------_-_--- Type of heating system —____ __._ Number of decks/porches Type of cooling system.--.__,._._._.-_-- Glcloscd Open -- 3. ""Total Project Syuarc i--uotage"may be substituted lilt"'Total Project Cost" -- ---- Proposal AB Carnes Roofing,Inc. 30 Arrowhead farm Rd Page 1 of t Boxford,Ms.01921 978.887.1431 MA.CS000230 and HIC Reg.176928 Proposal Submitted To: DEBORAH BAYLE Date November 2,2015 20 RAYMOND RD ProjectName SAME SALEM,MA 01970 Address 415-261-7371 We propose to furnish material and later-in accordance with the specifications below: Eighty Seven Hundred Forty Dollars($8,740.00) Payment to be made as follows:$300.00 Deposit,Balance Upon Completion', Nolica:All Mme Improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exemptfmm registration by pmvslons of Chapter 1471 M the General Laws,must be registered with the Commommalth of Massachusetts.Inquiries about registration and status should M made to the Mass.limAicenses website. ROOF PROPOSAL ® STRIP ROOF OF UP TO TWO.LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH THE UPGRADED RHINOROOF TITANIUM U20 HIGH PERFORMANCE SYNTHETIC UNDERLAYMENT MEMBRANE.COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. ® ICE DAM PROTECTION:INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVER ALL HEATED AREAS MCF991 WIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEY(S)AND SKYLIGHT CURBS WITH ICE AND WATER BARRIER. ® COVERALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. ® INSTALL GAF COBRA RIDGEVEKTAND/OR❑ ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ® COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. ® REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF$25.00PLFT.WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK AND YOU MAY NEED TO HAVE A CARPENTER REINSTALL OR REPLACE THE SIDING THAT WAS REMOVED. Z CHIMNEYFLASHING CUT ALL EXISTING TAR AND LEAD FROM ONE CHIMNEY(S).CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS. PROPERLY L INT. PLEASE ADD$450.00 TO ABOVE PRICE. ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK 24 BLIFET RRANTYSHINGLES. ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH 1X8 SP EBO AT AN ADDITIONAL COST OF$4.50PLFT. ❑ COVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF ® NAILING:SECURE SHINGLES WITH EIGHT IN TOTAL COATED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS. ❑ SKYLIGIl REPLACE EXISTING SKYLIGHTS WITH NEW VELUX OR WASCO UNITS.WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.OUR LABOR CHARGE IS$75.00 EACH IF THEY ARE THE SAME SIZE.INTERIOR WORK IS EXCLUDED. ❑ REMOVE EXISTING GUTTERS []INSTALL NEW SEAMLESS.032 ALUMINUM GUTTERS USING THE HIDDEN ZIP SCREW HANGER SYSTEM. ❑ REPLACE DEFECTIVE TRIM BOARDS WITH CUSTOMERS APPROVAL USING NO.2 PRIMED PINE,ADD$15.00PLFT TO THE ABOVE PROPOSAL. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY FASTEN ALL CONNECTIONS. _ CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA. THE PROPERTY OWNER AUTHORIZES AS CARNES ROOFING TO OBTAIN ALL PERMITS.WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE.HOWEVER,SOME MARRING AND OR MINOR DAMAGE COULD OCCUR. IN ADDITION,WE CANNOT BE RESPONSIBLE FOR ITEMS FALLING FROM WALLS,SHELVES OR CEILINGS DURING THE ROOFING PROCESS. SPECIAL INSTRUCTIONS: ff THE ABOVE PROPOSAL INCLUDES THE HOUSE AND GARAGE �,CVVTT >lCO1hGt- D SHINGLE UPGRADE:UPGRADE TO THE LANDMARK 300LB HIGH DEF PREMIUM SHINGLES,ADD$1108.00 YES.&16 IS OUR EXACT COST REAR LOW SLOPED ROOF:THIS WILL BE PREPARED AS PROPOSED ABOVE AND COVERED WITH A CERTAINTEED TWO PLY FLINTLASTIC ROOF SYSTEM. WARRANTY UPGRADE:TPE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WIT h U E TO THE CERTAINTEED HIGH PE ORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.Y S EMAIL ADDRESS: -eIP ,COvtj Warranty:All work warranted against installation defects for 5 years;this warranty is limited to the Installed dam(s)and its repair only.Material is warranted by the manufacturer against defects for 50 years;see the manufacturers warranty for exact warranty performance. Cancellation:Customer has legal right under federal law to cancel this contract without penalty or obligation within three business days from the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side. Dispute Resolution under Massachusetts Home Improvement Law 142a:All parties agree that any and all disputes relating to this proposal shall be settled by arbitration.This forum is user friendly and does not require lawyers.Please see reverse side. Signing this Proposal mean ,you have accepted all the tens as stated on the front and back of this agreement. Please see reverse side. *Date of Acc:aptanc Signature *Signatur Signature PLEASE SEE REVERSE SIDE Massachusetts Department of Public Safety IQ Board of Building Regulations and Standards License: CS-000230 Construction Supervisor 1 BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD MA 01921 r�/IL,.n' 1�..— Expiration: Commissioner 03/0712018 ��Pi �Q�J�9/J99iQ//9iG.UP�LY/�✓�I' ��_�%� � (/.�G�" Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176928 Type: Corporation •Expiration: 10/10/2017 Trp 269957 AB CARNES ROOFING, INC. BARRY CARNES 30 ARROWHEAD FARM RD BOXFORD, MA 01921 Update Address and return card.Mark reason for change. Scni q tom-osm _J Address I-I Renewal Employment 7i Lost Card CITY OF SALEM WASTE AFFIDAVIT As a result of the provisions of MGL Ch.40-s54, I acknowledge that as a condition of building permit# all debris resulting from the construction activity governed by this building permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL Ch.111-s150A. Waste Disposal or Solid Waste Facility: ALLIED WASTE Address: 300 FOREST ST Town/City, State, Zip: PEABODY, MA 01960 NAME OF HAULER: AB CARNES ROOFING, INC. DUMP TRUCKS DATE: 9-16-2016 SIGNATURE OF APPLICANT: The Commonwealth of Massachusetts Department of Industrial Accidents' 1 Congress Street,Suite 100 Boston,MA 02114-2017 wwwmassgov/dia Wurkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le iglu Name(Business/OrganizadoNlndividual):AB CARNES ROOFING INC Address:30 ARROWHEAD FARM RD City/State/Zip:BOXFORD, MA 01921 Phone#:978-887-1431 Are you an employer?Check We appropriate box: Type of project(required): I. 0❑1ameempleyerwah Some employees(hllmd/orpart-tune(' 7. El New construction I am a rule proprietor or partnership and have no employees working for unr in '- 8. C] Remodeling any capacity.[No workers'camp,inswame required] 3.❑I inn a homeowner doing WI work nrysell:[No workers'wrap.insumime required.] 9. ❑Demolition 4.F1 I inn n homeowner and will be hiring contractorsto conduct all work on my property. 1 will 10❑ Building addition ensure that all conuamurs either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a genual contractor and 1 have In, the sub-contactors listed on die attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.FZ]Roof repairs 6.r—]We are a corImakdOn and its officers have exccised then highs 0fexemption per MCL c 14.❑Other 152,§I(4),and we have no employees.[No workers'comp,insurance required.) *Any apphcunt that checks box NI must also till out the section below showing Noir workers'compensation policy information. r Houa:awnus who submit Una affidavit indicating they are doing all work and then hire Outside con xuClola rmist submit a new affidavit indicating such, tConuu ors that check this box most attached an additional sheet allowing Ne(tame of die sub-Comrnelors and suite whetheror&lot those rattles have employees. lfthc sub-eontracmn lave employees,they must provide their workers'cowp,policy number. I am an employer that is providiab workers'compeuxatiott iusuruncejor my employees. Below is the policy and job site information. Insurance Company Name:TRAVELERS INDEMNITY CO OF AMERICA Policy k or ScIF iqs. Lic.k' """"-""36156-6-15 Gxpunt' ion Date:10115/2016 — t Job Site Address: i•—"—- J City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure Insecure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER mid a tine of up to.$250.00 a day against the violator.A copy ol'this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I rho herebF p n��l p/�{4Jldes of pc jury to///or the huffortuation provided above is..trite ani!correct. Si Ilmlll'C: !L_�] D}IIC: Phone#:9Officialwrite in this area,to be completed by city or town official.City m' PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing.Inspector b.Other Contact Person: Phone#: f` CERTIFICATE OF LIABILITY INSURANCE °AT9116/20 6""' 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 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: BRIAN L. PRESCOTT 8 SONS INS PHONE FAX AIC No: 963 EASTERN AVE E-MAIL ADDRESS: MALDEN,MA 02148 - INSURER(S)AFFORDING COVERAGE NAIC If INSURER A: INSURED AB CARNES ROOFING ININSURER B: Travelers IndemnityCompany of America C - 30 ARROWHEAD FARM RD INSURER C: BOXFORD,MA 01921 INSURER D: INSURER E INSURER 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 OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE D COMMERCIAL GENERAL LIABILITYrr'— PREMISESEd occurrence $ CLAIMS-MADE El OCCUR II� MED EXP(Any we person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY PRO LOC $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT El Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS NON-0WNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE J `� AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WSLI IT OTR AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNERIEXE TIVE YIN E.L. CII ACCIDENT $ OFFICEIMEMBER EXCLUDED? FN NIA 6HUS-OG361566-15 10/15/2015 10/15/2016 100,000 (Mandatory in NH) E.4DISFASE-EA EMPLOYE $ 100000 It yes.tlescdbeuntler E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space IS required) ROOFING CONTRACTOR CERTIFICATE OC6ER CANCELLATION DEBORAH BAYLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 RAYMOND RD ACCORDANCE WITH THE POLICY PROVISIONS. SALEM,MA 01970 AUTHORIZED REPRESENTATIVE Brian N.Leary,PRESCOTT 8 SONS INS ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD NOTICE zNOTICE TO u m TO w EMPLOYEES EMPLOYEES 'y �W y OqM S�6 The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-727-4900 — http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P .O. BOX 1450 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6HUB-OG36156-6-15) 10-15-15 TO 10-15-6 — POLICY NUMBER EFFECTIVE D�� PRESCOTT & SON INS 963 EASTERN AVE MALDEN MA 02148 N OF�I SS R�NT ADDRESS PHONE # �= AB CARNES ROOFING INC 30 ARROWHEAD FARM RD BOXFORD MA 01 921 I MPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out or and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services o provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 000849 W29P1G15 TO BE POSTED BY EMPLOYER