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6 SOUTHWICK ST - BUILDING INSPECTION 1 a The Commonwealth of Massachusetts T } Board of Building Regulations and Standards CITY Massachusetts State Building r Code, 780 CMR, 7"edition OF SALEM RevisedJanuary Building Permit Application'fu Construct, Repair, Renovate Or Demolish a 1., _ollN One-or Two-Family Dwelling '-� This Section For Official Use Only Building Permit mber: Date Applied: 11 Signature: /D lluildingCommission&nrt<pectorof Buildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers Ila Is this an accepted street'?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(R) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Require) Provided Required Provide) 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. caner cord: e /n ��( //1W/d/( A•' Print) epi dress for Service: T" /J/i(� 97 k - A35-590 R ignature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New ConstructionX I Existing Building Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition 41 Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': S . RJ vd leilel /41 IP a WK P A d o )el b Full ,s-A SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials I. Building S 1. Building Permit Fee:S Indicate how fie is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 7. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire S Su ression Total All Fees:S Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: S a a JQ ❑paid in Full ❑Outstanding Balance Due: a l had 4o SECTION 5: CONSTRUCTION SERVICES 5,1 Licensed �C/pnslructionnSupenisor(CSL) SW `/ �V �r)f CV V` License Numf+er I:.rpirution Date Nome S(-y I lulder c List CSL 1)pe(see below) I,� �lolad� u fl) Rcsidential Urscri tion A vesuictcJ a to 35000 C'0(n/ �� /�T estricted 18c2 Famil UwcllSignator ason alROniv esidential Rootin CoverinTelephone sidential Window and Sidinsidential Solid Fuel Bumin A liance Installation Demolition 5.2 Registered orae Improvetnetyt Contrrit tof(HIC) / S, 0,y L' I� , . 71 ti ✓h /d1l (t); , t -q Registration Number FITCCompany'Nass/,W or IIIC Rye�gi rant1ryjy��'me G. v1I,— AJ 1C)7 Expiration Date Signature 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 relafi to work uthorized by this building permi, application. 1 , Igwaturc of Owner Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION I Y? Ju ,as Owner or Authorized Agent hereby declare that the statements and information A the foregoing application are true and accurate,to the best of my knowledge and behalf. 1.✓ 'I l,�,�. F r✓1� I Print Namf, Signature ot'Owner or Authorized Agent Date _Signed under the pains and penalties ofperjury) 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(FIIC)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 and Construction Supervisor Licensing(CSL)can be found in 730 CMR Regulations 110.116 and 110.115,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage, finished basemcnUattics,decks or porch) Gross living area(Sq. Ft.) Ilabilable 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" J 4 CERTIFICATE OF LIABILITY INSURANCECATEfMN)ODIYYYYI 08/10110 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO(LIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY Of r NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIG)ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IIAPORTANTt If me caffiI(eate Komar m an ADDITILNIAL INSURED,the polky lon)must be andorsed. If SUBROGATION IS WAWn,aub)ectto the term and conditions of the polity,eonnin Polk es may Motum 00 endonwment A statemard on this cod)OWte does not confer Hgms to the ea onto hotdarIn lieu of such ssdersamant(sL_ PRODUCER con Derek Cataklo R.M.Cata)daInsurance AgeneyInc e q 289.x,288.301 ' 1 2WS289 230 Squire Road ae dere Ongffi-NddILBurance com Revere,MA 02151 PRODUCER � Phone (781)2895288 Fax (781;2895285 APRCRO}N4C8VaRA6E Am Lues INSURED Ix A: NationalGELNeMutual y SCAt L onwaaar PISURER I' - {' 13 LabhmC DIME MSURER C: Ipswich,MA 019381272 IMSIM P: COVERAGES CERTIFICA FE NUMBER: REVISION ERP REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUGIES OF INSUF ANCE 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,T IS INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.IECT TO ALL THE T PXS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIE:i.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS. TYPE OrIHEVRANDEAM P HU 8ER M t8 U4am GRNEMIJABILITY BA HaCCUIZItENCE s 1,000,060 6}i COMMERCIAL GENERAL Leta1frY5001000 ❑ [] CLAMS.MADE R OCCUR e fi eaecwrenee s A MPJOS80WL MED EXP mane RMV, V, 10,000 0711212010 07112!2011 g ❑ ,..,.._ PERSONA annvlxduRY .'=� 1006,000 ❑ NERALAGCREGATE 2,000,000 OEM AWREGATE LMITAPPLIES PER PRODl1CT'S-COMPIOP AGG S 21000,006 © POLDY ❑ £D- ❑ LA0 $ AUTOMOBILE LIA®WTY COMBNEDSNGLELMC $ (Eagmlderd) ❑ ANYAUTO SODRYaUURYjPapeteon) S E] ALLL 40WNE OWNED AUTDB .� Cl SL'NEWLEOW= BODILY IxlURY{Per acddw S LJ HIRBTI nerds PROPERTYUAMAGE a" . (Peraccident)d ry❑ NON-OMMAUTOS I S F LJ i g (f❑— DMaRELLA Wi{B [3 OCCUR LACK OCCURRENCE u MMEBSUAls 0 CLAN84VOE AGORBGAM a DEDUCTIBLE I g i WOMR a a ANDEMPa COMPENSAILIT 9DEA ANOERPLCYERa'uAmLITY y/ANY EPJMrE ARnWMXUCUTNE j ECC IENT. . S pFPIdaf" M B' NIAIMyyappnaa,dn x � E. 8 EA EMPLOYE $ OBSCRIP O OPERAfa7N ten 1 ) E,L D6EnsE'PoLICYLMIT a i aE8CF4M=NCPOPERAIIONS/LOCAMNS/VEHICLRS/p+rnn RGORO Let,AMBdomd Rm++Arke SeMdWa,Hmarospeeeie nequlnd) ;;°::>' :� CARPENTRY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES✓3E,CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL SEDELMED W ACCORDANCE WITH THE POLICY PROVISIONS. # . AUT11 o ®1588.2008 ACORD CORPORATION. All rights reserved. ACORD 25(2009!09)QF The ACORD name and logo aro registered marks of ACORD CITY OF S'UY.,%I, .NLvL-SS.A cHUSETTS BULMLNG DEPARTM LNT ' 130 WASHNGTON STREET, Y°FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KI.,%BF.RLEY DUSCOLL NfAYOR THo.+us ST.PtERRa DIRECTOR OF PUBLIC PROPERTY/BUMMNG 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 I l 1.5 Debris,and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defincd by MGL c I 11, S I50A. The debris will be transportcd by: C�»�t +4xk (nam of hauler) The debris will be disposed of in (name of facility) r n (address of facility) signature of perrWat applicant date dcbnrd(dR . 1: 4. � t CITY OF SALEM _L PUBLIC PROPRERTY DEPARTMENT ,11111:H:I Y:)Mls('It 1. 1g L^�WASHNG I U\S'iaEL•T • SA 1 E 41,MA'&\0 H it ru 0197 Te.l.: )7Vt3-9595 tr 1:\s. 9711-7(VI46 Yorkers' Compensation Insurance :affidavit: Builders/Contrac torsi Electricians/Flu mbers tipi)licant Information Please Print Lepibly amCtlknuksslOrgonirltinNlnJlvlduull: Address: I );? Le b Iisl-e 1 r•L City, Srareizip:ML)L,,"tC� /� Ionil: CZE—JSP "66 1 � :\n you an employer?Check the appropriate bot: 'Typo of project(required): 1.0 1 ;un a employer with 4. 0 I ann a 6encrai coutiactot and 1 h. . have hired the sub-contractors now construction unpluyccs(full and/or part-tinx). X2. I ;un a sole proprietor or partner- listed on the attached sheet. ; 7. VRemodeling ship and have no employees These subcontractors have S. krbernolirion working for me in any capacity. workers' comp. insurance. g. Building addition I no workers'comp. insurance 5. 0 We are a corporation and its officers haVl`exercised ihelr 10.0 Electrical repairs or additions required.) 3.0 1 oma homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself. Ino workers'comp. c. 152,j 1(4),and we have no 12.0 Roufrepairs insurance required.) t cmpluyccs. [No workers' 13.0 Other comp. insurance required.] *Airy:y)pbcaut amt chucks box ill mut alw till w3-ale wetwo Wow ihownla(heir workers compen>ation policy in6onudori. ' I lumeuwmn whu submil this atYldavit indivaimi;they are doing all work mol Ihen hire uutsida ewumatom must.uhmik a newairiidavit indic:aing arch. •('omrwiory amt check this box most mlxh(d do additional slxel showing Ito name of lho sub<rmtrutors and their wurkan'comp.policy information. /mn wr riupluyer that Lr pruvidine rvorkers'c•untpen.vutinn ivauruncr jar my entplopves. Belory is the policy mu!job site information. Insurance Company Vine: v I'nlicy M ur Sclf•ins. Lice//q: M (,.T0,5(06&( �. .._ .._ Expiralwn Date: ,,�U Job Sitc :\ddress: CO ,/COV I7 � (.✓!�/\ CilylSlate/Zip: f' ((kj h419 (Th1"7f Attuch it copy of Ilio workers' cmnpensetion policy declaration page(showing;the policy number and expiration date). Failure to secure coverage as required uodcr Section 25A ofNlGL c. 152 can lead to the imposition of criminal penalties of a tlnc up to sl.500.00 and/or one-year imprisonment,as well as civil pcnullics in the form of a STOP WORK ORDER and a fine of up to 5350.00 it Jay against lite violator. Be advised that a copy of this statement may be forwarded to the Office of I lks'�alhalo)n5 ul the DIA :br insurance c,)vcra.,,e%crllicanull. I do her cert under the poi is Bird Mitt�alyd e.r�o(/'�pe/rjnnnrry_that the infunnuNon providerd above is trite and correct. 111gpllla'd: UPI CJJ/I'�i-- DatC' `.' ^ .9-11 Official use drily. Do nor n•rite ill thiv arra, to be completed by city or town o/Jirial. Cit v or l'own: Permit/License 0_ Issuing;Aullwrily(circle one): I. Iloard of Ilcalth 'E. Building nepartnlenl 3. t:itvi form Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other CauWel I'cnau: Phoale 1: Information and Instructions .Massachusetts General Laws chapter 152 requires ani employers to provide workers' compensation for their employees. Pursuant to this sutue,in empluree is defined as"...every person in the service of another under any contract of hire. -evpress Or implied. Oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more ,d the t0regoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of m individual,partnership,associauoa or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,cunstruction or repair work on such dwelling house or on the erountbc or building appurtenant thereto shall not because of such employment be deemed to be an employer." .%IGL chapter 152, @25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, NIGL chapter 152, a25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." .applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP docs have employees,a policy is required. Be advised that this of davit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The atf idavit should he renamed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the.low or if you are required to obtain a workers' compensation policy,please call the Department at die number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be Sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be.sure to till in the pennittlicense nunber which will be used as a reference number. In addition,an applicant that must submit multiple pennit/liceasc applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. it dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. I lic office of Investigatiomi would like to drank you in advance fur your cooperation and should you ham'c any questions, please do nut hesitate to give us a call. The Dcparunent's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents OIHce of Investigations 600 Washington Street Boston, MA 02111 Tel. k 617-7274900 ext 406 or 1-877-MASSAFE Fax p 617-727-7749 Rl,:i�cd 5-26-05 www.mass.gov/dia h Contractor Agreement ...................................................................... ...... ............................................................................................... . ........................... THIS AGREEMENT made 22 day of January, 2011, by and between William Mudey, hereinafter called the Contractor and James &Stacy Picone hereinafter called the Owner. Witnesseth that the Contractor and the Owner for the consideration names as follows: Contractor : William Murley 13 Pleasant Street Salem Ma 01970 978-210-6207 Owner : James & Stacy Picone 6 Southwick Street Salem Ma 01970 978-594-5637 r _ w.n i.socrmes.cam Page 1 of 3 854304-23D•Rw.05/04 Article 1. Scope of the Work The Contractor shall furnish all of the materials and perform all of the work shown on the Drawings and/or described in the Specifications entitled Exhibit A, as annexed hereto as it pertains to work to be performed on property at 6 Southwick Street Salem Ma 01970. Article 2. Time of Completion The work to be performed under this Contract shall be commenced on or before February 1, 2011, and shall be substantially completed on or before June 1, 2011. Time is of the essence. The following constitutes substantial commencement of work pursuant to this proposal and contract . framing, siding, plaster work both plumbing and wirering work. Article 3. The Contract Price The Owner shall pay the Contractor for the material and labor to be performed under the Contract the sum of Dollars ($22,500.00), subject to additions and deductions pursuant to authorized change order. Article 4. Progress Payments Payments of the Contract Price shall be paid in the manner following: payment one $7500.00 to start work .second payment 7500.00 after ruff inspections are complete. third payment, 3750.00 when walls and ceiling are plastered and primed , fourth payment 3750.00 when permits are signed off. Article 5. General Provisions Any alteration or deviation from the above specifications, including but not limited to any such alterations of deviation involving additional material and/or labor costs, will be executed only upon written order for same, signed by Owner and Contractor, and if there is any charge for such alteration or deviation, the additional charge will be added to the contract price of this contract. If payment is not made when due, Contractor may suspend work on the job until such time as all payments due have been made. A failure to make payments for a period in excess of 7 days from the due date of the payment shall be deemed a material breach of this contract. In addition, the following general provisions apply: 1. All work shall be completed in a workmanlike manner and in compliance with all building codes and other applicable laws. 2. The Contractor shall furnish a plan and scale drawing showing the shape, size dimensions, and construction and equipment specifications for home improvements, a description of the work to be done, a description of materials to be used and the equipment to be used or installed, and the agreed consideration for the work. 3. To the extent required by law, all work shall be performed by individuals duly licensed and authorized by law to perform said work. 4. Contractor may at its discretion engage subcontractors to perform work hereunder, provided Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this contract. 5. Contractor shall furnish Owner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 6. All change orders shall be in writing and signed both by Owner and Contractor, and shall be incorporated in, and become part of the contract. 7. Contractor shall, at owner's expense, obtain all permits necessary for the work to be performed. 8. Contractor agrees to remove all debris and leave the premises in broom clean condition. w.w+.socrz .Wm Page 2 of 3 554301-230-Rev.05/04 9. In the event Owner shall fail to pay any periodic or installment payment(s) due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 10.All disputes hereunder shall be resolved by binding arbitration in accordance with rules of the American Arbitration Association. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials. 12. Contractor warrants all work for a period of 12 months following completion. Article 6. Additional Terms Name and Registration No. of any Salesperson who solicited or negotiated this contract: Signed this a3 day of"�), , 20 1( Signed in the presence of: Witness Witness Name of Owner: By (Signature): 11 Name of Contractor: By (Signature): Street Address: City/State/Zip: o I S --)o Telephone No.: 7 210- Lo Contractor's Licenser No.: Page 3 of 3 SS4301-230•Rev 05/04 ---—-------------------——----------—------ '7y--- Voi 3306 Naa :DAVI L,FRANK ripe, Cin morrca�o!P�assadn�fs. 14;C a'Ores June i7,2014 �] .. -- - - -------- __ _ -- - ---- - - - ___ r 1