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7 TEDESCO POND PLACE BPA-16-1000 DRS/WIND f 2� ct< 3b3s� .4 The Commonwealth of Massachusetts X11? Board of Building Regulations and Standards L Massachusetts State Building Code,780 CMR 1 SeALEM Building Permit Application To Construct,Repair,Renovate Or Demolish a R xr�ad 2 bl 12: 2 One-or Two-Family Dwelling D 1 U 7�s,S,act$oa For Official:Llse tan " 14 Building Permit l lumber. Date App] 'lhnlding OtT,r4ial fP�'a+t Name) .Signaivre -' Date �} SECTION 1:SITE INFORM 4TDFIN ' lfAd . R} 1.2 Assessors Map&Parcel Numbers 12 I Lla Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: lA Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Iteq�dj 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❑ Zane: Outside Flood Zone? Municipal Q On site disposal system ❑ Check if yes❑ SECTION 2 PR4IP1rI3TY PWNERSIW " z.R?I r efg`tr at, rrzr �suo faWtQ lid. ja_[e _wnerl Dt 70 N (�Pn,',nt�)A ry city,state,ZIP e TIWY 25'Cn d'"CA40J eA No.and Street Telephone Email Address SECTION 3:DESCMPTION OF PROPOSED WORKS(e6'eck alt that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) A I Alteration(s) ❑ Addition Q Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: B 'on of Proposed Work': n : SECTION 4:ESTMATED CONSMUCTION COSTS Item Estimated Costs: O#Ttcial Use Only Labo and Materials 1.Building $ L Building Permit PIN-.$ Indicate horn fee is determined: 2.Electrical ❑Standard Chyfrown Application Fee O Total Project Gose(Juan 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List; J fj 5.Mechanical (Fire S $ Total All Fees;$ ression 6.Total Project Cost: $ Check No. Cheek Amount: Cash Amount: le 0� ❑Paid in Full ❑Outstanding Balance Bum: 'Mcu C cervi 0V t 3 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) � q7 7 Lt'..6A.l _ _ License Number Eipiradon Date r Name of CSL Holder 4go ()�M t�t - � LiCSL Type(see below) No.and Street T� Type Deseription - V. r n O Unrestricted 'din u in 000 cu.ft. b�'l�'T h) '7 R Restricted l&2Femi1 Dwelling City ,State,ZIP M Masomy RC Roofm Coverin WS Window and Siding SF Solid Fuel Burning Appliances 7 � I Insulation Telephone a Email addr D Demolition 5.2.Re ered Home Im rovement Contractor(MC) 101 3 1(7q ,a � d )SSeil- HIC s ' Registration' An Date HI Compmy ame r HIC R stran N e q 1 ^ 5 4A Jn 155Pu/ravrEY�cfluc] {Qlgytl/ N and Street np S7 2 //3 0 � J Email addrmJ Ci own State t(7 Telephone( (D V SECTION 6;WORKER S4 COINPENSATION INSURANCE AFFIDAVIT(ALG.L: G 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 QWNER'SAGENT OR CONTRACTOR FOR B. NG PERMIT I,as Owner of the subject property,hereby authorize LQI aJ M t 6 p�;3— to act on my behalf,in all matters relative to work authorized by this building permit applicatin. Print Owner's Name(Electronic Signature) Date SECTION 7bt OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains 30penalties of perjury that all of the information contained in this application is true and accurate to o@dge and_understanding. ,MMM ge e-(ow Print Owner's or Authorized Agent's N (Electronic Signature) to NOTES: '. 1. 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 IRC Program can be found at www.mass.sov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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" Massachusetts Department of Public Safety - Board of Building Regulations and Standards License: CS-032197 rConst Gaon LELAND HUSSEY: - 490500 WASHINGTON 5T LYNN MA 01901- - Expiration: Commissioner 10116/2017 - Sm cs�F. ,:Y/" YLP/:rot o u.rvu�/�. Office of Consumer Affairs&Business Regulation Y ( HOME IMPROVEMENT CONTRACTOR Registration--. 101743 T K ype: ., � = Expiration: -•,6/29/2018 DBA LELAND M.HUSSEY CONTRACTOR i Leland Hussey 490-500 WASHINGTON ST ,k LYNN.MA 01901 Undersecretary ® CERTIFICATE 4/255/ ATE ®F LIABILITY INSURANCE oATE(m2 4 16 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 RETWEEN THE ISSUING INSURERIS). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(i es) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies Trey require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such erxlorsement(s). PRODUCER NAME AMAZONia Insurance Agency Inc. PHONE 617 625-1900 FWr AX No: (617) 666-0037 66 Bow Street Eh AIL ADDRESS: Somerville, MA 02143 INSURER(S) AFFORDING COVERAGE NAIC0 INWRERA:COmmerce Insurance MURED ItsuRERB:AIM Mutual Insurance Co CREATIVE HOME IMPROVEMENT INsuRER c: EMERSON R DACRUZ INSURER D: 12 TIMOTHY AVE INSURER E: EVERETT, ISA 02149 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 OFSUCH POLICIES.LIMrTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ACD SUER POLICY EFF P CY E%P LIMITS LTR WPEOFINSURANCE I S WVO POUCYNUNBER MMM NM(DWYYYY A GENBtALLIABILDY BDWDXT 2/20/16 2/20/17 EACHS 1 000 000 DAMAGE TO FIRMED 5 100,000 X COMMERCIALGE1,ERALLIABIUTY CUlW5dtA0E ❑X OCCUR 1 MEDEXP(An ..pwr s 5 000 iPERSONAL&AOVINJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEMLAGGRr7 LIMIT APPUESPER PRODUCTS-COMPIOP AGG 5 2 OOO OO X POLICY FO_ LOG S AUTOMOBILE LIABILITY (Eaaccideel))NG ELIM S ANYAU 0 BODILY INJURY(Per person) S AOWt.EO SCHEDULED eODILY INJURY(P.,aeddent) $ AUTOS AUTOS NON-0WNEO PROPERTY DM1AGE 5 HIREDAUTOS _AUTOS eramaent 5 UNBIEUALIAB OCCUR ( EACHOCCURRENCE S EXCESS UA6 CLAIMS-MADE AGGREGATE 5 DED RETENTIONS s B WORKERS COMPENSATION IVWCIOOGO184642016 4/5/16 4/5/17 g WC STATI} OTH- MDEMPLOYERTLIKEILITY YIN ANYPROPRIEI)RIPARTNER/EXECUT� NIA E.L.EACH ACO DEM 5 _90DOOO OMCERIMEMBER EXCLLI)ED? (MaMaroryin NH) E.L.DISEASE-EA EMPLOYEE 5 500,DOD If RIPTIOe e) antler EL DISEASE-POUCYLIMIT I B 500,000 DESCON CF OPERATIONS CeIow DESCRIPTIONOFOPERATIONSIWMTIONSIVEHICLES (AVach ACORD1111,Addhicml Rema Schedule,Ifmane.para is required) LELAND HUSSEY CONTRACTING IS LISTED AS ADDITIONAL INSURED ON THE GENERAL LIABILITY POLICY Email : build@marblehead.org Husseycontractinq@Vahoo_eom CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LELAND HUSSEY CONTRACTING ACCORDANCE WITH THE POLICY PROVISIONS. 490 WASHINGTON ST LYNN, MA 01901 AUTHORED REPRESENTArnE AMAZONJA INSURANCE AGENCY ©1988-2010ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: CERTIFICATE OF LIABILITY INSURANCE � 5118 16 THS 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: H 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). tomo, PROOUC92 NAME: Benevento Insurance Agency Inc PiONE (781 599-3411 PAx N : (781) 581-7200 497 Humphrey Street ADDRESS, Swampscott, MA 01907 INSUTE S AFFORDING COVERAGE NAICN INSURERA:Colony IRS Co INSURE] INSURER B: Leland M Hussey INSURERC: Hussey Contracting INSURED: 490 Washington St. INSUKM E: Lynn, NA 01901-1218 INSURa1F: 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 ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 TR A. GAML 9UBR - '_ _._ POLICY EFF POLICY EXP LIMT$ TYPE OF INSURANCE POLICY NUMBER MIDON MMIDD'YYYY ENERALUMIL" 103GLOO13037 3/2/15 3/2/17 EACH OCCURRENCE s 11000,000 DAMAGE TO RENTED $ 5O OOO X COMAERCIALGENERALLIABIUTY CIANS401ADE rz OCCUR MED EXP(Aryore Pawn) $ 1,000 PERSONAL$ADVINURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMT APPUES PER PRODUCTS-WMPIOP AGG $ 21000,000 POLICY PRO. LDC $ IECT NEACHOCCUMENCE SINGLELIT AUTOMOBILE LIABILITY tt S ANYAUTO URY(Per Pelson) $ '- ALLOWRED SCHEDULED INJURY(Per xeident) $ AUTOS AUTOS DAMAGE NON-OWNED nt $ HIREDAUTOS —AUTOS UMBRELLA LIAR OCCUR URRENCE $ IXCESSLIAe CLAIMS-MADE TE $ OED RETENTIONS "IT $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOFLPARTNER/EXECUTNE NIA EL.EACH ACODENt $ OFFICE RIMEMBER EXCLlDED7 EL.DISEASE-EA EMPLOYE $ (Marrlaw,In NH) Ifyyeeas dmaribeuntler E.L.DISEASE-POLICY LIMIT $ DESCRIPDON OF OPERATIONS below DESCMMONOFOPERATIONSILOMTIONSIVEMCLES (AH ACOR0101,A(Mmonal Rerre ScheduN,NmareslewiamgLimd) General Contractor _ 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. AUTHORIZED REPRESENTATIVE Brvan Benevento © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: The Commonwealth of Massachusetts Department oflndustrfal Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass govhfia Workers' Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ,��JJ l'-- Please Print Legibly Business/Organization Name: ` Ltf04AA C1. 40511tV Address: 419 QAe, T8'� ,T# City/State/Zip: 1Me M t 01 Phone#: 7th t ST3 G G 3 0 Are you an employer?Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑Retail orpart-time).* 6. ❑RestaurantBar/Eating Establishment 2.59 I am a sole proprietor or partnership and have no y. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] S. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑ Manufacturing no employees. [No workers'comp.insurance required]' 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.0 Other *Any applicant that checks box 41 must also fill out the section below showing their workers compensation policy information. **If die corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box 91. I ant an employer that is providing workers'compensation insuraneefor my employees. Below is the policy information. Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lic.# Expiration Date: 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,u d pgyns'an enalties ofperjury that the information provided ab ve is�trla and correct. Si afore: P�r Date: 5 1Ib Phone#7 ��� Sq,5 6&So Oficial 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia ..tJ AZdagSdm. ey &Company 490 Washington St. Lynn,MA 01901 781 593 6630 This Agreement for Professional Services is entered into, by and between Leland M. Hussey Contracting hereafter called "LMH" or "Contractor" and the party(s) signing below, hereinafter called "Owner", governing work to be performed on the property and building located At: 7 Tedesco Pond Road, Salem, MA 01970 For: Alison Alden Or his/her/their representatives, hereafter called "Owner" LMH shall furnish all labor and materials to perform the work described in the following specifications and attached drawings, and incorporated by reference as part of this Contract and any Addendum attached hereto for the itemized amounts listed below: 1. Remove and replace existing patio door with Anderson 9'/ 3 panel in-swinging French door (no grills) Also repair damage to sill and re-attach existing deck. $8400.00 2. Remove and replace second floor casement window w/Arch window above with Anderson Vinyl clad casement and matching t/z round window. (no grills) $4600.00 3. Replace second floor double-hung window with Anderson replacement window of like size. (no grills) $1200.00 4. Remove basement casement window sash only and replace with Harvey solid vinyl replacement units. (no grills) $1350.00 Total $15,550.00 2) - Price does not include: a) Permit fees (building, dumpster, electrical, plumbing, etc). b) Port-a-San costs (approx. $130.00 monthly), if required. c) Dumpster cost @ $650 for 1/ 30 Yard unit d) Any other work requested by Owner or deemed structurally necessary. Page 1 of 5 HLeland M. ussey &Company 490 Washington St. Lynn,MA 01901 781 393 6630 3) - Other a Should the conditions at the worksite after demolition be found to be materially different from the conditions ordinarily encountered, the Contractor shall stop work and give immediate notice of the conditions to the Owner. b) Electrical allowance- None c) Owner understands and agrees that all communications concerning the job status,job changes, pricing, or any other job issues outlined in this Contract, will only be between the Owner and LMH (job superintendent or principals). d) LMH will not be held liable for any discussions or agreements made between Owner and any other parties including LMH subs or specialty contractors, suppliers or other workers. e) LMH will not be responsible for any bills, charges, debts, invoices or other encumbrances incurred in, on, or for this job by anyone other than LMH or its immediate authorized help. f) Owner shall be solely responsible to pay any and all subcontractors for work performed at Owner's direction without the written authority of LMH, and Owner shall indemnify, defend and hold LMH harmless from loss or liability which results from claims of any subcontractors or others arising from the performance of such work. g) If any other subcontractors hired by Owner have to work simultaneously with LMH, their schedule of work has to accommodate LMH's schedule and not the opposite. LMH will not be held liable for any delays caused by such subcontractors' schedule and/or their actual work or result of their work. h) Owner shall be responsible for any and all communications with tenants located in the building including resident, commercial and/ or government. Any clearances or written permission required for work to commence are to be procured by the Owner. 4) —Additional Work Orders (AWO) Page 2 of 5 I' HLeland M. ussey &Company 490 Washington St. Lynn,MA 01901 781 593 6630 a) Any other work requested or required to the completion of the job, not included in this contract, shall become an Additional Work Order (AWO) to be priced, written and signed prior to start of said additional work. In cases where a written consent can not be obtained in time, a verbal authorization given in person or through phone by the owner will be accepted and a written form will be procured as soon as possible. b) Unless noted differently, the labor within AWOs is to be calculated at the rate of$60.00 per man hour. c) Owner understands a design/estimating and coordination fee of$60.00 per hour will be incurred on the design, drafting and pricing of the change or additional work, whether the change is elected or not by the Owner. d) All AWO's have a minimum $60.00 fee for service. 5) —Materials and equipments provided by Owner a) Any item described in contract as "provided by Owner" that comes to be provided by LMH must be paid to LMH in full, with 20% surcharge. Payment is immediately due upon purchase of such item(s). b) A fee of$65.00 per trip will be charged to Owner, to any item picked by LMH. c) Owner is expected to have items available, in site, at the time indicated by LMH. LMH will not be responsible for any delay caused by missing items. 6) —Warranties and licenses a) All work warranted by LMH for 1 year, as per MA State Law, starting upon substantial completion of contract payment date. b) Any work done by any individuals or companies not hired by LMH will void any warranties given. C) Page 3 of 5 Rgd M. sey &Company 490 Washington St. Lynn,MA 01901 701 593 6630 Warranty contingent upon completion of contract by both parties (meaning all portions of Contract and AWOs are completed and paid in full). d) The warranties supplied by the manufacturers for items such as materials, appliances, fixtures, equipments, etc, that exceed 1 year, will not be handled by LMH free of charge, in the event these items need servicing (repair or replacement) after the 1 year warranty provided by LMH. The Owner understands that after the first year it's his/her job to procure and handle these services. e) MA Construction Supervisors License No. 032197 and MA Home Improvement Contractor Registration No. 101743 6)—Attached picture(s): 7) Price, payment schedule and signing This construction contract is entered into on the day of 12016 by LMH and the party(s) signing below(Owner). The above specifications, conditions and addendums are satisfactory and are hereby accepted. LMH is authorized to purchase materials and proceed with this job as specified in the proposal. LMH shall furnish all labor and materials to do the work described in the above specifications and Owner agrees to pay LMH as follows: Upon signing: $5550.00 Upon start of work: $3000.00 Upon installation of patio door $5000.00 Upon installation of arched window unit $1000.00 Upon completion of contract $1000.00 Total Contract Price (payments not necessarily shown in the correct chronological order of start/conclusion of the tasks). ATTENTION: LMH will do only that work which is written in the above specifications for the above agreed amount. The terms and conditions as stated are part of this Contract. Page 4 of 5 RgSd M. e Y &Com an P Y 490 Washington St. Lynn,MA 01901 781 593 6630 Parties may cancel this transaction at any time prior to midnight of the third business day after the date of the signing of this Contract. Owner acknowledges receipt of a copy of this Contract, and that they have read, under- stand and agree with the terms of this Contract and the payment schedule for this 'ob. g PY J Signed: Owner Date: Signed: Leland M. Hussey, Contractor: Date: Page 5 of 5