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97 TREMONT ST - BUILDING INSPECTION ` The Commonwealth of Massachusetts /! ,t Board of Building Regulations and Standards CITY Massachusetts State Building C'Code, 730 MR, 7"edition OF SALEM Revised Januart, I y Building Permit Application"fo Construct, Repair, Renovate Or Demolish a /• =////'+ One-or Two-Fumily Dwelling This Section For OIULql Use Only / Building Permit Numbe . Date Aplid: 1� Signature: Building Commissioner/Inyflctor ol'luildings / D � SEQTION 1:S IE RIVIATION 1.VertvrAddress, . Assessors Map& Parcel Numbers I.[a Is this an accepted street'?yes_ no Map Number Parcel Number 1.3 Zoning Information: IA Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(11) 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 Plood Zone? es❑ Municipal Onsite disposal system ❑ Public Private 13 Check ify SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Reco d: ,Cara .JIf lotiAt Pow-&l ao-y- L±6a.M/1 c1lod Name(Print) Address for Service: ,S,e eat Tr/�Jr q2,e:7J2 /, t o Signature 'telephone �— SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building - Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other �ecify:�di/'r-7dG Bri f Description of Proposed Work': SkJ / %;6A. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1. Building S I. Building Permit Fee: S Indicate how fee is determined: �. Electrical $ 13 Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing .S 2. Other Fees: S 4. Mechanical (IiVAC) S List:_ 5. Mechanical (Fire S Suppression) Total All Fees:S / ,�� / Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: .S Y J( ❑Paid in Full ❑Outstanding Balance Due: 0,16 %o /2 v -(I , Y SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 9q J) 6 3 Jbil0 ties /e J 1 C Livensc Number li—cpimationn D�atc— Na nc of CSI.-I folder _�f— Cds .rlGS ;d Jl l rbc AN 07 J List CSL�I)�pe lee below) :\JJrcs f`'PCDescription IJ I Unrestricted(tip to 35,00000Cu. Ft.) �i It I Restricted 1&2 Family Dwellin tilE,natare /' M I Masonry Only RC Residential Rooting Covering Telephone WS Residential Window and Siding SFResidential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 R ste ed Home m rerovement Contractor(HIC) Aa lib 'Company Name or HIC Rc�istmn Name Registration Number J l� J &=d-!—/ Aadre s 7 9 y y57 y Expiration Date Signature I-clephone 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 I, , 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. Signature of Owner Date J SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION I, r d re Zl w!C �n as Owner or A�ee ereby declare that the statements and information on the foregoing application are true and accurateknowledge and behal Print N Signature of Owner or Authorized Agq tDate (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(IIIc)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the FIIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.R5, respectively. 2. When substantial work is planned,provide the information below: Total floors 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 halt/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may he substituted for"Total Project Cost" 4.:>..a. tnsctts- ih:lrartttrcnt ta'YuiNit .,t;ax. ' y Bn:n'd of Buildin., Rr"olatiom and Standardu . Constn,lction Supervisor Specialty License License: CS SL 99218 Restricted to:. RF,WS .' '7 IHDIO VALENTE JR 4 PRINCETON STREET "> t PEABODY, MA 01980 ' c — �""4" Expiration: 3125!2012 t 1•nuniarinna'r TO: 99218 �. .<�� 6tTieea o�umt'r:� atn �ise�a AtguTs'fion'" HOME IMPROVEMENT CONTRACTOR. Registration 131251 Typer: ' Expiration 5J2jj;012 indrv�tlal,�- '•� ILS- VALENTE JR�f - -7, t' Y N to #� 3 ILIDIO VALENTE JR'�� r � �"' �' • . 4 Princeton Street "' ' �• d'' J_ . PFa18DDY,MA 01960\ undersecretary V Y •'4' .. ��--�....���wm�..-e«�..—a—.�.+ry an��—.-'.-e...-.may/ rvh rnl S(,MT-U) FROM: insoraneeviS ions.rom-TO: 19785315142 Page: 3 of a c>Rc V CERTIFICATE OF LIABILITY INSURANCE DATE`MMI°° YYY) PRODUCER JOHN V ZANNINO INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 16 FOSTER STREET ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PEABODY, MA 01960 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (978)531-5757 INSURERS AFFORDING COVERAGE NAIC If INSURED ILIDIO VALENTE INSURER A Liberty DBA RESIDENTIAL REPAIR SERVICE INSURER B. PO BOX 387 NSURERc. PEABODY MA 01960 INSURER D. INSURER E, COVERAGES 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 A€FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJ£CT�TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR DD POLICY NUMBER POLICY EFFECTNE POLICY E%➢IRAHON LIMITS GENERAL LIABILITY - EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISE„ EFI ae cfT'TEw,ne nl S,_ - I CLAIMS MADE f-1OCCURMEOEXPiA one nin S PERSONAL 6 ADV INJURY S GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER - PRODUCTS COMPIOP AD G S POLICY 7PRO. LOC I AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT $ ANV AUTO ren aubpnp ALL OWNED AUTOS BODILY INJURY SCHEOUL EO AUTOS IPer VerwS} $ HIRED AUTOS BODILY INJURY S NON OWNED AUTOS (Pei ncudanU PROPERTY DAMAGE $ IPer acddanU - GARAG£LIABILITY AUTO ONLY.EA ACCIDENT b ANY AUTO OTHETHAN EA ADC $ AUTOONLY . AGG 5 EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR EIOIAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION S $ ---_ A WORKERS COMPENSATION WC1-31S-366666.020 6/4/2010 6r41201i V TWO 5TATU� DTH AND EMPLOYERS'LUBIUTV YINCRY,MIT FR ANY PROPRkTOPUPARTHE'VEXECUTIVE EI.EACIi ACCIDENT b 100000 OFFI4 MEMBER EXCLUDED'' ❑Y Mandato,,in NH) E.L.015£ASE EA EMPIAYEE $ l0�ODG rI Pes d. h.under SPEC IAL PROVISIONS Bebw F.L.DISEASEPOLICY LIMIT 8 6000G0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Workers Compensation Insurance; Pan One of the POKY applies OTfy 10 the Workers'Compensation Laws of the State of MA. I THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR ILIDIO VALENTE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 110 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL I IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENI'ATNE Jeff Eldridge ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All Nghts reserved. CLIWT {noE: 12?3111 k.— CnanGl4l £eiv25;5 S:I::Oa An F,g I If I - CITY OF SALEM ; f PUBLIC PROPRERTY DEPARTMENT -.I%u':N:1'y:)KM:,-(I. 12C.WAMa\G I ON S IX ELI' • 5nua4,M.tn.tc l u sh ru 0197.^ To-.l.:WS-745-9595 • 9711.740•9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers \pnlicant Information Please Print Legibly Vit RIO tooudcuil)rganiratinrol ndov llluul): Address: �9JUoe�icl 3� City,Starc;%ip: l 019 d Phone L': Jld 541`2,Di :\re van employer! Check the appropriate but: 'Type or project(required): I. I ;um a cmpluycr with 4. C1 I :un a general contractor and 1 6. ❑ New construction employees(full and/ur part-tune). have hired the sub-contractors ?.C11 ;un a sole proprietor or partner- isted on rhe anachcd sheet. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition I No workers'comp. insurance 5. ❑ We are a colporatian and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I an,a homeowner doing all work right of exemption per MGL I I.❑ I' 4bing repairs or additions myself.(No workers'cunlp. c. 152,j 1(4),and we have no 12. Ruul'repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required] •:wily.ylihcunl That checks bJs it] malt also fill uca lhu suction below ihowina Iheir woAto wmpentwion policy intitrnutiun 'I lumeawncn who suhmil this affidavit indicating Ihcy am duing all wurk soul Ihen him uutside cwarxton must submit a new atrdavit indialing such. •C\m¢wlon Ilialcheck this box nowt attachsvl an additional ahuel.hawing the nand of the sub:ontrxhln and their wurken'romp.policy information. /sun ml catpfoyer drat&pruridinq lvurkrrs'c•ompen.rntinn in.tarnnrr jot racy etnployeev. Below is the policy and job site injonrwtion. Policy is or Sulf-ins. Lica N: ____.. ____ Expiruoon Date: lob Site Address: City%State/Zip: Attach it copy of the workers' compensation policy declaration page(showing;the policy number and expiration date). Failure to sccurc coverage as required elder Section 25r\ul':vIGL c. 152 can lead to the imposition of criminal penalties of a tine op to'it.500.00 and/or ane-year imprisonment,a.r well as civil penalties in the Turin of a STOP WORK ORDER and a fine orup o)5250.00 it day.Igattlbi lite violator. Be advised that a copy of this statement Inay be furwarded to the OI)ice of hlvebngaunns u1'the DL\ 1'or insurance coverage tcrilicalion. /do hereby cerfijy 1 der the pains told�pena/ticv of prrjury that the inforinallon provided above is true and correct. offi cial only. Do rant mire in this area, to be completed by city or town official. I : Permit/l.gcenae�__ lrily(circle enc): lv:dth 2. Iluilding Department 3.Cilyr•Ib,4n Clerk 4. Electrical lospector 5. Plumbing Inspector -- _ 0111tacl Ver oo; _ i'hone d: Information and Instructions >lassachuscus General Laws chapter 152 icqu;res all employers to provide workers' compensation for their employees. Pursuant to this statute, an empruree is defined as"...every person in the service of another under any contract of hire, evpre»or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of:m Individual,partnership,association 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,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL 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 woo has not produced acceptable evidence of compliance with the Insurance coverage required." .additionally. NIGL chapter 152, §25C(7)states"Neither the commonwealth nut 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 rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)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 does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be romnted 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 law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Offlclals please he 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 fill in the pennit/license number which will be used as a reference number. In addition,an applicant that must Submit multiple penniUlicense 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 drat a valid affidavit is on rile for future permits or licenses. A new affidavit must be filled 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. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. I he i)111ce 11t lavestigations would like to thank you in advance for your cooperation acid shutlld you have any questions, please do not hesitate to give us a call The D.parnnent's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, k 617-727-4900 ext 406 or 1-877-MASSAFE Fax N 617-727-7749 t;:is d S-?6 u5 www.mass.gov/dia b CITY OF S.UY..NI, %L-kSSACHUSETTS • Bt LMLNG DEP.ART`l&NT 120 WASHLNGTON STRFET, Y°FLOOR TEL (978) 745-9595 PAX(978) 79846 KlJ(BER.LSY DRISCOu MAYOR THO.�fAS ST.PIERRB DTRECTOR OF PUBLIC PROPERTY/BCILDING 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 l 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 defined by MGL c 111, S 150A. The debris wilt be transported by: 37i e (name 6f hauler) The debris will be disposed of in (name of facility) (address of facility) signature orpormit ap ''cant /d-1y-i6 dale Jcbnaaif Jx ^ .r. .K,-,^^^+• ...r `...�. .. .Y..,,.. ..,r.a...,n.q.. ..'1 .. . n*w .,, y.-orT...n...mwT -„ « .. VINYL TILT REPLACEMENT WINDOWS T ,. N RESIDENTIAL REPAIR SERVICES O ROOFING R Dump Truck Service • General Contractor M hat 0663 S ID D978-423-4574 0 NLIC#13125 R GUTTERS STORM WINDOWS ROOFING ESTIMATE ESTIMATE SUBMITTED TO: JOB N ME JOB# <AYACA UA 4) �l �ti� �/ �A All ADDRESSv` JOB LOCATION , s�,r a srt" 9`7 T're.,e,,jT— -T sri(WMr AA. Ol y CITU/STATE/ZIP _ DATE SAL,, ., . M/4. o/e o /1-?-/ o PHONE#q2g ,j iQ FAX# CELL# WE HEREBY AGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW... NOTE: ONLY THE MARKED BOXES PERTAIN TO YOUR ESTIMATE. WE AGREE TO: td n I ❑ 1. COMPLETELY STRIP THE ENTIRE M,+/A/./ �®A/1/—t II-eAT- eInT YI ROOF(S) OF THE EXISTING � _ LAYERS OF SHINGLES. ❑'`2.- INSTALL ANEW°LAYER`OF 1 ? '" 'T " i^ i} "" ' " "SHINGLES OVER THE EXISTING ONE LAYER OF SHINGLES ON } ROOF(S). ❑ 3. INSTALL A NEW RUBBER ROOF(S) USING ALL NEW RUBBER ROOFING MATERIALS ON THE 0"4. INSTALLNEWICsE&WATER SHIELD ON ROOF(S), ROOFS EDGE RAKES, VALLEYS, DORMERS, SKYLIGHTS, CHIMNEYS & FLAT ROOF AREAS. ❑'5. INSTALL NEW J L .ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE Af,+1�✓ f'�R/1� ytvt/I-f��-e4Y/- �Gkt_L1 O/6. INSTALL NEW 81NCH W411-e ALUMINUM DRIP EDGE ON THE ENTIRE 1,!,-iAv- f>G;rtf lg ROOF(S). ❑ 7. INSTALL NEW ALUMINUM STEP FLASHING ON ROOF(S). 0--8�' INSTALL NEW(VENT PIPE BOOTS)ON _M+A) ROOF(S). ❑ 9. INSTALL NEW(ROOF BOX VENTS)ON ROOF(S). O'10. CUT& INSTALL NEW RIDGE VENT ON ROOF(S). ❑11. INSTALL NEW LEAD ON CH MNEY ON /1"IA1AJ ROOF(S). ❑ 12. INSTALL NEW SKYLIGHTS ON ROOF(S).. ❑ 13. INSTALL //.V FT. OF (ROOF BOARDS) OR(PLYWOOD SHEATHING)ON THE ROO(rOF THE 1"141AI a.Yrhr h �� COSTS$3.00 PER SQ. FOOT, COVERS MATERIALS AND LABOR. ❑ 14. INSTALL NEW YEAR SHINGLES ON THE TT ROOF(S). 765.CINSTAL/ REPLACE/ REPAIR W el 4/4jr-/r- je-AA1&t5 S Arwl fA&M 6_T/I�ff3 �f.1/'Ct �PAY �fF A� r t ,�l Aar l2ii Cft d _l i4 /fird 5e-�-F; Tl Lr�>� .vim de I 1 �l ❑ 16. SPECIAL-CONDITIONS 4f flf,�j rt O/)Ykf But 1�r pr NOTE: WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS.CUSTOMERS SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE BY COVERING EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENT ANY-DAMAGE DURING THE S RIPPPIIINNGG/r.OF V E1 R/OOF.HOWEVR,SOME DAMAGE AND.MARRING COULD CUR BEYOND OURICONITROIL... NOTE: (I)MO EC AYERS OF ROOFING MAT RIA4LLS RE'FOUNDTHI IN ATE 'ABOVE,AN EXTRA CHARGE WILL BE ADDED FOR THE (LABOR&THE REMOVAL OF THE DEBRIS)OVER AND ABOVE THE PRICE OF THE ESTIMATE. We propose hereby to furnish material and labor- completein accordance with the above sp/elcificatiobris�ffor the sum of: $ / //UY �koli4.✓) /Ff t4-r 14yvJyr Dollars with payments to be made as follows: `�,5'//�J �5rY4wfC.;T f)Z/ )I iA,, V 150.1 Ww+ r r Any alteration or deviation from the above specifications invelvirg extra costs Respectfully IF will be executed only upon written order,and will become an extra charge over submitted and above the estimate.All agreements contingent upon strikes,accidents,or �^ delays beyond our control. Note-this proposal may be withdrawn by us if not accepted within 3C/ days. 'The above prices,specifications and conditions are satisfactory and are hereby Signature accepted.You are authorized to do the work as specified.Payments will be / q ' made as outlined above. - 1 .I Date,-of Acceptance Signature r,