Loading...
3 VALLEY ST - BUILDING INSPECTION / � The Commonwealth of Massachusetts Board of Building Regulations and Standards Town of Massachusetts State Building Code, 780 CMR. T°edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two-Familt Duelling This Section For Official Use Only Building Permit N bec Date Applied: ` Z• O Signature: �p Z • O Budding Commissioner/Inspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Propert Address: 1.2 Assessors Map& Parcel Numbers e I.I a Is this an accepted scree ?yes no_ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(It) 1.5 Building Setbacks(B) Front Yud Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: — / Zone: _ Outside Flood Zone? Munici al On site dis sal s stem E3Public B' Private❑ Check if es❑ p po y SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record Name(Print) Address for Service: 5-er co vTrT Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) EDemolitioff(03 CoExisting Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Accessory Bldg. Number of Units Other pecify: OruG Brief Description of Proposed Work=: r O P YP e r ,trNr SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials 1. Building S I. Building Permit Fee: $ Indicate how fee is determined: 13Standard City/Town Application Fee 2, Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (HVAC) S List: /y 5. .Mechanical (Fire S Total All Fees: S , Suppression) ��� p' Check No. _Check Amount Cash Amount: , 6. Total Project Cost: S 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) r JZZ, ,4trt ,���� ✓ 2 License Number Expiration Date Name of CSL- Hp Wer List CSL Type(see below) Addr• s Type Description U Unrestricted(up to 15,000 Cu. Ft.) R Restricted 1&2 Family Dwelling Signature p- Stason Only q/o q,2-2- � /-/rj q RC Res Roofing Coverin Telephone Residntia ennaI Window and Siding SF I Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 R=re Ifn=;:ent Cgntrsclor(HIC) HIC Cgmpa"ny Name or HIC Registrant Name Re siration Number —(fy /�d7T_il�v�/a�✓ �C� Addrc q� Expiration Date Signature Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 Afdavit Attached? Yes.......... No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,S e'{' 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 SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties ofperjury) 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 no 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 780 CMR Regulations I IO.R6 and 110.115, 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 halfibaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 1. "Total Project Square Footage"may he substituted for 'Total Project Cost" CITY OF S.-1I.XaM LvLkSSACHL;SETTS BL'B.DING DEPARTME.�1T 120 WASHINGTON STREET, ase FLOOR TEL (9711) 745-9595 FAX(9711) 740-9846 1CI\[BERLEY DRISCOLL MAYOR THosw ST.PIERRS DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CONMISSIONER Workers' Compensation Insurance Affidavit: Buildere/Contractors!Electricians/Plumbers Applicant Information 7 Please Print Le ibly MainelBusimx&Organi:ation,individwil: le Address: City/State/zip:—&4 ./k/1— Cl(2G() Phone #: 07 �—�1�Z— ((�� Are you to employer?Cheek the appropriate box: Type of project(required): 1.❑'yam a employer with- ;)� 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. : 7• ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9, E] Building addition [No workers comp. insurance 5. ❑ We are a corporation and its required:] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,¢1(4),and we have no 12.❑Roof repairs insurance required.)t employees. [No workers' l3.❑Other comp. insurance required.] •Any applicatd than checks box aI must also fill out The section below showing their worktxs'compen&s,d n policy information. 'I Lwtwuwtten who subunit this affidavit indicating they are doing all work aid then hire outside contractor,most suhmil a naw affidavit indicating sueh. :('untrsmion that cheek this box most attxhed an additional shoot showing the coma of the sub-contraemra and their workers,comp.put icy infunttation. I am an employer that Is providing workers'compensation insurance jar my employees. Below is the policy and fob rite fnjormation. / /_ Insurance Company Name:_L — fl yz V,(� Policy#or Self-ins. Lie.#:_ eY' 1-r1/1•4/K'e"/7� Expiration Date: Job Site Address: (Y_ z City/StawJZip:_M( /.fT C//eiiJ Q Attach a copy of the workers'compensation polity 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 S 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 5250.00 a day against the violator. He 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 pains and penalties ajperfury that the information provided above is true and earreeL Biu irate' Date: --aL9 rt Phone;f: q9t-- io � Y- 4 6( Oficial use atrly. Do not write in this area, to be completed by city or town aJfiei d City or Tuwn: Permit/I.lcense# Issuin \ulhoril - - ---- 8� y (circle ane): _-- 1. hoard of llealth 2. Building Department 1.Citytrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _. Phone#; CITY OF SALEM l (,y PUBLIC PROPRERTY DEPAR'I'�tENT c:>:aI I i • l.\I I M. \I III V'S '1;.)4•I; 1 \\ 'J78-V='t141, Construction Debris Disposal Affidavit (reyuircd for all demolition and renovation work) In accordance %%ith (he sixth edition ofthe State Building Code, 780 CNIR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit tf is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c I 11. S 150A. The debris will be transported by: (name of haulu) The debris will be disposed of in 3 F _ . (name of lacilily) 7/l�eST ST Prq--'Ic / � +ignatuic of Im Ilia applicant dale Liberty Mutual Group P.O. Box 9090 Liberty Dover, NH 03 82 1-9090 Ll erty Telephone: (800) 653-7893 7�/Zutu ,/R Fax: (603) 245-5330 l�'1 E-mail: IMS@LibertyMutual.com Quote Number: 242847-01 Insured: ILIDIO F S VALENTE JR DBA RESIDENTIAL Quote Period: 04/24/2009 - 04/24/2010 REPAIR SERVICE PO BOX 387 Issue Date: 01/26/2009 PEABODY, MA 01960 Legal Status: INDIVIDUAL FEIN: 562557834 Officers Title Included/Excluded ILIDIO F S VALENTE JR SOLE PROPRIETOR EXCLUDED Workers Compensation Insurance offered by this quote applies to the following states: MA Employers Liability Limits of Coverage: Bodily Injury by Accident: 100,000 Each Accident Bodily Injury by Disease: 500,000 Policy Limit Bodily Injury by Disease: 100,000 Each Employee Location Number and/or Address 001 4 PRINCETON ST, PEABODY, MA 01960-0000 Loc. Class Estimated Rate/ State # Code Description Exposure $100 Premium MA 001 5403 CARPENTRY NOC 0 11.92 0 5545 ROOFING NOC & YARD EMPLOYEES, DRIVERS 2,625 30.35 797 5645 CARPENTRY - DETACHED ONE OR TWO FAMILY 0 7.50 0 5651 CARPENTRY - DWELLINGS -THREE STORIES 0 7.50 0 Location Total 797 PREMIUM SUMMARY Charge Description Factor Status Premium MA TOTAL CLASS PREMHJ.M 797 MA STANDARD TOTAL 797 EXPENSE CONSTANT 250 MA MACHWC (SURCHARGE) 1.063 50 TERRORISM RISK INS ACT 2002 1.030 1 MA FINAL TOTAL 1,098 Total Premium and Surcharges 1,098 77te above rates are subject to state mandated changes. The factors used in rating this quote are also subject to change pending promulgation of final experience modification and classifications/exposures from final audit of your current x,orkers compensation policy. Requests for changes other than address, please consult your producer of record, if any. Quote Prepared by: Account Number, 1366666-0000 Page 2 a � ate\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 131251 r, Expiration: 6/21/2010 Tr# 267137 Type: Individual r ILIDIO VALENTE,JR:.. r. i ILIDIO VALENTE,JR. - 4 Princeton Street PEABODY, MA 01960 V Administrator j *• \lassachusctts- Dcpartmcnt ul' Public Saicl.. Board uf,Buildin„ Re."Ulati11O, and Stand:o•ds Construction Supervisor Specialty License License: CS SL 99216 Restricted to: RF,WS '1 IHDIO VALENTE JR 4 PRINCETON STREET PEABODY, MA 01960 4; Expiration: 3/252012 Tr#: 99216 ('onmri.yioorr _ Q41"3109 12:56 FAX H T BAILEY 2002 H.T. BAILEY INSURANCE AGENCY, INC. 20 MALL ROAD Surplus Lines and Special Risk Underwriters SUITE 100 BURLINGTON, MA 01803 TEL! 781-362-1000 FAX: 781-273-3750 COMMERCIAL GENERAL LIABILITY QUOTE Broker: --- —.---. Binder ZANNINO INSURANCE AGENCY ATTENTION: JOHN ZANNINO Assigned #: SGL. 3cwAC,4 16 FOSTER STREET Effective Date: 04_II,.b3} PEABODY, MA "01960 Expiration Date:04+,16_10 Named Insured: RESIDENTIAL REPAIR SERVICES RENEWAL Expiring Policy No. SGL3000206 Expiration Date: 04/16/09 LIMITS NSURANCE: General Aggregate Limit (Other than Products–Completed Operations) $ 1,000,000 Products–Comp)eted Operations Aggregate Limit S 1,000,000 Personal and Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Fire Damage Limit $ 50,000 (Any One Fire) Medical Expense Limit $ EXCLUDED (Any One Person) Professional Limit $ NOT COV RETROACTI AT_E ICG 00 D2 only) Coverage A of this Insurance does not apply to bodily mlury or property damage which occurs before Retroactive Date, if any, shown here: NONE DESCRIP OF BUSINESS AND TION OF PREMISE Form of Business: Individual Business Description ROOFING CONTRACTOR Location of All Premises You Own, Rent or Occupy: P.O. BOX 367 PEASODY MA 01960 PREMIUM Rate Advance Premium Classification CodeNo. Premium Basis Pr/Co All Other Pr/Co All Other (_cN N _N?RY OC [ 000 IN 'LUDL 5oS-6Q $1000 Deductible Per Claim BI & PD Including LAE Total Advance Premium $3,500.00 (Minimum & Depositl Subject to Affidavit by Assured 25% minimum earned at Inception.) Tax: 4% Filing Fee: $0 Policy Fee: $0 Other Fee: $0 Inspection Fee: $ 0 Please read terms an conditims carefully. This quote may not comply with all con rtions, terms or coverage requested. In order to bind coverage we must receive a written request prior to the effective date. Coverage cannot be considered bound without written confirmation from our office. FORM ENDORSEMENTS Forms and Endorsements applying to this Coverage Par[ and made part of this policy at time of issue: SEE ENDORSEMENT 7J 01 [luote 04/23/09 Expires: %09 Company: SENECA SPECIALTY INSURANCE COMPANY I -I / Commission: 10.000% By ar+�` PAUL HUGHES r?3 Account No.. PMH-2598$9 VINYL TILT REPLACEMENT WINDOWS T N RESIDENTIAL REPAIR SERVICES O L ROOFING M oa S Dump Truck Service • fieneral Contractor 0 978-423-4574 0 N - . LIE#13125 R GUTTERS STORM WINDOWS ROOFING ESTIMATE ESTIMATE SUBMITTED�/ ` TO: — / JOB NAME JOB# FNJl— .O//zi ADDRESS JOB LOCATION .^c CITY/STATE/ZIP DTE /Vl Ai A /2%09f G Af'_1 .2—Opel PHONE# FAX# CELL# s 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: 0.011. COMPLETELY STRIP THE ENTIRE _ ,1144-/A/ ROOFS) OF THE EXISTING _/11� _ LAYERS OF SHINGLES. ❑ 2. INSTALL A NEW LAYER OF SHINGLES OVER THE EXISTING ONE LAYER OF SHINGLES ON ROOF(S). ❑ 33. INSTALL A NEW RUBBER ROOF(S) USING ALL NEW RUBBER ROOFING MATERIALS ON THE CT 4. INSTALL NEW ICE&WATER SHIELD ON AtA AA Q CG redrvnLrre ROOF(S), ROOFS EDGE RAKES, VALLEYS, DORMERS, SKYLIGHTS, CHIMNEYS °& FLAT ROOF AREAS. 0",5. INSTALL 1,IW <' LB.ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE MA I.V. M'6. INSTALL NEW 8 INCH ALUMINUM DRIP EDGE ON THE ENTIRE X&;U ROOF(S). ❑ 7. INSTALL NEW ALUMINUM STEP FLASHING ON ROOF(S). it O 8. INSTALL NEW(VENT PIPE BOOTS) ON AlA-/N -9 ROOF(S). ❑ 9. INSTALL NEW(ROOF BOX VENTS) ON ROOF(S). 2/11 0. /10. CUT&INSTALL NEW RIDGE VENT ON MA-f xl ROOF(S). O"11. INSTALL NEW LEAD ON CHIMNEY ON MA-1 .✓ ROOF(S). ❑ 12. INSTALL NEW SKYLIGHTS ON ROOF(S). 0'13. INSTALL l FT. OF (ROOF BOARDS) OR(PLYWOOD SHEATHING)ON THE ROOrOF THE COSTS$3.00 PER SQ. FOOT, COVERS MATERIALS AND LABOR. O 14. INSTALL NEW . )© YEARc TAA rley d SHINGLES ON THE / - ROOF(S). 0 5 INSTALL/ REPLA E ER/PAIR r14 fA [h1! ZI,6- Y A� /.�-� AJ ITA a �Y7GA-T f7 16. SPECIAL CONDITIONS rl-M L/ dio�; 199.,Z ,. 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 PREVENTANY DAMAGE DURING THE STRIPPING OF THE ROOF. HOWEVR,SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR CONTROL... NOTE: (IF)MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED 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 hob//y to furnish material and labor'- Complete in accordance with the above specific/atiobns for the sum of: $ /j YI�t/SR �f/ rY /���r 5 C �`��aff Dollars with payments to be made as follows: e ZQ S //Pa-A.' Any alteration or deviation from the above specifications involving extra costs Respectfully 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 days. y7p� ,Acapt of The above prices,specifications and conditions are satisfactory and are hereby�lLP Signature B– accepted.You are authorized to do the work as specified.Payments will be – made as outlined above. ' Ir Date of Acceptance Oct Signature