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B-19-1198 - 0016 BAY VIEW CIRCLE - Building Permit The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: `� s f E vl� r✓v�-ii, y�Cs� ,: � C__.—=y �b 'v7i �t (�1 Building Official(Print Name) ' Signature Date• SECTION 1:SITE INFORMATION r tyi 1.1 P o er Address: r' : p 1.2 Assessors Map&Parcel Numbers r ;TI 1.1 a Is this'an acc pted street?yes no Map Number Parcel Number 4% ' 1.3 Zoning Information: 1.4 Property Dimensions: 'r. Zoning District Proposed Use Lot 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,§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.^1^Ow/ne`rr of Record: Name(Print) City,State,ZIP ce.cr i�,e.� �' a 21a�. o �- No.and Street I Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other J9 Specify: Brief Description of Proposed Work2: l-'V-7 a,ti 5 .'i`7��Z ati/ QT.v Vt — ct, ,PLk 16 SECTION 4 ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ U. q3 1. Building Permit Fee: $ Indicate how fee is determined: Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: J 1'!!�> 9 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ l � 3 0 Paid in Full 0 Outstanding Balance Due: i SECTION 5 CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) t l(T�� rGv-\ License Number Expiration Date Name of CSL Holder ` 1A n b` �l v� List CSL Type(see below) No.and Street t� l Type Description q� U Unrestricted(Buildings u to 35,000 cu.ft. �� '� V�\1� ► �t 8 R Restricted 1&2 FamilyDwelling City/Town,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding A2 SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1 No.and Street 0 Email address City/Town,State,ZIP 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 ..........tw 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. 11 GI9L '��SFS- �t4�U t �j 2- Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information co ' ed in this a plication is true and accurate to the best of my knowledge and understanding. P nt wner's or thorized Agent's me(Electronic Signature) Date 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 HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.pov/dpss 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" The Commonwealth of Massachuseus Deparblteitt of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 wwrv.mass gov/dia 'Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Applicant Information TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Lc 'bl Name(Business/Organization/Individual): 6/1 V-,,roy1Vn Address: City/State/Zip: ,,y 11/4 r'Z Phone#: SS S"7 EG' - *Any an employer?Check the appropriate box: m a employer with em to ees full and/or part-time).wType of project(required):P y a sole proprietor or partnership and have no employees working for me in 7• ❑New construction capacity[No workers'comp.insurance required.] 8. Remodeling a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• ❑Demolition a homeowner and will be hiring contractors to conduct all work on my property. I will 10[�Building additionure that all contractors either have workers'compensation insurance or are solerietors with no employees. I I E01 Electrical repairs or additions a general contractor and I have hired the sub-contractors listed on the attached sheet12.[]Plumbing repairs or additions se subcontractors have employees and have workers'comp.insurance) 13.❑Roof repairs arc a corporation and its officers have exercised their right of exemption per MGL a 14•( Otte r§1(4),and we have no em to es.P ye [No workers'comp.insurance required.]Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContmctors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I ant an employer that is providing workers'compensation insurance for uty employees. Below is the policy and lob site information. Insurance Company Name: -- lei C Policy#or Self-ins.Lic.M. 1 �V 2 3 S ` /�j Expiration Date: J'2 / i Lei j Job Site Address.--Le City/State(Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up i lion date). and/or one-year imprisonment, 0.00 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certrfi tder the p its and penalties of perjury that the information provided above is rre arrd correct. Si ature: C Phone#: FEeD only. Do not write in this area,to be completed by city or town official n: Permit/License# ority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#• I DocuSign Envelope ID:ABA241E6-F451-4A08-88B9-F937203E7B6A Permit authorization mass save Form Site ID: 3878513 Customer: MICHAEL FINNEGAN l� MICHAEL FINNEGAN ,owner of the property located at: (Owner's Name,printed) 16 Bay View Cir Salem, MA 01970 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on-my property. DocuSlgned by: Owner's Signature: f(,LkQ � flUGaN Date: 9/3/2019 1 4:09 PM EDT FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 FarOffice Use Only Rev.102015 i DocuSign Envelope ID:ABA241E6-F451-4A08-88B9-F937203E7B6A -.... ._........... ........... ............. CLEAResulf CONTRACT CLEAResult 50 Washington Street Customer Name:MICHAEL FINNEGAN Westborough,MA,01581 Email:mfinneganl02l@gmail.com Phone:978-269-4380 Premise Address:16 Bay View Cir,Salem,MA 01970 Mailing Address:16 Bay View Cir,Salem,MA 01970 Project ID:3880459 Date:Aug.30,2019 Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference. Measure Description '_ "gym Location " Ouahtity Unit,' " �' .Total Cost #° Custome"r '"Cost, Hatch-2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Damming 84 each $200.76 $50.19 Walls-Interior-3"Dense Pack Cellulose 128 SF $303.36 $75.84 Walls-Wood Shingle-3"Dense Pack Cellulose 1449 SF $3,173.31 $793.33 Attic Floor-10"Open Blow Cellulose 1780 SF $3,382.00 $845.50 Air Sealing at Estimated 62.5 CFM50 Per Hour 16 hr $1,481.28 $0.00 Door Sweep(with AS hrs) 1 each $25.31 $0.00 Exterior Door Weather Stripping(with AS hrs) 1 each $30.07 $0.00 Blower Door Test 1 each $72.75 $18.19 Ridge Vent(Inft) 62 each $1,928.20 $482.05 Total: $10,643.32 Program Incentive: -$8,366.65 Weatherization Barrier Incentive: -$250.00 Customer Total: $2,026.67 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$0..06 as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs).Mail check&contract to CLEAResult,50 Washington Street, ,Westborough,MA,01581:Final Payment:$2;026:67a as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Customer Page 1 of 4 I DocuSign Envelope ID:ABA241E6-F451-4A08-8869-F937203E7B6A understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of;$8;6f665. Changes to individual line items and/or.previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. DocuSignad by: �(Agfy' 9/3/2019 14:09 PM EDT VP'Qnature Date Indicate your selected IIC here, if applicable Initial here if you want the Program to assign a Participating Garrett Hodgson 8-30-19 Garrett Hodgson Contractor CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 F --"M'1 ENVIABA-01 CFOGARTY ACU►ROR CERTIFICATE OF LIABILITY INSURANCE DATE 12/12/2018Y) 12/12/2018 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 have ADDITIONAL INSURED provisions or 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 WR e 134ray Insurance Agency,Inc. HONE ) (AIC,Ne:(877)816-2156 INC,No,Et):(800 553-1801. South Dennis,MA 02660 EAbmpAg'Lrzssr mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER B: Environmental Abatement Inc.(EAI) INSURER C: 1200 Bennington St INSURER D: East Boston,MA 02128 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. LTR DR INSR TYPE OF INSURANCE AN DL SUBSD p POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR 5D80235-19 12/16/2018 12116/2019 DAMA_REMSETMoccurrent $ 500,000 MED EXP(Any oneperson) 10,000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000 POLICY�JECT LOC PRODUCTS-COMP/OP AGG 3,000,000 OTHER: EBL AGGREGATE $ 3,000,000 A AUTOMOBILE LIABILITY COMBIINEeD SINGLE LIMIT $ 1,000,000 X ANY AUTO 5Z80235-19 12/16/2018 12/16/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY NON-OWNED ONL� PROPERTY .,d.M AMAGE $ A X UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 5J80235-19 12/16/2018 12/16/2019 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N SH80235-19 12/16/2018 12/16/2019 500,000 OFFICERIMEMBER EXCLUDED? �N N/A E.L.EACH ACCIDENT $ (Mandatory in NH) - E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 98 Washington Street Salem,MA 01970 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office-Of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M mus8tts 0211.8 Home ImProvemetractor Registration 9 n ENVIROMENTALABATEM TYpe: Supplement C.Wd 1200 BENNINOTON�ST EIVTO' u w Registration: 177555 " w Expiration: 01/01/2020 • EAST BOSTON,'MA 02128 � � Y d �a 8CA 1 O 2QM-M7 5!� update Address and Return Card. Offtoe of ConaumerAffaha&811111neaa Reguletlon ` HOME 1MPR. ENT CONTRACTOR f Tl!P lement Card Registration valid for Individual use only before the expiration date. It found return to: ENVIROM 01101400 Office of Consumer Affairs and Business R eguistlon NC 1000 Washington Street.Suite 710 Boston,MA 0211a JAMES CRONIN 1200 BENNINOTO EAST BOSTON,'MA 28 uncle. ;0t valid without signature Commonwealth of Massachusetts ! Construction Supervisor Division of Professional Licensure ` 'k! Board of Building Regulations and Standards }}` Unrestricted-Buildings of any use group which contain I less Than 36,000 cubic feet(991 cubic meters)of enclosed Co nstructiofi'S•uperviso r space. CS-111477 EXpires: 05/20/2021 i JAMES CRONIN - a' I 16 ROLLINS AVENUE NAMANT MA 01908 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner For For information about this license Call(617)727-3200 or visit www.mass.gov/dpi