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B-20-718 - 0014 BAYVIEW CIRCLE - Building Permit G l Cj r The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 00 Building Permit Application To Construct,Repair,Renovate Or Demolish a — One-or Two-Family Dwelling This:Section For Official Use Only r Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1.: SITE INFORMATION 1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers Vle;-J C• rZk-e L l a Is this an accepted street?yes J no Map Number Parcel Number 1.3 Zoning Information: 1.4 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 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 O r'of aecevd: Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WOW(check all that apply) New Construction❑ Existing Building d Owner-Occupied Repairs(s) L ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Dens ion of Proposed Work2: v; n`fi%� .'oo �� Ci r Ile CAS!K r �rv:V/ �i Off. -K. SECTION-4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ �.�5`U r 1. Building Permit Fee:$ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ s ❑Tot al'ProjectCost (Item,6)x multiplier x 3.Plumbing $ 21 Other Fees: $ 4.Mechanical (FIVAC) $ List: 5.Mechanical (Fire $ Su ression Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ /g/{?To t GU 0paid in Full ❑Outstanding Balance Due: :04 SECTION 5: CONSTRUCTION SERVICES - 5.1 Construction Supervisor License(CSL) Or5�io License Number Expiration Date Name of CSL Holder I � p List CSL Type(see below) Uvrs,h�f'�'�f 30 IVIQSbn ��re No.aPn Street Type. Description. f/ bo 1 6v U Unrestricted(Buildings u to 35,000 cu.ft. { Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances �-S-q�5— � �t'S,�'160a (r1 ���Pi"'t 1 Insulation Telephone Email ad ress D Demolition 5.2 Registered Home Im51- pprovement Contractor(HIC) 176 HIC Registration Number Expiration Date HIC Company'„N�e or HIC Registr t Name 1W G�/I e S OtV 5 �✓S'Cil d©i��d' G/moi11, N .and Street Emai address City/Town,Stat ,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 .......... 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 OV�4ykey to act on m half,in all matters relative to work authorized by this building permit application. ti 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 _ contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(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.gov/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" 4 CITY OF SALEM) MASSACHUSETTS 3 BUILDING DEPARTMENT 98 WASHINGTON STREET,2ND FLOOR TEL: 978-745-9595 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING CONMSSIONER Construction Debris Disposal Affidavit (requiredfor all demolition & renovation work In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris, and the provisions of MGL c40,S54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licenses waste deposit facility as defined by MGL c 111, S150A. The debris will be transported by: Pr s-zn i 0 (name of hauler) The debris will be disposed of in: V7<t P,,�-o Re�ye,.11,7 ��, (name of facility) (address of facility) Signature of applicant (today's date) Aaafing Frapasal Invoice# Delarosa Construction & Design 30 Mason St. Peabody, MA 01960 Fully Licensed (978) 979-8600 Fully Insured PROPOSALSLIBMI DTO PHONE DATE STREET JOB NAME l v`t►tiJ CITY,STATE and ZIP CODE I JOB LOCATION l MVO- 01170 &q vi-eLA) C- �c We hereby submit specifications and estimates for: We hereby submit specifications and estimates for: SHINGLE ROOF FLATlRUBBER ROOF Strip entire roof ffReshingle ❑Sweep entire roof clean Replace any bad boards up to 100 linear feet ❑Strip entire roof nstall GAF Stormguard first 3 A�feet up roof ❑ Mechanically fasten down ISO board insulation nstall GAF Stormguard in all valleys and along dormers ❑ Install 060 Rubber Roofing on entire roof nstall secure grip synthetic under yment on remainder of roof ❑ Install metal flashing around perimeter of building nstall eight inch drip edge hite ❑ Black ❑Mill ❑ Flash chimney(s), pipe(s)and wall(s) stall ridge vent ❑ Edge caulk all seams lash or re-flash chimney(s) ❑ Install new copper center drain ns all new pipe flanges ❑Other: Poiln'stall lifetime shingle olor -ems ❑Clean up all debris ❑ Install gutters and downspouts 1" `�/ Po V14_1 ❑ Labor and materials guaranteed 100%for five years ❑ Install trim coil ❑ Install new fascia boards ❑ Install new rake boards Email: ❑ I stall sky light(s) Invoice#: Other: rf✓ I an up all debris abor and materials guaranteed 100%for five years II shingle roofs are nailed by hand. ,We?Propose .hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: TO Price($ IF YOU ARE HAVING YOUR ROOF STRIPPED,PLEASE COVER ALL VALUABLES IN ATTIC,AS WE HAVE NO CONTROL OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature //r charge over and above the estimate.All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our workers are fully covered by Workman's Compensation Insurance. FDate anre Of i3r0p0�al—The above prices,specifications ons are satisfacto and are hereby accepted. You are authorized Signature qa'-j rk as specified.P y nt wil made as outlined above. eptance: Signature yellow copy to above address. i The Commonwealth of Massachusetts Department of IndustrialAecidents > I Congress Street,Suite 100 Boston,MA 02114 2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly- Name(Business/Organization/individual): Address: 3 (? s� City/State/Zip:petit y Mom' 0)5(moo Phone -96 a Are you an employer?Check the appropriate box: Type of project(required): 1.EfI ern a employer with 3-5 employees(full and/or patt time).• 7. ❑New construction 2.O I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑T am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. [will 10[]Building addition ensure that aU contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions proprietors with no employees. 12.�P umbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-cons actms listed on the attached sheet. 13. OOf airs These sub-contractors have employees and have workers'comp.insurance.t 6. we are a corporation and its officers have exercised their right of ex 14.❑Other ❑ orPo gh exemption per MGL c. 152.§1(4),and we have no employees.[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 subunit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the same of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informadon. Insurance Company Name: r�s��_ � t,n ✓t fry y h u'. Aes4111 ), dl c t Policy#or Self-ins.Lic.#: 'T tW 14 p02-(0 Y bl/L/diyl 44:71/00 Expiration Date: � / P / ` Job Site Address: �1//If c� t��t' elA- City/State/Zip:_ /-e6v� j�/� b 7 10 Attach a copy of the workers'co4pensation 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certify under thepains andpenaldes ofperjury that the information provided above is true and correct Signature: Date: /���/Z Phone#: 1 21 — I �` �/ -- e Ir-'6 p F J use only Do not write in this area,to be completed by city or town oJjiciaL Town: Permit/License# Authority(circle one): d of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person:. Phone#: l ' DELAR-1 OP ID:MC ACORO° DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F07/10/2020 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 endorsements. PRODUCER 508-679-6486 RRMNTACT Douglas H.Brown Durfee Buffinton Ins.Agcy,lnc PHONE 508-679-6486 FAX 377 Second Street A/C,No,Ext: (A/C,No): Fall River,MA 02721 E- IL Douglas H.Brown INSURERS AFFORDING COVERAGE NAIC# INSURER A:Safety Insurance Company 39454 N URED INSURER B:Pennsylvania Manufactures ASSo el_aprosa Con tructiori a Design 30 Masonionf.�l rrrsr�1��I 2 e aros INSURER C: Peabody,MA 01960 INSURER D: 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. INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR BMA0026845 06/12/2020 06/12/2021 DAMAGE TO RENTED occurrencel $ 100,000 MED EXP An one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ c ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTD ��oy�/N Pe�acEciRdenDAMAGE $ OS ONLY AUTOS ONLY UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY CMA000087400 06/12/2020 06/12/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ (Wla daiory in BIW EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 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) Location: 14 Bay View Circle CERTIFICATE HOLDER CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 93 Washington Street Salem, MA 01970 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD s ass- husetts Lepartm. t .. t oard of Building Regulations and Standarus 'License: CS-110920 ; ";instruction Supervisor AI r, ARSENIO DELROSA 166 BOSTON STREET,APT 2 _ SALEM MA 01970 r f a F' ai tat 1• I Expiration: /Commissioner 01/01/2021 Commonwealth of Massachusetts Division of Professional Licensure I Hoisting Engineer HE-185864 �� -�- E*pires:01/01/2022 t ARSENIO R DELAROSA ' 30 MASON ST: PEABODY MAC 019 0 �.t,, F Commissioner �(Pte�c�y•�y ,� _ ! r c 6— office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TY;PE:�Corporation Registrations Expiration T78599 09/05/2020 DELAROSA CONSTRUCT10NrJ�&DESIGN CORP. T ARSENI0 ELA 30 MASON UNIT 2 Undersecretary, < PEABODY,MA 01960 $ OE,,,,,�� 36-004881920 }�t This card acknowledg es that the recipient has successfully completed a 10-hour Occupational Safety and H and Health alth Training Course in Construction Safety ARSENIO DE LA ROSA • 3/9/2014 Marie Athey --------- ---'--- (Course end date) (Trainer name—print or type) e aa l e v o e vv TM . QuickSquaresTM �.! July 10,2020 REPORT DETAILS e' i. bRAM [y� 71 F I � Roof#1 Area: 25 Squares N.jFAC,, Predominant Pitch: 6 100% This report includes up to two structures on a residential property and one structure on a multi-family property.The pitch 4RANI has been factored into the calculation with no waste. Please upgrade to a Premium Report to receive measurements for additional structures and for any lower roof areas that may be obscured from view in the top-down image,as they are not Satisfaction Guaranteed included in the totals on this report. www.eaaleview.com/Guarantee Upgrade Your Report! QuickSquares is a report used to estimate the overall size of the roof; for material-ordering accuracy, contractors should upgrade to a Premium Report. The price of your QuickSquares report will be deducted from your upgrade. A Premium Report includes: • 3D Roof Diagram • Length Diagram • Area Diagram • Aerial Images(Top, N, S, E&W) . Notes Diagram • Pitch Diagram • Waste Calculation Table • Report Summary • Customizable Report • Square Footage Pitch Table ©2008-2020 Eagle View Technologies,Inc.and Pictornetry International Corp.—PA Rights Reserved—Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840;8,209,152;8,515,125;9,183,538;8,818,770;8,542,880;9,244,589; 9,329,749.Other Patents Pending.