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B-20-590 - 0014 BERTUCCIO AVENUE - 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: tmk 1 C4, - i lBui ding Official(Print Name) Signature Date SECTION 1: SITE INFORMATVON 1.1.Property A t ess. . 1.2 Assessors Map&Parcel Numbers erA Il e 1.1a Is this an accepted street?yes 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: Zone: Outside Flood Zone? Public❑ Private❑ — Municipa Check if yes❑ l❑ On site disposal system .❑ SECTION 2: .PROPERTY OWNERSHIP' 2.I:Owney of Record: � / Lr.✓C(G 1U0 79/eu Name(Print) City,State,ZIP ly Relkec;v dive' ��1TZ aZ3�3 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check.all_that apply) New Construction❑ Existing Building❑ . Owner-Occupied ❑ Repairs(s) ❑ Alteration(s). ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work /i 4ela. O SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ '8� 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: $ . . 7 ( List: List:.. �1 U 4.Mechanical HVAC $ 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount 6.Total Project Cost: $ O } ' g ❑Paid in Full: ❑Outstandiri Balance Due:: i JUN 23 PM2=35 JU w „ SECTION 5: CONSTRUCTION SERVICES 51 :Construction Supervi or License(CSL) ©91?9y ./o.Z It) N �„� License Number Expiration Date Name of CSL Holder V List CSL Type(see below) �ONo and Street Type.t: Description / / U Unrestricted(Buildings u to 35;000 cu.ft.) ,Q ` /�#C�I�/�•�IVY ► or t R Restricted 1&2 Famil Dwelling City/Town,State,ZIP r : : M Masonry RC' Roofing Covering WS Window:and Siding SF Solid Fuel Burning Appliances. .4PA Insulation Telephone U Email address D Demolition 5.2 Register d Home A„Improvement C ntractor(HIC) Iv Uti�� ` e Z X 1e.S HIC Registration Number Expiration Date HIC Compa ame or HIC Registnt Name No. d Street / Email address own,State,ZIP Telephone ,.'. SECTION:6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L c 153 § 25C_(0) 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 .......... ::;SECTION Via;OWNER AUTHORIZATION TO BE COMPLETED WHEN s OWNER'S AGENT OR}CONTRACTOR"APPLIES FOR BUILDING PERIVIIT I;as.Owner of the subject property,hereby authorize �O h to ac : half,in all matters relative.to work aut orized by this buildg,permit application. Prin O er'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 qe and accurate to the best of my knowledge and understanding. JAO Print,Owner's or Au orized'Agent/s Name(Electronic Signature) Date . V 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: og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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 halfibaths 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 Commonwealtit:ofMassachsoon De ortment o I»dushYQl�fccidents .. - roe o 19, tions tom'' f ,. _� ', :�,�rfQ3'ette City Center - I w •: ZAvenue de tgfayette,Boston,"1VL4 021111750 www.rna�goi!/d�a _ Wockers':Gompensation InsurataceAffidavit:Builders/ContractorslEleetricians/Plumbers Apnlitssat haformation Pltse'Print LeaibW Name(Gutsiness/Organs hon/intiivtdtal):Unked Painting Company Inc,DBA United Home Experts Address:80 Pleasant Street,Suite 1 Phone Ct /StattJZi�:Ashland Ma,0472� `" 81-8555 Are you an emptoyec9 Check file appropriate box: Type of project(required] a ® i.aiti a turf 1 with 9 4•:[] i am a general contractor and 1 : New tonstrucdon P° 4 . have hired the sub-c�ltractors 6. E employees(full and/or part-hme): 7. Rernodelmg 2. t am a sole proprietor or Partiter- listed.on the attached sheet. 0 s9iipand have no employees . These ors have 8. ®Damolidon em yees and working forme in any.capacity: - p o have work 9. Q Building add 1.. , lion comp.insurance l� . i [hTa workers cam insurance additions 5 we- a;corporation and its 10 Elec "txl repairs or regiurtxa.]` officers ltavti exercised their . 1 t Plumb! irs or additions 3:a I am a homeowner.doing all work 7. right of exemption per MGL; myself [No workers comp 12.�Roof repairs t. cj_k,§.l(4),and we have no msuraitce:n tluired.] , IIEI Other employees.[No workers comp.insurance required.] Aay appGcoat that cheds"bag Q must also pu wa the section belowdhowing dwr worttets•eanpe,�satian policy iaronaotion t Homeo�we6��fio snbdut this_altidavit iud�cating they are itomg nil vvod.and tho hire outside eaiundois.muscsubmit a ueetiy afltdavit.iadtcaGng ouch. tContinctois that check this tiaot must attachod saaddmoaat shed sho�viag the aerric of the snb�contmctors and stele whetherar aot those entities have mast" de their workers-comp,potiey mtmber employees !f the orshavts emptaYeas.Chet' ptt►� l.am an enr.lo er.'ti�at ES rovlding inttrlters'romperrs7rtlon ursurancefor my employees. Below is the poUcy`and job srte P .V : P _ - AIM insurance Company Name. : . WCC5tl0 507027-2419a ._ tton Date: Z� Policy#or self-ins:tic.#: . �! City/StatelZip: lew e . Job Site Address:- �� - �t cc td / C —�"-- " a c t bowing the tic number•and !ration date). Attach a copy of the workers compensation polity dedarstion p.g ( Po Y Failure to segue coverage as required under Section 25A of MGL c. 152 can Lead to the imposttitui of cran�rtal penalties of a fine tip to,$I,S�.tlO and/or one=year tmprisanment,as well as CM Penalties in the fonin of,a STOP WORK ORDER and a fine of up to 5250.00 a day against thevtolator Be advised that a copy of this statement may be forwarded to the Office of investigations of file DiA for msuranct;coverage verjRt:adon. I do hereby certlfj/under-thet1irs opd,�eaatNes of perJrtry That Ure tirformatlon provided above is`trae andrrecZ_ - p O ci61 pse Duty. Do riot wrPte kr t&is nre�m berompleted by city f/1 City or Town: . Perzolivueense Issniag Aothortty(cliooe} 1�Board of Health- Bnildiug Dtartment 3nCttylfowp Clerk 4.�Eiet• Cs Inspector 5�1 t nnibing Insp.09r 6.Qthber Contsd Ptxson• Pbone#: - - AC R e CERTIFICATE OF LIABILITY INSURANCE 704/13t202O(` WODNYYY) 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 AOT 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 WANED,subject to the te►ms 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 NAME' Marc Laracque East Douglas Insurance A enc PNONE FAX - - --— -- g g Y (508)476-2101 AIc No: PO Box 1370 ADd _sr: marc@eastdouglasinsurance.com 306 Main Street INS URER(S)AFFORDING.COVERAGE ; N_AIC9 Douglas 01516 INSURERA: Associated Industries Of Mass T -33158 _ INSURED INSURERS. Mapfre Insurance Company I 34754 ! United Painting Company,Inc INSURERC Evanston insurance Company ( 35378 dba United Home Experts,United Building Experts INSURER D: 60 Pleasant Street Ste 1 INSURERE: 1 Ashland MA 01721 INSURER F: ; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THISJS 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - iADpl - I POLICY EFF POLICY EXP_I-....,.�,.,,..._.. ......._._.. r�....,..d..»....-.........,_................__.- -o.._ LTR TYPE OFtNSURANCf SUER POLICYNUMBER I MM/DDIYYYYI_(MMIDDIYYMi LIMITS 1XI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE $ 1,000,000 kj I (�X OCCUR � L_. l I PREMISES(Ea`occ�arence) ._,$ 300 000 I MED EXP(Anyone person) $ 51000 C X X MKLVlPBC000295 4-21-20 I 4-21-21 1 PERSONAL RADVINJURY $ 1,000000 _ GENLAGGREGATELIMITAPPLIESPER: ( GENERAL AGGREGATE $ 2,000000 _. ( PRO -,.. _ _ ICY L-_�JECT �_--_-I LOC i i PRODUCTS COMP/OP AGG $. 2,000 000 _ OTHERS ! 3 PROJECT GEN AGG $ 5,000,000 AUTOMOBILELtABILrrY COMBINED.SINGLE LIMIT ! LE!s accident _-.-- $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B X OWNED SCHEDULED AUTOS ONLY (AUTOS i X BDGTON 4-1520 [ 4-15-21 BODILY INJURY(Pee accident) XHIRED + NON•OWNED ( PRO0ifwYb MAGE _..._ . AUTOS ONLY AUTOS ONLY I I ,AMA i -(pa accident I $ X..UMBRELLA LIAR �/I X 'OCCUR I EACH OCCURRENCE $ 3,000,000 C ExcEssLIAB cLAlMsfinADe MKLV1EUL101881 4-21-20 4-21-21 AGGREGATE 3,000,000 DED I RETENTION$ 0 i $ 0 . NSATION AND EMPLOYERSERS .LIABILITY YI...N ', -STATUTE X ER A fE NYPROPRIETOWPARTNERXECUTIVE ! , - E L.EACH ACCIDENT $ 1,000 QOO A oFFICERlMEMBEREXCLUDED? a NIA WCC500-5010274-2019A 8-1519 : 8-1520 -- - — - -- (Mandatory In NH) I �EJ DISEASE-EA EMPLOYEE $ 1;000,000 If yes,describe under ? }---_=--- -.--EA --. _1 DESCRIPTION OF OPERATIONS below { E.L.DISEASE,POLICY.LIMiT2 $ 1,000,000 � � l DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES(ACORD 101.Additional Remarks Schedule,may be attache!If more space Is required) 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 REPRESE TIV `94988-2015 ACORD CORPORATION. All rights reserved. ACIDRD 25(2016/03) The ACORD name and logo are registered marks of ACORD a Xe eaa, W Office of Consumer Affairs and BusinessRegulation 10001Nashington Street - Suite'71.0 Boston, Massachusetts u2118 Home a mprovemen t Contractor Registration Type: Individual, JOHN DUDLEY Registration: 157108 Expiration: W/04/2021 D/B/A UNITED HOME EXPERTS ' 60 PLEASANT STSTE1 ASHLAND, MA.0172i 77 Update Addtess,ano Return Card. sCA 1 0 2OM-05117 e df, bnsumerAA r&su tion HOME'IMPROVEMENT CONTRACTOR Registration valid for individual use:oMy TYPE:'Individual before the.expiraticn date. If found return to: i � Expiration Office of Consumer Affairs and Business Regulation 1571081 08l0412021 1000 Washington Street Suite T10 JOHN D U D L E Y 4-� E Boston,MA_02118 D/B/A UNITED.HOME"EXPERTS JOHN C. DUD LEY@° 1rr2 60 PLEASANT ST STE t� J' tG ,t�'aGGr�C' ASHLAND, MA 0172t ,j of valid without signature Undersecretary Coninionweaith of Massachusetts Division of Professional Licensure ..Board of Building Regulations and Standards �:brlStrldL't7i78��t$�fVOS®r . CS-093790 EZsplres08/1012021 60 PL(EASANV ST. SUITEI Commissioner CcnsRvucQiovo Supervisor Unvestricted-Buildings®f:any use group Which contain less than 35,000 cubic feel(999 cubic meters)of enclosed space. I Failuve to Possess a MAU(eN adiYion of jhe iviassach6s4us state Building CcL9e is cause for vevocafion of this license: Fcv information about YYgis license CaIB 4617)727-3200 ov visit vnsuvv-mass.govIdpl Bid Date: 6/9/2020 United Home Experts Full Worker's Compensation Coverage 3d,000,000+Liability Ins.Coverage Owner: Linda Salvo &United Painting Co.,Inc. Industry leading Warranties Company: 60 Pleasant St.Suite 1 Flexible Payment Plans available Street Address: 14 Bertuccio Ave. Ashland,MA 01721 Family Owned and Operated City,St.Zip: Salem Ma 508-881-8555 FAX 508-881-5584 MAHICLicense#157108 Phone#: 978-270-2313 www.UnitedHomeExperts.com MA Constr.Supervisors License E-mail: iswlb6@hotmail.com RI REG#22948 RRP License#NAT-28008-1 Fed ID#04-3541521 Qty Roofing, Remove existing asphalt shingles and install new asphalt shingles,underlayment,flashing,and proper ventilation:Owens Corning system. Owens Corning Architectural Brand(if applicable): Total Cost of Labor and Materials: $$987.00 PAYMENT TERMS: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon contract authorization with 1/3 of EACH PROJECT due upon half of completion of EACH PROJECT,and the balance of EACH PROJECT due upon completion of EACH PROJECT along with any additional work requested by customer. LIENS DISCLOSURE: State law requires us to inform the property owner of contract liens.A lien or security interest has NOT been placed on the residence.Any contractor,supplier,or subcontractor may lien the real property ifthe property owner or the general contractor fail to pay for goods or services delivered or installed at the work location. Some contractors and suppliers automatically send letters of notification similar to this notice. At the owner's request, we will provide original lien release documents from anyone who provides said materials or service. NOTICE OF CANCELLATION: The property owner may cancel this transaction at any time prior to midnight of the third business day after the date of the contract without any penalty or obligation and has been notified in writing of such. NOTICE: All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to;Consumer Information Hotline-Office of Consumer Affairs and Business Regulation-10 Park Plaza,Room 5170,Boston,MA 02116-617-973-8787,888- 283-3757 or visit the OCABR websiteat hhttp://www.mass.gov/ocabr PERMIT: A building permit is required for work being done on the property listed above.The owner has authorized United Home Experts to obtain such permits as the owner's agent for any work requiring a permit.Owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. i SCHEDULE: The following schedule will be adhered to unless circumstances beyond the contractor's control arise. Proposed Work Start Date 7/1/2020 Proposed Completion Date 8/15/2020 RRR �Gr� ® • �,�. o Wit. Off.17 ?v Contractor Signat e - Date Autlloriz d Agent Date ' r f r _ f 1Begr e • CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT ° 98 WASHINGTON STREET,2ND FLOOR TEL: 978-745-9595 KIMBERLEY DRISCOLL MAYOR T'HOMAS STYIERRE DIRECTOR OF PUBLIC PROPERTTES/BUILDING CONMSSIONER Construction, Debris Disposal Affidavit (required for all demolition & renovation work) In accordance with the sixth edition of the State Building Code,780 CMR,Section 111.S 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: � f ell (name'o hau(er)" The debris will be disposed of in: a _ vsC1/c�c°i�UrCe_ (name of facility) AA y- (iddreis-bf facility) SI'nature g �Aof pphcant (today's'_ate)