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B-19-1170 - 0021 BOARDMAN STREET - Building Permit REU, WED s� The Commonwealth of Massachusetts ,i t.` Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR Revid Mar 011 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: Building Official(.Print Name) Signature Date SECTION 1:SITE INFORMATI 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 21 Boardman Street Lla 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❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Jon Winsor Salem, MA 01970 Name(Print) City,State,ZIP 21 Boardman Street (617) 359-7628 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 Work2:Strip and Re-Roof 8SQ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $5,000 1. Building Permit Fee:$ 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 (11VAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression Check No. Check Amount: Cash Amount: 6.Total Project Cost: $5,000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-113557 1 oi6i22 Enda S Garry License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 346 Western Ave#2 No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. Lowell,MA 01851 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 617-908-0242 permits@greaterbostonroofing.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 191498 4i23120 Enda S Garry, HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 346 Western Ave#2 permits@greaterbostonroofing.com No.and Street Email address Lowell.MA 01851 617-908-0242 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 ..........X 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 Enda S Garry to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's N (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 applicaf n is true and accurate to the best of my knowledge and understanding. Idl I rh q Print Owner's or Autho Agent's Name(Electronic Signature) I 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.eov/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" CrrY aF S�-�tir, tii�3ss,A cxisE�rrs • BUUMLNG DEpkRTm&NT ` 130 W ASHNGTON STREET,310 ftooR TEL (978) 745-9595 FAX(978) 740-9M IO,NiBER t FY DRISCOLL MAYOR 'IHoma ST.Pw-m DIRECTOR OF PUBLIC PROPERTY/Bun.DING CONMUSSIONER 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 111.5 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 will be transported by: Republic Services (name of hauler) The debris will be disposed of in : Republic Services (name of facility) 385 Dunstable Road tynsborough,MA (address of facility) signature of permit applicant date debrisat7:doc The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEiblV Name (Business/Organization/Individual): Greater Boston Roofing Corp Address: 346 Western Ave Unit 2 City/State/Zip: Lowell, MA 01851 Phone #: 978-905-5045 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.: ❑ required.] 5. ❑ We are a corporation and its 101-1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑x Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 131-1 Other 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. $Contractors that check this box must attached an additional sheet showing the name 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Policy#or Self-ins.Lic.#: VWC10060228482019A Expiration Date: 01/24/2020 Job Site Address:21 Boardman Street City/state/zip: Salem, MA 01970 Attach a copy of the workers' compensation policy 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$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. Be 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 of perjury that the information provided above is true and correct. Si ature: .rQ Z_al i Date: 8/20/19 Phone#: 978-905-5045 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone M . .�:.• �r%iJi.7vr/�r.I//r r�r:/��ii,:iri,iiu.;r//: � - t)fBee Of ConsumerAffsirs&Business iegulotion Commonwealth of Massachusetts. HOME iMPROvEi4ENT CONTRACTOR ® Division of Professional Licensure TYPE:COr00r8UGn Board of Building Regulations and Standards Registration Ho ConstrUctt n 5uoervisor 191498 04/23/2020 CS-113557 N i •.GREATER BOSTON ROOFING CORP Expires 10/06/2022 ENDA S GARRY *',� 278 K STREET 1. NO2 ENDA`OARRY n n BOSTON MA 0212T �` �+M w 278 K ST#2 "^" �""— �a,• BOSTON,MA 02127 C ----:� Undemecretary S Commi"loner Construction Supervisor Unrestricted Buildings of any use group which contain r, iessthan 36,000 cubic feet(991 cubic meters)of enclosed: space. Regiatradon valid for Individual'use only before the explraHon date. If found return to: Office of Consumer Affairs and Business Regulation One Ashburton Place.Suite 1301 Boston,MA 02108 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.govfdpi Not Vail without signature - 21 � Y Ago CERTIFICATE OF LIABILITY INSURANCE DATE(M.M,DD""") 03/0512019 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 endorsemengs). PRODUCERGlobal Help Center Inc NAME T TATIANA SALES 1252 LAWRENCE ST SUITE C2 PHONE 978-421-7769 FAX 9T8-710-5581 Lowell MA 01852 Ale NO E-MAIL ADDRESS,9owe hclll@hotmail.com �.% INSURER`S AFFORDING COVERAGE NAIC 0 INSURER A:WESTERN WORLD INSURED GREATER BOSTON ROOFING CORP INSURER I:NAUTILUS INS 27 JACKSON ST APT 123 INSURER C:AIM MUTUAL INS CO LOWELL MA 01852 - INSURER D: _ INSURER E: INSURER F: t 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 `n3DL SUB POLICY EFF POLICY EXP LT R TYPE OF INSURANCE POLICY NUMBER M/DOM'Y1� MMfD LIMITS be COMMERCIAL GENERAL LIABILITY Li M ' EACH OCCURRENCE $1,000,000 CLAIMS-MADE ✓�OCCUR DAMfk-GtY"b"KtNIL SU 100,000 PREMISES(Ea ce—unen — MEO EXP(A one person) S 5,000 A NPP851 T412 01125/2019 01/25/2020 PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2,000,000 IqPOLICY ElJJEECT LOC PRODUCTS-COMPIOP AGG S 1,000,000 OTHER: �1�-- AUTOMOBILELIABILITY ILi COMBINEDt SINGLE LIMIT Ea ecaden $ ANY AUTO BODILY INJURY Per( person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S A TED S ONLY AUTOS ONLD 1 -(FROaEuRllfa DAMAGE S II S UMBRELLALIAB ✓ OCCUR _ EACH OCCURRENCE 52,000,000 B S/ EXCESS LIAR Ll CLAIMS-MADE ANA047621 D1/25/2019 �01/2512020 gGGREGATE $2,000,000 DED RETENTION S l WORKERS COMPENSATION ✓ PEATUTQ,,, ERH„`_ AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNEREEXECU I IVE YIN $ 100 000 OFfICER/MEMBEREXCLU0E0? N MIA E.L.EACNACCIDENT $ r C (Mandatory In NH) VYVC10060228482019A 11124/2019 0112412020 E.L.DISEASE-EA EMPLOYEE S 1009000 If yes.describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $500,000 Elho DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) HIS W.C.POLICY DOES NOT COVER ANY OTHER STATE THAN MA. CERTIFICATE HOLDER CANCELLATION S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN „-'Town Of Salem ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ir 1 TATIANA SALES !' ©1988-2015 ACCIA CORPORATION. All rights reserved. ACORD 25(2016103) The.ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www.FormsOoss.com(c)Impressive Publishing 800-2011.1977 10/17/2019 Estimate Print Preview Greater Boston Roofing 10/17/2019 346 Western Ave •'e Lowell MA 01852 Phone:617-744-9690 GREATEN BOSTON Fax:978-418-0233 FUM Company Representative Lisa Zonfrillo Phone:(617)543-5472 lisa.zonfrillo@greaterbostonroofing.com Jon Winsor Job:2145:Jon Winsor Ace Solar 21 Boardman Street Salem, MA 01970 (617)359-7628 aRoofing Section I •Strip existing shingles down to bare wood, Inspect integrity of roof decking thoroughly. i IF UNUSABLE OR ROTTEN WOOD IS FOUND DURING INSPECTION IT WILL BE REPLACED AT A PRICE OF$60 PER SHEET OF PLYWOOD SHEATHING OR$4 PER LINEAR FOOT OF LEDGER BOARD*") ? •Install ice&water shield to first 6-feet on eaves,3-ft in valleys and immediately surrounding all protrusions -Install synthetic vapor barrier underlay I •Install all new white 8"non-vented drip edge on perimeter ! •Install manufacturer suggested starter course of shingles on eaves and rakes •Install GAF Timberline HD 50 yr.Lifetime/architectural shingles in color of your choice •Install ridge vent I •Cap ridge vent properly with manufacturers suggested cap l •Properly flash any protrusions and all new pipe flanges ' •Install new lead flashing around chimney •Maintain a clean job site throughout project,with meticulous clean up of site upon completion •Submit project for manufacturer's extended warranty upon completion of project i *"'ESTIMATE/CONTRACT PRICING INCLUDES THE TOTAL COST ASSOCIATED WITH MATERIALS, LABOR, PERMIT a COST,AND ANY DUMPSTER/REMOVAL FEES INVOLVED IN COMPLETING THE PROJECT.** Qty Unit GAF Timberline HD 8 SQ f •Color of your choice •50 yr./Systems Plus Lifetime Warranty `. Ice and Water Shield 0 RL i Vapor Barrier 0.8 RL Drip Edge 0 PC 1. GAF ProStart Starter Shingle 0 BD GAF Cobra Snow Country Ridge Vent 0 LF ? GAF Seal-A-Ridge Hip and Ridge Cap 0 BD ` Roofing Coil Nails 0.53 BX ? Chimney Lead Flashing 0 EA i Pipe Flashing(up to 4") 0 EA 44� Company Provided Lead Cost 0 SQ TOTAL $5,000.00 1/2 10/17/2019 Estimate Print Preview *Any work related structural deficiencies or work required to complete project to Massachusetts Building Code not covered in this estimate will require Change Order.Roof decking replacement cost will be billed at$60 per sheet of plywood or$4 per linear foot of ledger board. Company Authorized Signature Date Ql&n to IF I Customer S6Aature Date Customer Signature Date 2/2