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B-19-761 - 0029 BOARDMAN STREET - Building Permit t t ' C4 5 The Commonwealth of Massachusetts ',N .- "°'� Board of.Building Regulations and Standards CITY OF WMassachusetts State Building Code,780 CMR Hf j q JUL I IS S' EM Revised ar 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:,. p Bwldtnl;Official(Print Name) Signature Date- SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 29 Boardman Street L l a 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ .SECTION 2 PROPERTY OWNERSHIP - 2.1 Owner"of Record: Andrea Zeren Salem,MA 01970 Name(Print) City,State,ZIP 29 Boardman Street 978-302-0056 andreazeren@gmail.cwm No.and Street 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 Specify.Roofing Brief Description of Proposed Work2: strip rear porch roof and replace with architectural shingles replace gutters on porch SECTION 4:ESTMIATED CONSTRUCTION COSTS Estimated Costs: ST .:Official Use Only ' Item Labor and Materials " i e• ]..Building $5225 1 Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Applicahori Fee,. ❑TotaLProject Cost(Item 6)x multiplier. x 3.Plumbing $ 2 Other Fees: $ 4.Mechanical (HVAC) $ 5.Mechanical (Fire ; Su ression Total All Fees:$ Check No. Check Amount Cash Amount 6.Total Project Cost: $5225.00 --],[:]-Paid m Full ❑Outstanding Balance Due: ' # SECTION 5 CONSTRUCTION SERVICES: 5.1 Construction Supervisor License(CSL) 094763 5l14/20 Tom Dobbins License Number Expiration Date Name of CSL Holder List CSL Type(see below) 11 23 R Winter Street, es T e Dcri hob No.and Street yp p U Unrestricted(Buildin s u to 35,000 cu.ft.) Peabody, 01960 R Restricted 1&2 Family Dwelling City/Towh,State,ZIP M Masonry RC Roofmg Covering WS Window and Siding SF Solid Fuel Burning Appliances 978-531-Ei234 office@lengibely.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 100811 6/22/20 Len Gibely Contracting HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 23 R Winter Street, office@lengibely.com No.and Street Email address Peabody,MA 01960 978-531-8234 City/Town,State,ZIP Telephone SFCTION 6.'WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G _ a Workers Compensation Insurance affidavit must be completed and submitted with this application.rtFailure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .........V` No...........❑ SECTION 7a OWNER AUTHORIZATION TO BE COMPLETEDWHEN OWNER'S AGENT OR`-CONTRACTOR APPLIES FOR,BUIL DING PERMIT , ,..._ , I,as Owner of the subject property,hereby authorize Len Gibely Contracting to act on my behalf,in all matters relative to work authorized by this building permit application. Andrea Zeren Print Owner's Name(Electronic Signature) Date OWNER'ORAUTHORIZED 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. Tom Dobbins r7 - 1 - •_2 e.--:>L f f Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES .._ l. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor ctor (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 w"i.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass. og v/dps 2. When substantial work is planned,provide the information below: Total flocir 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" t. The Commonwealth of Massachusetts Department of Industrial Accidents _ 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PEPMTTING AUTHORITY. Applicant Information Please Print Ledbly Business/Organization Name:LEN GIBELY CONTRACTING Address:%?3 R WINTER STREET City/Stag;/Zip:PEABODY, MA 01960 Phone#:978-531-8234 Are you an employer?Check the appropriate box: Business Type(required): 1.❑✓ I am a employer with 10 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] g• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment. their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees. [No workers'comp.insurance required]* 4.❑ We are a non-profit organization,staffed by volunteers, 11.❑Health Care with no employees. [No workers'comp.insurance req.] 12.❑✓ Other CONTRACTING *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:AIM MUTUAL INSURANCE COMPANY Insurer's Address:29 BOARDMAN STREET City/State/Zip: SALEM, MA 01970 Policy#or Seplf--ins.Lic.#VWC10060109792018A Expiration Date:8/3/19 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 Signature: Date: / — 1 � Phone#: 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia Aco CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) o7/19/27/1s/2o1s 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 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 NAME: Fran McEvoy CROSS INSURANCE-WAKEFIELD INC ac°"N Et): (207)947-7345 aC No: E-MAIL ADDRESS: fran@sennoffinsurance.com 401 EDGEWATER PLACE STE 220 INSURERS AFFORDING COVERAGE NAIC# WAKEFIELD MA 01880 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B LEN GIBELY CONTRACTING COMPANY INC INSURERC: INSURER D: 23 WINTER STREET REAR INSURER E: PEABODY MA 019605941 INSURERF: COVERAGES CERTIFICATE NUMBER: 293400 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. ILTRR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD ICY EFF POLICYI EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGESI RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEO ECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea axident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X1 SPER TATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? NIA NIA NIA VWC10060109792018A 08/03/2018 08/03/2019 _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ff more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue.date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.m<iss.gov/lwdiworkers-compensation/investigations/. `CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Len Gibely.- ACCORDANCE WITH THE POLICY PROVISIONS. 23R Winter Street _ AUTHORIZED REPRESENTATIVE _ Peabody - >• MA 01960 'P C Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE °Ao;22,�o,9 T 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 NOTCONSTITUTE 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 cy('li Ie5}must have ADDITIONAL INSURED provisions or be endorsed. po If SUBROGATION IS-WAIVED,subject.;to the terms and conditions-of the policy,certain policies.may require an endorsement A statement<on this certificate doP`not confer rights tothe;certificate holder in lieu of such endomement(s),. PRODUCER: CONTACTStephen.GID Cross insurance-Wakefeld PHONE d: (781)914-1000 F^� (T 81)224-5777 as no e (to, 401'Edgewater Place.Suite 220 ADDRESS: sgill@sennottinsurance.corn INSURER(S)AFFORDING COVERAGE NAICS' Wakefield MA 01880 United National Insurance Co: 13064 .._. INSURER'A INSURED ... .;.. .... -' - ` IN31BtER:B.: Safety Indemnity 33818 Len(gbely.Contracting Co:,Inc. INSURER.C;: 23R Winter Street INSURERD INSURER E:: Peabody MA 01960 INSURER F': COVERAGES CERTIFICATE NUMBER: 19-20 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE7NSURED NAMED ABOVE FOR-THE POLICY PERIOD INDICATED. NOT msTANNNG ANY REQUIREMENT,TERM ORCONDITION OF ANY CONTRACTOR 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. Melt LTR TYPE OFINSURANCE INSD WVD POUCYNUMBER.. (MOLUDD LIMITS x COMMERCIAL�.CENERALLIABILITY E.4C1•IOCCURRENCE- $ 1,000;000 CWMS-h4ADE OCCUR PREME REN ISES To ES $.5DOW . .. .. MED EXP one person) $ 5• ._ A L7221167-A 01Y29/2t}79 01/29/2020 PERSbNAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2-000,000 X POLICY❑JEC LCd PRODUCTS-COMPIOPAGG $ 2,1I00,000 OTHER- AUTOMOBILE L1ASUff ...: _. _.... COMBINED SINGLELIMIT - $ 1,000 000 ANY AUTO BODILY INJURY(Per person): $ - - B. OWNED SCHEDULED 6221693. 01/2012019 01/29/2020 BODILY INJURY AUTOS ONLY X AUTOS LY Y(Per dent) $' HIRED - NON-0WNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY -Per acadera � $ ........ $ UMBRELLA UAB OCCUR EACH OCCURRENCE :$. EXCESS'LIAS H:CLAIMS-MADE AGGREGATE. -_$ DED.. .RETENTIONI$ ,$1 WORKERS COMPENSATION - .. - .. PER--. OTH-: AND EMPLOYERS'6.ABILnY YIN :STATUTE, ER_. ANY PROPRIETORIPARTNERIDIFCUTNE E.L.EACH ACCIDENT $. OFFICF_RIMEMBER E7(CLUDED2 ❑_ MIA. _ (Mandatory In NH) E.L DISEASE-EA-:EMPLOYEE $ if yes,describe under .. - DESCRIPAONOF.OPERAT IONS below .. _._. EL.:DISEASEcPOLICY LWIT` +$: :DESCRWTWN'OF OPERA ROM I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Spiedule,may be attached B more space is required) - CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED'POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILLBE.DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.. •. - ., .. AUTHORLMD REMESEWATNE ©1986-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The'ACORD name and logo are registered marks of ACORD LEN TGIBELY CC)NTRACTING CO., INC. submitted To Page No of Pages " Name Andrea Zeren -H 23 R.W i nter Street _ Pea body,MA01960 - PRO.POSAL " phoneAddr6sS97$02-0056nStreetDate. 628/1g970 (978)531 8234 Fax:(978)531=9304 E •,andreazeren@gmail.com F E www.lengibely.com office@lengibely.com _ _ mail Job Location,;Same, MA Reg pstration 100811 w All home improvement contractors and subcontractors engaged In home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142 A of the general laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place Room 1301, Boston, MA 02108 (617)727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Rugulation and the consumer shall be required to submit to such arbitration. We hereby submit specifications and estimates for work to be performed and materials to be used as follows: Strip back porch asphalt shingled roof up to two layers and dump all trash. Check all boarding and replace rotted/defective boards @$4/If or$2.50/sf if needed. Install Certainteed Roof Runner synthetic felt underlayment to all surfaces. Clean and inspect area flashings: Install 8 inch white drip edge to all perimeter edges. Install Certainteed Swiftstart and Certainteed Landmark architectural shingles. Remove and dump entire right side gutter and fascia. Change fascia to new PVC. Install seamless white aluminum gutter and downspouts. Remove and dump parch gutter and fascia. Change fascia to new PVC. Install seamless white aluminum gutter and downspout. Access and assess if there is a gutter above porch roof and it's condition for estimate if needed. WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this agreement,unless specified herein writing. Contractor will begin the work in approximately 1.5-3 months Barring delay caused by circumstances beyond Contractor's control. All work is weather dependent. The work will be completed in approximately_1-2 days . The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not to considered as violations of this Agreement. Hidden rot or conditions not seen at the time of estimate that are required to be repaired in order to complete this contract,will be completed at$$85 per MAN HOUR. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of 3 Years following completion and shall comply with the requirements of this Agreement. WE PROPOSE hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of Five Thousand Two Hundred Twenty Five dollars($ $5,225 ) All guarantees on all products from manufacturer Payment to be made as follows: Clean job site&remove all job trash ADD PERMIT COST IF NEEDED-WE PULL PERMIT ($Zero _)upon signing Contract NOTICE:No agreement for home improvement contracting ($Balance work shall require a down payment(advance deposit)of more upon completion of Job_) than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make,in % ($ _)upon completion of advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater. This proposal may be withdrawn by us if not accepted within days �---� uthorized Signature. ACCEPTANCE OF PROPOSAL I have read this document and accept the prices,specifications and conditions stated.I understand that upon signing this proposal becomes a binding contract.You are authorized to the work specified.Payment will be made as outlined above. YOU the Buyer,may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction.Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature: Date: 6/29/19 Signature: Date: Commonwealth of"V assachusetis Division of Professional Licensure Board of Building Regulations and Standards 55-094649 expires:03t08/2020 BRIAN J BOBBINS Commissioner r'%fie`�C�)X)N(iY2lltelrltll c�^:l�rrJ:;atlrr�v�t Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Oration before the expiration date. if found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 106811 06/22/2020 One Ashburton Place-Suite 1301 LEN GIBELY CONTRACTING COMPANY,IIdC, Boston,MA 02108 BRIAN J.BOBBINS. 23R WINTER STREET PEABODY,MA 0196o Undersecretary' Not valid 6ifthout signature ° I i i Commonwealth of Massachusetts Division of Processional Licensure Board of Building Regulations and.Standards CS-094763 Expires: 05114/2020 THOMAS R DOBBINS i i i Commissioner CIL i I ftiP`�nraixn�2ine{r/�c�^?��uuu�/rutell�- ,: I Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPL Supplement Card before;the expiration date. If found return to RRegisfxation. Expiration Office of Consumer Affairs and Business Regulation i 1008f 1 "" 06/22/2020 One Ashburton Place Suite.1301 LEN GIBELY CONTRACTING COMPANY,INC. Boston,MA 02108 i i a THOMAS BOBBINS �+� •� {G.�� _.a�- • 23R WINTER STREET PEABODY,MA .0196() Not valid without signature Undersecretary 1 e i i