Loading...
B-20-866 - 0055 BUFFUM STREET - Building Permit The Commonwealth of Massachusetts ` OF Board of Building Regulations and Standards CITY M Massachusetts State Building Code,780 CMR SALE W 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: Building Official(Print Name) Signature Date SECTION I: SITE INFORMATION 1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 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 Yazd 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`OWNERSHIl' 2.1 Owner'ofRecord: / / 41 /M? U1�7® Name(Print) City,State,ZIP �` �!� - 7 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ TAddition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work2: _ ®It i !' SECTION 4 ESTIMATED CONSTRUCTION.COSTS` Estimated Costs: Item Official Use Only (Labor and Materials 1.Building $ �' , �o 1. Building'Permit Fee- $ Indicate.how fee is determined: ❑ Standard CityJown Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List. =e: rt a .a� 5.Mechanical (Fire $ Suppression) Total_All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $��g , �® 0 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES::.:: 5.1 Construction Supervisor License(CSL) ®� - ,& 1/ 10W Se G'{ h ©C /® t- License Number Expiration Date Name of CSL Holder List CSL Type(see below) Normand Street C Type:: Description / ® U Unrestricted(Buildings u to 35,000 cu.ft. C/ R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Sidin (� SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 7 el HIC Registration Number Expiration Date Inc Company Name or egistrant Name No.and Street q �` Email address City/Town,State,ZIP Telephone SECTION 6:.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG.L.c.452.§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 ��f��y e ���U��✓ to act on my behalf,in all matters relative to work authorized by this building permit application. 4M4ed &-m/0201kc 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. SSerill Ces ZA0/0�0a_V 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: Information on the Construction Supervisor License can be found at :mass:gov/dM, 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"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations r 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit-.Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lesiibly Dame(Business/Organization/Individual Address: XT bull-ti yot City/State/Zip: _';�;el �o Phone#: Aren employer?Check the appropriate box: Type of project(required): 1.JDi am a employer with_` 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have"no employees I These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance.t required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ i am a homeowner doing all work officers have exercised their I].[]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑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 indicting they are doing all work and then hire outside coittractors must submit a new affidavit indicating such. tContractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name s %1 G Q✓� �f f'� �E'��e�✓ Policy#or Self-ins.Lic.#: 3�S ~��- — 4 0-0 Expiration Date:_JT��/ Job Site Address:_ �5V i��(/ :S'T City/State/Zip: ' Af^.'n 170 OlVO 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 ofthe 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 Sisnature• � Date: ZZ/ zgog Phone#. _ O 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.C by/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE .4CQRt1. CERTIFICATE OF LIABILITY INSURANCE 05/2 os/2 MIDDIYY 9/202 0 PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE NAIL# INSURED INSURERA:Evanston Insurance SRMB Contracting LLC INSURERS:Liberty Mutual 203 Washington Street #256 INSURERC: INSURER 01 Salem MA 01970- INSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADUL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MIAlDD1YYI LIMITS A GENERAL LIABILITY MMVIPBC000567 09/23/2019 09/23/2020 EACH OCCURRENCE s 1000000 g COMhIERCIAL GENERAL LIABILITY PRISES(RENTED ,ce s 100000 CLAIMS MADE OCCUR / / / / MEDEXP(Any one ) S 5000 PERSONAL&ADV INJURY S 1000000 GENERAL AGGREGATE $ 2000000 GENT_AGGREGATE LIMB APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 POUCY PE LOC / / / / ti0Y1f€D AUTOMOBILE LIABILITY / / / COMBINED SINGLE UMIT ANY AUTO (Ea arci3erl) S ALL OWNED AUTOS / / ' / BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS / / ! / BODILY INJURY NON-DINNED AUTOS (Pet accidentl $ PROPERTY DAMAGE (Per aacalerM g GARAGELIMUTY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / ' / OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE / / / / $ RETENTION $ $ B WORKERS COMPENSATION AND WC2-31S-621964-020 05/08/2020 05/08/2021 B TORY uaTs °R EMPLOYERS'LIABILITY ANY PROPRIETQRiPARTNER/EXECUTIVE EL.EACH ACCIDENT $ 100000 OFFICERIMEMBER EXCLUDED? I / / / E.L.DISEASE-EA EIAPLOYEE s 100000 If yes,describe under SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONSILOCATIONS/VEIICLESIEXCLUSIONS ADDED BY ENDOR^SEMENTISPECiAL PROVISIONS a. CERTIFICATE HOLDER CANCELLATION — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO NA& 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Town of North Andover FAILURE TO DO SO SHALT.IMPOSE NO OBLIGATION OR LIABILITY OF ANY IWO UPON THE INSU S AGENTS OR REPRESENTATIVES, A REPRESefTHE ACORD 25(2001108) ACORD CORPORATION 1988 Office of Consumer Affairs and Business Regulation 1000 Wa shington ton Stye et Suite e 710 Boston, Mass-husetts 02118 Home IrnprovementContractor Registration . . Type: LLC SRMB CONTRACTING LLC Registration: 197492 D/B/A PRESERVE SERVICES Expiration: 12/17/9021 203 WASHINGTON ST#256 SALEM,MA 01970 Not Jt 1"- &C I O. st c rtr. Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before the expiration date. It found return to: Ae1974 lion Irxptr 2 on 2i Office of Consumer Affairs and Business Regulation t9Y492,` =12/17/2021 ?� 1000 Washington St"rest -Suite 710' SRMB CONTRACTING LLC �b Boston,NIA 02118 � O/B/A PRESERVE SERVICES SEAN P.O'CONNORF ✓� 203 WASHINGTON STj#288�: SALEM,.MA 01970 undersecreta Not valid without signature ry k commonweatlth of Massachusetts Ol.vision of Protessiottal Lloosure aoard Of Euitdirag Rcgulattons and.Standards Cottsttut�t�b� rv��or CS-093403 Op 213112021 SEAN OCONNOR 26,CHESTNu SY ' SALEM MA 01990'_ Commissioner s r SALEM carpentry n )decks I ranf ng �aica .9 ,MA. 1970 �:, ` :978.745.3476 SALES@PR SERVESERVICES.00M Jessica Mitchell - Date Bid:7/22/2020 55 BuffUm st Estimator:Wesley Da Silva Salem MA 01970 Mobile:(978)594-6042 Email:wesley@preserveservices.com (508)654-5587 jessroy(a),gmail.com CARPENTRY *FRONT DORMER: Replace all shingles on front dormer and left side the dormer. Replace 10 shingles on front wall. *REAR DORMER: Replace 2 courses off shingles on front dormer and right side the dormer. Replace the sill nose on 1 double window. *RIGHT: Replace 3 or 4 shingles on the wall. Install 1 section of the railing on 3rd floor deck, Owner have the section of railing. PRICING Painting $0 Carpentry $6,985 Basic $6,985 Sales Tax $00 Total Price $6,985 Including Labor and Materials Payment Terms: 33.3%.deposit; 33.3%progress; 33.3% end of job McNisa/Amex DO NOT SIGN THIS CONTRACT IF THERE SPACES. tre f Wesley Da Silva Custo ADDITIONAL TO ABOVE: BID 1: If we need replace extra shingles will be $60 per hours plus material. Price $ Including Labor and Material l�2 5p,-Q S1 bi\J C—VTv 9AE5 O t, v^ �Y SIGNING CONTRACT:No work shall begin before both parties sign the contract and the owner has a copy. INSURANCES: $2,000,000 Liability Insurance and Workers Compensation. PRODUCTION NOTE: If we are powerwashing your home the windows may be streaky post washing. If you wash your windows on a regular basis,you should wash them after we wash the outside of your home. PAINTS INCLUDED:Ben Moore Regal Paint and Arborcoat Stain;C2 Paints and Stains;Sherwin Williams;Equivalants with other major manufactures. Specialty paints and stains will be extra. . ESTIMATE VALID FOR:The carpentry portion is valid for 60 days and the painting portion is valid for 365 days. LIMITED WARRANTY: SRMB Contracting LLC DBA Preserve Services is soley responsible and warrantees all exterior painting against blistering and peeling for a period of 2 years. The only exclusions are:wooden gutters;walked on surfaces; and structural problems such as but not limited to"mill glazing."Should peeling or blistering occur we will fix the affected area including labor and materials. . WARRANTY LIMITATIONS:Warranty work will be performed in a workmanlike manner by the independently owned Franchised business,SRMB Contracting LLC DBA Preserve Services,who contracted the work.For the warranty to be valid the final invoice must have been paid in full by the client.The independent Franchised business is solely responsible for performing the warranty work in a timely and workmanlike manner. Preserve Services Franchise Systems, LLC("PSFS")is not responsible for performing or paying for the warranty work.PSFS requires each independently owned Franchised business to maintain a warranty escrow account.In the event that the Franchised business is unable to honor its warranty obligation PSFS will contract a qualified company to perform the warranted work up to$10,000 per claim.Valid warranty claims will be paid in the order they are received and only until such time as the Franchised business's warranty escrow fund is depleted. PSFS assumes no liability for warranty liabilities that exceed the escrow account nor does any other independently owned business in the PSFS system. REGISTRATION NOTIFICATION:All home improvement contractors shall be registered.If you use an unregistered contractor you are not be eligible to access the Home Improvement Contractor Guarantee Fund. Office of Consumer Affairs and Business Regulation Home Improvement Contractor Program, 1000 Washington St, Boston,MA 02118 617-973-8787. ABITRATION CLAUSE: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 Regulation and the consumer shall be required to submit to such arbitration. YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.