B-20-703 - 0005 QUARANT ROAD - Building Permit The Comrnonwealth of Massachusetts
' Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,?80 CIVIR SALEM
O Revised Mar.2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling '
1 This Section For Official'Use Only
(� Building Permit Number: Date Applied:
t Building Official(Print me) ignature Date
�(\ SECTION 1:SITE INF TION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
;
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?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
IMR� nets cNc�s ULI�t•f:� SA/.�, , r�i.a o�g ro ` -
Name(Print) City,State,ZIP
�Dwod��n..%7" l�j} `�7$7�g®377 G.iw�e*�i,Jg 4'a�► a� y4�,o<, cps.,, ,
No.and Street Telephone y Email Address
SECTION 3:DESCRIPTION OF,PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Cl Addition ❑
Demolition ❑ 'Accessory Bldg.❑ 1 Number of Units Other V Specify;_Q,c4-
Brief Description of Proposed Work':
G Z.x 3Y
SECTION 4:ESTMOED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials Y , 115 AmO:21
1.Building $ D®r) 1. Building Permit Fee:$ Indicate how fee is determined L
2.Electrical $ ❑Standard City/Towri Application Fee
O Total Project Cost'(Item_6)x multiplier x
3.Plumbing. $ 2. Other Fees: $
.' 4.Mechanical (HVAC) $ List: ,
5.Mechanical (Fire
'~ Suppression) Total All Fees:$
a� Check No. Check Amount: Cash Amount:
Y 6.Total Project Cost: $ 6���� 1 0 Paid in Full ❑Outstanding Balance Due:
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SECTION 5 CONSTRUCTION SERVICES
( 5.1 Construction Supervisor License(CSL) r
I 0.59- 7,0
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
-4 oak r ltdGT
No.and Street Typik Description
U Unrestricted(Buildingu to 33,000 cu.ft. +
_ pr0.� y '- �� ' d Q�°® Restricted 1&2 FamilyDwelling
City/Town,own,State,ZI M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
q�' D 2G31s• arwvey.�cttir�y�o+►ic�r..c7t moo.•. I Insulation.
Telephone Email address D Demolition _
5.2 Registered Home Improvement Contractor(HIC)
i�eeT e
L-'•�P �• . i7G6zG 9- 1. Zr
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name /
?-y Do k' 'S T 9 j°A�rr��Ciao�iy�arS�i`•c7 'Gto�c-.
No.and St�,et Email address ;
pe.-A'd,, A11,9 0/4/so -:;IF
City/Town, State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.g'25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. ''.Failure tc provide
this affidavit will result in the denial of.the Issuance of the building permit.
Signed Affidavit Attached? Yes..........b 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 r y
to act on my behalf, all matters relative to work authorized by this building permit-application.
re
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 i is application is true and accurate to the best my knowledge and understanding. ;
� - 7. i3 -z® .
Pri Owner's or A nzed 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
(not registered in the Home Improvement Contractor(HIC)Program),will noe 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/dpi
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"
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Brett Emery
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From: Cimartin-fam@yahoo.com
Sent Wednesday,July 1,2020 4:00 PM
To: 'Brett Emery
Cc: Josh Roweri-
Subject: Re 5 Quadrant Rd
Hi Brett
Spoke to wife and we would like to move forward with you perform'ing all the labor. We are ok with the quotes.
Let me know when is a good time to talk further and locked down a time:
Chris
978 778 0377
On Jun 29,20201:59 PM, Brett Emery<bemery@emeryconstruct.com>wrote
Chris&Josh,
Please see attached. I put together a stock list for you Josh;see what ou think. The Want to d y They
_. : o i rail kit at the end of.
the deck near the garage.
k
A ' Chris,
Footings $1600.00
r ..
Deck frame labor $2600.00
Decking and rail labor 2400.00 '
,,
'These ace cash prices. Let me know what your thoughts are.
Regards,
e
r!
MORTGAGE INSPECTION PLAN 0
j .LOCATION:5 QUADRANT ROAD Ad%\ $OSTON c
CITY,STATE:SALEM,MA
APPLICANT:MARTIN SURVEY, INC.
R CERTIFIED TO:GUARANTEED RATE,INt P.O.0=2#Cno
DATE:09-27.2010 c t�" i mtm7lmtete
wwwBostnnrsueverNvacoet
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80.85' �8.50'DEED)
LOT 13
7,507t SF
rz
No-5
2 SWRY
�� r 9,W(DEED)
QUADRANT ROAD
SCAL -V-201
FLOOD DEMMWA770N
A-Wftt M01"°C1dC°'Asmw1Dv4ft DEED REF:1SIM145
ZONE:X pmtKnr�u wamad ned PLAN REF:99M 0°
COMMUNITY PANEL No.25009CO5320
EFFECTIVE DATE:T116f2014 0E0�
fP078 Tofibwaaacanroaaatat6Lphamust6apnw C.
oaleyntdmdpapv(dJ°a!4% COLLINS
Pem� an on as to can ro ita N78!•
MOL TWO
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CERTIFICATE OF LIABILI DATE(MMIODIYYYY)
TY INSURANCE
07/13/20
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 INSURERS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INS RE provisions or be endorsed.
a 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 NAME: Ingrid
Benevento Insurance Agency Inc —PI-40NE 7g1-699-3411FAX
497 Humphrey Street Alc No f 781-581 7200
Swampscott,MA 01907 ADDREss:
INSU S AFFORDING COVERAGE NAIC q
INSURER A: Arbelia Ins CO
INSURED
INSuRER e: Guard Ins Co I
F Emery Construction LLC Brett Emery INSURER c: Commerce.insurance Company {
24 Oak St Unit#2 INSURER D:
Peabody,MA 01960 INSURER E:
INSURER F
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COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i
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 CONTRACTOR OTHER.D000MENT 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. '
LTR TYPE OF INSURANCE INSD WV0 POLICY NUMBER AAMlD M LIMITS
x COMMERCIAL GENERAL LIABILITY
- EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE OCCUR -P-R—EMISES Me occurrence) $ 50,000
k MED EXP one $ 51000
A Y 8600069247 11/06/19 '11106110 PERSONAL&ADV INJURY $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY❑PRO.
LOC k
PRODUCTS-COMPIOP AGG S 2,000,000
OTHER: $
AUTOMOBILE LIABILITY, s e aBIN D S MIT
$ 1,000,000
ANY AUTO
s C OWNS ONLY x SCHEDULED BODILYBODILY INJURY(Per person) $
AUTOS 04/11/20 04111121 BODILY INJURY(Per accident) $
HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY PROPERTY
S
UMBRELLA LIAR H
OCCU - EACH OCCURRENCE S
EXCESS LIAR CLAIMSR-MADE AGGREGATE -
$
DED I I RETENTION S
WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY YIN x TAT
ER
ANY B OFFICE�RIMEI BER EXCLUDED?ECllrl�ED NIA E.L.EACH ACCIDENT .1,000,060
(MandatorylnNH) EMWC733479 09/08/19 09/06120 S
Iryes descdbeunder EL DISEASE-EA EMPLOYE $ 1,000,000
DESCRIPTION OF OPERATIONS Mow E-L DISEASE-POLICY LIMIT $ 1,000,000
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DESCtBPTK)N OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attacned If more space Is required)
1$ I
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CERTIFICATE HOLDER CANCELLATION
( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Chris Martin ACCORDANCE WITH THE POLICY PROVISIONS.
6 Quadrant Rd
Salem,MA 01970 AUTHORIZED REPRESENTATIVE
Bryan Benevento
�,_ 01988-2016 ACORD CORPORATION. All rights reserved.
�' •ACORD 26(2016J03) The ACORD name and logo are registered marks of ACORD
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CONSTRUCTION,
ta0ff M fdw•Nsidefltlal
' Cornawnwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Consir.y,di4�4Si3p�rvisor
CS-059344' � `~ �j
I Upires:0912512020
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BRETT S EMERY
24 OAK ST0r-
PEABODY MA.,01880..�
Contfimisaloner COL
17r,FOR FEDERAL '
450790�;
.41
0912
xQNe ,
Ofnee of Consumer Affalra&Business Regulation
} HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use onl
TYPE Individual before the expiration date. If found return to:
Expiration
Office of Consumer Affairs and Business Regulation
A7G828 09/09/2021 1000 Washington Street -Suite 710
BRETT S EME�i� � Boston,MA 02118
D/B/A EMERY UCTION
BRETT S.EMERY
24 OAK ST UNIT A2.-
PEABOt)Y,MA 01960 UndersecretaY Not valid wliasignature
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The Comimnwe4"ofMassachuwds .
Department o i e lndusaialAcfden
I _ is
4 Covffl$Serest,Suite 100
Boston,MA 02114.201 T`
H+w+casrassgov/dia
t I Uk, 1 tiorkesB'Compenaetion Insura nee A davitt201111ers/Contractors/ElectriciaesiNumbem
TO IIE FILED WrM THE
�licant Info PERMITitIVG AUTHORt'1'Y.•
rmation Please Pr[nt Legibly
Name(9usinessOr dot/Ldivivan: �
LC L
Adt ass: Z L/ t'O ck k S
Ci /Statwzi o
._ ty p: ��� � .� ,Phone#: q 7k•�� . Z G 3
Are you i m employer:Cheek the apptnptiate box
t 7Y* ofp��frog ,
e aired):
1. 1 am a employer wuh employees(Atiland/orpsrt tna�' 7. 0 Now ConstrucYton'
2. a or
Q I am sob my wttr►me6ipeadhavenoaapkyewwadit so%mei6_ 8. []Remodeling
3.0 I am a homeowner doing all watt myself(rro warders'eontp.h�urence rega1red.l• w 9: El DemOHtson 1
4.01 am a homowner amd will be hiring cowmctors to conduct all wortam lay property.'[will. 10 Q Buildutg eddlti0n
auiae that aU tanuactm either havo wodtas't'mpemsation fiLun ee or are sole, Electrical rell8(lg:Or additions'
wpriaM whh IIo employees ,� _
e s 12 dPlutubtng repairs or additions;
3.01 aims getrcraiemtmtxdrand l hive hbW the dialed om}he attached shM, _ -
Tkw mbcontractots have emptayeea wtd-heve wotloW oanv inx a ms 13•Q Roof resits,
4 6.0%care a aotyomtion ad its officers h,,exmrai d t6am right of n per MOL a 14.Q Otbt3r
` 1SX fl(41 wd we imve'no employees(No war".amp,tan=,,qudtad,J
+Any applicant tbd chee><s hot;#1 must ah o tall out the weth m below -
• �!O!vmB�► 4•anmpe�ion pD&eY informat�o," .
t H0Mwwmas who submit drn awdavit imdtoattgg they-so doling as work aadtbga hbo outside contmctas must submit a sow td"Uh odicettns such•
tcaria aura dsa chiA this boa mud amtew an additional sheet showing tbentme of do m64anw asm and see wherhv or not thane ealitlea have,'
-.employem if the sab•oonuumn have anployees,they trust proviQe thou►iorla rs•o0
w .. mp.pokey number.
7'm an�ewlew thatIsprotdding workers'con�renettdon>Tnsunanaejor:n�e,�ployees Xdow la rhepaltry ale�l/'ob she j
} Insurance Comp*Name:_ GQ Z,>_.
ft'hi io l Date `
Job Site Address• taw a t how CwStaterzip.��/ of r�
Attach a copy of the workera'compensation policy declaration Page(flawing the policy number and eapirat(oa date.
Failure to secure co ,
verage as required under MOIL c'152,§25A is`a criminal violationpunishable by'a Erne up to$10500.00
and/or onayear imprisonment,as well as civil penalties in the form of a STOP WORK 0RD9R and a fine of up to$2%06 a.
r day against the violator.A copy of this statement may be forwarded to the Office oflnvestiptions,oflhe DIA for insurance
i coverage verification.
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1 /do hereby ' thepos and penalda iVPedruy that tyre Injormadon provided above is brie and correct
Signature.— '
.. — .
•Date: � Z
Phone i1: ��'�'• Z G `
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i •O,�iclal rose only. Do not tta1te m this ones to be eosuplded by eI{y of torwr o�'Iclat? r
-71
A City or Town•
..
Permit/Llceaise it
: ..Issuing Authority(ctide one):
i.Board of Health 2.Building Department 3.Cky9own Clerk 4.Eleetrlcal Inspector 5.Plumbing Inspector
6.Other
1 Contact Person: Phoned:
o � y
f _ , CITY OF SALEM,MASSACHUSET M
1 'BUILDING DEPARTMENT
.98 WASHINGTON STREET,2ND FLOOR
I T4:978-745-
_ 9595
KIMBERUY DPisco L
MAYOR'
THOMAS ST PIERRE.
DIRECTOR:OF PUBLIC PROPERTIES
COMMISSIONER
Construction Debris,Disposal Affidavit
(required for all demolition-& renovation work)
In accordance with_the siicth edition of the State Building Code,780 CMR,5ection 111.5 Debris,
{` and the provisions of M(i c40,554;Buildin Penmt
_> _ ,is issued with the '
condition that the debris resulting from this work shall be disposed of in a pr6pe.rlV licenses `
waste.deposit facility as defined by MGL t 111,S150A.
- The debris Will be transported`by:i•
(name of hauler)°
The debris will be disposed of In
(name of facility)
f (address of facility)
t
Signature of applicant
(today t date),'"-' TM`
d �