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B-19-1103 - 0026 1/2 VALLEY ROAD - Building Permit The Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR liSALEM �i�Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a Cg ` _ � One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature .,Date � SECTION l: SITE INFORMATION 1.1 Propterty Addr ss: 1.2 Assessors Map&Parcel Numbers 1( h ValIN 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner'of Record: l Name(Print) City,State,ZIP I_( t& Valley, ".4 cos- 445 y1$4 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORle(check alt 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: 54 r,12 c.v,t SECTION 4-ESTIMATED CONSTRUCTION COSTS' Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ 74 "®0 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier X 3.Plumbing $ 2. Other Fees$��^— L Jy 4.Mechanical (HVAC) $ List: L..L!�. :�►!fZ7 �l1-r! 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ �,'a®®�®J ❑paid in Full. ❑Outstanding Balance Due: cC441-e� SECTION.5:. CONS T VON'SERVICES, , 5.1 Construction Supervisor License(CSL) ®eA V-'A-(A' C-0 Y—L O License Number Expiration Date Name of CSL Holder t ' ��� ' ' 1�S��r� List CSL Type(see below) V W No.and Street Type Description o��� U Unrestricted(Buildings u to 35,000 cu.ft. M A. R Restricted 1&2 Famfly Dwelling City/T n,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered ++Home Improvement Contractor(HIC) 1 63C, 0� Z! ZOZa MAC, W^,S4( 1J CA 1 0V-1 AM(A HIC Registration Number Expiration Date HIC Company Nam or HIC Regi trant Name W e.Sitvrn EVIL o.and Street AEmail address 1�I.� ���04 480�t�3- 2S�2 Ci 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.......... 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7bc 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. ad &cAc_G.✓Lo I DZ I 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.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.goy/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 halfibaths 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" �4 MAC CONSTRUCTION&R., INC. MA LIC. #110219 (781) 953 2592 MA HIC#185639 September 4, 2019 Nancy David 26 '/2 Valley Rd Salem MA 01970 Dear Nancy, The following estimate is for the roof replacement on the house on the property located at the above address. The following paragraphs describe the work that will be performed. Installation procedure • Strip existing roof on entire house down to the roof deck. • Inspect and replace any rotted or damaged decking, we allow 50 sq. ft. of plywood @no charge, $75 p/sheet thereafter for plywood and $5 p/ft for Ix8 board • Install an 8-inch white drip edge and asphalt starter strips on all edges • Install ice&water shield on eaves(6 ft.) and all roof penetrations,valleys and transitions (3ft.) • Install synthetic underlayment on all areas not covered by ice&water shield • Install new flange pipe collar on external roof pipes • Install GAF Timberline HD architectural shingles • Install GAF Snow Country ridge vent and.Low-profile roof vents as applicable to achieve proper attic ventilation • GAF Seal-a-Ridge caps on and hips and ridges • Replace lead flashing on chimney Additional specifications • Homeowners to choose shingle color. COLOR: -Fox 14 a4a,'o raj • All work will be done in a professional and timely manner • The dumpster will be placed on driveway • This quote includes the removal of up to two layers of existing roofing materials, additional layer removal incurs in additional charges • Flashings at roof to wall transitions are usually reused, if damaged beyond repair and the need to install new flashings arises; additional charges apply to R&R siding • Our dumpsters are sent to a recycling facility;therefore, no additional trash may be placed on them • We are not responsible for any of the cracks that may arise in any walls or ceilings • Please remove all valuables from walls • Building Permit from the City of Salem is included 1 ' s MAC CONSTRUCTION&R., INC. MA LIC. #110219 (781) 9532592 MA HIC#185639 Warranty: Our roof install is guaranteed for a period of five years, we will cover the cost for labor and materials to correct any issues that may arise due to faulty workmanship, additionally, homeowners have the option to get GAF Weather Stopper System Plus Lifetime material warranty directly from manufactures. Cost for Roof replacement: $9,700.00 Payment Terms: 30% deposit due upon signing contract, 30%payment due upon start and 40% is due upon completion of project Mac Construction &R.Qk er 2 CITY 4F S.UX-Ai, NWSACHUSETTS • BuUMING DEPARTNff.NT la 120 WASHINGTON STREET,3"O FLOOR �&a a TE L (978)745-9595 FAX(978)740-9846 ICI,xiBERLEY DRISCOLL THO MAYOR MAS ST.PIERRB DIRECTOR OF PE:BLIC PROPERTY/BU LDL'VG CO`MaSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information fj /� /� Please Print Le ibl Vatne(Busim-WOrganizatioNindividusl): ''`Ac 1.n + tvC. i c, /�1�� . Inc. Address: ��� w e sA e tf r1 Aw�-, City/State/Zip:�nrl �-A A OIC- ® A Phone#: -- C!S 3 Z 5- — Arepu an employer?Check the appropriate box: Type of project(required): 1.l� I am a employer with�_ 4. ❑ 1 am a general contractor and 1 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.: ?• Ptemodeling ship and have no employees These sub-contractors have ll. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp. insurance 5. Cl We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their p 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEl Plumbing rcpairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.)t employees.[No workers' 13.❑Other comp. insurance required.] •Any applivint that chucks box NI must also fit/out the section below showing their workers'compensation policy information. >I lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =ContraLton that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy infomtation. I am an employer that Is providing workers'compensation insurance for my employees Below Is the policy and job site information. /^� Insurance Company Name:_ /� A w Policy 4 or Self-ins.Lie.#: �ZI JG 03S JJD i (, ' Expiration Date:-O-i&q ,7®Z a ' Job Site Address: �1/L (jaieti City/State/Zip:Sri'e1f"v 1"l> 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 S 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 S250.00 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 rerti under the pains and penaltles of perjury that the information provider/above is truce and correct i n t ire• Date: 1 D D4 1 ci Phoned#: 9Bi .. cis — 2.j�;C Z.. Official use only. Do not write in this area,to be completed by city or town ofrciat City or Town: Permit/1.1cense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person:. Phone#• _ t 1 F °A*E` ",DD"YYY'ACR CERTIFICATE OF LIABILITYINSURANE`. _ 08/12l2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS'.NO RIGHTS UPON'THE CERTIFICATE'HOLDER.THIS CERTIFICATE GOES 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and condilions of the policy,certain poilcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holdor in'lieu of such endoesoment(s): PRODUCER CONTAC peter Lim NAME_' FRIENDLY INSURANCE AGENCY INC KQNEn.J*atl (7§.Ij 5g3 a3a4 FAX No .. ' •MAIL.. -- An0-gg,`inendlyins�Qmall_com --- 471 WESTERN AVENUE ...... _ _ INSURER{S)AFFOROINGCOVERAGE:- #}_ NAIGd LYNN _ —_--- _ _Mq 01904 INSURER A: AMGUARD INSURANCE`CO I 42390 .INSURED - INSURER B: MAC CONSTRUCTION AND REMODELING INC INSURERD: , 133 WESTERN AVE IwsuRERE LYNN MA 019042746 1 INSURER F: I COVERAGES CERTIFICATE NUMBER: 436150 " REVISION NUMBER: THIS IS TO CERTII'Y THAT THE POLICIES OF INSURANCE LIS•I'ED-BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOWTHE 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 RERTAIN,THE INSURANCE AFFORDED BY THE<'POLICIE-S OESCRiBED HEREIN IS SUWECT.TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN'MAY-HAVE BEEN REDUCED BYIPAID;CLAWS._ iNSR''--..— . AODL SUBRT --_' -----T`PO'LICI�ETFF POUCYEXP t R: TYPE OF INSURANCE. POLICY NUMBER LIMITS -i COMMERCIAL GENERAL LIABILITY . . I .. _. . i— EAA OCCURRENCE - $ — CLAIMS-MADE _.00CUR- I 'PREMISE$A gLq.q.Ynenael. 'S MEO EXP(Any ne person) S. N/A j r PERSONAL&ADV INJURY S _— GEN'L AGGREGATE LIMIT APPLIES PER: I i GENERAL AGGREGATE S -- _ ' PRO- —�POLICY. JECT ��LOC I I I. PRODUCTS•COMP/OP AGG,-S_ OTHER: `. $ AUTOM081LELIABILITY - - - COMBIN S N UMIT $ Ea accident ANY:AUTO _ -l I BODILY INJURY{Per person):. $ ALL OWNED ` :SCHEDULED ' AUTOS ,AUTOS I NSA - BODILY INJURY(Per accident) S - j - 'NON-OWNED.- I..PROPERTY DAMAGE -- — HIRED AUTOS .. 'AUTOS i {f>er_accld$nt I" — S UMRELLALIAe 'OCCUR I 4 EnCHOCCURRENCE S -- EXCESS LiAD CLAIMSnMADE NI/1 AGGREGATE `OED-. :;RE:rENT10N5 !WORKERS COMPENSATION i i PER O N AND EMPLOYERS'LIADiUTY X i STAT E E A �IWYPROPRIETORIPARTNER1EXECUTNE Y I N i ! 1 r E.L.EACH ACCIDENT S 1.000,000 OFFICERIMEMBEREXCLUDED? 1VA NIA f WA i R2WC035016 10712g/2019�,07i29/20201 - (Mandatory In NH) I I E.L.DISEASE-EA EMPLOYEE $ 1,000.000 :If SCRI TIONOcribe O , ,E.L-.DISEASE-POLICY UMIT: $ 1,000,000. -- DESCRIPTIONOFOitERAt10NStierow ' ._.... _. ... ... , _. :. i NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space to roqufrod) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant'to Endorsement WC 20 03 06'8,no authorization`is given to pay claims For benefits to employees;in slates,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:mass.govhW.d/worke s-compensafionfinvestigatibrisi; 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. AUTHOR¢EDREPRESENTATIVE... - DarnetM.CrowY)e CPCU.Vice President-Residual.Market-WCR BMA ©1g88-2014 ACORD.CORPORATION.:All rights:reserved: ACORO 25(2014I01) The ACORD name and logo are registered marks of ACORD ; Ac ® " CERTIFICATE OF LIABILITY4INSURANCE DA `Ms"`DDIYVYY' 09/11/18 THIS CERTIFICATE IS:ISSUEDsAS A MATTER OF INFORMATION;ONLYAND 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.W..an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED.provisions or be endorsed. If SUBROGATION I.s WAIVED,subject•to the terms and conditions of the policy,ceRain policies may require an endorsement.`A Statement on this certificate does not confer rights to the certificate holder im lieu of such endorsement(s). A PRODUCER; - . :,NAME i AAW insurance Agency PHco No E;<t: ac No 373 Cambridge Street MAIL Allston;MA:02134 7ADDREss:, INSURER(S)AFFORDING COVERAGE NAIC'9 .'INSURER A:: Northland Insurance Company(N: INSURED 'INSURER B-: - .. _. .. . MAC Construction-8<Remodeling, INSURER.:,; Attn:Joel A.Macario INSURER o 17 Valley Rd Lynn,MA 01902 iNsuRER E COINSURER F. VERAGES 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 i 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:SU.BJECT TO ALL THE`TERMS, { EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDO LIMITS 3' X COMMERCIAL GENERAL LIABILITY 7 EACH OCCURRENCE S­ 1,000;006 FUT CLAIMSMADE OCCUR - PREMISES Ea'occurrence 100,000. MED EXP one persony $ A" Y WS354805 08103118` 08/03/19 PERSONALBADVINJURY, $ 1,000,000 ; GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000;000 POLICY❑JECaT LOC PRODUCTS-COMP/OPAGG $ 2,000;000 OTHER:: � � � AUTOMOBILE LIABILnY „ COMBINED SINGLE LIMIT S Ea accident I ANY AUTO BODILY INJURY,(Per person) $ .: OWNED SCHEDULED - - BODILY INJURY-(Per accident) S AUTOS ONLY AUTOS- HIRED' NON-OWNED - - - ` PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY. - +' ,Perabcident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE - AGGREGATE .;. $ DED RETENTION$ $ .. WORKERS COMPENSATION 'AND EMPLOYERS',-LIABILITY LIABILITY - ST TUTE ER ANY PROPRIETOR/PARTNER/EXECUTNE❑ NIA E.L.EACH ACCIDENT $ 1 OFFICERIMEMBER EXCLUDED? (Mandatoryln NH) I.C.DISEASE-EA EMPLOYE "$ 'If-yes,describe under - - : - DESCRIPTION OF OPERATIONS'.below :- - E.L.DISEASE-POLICY.LIMIT $ DESCRIPTION OF 01PERATIONS t LOCATIONS!VEH161FS(ACORD 101,Additional Remarks Schedule,may beattaehed,if"more spaee is required)s " j CERTIFICATE HOLDER. CANCELLATION. i 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 REPRESENTATIVE f AAW INSURANCE AGENCY INC 1 ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25:(2016103) The ACORD,name and logo are registered marks of ACORD CITY OF SALEA MASSAMLSEM BUILDING DEPARTIENT 120 WASHINGPONSMET,3'DFLOOR IkL.(978)745-9395 RAMERLEYDRISOOLL FAX(978)74(M46 MAYOR TIOMAS STYIEFM DIRECTOR OF PUBLIC PROPERTY/BU[LD G COMUSSIOMR Construction Debris Disposal re A idavit u 'q fired for all demolition & renovation wo rk) In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris and the provisions of MGL c40,S54;Building Permit# ' s 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: A 6 N 5r U I'Sz (name of hauler) The debris will be disposed of in: N se-ru1 c c 3 ---U, c (name of facility) G n (address of facility) Signature of a cant /p _ v3 -JC (today's date)