B-20-594 - 0009 VISTA AVENUE - Building Permit The Commonwealth of Massachusetts
Board of:Building Regulations and Standards CITY OF
SALEM
Massachusetts State Building Code, 780 CMR
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:
/ w p%
ui ding Official(Print Name): Signature: Date
SECTION 1:.SITE INFORMATION .
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
VisVA I'Vl;• 9 151
1.1a Is this an accepted street?yes no TMap Number Parcel Number
1.3 Zoning Information: 1.4.:Property.Dimensions:
AI A/TI4 - I5-, 02.2- IIS
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
IS $ I 64- 6 66 + . to
6 20
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❑ Municipal WOn site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: F,asr NAMc �
B t=rl A 2 EA , A 13l L.q _ SA Lvi4 A4 01170
Name(Print) 1� �yy-NRM� City,State,ZIP.
Ylsfd AV. 1::5 ZI o 302 N I A
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 ❑
Number of:Units Other S ecif �BoVE GROYA10 Prot_Demolition ❑ Accessory Bldg. ❑ p y:
Brief Description of Proposed Work? *55Ent8L4; IZx2'/ 60W A60VC GW°VAI.O PovL w1c,+rJr1LE✓EQE_
S+FETy Lf P" & R4/�0-P4 A (roT4'c- OVIM LJ_ Wi'f•N c9M1(,fy*q �t-/.o 64-g"r-Q S"AAfikl6Q cocoMLC-re-L� :5,V/UVVW_*5 Poot-:-
SECTION 4::ESTIMATED CONSTRUCTION:COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1:Building $Z 6 �g j•°o 1. Building Permit Fee $ Indicate how fee is determined:.
_.
: $
p Standard: City/Town Application Fee
2. Electrical
u ❑Total Project Costa(Item 6)x multiplier. x.
3:Plumbing $ 0 2 Other Fees: $ U
4.Mechanical (HVAC) $ o
List:.
5. Mechanical. (Fire $ -
Total All Fee
Suppression) s: $
Check.No.. Check Amount: Cash Amount:
6:Total Project Cost: $ ZlOr 99t'U0 ❑Paid in Full 0 Outstanding Balance Due;. :.:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Nl/fAll
X EM pT License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) N
No.and Street
Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 FamilyDwelling
City/Town,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)
129931 Ir-zz-Zo2
g A f}L I pBoLS GO/LP. de BEQ NCO HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
ff 35 8ys7-a� Sj _ pete♦ @ U543wrM, com
No.and Street Email address
?oPSF�E'cw M�} or983 - Y78 $87 ZYZy
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....:..... 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 PBoLS
to act on my behalf,in all matters relative to work authorized by this building permit application.
Phn wner'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.
�J.de . :C N�tRa�p : S'Zq-Zo 2 o
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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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"
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
Lafayette City Center
�j 2Avenue de Lafayette, Boston,MA 02111-1750
www mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name:Gibraltar Pools Corp.
Address:435 Boston St
City/State/Zip:Topsfield; MA 01983 Phone #: (978)887-2424
Are you an employer? Check the appropriate box: Business Type(required):
1.❑■ I am a employer with 42 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] 8. ❑ 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.❑ 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.❑N Other On-Ground Swimming.Pool
*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'compensatiompolicy 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:Technology Insurance Company
Insurer's Address:59.Maiden Ln,
City/State/Zip:
New York, NY 10038
Policy#or Self-ins. Lie. #TWC3819310 : Expiration Date: 10/13/W. .
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under§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 maybe forwarded to the Office of Inv estigations.of
the DIA for insurance coverage verification.
I do hereby certify, qnder the pains and penalties of perjury that the information provided above is true'and correct.
Si nature R .--Date:
3'- Z9 ZoU-.
Phone#: (978) 978-887=2424
Official use only. Do not write.in this area,to be completed by city or town official.
City or Town: Ptrmit/License#
Issuing Authority(check one):
10Board of Health 2.❑Building Department 3.❑City/Town Clerk 4.❑Licensing Board
5.0 Selectmen's Office 6.❑Other
Contact Person: Phone#.:
www.mass.gov/dia
DATE(MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE osn/DDN
8/20
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 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 endorsement(s).
PRODUCER - UUNIAUI
NAME:
HN Kilgore Insurance Agency Al�No Ext: 978-531-6550 aC No: 978-531-9442
2 Centennial Drive ADODRRE
Suite 4-F SS: kcharland@kilgoreinsuranceagency.com
Peabody,MA 01960 INSURERS AFFORDING COVERAGE NAIC#
INSURERA: Nautilus Insurance Company 17370
INSURED INSURER B: Safety Indemnity Insurance Company
Gibraltar Pools Corporation INSURER C: Technology Insurance Company
435 Boston Street INSURER D:
Topsfield,MA 01983
INSURER E:
INSURER F:
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 ONUULr POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS
x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100,000
MED EXP(Any one person $ 5,000
A NC462997 10/12/19 10/12/20 PERSONAL&ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 4,000,000
RPOLICY 7
PRCTO ❑-
JE LOC PRODUCTS•COMP/OP AGG $ 4,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident 1,000,000
ANY AUTO BODILY INJURY(Per person) $
B OWNED x SCHEDULED AUTOS ONLY AUTOS 1023481 05/18/20• 05/18/21 BODILY INJURY(Per accident) $
x HIRED x NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY - Per accident
UMBRELLA LIAB OCCUR I EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I RETENTION$ $
WORKERS COMPENSATION x PER OR
-
AND EMPLOYERS'LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE[-7 E.L.EACH ACCIDENT $ 1,000,000
C OFFICER/MEMBER EXCLUDED? N/A TWC3819310 10/13/19 10/13/20
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
Commercial Package Bus.Pers.Prop. 650,000
A NC462997 10112/19 10/12/20
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
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.
AUTHORIZED REPRESENTATIVE
Cyrus A.Kilgore
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 021.18
Home Improvement Contractor Registration
Type: Corporation
GIBRegistration: 129931
435 BO STON ST TAR POOLS CORP Expiration: 11/22/2021
35 .
TOPSFIELD,MA 01983
Update Address and Return Card.
SCA I 13 20M-05/177
���. V�nmma�suea.�I�r o�'E'�la.iauc�zueetGi
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:Corporation before the expiration date. It found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
i29931 a: ';`'-.; 11/22/2021 1000 Washington Street -Suite 710
GIBRALTAR POOLS CORP Z* Boston,MA 02118
PETER J.DE BERNAR00
435 BOSTON ST �.a+dlG�� �
TOPSFIELD,MA 01983 Undersecretary Ot valid without signature
R
I--
Work Requiring a Home Improvement Contractor..(HIC);Registration or.
Construction Supervisor License :(CSL)
or Existin Owner Occu ied 1- to 4-Famil Dwellin s
Do l need a : .
Do I need a Home:
Type of Work Improvement Do I need a
Construction
(jobs over$500 each or over Contractor Bldg.Permit Comments
Supervisors
$5000 earned annually). Registration (BP)?
License(CSL)?:::
- (HIC)?
Air Conditioning,central. yes no yes By licensed trades,as required by law.
Window Awnings no no maybe
Carpentry,structural yes yes yes
Carpentry,trim maybe yes no CSL if fire resistance rating required.
Decks yes yes yes
Demolition yes 'yes yes Demolition CSL minimum.
Door Replacement es es maybe p y y BP req'd if exit door or public safety concern.
Door Installation yes yes yes
Driveways. no no no Check local zoning requirements.
Energy Conservation Devices no no no Thermostats,light bulbs,weather stripping.
Fencing maybe: no maybe BP/CSL not req'd:if:less than seven feet high.:
Flooring,finish,carpet,tile no no maybe BP req'd:if fire resistance rating in 3-and 4-family:
Flooring,structural yes yes yes
Gutters maybe yes maybe BP/CSL required if piercing.the building envelope.
Heating System;central maybe no, yes By licensed trades as required by law.
Insulation yes yes yes Insulation CSL minimum.
Kitchen Cabinets and Shelving maybe: yes no BP\CSL may be:req'd if part of larger project.
Landscaping,routine no no no
Locks maybe yes. maybe If affecting egress doors. .
Masonry Walls,not retaining maybe no maybe CSL\BP if greater than 4:feet in height..
Masonry,related to building yes yes yes Masonry.CSL minimum..
Masonry,landscaping no no no If no threat.to public safety.
Painting,exterior no yes no
Painting,interior no no no
Patios :. no no no
Plastering:. yes yes yes
Plumbing maybe no maybe By licensed trades,as required by law.BP/CSL
needed if cutting/notching building elements.
Roofing,minor repairs yes yes maybe BP needed unless considered an ordinary.repair by
the building official
Roofing,new orreplacement yes yes yes Roofing CSC minimum.
BP\CSL req'd if floor area more than 200 square
Shed Construction, yes yes maybe feet for 1&2 family:home lots;and 120 square feet
for others.
Sheet Metal/Exhaust Venting maybe: no yes By licensed trades:as required bylaw.
Sheetrock/Wallboard yes yes yes
Shutters no no no
Siding yes yes yes Window/Siding CSL minimum.
Solar Panels yes yes yes By licensed trades as required by law
Solid Fuel Burning Appliance yes yes yes Appliance CSL minimum.
Stairs,exterior yy_e yes yes
Swimming Pools,aboveground:. no__,)) no yes ANSI/NSPI-4 Design/Construction Required
Swimming Pools,below ground. ``no yes. yes ANSI/NSPI-5 Design/Construction Required
Walls,exterior retaining.:. :. :maybe yes. maybe :: CSL\BP if.greater than feet in height.
Window,install/replace :. .. : yes yes yes Window/Siding CSL minimum.
Wiring maybe no: maybe By licensed trades,as required by law. BP/CSL
needed if cutting/notching building elements..
This list is provided for guidance only and is updated periodically.
Last Updated August 21,2018
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Fee: $1,696,60 Cons-. S350 000.00
Quitclaim Deed
I, Rose Jacqueline Rodas(f/k/a Rose Jacqueline DeCosta), unmarried,of 9 Vista Avenue,Salem,
a. Massachusetts 01970 in consideration of Three Hundred Fifty Thousand and 00/100 Dollars
($350 0 0)grant to Abila Benazea, individually,of1��C --
County)Massachusetts D�lhvith
QUITCLAIM COVENANTS
The land with the buildings thereon located in Salem, Essex County, Massachusetts,shown as
Lot 3 on a plan entitled"Plan of Land in Salem, Mass. Prepared for Joseph M.Tauraso, dated
May 18, 1987,revised March 24, 1988,T& M Engineering Associates, Inc., 83 Pine Street,
Peabody, MA recorded with the Essex South District Registry of Deeds at Plan Book 237, page
77, bounded and described as follows:
Southwesterly: by Vista Avenue, as shown on said plan,one hundred fifteen and 0/100
(115.00)feet;
Northwesterly: by Lot 2 as shown on said plan, one hundred sixty three and 75/100
(163.75)feet;
Northeasterly: by Scenic Avenue as shown on said plan, ninety-two and 55/100(92.55)
feet; and
Southeasterly: by land now or formerly of Robert A.and Linda M.Tremblay as shown
on said plan, one hundred thirty-two and 08/100(132.08)feet.
Said Lot 3 contains 15,022 square feet, more or less,according to said plan.
�t�je sZ, c C - /6 /3 S7 7/py e 3��5
i
Executed as a sealed instrument this day of October, 2012.
Rose lace eline odas
Commonwealth of Massachusetts
Essex ss:
ras d On thiay of October, 2012, be ore me,the undersigned notary public, personally
appeared Rose Jacqueline Rod , proved to me through satisfactory evidence of
identification,which were Driver's license; O State ID; O Passport; ❑ Other Government
Issued ID; ❑Other, to be the person whose name is signed on the receding or attached
document, and acknowledged to me that she signed it voluntaril f its stated purpose.
Notary Public
My Commission Expires:
WAN O'9RIEN
NOWY PublfC
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13 — COMPONENTS
LEGEND STRUCTURAL COMP LEGEND FASTENERS ;
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t ��VId�14ge8,.gehmsieedxted tined pee., - F7: S14x3W Sheetmmalsvew m^nmlri+ham• '. - III
. .12 S tbrndderOwt31.^xJt?x.WB'dddt HDO Shad(.Q736'mhL 6eae hrehdtldc),4Pit ykM abea�46m. - FB: $14xtt/4'-Shedmetdsmew. �.
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ii Famreerxe d t �exndmen ateraIrm�t� NOTES
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iS Ccrre®e!(nme o9 pod vdparwl SAE•J429,Grade l(60mmhdmmnlenslk Strerglh)to Pa6rlxsmm rarx 1agaBeHDGesmi y &E
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F2 F8 x;:2
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. 26.Swkn ladder.IndiatoelddandeasskrJ ladamps,heagwlaz rnddeditm,a,,lm aged hardware GENERAL NOTES "Q•
•.F8. 1. POOL T08E QNSTAt1ID IN ACCORDANCE WITH ASSEMBLY INSTRUCTIOlLS.
. - NOTES - _ 2 POOL TO BE INSTALLED LEVEL WITHIN 1'.PROVIDE SMOOTH TRANSITION BETWEEN WALL "
. I. All FiDC>sleelwmporrarLv shall be Lalydcatedfmm sheet sled AND LINER,ASSURING THAT LINER CANNOT WORK ITS WAY UNDER THE BASE WALL RIM.
All
HOG
steel
Yond abeam k• mdaminp tD ASTM A6M(CS Type B), 3. ABOVE GROUND POOLS OF THIS TYPE ARE INI@IDm FOR SWIMMING AND WADING ONLY.
. .. - 81d _ be fabricated Minn mvummn page SLIDES SWINGS IS STRICTLY PROMTTED USE OF DIVING ..
_ NO JUMPING OR DIVING PabarrED.THE INSTALLATIONBOARDS -• ..
\ I 2 AM breckel pates,B� sbl�sal hardware map '' 14 AND SVUW
3. AO a*uded a m*=MMMOtls shM be exfnded Spin 61MT6 appy ahenlnum � AS NOTED
. ` 3 F I .. - DATE-February 28,2008 11
SRN BY: CTG CHK er•. REC
THIS IS ANENGINEERING DRAWING FOR THE STRUCTURAL COMPONENTS OF THE POOL,DECK
AND BARRIER ONLY.N DOES NOT COVER OTHER CODE TIEW.SUCH AS ELECTRICAL OR
• • �~ WATER SUPPLY/DISPOSAL RWUIREVENTS,ITAM DOES NOT COVER INDIVIDUALSITE DRAWING NO.
.SECTION ATPATIO.DECK (B) TYPICAL SECTION(A) f �— % CONDITIONS OR SUBMISSION TO LOCAL AUTHORM FOR SITE PERMITS. ///'''���n A ppp���
BTB.. ... - _I I THIS DRAWING IS THE PROPERTY OF ROBERT E.CHESTER ASSOCIATES,CONSULTING , '�'/'V'o
ENGINEERS,AND MAY NOT BE REPRODUCED WITHOUT WRITTEN CONSENT FROM THIS OFRCE. 4 Q
vi
r THIS DRAWING IS VALID ONLY WHEN AUTHORMED SEAL AND ACCOMPANYING SIGNATURE.-
T(2)
_ AFTIXED.. .
1 19-97