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83 ALMEDA ST WEST - BPA-12-84 RPR FRONT STEPS The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards 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 SectionFor Official Use Only Building�Pennitber: ate Applied: - Building Offi m cud(print Name) Signat - -Daze SECTION 1:SITE INFORMATION 1.1�ProperV Idmress-/� S, w� 1.2 Assessors Map&Parcel Numbers ,j / Q`f ✓ no Map Number Parcel Number 1.1 a Is this an accepted street. yes_ 13 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 Requited Provided 1.6 Wate upply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage"is System: Zone: _ Outside Flood Zone? Municipal sae disposal system ❑ Public Private❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: S3 /)jmecJ� S-.f WeSt _wn COL gbf0 Name(Print) City,State,ZIP IM IA U 1 q7 0 Email Address No.and Street Telephone SECTION 3:DESCRIPTION OF PROPOSEDWORK (check al .that apply) New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) Alterations) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ I Number of Units I Other ❑ Specify: Brief Description of Pr posed Work': fY.WI ove_ tro Yft-d- j✓�'o 'f SfG I rS "�' Sec. Dr wi. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ 5-SQp, 00 1, Building Permit Fee:$ Indicate how fee is determined: 0 Standard:-City/Town Application Fee _. 2.Electrical $ ❑Total Project Cost(Item-6)x multiplier x- 3.Plumbing $ 2. Other Fees:.$ 4.Mechanical (HVAC) $ List:' / --- 5.Mechanical (Fire $ -Total All Fees:�$ Su ression p .Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ j 19 V 0 Paid in Full 0 Outstanding Balance Due.. SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervi's,,or License(CSL) Qny 9.en� ;t I c- /Z aN [Liucense Number Ex ration ate"�'�'� QW Name of C� List CSL Type(see below) u Qtj fat S�' SvtA� a- Pia MRCRo,fin Description No.and Street ricted Buildin s u to 35,000 ted 1&2 Fnmil Dwellin City/Town,State,ZIP Coverinw andSidinuel Burning Appliances ion Tele hone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) 1S6/91 4 eubl ntv . u V1�1ytt ti 4ye C HIC Registration Number Ex ation Date HIC Comp�y,Y ame or HIC Registrant Name No.and Street Email address I /Town,State,ZIP Tele one 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 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 C-OL I 1 n4f L[ t e_— �+- to act on my behalf,in all matters relative to work authorized by this ilding permit application. 0 -�. -F�1-�,� 7 Print Owner's Name lectronic ignature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true ccu a to t est of my knowledge and understanding. Al u I"kt Print Owner's or uthorized Age 's Name(Elect nic 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 wtisma mass tievWtcet Information on the Construction Supervisor License can be found at www roar vov/dos 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" M Commamre fth ofMassarhaselts Depmtnient afladredrW Ac®kW:s OfjSeeOfl colon 600 Washington&reef Roston,MA 02111 www.eraysgov/tea Workers'Compensation 7nsarmw Affidavifl Bmldecs/Conk aetorsfl�ecL ieianslPimlbeis A nc Information Please Print tv uulrea ll 1.et=ih '^ Name(&ui-mdOrv,-i=t onnndividual): CO,b f�� ('('Y` U � n3 Address: a Ct:t G�C� S f 'SW t fG � CjtylSlate/Lip: r1��Y M4 Off Phone#_ 9 tQJ 7 Are 3�- m employer?Check the appropriate foz: Type of project(r4utv)= LQ�7amaerployer with 4.❑1 am a general contractor and l p New construction 4� • have tired the sob-rordlaams &lim r iog e�loyees(fdt aadha part fistod oadw att�shed.t �- `m"�"—' 2-❑Iamasoleve noietwmacsn - 'pose sib-comracto;s have f< pDemolition wtokind fora m n my capacity- ,�.insurance 9 ❑Bm7dmg ambon (No wa formeraamin�Y- 5.p We are a corporation and iffi (No mq*cd-I £'rip.insurance I0.❑IIxfieat repairs m adddi� _ officers have oaroaoi5edilsa 3.0I h doirgailwO* liotofesempa�per MGI. 11.p PI®Lmgrrpauseadditiam - MYWff[No workers•comp. c.152,§1(4),and we have no 12.❑Roof repairs ioruranca re9uffe&l t m pbye .[No workers- 13-❑Other comp^«' acquired l •Avy Mti�dariseds tin er mnsraim tm m the nctim bdov do @mmmlm'".Fa®pofrcr��' t rim Wvv�vhD�idt¢>�LLm�dErmedv EentvHk'LW dim LISU�difAMCfOE�Sl39�lPnGq iao♦BYal�rh. rpp�crosdm racicdn5boa��' mar-E1�ar�mYC OrdR �11QaRNrR�®P-�'�- 1amm�p(oyatbotisptr 81O 'OO oahwuaarejor orp eaptoyres Belowis eePot¢y ardjob site injamorian- '�'�Ol� Z� - Insurance Compaay Name: 46 f Policy N or Self-ins.Lic.M 1 S C O r✓�1,17 y.J I O rJ. Expiration Date: Job site Address: /i7 C t ell /� >_ CitytstatelZiP: � Attach acopy of the workers'compowdea Policy dedarehon page(showing the policy number and expiration date) Faihne to secure coverage as reTmed order Sedum 25AofMGL c.l52 can lead to the iurpotigan efrsimbzl pwalties Gl a fmc ap to$1,5W-OO and/or�year impriso caL as wdt as evil Pan ldtm in the fmmofa SLOP WORKORDFdt and a fee of up to SSO-W a day agaiaathe violator- Be advised testa copy oftha statement maybe forwarded to ft O1Zrce of Invenigpvans of Ibc DIA for iosormmco Coverage vuificatim- 1 do hereby - doe and ojperjmy d+m the orformadoa provided above if 8ae coire[L - D. (& fl Phone li. �1 are our}: /Jo rm!twi[e m this ore,m be coaplGed by oaq orterva of ffdat CRY or Town: Pe wLi�f Issuing.BO OfHea y(circle B onek 3. frown Qerk 4_Electrical Inspector S.Plumbing Inspector I.Board otHeakh 2 Bmldt�Department Cdy 6.Other Phone Cooledpersm: Aco o® CERTIFICATE OF LIABILITY INSURANCE °"'�'"�°6"il' 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(tes) must he andased. If SUBROGATION IS WAIVED,subject to the tends and conditions of the policy,certain Policies may require an endorsement A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsamerd(s). CONTACT R[ODICER NAME: Benevento Insurance Agency Inc PHONE 781 599-3411 FnX N ;(761) 581-1200 497 Humphrey Street EED LLu: Swampscott, MA 01907 Pf°R 4267 WSURER(S)AFFORDIM COVERAGE NAICS INSURED INSURERA:Travelers Insurance Co. Cabinetry Unlimited Enterprise INSURERB: Peter Bagarella INSURERC:HARTFORD INSURANCE 21 Caller St, Ste 2 INSURERD: Peabody, MA 01960 INSURER E: RMURERF, 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. NOTWUHSTANDDIG 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 H€REIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMPS INSIR LTR TYPE OF tlISURIWCE PIXNCY IAIMBFR P POIOYIFF bfVOn'�YY�YY UNIS GelEeIAL WBMY EACH OCCURRENCE $ 1 00O 000 A X CoanERDALGEINERALLMWTY I6804753B-409- TCT-1 10/21/1010/21/11 DALWGE TO RENTED $ 300,000 CLAISLS-MADE aOCCUR MEDDP(AMo,e PBsal) $ 5,000 PERSONALSADVIHILIRY E 11000,000 GENERALAGGRE:GATE $ 2,000,000 GEN'LAGGRBGATELEATAPPUESPER PRODUCrS-COMPIOPAGG $ 2000000 POLICY PRO- LCC $ JECT AUTOMOBILE LIABILITY COMBINEDBeNGLELIMIT S (Eaamdert) ANYAUTO BODILY INJURY(Per gn,,em) S ALLOWN=DAUT05 BODILY INJURY(Per atlltanU S SCHEDULEDAUrOS PROPERTY DAMAGE $ HIREDAUTOS (Perac dNrt) NONOWNEDAUTOS E E UMIOEMEALIAe OCCUR EACH OCCURRENCE $ ETCESS WB CLAMSMADE AGGREGATE S DEDUCTIBLE S RETENTION S $ WORKERS COMPENSATION X WC STATU- IANDEMPLOYERSINBanYC AN RROIRIEIORPARMNERIE)�iXTTNE NIA6S60UB-451OP53-5-11 1/20/11 1/20/12 E ,EACH ACOLENTS 100000 OFFMO:RAENSEREX(lIDED? EJL.NSEASE-EAEAS 100 000 underEl.gSEASE-POLICa 500,000 OESCPoPnONuOPERATIONS Clow �SCRIP110NOFOPRUDXX6l LOGIMON51 VBCCIEB(AvaQI ACORD tM;AA®la,ul Renarta Sallem0e,tlrrmeapeo brepJlva) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N City Of Peabody ACCORDANCE WITH THE POLICY PROVISIONS. Peabody, ma 01960 AUDIORIZED REP SENTATNE Brvan Benevento ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD dame and logo are registered marks of ACORD -.'>= 1la saehuxtt�- Dcpartnient of Public Safciti $hard o1'$uildin� Rc,uiatinac and Cttndards Con;S:jCicon Suoe-vixor icens License: CS 87554 7 4 PETER BAGARELLA 21 CALLER ST SUITE 2 4 r PEABODY, MA 01960 Expiration: 4/28=13 t...... omr Tr: 16479 CABINETRY UNLIMITED ENTERPRISES, INC. 21 Caller Street, Suite 2 Peabody, MA 01960 Pho 978) 977-3151 Fax(978)532-6646 Email: peterbagarella@comcast.net Job: Date: fi-+ t --t -; - � + +- -�- �--H- f --+--'�--+ T-r- ---- i+ -4 - i -y�-i----- i 77 y Ir 1�I � I , ! I I f G I ' I