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5 BARNES CIR - BPA-14-1443 SHED VEO The Commonwealth of Massachusetts �N Board of Building Regulations and Standards CITY OF 'AL SERVICES Massachusetts State'Building Code, 780 CMR SALEM - i - Revised Mar 2011 T SIP 3 Bpil Opgrmh Application To Construct,Repair,Renovate Or Demolish a H IfCC One-or Two-Family Dwelling . . r; This Section For Official Use Onl Building Permit Number: Date lied: S Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION Pf°Pe�y2AJ� es : /� ^/ 1.2 Assessors Map&Parcel Nun b s 1.1a Is this an acceptedstreet?yess—V no MappNtim a Parcel Amber 13 Zoning information: 1. P erty t eusions: ll M S7_ 00 Zoning District .. , Proposed Use Lot Area(sq ft) Frontage(11) 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: PROPERT/Y�OWNERSHIP` 2.1 wnrr'ofitecQrdJ s /��l rI ,� &?-7© - Name(Pr City,State,ZIP 1✓f t lG�' 5� 97g Z73/ 40d t No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ J Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units I Other Specify: Brief Descni ti fProposed Work 2: - t SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials Official Use Only 1.Building $ 3 Z 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee 114 ❑Total Project Cost'(Item 6)x multiplier x//,,�� 3.Plumbing $ 2. Other Fees: $ C�"11V� ' 1 4.Mechanical (HVAC) $ �l y List: 5.Mechanical (Fire Suppression) $ 1 JIX V Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ --4),o�t ❑Paid in Full 11 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings u2 to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling 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) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name - No.and Street - Emailaddress 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 CONTRACT APP BUILDING PERMIT I,as Owner of the subject property,hereby authorize to a�y behalf,in a tters relative to work authori by this budding mit application. J�; _ U✓1� , Zp�� Print Owner's Name(Electronic Sig ) 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 Comm this appli is true and accurate to the best of my knowledge and understan J ,y, ! � Print Owner's or Authorized Agent's ame(Electronic Signature) Date NOTES: I. 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.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" OTGAGE INSPECTION PLAN BAR,RY T&SULLIVAN,P.1.5. OF R4,�9 P.O.AOS 2513 p WOBURN,MA.81888-8413 6ASd0.Y 4G TEL(781)P4q.8750 RAX (781)942.2437 ,j SULLIVAN y 33426 GCr&r.iqe,;7T �71s? r s7,)0 O e06 r � d 4 1q� �rst v� THIS TAPE SURVEY, CERTIFICATION & MORTGAGF_' INSPECTION PLAN ARE MADE FOR THE USE C]F FOR MORTGAGE PURPOSES ONLY BASED ON MY KNOWLEDGE, INFORMATION & BELIEF, I CERTIFY THAT THE BUILDING CS3 CONFORM CS] TO 4 ZONING BY-LAWS UlWNSIONAL REQUIREMENTS? OF THE TOWN . OF. S-1C.e -/n_____MAS SACHUSET TS THc STRUCTURE [S] IS/AR N IN THE SPECIAL FLOOD HAZARD AREA AS SHO'.'N THU FEDERAL 6 ENCY MANAGEMENT AGENCY MAP [IF THE TOW CI OF r4j:;,''" MASSACHUSETTS - COMMUNITY PANEL NUMBER FLOOD,.INSURANCE ,RATE MAP EFFECTIVE .DATE / REVISE $S TGWN f IT,; DATE P,EGISTRY REFERENCE SCALE �1 Fj�JOIlZlYS GrfCX I IN, =d� A2C-A f©777 ` C',�t/�Fly`✓ �'C�.�' _ � -�. v � � f ReedsFerry h. )f ace of Sheds- CAMSUmerAtTaim and Busi"te"��tk��%a� .;, 10 Park Su te.S t"fit C n tnn, <� 'cb4 sett 02116 florae tttp aCrr ent, tt wtor ie is atio pomp*cwpwwi*A R EE} FE g 9 �L', IaILC}iW t f rid +: ra ra4is TIN ass" . grttC {A. f �,RLETON 3 TF� r1P LAtd ,3 k. HUC)SOP hdH 3t�53 r NII r tJttMerd#rrsk*a!rcercxe ran#.�ttWlr rr lnrelisrie. s6; . a :t Add � f rmrna . t.nrlt;a�,J t # 14 # � .,,� i 'xTs '�f� s?r��s �cN; x-� .c �w't�e' x,Ys fig, Oyu �:n s z ��f�}° x y-• as ryt fl�/X f'��}yy 3 5 r j' t� y�'.a`t fi. 4.d 29�{4.yq��}l11/1�6{ { k"t Y�`L i '1 4 y �'l y��N. N tJ + ±t .W,0s( N ' � wl � y x}y1 �i°€ (''Va"1b�' l'ugg. �'S'� " ¢' '''��a`�- 3"a" .Tq-I�4N4e°4 f ,}iT �l�i k tit �09W*40^, S Arw 59'i1hd� k BAEL CARLETON � � 'Y§ {�µN��J �} �'�`j'' p�nf �. 1!, { iSN'i'� � sy "202`�ARby k,� -DUNST.i'1 LE f NIA Y k .tea„,' u p " v y w . r L s--�-i fi*9 E g 1�!r y}Aiy" 5y'+kfaxNn4{XbUA+N as & t" 11 �x, +"b : p`j s x, leirv� .L"o, r 4 CERTIFICATE OF LIABILITY INSURANCE 5/29/2014°"29/2019 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 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 I certificate holder in lieu of such endomement(s). PRODUCER CONTACT Nq E: Rhonda Noble THE ROWLEY AGENCY INC. PHONE (603)224-2562 FAx AIC No-(603)224-8012 139 Loudon Road ADOAIEsS:rnoble@rowleyagency.com Concord BOX 511 INSURE S AFFORDING COVERAGE NAIC p Concord NH 03302-0511 INSURED INSURERA:The Netherlands Ins. Co. 24171 INSURER a:Libert Mutual Ins CO Reeds Ferry Small Buildings, Inc. INSURER C: 3 Tracy Lane INSURER D: INSURER E Hudson NH 03051 INSURER F: - COVERAGES CERTIFICATE NUMBER:14/15 general cart 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 LTR TYPE OF INSURANCE LS POLICY NUMBER MMIDOY EFF MMIDDIYYVV LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISES(Ea N-fEoctu $ 100,000 A CLAIMS-MADE FXOCCUR CBP8157302 6/2/2014 6/2/2015 MED EXP(Any one person) S 5,000 PERSONAL B ADV INJURY $ 1,000,00C GENERAL AGGREGATE S 2,000,DOC GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- X LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accldent 1 000 000 A X ANY AUTO X ALL OWNED X SCHEDULED 8158001 BODILY INJURY(Per person) $ AUTOS AUTOS 6/2/2014 6/2/2015 BODILY INJURY(Per adddern S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS $ Per accident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE g 9,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE g 4,000,000 DED X RETENTIONS 10,00 UB159603 6/2/2014 6/2/2015 S A WORKERS COMPENSATION A STATES: NR S MA WC STATII- DTH- AND EMPLOYERS'LIABILITY Y ANY PROPRIETORIPARTNERIEXECUTIVE YIN C EXCLUDED OFFICERS SLID DDD OFFICERIMEMBER EXCLUDED' N/A E.L.EACH ACCIDENT $ (Mandatory in NH) C8152302 6/20/2014 6/20/2015 It yes.describe under E.L.DISEASE-EA EMPLOYEE S 500,000 DESCRIPTION OF OPERATIONS hel. E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Atldltlonel Remarks Schedule,if mom apace Is required) Covering operations of the named insured throughout the policy term. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VVILL BE DELIVERED IN "For Informational Purposes Only" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rhonda Noble/RLN ACORD 25 ,,n, 05) INS07.5 rPm nnslm ©1988-2010 ACORD CORPORATION. All rights reserved. THn ArDDn namn e.M Inn,or.roniernroN mar4a of Arnpn