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23 BARNES RD - BUILDING INSPECTION � dS The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 730 CMR Revised,tlur 2011 J 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 Ap t d: a Building omicial(Print Name). Signature A is tom SECTION 1:SITE INFORMATION' m Pru er Address: 1.2 Assessors Map&Parcel Numbern 0 1.I a Is this an accepted street?yes _ no_ Map Number Parcel Number 1.3 Zoning Information: 64 Property Dimensions: t N Zoning District Proposed Use - Lot Area(sq h) Frontage(Il) I.-Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.(j.L C.40,§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if yesE3 SECTION 2: PROPERT ONV ERSHIPI' I Own rl I R�ecorclu �( Anne(Prin1j. City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alterntion(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. Nun ber f U its Other ❑ S city: De• escrip(4onot'Proposed Work': SECTION J: ESTIMATED CONSTRUCTION COSTS Estimated Costs: OfDcial Use Only 11C°t Labor and Materiels I. Building S (' OD I• Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee ?. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S �qOO.� ? Qther Fees: S -1. Mechanical (HVAC) $ List: 5. \lechanical (Fire S Total All Fees:S Su ression) Check No. Check Amount: Cash Amount: 6. Total Project Cost. g • oQ ❑ paid in Full ❑Outstanding Balance Due: 3/5 � � e J I\i I>l l-. �D Zoe Y f�N '�C � )�1 • 1-� 1 C�bLta7 l�.t 7 )o SECTION 5: CONSTRUCTION SERVICES ti 'trect imt Supet or 'cens 'L) O License Number Expiration Date lder List CSL Type(see below) - Type Description I, ,r /� U Unrestricted Buildin s u �to 35,000 cu.I t o AF `� J R Restricted 1&2 Family Dwelling .City/Town,State,"LIP M Nfisonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address U Demolition I6�2Mi.gis(�reJ Ho/p/te mprov(�e{ment�Cont}ractor(HIC) — G/6 (� ll "� pk►x".yo+-Ci Q'�G+^'✓\ } �e • HIC Registration Number Expiration Dale ` 1 2np:a ane r H �y M IZegt3lript Na; N ntICCSJJtre I / , �j�}}.`` ©�42,� � 78.77,�`�,(3, Email address rt /Town,Stare 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 .......... PY 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 t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Nane(Electronic Signature) Date SECTION 71b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of file information co witted it this applicat' is tru and accurate to the best of any knowledge and understanding. Fat Owner's or Authori Alfent' me(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. 1 d2A.Other important information on the HIC Program can be found at w+vw mass.�,ov oca Information on the Construction Supervisor License can be found at w+e++.nmss.sov'dps . 2. When substantial work is planned, provide the information below: 'rotal floor area(sq. ft.) :,(including garage, finished basementlattics,decks or porch) Gross living area(sq. 11.) Habitable room coma Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths "type of heating system Number of decks/porches Typcufcoolingsystem Enclosed Open_ 1. "total Project Syunre Foolage"miry be substituted fur`Total Projcct Cost" V/te fPmxmravauremClli o�Vl(n4daanuael7if ffice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR - "Istration: 11.5467 Type; - - xpiration: 1/30%2016-, Private Corpora tiot-. J.P. REMODELING AND CONSTRUCTION, INC a +�- JOHN POLIZZOTTI 220 YANKEE DIV HYWY DANVERS,MA 01923 - Undersecretary e - Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS•045528 JOHNS POLIyZ 220 YANF{Eg DIVA Danvers MA 019Z3 Commissioner ExPiration 10/31/2016 L Propool 220 Yankee Division Highway Free Estimates Danvers, MA 01923 Licensed and Insured Massachusetts Home Improvement Contractor #115464 (978) 777-7637 Fax (978) 762-7606 MsAtb'o nn avTremblay P978-744-8399 - 2-3STR . 23 Barnes Road 'baifiroom electrical & plumbing. CITY.STAT eM ZIP CODE )pa LOCATION Same. We hereby submit specifications and estimates for: 1. Install 1 new 20amp home run install GFCI outlet, add new vanity light with switch owner to supply. supply fanlight combo with switches. Run 2nd home run to basement for future use. Install vapor proof light with trim & switch. $1,550.00 2. Install main service, demo out old existing & install new 200amp complete main service per 2014 code. We will use all conduit pipe inside & outside, we will use all Square D materials for 200 amp panel breakers. $3,300.00 3. Plumbing- Stock & labor for the following: Replace soil stack from the 4"TY cast iron pipe in basement up through roof, Rough & finish plumbing for new bathtub with new tub & shower valve, new waste & overflow. Rough & finish plumb for new toilet & seat. Rough & finish plumb for pedestal sink & faucet. Connect kitchen sink line on to new stack. All fixtures supplied by owner. Heat owner wants to keep the radiator, just.spray withnew paint. $3,900.00 4. J.P.Remodeling & Const. will; A- issue a copy of insurance to owner & pull permits. B- be responsible for all waste from above work only. Contractor obligated in inform Customer of any and all necessary pemtits and to obtain said permits.Customers who.secure their own permits will be excluded from the guarantee fund of Mass.Gen.lows Ch.142 Eight thousand seven hundred fiAfirMdYfah(g.du 8shiff and labor—complete in accordance with above speciacapans,for me sum of. $8,750.00 Peyanam to be main an follows: 1/3 deposit $2,916.66, 1/3 start of work 2,916.66, balance on completion 2, 16. 7 ' ;ran due: 3rd or 4th week Nov. 2014 Date of Substantial Completion 2 or 3 weeks. 411 material is guaranteed in be as specified.All work to be completed in a xorksnwlike manner according m standard practices.Any ahenam.or deviation tom <�� / above specifications involving extra cents will be executed only upon wrinen Aumoriud Signature adem, and will become an extra charge over and above me estimate. Ali iimements contingent upon strikes,accidents or delays beyond our control. acceptance of proposal — The above prices, specifications and VDo not sign this contract if there am ayg blertk spa auditions are satisfactory and are hereby accepted.You are undercoat to do the vork as specified.Payment will be me&in outlined above. Signature ^� )ate of Acceptance: L O ` 7 /y -signature Customer has legal right to cancel contract within 3 days of acceptance 'connector shall perform the work in conformance with such plans and specifications,if any,as have Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, sent provided by the owner or the contractor,which plans and specifications shall be deemed casualty or general unavailability of materials or the discovery of the conditions or defects upon the sin ncorpomted into this contract by reference,and will do so in a workmanlike manner.Contractor is or in the suuclure(s)thereon not known to the Contractor at the time of execution of this contract and tot responsible for performing any work not specifically referred to in this contract. which may be discovered during the course of the Contractor's completion of the work.In addition,the n the event any installment is not paid when due,contractor may stop work without breach until Owner acknowledges and agrees that in certain remodeling work the demolition of portions of the pre. ayment is made and for five(5)days thereafter.In the event any installment is not paid within WE(10) existing structure may reveal additional defects,conditions or the need for additional work which must ays after it is due,contractor may,at its option deem this contract terminated by the owner and may be repaired,altered or carried out in order to commence or complete the work called for in this ike such action as may be necessary,including initiating legal proceedings,to enforce its rights contract.In such case,the Owner agrees that the duration of the work and any scheduled date of ereunder.At all limes during construction,owner shall provide and maintain free and unobstructed completion may vary from that which may be set forth herein and Owner agrees execute a change cress to all areas of the site where the work will be performed and shall provide,at owner's sole order detailing the cost and scope of the additional work necessary to repair,correct or alter such xpense,water and electrical service,including 220 amp outlet. additional defects and conditions. lontractur shall not be responsible for claims for damages to persons or property occasioned by owner Contractor warrants all work for a period of 36 months following completion. r his agents,third parties,acts of God or other causes beyond convector's control.Owner shall hold Owner moves rbar in the.evmt Ir M--tie.--ry feet n—.n.,,..,,....n.., Propoal 220 Yankee Division Highway Free Estimates Danvers, MA 01923 � � Licensed and Insured & Maesaehueetts Home Improvement Contractor#115467 (978) 777-7637 Fax (978) 762-7606 Nls. INN'a Trembla W-744-8399 TVV Z3 SrREEr JOB NAME Barnes Road Remodel Bathroom. C171Y.STATEmd9P000E IOB LOCATIOti MA ('1107n P e hemby sub it specifications antl estimams for: 1. Demo all existing plumbing fixtures, all 4 walls to studs, ceiling & finish floor to sub floor. 2. Install new ix3 strapping to ceiling, install any needed 2x4s, fire stopping. Install Owens Corning pink insulation 3 1/2"x15" to 4 walls with vapor barrier, install 9 1/2rrx15" to ceiling. 3. Install 1/2" blue board to ceiling & 3 walls, apply a smooth coat of plaster to ceiling & walls. Prime & finish coat ceiling, walls, all finish trim. Install 1/2" wonder board to ceiling 3 tub walls. 4. Install new underlayment plywood to floor glued & nailed. Install floor tile & grout, owner will supply floor tile, grout, adhesive. Install tub wall tiles on 3 walls, owner will supply tiles, grout, adhesive, soap dishes. Vent new fan outside. $11,830.00 5. J.P.Remodeling & Const. will; A- issue a copy of insurance to owner & pull permits. B- be responsible for all waste from above work only. Contractor obligated to inform Container of my and all necessary permits and to obtain said permits.Customers who.seeme their we permits will i e excluded from me rarson.fund of Mass.Gen.Iaws Ch.142 We celR£Pro as hereby to famish material and labor—complete in accordance with above specifications,for the sum of: $11,030.00 Eleven thousand thirty dollars.00 Paymemmtwmadeasfow llos: 1/3 deposit $3,676.66, 1/3 start of work $3,676.66, balance on completion $3,676.67 ) Stan date: 3rd or 4th week Nov. 2014 to of Sobsmntial Com letion: r 3 weeks. All material is guaranteed to be as specified.All work to he completed in a workmanlike manner naording to standard pmetias.Any alteration or deviation from above specifications involving extra costs will be execoled only upon written Authorized Signature irders, antl will become an extra charge over and above the estimate. All sgramems contingent upon strikes,accidents or delays beyond our control. Acceptance of Proposal — the above prise, specifications and Do not sign this contract if there ar�blank spaces :oni itions are satisfactory and ate hereby accepted.You are audsoaed to de the work as specified.Payment will be mode as outlined ag�veu signature �_._g,�rn/L/t�.i� )ate of Acce,=ee:l D ed 7 Signature f/ Customer has legal right to cancel contract within 3 days of acceptance .ontraclor shall perform the work in conformance with such plans and specifications,if any,as have Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, seen provided by the owner or the contractor,which plans and specifications shall be deemed casualty or general unavailability of materials or the discovery of the conditions or defects upon the site morpomted into this contract by reference,and will do so in a workmanlike manner.Contractor is or in the structure(s)thereon not known to the Contractor at the time of execution of this contract and not responsible for performing any work not specifically referred to in this contract. which may be discovered during the course of the Contraclor's completion of the work.In addition,the n the event any installment is not paid when due,contractor may stop work without breach until Owner acknowledges and agrees that in certain remodeling work the demolition of portions.of the pre- sayment is made and for five(5)days thereafter.In the event any installment is not paid within ten(10) existing stracmre may reveal additional defects,conditions or the need for additional work which must lays after it is due,contractor may,at its option deem this contract terminated by the owner and may be repaired,altered or carried out in order to commence or complete the work called for in this An such action as may be necessary.including initiating legal proceedings,to enforce its tights contract.In such case,the Owner agrees that the duration of the work and any scheduled date of ieremeder.At all times during co ourectim,owner shall provide and maintain free and unobstructed completion may vary from that which may be set forth herein and Owner agrees execute a change ccess to all areas of the site where the work will be performed and shall provide,at owner's sole order detailing the cost and scope of the additional work necessary to repair,correct or alter such spouse,water and electrical service,including 220 amp outlet. additional defects and conditions. .contractor shall not be responsible for claims for damages to persons or property Occasioned by owner Contractor warrants all work for a period of 36 months following completion. rt his agent,third narties nets of Owl or other cans•rovond rnntrarow'c ron,rol nwnrr char Fnld n....,......� i,.,:.o,...—a b.,,,.,_,.........,.1- — ._..__..___....-o-1 JPREM01 OP ID: PA ,d►14o. fzoa CERTIFICATE OF LIABILITY INSURANCE DATE(MMAO14YY) 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 certificate holder in lieu of such endorsements . PRODUCER 978-744-6715 CONTACT AHMED Insurance Agency, Inc. 978-741-0127 PHONE FAX PO BOX 449 AIC No Exit: AIC No: Salem,MA 01970 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Ins Co. INSURED J.P. Remodeling&Construction INSURER a:Associated Employers Insurance John Polizzotti INSURER C:SafetyInsurance Company 33618 220 Yankee Division Highway Danvers, MA 01923 INSURER D: 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. ILTR TYPE OF INSURANCE ADD POLICY NUMBER MM/DDYYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CP$1544256 05/08114 05I08I15 PAMAGE TO R5NTEIT__ REMISES Ea occurrence $ 100,000 CLAIMS-MADE lxl OCCUR MED EXP(Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ C ANY AUTO 6218249 04/26/14 04/26/15 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY X accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OLD I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY X T V B ANY PROPRIETORIPARTNEWEXECUTIVE Y❑ WCC5011421012012 10/18/14 10/18/15 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESC RIPTION OF OPERATIONS tmho EL.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Romance Schedule,if more space Is required) construction carpentry CERTIFICATE HOLDER CANCELLATION CITYOS1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. building dept 120 Washington St AUTHORIZED REPRESENTATIVE Salem, MA 01970 ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CITY OF SALEM, MASSAQHUSEM ' BUILDING DEPARTMENT l� 120 WASHINGTON STREET 3AD FLOOR TEL. (978)745-9595 KIMBERLEY DRISCOLL FAX(978)740-9846 MAYOR THomAs ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING ODMNIISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, 5 54; Building Permit #t is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of had er) The debris will be isposed of in: �(name of facility) � Q � (address of facility) U n� s. Signature Uf applicant ( ( - ? .-iL Date T° CITY OF SALEM, A-1SSACHl;SETI-S BUILDING DEP.IRTNLF_NT r�r�l 120 %V.1SHfNGTON STREET, 3'a FLOOR TEL (978) 745-9595 FA.tc(978) 740-9846 }CI\IB ERLF-Y DRISCOLL THO,%tAS ST.PIERRE ,u AYOR DIAECTUR OF PUBLIC PROPERTY/BUILDING CO\L\IISSION-ER Workers' Compensation insurance AMdavit: Builders/Contractors/Electricians/Plumbers A r licant Information Pt se Print Legibly VnIT1C(flminess Drganirati°u'Imlividuod) Address: 2 Z 0 '� �l Phone #: Are you un employer!Check the appropriate boa: Type of project(required): 1. I am a employer with ;• ❑ 1 am a general contractor and I 6. ❑New construction - eniplayees(full and/or pan-ime).e have hired the subcontractors 2.❑ lama sole proprietor or partner- listed on the attached sheer. t �• ❑Remodeling ship and have no employees These sub-contractors have N. ❑Demolition working Yitr me in any capacity. workers'comp. insurance. q• 0 Building addition ]No workers'comp. insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 I am q homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself.(No workers'comp. C. 152, §1(4),and we bave no 12.0 Roorrepairs insurance required) f employees. [No workers' - comp.insurance rcquired.j 13.❑Other ^Any upplicartt dial ducks bat 01 must also rill uut the section Wt owshowing their worker mmpensaff"puficy infnmtation. - 'I lumeuwrwrs why whmil this'atfitlavit indicating they are doing all wark and then hire ouuWe contractors mint ruhmil anew affidavit indicating such @•untMUM Ihm ch vk this bus must attached an addiliunaf shod showing the na is or rho sub4onindun and their workao'comp.pulley information. i alit on eirrpluyer thuf tr providing workers'cu euradun incu uueejar my etnp y s. Ue/ut r floe p / and job slle iujnrururinn. insurance Company Name: Policy it or Sclf-ins. Lie. d: Expiration Date: Job Site Address; �� w City/State/lip: Attach a copy of the workers'compdnsatloo pulley declaration page(showing the pulley number and expiration date). Failure to secure coverage as required under Section 25A of SIGL c. 152 can lead to the imposition ofcriminal penalties of a tine up to SI.500.00 und/or one-year imprisonment,as well as civil penalties in the form of o STOP WORK ORDER and a tine of up to S25o.00 a day against the violator. Ile advised that a copy of this statement may be furwardcd to the Office or In vest igutiuns ol'Ihe DIA for insurance coverage verifiealiun. /du hereby rrijy cur r t/rn puDur ur env/tirs of prr'ury that the iIt unuuNon provided ubru•-v/ar is true and carrret 1'1••n I Date: Phone 1: 4- Of iriul use ardy. Do not write in Ills area, to be cunrpleted by city of/noun n/Jkiul City nrl'awn: Per midl.lccnse q__._. - Issuiag Aulburity(circle unc): 1. hoard of Ileallh Z. fluitdlnq Department .l.Cayfruwn Clerk J. Electrical 6cspectur 5. Phnubing Inspecwr I 6. Other Cnofacl Perim): Ph nee Y'