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10 BECKET ST - BUILDING INSPECTION (2)
The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,730 CMR SALEM Revised bfev 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Sectieh For Use Building Permit Number; - ` 'Data;Applie i... Building Official(Print Nama).. ;. Signature; Date SECTION I:S TE INFOMNIATION 1.1 pefty Address: 5/11.2 Assessors Malsreel Numbers l.la rs this an accepted street?yes Ll--�no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ' 1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Informatlou: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system Cl Check if es❑ SECTION!, PROPERTTOWNERSHD' -" 2 Owner'of Record: S Name(Pri�� Y City.-State,P �/4 Gb Vee 7 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORI&(cbeck all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s Alteration(j) ❑ Addition ❑ Demolition Cl Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed 1Vorka: _ O t AeTrON 4: ESTINUTED CONSTRUCTION COSTS [:221'. rn Estimated Costs: Offtclal Use Only. , Labor and Materials Building g L Building$ermitFde:S' indicate Haw fee is determined: riectrical g ❑Standard.dtyCCown,Application Fe&- ❑"rota(Prdject Cost(Item 6)x multipl(er x Plumbing i 2. Other Fees S' 1. \leehanical (IIV.\Q List: i, ,Mechanical (Fire iiiP xcs;iun) _ S Ibtal:\II Fees:$_ ('heck No. _—Cheek�luanunt: ---Cash:\uwunt:.-.-- I'nr.al Project (' i,t S O Paid in 171111 ❑ Outstanding llah ua 1)ua: SrCr1ON 5: CO;Ns'fRUCI'ION SERVICES / 5.1 Constntction Stiiervisor Licen L) �S —t�63 _ slls License Number Cxpiration Date Name of CSL I lolder ) List CSL Type(see below) _ // r Description No d eft��J�� INA 0 z / � t Unrestricted(Buildings s u to Dwelling cu. tt. V�I �`t R Restricted 1.4c2 F;unil Dwclliu City rown,State,ZlP Vt �9asonr RC Roatin Cuverin WS Window and Siding SF Solid Fuel nurning Appliances ( I Insulation Tela hone Email address U Demolition 5.2 Registered Home Improvement Contractor(NIC) ( J fl[C I egistratio Number Expiration Date I IIC Company Name or MC Registrant Natne / i ��iC�� 0 No.and Street (� Emat ad less Ci /Town State ZIPTale hone SECTION 6: WORKERS',COMPENSATION INSURANCE AFFIDAVIT(NI.G.L. c. 152.1 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...:.......13 SECTION 7a: OWN AUTHORIZATION TO DE 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 SECT[ON 7h: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I reby attest under the pains and penalties of perjury that all of the information contain 'i this a icatio t�rruueeaand accurate to the best of my knowledge and understand. j� J I'rin wner's or Authurimd: gait's Name(Glectrunic Signature) l/ (D/ata NOTES: L :\n Owner who obtains a building permit to do hisiher own work,ur an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration s program or guaranty tend under i`I.U.L. c. 142A. Other important information on the 1-11C Program can be found at www nue+.cuv%aca Information on the Construction Supervisor License can be found at www.ntass.!tv_QJ 2 When 511b, Omuta twrk is planned,pro the information below: rural fluor area mut ltJ .___ —(including garage, tinished basement/attics,decks or porch) t Trus; living:era(sy. d.l — flabimble room count _ Nuutbcr of tireplaces ._.----_— Number of bedrooms - ----------- ----.--- Nuutherofb,uhruunts . ,-, I'vpe of h..uin4 ;y;iem _.. _ Nmnber of dock.,'purnccs E nclosed tpeit "N pe of conlin , ;y.tcnt _-- - t --" I,,ril t,,r ' I' r.il I'rijrd l'na,. e i Breakdown of the 10 Becket Street House Roofing Project in Salem, MA Roofing Your roof has an area of 22 square feet. • 1 will remove old roofing and replace with new shingles. • 1 will be using Architect shingles,with a durability of 30 years. • The wood beneath the shingles might need to be replaced. I will only know after removing the old shingles. You will need to pay extra for any removal and replacement of the wood beyond 1 square foot; anything less than 1 square foot, I will pay for. • Paper will be placed above the three feet of ice water. • 1 will be placing a ridge vent on the top • 1 will put lead in both the chimneys. • I will be putting 060 rubber behind the house. The grand total for the roof will be $7,730.00.There is a 40% down payment; the other 60%will be paid upon completion of the project. Gutter For removing the old gutter and replacing it with a new gutter,the total cost will amount to$1,650.00. Z2 3 �1zL AS KCS Payer of the Roof' Project Contract agle Roofing, Inc. Rightfax N3-1 6/28/2013 5 :20:35 AM PAGE 2/002 Fax Server `Cy DATE YY (MMJDDIYYI AilCERTIFICATE OF LIABILITY INSURANCE T41LPERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE O D R. 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 INSURERISI,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 and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: AL PONTEnSUR.-llvC.': PHONE FAX 319 C-NIBR?DGE ST fAJC,No,Ext): (A1C.No): E-MAIL CANABRIDG!t. MA 02141 ADDRESS: 781117 INSURFR(S)AFFORDING COVERAGE NAICa INSURED INSURER A: IC 1;AJYSRLCAN INSLm4NCE WAIPAN) hAG 1,It ROOMNU PALNTNG S:C%RPE'ITR iXl_ INSURER B: INSURER C: INSURER D: 49(AHlRN TERRACE C16 INSURER E: Hti hBd L`C.1t11 u7L49 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS O CERTIFY THAT THE POUC03—OrINSORANCE LISTED BELOW E TO THEINSUREO NARO:OABOVE FOR THE POLICY PERIOD INBICATEU. NOTWITHSTANDING ANY REDUIREMETIT.TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THEPOUCIES DESCRSED HEREW IS SUBJECT TO ALL THE TERMS.EXCLUSIONS Ata)CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAS CUM. NSR ADD SUR VOLICYEFFOATE POLCYEIIPDATE LTR TYPE OF INSURANCE L R POLICY NUMBER IMM.DDIYYYYI (NwrCO,YYYY) UMTS GENERAL LIABILITY ACH OCCLIRRE14CE O11b'ERCIAL GENERAL LIABILI I Y 'AAF CLAIMS MADE OCCUR. NOS 1F. IEC FS: R LITEC S " Anee) FI:FXP(Aw ane FCrsonl S RSONAL 2 ADV INJURY S CEN'L.A.wREG.4 E LINA?.PPI IFS PFR oFFIFRAL AGGREG.A11, POLICY [::]PROJFCT❑I U. PRODUCTS-COMPIOP AGO IS AUTOMOBILE LIABILITY COMB'NED SINCLE 5 APTY AUTO LPAfT(Ea awldelq ALL ONTIED AUTOS BODILY PJ!URY 5 SOAFIDUI E AU-05 ;Per persm0 HIRED AU 1 OS RODILY H.URY S reel t) NOIJ-.`JNiNED AUTOS I'ROF'ERTYERTY DAMAGE H'el ac�AMI) U'YIBRELLA LIAR MOUCUR EACH OCCURRENCE i5 EXCESS LIAB -VIADF AGGREGATE 'S DEDUC IELF 'S RF rLNI O(J S $ A WORKER'S COMPENSATION AND ` 'W::SIAI'JTORY T -R EMPLOYER'S LIABILITY YM 11,015 WJY'RC`2R RCRiPpJt 9:CLUUECUD=2XeCAff> VF NIA E L EACH ACCOF14T $ 100 C00 WRJERd:E!i.SSR IManlntoryin NN) EI_I SFAS"E-FA E1'iFL01'EF.; 100 C00 fYc.drer M,:1,;h E.L.DISEASE-PLT.C,Y L'Nr S 509,000 r:=SCR CA DF tFyiiT'J%EtneI[ I DESCRIPTION OF OPERATIONSJLOCATIONSIVEOCLESJRESTRICTIONS!SPECIAL ITEMS 'I IIIS RFPI_dfES IN)'PRDJ?CHSIECAT-LSs1/E!:'t"'1Ib,"I.Uz;CATE Fl:JER AR ?E,IWnR::-.S,^.YIPC"IVERAOE. CERTIFICATE HOLDER CANCELLATION CARLOSPEREfRADBA37—U?RS)OFi:ONTAACTINC SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED ) BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIV 8!U'.1* i ZD IN ACCORDANCE WITH THE POLICY PR�E AUTHORIZED REPRESENTATIVE II SOYISRVI"b.NIA 02145 ACO RD 25 M1010 5) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORA lIUN. Ali rightstes"`5,VeA. 1 CITY of S•V-E.,tii, j.)/W&wHUSETTS 1F ! 1TEADclG Ov.IRT oNr %0 120 CV.13Hc1GT0,Y STUST, 3" ` ~ TEL (978) 745-9595 <lUOR111 fiy DRISCOLL FL`c(973) 7•W-9343 D;UYOR 'I�to►t�Sr.PtE.tns D f:LECTO R OF PC OUC pROPERTy/BC MONG C0.%Wl5SlO.Y ER Construction Debris Dispasai Alf7davit (required tut 311 dcmclitiun and rcnuv3tion work) In accordance with the sixth edition of the State Building Coda, 730 C&fa section I I L5 Debris, and the provisions of,MOL a 40, S 34; ©wilding permit N this wur!<shall be is issued with the condition that the debris resulting from l I, S I50A. disposed of in a properly licensed waste disposal facility as defined by,tifGL c l 1'ltc debris will be transported by, (nam vt'haulur) The debris will be disposed ot'in : 7��= _ (n—am/-aof fac�dity) ;ilfiun;ra of permit applicant CITY OF SmX,,L%t, NANSSACHUSETTS Bl:ILDLNG DEP♦RTSIENT .• } y 120 WASHINGTON STREET,3"'FLOOR. TEL (978)745-9595 FAx(978) 740-9846 (I.N(BFRi RY DRISCOLL TTiOhtAS ST-PIER MAYOR RB DIRECTOR OF PUBLIC PROPERTY/3UH.DLNG COJLMISSIONER Workers' Colnpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anplicant Information z Please PrintLegibly Name(Busiix'S&Organiizzatiorulndividual): t� I Address: r City/State/Zip: � � I F' Phone Are you as employer?Check the approprtay�e bb 'type of project(required): 1.El am a employer with 4. am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' /fes have hired the sub-contractors 2.0 I am a sole proprietor or partner- - listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These subcontractors have S. ❑ Demolition working.for me in any capacity. workers'comp.insurance. g. El Building addition (No workers'comp.insurance 5. ❑ We are-a corporation and its. required.) - officers have exercised theta I0.❑Electrical repairs or additions 3.❑ l am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself.(No workers comp. c. 152.$1(4),and we have no12 oof repaint insurance required.)t employees.[No workers 3.0 Other comp:insurance required.] -Any applicant that checks box el most also all uut the accrue below showing their workers'.compenwian policy infamadom I hvrwuwncia who submit this affidavit indicating they an doing all work and then hire outside contractors must submit a new airldnvit indialing such. =Contmmon that check this box most attached an additiond sheet showing the name of the sobaconrractors and ihek'workers'comp.put icy infommgon. lam as employer that it providing workers'compensadan losurance for ray einployees: Below/s the pallet'and Job site inforrnaton. Insurance Company dame: Policy n or Self-its.Lia n: Expiration Date: ` Job Site Address: City/State/Zip:' Attacks 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 rine 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 line of up to$250.00 a day against the violator. 13e advised that a copy of this statement may ba forwarded to the Oftice of investigations ofthe DIA for insurance cov-rage verification. . /do hereby eros «ceder pains d e elites ojp� rrJary that the firfarnrmlon provide ve Z True nd correct. Phone 4: Official use only. Do tat write in this area,to be completed by city or yawn off efol City or'rown: Permitil.lcense# Issuing Authority(circle one): L Board of Ilealth 2. Building Department J.Cilyffown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other.- Contact ther._Contact Person: ---__......--_--- Phone n: n' M +' > N > M Massachusetts -Department of Public Safety ,. Board of Building Regulations and Standards Construction Supen icor I License: CS-106349 �- CARLOS A PEREMA 11 RICHARDSO. ER TCE_ SOMERVILLE MA 0i. Expiration Commissioner 07/15/2015 ' _ HOME IMPROVEMENT CONTRACTOR Registration .173394 Type. Expiration 10/1/2014 Individual � C LOS A. PEREIRA -j CARLOS PEREIRA 81 BAILEY RD g """«OMERVILLE MA 02145_ UndersL— reetary i