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118 COLUMBUS AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7"edition OF SALEM 'w Revised Junuwr Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 20MY One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: 1 Signature: Building Cummissioner/Inspecturof Bwldings Date SECTION I:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map dr Parcel Numbers I i 45 r=L u n.i rt(_i s �--_ I.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) I.S Building Setbacks(R) From 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: 1.3 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if es❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: EQ MORWIFAL) 9 C6i-u m i3l I S AtA& Name(Print) Address for Service: 9-7 Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': iq vo m OLy 'i_r/ -5i0''/F5- ) SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Ofllclal Use Only Labor and Materials I. Building is I. Building Permit Fee:S Indicate how fee is determined: O Standard City/Town Application Fee ?.Electrical S ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (iIVAC) S List: 5. Mechanical (Fire S Suppression) Total All fees:S Check No. Check Amount: Cash Amount: 6. Total Project Cost: S,,2V, 4/P/57 13 Paid in Full 0 Outstanding Balance Due: r SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) P�SD3^y.3 P)9U5T1111r> Mi=LO License Number Expiration 0-ite Name of C'SI.- I lulder 1 List CSL Type(see below) I'72A✓�✓ )L 63� G i f2 f`�f7Q7� r lhscri ion .AJJre 4 U (Inresll—i u to J3,000 Cu.Ft. - R Restricted Id2 Famil Uwellin SignatureQ M M Only 7-e �l 0 �j/� RC I Residential Rooting Covering felephrme WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) /Q fj 9S3 111C Company Name or HIC Registrant Registration Number er MELars GD K9T 2rl/ 7 e) /o 97g 53) 1>8 ll Expiration Date Signature - "telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. 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 ..........O No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 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. Si lure of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and behalf. Print Name Signature of(honer or Authorized Agent i�---�� Date - (SiRned under the pains and penalties of 'u 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 W have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS,respectively. 2. When substantial work is planned,provide the information below: Total floors 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" INN CITY OF SALEM PUBLIC PROPRERTY `'�'' DEPARTMENT :�.: flw :J%111;KI.Fy DIO'Col L - >'1avdra 12C WASHINGION STa ELT • SALEM.M.\s,n(:In NiCj is 01970 71.L;978-743-9595 a Pax:978-74.0-9846 Workers' Compensation Insurance Affidavit* Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeiblv %4atTlc: 1puciness/OroanizatinNlndividuu4: Ni5-0A 7,Ieu e-7z'a (,1 LL G Address:_ 3;� LL ,1At l i UGs C 1` 7 CityiS[a[e;'%ip: gne v Phone /': 978' // Are you an employer:' Check the appropriate box: 'Type of project(required): 4. ❑ 1 am a general contractor and I I.� an�employer with G. New construction employees lull and/or art-time).' have hired the sub-contractors ( P 7. ❑ Remodeling 2.❑ 1 :un a sole proprietor or partner- listed on the attached sheet. ship and have no employees 'these sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition I No workers' comp. 5. ❑ We are a corporation and its .insurance required.] officers have exercised their 10.❑ Electrical repairs or additions right of er MGL I LE] Plumbing repairs or additions 3.El 1 ;nn a homeowner doing all work S exemption Pon P' myself. [No workers' comp. C. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] r employees. (No workers' 13.❑ Other romp. insurance required.] •Airy applicant rlmt checks box#1 must also fill out the section W.ow showing their workers'cumpcnsation policy inionr atiun. 'I tomeuw,rem who submit this affidavit indicating they are doing all work and then hire outside contractors must ouhmil anew amdavit indiwbng such. �Contractuns that check this box must anachod a n additional sheel showing the n,auto of the sub-contractors and their workers'comp.policy information. i onr un employer iliat is providing ivork-ers'c•omrpensatiorr insar(orce fo•rtry eitiployees. Beloly is the policy and job rile information. Insurance CompanyVyne: Policv 4 or Self-ins. Lie. fie 1 lfU6 781 �J.tS.So�f.___._ Expirution Date: ! — 1, y Job Site Address: I I g' OL L/M i31 -� r414.E City/State/Zip: Attach at copy of like workers-'compensation policy declaration pale (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a Fine up to S1.500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up u, S250.00 a day against the vi,)hror. Ile advised that a copy of this statement may be lurw'arded to the Office of Inccstigatious ol'thc DIA t'or insurance coverage vcrilicalion. l do herchy rcrt' cr fh(h rs mud penalde• perju that tire information provided above is true cord correct. Iht � 'i � 7Sr � 31 © � lL Official use only. Do not write in this area,to be completed by city or town official. City or'fow•n; _. . - Permit/LicenseX---_-- -. Issuing 'Lulhurity (circle one): 1. Board of Health 2. Building Department 3. Cityfforvn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: _ ._--- Phone N: Information and Instructions Massachusetts Gcneral Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more Of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an Individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." SSGL chapter 152. Z25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s), address(es)and phone nuniber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial .Accidents for continuation of insurance coverage. Also be sore to sign and date the affidavit. The affidavit should - be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials. Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. I'Icasc be sure to till in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only-submit one affidavit indicating current policy information (if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. 'I he Otlice of investigations would like to thank you in advance for your cooperation and should yuu have :ny questions, please do not hesitate to give us a call. The Dcparnnent's address, telephone and fax number The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www,mass.gov/tile CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT NIMA T # SAI I M. NlAli 8-74�-9;95 # FAN; Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition oftlic State Building Code, 780 CN1R section 111.5 Debi-is, and the provisions ofMGI­ c 40, S 54; Building Permit it_,. - is issued with the condition that the debris resultingfrom this work shall he disposed of in a pruperly licensed waste disposal Facility as defined by NIGL c I It. S 150A. The debris will be transported by: n lMS C )LL(:�_ (name of lIaLlICr) Flic debris will be disposed of in L Ly- o (name of Facility) (address of l'arililyl — Signature ot'permit applicant (late �Zo ih. CERTIFICATE OF LIABILITY INSURANCE 12/4rD009 12/4/2009 PRODUCER (978)532-5445 FAX: (978) 532-2217 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION S.K. McCarthy Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ! HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 10 Centennial Drive i ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Entrance Peabody MA 01960 - INSURERS AFFORDING COVERAGE - _ NAIC_# 111SUREo � ,;;�,�_.., National Grange Ins Co T_ T - National Grange Mutual Ina Co T14790 Me_os Construction LLC ������-:=,8. 8 26666 c!o Faustino Melo ;;E;.�_;ER,_,Travelers Indemnity o 34 Jennings Circle INSURER o.------ ---- Peabody MA 01960 QNSURCR=_: — COVERAGES —=>^ ?CtES OF 4NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING Y R=EQUIRS!AE`:T. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH cGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL;1MS. 1\SR.,CnL POLICY NUMBER POLICY EFFECTIVE POKY E%PIRATION 1 tAT IMITB GENERAL LIABILITY EACH OCCURRENCE $GE TO KENTEV ___500�000 X COMMERCIAL GENERAL LIABILITY ! PA A1J5 (E oeuntQn�e)._-{S A j _ CLAIMS MADE LX OCCUR B23062 I11/26/2009 , 11/26/2010 MEDEXP"ormpereon) La_ 1Q,000, PERSONAL S ADV INJURY S 500,_000_ pENERAL AGGREGATE _! $ 1 000 000 PRODUCTS-COMPlOP AGG_LS' 1�000 000 X COMBINED SINGLE LIMIT I S . .. . j(Ea accident) $ ___ :- X9K439269/21/2009 9/21/2010 ( BODILY INJURY jg 250,000 X -:_ 1 (Per person) K =: BODILY INJURY EOPERTYDAMAGEr ecddenl) AUTO ONLY-EA ACCIDENT IS _. EAACC_ S OTHER THAN 1 AUTO ONLY: AGGS _ EACH OCCURRENCE Is AGGREGATE $ , WC STATU- E Y R VP R SATION I_� Y IMQcI Es AND MFLOY RS LIABILITY :-u ORIP..ATNEAr%ECUTIVe YIN j EL EACH ACCIDENT _J S^__,1 000 000 OFFIC 4AHEMBER.EXCLUDED( F-kI iMantnWry in NMI �"7814M46509 I12/4/2009 - 12/4/2010 E.L.DISEASE-EA EMPLOYEES 1,000 000 IF yee.2esabe order S.PECW-PROVISIONS below E.L.DISEASE POLICY LIMIT IS 1 '000 000 OTHER 1 _ .�.._ ._d.CLEs:EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS _- _=R CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION -G= =❑3_=_CIS =urnoses DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL IO DAYS WRnTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. i AUTHORIZED REPRESENTATIVE nnnn } John McCarthy/LG4 ACORD 25 (2009101) C 1988-2009 ACORD CORPORATION. All rights reserved. INS025 <a:_: The ACORD name and logo are registered marks of ACORD Melo's Construction LLC BB$ 34 Jennings Circle Peabody, MA 01960 �- Telephone: 978-531-0811 - E-mail: FallstinoMelo@msn.cotn t1.VrsdS.Jltb . _. MEMBER Faustino Melo, General Manager Unrestricted Mass Builders License No. 80393 Contractors Registration No. 108953 Proposal Subnutted to: Phone Number, . Address: City,State,and Zip Code Job Description: Job Location: Job Phone: We Pn 4'! aehy to famish materials and labor-complete in ecwrdence with dto spocifiaioo lis pelow,far the sum of r i71 LiLxHF i .tr 'JiiuusFa yr '5 eyry Hu11hyel U X-� �:� d^ dena,9 (S a3. :'c � Installation of Payments: Payments will be paid in thirds.The first installment will be paid before the job begins.The second payment will be obtainedin the middle of the job.The last paymtat will be obtained after the job is completed. Note:This proposal may be withdrawn by us Authorized Signature: if not accepted within 20 days. Date: e Hereby%brnk SpecMmtlom sad Estlo r.ates to RCA7014f OLD i >00 dS 5, 14; 1V G4,6_S ON _-JV".R/Tai A?0 YOU C, r 9-4J`r"i/2)_ #'{4'To3 s r. r ?4t.-. o 0 -:d- RfSTftL.i Lf� 1YL. ow FG7!?Ghr 5 r &L_if TYF)? 5 "77k 4'v2 /4 ?vo . 5.9¢F7 06, L//iS'rTyr o 1✓r1V tIc itlS A L L . C-,a r :mk t). .w rrF ' L�L.°!V LU {P uvl"41 t .- 'Icy �=aL' 6fC7�e`J s'.+V "aN ' ��•r7Y�',$/hC_ r Y��Ctc�'S Ge's�'^7 f'`tv SALiL dnr GLctt & t� L'LJ k -.Mr Y 'Alfi `Ii+ F fiic 6Ritse�1 f ;7r'0 5,71)1, All the debris will be cleaned and properly disposed of on a daily basis.Magnetic brooms will be used to extract all nails from your property. We will protect your property as best as we can, however, some foilage matting,breakage,or marring could occur. We cannot accept responsibilty for possessions inside of the house,or debris falling into attic areas. The customer should protect personal bdonaines. Extra work in which an additional cost wdl be added to the above pnce. Replace Rotted Rootboards _o::�y r Gutter Repairs Remove Aluminum Siding Relead Chimney(s) Install Skylight(s) Remove Old/Rotted Wood Replace Facia Boards Repoim chimney Install Garage Roof Install Ridgevent Install Azek Board Install Insulation Install Roof Louvers Install Window Trim Install Tyvek Paper Install,Aluminum Gutters 11 ri Install Shutters Cover Aluminum Windows Install Aluminum Downspouts gi ) Remove Vinyl Siding Repair Vmyl Siding Install chimney cap Porch Repairs Rebuild Chimney Total Amount for Additional Worst W by manufacturer to be free of defects for years, see manufacturer's warranty for details. All labor performed under sycontract shall be of good quality and free from defects not inherent in the quality required or permitted for a period of years. This warranty excludes remedy for damage or defect caused by abase, modification,improper or insufficent martenance, improper operation, or normal wear and tear under normal usage. This warranty shall be limited to the work performed by Melo's Construction,LLC and limited to either repair or replacement by Melo's Construction,LLC at its sole descretion and election. Any and all claims are waived unless made in writing to Melo's Construction, LLC within 21 days after J+acrumrmga%,rrfumc rcarnrcry, rvu%v tyov ME AM Telephone: 979-531-0811: - )rtnail: FaostinoMeloQ'ansn-cotn NISMBiR Faustino Melo,General Manager Unrestricted Mass Builders License No. 90393 Contractors Registration No. 108953 SubmittedPrwossl to: Phone N . aRNt q 7S 7 Address: city,state,and Tip Code R _ rY7A . 0 1970 Job Description: Job l ocaum: Job Pbope: SAmil: I 5AM1^ We Proposed hereby to Hwish avterids rod labor-oempkoe m eoecrdanee coif the ep-mike hem hsoed below,fQ mhe rim of. Six 7'"1n t) e A nl0 Ali M5 f UPORKI) Insta0a6on of Payments: / PWriusits will be paid in thirds.The rust romanni t will be paid befee the job begjms.The snood payment will be obteiued in the middle of tKe job:'a helasr psyiiiem'will be obtained Ider the job is completed / Note:This proposal may be withdrmm by us Authorized Sigashre: ✓�1 cJ if not accepted within 20 days. Dale: ,$-_ti— /o e Hereby%bvs a mff"Am nerd LarVb mar: THE INSTALLATION OF A NEW ROOF To protect the homeowners property,Blue Tarps will be used to cover the siding,bushes,and grass during stripping. All of the layers rooting wit be stripped;and all protruding nails,screws,and/or staples will be removed. Ice abe water shield will then be installed at the bottom of at edges,around all chmeys,skylights,and into all valleys. Fifteen(15)pounds of felt papa will be installed onto all other areas of the roofdeck. The 8•'aluminum dripedge will then be installed to all roof edges. Any existing pipes will be covered with new rubber flanges. The roofing material to be used will be-3 D X RDO�A/� 7The homeowner is responsible for the`selechon of�roof color. Also, the homeowner may select fter hand or pneumatic rs for the periling application of the new roof. All the debris will be and pmpedy disposed of op a da'w basis.Magnetic brooms will be used to extract all nails from your property. We will protect your property as best as we can,however,some foilage matting,breakage,or marring could occur. We cannot accept responsibk for possessions inside of the house,or debris fining into attic areas. The customer Extra work in whkh an a cust will be added to me above price. Replace Rotted Roo y rJ I Gutter R Chimney Relead _ epairs Remove s Alu minum Siding R lace Facia Boer)dsQ Ill Sy Install 1 t Remove Old/Rotted Wood Repoint chimney O o Install Garage Roof Install Ridgevem Install Azek Board Install Insulation . Install Roof Louvers Install Window Trim Install Tyvek Paper Install Aluminum Gutters Install shutters Coves Aluminum Windows Aluminum Downspouts Remove vinyl Siding Repair Vinyl Siding Install chimney cap Porch Repairs Rebuild Chimney Additional Notes: Total Amount for Additional Work: W nemufacturer to be flee of deli for _years see manufacturers wartanty for details.Ail labor performed rumder tlh4 contract shah be of good glmnty and free from defects not inherem in-the qw rotluirod or permitted for a period of Years• This warremy excludes remedy for damage or defect caused by abuse .modification improper or inau�cent E nce,impper operatioor . tywhet be limited to the work ed by os Construcolimited or Consrucd LLC at its sol on e on and election. Arty and all claims are waived umless made in writing to Melo's Construction LLC within 21 days after the otxvrtence of the event giving rise to such claim This warranty shall not extend beyond any limits imposed by applicable law. Payment and Penalties-Upon substantial completion of an work under this confirm customer shell-within 3 days-make the final and fitfl payment of the contract price. Any and all unpaid balances shall accrue with interest at 5Yo interest per month. You agree to pay all court costs and collection expanses inverted by NWs Construction,LLC in the collection amount you of any amount you owe under this contract,including and without any limitation of reasonable attorney fbes. Acceptance of the Proposal The above prices, specifications and conditions are satisfactory and are hereby accepted. Ypu are authorized to do the work as specd5ed,payment will be made as oudua above. Payments am to made as per requisittion and or invoice. The proposal may be withdrawn.within 20 days. Date of Acceptance: / Signature: � �.