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70 DEARBORN ST - BUILDING INSPECTION ,ZN The Commonwealth of Massachusetts Wk, Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 ' Building Permit Application To Construct, Repair, Renovate O emolish a One-or Two-Family Dwelling la t This Section For Official Use Only J Building Permit Number: Date Applied: Building Official(Print Name) Signat a Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map arcel Numbers :_ d O2r��b�ra� L Skl{/h 607d Lla 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 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.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public r Private ElW Zone: _ Outside Flood Zone? J A Check ifyes❑ Municipal On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(P yrx rint)) mcz op y City,State,ZIP 76 Qe,,,,rboro S% g17V-')G -t127Y No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units OtherSpecify: '— 0 jr, Brief Description of Proposed Work': ^L- n ce_ Agg&14- $� 17n r� k µ ✓Se. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials L Building $ t7 q 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ __P + 4. Mechanical (HVAC) $ List: `"V l 5. Mechanical (Fire Suppression) $ Total All Fees: $ p Check No. Check Amount: Cash Amount: 6.Total Project Cost: S ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Number C L. s G z� li N1rYrl,.av� f icense N Number E.epiration Date Name of CSL Holder 21 t/_ _ - ' 57-- List CSLType(see below) No. and Street Type Description �. b / eAA \ r a t pt�/ U Unrestricted(Buildings u [0 35.000 cu. R.) W"" JJJ l I 7 Restricted 1&2 FamilyDwelling Cityfl'own,Stal I M Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances 617 B'—9(n—Z"y 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 23 !Z V Uk1 &-r1' 4 rex^ /UGT'L'y HIC Registration Number Expiration Date 1-IIC Company N me or HIC Registrant Name I y1�C. o-� ST JbL�nSIY✓cf.bn 0/r16d 01AJ 0. and Str(eet(/ II /- u�Lo / •E-�6C I.r.tewl / GW. �1 1�7 `17'�3/7—dv� Email address r 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 CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property, hereby authorize JJ(/A`)a../yt.� to act on my behalf,in all matters relative to work authorized by this building permit application. G /3 /I N t gnalure) 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 and accurate to the best of my knowledge and understanding. Pri. wner's or Au oozed 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 w.vw.massj ov.oca Information on the Construction Supervisor License can be found at www.nias,nov/dos �. 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" JOHN BARNES CONSTRUCTION 46 CEDAR ST MARBLEHEAD MA 978-317-0085 6/13/11 To: Frank&Maura Murphy E mail fmurphy344@aol.com 70 Dearborn St. , Salem Ma. The following is a work agreement. The work consists of: EXTERIOR, replace damaged soffit, fascia ,roof: ROOF Remove & replace front roof& upper main roof(front half only)with like same shingles to match existing , Install ice &water shield , drip edge& 30#felt paper ------------------- $7,000 Dump fees &permit —--------------------------------------------------------- $ 660 SOFFIT& FASCIA Replace soffit with like same , (3/8 cdx plywood) , aprox 80 sq- --------- $ 760 Replace fascia upper& lower, with like same (lx8 prime pine), aprox 80' $ 675 TOTAL COST ----------------------------------------------------------------- $9,095 PAINTING NOT INCLUDED , LANDSCAPING NOT INCLUDED STARTING PAYMENT REQUIRED --------------------------------------------- $4,548.00 PROGRESS PAYMENT UPON COMPLETION OF FRONT UPPER ROOF $2,274.00 FINAL PAYMENT DUE UPON COMPLETION ------------------------------- $2,273.00 EXTRAS ARE BILL DAILY AT A COST PLUS RATE BASED ON $65/HR PLUS MATERIALS. Signature of ceptance _ 1 Thank you, and God bless. John Barnes CITY OF S.0 ENl, LPL-kSS.A.CHUSETI'S BLL DLIG DEPARTMEAiT 120 WASHNGTON STREET, 3'0 FLOOR THL (978) 745-9595 FAX(978) 740-9846 K1.%03E UEY DRISCOLL MAYOR THo.�us ST.Pm= DtRECTOti Of PLBLIC PROPERTY/Bt;IIDNG COMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 1 t 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit Al is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: Or3�oS�- (name of hauler) The debris will be disposed of in (name of facility) (address of facility) sisnature oCpermit applicant l3 t1:tfC �<f1f141�.�.A CITY OF SALEM " ' Ir PUBLIC PROPRERTY DEPARTMENT ..uc:Wtr ,n1,t,-i1 \I r1,,it 1 j.^\Vn,tuA\;I r)\119FL•1' •SAI C•.N, M.\>.v.\l.tlt q i I,JIY7,^, 1-IA; 17/.71593'$ a 1'r.r 'gM•71C•'1 t1a Workers' Compensation Insurunce .%t11dovit: Builders/Contractors/Electricians/Plumbers t titcrnt Inrurmation _II /J Plcax Print Le •bl Valnctllu,uu,ri)raanuatinrvindtruluulC� df�r\ IJo�/CPl S��riLfC1 �Jdress: l6A^m,, ce� City,Srarc,%iplL/t/��1Gg /�a /�/�It/� Phone it:_97?'-3/7 ddr5_ Are)too an employor?Check the appropriate NIOW I 1.0 1 am a emPluyur with 4. I am a guncral coutraetor and 1 Type o/proJeut(required): anlpluyccx(full JIIWur Putt-time).• huvu hired the sub-amtracturs ' 0 New construction m 2.0 1 aa sole prnprictor or Partner• listed on the anached sheet Remodeling ship and have no umpluy"m Thesd sub-contractors have g. Damolirion corking lbr me to any capacity, workers'comp, insurance. INo workers'cutup. insurance 3. 0 We are a co, 9, ❑ OuiWing aJditiun nyuircJ.J pontinn and its officers have cxcrsiswl their 10.0 Electrical repairs or additions 3.0 1 um a hnlneuwncr doing all work right of exemption per h((IL 11.0 Plumbing repairs or aJJifillne myself.(No workers'comp, C. 132,§1(4),a we h Iva nn 12Ruufrepairs insurance required.) t cmPluyccs. (No worker' crnnp, insurance rMuquiad,J t 2 D Utber -\�y••;yahcur ihW chcb bos�I mop alw ttll wa the verhon White atowine rMir.WwtWo cun,tr,tnuuiun rydiey arrivaWia\ 'Itumw,wr,ara he rubmtr rkia a/1ldevir indtcatin@ thuy are aoina all work and shin bite wrfide cum,rnetore "Out.uhnY a raw alflaevir irWiavlina.,rck, •f,v,trwrrm,,rhp ehccY this trrK mtrr atlacheJ nn aadittunrl,how,Miwina the„afros/the rubremrltl and them,wurker@'easy,prltcy inlbnnariva /tun all etup/uyer thus is pruviJ/nX 1vurkeri'ruurpenrnrlon GLrurnttee�ar uq elnp/upda.R Br/ury Js/he pu/ley urrr//ab slf� iu�unnu/iu6 / InaurauccCunrPanyVaree:�ltt/••f/' �/�--dc„I _. . _. ._..---- Policy a or Sulf--ins. Lie.N:_WCa 3 it 5 36 3O !/ y� -- . .. . Expiruuun Date: z.L Jut)Situ Addruss: 7d (/1a��jd�.t s/ C'ayBtaterL1p: .h,Iar,- I Failure ouch n %upy of u% r Vc aj r' uirnpensatlun pellcy Jeelaraliun pug@(showing the policy ntunbur and explratlun date). 111t to,ccaro 00 in lu as required under Section 25A of�IGL u. 152 caa lead to rile imposition of criminal penalties of a fine up nr.SLJIIO.tIn and/or arse-year imprisonment, us well ac civil pcualucs in the l'unn of a STOP WORK ORDER and a ring nrup fit '250.r)()a Jay tguinat the violator. Ile advised shut a copy urthis maicmcnl may be Iurwarded to the U11ice ut Ia,vsngawnu at';hc 01A for in,urarce covaragu \er itieultun. /du hereby r,rtily ender the paint surd penu/der u/prr/ary'hut the is urrrwllon ry, � /� provided ubuvar is rrai cud correct Date / r1,• : . r U//rrru/nse u,dy, Do,rnr a rirr in rhir ureu, to be ruurpA•reJ Ay city ur taivn a//lcruL i ('itY ur I'ntrn: _ Permittl.lcenre e I„uing.�uthority (circle nnc): II. ffivirrtj of Ilealth 2. Iluddurq Ilcp:vuucut I. gill:'1•u,ru Clerk J. LActrical lurpeetor 5. Plumbing Irt,ycetor G. Ihhvr l'�,utaet I'vnuu: �_ .___ I'huue .yr Information and Instructions trot in the service of another tinder any contract of hire. %Lusachuaetts General Laws chaetet I i2 reywrca a e ll uyrloyers to prov+da workers' compensation fix that en+p ogees. I'ursu.uu to this .acute. an rmplurrd is defined as"...every pe ;.press or implied. oral or written." ly two or more An employer Is dctined as"an Individual, purtnenhip,associanoa,corporation ur other legal entity.or to atmershrp, d Including or other legal entity,employing employees. However the t the e'oregomg engaged m a Joint enterynsa, and including the legal(tprclantattves of a deceased empluycr,or the Ofthat ecewer or uuatee of.m iudiv+dual,p house owner of a dwelling house having not more than three IParonenu and who resides t)rercm,or the occupant dwelling .welling iruud of another who a l thereto sions hall to do uotnbecause of such employment be deemed ruction Of repair work in ube an employer or on the around+or building appurtenantshag withhold the issuance or \IGL chapter 152. 425C(6)also states that"every fiess or state or local tract licensing buildings In the renew a,of repel ant th for any a license has n or permit to ot permuted ace ate a bus[ face of compliance with the)Insurance coverage lrequired. \ddinon, vie SIG s chapter I c a25 dpl atatea"Neither the commonwealth not any of its Political subdivisions+hall en�er into any contract c for the perfomtanca states of " Pic work until acceptable vidence ul'cunteliartca with the insurance reyuiremnts of this chapter have been presented to the contracting authority." �yyllcants to our situation and.if Please I;II out the workers' compensation affidavit completely,by checking the boxes that apply Y necessary, supply sub cone ictor(s)name(.$), addresa(es)and phone number($)along with their Cartiticalels)th with no employee insurance. Limited Liability Companies(LLCworkee'tcompasatioed Liability e iruutancm(If an)LLC or LLP does have ar Than the ndustrial members or partners, are not required to carry ent Of employees,u Policy is required. Be advised that thunlso be sure to,Tidlvit mayita antd dale the ofildavilt. 1lulotl'Idov t should being q artment of Accidents for confirmation oP insurance coverage. aired to obtain u workers' he rcrc+med to the city or town that the upplicAd questions regarding the law or the permit Or or it'yuu are required, not the 'P Industrial Accidents. Should ynu have any cornpenaation policy, please call the DeptuQttenl at the number listen below. Self-insured companies should enter their self-insurance license number on rhea ro riuto line. ('Ity or Town Offlelais please he sure that the affidavit is complete and Printed legibly.f investigations The Department has provided u apses at the bottom of the affidavit fur you to Pill out in the event this 011ita of Investigations has to contact you regarding the applicant please ff sure ro tilt in the permit/liense Wombat which will be used as a reference number, In addition,an applicant that must submit multiple pennit, cense applications in any given year,need only submit arse at7idovit indicating current of the needs that has been officially stamped or marked by the city or town tnay be provided to the policy information lit necessary) and under"Job Site Address"the applicant should write"all locations b p o (coy or town),",\ cope applicant as proof that a valid affidavit is on file for future Permits or licenses. to any now aeusines trust commercials or tilled nut eat eat.;r��KR apse a Owner tOr citizen is o bum leaves Ote.)s`id Penn a license is NOTtrequired toelateJ amplete eh ae'fidav t venture permi I he +)dice ui cooperation and should you hard.my yuesumrs, luvestigations wuuld like to durnk you in advance fur your please du not hesitate to give ua a call. fhc Uepanmont's addtess, tvlephune and fax mmonwealth of Massaehusettli Depattment of industrial Accidents 0Mce of lavtesdIIadona 600 Witaington Street Boston, MA 02111 •fee, N 617-727.4900 eat 406 or 1-977-MASSAFE Fax M 617-727-7749 www.mass.gov/dia 12 A/o (aNsTguLT=c)nj Al, I�J �T- ({em s T7?— Z,?- �r%J ' ST � ✓vkr�d 4 /Kf,, DATE ACORD CERTIFICATE OF LIABILITY INSURANCE 06/1M/D2011) 06/13/2011 PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A.MERCHANTS INSURANCE GROUP John Barnes Construction INSURER B:Liberty Mutual 42 Cedar Street INSURERC: INSURER D. Marblehead MA 01945— INSURER E. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDO/YY) DATE(M M/DOM') LIMITS A GENERAL LIABILITY BOP9098262 10/10/2010 10/10/2011 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREM SES(Ea TO occ an.) 5 50,000 CLAIMS MADE 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 S 2,000,000 POLICY JECT LOC / AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS / / BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS / / / BODILY INJURY 9 NON-OWNED AUTOS (Per accident) / PROPERTY DAMAGE (Per accitlent) S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY / / EACH OCCURRENCE $ OCCUR CLAIMS MADE - AGGREGATE 5 S DEDUCTIBLE / S RETENTION $ $ B WORKERS COMPENSATION AND WC231S3630 07/24/2010 07/24/2011 $ I TORVLMIUS GEa" EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT 5 100,000 OFFICERIMEMBER EXCLUDED? / / / EL.DISEASE-EA EMPLOYEES 100,000 If yes,describe under SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT I 5 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATIONI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. — AUTHORIZED 77Ei�VE ACORD 25(2001/08) ©ACOIRnDD CORPORATION�1988 INS025(oim).m Page 1 of 2