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34 BUFFUM STREET - BUILDING JACKET No. 153L-2 HASTINGS, MN LOS ANGELES-CHICAGO-LOGAN.OH MCGREGOR.TX-LOCUST GROVE.GA U.S.A. aCITY OF SALEM, MASSACHUSETTS BUILDINGDEPARTMENT 120 WASHINGTON STREET,3RD FLOOR T)EL. (978) 745-9595 F KIMBERLEY DRISCOLL FAX(978) 740-9846 MAYOR TYLOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER November 4, 2015 To Whom it May Concern RE: 34 Buffum Street Salem, Ma. 01970 According to our records, it has been determined the property located at 34 Buffmm Street is a legal four(4) family dwelling located in an R-2 zone. This is to determine use only and in no way meant to confirm or deny whether said property is in compliance will all building, plumbing, gas, electrical, fire or health codes. Since , Thomas St. Pierre Zoning Enforcement Officer Unofficial Property Record Card Page 1 of 1 Unofficial Property Record Card - Salem, MA General Property Data Parcel ID 27-0087-0 Account Number Prior Parcel ID 62.- Property Owner NEWCOTT LLC Property Location 34 BUFFUM STREET DENISE M.V.JOHNSON Property Use Apts.4-8 Mailing Address P.O.BOX 595 Most Recent Sale Date 2/26/2008 Legal Reference 27555-2 City MARBLEHEAD Grantor JOHNSON DENISE, Mailing State MA Zip 01945 Sale Price 0 ParcelZonmg R2 Land Area 0.221 acres Current Property Assessment Card 1 Value Building 409,000 Xtra Features Value Value 5,900 Land Value 113,800 Total Value 528,700 Building Description Building Style Apt 4-8 Foundation Type Brick/Stone Flooring Type Hardwood #of Living Units 4 Frame Type Wood Basement Floor Concrete Year Built 1890 Roof Structure Gable Heating Type Forced H/W Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Oil Building Condition Average Siding Aluminum Air Conditioning 0% Finished Area(SF(5207 Interior Walls Plaster #of Bsmt Garages 0 Number Rooms 16 #of Bedrooms 8 #of Full Baths 5 #of 3/4 Baths 0 #of 1/2 Baths 0 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 0.221 acres of land mainly classified as Apts.4-8 with a(n)Apt 4-8 style building,built about 1890,having Aluminum exterior and Asphalt Shgl roof cover,with 4 unit(s),16 room(s),8 bedroom(s),5 bath(s),0 half bath(s). Property Images pt j� , �1 Disclaimer:This information is believed to be correct but is subject to change and is not warranteed. http://salem.patriotproperties.com/RecordCard.asp 11/4/2015 34 BUFFUM STREET 421-09 FIs # 4163.,;' F# COMMONWEALTH OF MASSACHUSETTS Map - dix; y, 27.:, % Block. � rya. ,. CITY OF SALEM Lot: , 0087 Category: REPAIRIREPL'ACE`; Permit# 421-09 ,.: BUILDING PERMIT Project# JS-2009000681= ra Est. Cost: -- $28,000 00�W`,?N'` Fee Charged``," $315.00 " s4 Balance Due: S-00; PERMISSION IS HEREBY GRANTED TO: Const. Class ' Contractor: License: Expires Use Group: t14-d, M ark Tremblay CONSTRUCTIO SUPERVISOR-076246 Lot Size(sq.'ft.) 9635.9076 - ani ' 3 Owner: Denise Turcotte Zoning:' 'R2 jUmts Gamed: ;7g(Applicant: Mark Tremblay Units Lost �: I .;x AT: 34 BUFFUM STREET Drg Safe#: "i'. , �:',"Aqk!" "P ISSUED ON. 20-Nov-2008 AMENDED ON. EXPIRES ON. 20-Apr-2009 TO PERFORM THE FOLLOWING WORK: RELOCATE FIRE EXCAPE ON RIGHT SIDE OF DWELLING, IMPROVE EXISTING VERTICLE LADDER TO STAIRS (4) UNITS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Escavaiioa: Service Meter: Footings: (dough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: FirepI acc/Ctint cy: D.P.W. Fire Health Insulation. Meter. Oil: Final: Ilouse# Smoke: Treasury: Water: Alarm: ASSe550r Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATIO ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Anuumn BU C,r RE� 200I"M0193 -----'20-Nov-08 1282 5315.00 UPM olarnplCtion, (ii h,t Ik ,f i(y3�i G! 2x tt 795-9595 East or''6 y5! GeoTMS©2008 Des Lauriers Municipal Solutions,Inc. �•�ONDIT� YSDYE AD 1� CITY OF SALEM BUILDING PERMIT t o fCwn N W n LLJ' N w C Y a e I w 3 - - — J Xl �?tips YJtrJpOvJ CK ° a -- — I XiS-C. °� 1�i9�.. — �ryhJ IjOcf— i 1 I I TO et= '",",1•-�qqll.l♦�f ,� W-1 NdV to Zobca i — �yE..6 D n1 1 � iv @rx"�sa ,rte 1[3 v t -- - - -- - - N APP'D. .Y Pr�ro ry to—n 19T d in` TO ce OF , 1,e�llxl9� Q„ I O ' Q I _EXIST.- HOUSE Eats c. GP�t�T�IT \ \\ 0 I V \ \ \ \ #34 L ' ~� AR/k'LLIIJG .lF. M P '.. 1 vA45 \ Al]F - ° d Izt`LIU (PGaN) � - 1� 14533..(�E :D� EXtsT[ku¢.Fr RE- \ . . Alp Sm I ESCKPE To gF. - - - - - R�ttOveo. FFPp> raj P-XIST HOUSE LIJ \ LQ W �t iV sat\amu I I I P4zP � CA EE] F. I f Twp � 1 I Ell 0 irk o o � 4z" v l c 20 Re 7. 95` S7S, t' ul C r 'I z. it I t I � � I V; it i i - C] NA FIRE E45 APE REPLACEMENT` T .— �A �s, RAYMOND T. GUERTINIVEWCOTT LLC _. _ r EXTERIOR &E`VA TIONS " 4 pT v ARCHITECT �� b `" o o a "--� -� I 34 Buffum Streets -� $ V d`a a � - ' 89 TURNPIKE ROAD,SURE 207 1.I IPSWICH.MASSACHUSETTS 01938 -. Salem, Massachusetts £9����3 sy4x4 1\J i AL S08-843-Y97d fAx:978-356-3d09 �tits � � � �. FMAIL'diGAR011@VEIRON.NET , I i 121 " ctctco �� RECEIVED IvSPECTIONAL SERVICES The Commonwealth of M a tt Department of Public Sa et & 4 b Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (rhis Section For Official Use Only) Building Permit Number: Date Applied: Budding Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) v S �— No.and Street City/Town Zip Code Name of Building(if applicable) (� SECTION 2•PROPOSED WORK. \i Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below ^ Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of, ❑ Other ❑ Specify: I Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ ^ Is an Independent Structural Engineering PeerTe,iew rewired? Yes ❑ No ❑ IrIL`-'1' Brief Description of Proposed Work: 1 f� �Y D SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here Ilan Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): I Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-L❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 7 Institutional I-1 ❑ I-2❑ 1-3❑ 14❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use. SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IHA ❑ IIIB ❑ 1 1V ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis osal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ trench will not P ree quired❑or trencc h or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: \t\I h turic,C ,mmf.Slong .u,� Pr}7cgs: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Gniup(s): Type of Construction: Occupant Load per Flour: Dues the build big contain an Sprinkler System?: Special Stipulations: (Y\ P> CONTV-j: ck L (x(1fa1kI�D t /2-1 k ,-.SECTION 9: PROPERTY OWNER AUTHORIZATION Nameand Addresspf Proerty,Ownerl'"` "e-LA ti IJ A&3cA 3� t�uFrur, s� Sra o� Name(Print) ri iI :R A h 1. j',No.hd Street City/Town Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owners behalf,in a6 matters relative to work authorized by this building permit application. SECTION.10:CONSTRUCTION CONTROL(Please fill out Appendiz.2) - If building is less than 35,000 cu.fL of enclosed space and/or not under Construction Control then check here O and ski p Section 10.1 101 Registered Professional Responsible for Construction Control- GS — �8 "7L �� Name(Regis ant) Telephone e-mail address Registration Number Y� fX I Z-1 (C>- 1-1 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor M t�N c,� ram, C�SrZ-ova-��s Company Name rosE N��r� c�� NAG itc2o2 � � � �� � 17 Nppame of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip S`/ r g Q f d 7 Z-SZ_ Telephone No. business Telephone No. cell e-mail address SECTION 11:WOItKE1i5'CONIPISNSA'I[ON INSURANCE APF'll?AWI M.G.C.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE- Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building I $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3. Plunrbm $ d. Mechanical (I-IVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ O (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I 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. _PiO� f 171�f G Ple< ie print and sign name Tide., Telephone No. Date-� Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date The Commonwealth of Massachusetts CITY OF a Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or De is One or Two Family Dwelling This Section For Off cia se only 1✓ Building Permit Number � Date plied S 3 C•} �_ �i( 1 Y Budding Official(PrmtName) .t _"Signature; '. f Date SECTION I: SITE INFORMATION �4ropeerty jldSesUm Se 1.2 Assessors Map & Par +el umbers''' L 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 ft) Frontage(ft) 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: Zone: _ Outside Flood Zone? Municipal El On site disposal system El Public❑ Private❑ Check if yes❑ _. SECTION 2:, PIYOP RTY OWNERSHIP' ` 2.1 Owner`of RecorIrn (J&-+it ," ZA O 1 Name riot City, CQSSttatlee,,�ZIP -� -9`v'�`�• �No. and Street Telephone Email Address SECTION3a DESCRIPTION OFPROPOSEDWQRK�(checkall,that_apply)7, `,'. New Construction ❑ Existing Building❑ Owner-Occupied ❑ airs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': ' SECTIO 4: EST'IMATEI).-QNST1,1 1 CTION COSTS ; Item Is ibor ated Costs: -.` Official Use Only ,, d Materia 1. Building $ 1 Building PermitF $ee Indicate how fee s dete mined: ❑ Standard Ci Gown A licatioln Fee 2. Electrical $ ty 'Pp ❑Total Proledt Cost (Item 6)x multiplier' .x 3. Plumbing $ 2 .OtlagrFees $ 4. Mechanical (I VAC) $ List. . ' 5. Mechanical (Fire ` Su ression $ Total All Fees: ,heck No Check Amount Cash Amount 6. Total Project Cost: $ b 0 ` ❑paid in F ll . ❑ Outstanding Balance.Due b10 o SECTION 5: CONSTRUCTION SERVICES 5.1 C/o'ns�truc�tio�n� Sup�►Ervisor License(CSL)I License Number ,Expiration Data Name of CSL Holder ��, / ,uJ� List CSL Type(see below) C No. and Street �' '�/,} •n'Pe Description , CSC v" ` ' U Unrestricted(Buildings u to 35,000 cu. ft. t R Restricted 1&2 Family Dwelling City/Town, State, ZIP M Mason ry RC Roofing Covering / WS Window and Siding SF Solid Fuel Burning Appliances I J �T YYY Insulation Tele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ^ I&S- N HIC Registration Number Expiration Date HIC Company Name o Ili Registra t Naine No.S reef Q A �� Email address City/Town, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFEIDAYIT(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. [11, gned Affidavit Attached? Yes .......... ❑ No ........... ❑ SECTION 7at OWNER AUTHORIZATION TO'BE COMPLETED.WHEN ' OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property, hereby authorize act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) 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 contained in this application is true and accurate to the best of my knowledge and understanding. :S,!�� 0 C -�J / "�(J/ c)_ Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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.,mv/oca Information on the Construction Supervisor License can be found at www.rnass.gov.dos 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 halfibaths 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" i� CITY OF SiuI E. III LAXSSACHLSETTS BL•t owr,DEPARTMENT • } ` ' 120 W.I.SHOVGTON STREET, 31n FLOOR TEL (978) 745-9595 F.*,e(978) 740-9846 KI\(BERL.EY DRISCOLL T MAYOR HoatAs Sr.PtERRB DIRECTOR OF PUBLIC PROPERTY/BUILDL`IG CONLMISSIONER Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information lPlease Print Legibly NatnC(OusitxsyOrgtnizatiowind'vidual): Address: a) _ City/Statc/Zip: Phone lie e on as employer?Check the appropriate box: Type of project(required): 1 am a employer with 4. ❑ I am a general contractor and 1 e have hired the sub-contractors 6. ❑New construction crap eyed(tLll and/or part-time). 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have S._❑ Demolition workingfor me in an capacity. workers'comp. insurance. Y P tY• 9. ❑Building addition (No workers'comp.insurance S. ❑ We are a corporation and its required.) of iccrs have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL t I-[].Plumbing repairs or additions myself. (No workers'comp. c. 152,$1(4),and we have no 12.0 Roof repairs insurance required.)t employees.LNo workers' comp.insurance required.) l3.❑Other, Any applicant that dwoks box r l mutt slat,fill uut the scelieo blow showing thee wwkeni cumpensadon policy information. 14.uownen who submit this affidavit indicating they am doing all work and then him outside contmoon onus submit a new anidevit indicting such :Currtmotom that check this box must attached an addinurol sheet showing the name of Iho subadntracton and their workm'camp.pulley infixtnadon. lam un employer chat is providing worker.#'cotnpentadon lit.#urance for ray ernployeer. Below is die policy and Job site inra Insurance ncc Company Name: �i+ /- n^ /�,�-��f / Policy it ur Self-im. Lie. r�i.� CtP rDto awr:to Expiration Date: d - Job Site Addruss: ��4 V+T v(V-t Cz� City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Suction 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 und(or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.0o a day against the violator. lie advised that a copy of this statement may be furwardcd to the Office of investigutiots of the DIA fur insurance coverage verification. l du hereby certify"adeerr/the��-p�jrJlIts and penuhles ojperJury/flat the hijararallan provided abu've is/true artd(.•/orrrct Si„n.mtre: / 1! /✓' 7- )ate: Phone rl: 1� - �1 4[ (� ���/ V OJJiciul use wdy. Du rot write in thud urea,to be cmupleled by city ar lows official City or Town: __.__ PermitA.icenseN Issuing,%ulhority(circle one): 1. Board of l(ealth 2. Building Department J.City/rows Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone th CITY OF S�1I..EM, UxSSACHUSETTS H t . i3UILONG DEPART%MNT `^ it 120 %V.%sHINGTON STREET, 3'FLOOR TEL (978) 745-9595 FA.K(978) 740-9846 KI\CBERL.EY DRISCOLL '1rLkYOR THmw ST.PtERRa DIRECTOR OF PUBLIC PROPERTY/BUILONG CONWISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5 Debris, and the provisions of MGL c 40, S 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 disposal facility as defined by MGL c 1 11, S 150A. The debris will be transported by: � sA( 1L (name of hauler) The debris will be disposed of in (name of facility) -- —(address of facility) signAI_u7ro,,6f permit applicant date kbm:a(f,l.ro ,aco CERTIFICATE OF LIABILITY INSURANCE o1 11/10/2012lo/zolz 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 endorsement(s). PRODUCER CONTACT Boynton Insurance,Boynton Insurance Agency PHONE . (781)449-6786 ac Ne:cTe1)449-4ze9 72 River Park Street ADDRESS: PRODUCERR QQ004109 Needham MA 02494 INSURE S AFFORDING COVERAGE NAICO -INSURED INSURERA: Kyron Inc. INSURERB:Hartford Insurance DRA Preserve Services INSURERC34t Hawley Ins Coma n 203 Washington Street,#256 INSURERDCommerce Insurance Salem,NA 01970 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:14-18 Union St. Condo 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 TYPE OF INSURANCE ADM SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M M LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea oau. $ 50,000 C CLAIMS-MADE IX I OCCUR SCO060025000164 /23/2012 /23/2013 MED EXP(my one peon) S 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 XPO-POLICY JET LOC $ AUTOMOBILE LUUNUTY COMBINED SINGLE LIMIT $ 1,0Q0,QQO (Ea acaden0 ANY AUTO BODILY INJURY D ALL OWNED AUTOS NM21 1/02/2012 1/02/2013 BODILY INJURY(Per acdtlen[) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Peraccitlen0 $ X NON-OWNED AUTOS $ UMBRELLA LUIB X OCCUR 0316545 /23/2012 /23/2013 EACH OCCURRENCE $ 2,000,000 X EXCESS LU1B CLAIMS-MADE AGGREGATE $ 2,000,000 DEDUCTIBLE $ RETENTION $ $ S WORKERS COMPENSPIMON X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUNVE EL EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED NIA (MaxWory In NH) 6S60UB0523NO0912 /213/2012 /20/2013 EL DISEASE-EA EMPLOYEE $ 100,000 I(Yes,tlewibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allach ACORD 101,A4ditlenal Remarks schedule,R more space Ia"ulmd) General Liability includes underground liability coverage. 30 day notice of cancellation applies, except 10 days for non payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE William Rohr/WRR ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(21XXQ9) The ACORD name and logo are registered marks of ACORD a Massachusetts - Departiocut of Public Safetl _ 9 BoaNl of Buildin_Rc,ulatiuns and Standards "ens±ruc<iea S� eriisar License License: CS - 93403 SEAN OCONNOR . 26 CHESTNUT ST SALEM, MA 01970 Expiration: 1 2131/201 3 l'.numi>.imcr' Tr: 7996 Office rs ofonsamer a CONTRACTOR P-14a HOMEIMPROVE 2355 Type: R, PL Registration -123553 p8A � '^� r=J E.-,raUon 3t612013 Prerserve Paibttin9 Sean O'Connora- 203WASHI14GTON;ST-=-t56' - undersecretary SALEM,MA01970 e 203 WASHINGTON ST.#256 PRESERVE SALEM,MA 01970 SERVICES careen try)pain[ingl roofing)gutters PHONES 8.745. 476 SALES@ PRESE RV ESERV ICES.COM Newcott —V �Qhfo sojj P.O. Box 595 `I O N Date Bid: ' Estimator::Sean Sean O'Connor Marblehead MA, 01945 Email:sean@prese"esewices.com (781) 307-2940 Mobile:(978)395-7737 nwcott@yahoo.com PROJECT 34 Buffum St Salem MA ROOFING ESTIMATE COMMENTS Replace the sloped roof on the entire house minus the flat roof below the deck and the garage. PRIOR PREPARATION PERMITTING: All permits will be obtained in accordance with the law as required. DISPOSAL: A dumpster will be placed in an area designated by the homeowner. ROOFING PREPARATION COVERING: Tarp the exterior of the house so as not to damage the siding. SHINGLE REMOVAL: Remove all layer(s) of old shingles. NAILING: Re-nail roof decking as necessary. UNDERLAYMENT FELT: Install 15 lb felt on all areas not covered by ice and water shield. ICE AND WATER SHIELD: Install 3 feet of ice and water shield on eves and valleys. Install as necessary on other areas. FLASHING DRIP EDGE: Install drip edge on all perimeters. WALL JUNCTION: Install or rework flashing where the roof meets the wall. w VENT PIPES: Install new boot or flange around vent pipes. CHIMNEY(S): Install new flashing around all chimney(s). ROOFING MATERIALS ASPHALT SHINGLES: Install architectural Limited Lifetime shingles. PRICING Basic $ 16,950 Sales Tax $ 0 Total Price $ 16,950 including Labor& Material Pay Terms: 20% deposit (day of start); 30%progress; 50% f job c 'sa/Amex n O'Connor usto ignature Installation Note: If you have an older home that has dimensional lumber for roof decking you will need to cover your attic because shingle debris may fall into the attic and create a mess. *Above additional prices includes all discounts and coupons discussed prior to estimate. The above quote is valid for 60 days. *Warranty: Craftsmanship: Kyron Inc. DBA Preserve Services warrantees all work performed for a period of 2 years. If any problems occur we will cover the cost of labor and materials. For the warranty to be valid the invoice that was presented at the time of completion must have been paid in full. Materials: The duration of the manufacture's warranty is specified in the materials section above. Acts of god are excluded in warranty such as but not limited to tornados and hurricanes. Licenses: Home Improvement Contractor (HIC): 123553 Protection: It is required by law that roofing contractors have a home improvement contractor license. If a contractor is properly registered, you are entitled to limited protection by the Residential Contractor Guaranty Fund up to $10,000. (The above is a only a summary of Massachusetts General Law 142A) To check our license or our competitors go to: http://db.state.ma.us/homeimprovement/licenseelist.asp and license 123553. Constructor Supervisor(CS): 93403 The construction Supervisors license is under an individual's name, not a company name. To check Sean O'Connor, owner of the Kyron Inc. DBA Preserve, license go to: http://db.state.ma.us/dys/licenseelist.asp select Construction Supervisor and license 93403. Insurance: Worker's Compensation: Our policy is under Kyron Inc. DBA Preserve Services Protection: Covers the injury of a worker employed by the contractor doing work at your home. To check our policy or our completions go to http://mass.gov/dia/ on this page go to"check worker's compensation proof of coverage"our license is under Kyron Inc. Liability Insurance Our policy is under Kyron Inc. DBA Preserve Services and has limit of$1,000,000. Protection: Covers your property in the event of accidental damage up to a dollar limit specified on the policy. To check our policy we will have to contact our insurance company. t PUBLIC PROPERTY C jga DEPARTMENT MAYOR `J 1'.A WASHINGTON 5'rttEET S,ut,N,`f l�cAQll:StX S 01970 TEL,978-745-9595 0 FAX 978-740.99" APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: Building: Property Address: - 3y Property is located in a; Conservation Area Y/N nJ Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: Address: Telephone: t— I 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (so Renovated construction or renovation of existing building New Brief Description of Proposed Work: %fa G, N fo S` Lc P��GIi �1 �f-(Z. 0,R 5� S� • Mail Permit to: 2„2 H �(- ITI- nj - �u-r. M 14 !Wa V4 What is the current use of the Building? I,EN7 Material of Building? If dwelling. how many units? y Will the Building Conform to Law? _ Asbestos? Architect's Name Address and Phone Mechanic's Name O .1941S Address and Phone `� 2 ►-� C /}Z o� � n /1!I ► of off- (b.l� Construction Supervisors License# O 7 2 9.5 HIC Registration# j ► 3 Estimated Cost of Project$ 14 d"Q) - Off' Permit Fee Celeutation Permit Fee$ � Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays In processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of perjury X �� Date I [ } a I N r 9 a b � IL °o ►o. t CrrY of SAmm ' PUBLIC PROPERTY DEPARTMENT wvoa taaweeor�ow staua•�suatiwa�oaysessottrrs Tw MUSLOSas PNa V&74►" Construction Debris Disposal Affidavit (requited br all demalldon and mamatien crack) to umdsoee with the sixth edidon of the State Building Cods 780 On secdos 111.5 oaw*and dw psovidons of MGL.o 40.0 341 Budding Pottnit M is blood with do minion what do I I - moons am this want sbog be diapoaed of in s plop b 8eansed wow dispoed boigty as defined by MGL.o The ddxis wig be t<anspoMd by: (aama d1twM�l The debris wig be disposed of in: nn_�►<iZP CIA(L E - (aama of heiliM �( 'gyp..- 5Lo i� i'�C SP�.c1�n Yl-i►1 (Odrm of helt w . aaaeue dPtm� �pplita� If r3 c� .6 due r.hn..u►.Gs / . ti CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT ICAIaERiEY DR1fCOLL MAYOR 120 WAMM4GTON STREET•SArEa,MASGCtiU5ETr101970 Ta-9M745.9595 a FAx:978-740.98" Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriclaat/Plumbe» Aaoticant Information Pleas rat IF -t h+ Name(BusinesUOrganiucodlndividual): co ko,� eat ( Address: 1-i 1A. (�/f LA !,A TC 1/1 t4 c— City/State/Zip: l h A/Ln,fie .len?, A-^ o /9 L3 Phone#: ~l f�1— G 39 — i✓ 6 T7 Are you an employer?Cheek the appropriate box: Type of project(required): L p I am a employer with G 4. 0 I am a general contractor and I employees(fish and/or part-time).• have hired the sub-contractors 6. 0 New construction 2.0 I am a sole proprietor or patmer- listed on the attached sheet. t 7. P Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for we in any capacity, workers'comp,insurance.(No workers'comp.insurance 5. 0 We are a corporation and its 9. 0 Building addition required.) officers have exercised their I O.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions myself.(No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required)t employees.[No workers' 13,0 Other comp.insurance requite) fAnr+vet wa dfeclu eon NI must also 60 nut the s«tlan bdw shoving their nabs,eootpmyym pohay iafarm.uos.Hameowoms who subteir this Affidavit indenting they we doing as work and am hug Onuids s thin boa amhaaors tcoe must suhmit a asw atRdava mdiatlq soeL ttactoo that clock mug wched so disci showing the Hama of the am their wards'camp•Policy infaenadaa f am an employer that Is providing workers'compensation dnsuroncefor my employees Below is the poldcp and fob site Information. Insurance Company Name:_ Policy#or Self-ins.Lic.#: Expiration Date: — Job Site Address:_3y City/State/Zip: s/SLe M�v O /,P'20 Attach a copy of the worker'compensation poBry 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' sition of criminal thin up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form i f a STOP WORK ORDER and a fine In penalties of a es to bons 0 a day against the violator. Be advised that a copy of this statement maybe forwarded m the Offte of Investigations of the DU for insurance coverage verification. I do hereby cc r Nu pass and penal des ofXrJa*that the information provided above Is due and cornet Phone#: 2g�1 — Of)?eiol use only. Da not write in this area,to be completed by city or town of)7cdail City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employxs. pursuant to this statute,an earployet is defined as"...every person in the service of another under any contract of hit% express or implied,oral or written r is defined as"an individual.partnership.assoeiatiort,corporation or other legal wtity,or any two or mote An earp1oye vtd representatives of a deceased employer.or the of the foregoing engaged in s joint enterprise.and including the legal gal a en employees. However the of an individual,partnership,association or other legal entity,employing receiver er � not more than three apattmenta and who resides therein,a the ocetrpast of the owner of a dwelling honer having construction er re pair wort on such dwelling home dwelling house of anther who employs Persons s do maintenance' be deemed to be an employer." ds or building appurtenant thereto shall not because of such employment or on the groan MGL chapter 152.$25C(6)also states that"every state or local licensing agency loshag the commonwealth Issuance for a ae r renewal of a license or permit to operate a business or to construct building sPPiiean<who has sot produced acceptable evidence of compliance with the insurance coverage al required." visions shall Additionally.MGL chapter 152,$25C('n states"Neither the commonwealth not any Po of iance with the insurance enter into any contras public work until acceptable evidence of compl for the performance ted to the contracting authority." requirements of this chapter have been presented Applicants ion affidavit completely,by checking the boxes that apply to your situation and.if Please fill out the worker'compensate hone number(s)along with their cor ificuc(s)of necessary. Limit sub- ability t°x(s)n ies (s).addr Limit and P Partnerships(LLP)with no employees other than the insurance. Limited Liability Companies carry or Limited Liability insurance. if an LLC or LLP does have members or pazmers'are not required to carry workers, compensation davitmbe employees.a policy u requited Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be erne to alga and date the affidavnt. The affidavit should be mttune4 to the city or town dua You �application for the permit lilicensew or risyoumaa required to obtain a workers' g requested,not die Depuftnent oP Industrial Accident& have m questions regarding below. Self-insured companies should enter their compensation policy.please call to Dcp at the number listed self-insurance license tnimber on the a lim. City or Tows Official 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 is the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the Penruoicense number which will be used as a reference number. In addition,an applicant that must submit multiple permiVliccnw applications in any given year,need only submit one affidavit indicating current essary)and under"Job Site Address"the applicant should write"all locations in_city or policy information(if nee 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 Anew atadisvir moat be filled 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 The Office of investigations would like to thank you in advance for your cooperation and should you have any questions' Please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of MaaachUSCUS Department of Industr W Accidents O®ae of Invatiptions 600 washM9M strut Boston,MA 02111 Tel. #617-727-4900 Cd 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 5-26-05 wwWM&V,&&OV/dice �ACV �i� � 1� ���� �i�J_.�L�� ��' -��-_\� . \A •Y �R��,. . ' � � ) ) ; . „� ,+,: 4� ,,-, 1 C`131:.I(_ 1 RO1 l lt'i'1' �. .'Q.�'�' ' � d �l � _��:,,.�,:gM�� � I�TP_\R"1'�IL�.N"1' �� �.�,::;� �::�., �,�s�<, ,,��_ � ��,,,��< � �,����_�:���..,.��,�.�;�,<�.�.�� . ;�� ��:,�.�� ,;."_��� <� ���>����,—�� i'r��.��-a.-a;�i;v; � i���:�rn.-.���.,�s.��, APPL[CATION FOR PLAN E�CAN[INA'f10N AND I3UILllING PERNII'1' ALL I3UILDINGS EXCEI'T ONE AND 2 FAMILY UWGLLINGS IDIPOR"PAN'1`. A liconls must cnm lele nll ilems un[hix �a•e - srrt. in�rotin�,�•r�oN �p/�� �/ L���atiunN;iine �� (Qv�"F'VP� S� Building �F�/��/1��. �-/ lJn.il� Pruperry Address . � Lorut�d in: Cunservution Area Y/N�Historic district N� APPI,ICATION DATE Use Groups � (check une) Group Homes R3 RJ_ ' Residentiul (3 or more Uni[s) R2� "Cype of improvement Residencial (ho[el/mo�eq Rl _ � (check one) Assembly (Theaters) A1 �, New [3uildin�_ Assembly (restaurants& clubs) A2r_A?nc_ � Additinn Assembly (churches) A1 _ Alreratiun ✓ Business I3 � � Rep:�ir/ Replacement_ Educational E � '�. Demolition= , Factory (moderate hqzard) I'1 � � Muve/Relucate� � Factory(low hazurd) F2_ � ,i Foundation Only High Hazard H , Accessory Building_ Institutional (residential care) I1 �, �.. Institu[ionul (incupacitated) 12 '� I Institutional (restrained) 13 � � Mercantile M (� � Sturage Sl Mudcratc 1-lar:ird � . Sturaee 52 Lo�v liazard � O\t'\h:IttilllP INM'Ult:�fA'1'ION(Plr•rse typeor Print Clearly) � OWNER Name I���)f('�L1,��'g�� i Address �y �� �'7— �a L v�/seA— Telephone SiQnuture __,__ u��scicu�rion oH��voHK�ro nr: ��H:kH�ow�iH:►� /��C — � C'. P�e a,�' �2 � r S�' � 5�t� P LL�w�,�a� e �)CI�S'TIN �, VP��i7LP��C��? �� Ai2-� �•s rm�,�r��:u cous rkuc�r�orr cos r E'�O . � !� _ _ — _� , r.. � (,'l)\'fltACfl)R IVPUILII:\"1'ION � . Name �Z� �2�n.t�� Address ��� U' =' {l�i Telephone , � � ,�� q r�- ,/ Construction Supervisor's Lic # (;S l W�T � Home Improvement Contrarror # j2�� 4^•,(�c-� nucurru:crn:hc;INb:ER IY@'U{LINATII� � Name ('��4 � ' " Address 1/ AJ�/��P B. �%!��'�/�i.l /Y+3'� Telephone �OQ� '£3'� �('2,� Mass. ReQis[ration # riaim�hr h�i.r:cn�.cu�.n•r�oN � Estimated Cost x $11/$1,000 + $5.00= �� L<�,N�h��.N7�5 X� „ r�(' P R e�u'r kP d /=oiz �r�--� �,�/r�rr� ar� 30`� � v � fef�eK Ge V/1� STA-%2S �"`r �l'r�` /AY✓c%+rq �0 3r�/� l�x,vc(�.�1 77P( `� The undersigited app[ica�:t does hereby attest that all infonnalion stated nbove rs trr�e to Uie Ges7 of�ny knoivledge wltler the pe�talties af erjury Sigrted (owner) (a��ent) APPROVGD I3Y : DA'fE APPROVGD: I 1` � � 0 � r- � ; �� , d , '' I ' ' . i I• ; ' / � \ � � oary / � � = u ��"_ � � _ � o / I \ � / � � � � � a C / I I � \ I X ',. , . 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