182 FEDERAL ST - BUILDING INSPECTION (2) cam. ZS6�j
The Commonwealth of Massachusetts 4
Board of Building Regulations and Standards Cj SALy
�-- Massachusetts State Building Code, 780 CMR 11 r SAMar 2011
Building Permit Application To Construct,Repair, Renovate Or Demolish'a�lb `J V P S �
One-or Two-Family Dwelling
( This Section For Official Use Only
Building Permit Number: Date Ap
)31/k
l" Building Official(Print Name) Signature Date
( SECTION 1: SITE INFORMATION
h 1.1 Proplr Address: 1.2 Assessors Map&Parcel Numbers
l �2 rr ¢cle•-a..1 Sl . Sw,e,ttmA
1.1 a 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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSIUPt
2.1 Owner of Record: cc
�ct�kerti �� to, 'SCAQvti , WI 1�
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied)g( I Repairs(s)>< I At ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work : t }z11 Yt ..J S
O'A<-I UctIl I•t,« Q..w acl e $ re lac
L%J "-ew .tin Pr eaaoV22 r4 d0.wvGCIP � 1-2647 ,r t t^2)1 PGca
w t vta-w
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 11.7e ,57 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ �
4.Mechanical (HVAC) $ List: /o
5. Mechanical (Fire $
Su ression Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ L{1, 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C S- o tg3 t{& C>& 131 ?,-317
\`„n�De,. W, '��.G N S J r License Number Expiration Date
Name of CSL Holder
11 List CSL Type(see below) 0 h v^2S4.cA-@ s�
T Description e
No.and Street
�r �JGPi.J uX'gt' M A 0 2333 U Unrestricted(Buildings u el ing cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
!-j�a-•32�•a y�.Y l`w �i S a�c.awtCaO t.NE7' I Insulation
Telephone Email address D Demolition
5.2 R istered Home Improvement Contractor(HIC)
S �J�S�s \ 1 a'1 7- O� I
HIC Registration Number Expiration Dale
HIC company NwjLe orb C Re i tmnt Name 1 / )
No.aiAstreet Email address
< 32�•syl��
City/Town, State,ZIP o a 3 3 7 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 �D`D 2aT %.,D . i S J .
to act on my behalf,in all matters relative to work authorized by this building permit application.
Zzr4Glcf:..�2Y tJJWrpti1.T ��n„w \� •ZOI�
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW 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.
Print Owner's oAuthorized Agent 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage, finished basementiattics,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"maybe substituted for"Total Project Cost"
s
7
f
I
i
i
I
1
• �fzPbAC�L � �Aw,ljFE.o
i --
{
I
j
Xai X 0 ` Fec-V-jN,:;;S
1_mJ m I LIj�IL { CQ6Jw1rJ 5
_ � F
Property Address � N Robert W. Dennis Jr
RDBERTME Registered Structural Engineer
GE mJAP n, P.O. Box 534, East Bridgewater, Ma
SA,cal. rv7A 'x, STRUCTURAL �- _ 02333 j
90. 138U Cell 508426 2484
bg +� rwdennijr@comcastnet
88MIYAL
e �
CITY OF NLksS.A.CHUSETTS
BU DLNG DEPART WINT
f 120 W.3,SHLNGTON STREET, Ya FLOOR
"IE1- (978)745-9595
FAX(978) 740-98"
K[.NIBHRLEY DRISCOLL
MAYOR T Homm ST.PmRRE
DIRECTOR OF PL'BL(c PROPERTY/BunmLN<;CONMUSSIONER
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 It 1.5
Debris, and the provisions of MGL a 40, S 54;
Building Permit# 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:
(name of hauler)
The debris will be disposed of in
���PS-(-E1L— off Srt-rL
(name of facility)
l'-
(address of facility)
signature of permit applicant
/ �CF //('
date
' The Commonwealth of Massachusetts
Department of Industrial Accidents
Office ofimtestigations
600 lVasltingion Street
=' Boston, MA 02111
wwtv.rnassgor/die
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Phtmbers
Applicant Information \\ \_ Please Print Leg ibiv(
i`tamC (Business%Organizationllndivicivai)��tZy� W _' �n•S �_�b�.� S�Y Uc YWt wV�l7Pca
Address: \D C7
City/State//.ip: -fir. w w IViI� Poa.�33hone I;: _ jb -_--
Are ygurUn employer?Check the appropriate box: Type of project(required):
1.r, 1 am a cm Flo with 2.3 4. Q 1 am a general contractor find 1
1 Yer — _—-- (i. ❑ New construction
employees(full and/fir Hart-time).-' have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1. ❑ Remodeling_
ship and have no employee, rhese stab-coniractor,have 8. [] Demolition
working tier me in an capacity. , employees and have workers'
Y ' pt 9. Buildim,addition
[tio workers' comp. insurance comp. insurance.'
required.) 5. ❑ We are a corporation and its ME3 Electrical repairs or additions
;. I am a hnnteowner doing all work officers have exercised their I L[] Plumbing repairs or additions
myself. (No workers' comp. right of exemption per MG1, 12.❑ Roof repairs
insurance required i " C. 152. §1(4)r and we have no
employees. jNo workers' I3.0 Other---------_-_._—_--
contp. insurance required.)
I;l o,anp8caitt that check bin;:l nw,t also hli not Or section hdoo,kon ing their onrker;e<tmpat<atian poiic•inrorramon.
i icy acooners uha,abnnt dn,affidavit indicating they are doing a:l wfir and then hiu.ola-;dc co'nu cit s ain't nrbant.;new❑aivar if mdicxwfa. neh
Contractor,that cheek fir,bm mint attached an additional sheet shoo ing the name of die s!tb-ennirac[m-;and aine ohcthcr or not dmsc entiues?mva
emninpae.. 11'thr Sub-coniracutn have rntployccs.they must provide their enrkcr camp.policy nunthcr.
/rmt an entpinf er lbrrt is prnrilting workers'conrpein-atdnit iitsaraitce ftr niV entpdgyees. Below is the poffey and job.site
information. \ _
Insurance Company\nine:.—_-- 1_C.e� 3'¢,--_�-v�S C .
Policv 4 or Self-ins. Lic.(l:._W C-20_Zn= G70�1g17_-2. 1-xpiration Date:.----5.�3f
Job Site Adds,,: _-� - � t?r S -_--_City/Slate/Lin:, _1RaJ .1,L4 IVf
Attach a copy of the workers'compensation police declaration pare(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ol'v1GL c- 152 can lead.tothe imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and if fine
of up to S250.00 if day against the violator. Be advised that a copy of this statement may be lorwarded to the Office of
Investigations of the DIA liv insurance coverage verification.
d do herebr cerli i'under the pain.,'ant p realties of perjrirr that the it? itrnratimt proritietl above is true tint correct.
Si >_:uw'. �+`'J -- 90.""" - ---- Date:_—_y
Offtcial use only. Do nor write in this area,to he completer/by cite'or town official
City or Town: PermittLicense#
Issuing Authority(circle one):
1.Board of health 2. Building Department 3.Cite/Town Clerk 4. Electrical inspector 5, Plumbing Inspector
6. Other
Contact Person: Phone#:
,ac Ro v® CERTIFICATE OF LIABILITY INSURANCE °"'E0"'°°°""Y'
1 06/20/2016
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 �g CT Justin DeLoach
MCSWEENEY AND RICCI INS AGENCY INC P1ONE (781)848-8600 No:
ADmORESS: "deloach@mcsweeneyricd.com
PO BOX 850984 INsu S AFFORDING COVERAGE NAICO
BRAINTREE MA 02185 INSURERA: ACADIA INS CO 31325
INSURED INSURER B:
ROBERT W DENNIS JR & DON ATKINSON INSURERC:
DBA HOME STRUCTURAL SPECIALISTS INSURER O:
PO BOX 534 INSURER E:
EAST BRIDGEWATER MA 02333 INSURER F:
COVERAGES CERTIFICATE NUMBER: 62581 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 ADDL TYPE OF INSURANCE UBR POLICY NUMBER POMIDO EFF MMfDDrIYYYI
POLICY EXP UNITS
COMMERCIAL.GENERAL LIABILITY EACH OCCURRENCE S
CWMSAIADE E OCCUR PREMISES Me eranmhce $
MED EXP(Any one person) $
N/A PERSONAL S ADV INJURY S
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S
POLICY❑JECT LOC PRODUCTS-COMP/OP AGG S
OTHER $
AUTONOBILELIABILRY COMBINED SINGLE LIMIT S
Fa acddenl
ANY AUTO BODILY INJURY(Per parson) S
ALL OWNED SCHEDULED NIA BODILY INJURY(Per sccident) E
AUTOS NON-OWNED PROPERTY DAMAGE y
HIRED AUTOS AUTOS Per a.d%D
$
UMBRELLA LIAO OCCUR EACH OCCURRENCE S
EXCESS DAB CLAIMS,MADE N/A AGGREGATE S
DED I I RETENTIONS S
WORMRS COMPENSATION
X STATUTE ER
AND EMPLOYERS LIABILITY
ANYPROPRIETORRARTNEWEXECUm/E YIN E.L EACH ACCIDENT E 100,000
A OFFICERIMEMBEREXCLUDED4 WA NIA WA MAARP301573 05/31/2016 05/31/2017
(Mandatary In NH) EL DISEASE-EA EMPLOYEE S 100,000
6 YYes,desaibe enter
DESCRIPTION OF OPERATIONS below E.L DISEASE-PODGY LIMB S 500,000
N/A
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACORD 101,Additional Remarb ScMdule,may be atiedMd Nmoro space is repuhed)
Workers'Compensation benefits will be paid W Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to
employees in states other than Massachusetts If the Insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in farce on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this
certificate of insurance). The status of this coverage ran be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tod at
www.mass.gov/lwdMrorker mpensabonriinvedgations/.
No partners have elected Coverage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Zachary Dumont ACCORDANCE WITH THE POLICY PROVISIONS.
182 Federal St AUTHORIMD REPRESENTATIVE
Salem MA 01970
Daniel M.Cx y,CPCU,Vice President—Residual Market—WCRIBMA
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
., R Massachusetts Department of Public Safety f
Board of Building Regulations and Standards
License: 6S-018348
Construction Supervisor
ROBERT W DENNIS
624 BRIDGE ST POBX. 34 �.',..,:,i•; ,
EAST BRIDGEWATE fHA 10 333 -
ice'-jMn CA— Expiration:
-Commissioner 08/31/2017
. � V' lta�d»tntnntuerz�fl.a�C-�lZ[tJJ4c�tt5P.� .
Office of Consumer Affairs&Business Regulation 1
OME IMPROVEMENT CONTRACTOR
egistratwn G 118272 Type: 1 -
Expiration 2121120f7i DBA
HOME STRUCTURAL SPECIALISTS
+
=
ROBERT DENNIS JR, ' a'—
' 524 BRIDGE ST.
j EAST BRIDGEWATER,MA02333 Undersecretary
Q•GOMMONWEA.LTH OF MASSACHUSET€SS .
._ ....,;BOARD OF
ENGtNEERING �
,.ISSUES THE FOLLOWING LICENSE AS A iW
REGIPROF'STRUCTURALENGINEER' '' �
ROBERT W DENNIS JR' _'`�
E BRIDGEWT[2,MA 02333-0534 4 * ')
i4 R� J
-• 13834 O6/30f2018 l 58213' '
".
Robert W. Dennis Jr.
Registered Structural Engineer
Don Atkinson
dba/ Home Structural Specialists
P.O. Box 534
East Bridgewater, MA 02333
508-326-2464
rwden n isi r(v7comcast..net
www.homestructuraispecialists.com
Proposal
Structural Work
182 Federal St, Salem, MA
May 15, 2016
We propose to obtain a permit and provide labor and material to perform structural
work at a property located at 182 Federal St, Salem, MA.
Work generally will consist of the following:
1. Provide cribbing, lumber and hydraulic jacks to temporarily support floor joists
2. Remove partition wall to gain access to damaged beams in basement
Replacement of wall, if desired, is responsibility of owner
3. Excavate and install 10 new reinforced concrete footings
4. Remove existing brick support piers in the area of work
5. Remove approximately 50 ft. damaged 8" x 8" main carrying beam and replace it
with new LVLs
6. Remove four damaged beams approximately 12-13 ft. each and replace with new
LVLs.
7. Sister one 2" x 8" joist approximately 14 ft. to existing joist
8. Connect joist to new LVLs with steel hangers
9. Install 10 new lally columns
10.Cleanup
Estimated time 3-4 weeks
Cost$47,500
Deposit when sign contract $500
Deposit when work begins $3500
Three progress payment as mutually agreed $11000 (approximately every 4 days)
Final Payment at completion $11000
Relocation of wiring or plumbing, if needed, will be considered an extra cost. It does not
appear that this will be necessary.
We will be responsible for removal of debris.
All work will be done in a professional manner to the complete satisfaction of the
owner.
Please call if you have any questions.
Bob Dennis 508-326-2464
Don Atkinson 781-724-4257
Please sign the contract, and return it with a $500 deposit payable to Home Structural
Specialists. Upon receipt, we will proceed with obtaining a permit and schedule the
work.
CONTRACT
Contractor Home Structural Specialists
�-'' Trevor Meek (Unit 1)
Owner
Signature / Print
Lisa Delissio (Unit 2)
Owner
Signature Print
Zachary Dumont (Unit 3)
Owner
ignature Print
Date ��ne aOIS