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25 FLINT ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7"edition OF SALEM \_l\ Revised January Building Permit Application To Construct, Repair,R ovate Or Demolish a 1, 2008 One-or o-FamilyDwellI g s Se tion For Ofc' Use Only Building Permit Number: Dat Applied: Signature: /a// /� Building Commissi er/Inspecto of Bd ng Date S O 1: SITE INFORMATION 1.1 V 1.2 Assessors Map &Parcel Numbers I.Ta Is this an accepted street?ye no Map Number Parcel Number 1.3'rZoning Information: 1.4 Property Dimensions: ZMing District Proposed Use Lot Area(sq tt) 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 yesO SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ame / A ess for erv�ce: 4S7 - Lcz33Co igna[ure Telephone SECTION 3: DESCR ION OF PROPOSED WORK' (check all that apply) New Construction❑ Existing Buildin Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1. Building $ � 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: 5. Mechanical (Fire $ Su ression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $—I COC) ❑Paid in Full ❑ Outstanding Balance Due: C� SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Constru r upervisor(CSL) 77 Licen a Number Expr tion Datt Name of CSL-Holder _ List CSL Type(see below) dress Description U Unrestricted(up to 35,000 Cu.Ft. Restricted 1&2 Family Dwelling gnall e J M Masonry Only C� FRC Residential Roofing Covering elephone f Residential Window and Sidin Residential Solid Fuel Bumin A liance Installation Residential Demolition 5 e 'ste d Ho a Ir provem t Co tr�ctor C !�/L I-iI om i Nan a or e_ n Nn \ � (V I strahon Number ss ' 24 1 Expiration Date Signature \Telephafie 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 s ce of the budding permit. Signed Affidavit Attached? Yes ........ . No...........❑ P SECTION 7a: OWNER AUTHORIZATI N O BE COMPLETED WHEN OW R'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize > to act on my behalf,in all matters Z work autho � by this buildin �G1�1)0 f Owner DatDat SECTIO ,OWNLYWOR AUTHORIZED AGENT DECLARATION % I, ' ,as Owner or Authorized Agent hereby declare that the statements and informatio on th regoing application are true and accurate,to the best of my knowledge and behalf. Print N 1 store r or u ooze g Date (Si der the ains and enalties of �u ) 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,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" CITY OF S�U.&NI, 1VLXSSACHUSETTS B1:1LDLNG DEPARTNE&NT 130 WASHINGTON STR=, 3*0 FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KINtBERLEY DRISCOIL MAYOR T HoNw ST.PmmE DIRECTOR OF PUBLIC PROPERTY/BUnDiNG COJLNQSSIONER 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 111.5 Debris, and the provisions of MGL c 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 auh ter) The debris will be disposed of in (name of facility) (address of facility) i signature of permit applicant Vd,--iI10 date debris f .dm The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): UI 1 Address: • r—) City/State/Zip: Phone#: Are,you an employer? Chec ppropriate box: Type of project(required): ) am a employer with 4. ❑ I am a general contractor and I 6. El New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S, ❑ Demolition working for me in any capacity. .employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12jRoof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. - t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they most provide their workers'comp.policy number. . I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins. ��tic.#: (�JC�� 1 `J���i�f9(% n1 Expiration Date: ^, Job Site Adtiress t1�1 City/State/Zi • L QN/��/4 ( ��LJ Attach a copy of the workers' compensation policy declaration page(showing the policy number.and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct Signatur . Date: w Phone#: �'6' Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1, Other Contact Person: Phone#: 9� _ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improveme nt Contractor Registration Registration: 106603 Type: Private Corporation Expiration: 7/24/2012 Trk 297944 AJ WOOD CONSTRUCTION, INC. Richard Smith PO BOX 1769 - SALEM, NH 03079 — Update Address and return card.Mark reason for change. Address F-] Renewal ❑ Employment ❑ Lost Card DPS-CA1 O 50M-04/04G101216 0/2 -�oowvi / �✓1 Regulation _ License or registration valid for individul use only OM,,,o onsumerr A1t�a rs mess Regulation g HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Regtstrauon 106603 Type: Office of Consumer Affairs and Business Regulation Expiration 7/24/2012 Private Corporation 10 Park Plaza-Suite 5170 - _-.- Boston,MA 02116 MWD CONSTRUCT6K INC.-- Richard Smith 4 RUSTIC LANE -- — — DERRY,NH 03038 - - Undersecretary Not valid without signature - Commonwealth of Massachusetts .x.�... \l assachusctts- Dcp:u-tmcot of Public il(hil> Division of Occupational Safety 7 Board of Buildin� Rcculatiuns :uu1 standard. HeatherE Rowe,Acting Commissioner Construction Supervisor License Deleader-Contractor License: CS 70882 RICHARD S. SMITH Restricted to: 00 EK.Date 0&23110 RICHARDJ SMITH OC Date 07/10/11 DC001721 PO BOX 1769 •, SALEM NH 03079 _ Memoer of C.O.N.ES T. .� e BO Expiration: 7128/20 BOSON-RENEW t, IIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIII�III�IIIIiIII E ('ommi>.imrr , 1 LiJ\tv ' L 1✓ „ 23153c)C9 � `�-5 43 kLek l0 ACORD. CERTIFICATE OF LIABILITY INSURANCE Dosnono 0 PRODUCER - - - - THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION Matthews insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 182 Parker St - ALLTER THE HCOVERAGE AFFORDED BIS CER71FICATE DOES Y THE MPOLICIES BELOND W Lawrence, MA 01 M 978-681-1112 INSURERS AFFORDING COVERAGE - NAIC# 1NS1'� A.J.Wood Construction,Inc. Liberty mutual Ins- . P.O.Box INSURER@ Salem,NH 03079 INSURER c wsvRER¢ INSUREfe E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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. - - - VNSR POUCYNUMBEit I POLICY EFEECIIVE. DATE(MMMDNYI POLICY EXPIRATION UNITS GENFAALUABILRY EACHOCCURRENCE I S OAMAGETORENTED 'COMMERCIALGENERALDABLLrtY PFWUSES Ma S I CLAIMS MADE OOCCUR MED EXP(Myane PNsan S PERSONAL B ADV INJURY S GENERAL AGGREGATE S GENT.AGGREGATE UMITAPPUES PER :PRODUCTS-COMPJOP AGG S ) POLICY - PRO- ED LOG I ,w AUTOMOBILE LABILITY COMBINED SINGLE LIMIT S ANY AUTO (Fa aNdele) ALLOLVNEDAUTOS - BODILY INJURY SCHEDUIEDAUTO.S (PuprisDV S HIREOAUTO.S _ BODILY INJURY NOM.Ov"M-0AUTOS (Pw.cdde)d) S - PROPERTY DALwGE S (Par acddem) GARAGE UABNJTY AUTO ONLY-EA ACCIDENT S I ANY AUTO OTHER THAN EA ACC S k AUTO OM.Y: AGG S EXGESSIUMBRELLALWBIUTY EACH OCCURRENCE S OCCUR CLAi/A5 MADE AGGREGATE S S DEDUCTIBLE- f S RETENTION S S WORI®eS COMPENSATION AND WC231 S353819029 02/13/2010 02/13/2011 ` TORY LIMIT ER I 9MPLOYERS UARILTM EL EACHACCIDENr S 500.000 OFFlCANYCEFWEASEREXCLVOED7OPRIETORFARTNERIEXECUTNE EL DISEASE-EA EMPLOYEE S 500000 H PO 1FMer EL DISEASE-POLICY LIMB s 500.000 sv�`EcwL PRONnsolNs De6vi OTHER DESCNPUON OF OPEMTIONSJ LOCATIONS)VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECAL PROVISIONS CERTIFICATE HOG[T __ CANCELLATION SHOULD ANY OF THE ABOVE DESMUSED POUMES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENOEAVOR TO NAIL__DAYS WRTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAHURE TO 00 SO SHALL WpOSE NO OBLIGATION OR UAMUTY OF ANY HIND UPON THE INSURER=AGENTS OR REPRESENTATIVES auTNDIBgD ... ACORD 2S(2001108) - - (D ACORD CORPORATION 1988 T •d dZS =EO 01 [.T JeW .j10/THU 01 :06 PM Financial Insurance FAX No. 6034323852 P. 001/001 'R CERTIFICATE OF LIABILITY INSURANCE A9/9/2010 MMM fYY .DUCER (603)432-6414 FAX: (603)432-3852 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION :inancial Insurance Services Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 950 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Derry NH 03038 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A:Peerless Insurance Co A J Wood Construction Inc INSURER B' PO Box 1769 INSURER C: NSURER D: Salmi IIT}I 03079 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWTTHSTAN DING 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. INM WUL POLICY NUMBER DPOLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 100,000 A X CLAMS MADE aOCCUR BP8706685 8/16/2010 8/16/2011 MED EXP(Any me person) $ 15,000 PERSONAL 8 ADV INJURY $ 1,000,0001 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY PROT LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea ecddenl) ANYAUTO A X ALL OKNED AUTOS BAS693505 7/8/2010 7/8/2011 BODILY INJURY X SCHEDULED AUTOS (Perpeman) $ X HIREDAUTOS BODILY INJURY $ X NON-ONNEOAJTOS (Per acatlenq PROPERTY DAMAGE $ (Pe ..d nl) GARAGELIABRJTY AUTO ONLY-EA ACCIDENT $ MY AUTO OTHER THAN EAACC $ p AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION § $ WOPo(ERSCOMPENSATION NC STATU- OTH- n I AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR)PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ ❑ OFFICERJMEMBER EXCLUDED? (Manialory in NH) E.L.OBEASE-EA EMPLOYE $ Ilyes.descdbermtlar SPECIAL PROVISIONS Wmv E.L.DISEASE-POLICY LNIR $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER VALE ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUTFAILURE TO 00 SO SRALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY WND UPON THE INSURER,ITS AGENTS OR � � REPRESENTATIVES. AUIy10PoZE0 Po:PRESFMATIVE Sam Fragala/PAT ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200em) The ACORD name and logo are registered marks of ACORD Salem Historical Commission 120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 (978) 745-9595 EXT.311 FAX(978) 740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: Cj Construction ❑ Moving Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ . Sibmage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 25 Flint Street Name of Record Owner: Eleanor Meadow-roft Description of Work Proposed: Replacement of existing 3-tab rovjwith Certainteed 3-tab tile, X730 in Weathered Wood Non-applicable due to being an in kind replacement. Dated: September 11, 2010 SALE M MMISSION, By: The homeowner has the option not to commence the work(unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. Z00 2 XVd BS:ZZ Loozlvol50 Telephone: (603) 898-4468 CONTRACT Cell: (603) 235-7624 Toll Free: (800) 458-4468 HIC #106603 Fax: (603) 898-6942 A.J. WOOD CONSTRUCTION, INC. P.O. Box 1769 Salem, New Hampshire 03079 Email: info(>ajwoodconsiruction.net Website: www.ajwoodconstniction.net ROOFING*SIDING*WINDOWS• DECKS• KITCHEN & BATH REMODELING Workmen's Compensation and General Liability Carried on A// Work Date October I. 20I0 No. 25 Flint St. Salem MA 01970 (Street) (City) (State) (Zipcode) Owner's Name Eleanor MeadowcroR Telephone: (978)715-0336 Address SAME AS ABOVE Email: ananoblenetor 1 (we), the undersigned, hereby accept your proposal to furnish Labor and Materials to perform the following work on premises located at the following address: SPECIFICATIONS OF CONTRACT The contractor agrees to do the followin2 work for the homeowner- ROOF S7,000.00 • Strip of all existing roofing material Install ice and water shield on all roof edges, valleys and roofing protrusions. Install GAF Sldnglemate roofing underlayment with 8" aluminum drip edge. Install 30 year roofing shingles with a Cobra ridge vent on peak. All permits and debris removal included. Homeowner is responsible for the protection of all trees, shrubs, and Oowerbeds. We guarantee our workmanship and provide a one(1)year Labor Only Warranty from date of completion. • Reseal Skylight to ensure no leakage • If gutter is removed, reinstalled existing gutter when finished The contractor agrees to perform the work,furnish the materials and labor specified above for the Total Sum Of$7,000 00(Seven Thousand Dollars and 00/100) Pavments will be made according to the following schedule: 1/3 due with signed contract $2 320 00(Two Thousand Three Hundred Twenty Dollars and 00/100) 1/3 Due When Project Is 30%Complete: : $2 320 00(Two Thousand Three Hundred Twenty Dollars and 00/100) 1/3 Due When Protect Is 100%COMI)ICtC7 $2 360 00(Two Thousand Three Hundred Sixty Dollars and 00/100) Required permits - The following building permits are required and will be secured by the contractor as the homeowners agent. Proposed start and completion schedule will be adhered to unless circumstances beyond the contractors control arise. The contractor will start the project within 30 days and the project will be done within 60 days of the start day. NOTES: (*) Including all finance charges (**) Law requires that any deposit or down payment required by the contractor before any work begins may not except the greater of(a) I/3 of the contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion of schedule. You may cancel this agreement if it has been signed at a place other than the contractors normal place of business, proved you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delibcry, not later than midnight of the third business day following the signing of lids agreement. See attached notice of cancellation form for art explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two idetAic l copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor. All home improvement contractors and subcontractors shall be registered and that any inquiries about a conimctor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation—(617) 973-8700 10 Park Plaza, Suite 5170 Boston, MA 02116 Owner agrees that the title or equity in this property is his and is security for this contract. IN WITNESS WHEREOF the undersigned has(have)hereunto set his(their) hand(s)the day and year first above written. Buyer(s)Acknowledge Receiving a Completed Legible Copy of This Contract. This contract may be voided by the Owners giving written notice to the Contractor by ordinary mail within three full business days following the date hereof. pp By QYc:l1R7"G�Cam" . Qb11111l1 ,�l'��L'C E ' " i'�, ' L.S. (Richard J. Smith, President) (Legal owner of prog¢rty to be improved) 337 Haverhill Rd., Chester, NH 03036 FID: 20-0487037 HIC 4: 106603