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52-54 FLINT ST - BUILDING INSPECTION U"Buildin The Commonwealth of Massachusetts Department of Public Safety NIa%%achU>elt>State Building Cade(780 CAIR)Seventh Edition City of Salem Permit Application for an Buildingother than a 1- or 2-Famil Dwellin (This Section For Official Use Only) Building Permit Number: Date Applied: Building Inspector: SECTION 1: LOCATION (Please indicate Block#and Lot# for locations for which a street address is not available) v No. and Street City /Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK If New Construction check here❑or check all that apply in the two rows below Existing Building Repair❑ Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ Other specify: (J- Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 8r- Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑/ Brief.Description of Proposed Work: d' ✓J /u ir(� r� lr Tom — S ?"AI S A ry c () Y1Jrr 4 SECTION 3:.COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ Existing Use Group(s): Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 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 as applicable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A4❑ A-5❑ B: Business ❑, E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ L• Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-lO�R-2 ❑ R-3 ❑ R-4 S: Storage -1 ❑ S-2 ❑ U: Utility ❑ - Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: PubliC f3/- Check if outside 1:1 ood Zone ❑ Indicate municipal ❑r A trench will not be Licensed Disposal Site❑ Private❑ or indentik Zone: or on site svxtem ❑ required ❑or trench or specifm-_ permit.is enclosed ❑ Railroad right-of-way: Hazards to Air.Navigation: \I:\ Ili>h rK C„inniii„n Krc.... Not \pplic.dble ❑ 1.Slru C,t a rc tcith in airport approach.]era' 1> their rev iutc Completed.' ur C m.unl to Build e11611Vd ❑ YrN ❑ or No❑ 1"e•s ❑ \n ❑ j SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY L.iition of Code' C:r GnnipPl: fcpu of Construction: Occupant Lund per Pluoe I too. the I'miding Contain an Sprinkler S%stem'. Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION ,tod Address of Property Owner Name (Print) No.and Street City/Town Zip Properly 0%%tier Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If a >>licablr, the prurty owner hereby authorizes �Yrrorr�,d -r A4-- ��4G Name Street Address City/Town Stale Zip to act on the pro perly owner's behalf, in all matters relative ht work authorized by this bit ildin g permit a p tlication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (If building is less than 35,tXf0 cu. ft.of endoscd space and/or not under Construction Control then check here O and skip Section 10 1) 10.1 Registered Professional Responsible for Constn coon Control =r Na�yr,(Registrant) Telephone No. e-mail address Registration Number S &1 ti= /I Stree dress City/Town— State Zip bliscipline Expiration Date 10.2 General Contractor E- o—t��r� & ,.7r, s a�/���_������y+ 'I! Company Blame: r �d& T(2 Name of Person Respo Bible for Construction f—� License No. and Type if Applicable tf �rlAlG..�f-srJ � � Street Address City/Town State Zip Telephone No. (business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.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 is nce of the building permit. Is a signed Affidavit submitted with this application? Yes No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor edof Item and Materials) Total Construction Cost(from Item 6) 1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=$ 3. Plumbing $ Note: Minimum fee=$ (contact municipality) 4. Mechanical (HVAC) $ 5. Mechanical (Other) $ Enclose check payable to 6. Total Cost $ Q (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. TWA ( 2 6 ��sZ� O,ease rint ondd ign name Title Telephone No, Dale Ktre•et Address C it% Tuwn State Zip Municipal Inspector to fill out this section upon application approval: 2� Name I ate 9 Y n 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: ❑ Construction ❑ Moving • Reconstruction -0 Alteration Demolition ❑ Painting ❑ Signage ❑ 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: 52-54 Flint Street Name of Record Owner: Ron J. Cimon Description of Work Proposed: Replacement of main and porch roofs in kind(3-tab, black asphalt). Repair facia and soffit damage. Replace existing gutters and downspouts on porches to replicate existing. No changes in color, material, design, location or outward appearance. Non applicable due to being in kind maintenance/replacement. Dated: September 28, 2009 SALEM HI RIC COMMISSION 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. Liberty Mutual Group P.O. Box 9090 Liberty Dover, NH 03821-9090 Telephone: (800) 653-7893 10� Mutual.m Fax: (603) 245-5330 Y E-mail: IMS@Liberi Mutual.com Quote Number: 242847-01 Insured: ILIDIO F S VALENTE JR DBA RESIDENTIAL Quote Period: 04/24/2009 - 04/24/2010 REPAIR SERVICE Issue Date: 01/26/2009 PO BOX 397 PEABODY, MA 01960 Legal Status: INDIVIDUAL FEIN: 562557834 Of ficers s Title IL ILIDIO P S VALENTE Included/Excluded JR SOLE PROPRIETOR EXCLUDED Workers Compensation Insurance offered by this quote applies to the following states: MA Employers Liability Limits of Coverage: Bodily Injury by Accident: 100,000 Each Accident Bodily Injury by Disease: 500,000 Policy Limit Bodily Injury by Disease: 100,000 Each Employee Location Number and/or Address 001 4 PRINCETON ST, PEABODY, MA 01960-0000 Loc. Class Estimated Rate/ State # Code Descri lion P Exposure $100 Premium MA 001 5403 CARPENTRY NOC 0 11.92 l 5545 ROOFING NOC & YARD EMP LOYEES, DRIVERS 2,625 30.35 797 5645 >- CA121 ENT12Y DETACHED ONE OR TWO FAMILY 0 7.50 0 5651 CARPENTRY - DWELLINGS - THREE STORIES 0 7.50 ) Location Total 797 FMAAMACHWC SUMMARY cription Factor Status Premium CLASS PI2EM. I-IJM ARD TOTAL, 797 ONSTANT' 7 (SURCHARGE) 250 1.063 TERRORISM RISK INS ACT 2002 50 1.030 1 MA FINAL TOTAL, 1,098 Total Premium and Surcharges 1,098 The above rates are subject to state mandated changes. The factors used in rating this quote are also subject to change pending promulgation of final experience modification and classifications/etposures front final audit oj' your current a orkers compensation policy. Requests for changes other than address, please consult your producer of record, if any. Quote Prepared by: Account Number. 1366666-0000 Page 2 04,29i09 12:58 FAX _ [�j002 _. H T BAILEY H.T. BAILEY INSURANCE AGENCY, INC. 20 MALL ROAD Surplus Lines and Special Risk Underwriters SUITE 100 BURLINGTON, MA 01803 TEL: 781-362-1000 FAX: 781-273-3750 COMMERCIAL GENERAL LIABILITY QUOTE Broker: _.--.----------- - Binder ZANNINO INSURANCE AGENCY ATTENTION: JOHN ZANNINO Assigned #: $G(^ 3a00zC)6 16 FOSTER STREET )Effective Date: 04-(►,.bA PEABODY, MA 01960 Expiration Date:C,4_16_10 Named Insured: RESIDENTIAL REPAIR SERVICES RENEWAL Expiring Policy No. 5GL3000206 Expiration Date: 04/16/09 LIMITS NSURANCE: _ Gzneral Aggregate Limit (Other than Products--Completed pan , :nsl $ 1,000,000 Products--Completed Operations Aggregate Limit $ 1,000,000 Personal and,Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Fire Damage Limit $ 50,000 (Any One Fire) Mecical Expense Limit $ EXCLUDED (Any One Person) Professional Limit $ NOT COV RETROACTIV ATE ICG 00 02 onlVl Coverage A of this Insurance does not apply to "bodily injury" or "property damage" which occurs before Retroactive Date, if any, shown here: NONE DESCRIP OF BUSINESS AND L TION OF PREMISE Form of Business: Individual Business Description: ROOFING CONTRACTOR Locapon of All Premises You Own, Rent or Occupy: F.O. 80x 387 PEA13001' MA 01960 PREMIUM Rate Advance Premium Classification Code No. Premium Basis PrOo All Other Co All Other cN i:NtRY N0� 10,. IPr/N LVD[ $1000 Deductible Per Claim BI & PD Including LAE Total Advance Premium $3,500.00 (Minimum & Deposit/ S�bject to Affidavit by Assured 25% minimum earned at Inception.) Tax: 4% Filing Fee: $0 Policy Fee: $0 Other Fee: $0 Inspection Fee: $ 0 Please read terms an conditions carefully. This quote may not comply with all con rtions, terms or coverage requested. In order to bind coverage we must receive a written request prior to the effective date. Coverage cannot be considered bound without written confirmation from our office. FORM ENDORSEMENTS Forms ano Endorsements applying to this Coverage Part and made part of this policy at time of issue: SEE ENDORSEMENT if 01 auoterT04/23/09 Expires: %09 Company: SENECA SPECIALTY INSURANCE COMPANY / Commission: 10.000°/a By PAUL HUGHES . Accoorn No.: PMH 259889 CITY OF SM.EM, AASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET, 3w FLOOR TEL (978) 745-959S FAX(978) 740.9&M ICl�(BFRi FY DRISCOLL . TOM SST.PIERRI& �tAY DI DIRECTOR OF PUBLIC PROPERTY/fIVILDLNG CO\L%DSSIO%EJL Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information �/y Please Prin{t-LeaibIV .Nairn: tBusisw•sa.Organizaiiomindsvtdual):_Pe-2 //ial l /1-t ()�1P/ft Y —2 Le' 3s, � l e IX Address: City/State/Zip: ,gip ,1 (t.(14ld — Phone 41: q 2e Z/)- 5-2 61 Are you to employer?Check he appropriate box: Type of project(required): 1.[�'�m a mploya wish 4. ❑ 1 am a gencral contractor and I employees(full and/or pan b -time).• have hired the sucoturunto 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached shceL I ?• ❑Remodeling ship and have no employees These sub-contractors have a. ❑ Demolition workingfor me in an capacity. workers'comp.instaanoa Y P tY• 9. ❑building addition (No workers'comp. insurance S. ❑ We are a corporations and its required.) officers have exercised their 10.0 Electrical repairs"additions 3.❑ I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions myself.(No workers'comp. c- 132,$1(4),and we have no 12.0 Roof repairs insurance required.) t employees. two workers' 13.❑Other— ;Anycomp. insurance required.) •Any applicant dun,heck mum also sl mu also fill col the mclius below allowing their wtxkera'congen aiian policy inrurmatloa r I Iswtwuwnms who submit this anldsvit indicting They am doing all wwk and thus him swtwida 000110001111108 suhtnit a now aflldavit indicting such. :('.mtrat,•toa thin cheek this Asa mull anachttd an a klic mal shoes showing the tome of ttt suk.eentmcfoas and thek workers'camp.policy informeuoa. l am an employer that is providlnir workers'rompensadon fnsurwaee for my employees, Blow/s the popsy sad fob sib informwioiL ­., Insurance Company Name: 61e Policy N or Self-ins. Lic..N: !�y J � 0 - Expiration Date: lob Sire Address: .51 City/StatriZip: 15w,.eAl,F OAr q D Attack a copy of the workers'compensatlou policy dealaratlou pegs(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of VIOL C. 152 can lead to the imposition of criminal penalties are nine up to S 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 S250.00 a day against the violator. Ilo advi•ttd that a copy of this statement maybe forwarded to the Office of Investigations al'dte DIA for insurance coverage verification. f do hereby Berri der tha pains�and penaties sif perjury thin Ar informadow provided above is true and correct �mnvurr / / _Dal! 1 Phonc ri, S--? 14 iOffirial Use Wily. Do nor virile in this area, to be runrpfeted by city or town o1f,-iw4 i I City or ruwn: _- _ Pcrmit/Llccnse N hsuing Authority (circle une): j I. IluarJ of Ilvahh 2. Building Department J. City/town Clerk 4. Electrical Inspector 5. Plumbing Inppector 6. Other Uuttacl Person: _ __. _.. Phan*N• CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT 120 WAil IING'I'ON S CHUT ♦SAI UM.MASiACI II it I i i J I'" T•1I:478-74i-9;95 ♦ FAX:978-740.9846 Construction Debris Disposal Affidavit (required I'or 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 It _ _ is issued with the condition that the debris resulting from this work shall.he disposed of in a properly licensed waste disposal facility as defined by MGL c 111. S 150A. The debris will be transported by: Car uM True (� (name of iauler) fhe debris will be disposed of in (name of face i5i P-el /444 0?6 D _ (address of facility) signature of permit applicant date e•h cQ:I'I!OC VINYL TILT REPLACEMENT WINDOWS T N RESIDENTIAL REPAIR SERVICES O ROOFING MIQ osso S Dump Truck Service • General Contractor D � 978-423-4574 0 N ucst3105 R GUTTERS STORM WINDOWS ROOFING ESTIMATE ESTIMATES BMITTED TO: - JOB NAME JOB# I�ia.�l S/U 61AI ADDRESS _ JOB LOCATION CITYISTATEIZIP ����, �?' DATE 17 PHONE# FAX# CELL# WE HEREBY AGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW... NOTE: ONLY THE MARKED BOXES PERTAIN TO YOUR ESTIMATE. WE AGREE TO:0"l' /-COMPLETELY STRIP THE ENTIRE ikI t) -f Pr•A r- Plik-e- P ROOF(S) OF THE EXISTING ___...._`J_�_ (� 1.tAl1 1 _ LAYERS OF SHINGLES. ❑ 2. INSTALL A NEW LAYER OF SHINGLES OVER THE EXISTING ONE LAYER OF SHINGLES ON ROOF(S). ❑ 3. INSTALL A NEW RUBBER ROOF(S)USING ALL NEW RUBBE}R�ROOFING MATERIALS ON THE Off. INS AL-L.NEWIE 8 WATER SHIELD ON /YI141 Al �ROOF(S), ROOFS EDGE, RAKES, VALLEYS, DORMERS, SKYLIGHTS!CHIMNEYS S:�FLAT ROOF AREAS. O S. INSTALL NEW T_LB.ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE A v iW A-reA L/.c ,C.M 1 ❑ems. INSTALL NEW 8 INCH 1AA#il I' ALUMINUM DRIP EDGE ON THE ENTIRE /��iw a. Mlrnwfe .6+. ROOF(S). ❑ 7: INSTALL NEW ALUMINUM STEP FLASHING ON ROOF(S). O"8,. INSTALL NEW(VENT PIPE BOOTS)ON M-*t r✓ ROOF(S). ❑ 9. INSTALL NEW(ROOF BOX VENTS)ON ROOF(S). 2-'10. CUT&INSTALL NEW RIDGE VENT ON 444 A.1 ROOF(S). ❑ 11. INSTALL NEW LEAD ON CHIMNEY ON ROOF(S). ❑ 12. INSTALL NEW SKYLIGHTS ON ROOF(S). Oy 13. INSTALL r/40 FT. OF (ROOF BOARDS) OR(PLYWOOD SHEATHING)ON THE ROOD OF THE �.�-- COSTS$3.00 PER SQ.. FOOT,COVERS MATERIALS AND LABOR. ❑'14. INSTALL NEW .36 YEAR lr�,0V AA1-ry e L IA-t ej *tA? It SHINGLES ON THE _ /HRr.� f7nrr I� ROOF(S). ' / ry �^ f1 O 1'S. INS STD REPLACE EPAIR /CA��P � f'lb_-ins -1 �nFf�� ��rAv �C /la/►y. b/�/`i. �l f C�..r'1".wfr Ai J lLoiAti O 16. SPECIAL CONDITIONS C ,?-A0 .L f,r r Ail. a P, RI AJ I[ iA l �i,sG Ir1W vri� NOTE: WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS.CUSTOMERS SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE BY COVERING EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENTANY DAMAGE DURING THE STRIPPING OF THE ROOF.HOWEVR,SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR CONTROL... NOTE: (IF)MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE,AN EXTRA CHARGE WILL BE ADDED FOR THE (LABOR&THE REMOVAL OF THE DEBRIS)OVER AND ABOVE THE PRICE OF THE ESTIMATE. We propose hereby to furnish material and labor- complete in accordance with the above specificatiobns for the sum of: $ / ky4ey �3.,ys I -j �i s,�Lr,'r �--�(IAIA e � p} / "r/ ), psd� Dollars with payments to be made as follows: J. /ildd '7 n/i",A—i r/4VA*Yvf' !' 0,1/1Wg/ /e��rr)(rTroN Any alteration or deviation from the above specifications involving extra costs Respectfully i ��} //�__i r will be executed only upon written order,and will become an extra charge over submitted and above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note-this proposal may be withdrawn by us if not accepted within tf days. ,Arceptz m Of rupasul"`� The above prices,specifications and conditions are satisfactory and are hereby Signature "—/- \` �� �✓' v accepted.You are authorized to do the work as specified.Payments will be = made as outlined above. I Date of Acceptance "T ©�C..i �! Signature I