Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
4 FLYNN ST - BUILDING INSPECTION (2)
The Commonwealth of Massachusetts Department of Public Safety '\ ^> +••i \10ssachusetls Skate Building Code(780 C,%IR)Seventh Edition l City of Salem Building Permit Application for any Building other than a 1- or 2-Fam' wellin J (This SrRiun For Official Use Only) Budding Pennn Number: Date Applied: 2 i, Building Inspector: SECTION Irr: LOCATION (Please indicate Block B and Lot A for locations for which a street address is not available) YIIYAn S-t 3(1tjM f1N1 1 1-70 No. and Street Cit\ /Town Zip Code Name of Building (if opplicable) SECTION 2: PROPOSED WORK _ If New Construction check here❑or check all that apply in the twu rows below Existing Building❑ Repair❑ 1 Alteration Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plan,and/ur cunmruction documents being supplied as part of this permit application? Yes ❑ No Is on Independent Structural Engineering Peer Review required? Yes No ❑ Brief D ,eruption of Proposed Wurk: ✓1 r W YA) UZ C 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): p 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(Check as applicable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ -" B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2 ❑ H: High Hazard H-1 ❑ H-2 ClH3 ❑ H-4 ❑ H-5❑ I: Institutional I-1 ❑ 1-2 ❑ 1-3 ❑ I-4 ❑ M: Mercantile❑ R: Residential R-10 R-2 ❑ R-3 ❑ R-4 ❑ 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 ❑ IIIA ❑ 11113 ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR I IL0 for details on each item) Water Supply: Information: Flood Zone Infoation: Sewage Disposal: Trench Permit: Debris Removal: I'uhlic❑ (-heck if outside FI,,od Zune.❑ Indicate municipal ❑ A trench will not he Licensed Dispadl Site ❑ rtequired ❑or trench nr'peatc I'r i+>vv ❑ ��r indunulc Zone:_ or on rile��stem ❑ permit is unclosed ❑ _ Railroad right-of-way: Hazards to Air.Navigation: \I:\ I li.l•,m t „n nnh.Lm R,"„o l'r,,,,��: \d :\(+phi dbr❑ Ltilrurlurc +nlhin.lirpnrl.I F+proach,irc•a' hlhcir lvi o%r r„m(,IcicJ' I„ Build cncl„"cd ❑ 1\s ❑ ur ..No❑ 1'e. ❑ \u ❑ SECTION 8: CONTENT OF CERTIFICATE OF OCCUPANCY I Jown „I (-„dr: ---- L.e rvpe"I (n1n1IRllhUn: Occupant l.n.ld per PlnuC „r. Ihr buildurg c„nlaum dn.tiprinkler tic.lem': tipccial S ipu la lions: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Ow iyV1t, S1 S 1Cit yip Name(Print) Nu. and Street Cih•/Town Propene(hc tier Contact Information: e-mail address Title Telephone No. (business) Telephone No. (cell) Il applicable, the pntperty tncner hereby authorizes Street Address City/Town Stole Zip Name wi-mn a ,,IlcatiOn. to act on the rt ,ert% ,tic nee'+behalf, in .ell matters relative h,work authorized by this buildin SECTION 10: CONSTRLCTION CONTROL (Please fill out Appendix 2) (I I buildin•is less than enclosed>,ail'and/or not tinder Con tr Cltruction Cunul then check here and ski,Sediu❑ IU 15,oUU Cit. ft.of .U 10.1\Re istered Professional Res onsible for Construction Control e-mail address Registration Number Name(Registrant) Telephone No. — State Zip Discipline Expiration Date City/Town Street Address . 10.2 General Contractor r I um .ny Name: �'ti CS 73 b�3 re b�4 0 License No. and Type i&Vt, ��gs,.� Nam u Person Res ysv e fo{Cunstructiun 11 I( � S ui�T-•e City/Town fate Zip Street Address 1 le Crri c' �{✓(thy^ '� q-xj7�� 3 ciffie e-mail address Telephone No.(business) Tele hone No. (cell)- e b SECTION 11:WORKERS'COIvIPE NSATION RJSURANCE AFFIDAVIT IM.G.L.c.152. 25C A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must e 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 application. signed Affidavit provide submitteds with this a lication? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item. and Materials) Total Construction Cost(from Item 6) _$----- 1. Building $ O� Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ .3 appropriate municipal factor)_ 3. Plumbing $ Note:Minimum fee=$ (contact municipality) 4. Mechanical (HVAC) $ 5. Mechanical (Other) S Enclose check payable to 6.Total Cost $ 2 y c)—J (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT ontained in this By entering my name below, I hereby attest under the pains and penalties of perjury that all of the inhumation c application is true and accurate to the b st of my knowledge Ind understanding. ju ti �{� A UIOn ' /1^est e i t w hl� Trlc•phu - Title No. Dale iII'Ie,,:e print dnrigtn )III's l' _ L 0 01c Cit%jo,.%n I;L e, Zip titreet \ddres ' ion approval:Vlunici pal Inspector to till out this section upon applicat Na Date i j . __\3 The Commonwealth oJMassachusetts Department of lndiestrial Accidents = OMiceo/lnrestlyatlons /�7 600 R'ashington Street � Boston, Mass. 02111 Workers' Compensation Insurance Affidavit a, 61, Ization 1O ¢J(ON 1'--9 LLYParma o147J ahonc a C I am a homeowner performing all work myself. C 1 am a sole proprietor and have no one working in any capacity C f am an cmplo er providing workers' compensation for my employees working on this job. p �o hon et . t>ba�atmsrsoawsea C 1 am a sole proprietor, general contractor, or homeowner(arcle one) and have hued the con ractors listed below who have the following workers' compensation polices: insurance c trzmo�nr nime h, ipIIlan aY nnmC ?:r 5 's DdSiCt]]' t la]aFa a[Cta OI CYK '• {{hack ado non.rt.s rt<'eT"a auu^^. Fndmr,to>ecurt env trage as required under Section 25A of hICL 152 can tend to the imposition of criminal penalties of. tine up to$000.00 and/or ant roars'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER sad n fine of 5I Wall a day against me. I understand that u Copy of this nalcment may be fo wurdad to the Office of Inve3tigalions of the DIA for coverage vtrineation. _ 1 do hrrcby cr`n�iJ�y_.under rh ns and penalties o/perjury that the information provided above is true and correct Signature" ,t-'of 'J+'^ /',r, Date F�13 3. —2iJ]L) Print name Phone p (mciul we only Jo not write in this arcs to be completed by city ar town omcial :GI ciry ur to..n" ermitnieense p p nDuildifig D<panmcm CLiccmine DaarJ g, f]chccu if imnm Jiutc response is reyulrrul - CSdectme n's Office 1_ CHealth Department ] coorscl person: phone a; -Other y} Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association,-corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal-representatives of a deceased employer,or the receiver or trustee of an individual , partnership, association or other;legal entity, employing employees: However the owner of a dwelling house having not more than three apartments and wh'o resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance;construction or tepaii work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any. applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be rctumed to the city or town that the applicatioP for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns - 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 in the event the Office of Investigations has to contact you regarding the applicant. Please.:.. .. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to.thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. mom The Department's address, tglephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents afllce of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone 4: (617) 727-4900 ext. 406, 409 or 375 A -ORQ CERTIFICATE OF LIABILITY INSURANCE 07/08/20 9' PRODUCER (508)651-7700 FAX (508)655-8853 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 INSURERS AFFORDING COVERAGE NAIC# INSURED Roger A. Tremblay Contractors, Inc. INSURERA: Selective Insurance Co of SC 19259 10 Colonial Road MSURERB: National Union Fire Ins Co PA Suite 4 INSURER C: Salem, MA 01970 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATIONLTR LIMITS GENERAL LIABILITY S 1842342 04/15/2009 04/15/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,OOO CLAIMS MADE I OCCUR _ MED EXP(Any one person) $ 10,000 A PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 POLICYX P JECTRO LOG AUTOMOBILE LIABILITY A 9091419 04/15/2009 04/15/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea acoidenQ $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS (Per person) X HIRED AUTOS _ BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X $500. DEDCUTIBLE PROPERTYDAMAGE COMP./COLL. (Per accident) $ GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ ' AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY S 1842342 04/15/2009 04/15/2010 EACH OCCURRENCE $ 2,000,006 AGGREGATELVVVUVV A _1 $ DEDUCTIBLE $ X RETENTION $ $ WORKERS COMPENSATION AND WC3531587 07/01/2009 07/01/2010 X I WCSTATU- OTH- EMPLOYERS LIABILITY" 'A - - - B ANY PROPRIETOR/PARTNER/EXECUTIVE ' E.L.EACH ACCIDENT $ 500,000 OFFICEWMEMBER EXCLUDED? 500,000 E.L.DISEASE-EA EMPLOYE $ yes,describe antler S PRO SPECIAL PROVISIONS below E.L.DISEASE-PoLICV LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 0. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL \ 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.AUTHORIZED REPRESENTATIVE 4-"- Rosemary Fulham/PMA ACORD 25(2001108) FAX: (781)586-8120 ©ACORD CORPORATION 1988 Ylassnchu.setts - Department of Public safetl Board of Building, Reutdations and Standards Construction Supervisor License .License: CS 53693 Restricted to: 00 c: ROGER A TREMBLAY JR 29 HATHAWAY AVE BEVERLY. MA 01915. "—�� s—� Expiration: 5/9/2011 (' inmi.vinicr Tr#: 14696 wN3 3 DPS-CA1 6 40M-*08&DBSLIF0RMCA108212008 .. . . ..____._. /_-____p .. _. ..._. ... ...../_�... ._.� .. ✓ 6 lDo9�viieaiu//eal�6 a�✓!'GRdO¢Uu[de�(d n z . Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registry pn: 145375- E trot 32011 Tr# 262954 j Corporation ROGER A.THE -. ORS,INC. ROGER TREMBL 10 COLONIAL RD = SALEM,MA 01970 Administrator I ,P I i s November 20, 2009 Mark and Tina Vassey 4 Flynn Street Salem MA 01 970 Dear Mark and Tina, Here is our cost for work at 4 Flynn Street.This price includes labor and materials for the following work: New Kitchen: • Demolition of the entire kitchen,down to the existing framing, install rough and finish electrical and plumbing for the new kitchen. • Install one new window and lose in one window, install new rear door,install new door to the basement. • Install new hardwood flooring in the kitchen, insulate all walls,blue board and plaster ceiling and walls, all trim to match the existing. Bathroom: • Demo bath down to the framing, install rough plumbing and electrical work. • Close in the window, insulate all wall,blue board and plaster. • Install crown molding&61e floor. Total cost: $24,000.00 The owner is responsible to purchases the following: Appliances,kitchen cabinets,counter tops, sink& faucet,hanging light fixtures and painting,toilet,vanity, shower stall, sink&faucet,medicine cabinet, vanity light,tile and towel bar. Respectfully submitted, ��JeTLblay