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5 FOSTER ST - BUILDING INSPECTION
The Commonwealth of Massachusetts a Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use O Building Permit Number: ate pl i 2 11 Building Official(Print Name) gna Date SECTION 1: SITE INFO N 1.1 Proper�y Address: 1.2 Assessors & Parcel Numbers Yo5 2r� 4) J.l 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 OWNERSIi1P' 2.1 Owner of Record: \/ Ic�\/ 1Z.t t- %C' �1211u Alen, � M A Q lam+ �� Name(Print) City,State,ZIP 5 G„nicr S ) q70--VA-� com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building tl� Owner-Occupied Evi Repairs(s) Erl Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work 2. iN SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ -3 9 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ USA ❑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 $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $l y S-C) ❑Paid in Full ❑Outstanding Balance Due: i< , 661z /7/ vex z/o, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (,(3 l �qu �.�p Z Z �- _ -11 O_�. �� `M19"D License Number Expiration Date Na'm1e of CSL Holder "I MU y-CGn � List CSL Type(see below) No.and Street V Type Description yI t\ �1�( . r) J�r�A- D , U Unrestricted(Buildings u to 35,000 cu,ft. / l O O R Restricted 1&2 FamilyDwelling City/Town,State, P 1 ' t M Masonry RC Roofing Covering WS Window and Siding �QQ \!� SF Solid Fuel Burning Appliances -p-� �Q.�fC.MO'b,��COmc�+Sa•Y�k I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1A.}f90c� .13 Piz- 14a� c�m�n 0� `i Lh Essex pG ti HIC Registration Number Expiration Date HIC Company Name or C Registrant Name No.and Street U Email address City/Town, State, IP 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 I,as Owner of the subject property,hereby authorize 6k C`bk'n 1 oa to act on my behalf,in all matters relative to work au by this>yilding permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNERS 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. e cJ Z-13 = 12. Print ner's or Authorized Agent's Name(Electronic Sig e) 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 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" 1� Stephen Morad President O..wh.dyrnm.com 7 2 De Bush Avenue,Unit B-2 Phone:978-531-5939 Middleton,MA 01949 Fax:978-535-3199 CS-o94762 steve.morad@mrhandyman.com i' CITY OF S�UMN4 2ANSSACHUSETTS • BL'IMING DEPARI'%IENT • 120 WASHINGTON STREET,3-FLOOR TEL (978)745-9595 FAX(978) 740-9846 KIMBFRf EY DRISCOLG 141AYOA THOttAS ST.P[ERRB DIRECTOR OF PUBLIC PROPERTY/BUUMINIG COMMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers -Applicant Information _J .( Please Print Leelbly Name(BusitwssiOrganization m/Individual): /'/Q. ��9 e'1 C:✓I s'r7dJ n Q�(/0u ,A rSSex Address: ,fie ,artd A Poe , City/State/Zip: 17?',1d0v,7 0?6 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.�l am a employer with 1_/ 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time)! have hired the sub-contractors, 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t 7. U Remodeling ship and have no employees These sub-contractors have S. 0 Demolition working for me in any capacity. workers'comp.insurance. 9. 0 Building addition [No workers'comp. insurance 5. 0 We are a corporation and its required.) officers have exercised their ME] Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions myself.[No workers'comp. c. 152,41(4),and we have no 12.0 Roof repairs insurance required.)t employees. [No workers' 13.0 Other s 2 S COMP. insurance required.) •Any applicant that dus;ks box#1 most also fill out the section below showing their worker'compensation policy information. t I Inmeowrer,who submit this affidavit indicating they am doing all work and then hire onside cauresso s must submit a new affidavit indicating such, :Contractor,that cheek this box must attached an additional Awl showing the mmno of the aubcontneams and their workm'comp.policy mammalian, I am an employer that is providing workers'compensation Insurance for my employees. Below Is the policy and fob site information. /� Insurance Company Name: An7)'YwJ f l 1 n1a1 vl er Ce L ), 22 24 Policy#or Self-ins.Lie,q 3� b 3 T Expiration Dace: g— lob Site Address: S r'oS City/State/Zip: c St�Jem ✓n iq 0/9 70 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 S1,500.00 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 orthe DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct SianatuT_J L�1(p� cti tMg�� Date: 12 — 19-12— Phone#: Official use only, Do not write In this area,to be completed by city or town official, City or Town: Permit/l.icense# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person• Phone M CITY OF SMY.M. NLksSACHUSETTS BULDLNGDEP1,RT ENT p• 130 W 1SHIINGTON STREET,3' FLOOR ` TEL. (978) 745-9595 FAX(978) 740-9846 1CIJtBERI.EY DRISCOLL MAYOR T Homm ST.PtERRa DIRECTOR OF PUBLIC PROPERTY/BUILDING COMNSISSIONER 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 h uler) The debris will be disposed of in : J' < V1 �D sovsa (name of facility) (address of facility) e 2ofpermi pplicant �/3 -l2 date JcbrisdiJce Estimate GoOn otuime.Done tight® Client Name: Vicci Ricciasdiello May 10,2012 5 Foster St Salem MA 01970 Page 1 DESCRIPTION OF WORK PERFORMED Back area Remove and replace 3Lx 53 vinyl polls replacement window.Trim window inside and our C 3o t x e lJ 7,io /a d 1 JP Remove and replace asphalt shingles with grey vinyl siding in back of house rf Z s 3 Siding to be certainTeed main street siding color: 6t 1 tte r A 5 h s7 Install 3/8'Insulating Board lestail soffl panels Replace trim and fascia as needed.Wrap with coil stock Interior Bedroom Open up back wall and insulate as needed Shcorock entire room wit 3/8 inch drywall mud and tape Paint entire room ceiling walls and trim Front Storm Door - Remove and replace oversized storm door with Anderson 3000 Storm Door. Door is custom size door(38 x 80)and needs to be ordered., Repair and stain front door;Repair doorjamb Permit to be puffed by Mr.Handyman. All Debris disposed of by Mr.Handyman 113 deposit upfront remaining due upon completion. n DEPOSIT =$4,588.00 b� 12-13-1z Is 1s,8W.00 Any undiscovered or hidden problems could result in additional charges and will be brought to the clients attention inurredtalely upon discovery, payment is doe upon receipt offural invoice We accept as means ofpayment Cash,Check,Via,MasterCard,Discover,andAmerican Express Any etrrent discount offers in affect at the time Stow estimate have been applied and no additional discount offers may be /fpayments not made upon completion ofdre job aymem is not red within*days,interest will atone at a rate of 2%per ~nab from do,date ofcan p��n. In the of galacriaa in r ncer afco agreevla pay all costs and Client Signature. Signature ` u 5 Elm Street Peabody,MA 01960 (P)978 531 5939 HIC#147809/MA CSL# 0947624 OP ID: JD CERTIFICATE OF LIABILITY INSURANCE Dar081131 2 Q8N 3/12 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,sub)ect 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 978-774-4338 NAME: Phil Garden RichardStreet U Insurance,Inc 27 Garden Street Unit 1B 978-774-1318 PRCNN Eat): FAX Danvers,MA 01923 E.MA L -- -- Cynthia Backe ADDRESS: C Yn CUSTOMER EC R CILOMER ID 0:COt-UM_'1 INSURER(S)AFFORDING COVERAGE NAICA INSURED a Columbus Property Services Inc INSURERA:Travelers 10647_ Mr. Handyman Of South Essex Co ---"- --_—_.__- y WsuRERe:Technolog_y_Insurance Company 2 DeBush Avenue, Unit B2 Middleton,MA 01949 INSURERC:Safety Insurance Co 39454 -- --------------___..___._.__ INSURER O: INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ` r WSR AODL B -POLICY LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYYi (MMIODNY"l L114ITS GENERAL LIABILITY EACH OCCURRENCE S_ '1,00D,000 A X Cho, O IMERCIALGF.NERALLIABILITY X 16803264R495 08/06/12 08/06/13 pREMIBES IEa aaurc nco_ $ _ 100,000 GlAIMS-MADE OCCUR MF-O F.XP(An one person) $ 10,000 ! PERSONAL B ADV INJURY _ _$ 1,000,00C GEN ERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER'. _PRODUCTS-COMP/OP AGG S 2,000,00 X POLICY PRO. LOG $ AUTOMOBILE LIABILITY x COMBINED SINGLE LIMIT (Ed aeoident) $ 1,00D,00 C _I ANY AUTO 6204208 08/02/12 08/02/13 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(P.,aaidan0 $ X SCHEOULEAUTOS -- --- PROPERTY DAMAGE S X HIREDAUTOS (Pe,scud-nt) X NON-OWNEDAUTOS Comp Ded $ -so Coll Ded ---- -- I s ------ - 50 UMBRELLA BAR OCCUR EACH OCCURRENCE $ F�CESS LIAR --__-- CLAIMS-MADE AGGREGATE $ DEDUCTIBLE S RETENTION $ --_ $ - WORKERS AND EMPLOYERS'COMPENSATION YIN _X TSIRY T1WIIfl__.._.E.R B ANY PROPRIETOR/PARTNERIE%ECVTNE TWC329317 08/09/12 08/09/13 E.L.EACH_ACCIDENT $ __ 500,00 OFFICERIMEMBER EXCLUDED? NIA -- _ (Mandatory in NH) E L,01SEASE EA EMPLOYEE $ 600,000 If yyea,tl ac .uncle, -- DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,00 A BPP 6803264R495 08/06/12 08/06/13 BPP 10,20 DESCRIPTION OF OPERATIONS/LOCATIONS r VEHICLES (ABach ACORD 101,Additional Remarks Schedule,If more space Is required) Mr. Handyman International LLC is included as an additional insured, CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mr.Handyman International LLC ACCORDANCE WITH THE POLICY PROVISIONS. 'r Attn: Legal Franchise ' - Administrator AUTHORIZED REPRESENTATIVE 3948 Ranchero Drive Cynthia Backe IAnn Arbor MI48108 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD L Massachusetts -Department of Public Safety, `. Board of Building Regulations and Standards;° Construction Supen'isor t^ License: CS-094762 " STEPHEN MORAD .F. 4 MORGAN Ad AD;VM W H.NHNGT9N MA,018)87 ExPitationx Commissioner 02117/2014st + � - e�anvnea�amea�l�'o�P/llneancfuaeCla Office of Consumer Affairs&Busin ss Regulauon - ME IMPROVEMENT CONTRACTOR Type. rtF.. gistratlon 147809 DBA plratl�on: B/9I2013'— MR.H DYMAN OF,SODTH ESSElf COUNTY STEPHEN MORAD g, , 4 MORGAN RD. �. .; WILMINGTON,MA 01887 :Undersecretary- ii