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1 FRIEND ST - BUILDING INSPECTION (2) /I The Commonwealth of Massachusetts r1 Board of Building Regulations and Standards CITY U1Il ! Massachusetts State Building l Code, 780 CMR, 7ih edition OF SALEM Revised Januory Jh Building Permit Application To Construct,Repair, Renovate Or Demolish a 1. ?008 One-or Two-Family Dwelli is Section Fir OBic' Use Onl Building Permit Number: Da Applied: 'J Signature: 3/l/7/lD Building Com isioner/Inspec r ole ifdi gs Date' J %,t O 1:SITE INFORMATION ` 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers _J f/{f END 5T. 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Luning District Proposed Use Lot Area(sq It) Frontage(Il) 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: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system 13 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 'A/A/E 8fr2Ga i72e,N1 F/,lfA/t7 Name(Prim) Address for Service: Gam_, 6" 7V'I- VPI 3 SignSign t� 'telephone SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) #7 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': 5r9l ep & SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building S L .SSD 17. 00 I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: S L/ ,�p(7. OBJ 11 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) CS cp, 6 IS-11f 1� - 11A e 6o V E o s& License Number Expiration Date Name of CSL-I folder List CSL Type(see below) (moi 7 SAU, t t S , - /11 Eg 'rype Description antu5m D Unrestricted u to 35,000 Cu.FtR Restricted I&2 Famil Dwellin M Masonry Only RC Residential Rooting Covering Telephone WS Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installation D I Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) J 7eJ 7 i�AJ . -SOA.) 110dfWg 1ArC HIC Company Name or HIC Registrant Name d Registration Number Address /i���•)��0.>� Expiration Date Si atu "relephone 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, qzaiAk� , as Owner of the subject property hereby authorize &ZAEJ , to act on my behalf,in all matters relative to work authorized by thig building permit application. Signaturer Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I, dfkj� --r R ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. y I � g Ll Print Name Signature owner or Aut ¢ed gent Bate Si ncd under the pains and penalties of perjury) NOTES: I. 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&of have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 1 IO.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" �S CITY OF SALEM I� PUBLIC PROPRERTY aDEPARTMENT goo ra;z x l r 1 !•xlw 'I \I`.n I/ I�C�.1i111\b:,L�151'xll'T �j•11 I'fl, St.Ni.\t 1'FI:'/78d�iAi9s I'.\Y:978.7444846 Construction Debris Disposal AfPdavit (required tor all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section 1 l 1.5 Debris, and the provisions of MGL c 40,S 54; Building Permit N.- 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 I11. S 150A. The debris will be transported by: I home of hauler) The//debris will be disposed of in 61 ao Ity) (oddress ul'lacduy) i gnature of Ixnnit ap lean 3/rolro date CITY OF S.U.E.`I, ,tLASSACHL:SETTS ftmi:l NG DEDARTSIL%iT 120 W.ksmiNGTON STREET, )aa FLOOR 'a TEL (971)UMSIS FA2t(978) 744984 K NMEALEYDRISCOLL THobiou ST.PmM %4AY01 DIRECTOR OF PL BLIC PROPERTY/BUILDING COSOOSSIONER Workers' Compensation Insurance AMdarit: guilders/ContractorslElectridansl Plumbers toprllcant Information Please Print LMblr Natnc(9usir OrwmrrariotilnJrvidual)! t�L1/jA/ ; S01) Address: /3 SJA/S-i-T 4✓/2/vt Phone N: �O/ City/StatdZip:.�/�"L `�t�� /�� .%re yon as empleya'Check the appropriate box: Type at'project(required): 1.(A 1 am a employer with-(- e• ❑ 131111 a Smeral contractor and 1 6. ❑New construction employees(full and/or pan-time).• have hind the srabcoaltracton 2.❑ I am a sole proprietor or partner- listed on the attached shttalt,: 7. ❑Remodeling ship and have no employee These subcontractoso have B. ❑Demolition working for me in any capacity. works"'comp.instraaoe. 9. ❑BuiWing addition (No workers' comp.insurance S. ❑ We area corporatism and is 10.❑FJxtrical repairs or oddities" required.] offices have exercised thew 1.❑ 1 am a homeowner doing all work right of exemption pe MGL 11.❑Plumbing repairs or additions myself.LN'n workers'comp. C. 132,41(41 and we have no 12.0koof repairs insurance required.]t employee.LNo workers' Il.❑Other comp insurance required.) •Any applicart thx diwcha toes 01 must a m no out th lactim babe showing thtdr vprtaOa'cwapsaaadm policy inAm adaa 'i ItvRrrtwRRwa who rubnot this aeldvk indicating ihr at doby all work and thus him oulsida egoom eaa moa mheRa a two aMdavil indiudy rod =C.wtnavn the check this has maw anaehae ax additiurrl Jut showing the mew o/tM uh corAthoom soft tMr.what'CORP.policy inflannWow /am an earployer that Ar povid/ng warken'rampormosdsa/nsanwn fmr my ewplaysrea Beier,a flff pN/q swd/b1 star injarmarlaa. Insurance Company Name: C/. �/,o NlzAA�r Policy N w Self ins. Lie.N: O yd.-UoZJ (�Expiration Date. S—/)let//O !obSiteAdohcss: l flUktvQ ST' City/Statrizip. -fA-crto, MA .%ttach a copy of the werkers'compessatlen policy declaration pep(showing the policy number mad aspiration daft)6 Failure to secure coverage as required untie Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of■ rine up to S 1.500.00 and/or one-year imprisonment.as well as civil penalties in tM form of a STOP WORK ORDER and a tine of up to S250.00 a day igainsr the violator. I]e advised that a copy of this statement maybe forwarded to the OITDCe of I itvvso i Barium aft fie DIA for insw3mce coverage verification. /Ja hereby certify O n rhe, ed yenuldes a fRedury that the ist/brwarlon provid—e7d ubove is true and averred "" t // auto: ✓//J�(O Phone r: CP �7'.S O/flrial use only. Do not write in this aremi lab#.umpicted by Miry or tarvn„//1avaL Ciry or fuwn: Prrmiell.lcense N � i Itsuint Authurity lcircle uncy I. Iluard of Ilcalth 2. Ruilding Department I Citylrown Clerk 1. Electrical Gatpcctor 5. Plumbing Inspector 6.O1her _ l uRlad Peron: _ ._ _., Phone N• -T1. e..,.a" �. 0 Board of Building Regulation's and Standards - HOME IMPROVEMENT CONTRACTOR Reglatratiotl: 159797 .� Eaplratlone;5129/2010 Trp 269016 Pfivate Corporation RYAN AND SON ROOINGINC. PETER RYAN 13 SUNSET DR. -.W+G�-�� WAKEFIELD, MA 01880 Administrator - Massachusetts- Dcpaltmcnt of Public Safet Board of Buildim_ Rc_ulations and Standards Construction Supervisor License License: CS 85315 Restricted to: 00 -" BERNARD H MCGOVERN v 7 SAWYER STREET MEDFORD, MA 02155 Expiration: 6/5/2011 f anmisviau.r Tr#: 16875 A11. o CERTIFICATE OF LIABILITY INSURANCE D 0/13/20 9) PRODUCER 781-395-3030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pasciuto Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9 Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 84 High Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford, Me 02155 INSURERS AFFORDING COVERAGE NAIC 0 _ INSURED INSURER X Tower Group _ Ryan and Son Roofing Inc. INSURER B: AIG 13 Sunset Drive INSURER Q Wakefield MA 01880 INSURER D: INSURER E: COVERAGES TPOLICYF7 S OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING EMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR IN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH GGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL B203169745 05/12/09 05/12/10 EACH OCCURRENCE $ 1,000,000 COMMERCIALGENER LIABILITY DAMAGET RENTED PREMISES Ea occurrence $ CLAIMS WOE %% OCCUR MED EXP(My one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 JECT POLICY PRa LOC — - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea acdtlenU ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NONOWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ _ ANY AUTO OTHER THAN EA ACC $ _ AUTOONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- B AND EMPLOYERS'LIABILITY YIN 0405025 05/12/09 05/12/10 xx ANY PROPRIETOR/PARTNERIEXECUTIVEE.L EACH ACCIDENT $ 100,000 OFFICEWMEMBER EXCLUDED? a NO eXCIUSIODS for owner _ (Mandabry in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 _ Ues,describe under - ECIALPROVISIONS belaw E.L.DISEASE-POLICY LIMIT $ 100,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION R LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REP ENT V AUTH ES ATIVE ACORD 25(2009101) ©1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OFFICE (978) 922-6120 (91>d Tolung Iguildrrs, fnr. 13 SEWALL STREET NA81. PEABODY, MA 01960 " NATIONAL ASSOCIATION SOCIATION of the REMODELING INDUS SPECIFICATION SHEET 5, Home Phone: . G� 't <, , , ,, ,,, Work Phone: .. . .... . .. . Owners Name . . . . . . . .. .,.-�. . .. .. . .. . ..... . . .. f �d� .. .. .. .. . . . I .. .. . Cit . . ... ..�'. ... .. .. State')V��. . Zip ..... . ... Home Address ... . .. . . .. .. ... .. . . Y ..-`,/ r.. ... Job Address . . . ... . . . . .. . . ... .. . . . .. .... . . . City ..... . . ... . .. .. . .. . .. .. . State ... . . .. . . Zip ... .... . . SIDING 1. iding•Type ... . ... . ..I .. . .. . .. .. . .. . . .. I . . . . ... . ... .... . . .... . . ..... . .. Width . .. . . . . .. .. . .. .. Color .. .. .. .. .... . . .. li 2. Areas done. Main House . . . . . . ... ... .. . Breezeway . . ... . .. . .. . . . . Garage . . .. ... . . . . .. .. Additions . . . ... ... . . . Porches . .. . ... . . . .. . . . . .... . Dormers .. ... .. . ... ..... .... .. . Other .... ... .... .... ... . . . 3. Insulation . ..... . . . .. .. .. . . ... .. . . . ... .. . . .. . . .. . .. .. ... ..... ..I ........ ... . .. .. . . .. .... . . .... . .. .... .... .... .. 4. Aluminum trim cover ED].Yes ❑ No Color . . . . . . .. . . . . . . . .. . to be done: Soffits . ... . . . . .. Fascia .. . . . . . ... Rakes .. . .. . ... . . . . .... .. . ... .... . Ceilings ... .. .. . .. . .. .. . . . . . . . . ... .... . .. ... . . . . ... . . . . .. . . ... .. . ... . . ...... S. Casings . . . ... . . . . .. .. .... . .. .. . . .. .... . .. . .... . . .. . ... . .. . . . . . . . . .. .. . . .. .. . . . .. . . . . . ... . . .. .. .... ...... . . . ... . . 6. Gutters and spouts ❑ Yes o . . .. . . .. .. . . .. .. . . . . . . . ... . . . . . ... . . . . .. . .. . . ... .. . .. . ... . ... .. . .. . . . . . . ... ... . .. 7. Shutters ❑ Yes o . .. . .. .. .. . . . . . . . . ... . . .... .... . . .. .. .. .. . .... . . .. . .... . ... . . .. .. .... . . . ... . .. ... ... . . . ..... 8. Wi and Doors . . . . .. . .. . . . .. .... . .. . . .. . ... . . ... ... . . .... . . . .. . .. . .. ... . . . . . . .. . .. . ..... . . . . .. .. . . ... ... . .. .... . ROOFING /j/������ _ Material Type U� .� Areas to be done .. Color .C.e' � � '�. u . .. . . .... . . .. ... .. . . . . .. . . .. . . .. . .. . . . .. . . . .. . . . .. .... �l�/ Remove existing shingles Ye ❑ yNo 15 Ib. felt .. .�!... .. . . ... . . ... . ... Metal Edging .. . . ...... Chimney an vents, etc. Other . ... .. .. . . .. ... .. ...... ..o.. .. .. ... ..... ... . .. S __J� A.` e,4 ' A-I �l...Jyl >A5. .. ..E . . :. C l�<9 ltd � n..f. .4 .cam-?- . . .. .... .. . . . ... . . ... . . . . . .... . . . ... ... . .... .... ... . .. . ... .. . .... . ... . . . .. . . .. ... .... .. .. . . . . . .. . .. . . . . . .. . ... . . ... . .. .. . . . . . ... . . . .. .. . . . . .. . .. . . .. . .. . . . . .. . .... . . . .. .. . . .. . .. .... . . ...... . . . . .. ... .. .. . . . .. . . ... . . ... ... . . . .. .. .. .... .. . . .. .... . . .. . .. .. ... ... .. ......... .... ... ... . ... . ...... . . . . . .... . ...... . .. . . ... . . . . . . . . ... . . . . . . . . .. . ... . .. . . . ... . �I ... . . .. ... . . .. . . . . .. . ... .... . . .. .. .... . .. . . . . . . .. <v t. . . ..` ` G . .... . ... . . . . ... . . . ... ... ... . . . C. S. .t7.��. .�...Deposit �. Material and labor to cost $. . .t. ,). . . ... ....(✓. ... . ... . . .. . .. .. .payable as follows: $.... .—.. . ...Ist Installment $. . . . . ... . .2nd Installment Balance on completion Contractor will do all said work in a good workmanship manner. You may cancel this agreement if it has been consummated by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by deliver),, not later than midnight of the third business day following the signing of this agreement. All work performed by the company is fully insured. O 1N WITNEY THEREOF, the partie have hereunto stgned their names this......../.../....../..........day o!....... L.. 19..1..... Accepted: Signed{/....Qj rv! .L-� ............... Accepted"(IIdlnnPro. 71st. ... ....... .. Signed.................................................. ....... �` Owner Per.. ..... . /./ !/�'��..... ... ..... .. / Represcnratfve Authorized Rep.............. ................................... I