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51 GALLOWS HILL RD - BUILDING INSPECTION (3) r I ra The Commonwealth or Massachusetts iBoard of Building Regulations and Standards ICITY OF v\ �� Massachusetts Slate Buildin>�fi�EI�Ff[CMR SALEM ' 17 INSPE TIONIL SERVI�E� Revised,Llar20ff Building Permit Application To Construct, Repair, enovate r e molish a One-or Two-F r Y u, i g This Section se nl Building Permit Number: Date Applied: Building Official(Print Name) Signature D to SECTION 1:SITE INFORMATION I.I Propea,tY Address: 1.2 Assessors Map& Parcel Numbers Pea S NiLL 0 I,la 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 It) Frontage(It) 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 OWNERSHIP' 2.1 Owner of Record: o RV;1J C O(.I=M/ L r i\A MA e) O Name(Print) City,State,ZIP S I Gia�ow L�;LL �Z� �i ?� 7`/S 6�53 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction Cl Existing Building❑ Owner-Occupied Repairs(s) M/ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: _ Brief Description of Proposed Work': RFAA 0VA-A" G'f_ /" R_ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑,row Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. iYlechanical (I IVAC) S List: s �V 5. Mechanical (Fire $ Su ression) Total All Fees:$ v Check No. Check Amount: Cash Amount: 6. 'rotal Project Cost: $ ,2 St 11 Paid in Full 0 Outstanding Balance Due: t � , SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0203Q3 •'�— � — �� F—A US'?t N D Mse l�41Q 1 130 License Number E.piration Dute Name of CSL Holder +j `. r . ' . Ol f i"j,V. e S� . % N �.. List CSL"type(nee below)_��_ �,yjj �i!/A//ivtF G/.� '�—� Type Description No.and Street * i:. C'1 C ' rtl 0f Ul U Unrestricted(Buildings up to 35,000 cu. ft.) �IJoN% wx �/ % �p R Restricted 1&2 FamilyDwelling City/Towq State,/�v M Mwonly RC Roofing Covering WS Window and Siding � -AN SF Solid Fuel Burning Appliances 78 / �S?itJOyt�Jt�(pg� I Insulation "rele hone Email address it-4.S4,C04K D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or I IIC Registrant Name No.and Street Email address City/Town, State,ZIP 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 1,as Owner of the subject property, hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Mime(Electronic Signature) Date SECTION 7b:OWNER[ 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. Print )wner's or Authorized Agent's Name(Electronic Signature) Date 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 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.t;ov/oca Information on the Construction Supervisor License can be found at www.nrtss.gov/dos 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 half7baths Type of heating system_ Number of[leeks/porches Type of cooling system Enclosed Open i. "Total Project Square Footage"may be substituted for"Total Project Cost" } • CITY O F S:VL E\,I, ;�L1SS:1C '. HLSETTS ti.. ) BCILONGDEPAR'M&NT 130 WASHLNGTON STREET, 3'0 FtOOR TEL (973) 745-9595 Fmx(978) 7-9-9845 K1\[BEI2LcY DRlSCOLL &LAYO't -rrtobLASST.P[ER 3 DIRECTOR OF PUBLIC PROPERTY/BL=LNG CONNISSIONEX Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section l l 1.5 Debris, euid the provisions of 1,yIGL c 40, S 54; Building Permit k this work shall be is issued with the condition that the debris resulting from l 11, S l SOA. disposed of in a properly licensed waste disposal facility as defined by NfGL c The debris will be transported by: y (n;mte of hauler) The debris will be disposed or in (name of racillty) (�dJressof laeilit�) i s natureufprrmit.�pplieant CITY OF SM-ENI, NL1 SSACHUSETTS / Y r BuILDING DEPARTMENT 120 WASHCdGTON STREET, 3aa FLOOR T EL (978) 745-9595 F.A.r(978) 740-9846 KIJtBERLEY DRISCOLL i1AYOR THOh415 ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BU ILDLN G CO',LLtHSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NatnC tnminess.Organizatiom'Individuzl): //��L�.� ( CA'v/J�72(,J Q C�I• G Address:2Y /7%'rUlt//ru6s Cll,2n p G City/State/Zip: O Are>P,9 employer?Check the appropriate box: Type of project(required): I'.V I am a employer with 4. ❑ I am a general contractor and 1 6. ❑Ncw construction employees(full and/or part-time)." have hired the sub-contractors L❑7 am a sole proprietor or partner- listed on the attached sheet.t 7• ❑ Remodeling .hip and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition [No worked'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.(No workers'sump. C. 152,¢1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. (No workers' 13.Q Other comp. insurance required.) •Any upplw mt ilui checks bus BI mst u also fill uul the xctiun blow showiitg their workca'cumpemmiun policy inhumation. 'I hvncnwM"who submit this affidavit indicating Ihey are doing all work and then hire outside contractors must suhmit anew affidavit indicating such. :Cmnrxton ihol chock this box most ail achod in additiurutl shM1 showing he nmne of the sub.conlnchut,and Iheir workers'comp,policy infomtation. I unr un eurpluyer that is pruvidinK workers'ronipensatloa insurance for my employees. Below is die policy and job site inforururion. _ Insurunce Company Name: S a_ �1-ys' (J/�i4/I Pill icy 4 or Self-ituv. Lic. 0: / b y M iy-_ Gi Expiration Dale:'/Job Site Address: I G�LL©(,vs' L � City/State/zip:.QAL EAA /li p Attach a copy of the workers'compensation policy declaratlan page(showing the policy number and expiration date). Failure to secure coverage as required under Section 23A of MGL c. 152 can lead to the imposition ofcriminal penalties of a ins up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the t'orm are STOP WORK ORDER and a Tine of up ro S250.00 a day against the violator. lie 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 car ' der rite polar u pea allies of perjury that the infuralution provided ubuve is true and correct. 91"Im111fC Date: � O� / Po : 7F S3 / OJjicial use may. Do not write in this area,to be completed by city or lows njjlcial City or Town: _ PermitlUcense# Issuing Authority(circle one): I. Board of health 2. Building Department 3.Cityfruwn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Otter Contact Person: ..... __ Phone fit: 1 AeCA CERTIFICATE OF LIABILITY INSURANCE `�°�° / 12 44/ 13 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: the certificate h der Is an ADDITIONAL INSURED,the polic as)must be endorsed. If SUBROGATION IS WAIVED,.su 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 endorsemen PRODUCER _ Lauren Goldman . . Cross Insurance - Peabody °HONE 97 5 Fax 32-5445 - (978) 532-2217 139 Lynnfield Street E7dWL 1 oldman@crossa enc .com Peabody, MA 01960 INSURERS)AFFORDING COVERAGE NAK:B INSURERA:Travelers Indemnity of America INSURE - INSURER B: Melos Construction Llc I INSURER C: 34 Jennings Circle INSURER 2- Peabody, MA 01960 LS11R E: . INSURE P: 4 COVERAGES - CERTIFICATE NUMBER: - REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE USTED BELOW HAVE BEEN ISSUEDTO 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 ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS. INSR LTR TYPEOFINSURANCE AWAIR POUry NumBER MMO/Y MMAIDI(M) UNITS GENERALDABILITY EACH OCCURRENCE $ COMMERCUIL GENEPALLIABILITY DAM4 TO RENTED S CLAM-MADE ❑OCCUR MEDEJM(Anyompersm S PERSONAL&ADVINJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LPeTAPPUES PER PRODUCTS-COMP/OP AGG $ POLICY PR6 LOC - $ AUTOMOBILE LUIBBIRY a BCCIdeItSINGLELIMIT 1 S ANYAUTO - BODILY INJURY(Pw person) $ ALLOWNED SCHEDULED BODILY INJURY(Per aWdeM) $ AUTOS NON-0WNED P�aE� JeMGE g HIRED AUTOS —AUTOS S ideml UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DrD RETENTIONS $ V.ORKERS COMPENSATION 7614M465 12/4/13 12/4/16 WC STAID- OTH- - AND EMPLOYERV LU1mUTY ' I ITS ANY PROPRIEIOR/PARRNERIEXECIITNE Y� N/A E.L.EACH ACCIDENT $ 1,000,000 ID OFFICEPMEMSEN 0(CI. rD7 (Mamlawryln NH) - EL.DISEASE-EA B,'PLOY n de amler 1 00000 DESRIPTIONOPERATIONSW.w ELDISEASE 01000 DESCRIPTION OFOPERATIONS I LOCATIONS IVEMCLES (Au=h ACORD 101,Ad9donal Ro mrN&SdmUe,Knromspaw is regdmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLE D BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Insured's Purposes ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE " Laura Goldman ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: s+c a CERTIFICATE OF LIABILITY INSURANCE 12/4 13 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 INURED,the policypes)must be endorsed. If SUBROGATION IS WAIVED,subject to the temps 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 endorsemengs). PRODUCER CONTACT NAME: Carlos Pinto North Shore Travel S Insurance PHONE Carlos 531-2755 Fax N (97e) 531-222e 111 Foster St EA Peabody, MA 01960 Ao&6s: into.c@noshoreinsurance.com INSURE1qSIAFFORDINr COVERAGE NAICd INSURER A:Northland Insurance Com an MMuRm - INSURER 8:Pro ressive CaUgUalty Ins. Co. Melos Construction Llc 34 Jennings Circle INsuRERc:INSURERD: Peabody, MA 01960 INSURERE: IfQSURER 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 HEREN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFINSURANCE A UBR POLICY EFF P CY FXP POLICY NUMBER MILDIY MM D/YYW LIMITS GeIERALLIAeiIlfY WS206527 11/26/13 11/26/14 EACH TORRENCE s 1 OOO QQQ X COMMERCIAL GENERAL LIABILITY DANWGETORENTED S 500,000 CLAPASWADE QOOCUR NED DP rtyom pwam) $ $ 000 PERSONAL&ADV INJURY S 1 QQQ QQQ GENERAL AGGREGATE s 2,000.000 GEN'LAGGREGATE LIMIT APPLIES PER - PRODUCTS AGO s 2,000,000 iPo PRO•UCY LOC $ AUTOMOBILE LIABILITY 02383499-0 9/21/13 9/21/14 as M I $ 500,000 ANYAU10 BODILY INJURY(Pw person) $ ALLOVAED SCHEDULED AUTOS AUTOS BODILY INJURY(Pw axidani) s X HIRED AUTOS _AUTOS ED PROP RfY DAMAGE S w aeddanl s 100,000 UMBRELLA B OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-WDE AGGREGATE $ DED RET@mON s I ORRERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE OFFICERMEMBER EXCLUDED? NIA El,EACH ACCIDENT $ @randaHory in NH) EL.DISEASE-EA EMPLOYEE S DB dwalbeunde, DESCRIPTION OF OPERATIONS below EL.DIS EASE-POLICY LIMB $ DESCRIPTIONOFOPERATnONsILCi ATONSIVEHICLES (Aaah ACORDIe,AddiU-WRenallm SdreduM,nnmweap..I,,gdred), CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN For Insured's Purposes ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE Carlos Pinto ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: — x - `\ Omee elC'vmamer.4itlirs 3 Badlen Regehtloa - Liceme or registrarioo valid for individul use only _ 0e E iMPR ta OVEMENT CONTRACTOR - before the e:pirstion dam. 1f foand return for a tt t1553 TYIM j Office of Consumer Affairs and Basin Repletion ? -i aplration 3=2014 UdUabU uyCorpd IOParkPtaza_Suite5170 Boston,MA 02116 tf :L eOi CONS„„RUCTION.' FausUno Moto .. 34 JENNINGS CIR. �zrc I . Peabody.MA 01960 Not vali without sigsamre . . t'oderseertuy Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor diiibLA License:C8 MMM FAUS't7NO N tiO 34.16NNINC3 CIACL s Peabody MA 019a0 r , ,flit Expiration -_' Commissioner ` 03MIMS Melo's Construction LLC , 3BBE 34 Jennings Circle Peabody,MA 01960 x�=S Telephone: 978-531-0811 - E-mail: FautstinoMeloCa).msn-com rrweds..aa..r.. MENDER Faustino Melo,General Manager Unrestricted Mass Builders license No. 80393 Contractors Registration No. 108953 ftoposal to: Phone T.-, ,.,'li /-,.-s! r. ?�,/ Cr ? v'" .. j rl' r47. �; 3a Address: City,State,and Zip Code G7 Job Description: Job Location: Job Phone: We Proposed hereby to fish matotials and labor.oompkte innoeadanoo with the spou ma 6cad listed below,far the rum of done. ($ �11 i .2 Q1, A Imtanstion of Payments: Payments will be paid in thirds.The fast mstallmmt will be paid before the job begins.The second payment will be obtained in the middle of the job.The last payment will be obtained after"job is camp) tcd Note:This proposal may be withdrawn by us Authorized Signanne: l 12t '�'= �--.t �,. if not accepted within 20 days. Date: e Hereby Subma SseolMUme and Faeboatra far. THE INSTALLATION OF A NEW ROOF To protect the homeowner's property,Blue Tarps will be used to cover the siding,bushes,and grass during stripping All of the layers of roofing will be stripped,and all protruding nails,strews,and/or staples will be removed. lee and water shield will then be installed at the bottom of all edges,around all chineys,skylights,and into all valleys. Fifteen(15)pounds of felt paper will be installed onto all other areas of the roofdeck. The 8"aluminum dripedge will theft be installed to all roof edges. Any existing pipes will be covered with new rubber flanges. The roofing material to be used will be r r j,M`,- ,._z,. •->s,' t ;,- ': - !� J... The homeowner is responsible for the selection of the roof color. Also, the homeowner may select&4er hand or pneumatic nail u for the nailing application of the new roof. All the debris will be domed and property disposed of on it dailyjwk.Magnetic brooms will be used to extract all nails from your property. We will protect your property as best as we can,however,some foilage matting,breakage,or marring could occur.We cannot accept responsibilty for possessions inside of the house,or debris falling into attic areas. The customer should protect personal belonsigm. MR work to whicb an addinonal cost Will be added to Ire above price. Replace Rotted Rootboards Gutter Repairs Remove Ahi minum Siding Reload Chimney(s) Install Skylights) Remove Old/Rotted Wood Replace Facia Boards Repoint chimney Install Garage Roof Install Ridgevent Install Azek Board Install Insulation Install Roof Louvers Install Window Trim Install Tyvek Paper Install Aluminum Gutters Install Shutters Cover Ahuninum Windows Install Aluminum Downspouts Remove Vinyl Siding Repair Vinyl Siding Install chimney cap Pore Repairs Rebuild Chimney Additional Notes: o�"_ .n n .�; ] ' pF Fd r'. _„/7 'i^��t f / L°`/✓'("� /7 i C-"<' -7 . _ls �.� r /ice- f �7 .I� r? Sri 3f . �� /.ir)" C, I:1P'—• ,f r Total Amount for Additional Work: Warranty by manufacturer to be free of defects for 3f, years,see mapufadurees warranty for details. All labor performed under this contract shall be of good quality and free from defects not inherent in the quality required or permitted for a period Of 1 years.This warranty excludes remedy for damage or defect caused by abase,modification,improper or insufficent maitenance,improper operation,or normal wear and tear under normal usage. This warranty shall be limited to the work performed by Melds Construction,LLC and limited to either repair or replacement by Melds Construction,LLC at its sole descretion and election. Any and all claims are waived unless made in writing to Melds Construction,LLC within 21 days after the occurrence of the event giving rise to such claim This warranty,shall not extend beyond any limits imposed by applicable— law. Payment and Penalties-Upon substantial completion of all work under this contract,customer shall-within 3 days-make the final and full payment of the contract price.Any and all unpaid balances shall accrue with interest at 5%interest per month. You agree to pay all court costs and collection expenses incurred by Melds Construction,LLC in the collection amount you Of any amount you owe under this contract,including and without any tinnitation of reasonable attorney fees. Acceptance of the Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. I. You are authorized to do the work as specified,payment will be made as outlined abovf ~i i Payments are to made as per requisittion and or invoice. The proposal may be witbdrawu within 2t)days. Date of Acceptance: Signature:,