2A HAZEL ST - BUILDING INSPECTION The Commonwealth of Massachusetts
\ I Department of Public Safety
�'v.,.✓ ..\Iassachuseus Slate Budding Code(780 C\IR)Seventh Edition
City of Salem
81� Building Permit Application for any Building other than a 1- or 2-Family Dwelling
( oV (this Section For Official Use Only)
f^ Building Permit Number: Date Applied: Building Inspector:
W SECTION I: LOCATION tPlease indicate Block 0 and Lot M for locations for which a street address is not available)
R 1AAW S� r rtA- o \97o ilk k3o-z sl Si-- ce"I(jo
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 0 Repair❑ 1 Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 1$
Is an Independent Structural Engineering Peer Review required? Yes ❑ No fir
Brief Description of Proposed Work: .3±rliP O Cn0—� S•I-+In�� S ccni 1T,9-f .)I 'Re 'I)
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 UseGroup(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.) 114 FW5.
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❑ I B: Business ❑ E: Educational ❑
F: Facto F-I ❑ F2❑ H: High Hazard H-I ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage 5.1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use: '
SECTION 6:CONSTRUCTION TYPE(Check as Applicable)
IA ❑ IB ❑ IIA ❑ I18 ❑ IIIA ❑ HIS ❑ 1 IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
tVaterPP Y'
Su I Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public Check i(outsidc•Flood Zone❑ Indicate mumcipalo A trench will not be Licensed Disposal Site 0,
required❑or trench urspecily:
I ncate❑ or mdcntifv Zone: or on site s.%stem ❑ permit is enclosed ❑ 0{y1Ga•ni C�—
Railroad right-of-way: Hazards to Air Navigation: it u Itr ra 1'r,•
\ol :\pphcabla•❑ Is�truc lure rcuhm aupurt apprnach area' Is their revmc mmplcled'
.r Ui Budd enclow•d ❑ 1'es❑ or.No❑ 1'es❑ \o ❑
u SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Fdm-it,of Cale: __ L,c Gnng4st: . spent Construction: Occup•ml Load per hour:
I)ov. the building contam,tn Sprinkler?cslcm': !4,vialStipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner A o(q.
PP,r '?XF L�.S)- Ccn3o ZAI6utS')• S�4 _l
Name(Print) Nu.and Street C it /rown Zip
Property the ner Contact Information: ,
Nr6.Q9 T {Soh 6171jtlo-_
Title Telephone No. (business) Telephone No. (cell) a-mad address
If applicable, the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the pro pert%owner's behalf, in all matters relative to work authorized by this buildin p permit a p plication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If buildin•is less than 35,1x1)cu.It.,)(endowd s pace and/or not Under Construction Conwl then check here D and sbup Sectiun 10.0
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Alp%nL Lfro SVC- CO l nc
Company Nam e: L 1 b 1 0 6
s ��s wlo �10.s CS S 3
Name of Pe 1 W!i \SoResptmsi�lp f ur Construction 5, �� License No. and Type if ApPl cal lq b
Street Address S t City/Town State ZipZip
A8 22E- 39 F &
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 issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes O No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor -7 q 7S
and Materials) Total Construction Cost(from Item 6)=8
1. Building S 7 7 Building Permit Fee-Total Construction Cost x_(Insert here
2. Electrical $ appropriate municipal factor)=$
3. Plumbing 5
4. Mechanical (HVAC) $ Note:Minimum fee=S (contact municipality)
5. Mechanical ( t I $ Enclose check payable to
6.Total Cost I S �( -7S (contact munici alit )and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I herebv attest under the pains and penalties of perjury that.dl of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
S�avrvS Ivlrt/�Sr�t'j Pctsl ` 28 .265- VS`6 'f
'lea.. prnpt and agn n.tme ride Telephone No. Date
<trcel Addre.s Cit%iTown State Zip
Municipal Inspector to fill out this section upon application approval:
Name Uat
......................
r
CMWICATE'OF
.1./.13./2010
PROOUCEA (617)471-1220 FAX: (617)479-5147 THIS.CERTIFICATE IS.ISSUED AS A-MATTER OF.INFORMATION
Amity InoLranee Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON-THE;CERTIFICATE
500 Victory Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND' EXTEND OR
Marina Bay ALTER THE COVERAGE AFFORDED BY'THE.-MLICIES BELOW.
North Quincy MA 02171 INSURERS AFFORDING COVERAGE _ NAiC#
INSURED wsuRERA:First Mercury Insurance Co
Alpine Property Services Co. , Inc. INSURER a Harleysville Insurance Co. -'
P.O. Box..365 _ __.. . .. ...._.
„ '..... ,-•-.. iNsuRER coGrea't•American Insurance'.. 1 .,..._,;
239 Boston Street I -
..
Tops£ie d MA 01983
COVERAGES
INSURER e'
-
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO.-N67WITHSTAINDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE'MAY'SE ISSUEWOR
MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CdNDMONS OFSUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD•4 -- -_----- POLICY EFFECTIVE POLICY PXPIRATION POLICY NUMBER
uNOs
GENERgLOgBIOTY EACH OCCURRENCE a 1 000 000
�X COMMERCIAL GENERAL LIABILITY - PREMISES rke. S _ 50000
CUMSMADE n006uR 001186-2 6/14/2009 6/14/2010 MEO EXP «lepem6m '! ' MExcluded
X ned $10,000 PERNA�SAOv w1URY a 1-OOO 000
GENERAL AGGREGATE_ S ' 2 000 000
GENL AGGREGATE LRo-APPLIES PER PRODUCTS-CONtiAPAGG S 2,�000 000
I X POUCY x -
LOC ,
AUTONOBILSUABIuTT
COMBINED SINGLE uMtr
ANYAVTO IEe&=wwgI a . .1,000;000
B I ALL OWNED AUTOS BA00000081026E 1/9/2010 1/9/2011 '
GODLY MURY
I X SCHEOULED AUTOS Ip�PMOI) S
- I �X HIRED AUTOS
- -- - BODILY INJURY .
IX NON-OWNED ALTOS BbDILY INJURY
S. i�
i
PROPERTY DAMAGE ,a
(PerAmaerrc)
GARAGEUAEIt/iY AUTO ONLY-EAAdCIDENT S
ANY AUTO
OTHER THAN 'PAACC 'S
AUTOOHCI: AGO ..S
A EXCEssruNBRFJIA LIABILITY EACH OCCURRENCE S,' 5 000 000
I X OCCUR CLAPISMADE 00117-3 6/13/2009 6/14/2010 AGGREGATE. ' .. S ''5 000 000
i I
DEDUCTIBLE
X RETENTION a 10,00
I e .
V/ORKERS CONPEHSATION
ANO EIIPL.eYHLE'1.IAe1UiY YIN I I WC 6TA
ANY PROPRIETORIPARTNERIEXECUTNS I
OMCERMEMBER EXCLUDE07 ❑ I :e.L EACHAMIOENT S
AbW1 ym.peVme
lRry NH)
oI ura I E.L. ISEASE.FA EMPLO S
1 IE.L.SPECIAL PROMSION50ebw { IE.LO16EA8E-POUCYLIMIT S
OTHERInland Marine I
C Miscellaneous Tools 367004BOX 2/28/2009 2/29/2010 (35,000 . T.;.Hi t
6 EquipRLent IAl om Deductible
OESeMpnom Or OPE nONBILOCATONSIVEHICLESIEXCLUSIONSAODEDBYENDORSE MTISPECIALPROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOVMANYOFTNEABOVEDESCNBEDPOUMESEECANCEl1EO BEFORETNEEX9]RATION
DATE THEREOF,THE ISSUING INSURER WILL ENUFAVORTO MAIL,- dAYS vl rtw
NOTICE TG THECERiIFlCATE HOLDER NAMED 7O THE lFDf,BUT FAILUP�TO DO SO,SN,ALL .
IMPOSE NO OBUGATpN OR LIABILITY OF ANY KIND VP THE INSURQi,ITS AGENTS OR
REPRESENTATYe6,
AUTHORIZEDREPRESENTATNE
ACORD 26(2009101)
IN50261za0 01988-2009 ACORD CORPORATION. A l.r(ghts
reserved-The ACORD name and logo are registered marks of ACORD
lJ
AGO!4D. 1/14/2010
I
O/TAIATTO} � ...
ONLY AND CONFEfLR NO RIGHTS UPON T1TE,CFRnFICATE'., •.,
`H.J.Knight lntemational lnsuTTmcc Agrneies,Inc: MOLDt:R. THIS CERTiFIwTE DDEs NDT AMFJJDrEXT.ENO OR• .. .
500 V iuory Road-Marina Kay ALTEJt 7HE IAVEMCE AFFOPOED 8Y Tl{EJJOlIC1ES 9ELOYIl.
North Quinry,MA 02121 MPAwEa IiGROSA('COVERAGE.
I •COMPANT '-•
A Atinntic Chbrler InsvrBnce Com an VDAC
ANWRTD COMPANY
Alpine Property Scrviecs Co.,Inc. B
PO Box 365 C
....._ToWeld,.MA....01983.. .. - - ,.. COMPANY-.-
! t.
TNIBIb TOCERTLFY TMAY THE►OUCE90FINSURANCE LISTED BELOW WIVE aF:EN ISSUED TO THe IRquRFD/+AMEDABOVE FIXRTHE POLICY vEwoO
INDICATED.NOTWITHSTANDING ANT REGwIRMENT,TERM OR CONDITION OF ANY CONTRAGYMOTMeM OOCUMEM,ITH RESPECT TO WNICIL TM
cEITfIFICATE AUY BE ISSUED CR LNY PERTAIN,THEINBURANCE AFFORDED BYTNE POLIGEB OESCWBEO HFAEINUSU0.JEGT TO ALLTNETEIIME,: .
ECCLU1140""a CONDITIONS OF SUCH POLICIES.LIMITS aNOLVN MAY HAVE PEEN REDUCED BY PAID CLANS. '
NW TYPEOFASw1ARRX POUVY NURSER POLICY EFFECTIVE POIICT EtFMAMT •ulilTs•;
LTR WTEII^RICCFTYI PR1e TRJJICDIRI {In Tliwad�l
DANARALUR�AITV - IWCLLT INJURYOCG
i
CtTTPRENENSNe FGITR eCOAY IILIIIRY,AGD T
PREMISE9APERATION3 ITROPFNrlOAWOE OCC• T
UND&PIGNOUN0 PR9PERT•YGNMGEAW F
EWLOBpN 6CDUAPSE IVWRO . . MAPp COYAMEO OCC f
PftODVCT&COMPLEIEO OPER @SPVIAMMEQAGG is
CONTRACTUAL Pf3tSONALDUVRYAOp i
WPFPEA06Nr CONTMCmn
fl J PORM PNOPERTY DAMAGE
PFR9DNAL INJURY
AUTDAWRE WIBIINY 11CULT"Am --•'
ANT AUTO ypyp.,,a, l.T
NLDNNEOAVFoe(Pma Pawl WDILY IWURV
AILOViNEDADTOS B'u Aufan�IJ , ';y
IGAIR MP,Iwu n..elN.d .
NWW AVTR4 PROPERIy DAMAGE •. 'f .
N0116MIEDAUT03 SDCILYWAIWA, . .
TiA1MGELABILTIT t+OF61bY DAMAGE
CONm*mD'• i .
PEXCUTY
SSUIIB f:AR19000ARENGE' Is
WSRE OM UAT ACEREGATe i
FJTNEA TINN UNSREIN FORM ':F
WCV00754903 11512010 1/5F2011 SrATVWRT iAHTe ••"
EAOIACOGETTr, •. •s - 500,000
UIS"SU-POUCTLBTIr' •y. Soo ON
VISE A9E•T�EATPLOTEE•I 500,000
OTTER
AI2CA/fnill ar oruMnoPNwanvwwevcLav3P3DILrrtae .
�SHOULO ANT OF TIRE ABOVE VESORRGEO PDUCM3 BE CAHC9IIF0 R6FDR8 THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANT WILL.ENDEAVOR TO MAIL
DAYS VdarTEN NOTICETOT46 CERTIFICATE HOLDER ME D NA TOTNE L EFY.
BUT FAILURE TO ATARL SUCH NOTICE SHALL WOSS NO OBLICATIO14 Ok LIABILITY
OP ANY KIND UPON THE COMP AGENT"OR -TATlVES.
ADMORCB07-9 R "TATM I IA
q
M 172-
r lass
A.Moutsoulas Home Improvement Roofing • Siding • Painting HIC 4154326
I I Willson St. EIN#56-2618812
Salem,MA 01970 Job#:
978-i 14-4191
Job Location:
2A Hazel St—Salem.MA
Apri 1 7-2010
The following estimate is for the roof installation for the property located at the above address.The following paragraphs describe the work that will
be performed. GAF-Elk Corporation Weather Stopper System Plus Limited Warranty offers you a full coverage warranty on detective shingles—to
be obtained directly From the manufacturer(see enclosed brochure).
Installation Procedure
,y Strip existing roof on the entire house down to the roof deck
1, Install an 8 inch drip edge on all leading edges(rakes&fascia)
-4 Install ice&water on all leading edges&valleys
,4- Transitional walls are optional and incur an additional cost for the siding repair
Install new vent pipe Flanges
i. Replacc any rotten or damaged decking(we allow 32SF a,no charge,$80.00/shee(thereafter)
1 Replace any rotten or damaged ledger board(we allow 30tt.it no charge,S3.00/It.therenfrer)
.* Install 15 pound felt paper on all areas that is not covered by ice&water shield
k Install new GAF 30-yr Architectural shingles
-1- Install new ridge vent system
L OPTION: Transition walls will be stripped(al least I'above roof line),ice&water shield applied,new step Flashing&re-install vinyl
4. OPTION:OPTION: Redcad and re-flash chimney
Additional Specifications
1. Homeowner to choose color of shingles COLOR:
4, Oil?Our dumpsters are sent to a recycling facility;therefore no additional trash may,be placed in them. The transfer station will charge as a fee
Itx additional trash which will be passed on to the homeowner.
4. Transition walls are an option,and if the existing flashing is in good shape,usually do not require replacement
1 During a roof loh,the nails could break the sheathing during the nailing of the shingles
4- We are alit responsible for any of the cracks that may arise in any walls or ceilings
.1. Please cover all your Floors in your attic to protect.(coin dull and debris
4- We We will remove all of the.job related debt is
.4 Permit costs vary from town to town and are not included in(his bid
Initial the options you are choosing below:
Cost for Labor&Material for Roof: S7,125.00�,_
Cost for Labor&Material for Transition Walls: S 575.00
Cost for Labor&Material to Re-lead&Re-nosh Chimney: $ 275.00 4,
Cost for GAP-Elk Weather Stopper System Plus Ltd.Warranty: $ 250.00
Payment Terms: 113 deposit upon signing contract S , 1/3 work in progress $ and 1/3 upon completion,$
Remit to: Alpine Propery,Servic
esCmnpan)q brc., P.O. Sox 365, TopsFeld,MA 01983
LJ
'total Amount AgreedTo Be Paid: S L�_�_� '
"the following schedule will he adhered to unless circumstances beyond Alpine's control arise:
Work Scheduled to Begin: TBD 1i.epcctcd Date of Completion: TBD
Warranty: Alpine Property Services Inc.guarantees all work performed for n period of one year. If any problems occur we will cover the cost of all
labor and material to correct the problem and mect the customer's satisfaction.
Do not sign this contract if there are any blank spaces.
nnl pr'ordsion,c follow and me incorporated herein by this reference)
to outsoulas,Gcncr onager
me.P.ropmttyServtc� ompany Inc.. A.Moul_soulas Home Improvement
d/b/a Olympic by(None)
Tel: (800) 535-4312 • Fax: (978) 887-5875 • 239 Boston Street • Topsffeld,MA 01983
1-888-50LYMPIC • www.Olvmvicroofing.com
. iYlnseachusetts- Daportment ur Public:Sarerl - ---
-. . Board nl'Building ..........--- ---`
Rc�ulatiuns:md
Construction Supervisor Specialty License r tl`
License or registration valid for ind(v(dul use only
License: CS SL 101003 _ -" Ibefore-the-expiration date. If found return to:
Restricted.to:. RF,WS iBoard of Building Regulations and Standards
One Ashburton Place Ran 1301
STAVROS MOUTSOULAS iBoston ,
11 LEM, MA STREET. .
SALEM, q 01970
i
Expiration: 1y 011 14/2 I Not,., without signature
('ununkvLuu:r .
Tr'-: 101003'
�
Boar o u> uig egul ion�s an tan ar s
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvemei t;Contractor Registration
Registration: 154326
Type: Private Corporation
- - - � Expiration: 2/27/2011 Tr# 279846
ALPINE PROPERTY SERVICES'G0,-1t:--,h:,
STARROS MOUTSOULAS
11 WILSON STREET
SALEM, MA 01970 =
Update Address and return card.Mark reason for change.
❑ Address Renewal ❑ Employment Lost Card
nPS.cA1 0 50a407107-PC6490
..... �lre'�oonmeonu�ea�a yoeea�'rseld ,
Board of Building Regulatfudns end Standards License or registration valid for individul use only ,
p1 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Beard Building Regulations and Standards
Registtatlon 154326 One Ashburton Place Pin 1301
Fxpiratlorr• 21272011 Tr# 279846 Boston,Mo.02108
, -t- N e•-Private Co oration
-.,-e FYP-..
ALPINE PROPE,R'R ER1%IEE500,INC.
STAR MOIJ];fibIJl _' ::
11 WILSON STREET,;._�%,;,'' Not valid without signature
SALEM,MA 07970 -' Administrator -
CITY OF SALEM
PUBLIC PROPRERTY
�• DEPARTMENT
I'JI: M111 ''Mlv „11
\t 1 'M I:C�•.�N II\I...C�)1'a kr r 111 J 1.'.I'1•.
ffl:Yl1.!14.1iy701'\!(:'/7b:Jl}'NIM
Construction Debris Disposal A111davit
(required lur all demolition iutd renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5
Debris,and the provisions of MGL c A S 54;
Building Permit p is issued with the condition that the debris resulting from
this work shall be disposed of Ina properly licensed waste disposal racility as defined by MGL c
111. S 150A.
The debris will be transported by:
Q(na d C M,laS�2
(name If hauler)
The debris will be disposed Orin
(natns ul'�acilny) .
1 aJdraa ul'facdityl
vOita a al I/.1mit applicant
,laic