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40 HAZEL ST - BUILDING INSPECTION 1 7 I he C'unununsreahh of Massachusetts CI 11 OF Board of Building Regulations and Standards s +� Massachusetts Slate Building Cude. 780 C NIR S,\LI:\I ReI6eil.l6tr 2011 Building Pennit Application 'ro Construct. Repair. Rename Or Demolish a One-or Tivo-kantlt,P Dn ellin,l; This Section For Use Onl Building Permil Number: D e,lpplicd: / -- --- Building O1licial(Print Mum) Signature ate SECTION 1: SITE INFORMATION I.1 Proper y Address: 1.2 Assessors.Nap di Parcel Numbers _4r7 /�y el Srnt� �- _ I.In Is this an accepted street?yes no Map Nunsher Purcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Isy 11) frontage(11) 1.5 Building Setbacks(It) Front Yard Side Yards Rcar Yard 7 Required Provided Re4uircd Provided Required Provided 1.6 Water Supply:(M.G.I.c.Jd. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Ihtblie@L Private❑ Zone: _ Outside Flood"Zone? Chock ifyes❑ Municipal❑ On site disposals)stctn ❑ SECTION 2. PROPERTV OWNERSHIP' 2.1 Owne��t f Rfffford: „,�i ''rr 7)m (_e0—&' Id C()AAIA4� t- N /EYttt�� /)1iSL Name(Prinll City.State.ZIP SU wn5ht���u sr 97S'-4t69-/Z3� r No.and tercet relephone Fmuil Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building❑ I Owner-OccupieEOREepairsas) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Unitther ❑ Specit'y: flJ Brief Description of Proposed Work': ,6s t s t/ 'Z SECTION 4: ESTIMATED CONSTRUCTION COSTS Items Estimated Costs: OlTlclal Use Only (Labor and .Materials) Y I. Building S rjSO(J I. Building Permit Fee: S Indicate how fee is determined: '. r1corical S ❑Standard City,Tosvn Application Fee ❑Total Project Cost'l Item 6)x multiplier i. Plumbing S 2. Other Fees: S J, Mcdtanical ill\ .W) S List: 5. \lechanicaI II Ire S \u ,siunI Total .\ii Fccs: S_ ('heck Nu. ('hack Ansount: _ l',ish \m,mnl: o Total Project Cmt: S 55�O 0 Paid in Full ❑Outstanding Ilalmtce Due: SECTION 5: CON5 I-11lic-l-ION SF.RVI( ES 5.1 Construcliun .supe isur Lice/rise(Csi.) I ivense Numhcr 'nfolder I ist('St. I)Pe Vic-.5-- ------ - I')PC Description No and S(rcd I -V�41/ It lictrioed M2 F-ji-J. M-11in" % Slawil KC' Nowlin Owcrin Ilk's Window,uld Sidill SF solid Fuel Homing Appliances I Insulation 1'ck hone —T—naHadJrvA D DC1110 Lion 5.2 Registered Home I ovement Cunt ct r I IIC) /A!� -" 1 111C ItcSibiration Ntunb%r F%piratioll IJJIV id XN v or I=( Itcg 'rell N.unu.. g qAM- F No. and Street �Zelq-7q-9'9',-5Ib75 Email addrcis Cityrrown. Sinte.ZIP - relephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25CM) 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 ..........0 No...........0 SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize 7---nyeo' '�e— e� to act 0 y behalf,in all matters relative to work authorized by this building permit applicatio9e I ntu, 'esNanic(Electrullicsignature) 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 colain this a lication is true and accurate to the best of my knowledge and understanding. /01 Print Name lFle"ronic`iiill;ltk]N) Date NOTES: I. .\n Owner %Ooobtains a building permit to do his.htro\vn %york.oran owner who hires an unregistered contr%tur trial registered in the Home Improvement Cuntractur(HIC) Program).will no have access to the arbitration program or guaranty fund under M.G.L.c. 142.A.Other important information on the HIC Program can be 11ound at \%\%,\ ,,% ''t I Information on the Construction Supervisor License can be found at 2. \\lien substantial%sork is planned, provide the information below: row 11ourarca 11+ 11 ) 011cluding garage, finished basement.attics,decks or porch I (;ross oil ing area i s4. It Habitable fool',count timhcr of fireplaccs Number of hedroonis \uIlillcr of hall,hailli \tmlherol hathroolils 1p I'Jlclorid 1 CITY OFSAL.ENf, ttiL1SS.1CjL'SETTS ©LttDLYG DeP.1ATtp,VT I'0 W,I.iNCNrTON STxzjrr, jw FtOOA I1L (978) 743.9591 KIMBEALSY DkMOLL Fkx(978) 744.984d .tiG1YOR I ko..%4u ST.PMUA DtAECTCA OP PL8L1C PROPLf aTy/8CaZLNG COJp1t3SIC.%EA Construction Debris Disposal Affidavit (required for all demolition and renovation work) in accordance with the sixth edition otthe State Building Cade, 780 CMR section 111.J Debris, and the provisions of MCL a 44, 9 J4; Building permit N(his work shell be disposed of in is issued with the condition that the debris resulting tram 111, S I JOA. a properly licensed wait@ disposal racility as defined by NIGIL c The debris will be transported by: vyl r t�ti (mono ot'Aeuler) The debris will be disposed of in : (name or�1y) (iddrerr or +h+y) + 9nuuraor� .— ,.ermlt�ppllc�nt 7 27' -�_ HIC#167567 i EIN#27-3470462 sty Turnpike General Contracting Inc. Job#: Roofing—Siding-Painting Office: 978-887-5870 239 Boston Street—Topsfield.MA 01983 Fax: 978-887-5875 Jim Collette Essex Management Group 50 Washington St. Haverhill,MA 01830 (978)469-1232 Job Location: - 40 Hazel Street—Salem,MA February 28,2012 Dear Jim, 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.We will also replace the lead flashing on the two chimneys. We will also Installation Procedure • Strip existing roof on the entire house down to the roof deck • Strip the two dormas and dress with vinyl • Install an 8 inch drip edge on all leading edges(rakes&fascia) • Install ice&water on all leading edges&valleys • Transitional walls will be replaced with vinyl • Install new vent pipe flanges • Replace any rotten or damaged decking(we allow 32SF @ no charge, $95.00/sheet thereafter) • Replace any rotten or damaged ledger board(we allow 30ft. at no charge, $4.00/ft. thereafter) • Install 15 pound felt paper on all areas that is not covered by ice&water shield • Install new GAF Timberline 30-year Architectural shingles Charcoal • Install new ridge vent system • The droma will be done in vinyl with a band on the larger one Additional Specifications • Homeowner to choose color of shingles COLOR: _Charcaol_ • Our dumpsters are sent to a recycling facility;therefore no additional trash may be placed in them. The transfer station will charge us a fee for additional trash which will be passed on to the homeowner. • Chimney re-pointing and re-leading is part of the roofing contract and will be completed • Transition walls are an option,and if the existing flashing is in good shape,usually do not require replacement • During a roof job, the nails could break the sheathing during the nailing of the shingles • We are not responsible for any of the cracks that may arise in any walls or ceilings • Please cover all your floors in your attic to protect from dust and debris • We will remove all of the job related debris • Permit costs vary from town to town and are not included in this bid Initial the options you are choosine below: Cost for Labor&Material for Roof: $5,500.0 Cost for GAF-Elk Weather Stopper System Plus Ltd.Warranty- $ 250.0D Work Scheduled to Begin: TBD Expected Date of Completion: TBD Warranty: Turnpike General Contracting Inc. guarantees all wor erforme�,for a period of one year. If any problems occur we will cover thcl �0 11 labor and material to correct a pr blem and meet a customer's satisfaction. `Ge ge VLsih des, CEO Coll / ! Turnpike General Contracting Inc. Essex Management Group CITY OF SALEM, NWSACHl;SETTS BUILDING DEP.1Ri\LENT 120 WASHLVGTON STREET, 3's FLOOR •�.; � TEL (978) 145-9595 Fkx(978) 74AQ9844 >(pPRLEY DRISCOLL INLAYo Z Ttionu ST.Film,u DIRECTOROF PUBLIC PROPERTY/11UIt-DING COSLMISSIONER Workers' Compensation Insurance,%Mdavit: Builders/Contractorv/Piectrici•rns/Plumbers A f llcnnt information tease Print Lezihl NainCII1miIx,rUrganrration,lndividuLll): �/ fL lu Address: ZZA N40( CityiState/Zip:�/6 4e l,4` Phone M: Q I1f — ELT 7 T73 ,\re you an employer'!Check the appropriate boss Type of project(required): 1.6,1 am a cmployor with _LQ _ 4, 0 I am a general contractor and 1 6, Now construction dniployces(flail and/or part-time).• have hired the subcontractors 2.0 lain a sole proprietor or partner- listed on the attached.sheaL t 7• ❑Remodeling .hip and have no employees These subcontractors have V. 0 Demolition working for me in any capacity. workers'camp.insurance, q, 0 Building addition (No workers:camp. insurance 5, 0 We are a corporation and ib required.) officers have dxereised their 10.0 Electrical repairs or additions ).❑ 131113 homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or uJJiliana myself, (No workers'Gump. C. 132,11(4),and we have no 12,&Roof re ra insurance reyuireJ.) t cmpluyesu. nc workers, t]�Olher�QDE /j,, , cumµ insurance reyuircJ.J L-�`=— ;X,y appll.mn der Omits ban of mutl alwt rill uul the uwliuo below showing their watkare'compensation PuBvy anumution. 't hvneuwners who.ul+mil this amdovit indlcauing they an doing all work and then hire""side eononctom moat submit a new a01davil indicting.ugh. t' mnwwn ihal,hvvk this but moat auashud an eddidurvd.beet.hawing the Maine o/the rub+utumton and their wilAva'sump,puller Inrurrra ion. I urn as employer that li pruv/J/nX Ivorkors'cu piusar/un lruurunea/er my anp/uyera Bduw I:r/�e polky and/ub s/ra infolrnrtlleA, In,urmce Company Namr ril� e Policy 4 or Scir-ilu. Lie, d: '✓GS� �' / Eapirution Date: I•/ it,L /ub Sifts Address: YC /7kZ.Q ( Cityistate/zip: a�PM f r' /fC \Mach a copy of the worker'componsalloe pulley declaration page(showing the Polley number and expiration data). F.liluru to securu coverage as required under.Section 2JA of MGL c. 152 can lead to the imposition of criminal penalties of a fire up 10 51.500.00 und/ur one-year imprisnnmenL as well as civil penalties in the form of STOP WORK ORDER and a lino Of up to $230.00 a Jay against the violator. Its advl,+od that i copy of this.,ratement may bu furwarded to die Of lice of Invc,tig�livas OfA for iolunnce coverage veriticjtiun. /rla berab erlij rill r 1/1 t surd enu le.r 4pei jury/but Ilto infunaallopt provided eve .e uue wid eorreca lDora: — . U//ic'iul,ue,ndy. Ors„or writ,its I/rfr.sna, m be cuory/�ldJ by rr'ry ur ru airs n/flriuL Cify or 1'Inv11: I,vuia-.%tolwrily (circla nnc): I. Huard of liealih !. Iluild{nq Ocp.lr tma•nl 1. ('ilyi rnlvn Clerk i. Efectrie ll In.pcc hlr i. Plumbing; Inspector (. Ihher Cunl.l,t Pfrim,: TURNP-3 CERTIFICATE OF LIABILITY INSURANCE CA DATE(mmOroorvrvriAYYy) THIS`CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O�JLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 10/24/11 CERTIFICi1TE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED TE THE POLICIES ` 6ECOW: 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 ions f to Bolder is an ADDITIONAL INSURED,the poltcy(ies)must be entlorsetl. If SUBROGATION IS WAIVED,subject to the tends a of er In conditions of the polity,certain policies may require an endorsement A statement on this certlOcate tloes not confer rights to the certificate holder in lieu of ouch endorsemen s. PRODUCE0. Chase&.Lunt LUC 978-462-4434 c EnCT P O Box St Me P ENE 47 State Street Pax Newbury Sort,MA 0195D AIL Arc Nu: Marcos W.Shaner INSURER S AFFORDING COVERAGE INSURED Turnpike General Contracting if $USSR A:Scotts dale Insurance Co. NAICP George Vasllla 239-Bos dea INSURIO B:COmmerce Insurance Com any ton Street INSURERC; Topsfield,MA 01983 - ` INSURER o: INSURER E: COVERAGES CERTIFICATE NUMBER: NSU F: THIS IS TO CERTIFY THAT THE POIJCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERG! REVISION NUMBER: EXCLUCERTISIONSCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E%CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDANY OUCED OYINTRACTPOq pOCLA1MS OCUMENT WITH RESPECT TO WHICH THIS SR lTH TYPE OF INSURANCE GENERAL LIABILITY PDLICYNUMa L EFF POLI D Li A X COMMERCIAL GENERALLIABILITY BCS0026080 SAO"OCCURRENCE S 11000.000 CLAIMS-MADE 1K OCCUR 10/21/11 10/21/12 EMISEC EPP ® $ 50,00 MEDEKP .. moon) a 5,00 PERSONAL&AOV INJURY a 1,000,000- GEN'LAGGREGATELIMMAPPUESPER GENERALAGGREGATE a 2,000,00 POLICY X PRO we PRODUCTS-COMPlOPAGO a 2,000,000 AUTOMOeILE UASIUOY S B, ANY AUTO C I ED SINGLE LIMIT BOBRJM Ea eWdiin a 1,000,000 AUTOS SCHEDULED 10/20711 10/20112 BODILYIWURY(pprpereonl S AUTOS AUTOS X HIREDAUTOS X A QED BODILYINJURY(Par.c*sm) S R D e ae m a UMBRELLA LIAR X OCCUR E Q X EXCESS ugE CWMS,MAOE -1 XL$0077698 BACHOCCURRENCE a 5,000,00 DED X RETEWION$ 0 10/21/11 10/21/12 AGGREGATE WORKERS COMPENSAIiON E 5,000,00 ANO EMPLOYERS'LIABILITY S ANY PROPRIETCRIPARTNERJSXEOU YIN WG$iATU• OTti- OFFICERIMEMSEREXCLUDEDT ❑ N/A (Maneamry 1p NH) E.LEACHACCIDENT IS ar DESCFIP IONOfte FCPERATION D E,L DISEASE-EA EMPLOYE S EL DISEASE POLICYLIMIT S OESCRIPTON DF OPERATIONS)LOCATIONS/VEHICLES(papch ACORp 101,AEtlIllonvi RemaHm Schedule,Irmore epaco irs mqulmtl) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABO VE DESCR THE EXPI IBED POLICIES BE CANCELLED BEFORE RATION DATE THEREOF; NOTICE WILL ACCORDANCE BE DELIVERED IN -WITH THE POLICY PROVISIONS. AM ORRED REPRESENTATIVE ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORDRD CORPORATION, All Kghts reservetl. ACORD. CERTIFICATE OF LIABILITY INSURANCE THIS CERTFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE GOES 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:d the c.U.1 at hope,r an em(s).ADDITIONAL INSURED,the Peff'"Rs)must he endomatl. R SUBROGATION IS WAIVED,subject to the terms and cAndilians of the PARRY,oa Sjn poQeie9 me,requlre and end9rcemerd. A statement on Uns corUOceta tloes not confer rights urtifcele hoitlar in lieu of catch andorsament(s). 10 the PRODUCER CONTACT CHASE&LLTTP LLC NAME:PHONE FAx POB 590 (A/C,No,Ent): FAX EMAIL (NC,No): ADDRESS: NEWBL1typORT,MA U1950 PRODUCER 77BPK CUSTOMER 10 e: INSURED INSURER(S)AFFORDING COVERAGE INSURER A: TRAVELERSNAICk TURNP1 E GEIVFR CONTRACTING INC INSURER B: DT I'ASSIGNMENT INSURER C: 239 BOSTON,STRW INSURER D: TOPSFMLD,MA 01983 INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F: THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELCW HAVE BEEN ISSUEOTOTHE WSURED NAMED ABOVE FOR THE POLICY REVISION INDICATEDBER- ORMAYPERIAINTHEINSOMREMENT,TERMORCONpmONOFANY CONTRACT OR OTHER DOCUMENT WIN RESPECT TOWHICH THE;POLI pECADEISSUED OR MAY PERTAIN.THE INSURANCE AFFOROEYP BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY MAYS BEEN REQUIREMENT T BY PAIOCL CONDITION INSR LTR TYPEOFINSURANCE ADOLSUBR POUCYEFFOATE POLICYEXPOATE POLICYNUMSER (MIEDIR YIT (MM,OOIYYM GENERAL LIABILITY INSR Win, LIMITS _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS MADE OCCUR. DAMAGE TO RENTED PREMISES(Ed eccmmnoe) $ GENT AGGREGATE LIMIT APPLIES PER. MED EXP(Any one person) $ POLICY PERSONAL A$.ADV INJURY $ PROJECT LOC GENERAL AGGREGATE $ AUTOMOBILE LIABILITY PRODUCTS-COMP/OP AGO $ ANY AUTO ALL OWNED AUTOS COMBINED SINGLE $ SCHEDULE AUTOS LIMIT(Ea accidem) HIRED AUTOS BODILYINJURY $ (Par Person) NON-OWNED AUTOS BODILYINJURY S (Per eccldem) PROPERTVDAMAGE $ (For accidera) UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE DEDUCTIBLE $ AGGREGATE RETENTION $ $ WORKER'S COMPENSATIONAND $ WCSi'ATUTCRYLIMITS OTHER EMPLOYER'S LIABILITY YIN UB-4939FISS-11 ANY PROPERITGTLPAfTTNG1/EXECURVE N 10'2712011 10/2212012 E.L EACH ACCIDENT OFFICERIMEMAER EXCLUDED, E.L.DISEASE- $ 1,000.000 (Manaalaryln NH) EA EMPLOYEE $ 11000,000 IIyAR,ddielba under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATX)NSbelow DESCRIPTION OF OPERATONS/LOCATONSNEMCLESIRESTRICTIONSISPECIALITEMS THIS REPIACPS ANY PRIOR CERITPICATEISSUED TO THE CPRTDTCATEBOLDER AFFBL7 NG WOPjams COMP COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL Be DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Charles 7 Clark 4�oRo zs(zooeiPs/ 19811-2009 ACORD CORPORATION. All rights reserved. UrSrem 6 1�4ti d� tYy ieBgrOGpwhich t 1vlsssaehuaetts Department4tPu61i Safety 3 Yt;esa tYtBn 99,UOi}tubi$ t� ,g Soara of SOO!n f ;igulaH.onS and Staod�rds . �4C4�'�+.6Q$CE• � CmrttYattind 5u}�ni'i�Y'�r �w Wcensa d"66145 r + Y p� e isTeW3eY# roton L�s�.glMaitlistimi: :Ex{}ir@;ion r+asovlurs Commtssi611aF 10662613 bCe o _' "`�and�ess e�u��,hTcin - Suite 517D U tts o 116 � ixactor Reg stration' RepT3tialNn; 107rAl ,_ fiype: sligpiommrrtCarit, �T]/ TOPS)iURN-PIKE4 NEfF�ZAL�QCONTRA ' w ExpJraiton: tllld12612 ' .GJ8©B ] FSD�J - ✓p � . y upgaie AAArab and raft Eatd M?rk raaeyu foc cliaut s Drscat a r earoaeto{re• - '' ��Addresa ❑Iteaaw9l Bmploymm;: nLostCard Olpee pt'Congp $gHeeie Re 'Yoga;s - -- �, 11"• t he pt�reyhtraHoq"vepd for lodlvmid sae onlyILL - OME11SaPA0 �t'pk �td9ie`�4'p�aaHan deer. It[onnd�rLr'ih tyl , : - itd'glatratiq. .u� dk. >;sag8mporA4l'etrsindBuelneYs$ogu(at[oo TURHPIISE � y� PA!atPa94 9, '�agot�rMA PIP GEORGE UPy81 20BBOTOIV a �` .,, TOPBFIE a'' s ' '[lnarremreHty Nbt Vdlia Mtliovtai41natare . i y T Y { a e iS : TURNPIKE GENERAL CONTRACTING,INC. 239 BOSTON STREET, BOX 365 TOPSFIELD, MA 01983 978-887-5870 December 6, 2011 To Whom It May Concern, - This letter authorizes Russel E. Gendolfe of 24 Rose Street in No. Providence, RI to apply and obtain building permits for Turnpike General Contracting, .Inc. Sincerely, By yGeorge Vas►is es, CEO �� / „`„pr.nrorerrgpr Notary � —� b , r,�PFARET .ySACH 01 r e