127-129 HIGHLAND AVE - BUILDING INSPECTION The Commonwealth of Massachusetts
Department of Public Safety
/t.� 4 1 •j \Ll..,tahlna•II.St.ur Bmldm);('Ode I•-SO C\Ili)Sa•ccnlh Edrtwn !
r JU City of Salem
'1 Building Permit Application for any Building other than a I or 2-Family Dwelling
(rhts"-twn For Official U<e l)nly)
8uddmg Perimt Number: Date Apphral: Building Irispechir: =
rSECTION I: LOCATION (Please indicate Blocks and Lots for locations for which a street address is not available)
/T,7- t ;iq
\o. and Street C It% i iulvn Zip Code Name of Budding(it.tppbcablrl
SECTION 2:PROPOSED WORK
If New Construction check here C or check all that apply m the two ruws below I
--- -----E�rstng-Building - --Rrpair-0 —Altrratiun-0---Adalitiun-O - melilon--O—(P-Irasr-fill-eut-.Isad�ubm+t-Ayprn.ii
Change of Use ❑ Change of Occupancy C Other ❑ Specify: I S:
Are building plans and/or construction documents being supplied as part of this permit applicatiun? Yes C Nu
Is an Independent Structural Engineering Peer Review required? - Yes ❑ No
Brief Description of Proposed Work:
c rJ44
—dr 014
r
kcnffiON 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
e if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) C
se Group(s): Proposed Use Group(s):azard Index 780 CMR.34: Proposed Hazard Index 780 CNIR 34:
SECTION 4:BUILDING HEIGHT AND AREAExisting Proposedrs/Stories(include basement levels)&Area Per Floor(sq.ft.)
(.sq. ft.)and Total Height(ft.)SECTION 5:USE GROUP(Check as a licable)bly A•1 O A-2r ❑ A-2nc O A-3 ❑ A-0❑ A-S❑ B: Business E: Educational ❑
F: Facto F-1 ❑ F2❑ H: HI Hazard H-1 ❑ H-2❑ -3 ❑ H-4 C H-S C
1: Institutional I.1 ❑ I-2 ❑ I-J❑ 1-�❑ M: Mercantile❑ R:-Residential R-I❑ R-2 ❑ R-J❑ R-4 ❑
S: Storage S-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe below:
-Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IAC Is IIAC 1180 1 IIIA ❑ Ills IV C VA VB ❑
SECTION 7: SITE INFORMATION (refer to 780 CNIR 111.0 fordelails on each items
( 1W1<r Supply: Flood Zone Information: Sewage Disposal:
rrench Permit: . Debris Removal:
bi -
Ton,❑ Check II ,(d>tde Plr,.al Lnnr❑ Inahr.rtr.muntcq.al❑ \ trench Ivdl nut be Ltcen.ed Ui.p,..,Il for❑
requlrud C or trench nr •pcoic.
I h'tcata•❑ ,rr uldcnblc Zuna•: + ', r un ar tr•c.lrm ❑ )perm it t,ena lu.ral C
I
Railroad fightof-way: Haurds to Air Navigation: \I-s I h.1,,n, t .rruur....... 16"
\rl \I•ph.dple0 L'IrualurV 1l nhul utr laat.q•Iru ardl.rn•a' I. Ihanr'c+ir+• :.•ml•1.toJ' i
..r t . n�rnl tar ltuJ.l cnJrr•..I ❑ I 5c.0 . rN.,0 lr.❑ V. 0 .._�
SECriON 8:CON TENT OF CERTIFICA fE OF OCCUPANCY
.Llim ..l l •Jc .___ L-c l.n,ul•(.t __ frpv•nl- n-Inplin� ___— Iliiuf•.ull l .ral icr llrna ._ .___ __.... '
16.r.for lvu lrli nq.,rnl.tm.ln �pn nk for?% Ivrilr `l%, al Ali puLlorm`
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GL/nrr&I-► WHRW 77CAvIJ, G
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SECTION 9: PROPERTY OWNER AUTHORIZATION
V.tnte.nid Addrvas t Pn-pertc Osaner '� o
S A ti I e h� t,a,yt bJ tl-C'I
\.una•lPnnl) V Vrr ,md Sireel l ih, (.nvn
j Pr .rrlr lht ncr( ont.t Inlurmaliun — —
role eleph'me No.(busmess) relephune No (cell) r m,ul .iddrell
I(,tpF•hcablr, the pn•perlt uw ar hr ebv.urthunlrx �
!/r_ti SF�< S7 51� 1rO� L f � G/��d
V.tmr >Irerl Addre.,s CihV Town ?t.rte lip
to act nn the ro erh'owner',behalt, in.dl rnalterc rclati%e to work mahonn•d be this building •ermna • �hcotunt.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
ill bw4 in•n las than 15,00ocu.tr ul enduxJ.mce anJ/er nul unalrr Con>trm tion Cuulrul then check here D.tnd .k, •\•.hun Ill I)
10.1 Re istered Professional Responsible for Construction Control
/vt•�r7 s7< gos6 ys6
-NmneyRzRi;tra(�t r rp ury� u. a-mal .1 dress Registration Number
Strut Address City/Town State Zip Discipline Ex�uauon Date
10.2 Gnneneral Contractor
(`
Comp. V- -
-T�se `ble
Name tf Prrsam R mstb r fur Cunstructiun Licr ser� and Type if A,R�licable
%M �A � 6t1'� �fEE�
Street Address City/Town State Zip
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.L.e.151 25C(611
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents mustbe 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
and Materials) Total Construction Cost(from Item 6) _$
1. Building $ S O Building Permit Fee-Total Construction Cost x_(Insert here
2. Electrical $r appropriate municipal factor)=f
3. Plumbing f �n
N. Mechanical (HVAC) f Note:Minimum fee=3 ./ (contact municipality)
S. Mechanical (Other) f Enclose check payable to
P•Y•
6. Total Cost $ Cg 3 (contact munici alit )and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
Rv entering my name below. I hereby attest and . ins a penallles of perlury that all a the n(nrmati,,n a �nt,ilned ,Ihn
.tl.plicaoun is true and accurate to the best,4 a edg under+landm ,.
i I'le.. o pant and tina fide
rrlcphonr \• I)alc
�trrct \ddrv" Ca%. r..wn
ate Zip
I \lunicipal Inspector to fill out this section upon application approval:
- .one
I
a
r'i °TiF� �ou�aled o�✓��,daar�eud¢� f
Board of Building Regulations and Standards l
� I
HOME IMPROVEMENT CONTRACTOR �
Reglatratl0h 159797
- Expiredon: 5/29I2010 Trill 269016
,Type PjNate Corporation
j !
RVAN AND SON ROOFING INC.,, .
PETER RYAN
13 SUNSET DR. p�...CLe...�
WAKEFIELD,MA 01880� Administrator �$,• I
—! :Massachusetts - Department of Public Safcti
Board of Building Regulalions and Standards
Construction Supervisor License
License: CS 104865
CLINTON GALVIN
102 DELMONT AVE Apt
The Commonwealth of Massachusetts
L - Department oflndustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information {` Please Print Legibly
Nagle(Business/Organization/Individuat): �/.��'7tlr� 5��-� �.t
r
Address:
City/State/Zip_ 1 �4 111.4 421 Phone#: 77 t- /�`G S 6
A4e you an employer?Check the appropriate box: -
tr}g�I 4. I am a general contractor and 1 - Type of projecttrequired):
1. 1 I am a employer with� ❑
employees(full and/or part-time).* have hued the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- - listed on the attached sheet_ 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp. insurance comp.insurance.
$ 9. El Building addition
required] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions
myself. o workers'comp. right of exemption per MGL -
r C. 152, 1 4 ,and we Have no 12-❑Roof repairs
insurance required.] � ( 13.WOther eri � Q emP toy•ees- o workers'
comp.insurance required]
*My applicant that checks box;#1 trust also fill out the section below showing their workers compensation policy infom®tion.
t Homeowners who submit this affidavit indicating they are doing all work and than him outside contractors norst submit a new affidavit indicating such.
'Contractors that check this box mast attached an additional shut showing the nanc of the sub-contractors and start whether or not those emtities have
employees. If the sub�coniractors have employees,they nnetprovide their workers'comp.policy number.
I can an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site
information-
Insurance Company Name: ACC ^ 0V&- ,
Policy#or Self-ins.Lic.#:_ ! �V Expiration Date: 3 W /
Job Site Address: ram_City/Statelzip:
Attach a copy of the workers'-compensa on 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$1,500.00 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 of the DIA for ingmance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phone#: — _7 6
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Llcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityfFown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
4/20/I 1
' v
-yan-and-Sons Proposal
G°�O®G
www.RvanAndSonRooring.com
RyanAndSons@me.com
93 (Rear)New Salem Street, Wakefield, MA 01880
Office: (617)571-9056
Submitted To: Job Location:
Stanley Botha
129 Highland Avenue 129 Highland Avenue
Salem,MA Salem, MA
Phone: 978-744-7575
Email: unknown at this time
Proposal Date:March 30,2011
We are pleased to hereby submit this proposal to furnish materials and labor,completely in accordance with the below
specifications: (Additional charges may applyfor any change's not included below in proposal either by request of owner, or if Ryan and
Son Roofing finds unforeseen circumstances that will affect the performance, quality or integrity of this job). In the event that legal action is
taken to enforce any provision of this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-
house or outside attorney's fees. Not responsible for debris in attic.
This proposal is to:
Install Vinyl Siding:
Remove existing siding on house
A6 Prepare existing walls of house for installation of vinyl siding
e6 Remove all existing corners
e�6 Install Tyvek house wrap on entire house
Install Insulation 3/8""Dow
06 Install vinyl siding on house,in style and color ofyour choice
Install J-channel to match siding color around all windows and doors,to receive siding
P66- Install all outside and inside comers to match siding color
r6 Install white vinyl soffit
42- Wrap all windows and doors in white metal
46 Remove debris related to work
Payment Terms made as follows: (This includes: Labor& Materials)
Original price: $7,500.00
Dumpster/Removal price: Included
Total price: (fno changes) $7,500.00
Ist payment due upon scheduling: $2,800.00
2"a and final payment upon completion: $4,700.00 (Kindly make checks payable to Peter Ryan)
i
Submitted by: Pe_l y Q4o Accepted by:� 0 k
All work is 100%Guaranteed for 5-years on all craftsmanship. All other warrantees through the manufacturer.
All warrantees will be null&void if balance is not paid infull.
Thank You for letting us serve you!!!Ryan and Son Roofing, Inc. is Fully Licensed(#159797) & Insured
CERTIFICATE OF LIABILITY INSURANCE °A'0`0311711117111""'w
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 polily(ies)must be endorsed H SUBROGATION IS WAIVED,subject 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 endomeme s.
PROOu 978-998-6896 CONTACT
MasSPay Insurance Services,LLC 978398.6897 PHONE Fax
27 Garden Street Unit 1 B E : No):
Beverly,MA 01915 EDDR
Sharlene Hilda Wulleman P�OpUCER
CUSTOMER md:RYANSON
INSU AFFORDING COVERAGE NAICO
INSURED Ryan&Son Roofing,Inc INSURER A:Are American Insurance Cc
93 New Salem St "MRER B,
Wakefield,MA 01880
INSURER c:
INSURER D:
INSURER E:
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 POUCY 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 POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
INTR POLICY NUMBER MmlOPOLI�EFT POMIDGCT EXP LIMITS;LTR TYPE OF INSURANCE
GENERAL UABRnY EACH OCCURRENCE $
COMMERCW-GENERALUW LTTY
PREMISES Eaamvremx $
CLAIMSd1ADE ❑OCCUR MEDEXP(Anyane Pelson) S
_ PERSONALAADVIWURY S
GENERAL AGGREGATE S
GE GGREGATELIMR'ECTAPPUESPER: PRODUCTS-COMNOPAGG S
POLICY PRO- LOC $
AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $
(Ea=iderd)
ANY AUTO
BODILY INAIRY(Pw person) $
ALL OWNED AUTOS
BODILY IWURY MW=dite ) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
HIRED AUTOS (Per acaaNlg
NON-OMEDAUTOS S
E
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS UAS CLAIMS-MADE AGGREGATE E
DEDUCTIBLE
E
RETENTION $ $
WORKERS COMPENSATION WCSTATU- OTH-
ANDEMPLOYFSS'LMBILffY X T LIMITS R
A ANY PROPRIETORIPARTNERIFJECUTNE YIN D 03f16f11 03/16/12 EL EACH ACCIDENT S 100,00
OFHCERN&MBER EXCLUDED? HIA
(MandatorymNH) EL DISEASE-EA EMPLOYE $ 100,00
n DESCRIPTION
OF O
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I E 500,00
DESCRIPTION OF OPERATIONS I LOCggAAhTIOMMNS I VEHICLES(Attach ACORD 101,Addiemot Renor�Schedule,Umore space M regWred)
coverage applied Polliicy ttermm through Massachusettsworkers Comp Bureau combo ID
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ryan&Sons Roofing,Inc ACCORDANCE WITH THE POLICY PROVISIONS.
Peter Ryan
93 Hain,Salem Street AUTHORED REPRESENTATIVE
Wakefield,MA 01880 �' f a �
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2DO9109) The ACORD name and logo are registered marks of ACORD
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