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141 HIGHLAND AVE - BUILDING INSPECTION (4)
i RF4fWE LI o The Commonwealth of Massachusetts i. SPECTIO Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMJDJb MAR 22 A 1 BEM 00 W e Building Permit Application To Construct,Repair,Renovate Or Demolish a rased Mar 2011 ' One-or Two-Family Dwelling This Section For Official Use Only l Building Permit Number: Date Applied: 4�)c,< 3 -zZ I ( Building Official(Print Name) Signature QU Date SECTION 1:SITE INFORMATION AP rty,r�d�d�sg�V Ga� ,.,�^ 1.2 Assessors Map&Parcel Numbers I.I a 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(ti) 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 Ownert of Record: [ on H(AYA)tnj .S4/eow- AMY 01170 Name(Print) City,State,ZIP - 14// f//&t14 oQ AJ0 3�S-53yg Liaat�a (� u ants Cad �1 ov•tavry No.and Street one Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 131 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: - Brief Description of Proposed Workz: CA 1 — M SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ �Q 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Sup ssion) Total All Fees: $ 6 r Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ / ❑Paid in Full ❑Outstanding Balance Due: 752-g Htc-ta( ST 021SS 3 0,�/6 a SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) M /�53 License Number Expiration Date Name of CSL liolder (�O ( List CSL Type(see below) Wg No.and S t /� rr Type Description rd n/1 ©� I5t� U Unrestricted(B Family s u el ing cu.ft. ��!-r J R Restricted Unrestricted(Buildings ildin Dwelling to 3 City/lo State,ZIP M Masonry RC Roofing Covering WS Window and Siding 13 ROM"'5 C 1 /O / Cl�1 ��✓ SF Solid Fuel Burning Appliances J I 1/ ' I Insulation ele hone Email address D Demolition -51-Re i(stt-er Home Improvement ontra or(HIC) v '9" ne roL' Co V�w 00R HIC Registration Num gxpiratio6 D to C oMy acne otf Fi �/ NqE� �/1 ,5r,'cl [1 C' !A. Email address City/Town,State,ZIP �T T Telephone V 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 I,as Owner of the subject property,hereby authorize V t NOt ill "U11 to act on my behalf,in all matters relati a to work authorized by this building permit application. Print Owner's Name(Electronic fignature) 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 contai d in this application is true and accurate to the best of my knowledge and understanding. 3 ,'9- tOwner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dns 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 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" _274 GENERAL CONTRACTOR INC ROOFING SPECIALISTS ibrggcinc(apmail.com www.medfordroofservices.com 328 High St. Medford MA 02155 857-251-5404 & 617-415-3264 License & Insured CS-106753 HIC-175198 Quote to: Linda Huynh 141 highland Salem Ma SET-UP before We will review the plan to protect plants, walls, windows, door, around each Section of the house as the work progresses that area. . Multiple-day Installation: If our installation takes more than one day, our crews will clean up their work site, collect debris and leave you able to walk around the house at the end of each day. Estimate to stri tO9°Im1l layer of asphalt shirt le end install new shin arle on entire and porch roof, *Install new ice water shield all way around of the roof edge,vent pipe,valley, chimney *Install new Rhino Roof Synthetic Roofing Underlayment, Shingle-Mate® Roof Deck Protection (also called roofing felt for underlayment) Superior-PROTECTION Quality Roof *Install new 8 inch white drip edge on entire roof edge Drip-edge materials protect the edges of roof sheathing from water penetration due to driving rains *Install new flashing on chimney new lead *Install ice water shield all way up on the chimney under flashing *Install new pipe boot flashing *Install new cobra exhaust ventilation on the ridge *install new start strip *Install new Architectural shingle roofing GAF TIMBERLINE LIFE TIME owner chose the color *Install new roof ridge cap Dumpster will be provide by contractor Permit will be provide by contractor -.y • 100% labor and material specified above included Note only 60 line ft of roof plank is included for the rotten wood if there is some, more than 60 will be charge $25 by plank installed Install if needed the plank size is 8x16 long 8 years labor warranty *After Installation: We will do a walk through with you, to assure your complete satisfaction. We want you to be 100% satisfied with your project! Payment: 40%of payment upfront when sign the contract and pull the permit and the remaining balance when job is 100% completely done. The Total sum is $6,150 At signing of the contract $2,460 At the completion of the project $3,690 I G/A�D f�� 4—CL"/n 4-1 have read this Agreement and agree to the terms and conditions. Owner Signature: date Home Owner Contractor Signature: . Joao Baia date JBRG General Contractor Inc. ,per i �\ The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia WWorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE MAD WITH THE PERMTITING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Orgaaizaatio onandiividual), Address: "City/State/Zip: 6't� Phone#: J s Are you an employer?Check the appropriate box: Type of project(required): l.gIl am a employer with _employees(M and/or part-time).* _ 7. ❑New Construction 2.❑I am a sole proprietor or partnership and have no employees working.for me in S. Remodelin ty capacity.[No workers'comp.insurance required.] ❑ g ar 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required]t 9• ❑Demolition 4.❑I am a homeowner and will he hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub.cont actors listed on the attached sheet These13oROof I¢ airs sub-contractors have employees and have workers'comp.insw . ance.r P 6.❑We are a corporation and its officers have exercised their right of exemption perMGL c, 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insraance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. tCommctors that check this box must attached an additional sheet showing the name of the sub�coub too and state whether or not those entities have employees. If the sub<ontrnctors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: 4'Y1x2641',q l ttlt>»GF Policy#or Self-ins. l Lic.#:�Sn _UIIa D G 113�S��L�i �.> Expiration Date: Job Site Address: 1 �l H 112' k lV 4 !; (IPM, City/State/Zip: Attach a copy of the workers'CQ6mpensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA'for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that tite information provided above is true and correct. Sismatum Date: 3 Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): - 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person• Phone#• - t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cunaruetion Supcni.or License: CS-106753 JOAO BAIA = k Ile ,. Medford MA 02I55 Expiration Commissioner 07/22/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration w^^` Registration: 175198 Type: Corporation e7. � t�t `• , Expiration: 4/2 912 0 1 7 Tr# 263431 JB RG GENERAL CONTRACTOR IN JOAO BAIA - } f i1 i 328 HIGH ST — MEDFORD, MA 02155 Update Address and return card.Mark reason for change. Address 1 j Renewal (,j Employment I Lost Card SCA 1 C• 2OM-05111 !"/fir•�nru nrcrrnrrr//�r/+'s�lr�iac�rr�rl(' _ ._ _. .,. - _ Office of Consumer Affairs d Business Regulation License or registration valid for individul use only - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Registration: 175198 Type: Office of Consumer Affairs and Business Regulation - Expiration: 4/29/2017 Corporation 10 Park Plaza-Suite 5170 Boston MA 02116 JB RG GENERAL CONTRACTOR-, INC. JOAO BAIA --- 328 HIGH ST MEDFORD,MA 02155 Undersecretary Aitvalid without signature �.w r/rrt r t�tnty ► NOTICE NOTICE TO o TO A EMPLOYEES EMPLOYEES y �W OqM SVg The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ACE GROUP NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6SG2UB-2E10754-4-15) 03-25-15 TO 03-25-16 POLICY NUMBER EFFECTIVE DATES AMAZONIA INS AGENCY INC 66 BOW ST. SOMERVILLE MA 02143 NAME OF INSURANCE AGENT ADDRESS PHONE# o= JB RG GENERAL CONTRACTOR INC 328 HIGH ST 1 o� MEDFORD �— MA 02155 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE _ MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS o,00aa W20PIG02 TO BE POSTED BY EMPLOYER