388 HIGHLAND AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 CMR, 7t'edition OF
Jan a Rry
V I Building Permit Application To Construct Repair,Renovate Or Demolish a 1, 2008
One-or Two-Family Dwelling
This Sectio `For Official Use Only
Building Permit Numb Date Applied: 2 U
Signature: �2to
Build, g Commission r/ s r of Buildings Dale
SECTION ]:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1 vE
I.la Is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
/►��/e��y ZFoz./ 313irAzig ,tw '0096/E'
Name(Print) Address for Service:
n. RTg- -7ti Sc'- s3sa
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply).
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work :
Sr Jdoa /9-rZ ra
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ "' 1. Building Permit Fee:$ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $
❑Total Project Cost Item 6 Itiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire Suppression)
$ Total All Fees: $
c p e o Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ (�'O� 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
to t 8a6 s
/C'NA�L % 12k y& License Number Expiration Date
Name of CSL-Holder
C/4w/ L T /� *.9 List CSL Type(see below) (�
Address Type Description
U Unrestricted(up to 35,000 Cu.Ft.
A Restricted 1&2 Family Dwelling
Signature M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Reel Home Improvement Contractor(HIC) a( O 8'
J'o� S"Qt1tccA nE vc . 7
HIC Company Name or HIC Registrant Name Registration Number
o IP Cye- s ,., ^ 06 06 - co
A dres
R,, Expiration Date
Signature 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 ..........;G No ...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 14 A ale Z e-O L/ , as Owner of the subject property hereby
authorize J'O E :YA 01 6 L^AZ711 /h/C to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
I, M/Ct/siEc 42 .C/R`�/'� ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
rr/ c rwc L 7-
Prim N e
ll^ 16 ^ oq
Signature of Owner or Author gent T Date
(Signed under the pairs and peAaes of e
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 11 O.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"
i CITY OF siuxm. NLkSSACHUSETTS
• BUILDLNG DEPARTMENT
130 WASHNGTON STREET, 3w FLOOR
Ttt- (978) 745-9595
FAX(978) 740-9846
KINMERLEY DRISCOLL
MAYOR T HoNms ST.PtERRE
DIRECTOR OF P mic PROPERTY/BunziNG CommssioNER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
JOcc SQytLLA rU M I KI c
(name of haul r)
The debris will be disposed of in :
Cti ob0 Ltj&St1 ®f QC1zrOr0
(name of facility)
9.57 60STOW 40 0-6/e��eT .
(address of facility)
signature of pe �t applic
61 - 16 - a�
date
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Ulf www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Orgmimtion/Individual): 710C SQJI LC /n/C .
Address: l/c9 R CI9/t/I9L -
-5-7-City/State/Zip: lYj� DAr Phone #:9 . r 78l— 30 4�, — 093(9
Are ou an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 'L-7 4. ❑ 1 am a general contractor and 1 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 1 L❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.RRoof repairs
insurance required.] f employees. [No workers' 13.0 Other
comp. insurance 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 hire outside contractors most submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: 16 C e
Policy#or Self-ins.Lie.#: C &/ K__S O 30 Q o Expiration Date: fS'— t 6 l O
Job Site Address: SFC$ �,t\GMC_J4'h/6 .+9(/C City/State/Zip: J;� /!y/,1
Attach a copy of the workers'compensation 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 insurance coverage verification.
I do hereby certify under the pains and pe Ities ofperjury that the information provided above is true and correct
Signature: Date: l C — o
Phone#:
Official use only. Do not write in this area, to he 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#:
ACORD_ CERTIFICATE OF LIABILITY INSURANCE GP ID BS1
SQUIL-1 1 08/18/09
PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
McLaughlin Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR
828 Lynn Fells+Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Melrose MA 02176 .
Phone: 781-665-2775 Fax:781-665-0295 INSURERS AFFORDING COVERAGE NAIL9
INSURED INBLRERA united Specialty mm,ranw Co.
Sqquuillante, Inc.
INSLRERB: ACE Insurance Company
Joe
Mike Sryk INSURERC: Tsayalera e:op. eaa. ee, ey >r
P.O. Box 560143 INs(aEN o: Peerless Insurance Co. 24198
West Medford MA 02156
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED RAED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITIISTANDWG
ANY REOUIREMENT,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 AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR "m TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(M MADONY) LIMRS
GENERAL UASLLIiY EACH OCCIATRENCE $ 1000000
A X COMMERCw GENERAL LIABILITY CRA509PO9 02/OS/09 02/05/10 PREMIsEs(Eeoenerme) s 50000
CLAIMS MADE FxJOCCUR - - MED EXP(Any one person) s none
PERSONPIBADVINJUiY i 1000000
GENERAL AGGREGATE s2000000
GEM AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPA)P AGO i 2000000
POLICY X .PPIECT
ROU El LOC
AUTOMOBILE LABILTY
COMBINED SINGLE LIMIT $ 1,000,000
C ANY AUTO BA8567M134-09-SEL 01/18/09 01/18/10 (Ea mddmU
AL ZED auros
BODILY TN. s
X SCHEDULED AUTOS (P�P
X HIRED AUTOS
BODILY INARY s
X NON-ON AUTOS (Par amcd )
PROPERTY DAMAGE $
(Per eoodmt)
GARAGE LIABILITY AUTO ONLY-IAACGDENT $
ANY AUTO OTHER THAN EAACC s
AUTOONLY: AGG s
EXCESSIUMBRELLALABILITY EACH OCCLRREN(E s$2,000,000
A D OCCUR F_1CLAIMSMAOE CXA519009 01/14/09 02/05/10 AGGREGATE $ $2,000,000
a
DEDUCTIBLE $
X RETENTION $10000 1$
WORKERS COMPENSATION AND X I TORYLIMIIS I I ER
B EMPLOYERS•LABum ANY PROPRIETOTLPARINEILEJECIRIVE C45803090 08/16/09 08/16/10 E1.EACHA.CCIDEM s 1000000
OFFICERR,ENeEREXCLUDED•I E.L.DISEASE-EA EMPLOYEE i1000000
R eS.daHrineuafer E.L.DISEASE-POLICY LIMrt s 1000000
sr�ECAL PRowsloNs bNav
OTHER
D rented/leased Equi CBP8592554 02/OS/09 02/05/20 $250,000
D Stored Material CBP8592554 02/05/09 02/05/10 material $42,600
DESORPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Not valid for additional insured or loss payee
CERTIFICATE HOLDER CANCELLATION
INFO-OS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL 30 DAYSWRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
For Information Only IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER,TS AGeM OR
REPRESENTATNES.
AUiHOR17E0 RE A
O
ACORD 25(2001108) V @ ACORD CORPORATION 1988
.. .?lassachuxtts - Department or Public Safet%
Board or Building Regulations and Standards
Construction SuperviscT License
License: CS 101826 -
Restricted to: 00
MICHAEL BRYK "a" p
693 FULTON STREET .
MEDFORD, MA 02155
Expiration: 9/21/2612
t'"uuui"i"n''. Tr#: 101826
p� �u �o�nnzo�uueal� o� j�a��uaeLla
Board of Building Regulations and Standards _
F"i
HOME IMPROVEMENT CONTRACTOR
Registration: 121708
Expiration:-616/2010 Tr# 268846
.. . Type: Privaie Corporation
JOE SQUILLANTE INCORPORATED
JOSEPH SQUILLANTE.. _
40 R CANAL ST.
MEDFORD,MA 02155 - Administrator
i'KUt'UJAL S
3592
PROPOSAL
JOE SOUILLANTE, INC.,
CONTRACTING &'ROOFING
P.O. Box 560143 DATE
West Medford. MA 02156 11/3/2009
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED ...
Maureen Zeoli 388 Highland Ave Salem
388 Highland Avenue
Salem, MA 01970
We hereby proaose to furnish the materials listed below and perform the labor necessary for the completion ofthe following: _
DESCRIPTION COST TOTAL
1. Protect exterior of building and any landscaping in the area: 9,785.00 9,785.00
2. Strip all existing asphalt shingles from entire roof.
3.Inspect all roof sheathing.
4.Install G of WR Grace Ice and Water Shield.
5. Tri-flex Paper to be used as balance of underlay.
6.Re-flash all penetrations. =
7.Any wall to roof transition flashing that requires replacement will be billed at an
additional charge.
S. Install 8" drip edge to perimeter.
9.Cut ridge vent into peak of roof.
10.Install 30 Year Architect Shingles.
11.Remove all debris associated with scope of work.
12.It is recommended that homeowner removes or protects items stored in attic.
13.Obtain all necessary municipal permits.
14. 1201 year warranty is provided on all workmanship.
TOTAL $9,785.00
Any alteration or deviation fiain above specifications involving extra costs will be evecnted only upon written order and iri/1 become an extra charge over and
above lire original proposal. Persons odder that Joe Squillante. hnc.employees and authorized agents of Joe Squillante,Inc.are expresslyforbidden on aty,
ladders, scaffolding or use of any tools owned or operated by Joe Squillante, Inc. or authori=ed agents of Joe Squillante,Inc.Joe Squillante,Inc.shall be entitled
to charge a one and one half penrent(/ 1/1%)monthly!finance charge for all invoices on which payment is not received within ilarp•(30)days. The customer
agrees to pay all costs of collection, including,bia not limited to, reasonable anorney's fees in regards to any and atl past due onrowus.
�1
Please sign and return with deposit to indicate your approval. SIGNATURE:
� � PAYMENT TERMS
a r 1/2 agreement 1/2completion
Respectfully submitted by:Joseph Squillante
� t .
Phone# Fax# V E-mail �
V/SA
781-306-0939 781-395-2249 joesquillan[e@msn.com