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5 HODGES COURT - BUILDING INSPECTION v 1 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a n 1 One-or Two-Family Dwelling `\ This Section For Official Use Only Building Permit Number: Date Applied: adding Offictal tName) Signature Dale SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers ( 7i)ooi 1.1a 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 fit) Frontage(it) 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 nerI of Record: t Nrr �' .1�14 vim a Name(Print) City,State,ZIP Sc�.g-v�3-2� a No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Altermion(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Z. Other ❑ Specify: Brief Description of Proposed Workz: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ 2,MV t::- 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: �l V 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ `7 ¢jJrj 0 Paid in Full 0 Outstanding Balance Due: r SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder _ List CSL Type(see below) (, .a No.and Street Type Description 0 l5Z� U Unrestricted(Buildingsu to 35,000 cu.ft.) vTr-� YL(r-1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofm Coverin WS Window and Siding SF Solid Fuel Burning Appliances c�C Qrr7 I Insulation Telephone Email address D DemOlihon 5.2 Registered Home Improvement Contractor(HIC) LL-r-- HIC Registration Number Expimtion Date HIC Company Name or!-IBC Registrant e tr3r� C-n o Q f1 Email address T4. F�fCL£z�LC1�Q� vNX� a71�.(�Z �c.7 b(�—yZfdU City/Town,State,ZIP 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 .......... IH,-�, 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 -1 S!�rp C\C L C- to act on my behalf,in all matters relative to work authorize4y this building permit application. Print won Signature) 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 contained in this application is true and accurate to the best of my knowledge and understanding. PrintBwner'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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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" . 1 The Contntonrvealth of Massachusetts _ Department of Industrial Accidents ! _( Office of7nvestigations -r'" • ' '�� 600 Washington Street Boston,MA 02111 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibli N Elmo (t3 us mess/Organization/Individual): Address: � 'ne `� City/State/Zip:�.BtL1-[--221c fPIO Z.Phone#: — Are you an employer? Check the appropriate box: Type of project(required): I.�am a employer with I Z— 4, Q I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or parncr These sub-contractors have ship and have no employees 8. ❑ Demolition employees and have workers' C addition wmkin for me in any capacity. - 9. ❑ Building [No workers' comp. insurance comp. insurance? . �5 We are a corporation and its 10.❑ Electrical repairs or additions required.] .i.❑ i ain a homeowner doing all work officers have exercised their 1 LQ Plumbingrepairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required] c. 152, §1(4), and we have no 13.O'6thett � 1 employees. [No workers' comp. insurance required.] Any appli capt thus cheeks box NI must also till out the.section blow showing their workers',eompensoti on policy information. +li onlcowncrs who submit this affidavit indicatingthey are doing all work and then hire outside contractors must submit a new affidavit indicating such, lConu actors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have cnyiloyces. If the sub-conu'acunx have employcee,they must provide their workers'comp.policy number, l nun an employer that is providing workers'conipen.sation insurance for my employees. Below is the police and job.site inforauuion. Insurance Company Name:_ Policy k or Self-ins. Lic. #:cill01 ( Expiration Date: (—Z`Z—lZ _ Job Site Address:_S 4ur�14" C--ciyF-1i City/State/Zip:5k(e l� -7 c> in, IDAttach it 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 tine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 Investinations of the DIA for insurance coverage verification. 1 do hereby certijj-nn cr the pains and penalties of perjury that the information provided above is true and correct. SienauilC Data o��L Phone#--4�r�—� � S Official use only. Do tzar 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,".: PAGE 3OF4 OP ID: KG .� DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 12/08/11 CERTIFICATETHIS S ISSUED AS A MATTER CERT F CATEDOESNOT AFFIRMATIVELYOR NEGAT VELY AMEND, CERTIFICATE EXTEND OR ALTER THE COVERAGE AFFORDED THE POLIC EIS 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 policy(ies) must be endorsed. If 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 endorsement s). CONTACT PRODUCER 7B1-914-1000 NAME: TGA Crass Insurance Inc 781-246-2601 a°NH Ext: FAX INC,Na: 401 Edgewater Place S220 E-MAIL Wakefield,MA 01680 ADD REs s: Gary Heaslip cJET .E.IDPIJAYRO-1 INSURERS AFFORDING COVERAGE NAICk INSURED Jayron LLC INSURER,:Arbella Mutual Insurance CO. 17000 Jayron Realty Trust INSURER B: Ron Habeshian Jr INSURER C: 1001ron Horse Park INSURER D: North Billerica, MA 01862 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 POLICY 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LIMITS LTR TYPE OFINSURANCE Smn UB POLICY NUMBER MM/ODNYYY MMIDDNYYY GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 A X COMMERCIAL GENERAL LIABILITY 8500053418 11/29A1 11/29/12 PREMISESOEa occurrence s 300,000 : CLAIMS-MADE OCCUR MEO EXP(Any one person) 8 S,000 PERSONAL B ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY (Ea SINGLE LIMIT S 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJU RY(Pe;accitlenp S A X SCHEDULED AUTOS 79854400004 11/29/11 11129/12 PROPERTY DAMAGE $ (Ps raccidenl) LX HIRED AUTOSSS X NON-OWNED AUTOS S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE 1,000,000 A 4600053419 11/29/11 11/29/12 AGGREGATE I3 II DEDUCTIBLE X RETENTION S 10,000 $ WC STATU OTH- WORRERSCOMPENSATION X CRY LIM AND EGIPLOYERS'LIABILITY 11/29/11 11/29/12 E.L.EACH ACCIDENT $ 1,000,000 A ANY PROPRIETORIPARTNERIEXECUTIVE Y NIA 9119391111 OFFiCERAMEMBER FxCLUOEDi E.L.DISEASE-EA EMPLOYEE S 1,000,000 (Vandal.,In NH) If yes, "'under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Evidence of insurance as respects operations of the insured. CERTIFICATE HOLDER CANCELLATION SAUGUS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Saugus ACCORDANCE WITH THE POLICY PROVISIONS. Fax:781-231-4109 298 Central Street AUTHORIZED REPRESENTATIVE Saugus,MA 01906 , ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD i �Ltsachu,rtt.- Dcp;unucnt nl Public A Bu;u•tl ul Building Regulation d. an �l;uulanl+ Construction Supervisor License License: CS 75630 RONALD C HABESHIAN JR 545 FOREST ST DUNSTABLE, MA 01827 ;— Expiration: U7/2013 t ..ne.. Tr,: 18476 License or registration valid for individul use only pn;.r or Consumer Affairs S Business Regulation before the expiration date. if found return to: 'HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation Ii Registration: 147423 10 Park Plaza-Suite 5170 �Explra[ion_ 7/7/2013 Ltd Liability Corpor Boston,MA 02116 � ON,aLD HASESHIANR t001 RON HORSE PAK ,N SIU_ERICA. MA01862 Undersecretary �Not vae w' o {signature c. LLC ADDITIONS REMODELING 100 Iron Horse Park North Billerica, Ma. 01862 978-663-8400 -(Fax) 978-663-8199 www.jayronllc.com Proposal Date: July 11, 2012 A' Proposal Submitted to: Amy Swallow Address: 5 Hudges Court City, State,Zip: Salem,MA Phone#: 508-813-2728 We hereby submit specifications and proposal for: Reconstruction of the second level deck only. JAYRON, LLC to supply all materials and labor as listed below in accordance with the Massachusetts Building Code. JAYRON, LLC will have a dedicated Project Manager readily available. PERMIT& INSPECTION: • Will be the responsibility of Jayron LLC (to include cost). •. Permits included are (Building) _ • JAYRON, LLC will be onsite for all inspections. TRASH REMOVAL: • On Site dumpster for JAYRON,,LLC use only. a Yard to be kept neat and clean daily from construction. • Does not include disposal-of hazardous materials. PORCH: • Support the porch roof. • Demo the 2nd level porch if necessary • Remove the existing railings for reinstall. • Supply and install 4x4 Pressure treated supports if necessary ip Supply and install 2x8 Pressure treated floor joists if necessary Supply and install fir decking. • Reinstall railings with additional bar to meet code. • Supply and install vented vinyl soffit. We hereby propose to furnish labor and materials -complete in accordance with the above specifications for the sum of. $7,000.00 Acceptance of Proposal Proposal is good for 30 days from the date of issue. Customer Signature: 1 Date: Illull2 Contractor Signature: - Date: cam-2— i Z