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15 JACKSON ST - BUILDING INSPECTION r The Commomvcaltlt of Massachusetts Board of Building Regulations and Standards CCCY OF Ij lfassacltusetts State Building Code, 130 CMR SALEM Building Permit Application TO Cunstnict, Repair, Renovate Or Demolish a Raviszd dfnr 2Ul One-or Two-Family avelling Chis Section For Official Use Permit Number: eBuilding Official(Print Nema) Slgnat rDatet SECTION1:SIT tiEATION[Building 1 PropertyAdd a s:r 1.2 Assessors Mip& Parcel Numbers f T acxc[can1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Aree(sq R) Frontage(ft) / 1.5 Building Setbacits(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ' 1.6 Water Supply:(M.O.L a.40,§54) 1.1 Flood Zone Ialbrmatloat 1.3 Sewage Disposal Systems Public� Private❑' Zone: _ Ouufde Flood Zonal Municipal❑ On site dis osal Cheek if es❑ P P system ❑ SECTION 4 PROPERTId'OWOERSRUIlf : 2.1 Owners of Record: 1--t(r . S4rM F�c V 0 VA G Name(Print)�,�Y� r gCity,Stets,ZIP No.e n� e�t Email Address SECTION 3: DESCRIPTION OF.PROPOSED WORW'(check all that apply) New Construction❑ Existing Building❑ I Owner-Occupied ❑ Repairs(s)gj Alteration(j) ❑ Addition ❑ Demolition ❑ Accessory Bldg, ❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work SECTION 4: ESTINLATED CONSTRUCTION COSTS ­ Estimated Estimated Costs: OfRelal Use Only. Libor and;�fatcriais 1. Building I. Buildihq Permit Fee:S Cndicata haw fee is determined: 2. Glcctric:d QSfvtdard.Ci[y/fowrtApplicationFas. ❑'Cu tat PiojcctCostr(Item6)xmultiplfar x 1. i htmbin,y S 7. Other Faes: .I I ,\Idchanical (11VAQ S List:. � ,\ftdt.lnie.tl (Piro ___ __._ IJtdl All I'cear tS� l'hxl No. _Chcc!c �lutuullt: h :\utounc fatal I'rnjcit ( 'na S Il) \QQ . I 0 Plid in Lull Cl ohlGt:ut,lim; ILll.vie: Ihn: srC•rIUtN it CONSTRUCTION SERVICES 5.1 Constntction Supervisor License(CSL) i.icense Nuntbcr Expirauuu Date Name of CSL I luldcr List CSL type(sea below) _( .-\ type Description No. and Street U Unrestrichl Buildilhis up to JIM C tt. QQLO It licstricted I:e?Fnmil 'fling City/ wn, tote, !P bI Masonr RC Ruutin Cuverin WS Window IndSidin SF Solid Fuel Planting Appliances I Insulation Email address D Demolition hunt ) (P g(AS� �3-ao .r 5.2.2 Registered Hot a Improver nt Contractor(II[C) IIIC Registnuiun Number Expiration Date III Cmnpany Nana ur ilIC Rcru ,'t Nuna �f� ant! trees Email address Ct /Town State ' IP role hone SECTION 6: WORKERS'COMPENSATION INSUR ANCE AFFIDAVIT(NLG.L, c. 152. 1 2SC(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.SignedAftidavitAttached7 yes.,........ No...........11 SECTION la:OWNER UTHORIZATION TO Be COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize I INNL to act on illy behalf, in all matters relative to work authorized by this building permit application. ae onto Print Uwner's Nume(Flee tool tgnaturo) SECTION 7h: OWNERt 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 thin application is true and accurate to the best of my knowledge and understanding. � �C`�C1/\Cl' �--- Date P_rint wner's ur'Whuria:d agent's Name(Electrunte aignauud) NO'iES: I. An Owner who obtains a building permit to do hisrher own work,ur an owner who hires an unregistered contractor (nut registered in the home Improvement Cuntractur(HIC)Program),will nu have access to the arbitratiun pro train or guaranty bind under M.O.L.c. la?A. Other important information un the HIC Program can be found at www nius+ urv%aca In formation un the Construc(ion Supervisor License can be found at tww.ina>s. yIL} r When substantial work is planned,provido the it below: I'ut: Ittour.ues(+q. lt.) _____. —(includinggar:tga, tinisltedbaseinanVtttics,docksorpurch) IlabiGtblu room count _ t lro:: livin,arcs("stl. 11.) -- Number of bedrooms _._-- Nnmboroftireplaec, _-- _..._-- _ --- ----- Dud+cro(h.dE'b.uhs \Imahcr of b.tthrolmu ._-- - l inmbcrot ,lak 'I•uriltc+ _ . _-- [•.Iw. Cb.•.wug ;yucniot — `ido:cd pen i .. I'.,t it t Oyu u',- ut.ry he aih,ntnl,�I l;�r -I'�4.il l4�q,r.l l ,�,t" �OI ti Cho �— CITY OF Sm.&%f NLks&kCHUSETTS BUIMIING DEPAM.L&iT .3 } J • 120 W."HIINGTON STREET, 3"FLOOR TEL (978)745-9595 Este(978)740-9846 KINBERi EY DRISCOLL THobtASST.PiF.RRB MAYOR DIRECTOR OF PUBLIC PROPERTY/BUI DING CONLMISSIONER Workers' Compensation insurance Affidavit: Builders/Contractor.9/Electricians/Piumbers Antillcant information Please Prinj Le 1bl Name(13usii%4&organizaiiarulndividual): Address: 62 City/State/Zip: 0 Phone 1,53 r nu an employer?Check�he appropriate box: Type of project(required): 1•AFT'am a employer with 4. 0 I am a general contractor and 1 6. ❑Now construction employees(fall and/or part-time)." have hired the sub-Lontractorx 2.0 1 am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These subcontractors have 8. 0 Demolition working,for me in any capacity, workers'comp.insurance. 9. 0 Building addition (No worker'comp.insurance 5.'0 We area corporation and its. required.) officers have exercised their 10.❑Electrical repairs or additions 3.0 i am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§l(a),and.we have no l oof repairs insurance required.)t employees.[No workers'; (J.0 Other, comp..insurance tgtluiied.J •Any applicant that checks brat sit mutt ahw fill out the uctiaa below showing their"it=,compensatloo policy inflamed" /I hnnouwmas who submit this affidavit indicating they am doing all work and that hire outside contractors must submit a new aMefavil indicting such. :Gmtrmtors that chuck this box most attachod an additional shear showing the name of the subconlroctors and their warrant,wait,policy infmwtion. l ran an employer that Is providing werkers'compensat/on bssurance for my employees- Below is the pollcy and fob site inforrnallon. w ` insurance Company Name'— U� I-As t Q IN ) 1 Policy 4 orSclf-inn. Lic. N: /� C,-yUQ^,2U AC) (0f rl) pimtion Date: —0 Job Site Address: l 5— 5iic & S,cin eS . City/State/Zip., : X—ii-0 K4 t--\C SL5,07o ,%ttaeh 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 ot'4IGL c. 152 can lead to the imposition of criminal penalties of a ine up to S1,500.00 and/or one-year imprisonment,as well as civil pcnal8es in the form of a STOP WORK ORDER,and a tine of up to S250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Ofrica of Investigations of the DtA for insurance covcrage verification. /do hereby certify rr s abater/ns uud penaties ojprrJa - that the ht/l rmaden provided above is true and correaa � — OJ1tcial use euly. Do not wrile its this areas(a be completed by city or town ajj7clut City ar'rown: Permit/i.Icense x IssuingAulhority(circle one): 1. hoard of health 2. Building veparintunt J.Cilyfrown Clerk 4. Electrical Inspector 5. Plumbing inspector 6.Other Contact Person: . Phonelt: [ I � � CITY Uir' , L,I1;�J.5:1C�iUSE?'I'S t� / l'lLD4YC❑EP.IRT1tE`iT ; I I0 Vv..IiH A. GVGTO,V STtzFs-c, 3 FLaaR tQM0ERLcY DRISCOLL FV4(973) 7-W344 �� L1YO;i •I�lOSG19 ST.FIEdltB ON(Ecrait UP Pt:OLlc PROPERTY/at:MnNC COSL�ttSytO.YEa Construction Debris Disposal Aft7davit (required tur all demolition and r""Olon work) In acconlanca with tlta sixth edition of the State Building Coda, 730 CUR section I 11. ocbris, curd the provisions of MCL c 409 S Sd; ©wilding permit 4 is issued with the condition that thet debris resulting from this wUfl<shall be dlsposcd Uf in a properly licensed waste disposal facility as dcHrtcd by tYfCL c I 11, S 1 SOA. 1710 debris Wiill�ba tr,u3portcd by: (nama ut hauler) The Hubris will ba disposed ot'in (name or f]cdit�) (idJress of ra�ih ly) ipuuire ii p<rmit.ipphc.nu Proposal# 7112013 Page # 1 of 2 From: Steven Lamonde July 11,2013 SML Roofing & Roof Repairs, LLC 6 Felton Street Peabody, Ma. 01960 (978) 531-9557 Job Name: Souris To: Mr. & Mrs. Stanley Fudala and Ali Souris 15 Jackson Street Job Address: 15 Jackson Street Salem, Ma. 01970 Salem, Ma. (978) 869-3853 I hereby submit specifications and estimates for: Approximately 29 Squares of a strip & a re-roof of shingles including the roofs cap. Shingles I will first begin stripping the 1 old existing layer of shingles from the porch and main roofs, except for the elevator shaft roof as requested and then I will de-nail the roofs as well as nailing off any loose boards. I will replace any rotted roof boards up to 48' or any rotted sheets of plywood up to 8' (1 sheet) for free and any additional board replacements after the specified amount will become an extra charge on the final payment with prior notice. Board replacements after the specified amount will cost$4.00 a foot to install plus the charge per each board. Then I will apply an ice & water shield 3' up from the roofs bottom edges, in any valleys and around the base of the 1 existing chimney after I re-lead it using 12" lead. Then I will cover the remaining opened areas of the roof with rolls of 15 felt paper and I will nail down F-8" White drip-edge to all of the roofs perimeters to match the elevator shaft roof. Then I will begin to re-roof with new 50 year GAF Architect shingles by Timberline in the color of Weathered Wood. I will re-use the existing copper flange, 4 existing vents along with new Karnack for a water tight seal. The flange and vents are still in good shape and it saves you the home owner some money. Then I will install new 3-Tab cap to match where needed. Unfinished attics: If there is attic space that is unfinished with personal belongings that may be affected by the debris that can fall while stripping the roof you may want to remove or cover them for your protection. If you do not have tarps or drop clothes we can supply you with some if needed. SML Rooting is not responsible for any damages that can occur to stored items that were not previously removed or covered prior to the start date. _ _ J Page #2 of 2 Prior to receiving written permission to do the Job we can't physically remove shingles/060 during an estimate to know how many layers are currently on the roof. This could contribute to more water damage to the interior or it may cause new leaking. Therefore we will use our professional judgment to price accordingly, if any additional layers are encountered when stripping the roof you the Home Owner will be supplied with photos if, you are not available to view the additional layers. We will add the additional charge per square to the invoice. All material and debris pertaining to this Job will be supplied by and removed by SML Roofing & Roof Repairs, LLC. This Job comes with a 5 year guarantee to Ali Souris. These terms above to be voided in the event of new Ownership, and or if any future work is to be done to or on the above areas mentioned in this proposal, unless done by the said Contractor. I hereby propose to furnish labor & materials-complete in accordance with the above specifications for the sum of$10,100.00 Ten Thousand One Hundred Dollars. With It (o, payments to be made as follows, a deposit in the amount of 1/3 $3,367.00 for the stock and the permit will be required in advance along with the signing of this proposal in order for SML Roofing to start this Job. When 'h of the job has been completed another payment in the amount of$3,367.00 will be due. The remaining balance of$3,336.00 to be paid in full upon the completion of this proposal with extras if any is requested by Ali. I?Z) C�.\6-ti _A LA , IpD If this proposal is to your satisfaction and you are accepting these specifications and conditions along with the payments to be made as follows, please sign and date then return Our signed copy with the deposit to schedule. Upon receiving the deposit I will pull the permit to start ASAP. (July of 2013,weather permitted). X Accepted Signature: S�ah X Date: T l 1i Contractors Authorization to do the work as specified,:Steven La nde. Please keep this copy for your records. Thank you in advance, Steven Lamonde SML/tdl 'CQ CERTIFICATE OF LIABILITY INSURANCE 7/16`/20 3" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTL A CONTRACT BETWEEN THE ISSUING INSURER($), AU HORRED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: I tM dsrUflCA"hOWW Is an ADDITIONAL INSURED,the P01"lea)mast be andomad. N SUISRO"TIoN IS WAIVED, I,04act to 04 tiNht and cOr1NI01111 Of IRS PW".C"In POR CUTS"ragL#m an NWIn samenl A 0damem On dds c*r0 Cato does mn caxfar nom,to am eertlft a holder In Ilse of such woo s). 40DUCER =OLMY INSURANCE AGENCY INC (978)774-2463 Nf:(978)777-8415 123 sylvan St 3anvers, MA 01923 � annmepat wrpAOWp tavmRAOE Nucs INSURER A:AIM Mutual Ina. Co. SURER SML Roofing 6 Roof Repairs LLC INSURER B;ComfDerce ,NSURERD;Max "cis ty 6 Felton Street INSURER D: Peabody, MR 01960 INSURER E INSIRtER F: 3VERAGES 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 ANY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN M SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I TYPE OF INSURANCE MID POLICY NVIANA. UNITS GENERAL UABILfTY 7/12/1 ��nAcv ENCE f 100,000 X COMWRCIAL GENETR.0 UP UTY E 50,000 cwMsaADE � OCCUR o vamt s 5.000 113700007752 1/12/1 DvlwuRr ,s 100,000 GREGATE s 200 000 OWL AGGREGATE LIMrr APPLIES PER: OWYOP AGO f 200,000 POLICY 17 PRo F7 Lin s AUTOMOBILE LIABILITY Es ecddanl ANYAUTO BODILY INJURY(PW oelwnl f 20,000 AUTO$ x SCHEDULED AUTOS BODILY 3f14/1 3/14/1 BODILYINAm7(FWmddem) f 40,000 HIRED AUTOS AUTOS NED PftOPat ar"Il s 100,000 s UMtAYtLA LIPS OCCUR EACH OCCURRENCE f D[CESS LIAB O-.UMS•MADE AGGREGATE $ OW I j RETENTIONS f YNORRERS OOMPEK APON AND EMPLOYERS LIABILITY YIN ,,,,• PRovrnrTOR,PAarNr t&cTmvs M11 AWC-400-7020642 2/24/1 /24/1 E.LEACHACCEENT f 100,000 FI OCEPAIELSF3R E VOFOT E.L.DISEASE-FA EMPLOYE] t 100 000 I u~M M w11 L»unv EL.DISEASE-POLCY UNIT t 500,000 OF OPERATIONS Sala. t )ORFMN OF OPERATIONS 1 LOCATIONS I VEHICLES (Atech ACORD tOr,400"n R&nWa Se tft tt owls R Ir rapArvd) )ofing RTIFICATE HOLDER CANCELLATION Mr 6 Ire Stanley Fudalla SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 15 Jackson St THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Salem, Ma 01970 ACCORDANCE wITH THE POLICY PROVLSIONS- AUTVgRI]EO TATIYE ®1988-201 D ACARD CORPORATION. All m"reselvad. ORD25(2010M) The ACORD 1Tame and IOW are registered marks of ACORD NIn.•arhu1eti Dci,anmcnt ; ( Puhlii Bnanl of Buildin Rr_ulali fI, And �i;unLu d • Construction Supervisor Speciaity License License: CS SL 99962 _ Restricted to: RF rxf STEVEN LAMONDE 6 FELTON STREET PEABODY, MA 01960 i Expiration: 10/22/2013 f iiuni_,,..n�r Tr=- 5473 i,. 41,,,,,,,, Office of Consumer A lla i rs& Buei ness Rey�_ I,nlalion License or registration valid for individul use only li �(OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �egistration: 168689 Type: Office of Consumer Affair and Business Regulation x - `expiration: 3/20/2015 LLC 10 Park Plaza-Suite 5170 SML ROOFING& ROOF REPAIRS LLC. Boston,MA 02116 STEVEN LAMONDE /�/^}//� 6 FELTN STREET ggg���IL PEABODY, MA 01960 flndersecretnry Not valid wit out signature