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196 JEFFERSON AVE - BUILDING INSPECTION The Commonwealth of Massachusetts (� Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, T°edition OF SALEM i Revised Junuury Building Permit Application To Construct, Repair, Renovate Or Demolish a �• =t/t�Y One-or Two-Fumi v Dwelling This SectigRIfor Official Use Only Building Permit Numb Date Applied: t rL2�! r l (7 Signature: S ` Z%J' L BuildligCommissio IL15n for of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Number 19G vEEFeasotii 4U I.la 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 11) Frontage(11) 1.5 Building Setbacks(B) Front Yard Side Yards Rear Yard Required Provided Required Provided Requirei 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? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if es❑ p y SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownerr of Record: L1A/DITR ZF—PA `Z 196 :[EFFi 95nd ALAI Name(Print) Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Descri sed Work'-: 041 =te SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Omclal Use Only Labor and Materials I. Building S I. Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (fIVAC) S List: 5. Mechanical (Fire S Total All Fees: S Su ression Check No. Check Amount: Cash Amount: 6. Total Project Cost: S 6"0OQ ❑paid in Full 0 Outstanding Balance Due: 4 r SECTION 5: CONSTRUCTION SERVICES 5.1 rL-i 3 Licensed Construction Supervisor(CSL) � � 3 AOJTf AIC' :�"/.L-LO License Number Ispiration Date Name of CSI.• I folder ( I List CSL Type(see below)�_ 3y /UNiNCS C( Z Address r)PC Description L,q Y D/C�� U Unrestricted a to 35,000 Cu. Ft. ( ( R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential Roaring Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) /0!5� / L'3 I IIC Com any Name or HIC Registrant Name Registration Number rCi,=l-o s cam,rizoc-7- t o.c/ 9- �� _ ( p AJJress3 NJ�lV[bIGS C(R 97g531oF1/ Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152.1 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 ..........0 No...........O 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 1, 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. Print Name /SUS Signature of Owner or Authorized Agent Date (Signed under the pains and penalties ofPerjury) 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 HX have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations 1 I O.R6 and 1 IO.RS,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 Ito�rUoi=lPrtllUnle'ltttaithfioro�t�'(I4ti7(iit4K"�:: ' HOME IMPROVEMENT CONTRACTOR Registration: 108953 . Expiration: 8/28/2010 Trif -273838 Type: Ltd Liability Corpor ....:OF CONSTRUCTION- . -, -s'_st.no Maio 34 JENNINGS CIR . Pcabody. MA 01960 - Admiuistr qnr. \] n.uhuaii. Ucp a tlnutl of Publtt laicTN 9l Board of Butttlm - Ri ul itiuns and sIantL• r& - License: CS W393 _ - c`a i Restricted to: 00 'y FAUSTINO N MELO . 34 JENNINGS CIRCLE 3` PEABODY, MA 01960 6„�_ _may/� •< Expiration: 3/11XIII Tr,: 12192 ACORB® _ DATCjMrmDDrcrrT) �� CERTIFICATE OF LIABILITY INSURANCE 12/4/2009 PRODUCER (978) 532-5445 FAX: (978) 532-2217 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B.K. McCarthy Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 10 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Entrance i Peabody MA 01960 _ INSURERS AFFORDING COVERAGE j NAIC# _ I+suaw j,S .National Grange Ins Co Melos Construction LLC National Grange Mutual Ina Co�i4Tee c/o Faustino Melo .. +; gD_Travelers Indemnity of - - a56s6 34 Jennings Circle NS RD. Peabody MA 01960 '.N,LR—Re_--- ------- ------- COVERAGES ='OL!CIES CF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING REC+_IRc°I;tN-T, TERM OR CONDITION OF ANY CONTRACT OR OTHER OCCUTAENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR �,•_v o-RT_t+) 7HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH =C'!CsES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CiAIMS- 1 SR I;oSL POLICY NUMBER POLIC WPE OF INSURANCE CA Y EFFECTIVE YYI;GATE M %PIRATION! LIMITS GENERAL LIABILITY EACH OCCURRENCE $ X COMMERCIAL GENERAL LIABILITY ; _ FUAMAGE TORE-,PREMISES Meocwrrgnce) 500,000, A 1 INS MADE IX OCCUR B23862 11/26/2009 I11/26/2010 MED EXP(Alg one person) S_ 10 000 �._ _ PERSONAL B ADV INJURY $ 500_000- _.__--.- GENERALAGGREGATE —I�S 1 0001000 p- N ES PER" - - - � - jPRODUCTS-COMP/OP AG_G j $ O�-� SHODOO f X - -_� COMBINED SINGLE LIMIT $ (Ea smident) B __ x9Y.43926 ( 9/21/2009 9/21/2010 IBODRV INJURY � g 250,000 X _-- - )(Per person) --- X SODILY INJURY } P.r.md. H 3 500,000 PROPERTY DAMAGE Ib (Per ecoWent) AUTO ONLY-EA ACCIDENT $ EA ACC b OTHER THAN i AUTO ONLY: AGG b EACH OCCURRENCE $ _ j AGGREGATE IS C '.-­ KFAS. M.7EISATION- iVIC STATU- ! BOTH YD EMPLOYERTLIABILITY _SORY LIMITSI ER I YIN i !_-TOR RTNERIEXECUTIVE FEL FACHACCIDFNT 11000,000 OFF I,. R/M MSER EXCLUDED? IMxndatory n NH) �IBOB7B34DI46509 i 12/4/2009 12/4/2010 j E.L.DISEASE_EA EMPLOYEE S 1,000,OOO descfa+e Nmder S..bktAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 1.000.000 OTHER 1 i ...+ES'EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION =L'rooses DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL IO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 3 REPRESENTATIVES. 1 AUTHORIZED REPRESENTATIVE I - John McCarthy/LG4 ACORD 25 (2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 -;;,; - The ACORD name and logo are registered marks of ACORD - CITY OF S.U.E.ti[, NOWSACHUSEM SL ancgG off.cl niENT 120 W.AMCNIGTON STREET. )a'FLOOR T= (971) 743-9599 F.tx(97Z9 7�4961ti KINE30 if DRISCOLL it OMSST.PQIu1s HAYO(L DIRECral Of R OLIC PROPERTY/K aDNG CO-%*M %EA Wurkerst Compensatloa Insurance AMdaeit: Ouilden/Contractors/BleetriclrnalPlnatbers a lnllcant Inrnrmatl0011. / Please PrIM LuM vatnd leeurrnaOrailnrralionlnJv.daall: /Y��=L(�`S COnf S'�i?U�?iQ /1/ L.L.G City/5tatelZijte'rr-Aena y i/�� 4i9/d rlwn. �' 7 fs Des r FIND M you ao ompioyw?check the apeP m rkse be Type orprojeek(►a9rlr : e gramacmpbaywwick 1. ❑ 1 ant a practical comreeter ored 1 d. ❑Nor consauetion am yc rtco(Nu and/or padanal.• have hied tie atbmmtwasaws 1am a sole prsprias ofPunta• limdan lheasachad spree t y. ❑RamalNins +hip and have to employees TheseFAIcontrsnsrs have L ❑Domoadc n warkily for main any capacity „'Oka'Ca11Flanasaca 9. ❑Buildng addition workers'coop insurance S. C> We'w a cerpaa- and ix I0.0 abeftical raps"or addidonto h9ul�) 0f11:m!have ctondaW chair ).❑ 1 am a haasaownw doing ad work ^III a/atnarlpeis Pm IMOI 11.0 Phunsbing repairs or addkterta myself(1,40 workers'carp, t 13%L 1(4}and we haw to 12.0 Roof repairs incurattcn r"Wrical a emild n , lme ems' I J.❑Otker cornµ incursions re4lkd.) •nq apsaos Inr1 east Do of nnlra mire no wlt an saaa=tallow aawlee udr+.tfaa'owAanaloo peMryb ��n ■rda '16r ,do arpo oe YdiNllne 1ho ore dome as aetb and deo No si ecowsats~wihna a eon allhbls Whodea aei :C.'WWYA o AN as Nor dda ban Brad alreraaa r 2"WWW A"Aorlq Can,lswe of An w► 0MMOM d Ask wwaNa aeey.p111"iarslN M f rue oe 00WAarw(am ispodr/big IwNbers'eew/ueaarlaa/asareAOlfbI av rMd+Y«a Aetna AP/AVPA*7IW/hd JIM ie/«ter&^ � Insurance Company Name:E' 1 Ac 1<A' grb x .�"lily Z)/G. rmicy o ur Self-ina tic A* 1 14 UB`7 8/ N M q 6 S/7 ! Evpiracion DaW.. .1a " 'f— /12 Job Site Adthse I C yt f C Qn I Cary/JlatrZipe �/`7 �/9 U 7v .waeb a copy of the Workers'compensation policy dulvatlsa pop(skewing IM peft asmkar,and esplrealen draft)6 Failure to sswlat coverap as rltquired under lecdon 2JA of MOL a. 132 w lead to tho Wposidois of criminal pancems of r1ne up to S l.J00.00 aml/or ono-year imprisenntemr as well m civil penahMs in do form of a STOP WORK ORDER and a fleas .If up to 51J0.00 A Jay iWiast the violator. lie adviw:d chats copy of this slalenwm may be forwarded to the 0111ee of I1lccallaillYN of Jso nlA for insurance covcrap v.•nfkaliou. 140 hereby rrrM�� rho print Yad�"�6W elpwiNvy rAdw'At infwMflaw yrari/.rd u&~is true dad a wires P`ut:e,l: 978 _5 / tooll OJJf.iel Y,r mdlt A0 nor suits he this rrrq to N.Ympk/d by rily or reins.r//i•iad city orrulvn: Awint.\whorlty (circle wscrp I tluarJ rtllrallb 1. Hwhling Mpirtment I. C'ilyfrowa Clerk I. flaclriril Inspector f. Plunsbme Inspector 6. Ulher _ C•�nl act Person: _ _ Phone a: CITY OF SA LE M I PUBLIC PROPRERTY DEPARTMENT \I .,•'M IT isIpilf T it Jill M.\I.\"\I IIIJ1. -1•r•• Construction Debris Disposal Affidavit (required lur all demolition vtd runovatiun work) In accunlane with the sixth edition of the State Duilding Code, 780 CMR section I I I.S j Debris, and the provisions of MGL c 40, S 34; is issued with the condition that the debris resulting from Ouilding Permit N 4cenal-d waste disposal facility as dafined by MGL c This work shall he disposed of in •a Property 1 11. S 130A. The debris will be transported by: Ills ul•hauler) I'he debris will be disposed of in © �./ -r 12 An15 Fc'lZ S Tfk i ( rl� (mane Ul Willy (aJdms of Ixlhly/ + anamre,lf Iturmir applicant date 6) Melo's Construction LLC $$$ 34 Jennings Circle Peabody,MA 01960 xir=s Telephone: 978-531-0811 - E-mail: FaustinoMeloCalmso cone mt.tr.art.al NI/MdiR Fausdno Melo,General Manager Unrestricted Mass Builders License No. 80393 Contractors Registration No. 108953 In.4 - / e ��' CQity,State,sad Zip Cade Job Description: Job Location: Job PhooE: CO fc- <,� Ong ' O We A°Pn*ed hmeb5'ro aosiA emtrrieb and hhar•oompkre m soombnae with the apeo6atima fisted bebw,far the mien of S ;h !Nnn ra rV 07 Od/i o -- � ($ n 10 Installation orPsyments: Psymmb will be paid in thuds.The rest oretalhnmt will be paid before the job begins,The second payment will be obtained in the middle of the job.The last payment will be obtained attm the job is completed Note:This proposal may be withdrawnor by us / if n accepted within 20 days. Authonmd signature: Date: e HeMy @ieh 8peeta wirer anal Er"ehs for THE INSTALLATION OF A NEW ROOF To protect the homeowners Property,Blue Tarps will be used to cover the siding,bushes,and grass during stripping. All of the layers of roofing will be stripped,and all protruding mils,screws,and/or staples will be removed Ice and water shied will then be installed at the bottom of all edges .around all chimteA skylights,and into all valleys. Fifteen(15)pounds of felt Paper will be installed onto all other eras of the roof leck. The 8'•aluminum dripedge will then be installed to all roof edges. Any existing pipes will be covered with new rubber flanges. The rooting material to be used will be �p y /e r2caTi • r// The homeowner is responsible for the selection of the roof color. Also,the homeowner may select ether hand or naminatic Milan for the nailing application of the new roof. All the debris will be d aned and maeriv disnmrd of on a a ao basis your Proper - — Magnetic brooms will be used to extract all mils from We will protect your Property as best as we can,however,some ras foil age matting, cur a . or marring could oxen. We cannot accept responsibiltY for possessions inside of the house,or debris falling into attic e . The customs Extrin WOM new an additional cost win the a Dve price. Replace Rotted Rooftbards u 7 F nT Gutter Repairs REMOVE Aluminum Siding Relead Chimney(a) Install SkyWs) Remove Old/Rotted Wood Replace Facia Boards Repoint chummy Install Garage Roof install Roo Roof Install Roof Louvers Install Aaek Board Install Insulation uvers Install Window Trim Install Tyvek Paper histall Aluminum Gutters install Shutters Aluminum Cover Alnum Windows Install Aluminum Downspouts Remove Vinyl Siding Repair u Siding Install chimney cap Additional NotNotes: Porch Repairs Rebuild Chimney Total Amount for Additional Work: Warranty by manufacturer to be five of defects for years, see mmufecrurces ww anty for details. All labor performed under this contract shall be of good quality and free from defects not inherent in the quality required or Of O permitted fora period �_yarn. This Warranty exclude remedy for damage or defect caused by abuse,modification,improper or inexufficem maitenance,improper operation,or normal wear and tear under normal usage.This warranty shall be limited to the work Performed by Melds Comtructi m,LLC and limited to either repair or replacement by Melds Construction,LLC at its sole descretion and election. Any and all claims are waived unless made in writing to Meld5 Construction,LLC within 21 days after the occurrence of the event giving rise to such claim. This wartamy shall not extend beyond any limits imposed by applicable law. . Payment and Penalties-UPon substantial completion of all work under this contract,customer shall-within 3 days-make the foal and full Payment of the contract Price.Any and all unpaid balances shall accrue with interest at 5%interest per mouth. You agree to pay all nowt vests and collection expense ioairrad by Melo's Construction,LLC in the collection amount you Of any=mown you owe wrier this contract,including and without any limit Lion of reasonable attorney fees. Acceptance of the PropaaaL• The above Prime, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified,payment will be made as outlined above. Payments are to made as per requisittion and or invoice. The Proposal may be withdrawn within 20 days. - pta _ Date or Acceptance- ;,+ Signature l ..