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357 LAFAYETTE ST - BUILDING INSPECTION (3) A i -1 N- l/ qX1 (p D The Commonwealth of Massachusetts R6�&I�hEU ° Board of Building Regulations and Standards INS ECTf�11�14 SER ICES Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish all 4 AUG 28 A S One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: 61,6114 Building Official(Print Name) Signature ate SECTION 1:SITE INFORMATION 1.1 roperty Addr s: g 1.2 Assessors Map&Parcel Numbers 1.In Is this 5n accepted street?yes i---no Map Numkr Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 Building Setbacks(it) 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?Check if yes❑ Municipal❑ On site disposal system 11 SECTION 2: PROPERT O ERSHIP1 2. Owner f Record: -Q Name(Print City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ I Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Bri Descriptio of PAP p ed Work'' Ue Uw Sl >u SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only 1.Building $ <27 00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cosf(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (BVAC) $ List_ 5.Mechanical (Fire $ Su ression Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ��S© (?U ❑Paid in Full ❑Outstanding Balance Due: t a SECTION 5: CONSTRUCTION SERVICES 5. ons tctio e i or ense(C License Number Expiration Date of CSL older 1 1 y R ' List CSL Type(see below) �d No.andRaftt ©L Description U Unrestricted Buildin s u to 35,000 cu.ft. GI own State ZIP Restri tied 1&2 FamilyDwelling M Maso RC Roofin Coverin WS Window and Sidin SF Solid Fuel Bunting Appliances I Insulation Tele hone Email ad ss D Demolition e 'stet (Home t oven utCo tra or(HIC)a9 att a ^ or Re e HIC Registration �Number Expiration Date o treet A' © 9< Email address t /Town,State,ZIP _Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(Q) 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 ...........2� No...........❑ SECTION 7a:OWNER AUTHORIZATION`TO COMPLETED WHEN OWNER'S AGENT OR CONT TOR A SFg!ABJ4LDINGPERMJT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work a ri d by this building permit application. �. Pnnl Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information cent ed in t ' application " true accur a to the best of my knowledge and understanding. Print er's or Authorized ent's N 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 w•ww.mass.goe•/oca Information on the Construction Supervisor License can be found at www.ma:s.gov/dps 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" l ` CITY OF SALEM, MASSACHUSETTS tSl. Ri BUILDING DEPARTMENT 120 WASHINGTON STREET,3' FLOOR TEL. (978) 745-9595 KIMBERLEYDRISCOLL FAX(978) 740-9846 MAYOR TrIOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER 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 c40, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transpoottrtedd, by: (name of hauler) The debris will be disposed of in: (name o facility) I W (address of facility) Signature f applicant Date Massachusetts-Department of Public SafeSy Board of Building Regulations and Standards Construction Supervisor License: CS-045529 7-0JOHNSPOLIZZO41► - 220 very MA 19ZDIV HGN Danvers]t1A 019I3 4'} { Expiration Commissioner 10/31/2014 I .. Vx��auvnrairaea�(fv o��rrv,urc�«aelA ffice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type. gistronon 115467 Private Corporatior xpirotion 1I3012016 E F#3 r J.P.REMODELING AND CONSTRUCTION,INC JOHN POLIZZOTTI ;`:- . 220 YANKEE DIV HYWY,::, . DANVERS.,MA 01923 Undersecretary 220 Yankee Dimion Highvay free PAiulatey Danvers, MPS 01923 cJ�' Gef720Ce�% hicenbed and Inured cL• 17Pf1.5',hYIC(LO/L; ��LC. hte,fachu€ells t]eme hiprovement Conhuetor MD467 R POSALS IU>III'1'Ln (978) 777-7634 b Fax (978) 762-7606 r ors. ,tune Ericson 7$9' 254-3056 �-t4 14 \IAF.hT i '.6\E A57 Laffette Street roofing, 1 x8 Azek facia board, crown CITK.STATEnntl LPCOM: Ton LOCATION Sa 14A-W970 ame We heresy a rout spcclttcations aml wdragtes on: Left side gable end- repair damaged crown moulding, rake, Azek 1x8 facia boards caused by squrrels, prime & finish paint customer to supply paint. $1,750.00 !. Install 1/2" substrate over existing metal roof with screws & plates. Install black rubber, 100% glue down. Remove existing siding & reinstall. Install white alum drip edge where needed & 6" cover strip. $2,000.00 t. J.P.Remodeling & Const. will; A- issue a copy of insurance to owner & pull permit. B- be responsible for all waste from above work only. Contactor obligated to igfornt Customer of an,and all seens'dry perm f,and to anti In said ,,ouu,C eta n.n wl to onto , "'moil c,If b,n"advl 6n n The uam lac and r>Iv e G.n.La,,Ch.lad Wee thousand seven hundred d 16 ha "—'waplete in aeon.ace"i'l,ahn,,",iwconn,.i one on nc $3,750.00 'aymeta to�e/ja`le�f_lon',: 1/3 deposit $1,250.00, 1/3 start of work 1,250.00, balance on completion 1,250�0 tan date:�dW 2014 fa,,of Fubnan el cer, lesion 4 d ys II material is g area,eed to be as specified.All work to be completed In a ,oak nadike manner isco,ohn,I. t Ida d nallice,AI y clebeando or dalorli u .tin active sp ih tons involving earn cous veal be executed only,per written Anahern,oi Siu elc,e rder, aad will become gn Ann charge over and above the cebrull, All go"Inems contingent upon strike,inciters or delays bey and our control, leeeptanee of Proposal Tha above lave, pu nfion Tin and -- Do flat sign this contract if there are any blank spaces caulanan,at., ed fa for a d are he by accepted You co,aundaiz in do the ok',s'pcuf d Payment will be Tort a,oudinel ahove. S'e t rc Anne,of AnIqua c (J � Custofner has legal right to cancel contract within 3 days of acceptance :onnnetor shall perform the wink in oo m nfarance suc with h s a plannd specifications.if any. is have Contractor shall not be liable for any delay slue hit ciocuris ancc beyondits connl including strikes, can provided by the owner or the contractor,which plans and specifications shall be deemed casualty or general unavailability of ini croak or the dis'ovcry Tit the condilions or defects upon the sin Temporal into this contract by reference,and will dose,in a workmanlike Internet.Contractor is c r in the sramac,)Trent,not known to the Contactor all the tilne ofcxecwion of Olk contract and of responsible for performing any work not specifically refen'ed to in this contract, which may be d3Cocemd daring the course of the Contractor's completion of the work.In addition,this I the event any'installment is not paid when due,contractor nmy stop work without breach until nwu r ackn tvledges and,•lac..that in ceuaun remodelil g ark the der,il 11.n of portion of the pre- ayment is made and for five(5)day,thereafter.In the event any mnallment is not paid within ten t11,11 existing mnetr I ac olds cereal additional defects.condition,ur the need f ad,iliomd work which roBt aye after It is due.Contractor may,at its option dean this contract terminated by the owner and fluty be repast d dl e cud 01 Curried Out I.rodeo to cnmmence or c sal Isle the m crk called lot In Ibis Ike such action as only be necessary.including initiating legal pt'ocinalings,m enforce its rights coalr,t In su h ose tic Owner agre•s that the duration of the work and or,'el"dul"I date of ,rounder At all times during construction,owner shall provide add maintain free and unobunmted e.mpletu n n,v very tT.w that which Try be set fotlli fiction,and Owner avocr,csecutC r'hang.,. 2esss to all areas of the site where the work will be performed and shall provide,at owners song order de Tiling The cost and_cope of the additional word necessary in repair,copeet or tdlensuch spume,water and electrical service,including 220 amp nutlet I I I . , olditionel defects'and condition, 'collector shall not be respa u,blo for claims for damages to persons or property occasioned by owner Contractor wcounts ltl work for a ruled of 36 months follaving complatiman JPREM01 OP ID: PA CERTIFICATE OF LIABILITY INSURANCE °AT 07124Dn,YYY) o7fzana THIS CERTIFICATE IS ISSUED AS A mAI I ER OF ::,FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICPTE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED E:Y THE POLICIES 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 endorsements. PRODUCER 978-744-6715 CONTACT AHMED Insurance Agency, Inc. NAME: PO BOX 449 978-7411.0127 PHONE PAX C No Exit. A/C No: Salem,MA 01970 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC It INSURER A:Scottsdale Ins Co. INSURED J.P. Remodeling&Construction John Poliuotti INSURERS:Associated Employers Insurance 220 Yankee Division Highway INSURER C: Danvers, MA 01923 INSURER D: 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 P LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYYI I fMM)DDJYYYYJ UNITS GENERAL UASIUTY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPS1544256 05/08/14 05/08/15 PREMISES Ea occurrence) S 100,00 CLAIMS-MADE 1_x I OCCUR MED EXP(Any one person) $ 5,000 PERSOB ADV INJURY $ 1,000,000 IGENERMALAGGREGATE $GGREGATE $ 2,000,000GEN'L AGGREGATE LIMIT APPLIES PER: -COMP/OP AGO $ 2,000,000X POLICY PRO LOC $AUTOMOBILE LIABILITY SINGLE LIMIT $ANY AUTO RV(per Person) $ALL OWNED SCHEDULEDAUTOS AUTOS URY(Per accident) $HIREDAUTOS NON-OWNED PROPE 'AMAGE AUTOS Peraocident $ $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILITY X B ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N WCC5011421012012 10/18/13 10/18/14 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 0 yes,atory In under DESCRIPTION OFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Payroll- Owner.28,600 employees- $6,000 Subs$5000 CERTIFICATE HOLDER CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 120 Washington St. AUTHORIZED REPRESENTATIVE p�— ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CCI'Y OF S:U Em, A-USACHLSETTS a BUILDING DEPART\IE.NT I?O \X/.ASHL�1(:TON STREET, 3w F100R T TEL (978) 745-9595 F.--X(978) 740-9846 KI.NtBERLF-Y DRISCOLL THoNw STTIFUME "AAYOR DIRECTOR OF PL'RLICPROPERTY/BIaLDf-NIG CO\LMRSSIONER Workers' Co npensation Insurance A171davit: Builders/Contractors/Electrlcians/Plumbers Applicant Information case Print Lelzibly Name IRwiness Organization'IndiviJual j: Address: City/State/Zip: Phone #: Arc you player?Check the appropriate box: 'type of project(required): I. 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction dmployces(full and/or part-time).* have hired the sub-echrimctors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t ?• ❑Remodeling ,hip and have no employees These sub-contractors have S. ❑ Demolition \vurking for me in any capacity. workers'comp.insurance. 9. ❑Building addition INo workcn''comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.❑ Electrical repairs or additions J.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself.[No workers'sump. C. 152, §1(4),and we have no 12.0 Roof repairs insurance required.) t employees. [No workers' comp. insurance requirclij Il.❑ Other •Any applivatn nul checks box 01 mwt ilia rill out the scctiun below showing their wotken'compensmlun pulisy inY,rmatlon. 'I lamuuwncn who.wbmil this sttirblvit indicating ihey art doing all work and then hire umside mninscars most fuhmit a new altldavil indicating such. Cnnnclun lhol check This box most anac d can addaiurul.hwa showing the mmne of the subaunincWrs and lholr worlten'comp.Pulley iniurmalion. /ant an empluy'er that ix pruvid n Pork r 'con a adan in.rur�nee for my unpluy $s. Be/ !is dre !ry mrd fob rile Insurance Company Name: d Policy it or Scif-ins. Lie. 0: 4 -__. &Y/Srutcaip: xpiration Date: 1 Job Site Address: 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 ofcriminal penalties of a line up to S1,500.00 und/or mu-year imprisonment,as w'cll as civil penalties in the form of a STOP WORK ORDER and a line of up to S230A0 a day against the violator. De advised that a copy of this statement may ba rurwarded to die Miieu or III\'1911gall lilts of the DIA r°r InSafallCe l'U Verlge vC(IIICa11Un. /du bereb c• dfy rut ee the puin.r d l enal es u pr jury that the h jrannution provided ubuve iv true and correct. S i,n I re' 2D:Ifd: Phoned: ✓ — 011hiul use un/y. Do not write in this area, to be completed by city or town ojjh•lut • I Ciry or'fuwn: Permitfl.lccoae p__, Issuing Authority (circle one): --- --- --- 1. board of Ilealth 2. I)uildln„. Dupastutew J.ciiylruwu Clerk J. Electrical Lupector 5. Plumbing llupcctor 6. Other I Canlact Person:,_---..__.--_ .. ._.___.___ Phone!:_