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359 LAFAYETTE ST - BUILDING INSPECTION (2) / Che Commonwealth ofMassachusetts iNSPECTIG AL GYYWES Board of Building Regulations and Standards SALEM / Massachusetts State Building Code, 780 CNIR Revi¢cvJ.iJ�{r (�1l tlI; A PqT t 1r 44 Building Permit Application To Construct, Repair, Renovate Or De s One-or Tivo-Family Divelling This Section For Official Use Only Building Permit Number: Date ppliedt Building Official(Print Name). Signature . . Date S CTION 1:SITE INFORNIATION` 1.1 Proper2LAddr s: C1 1.2 Assessors Map&Parcel Numbers GG I.I a Is this an acce fed scree . yes no Mop Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy Il) Frontage(It) 1. Building Setbacks(R) Front Yard Side Yanh Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.L C.40,9.)4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal O On site disposal system ❑ Public❑ Private❑ Check if Yes13 SECTION2: PROPERTYOWNERSHIP" 2.1 Ot rdaf ecord: JC r e(Print) / City,State ZIP No.and Street Telephone Email AJJnsg SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑Mcupiedairs(s) Altemtion(s) ❑ Addition ❑Demolition ❑ Accessory Bldg.❑ Other ❑ city: Brief Description of Proposed 1VorV: .r SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials) - I. Building $/Z C L Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costj(Item 6)x multiplier x 3. plumbing S P Qther Fees: S 4. kIcehmtical (tivi\C) S List: / 5. :Mechanical (Fire Total All Fees:$ Suppression) Check No._Check Amount: Cash Amount:_ 6. Total Project Cost: .S to v ❑Paid in Full ❑Outstanding Balance Due: k •C . C. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Dale Name of CSL 1Jolder � List CSL"type(see below) Nu.:m Sued Type - Description . U Unrestricted(Buildings tip-to 35,000 cu. 11. R Restricted I&2 F;unily Dwelling City/fuwn,State;Z'IP M Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances c I I Insulation Telephone Email address D I Demolition 5.2 It reed Ho a Ira ro ontractor(HIC) V// o �e r1cHIC Registration Number E.vpiru I IIC Cuntqny nme Y 111 Re ' e Nu. Email address Cityrrown,State,ZIP �J Telephone / SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L:c.152.§25.C(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 ..........❑ No........... ❑ SECTION 7a;OWNER AUTHORIZATION:TO BE.CONIPLETED.WHEN OWNER'S AGENTOR CONTRACTORAPPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize Zn / t9 act on my behalf,1 11 atters relative to work authorized by this building permit application. Print Owner's Nance(Electronic Signature) Dale SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION By entering my name below,)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. d / /" T Print Owner's or Authorized Agent's Name(E ••trunic Signature) Dale 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 rr�i have access to the arbitration program or guaranty fund under 1I.G.L.c. 142A.Other important information on the HIC Program can be found at wwvv mass.eov'oua Information on the Construction Supervisor License can be found at wwwai� _ 2. When substantial work is planned,provide the information below: 'total floor area(sq. R.) "A .(including garage, finished basement attics,decks or porch) Gross living area(sq. I1.) 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_ 1. "1"oral Project Square Footage"may be substituted for"Total Project Cost" aN Office of Consumer Affairs and Business Regulation u0 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 166565 I-It��. r; Type: Corporation ��. a;s „ Expiration: 6/9/2016 Tr# 251720 A.C. CASTLE CONSTRUCTION CO,�i:t�( 4-- BRIAN LEBLANC -; 9 TIBBETTS AVE a, �:a 1,-,F;; DANVERS, MA 01923 "- _ Update Address and return card.Mark reason for change. --'" ❑ Address Renewal ❑ Employment Lost Card SCA1 0 2aM-OSA1 C-��ie 10a'mmzomuseas�e a�C�aaaar,�iuoella Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: W -egistrahon i166565 Type: Office of Consumer Affairs and Business Regulation xpiration W061fi Corporation 10 Park Plaza-Suite 5170 �E. Boston,MA 02116 A.C.CASTLE CONSTRU f',IO6vI CO_ -INC. �. L BRIAN LEBLANC 9 TIBBETTS AVE = g � DANVERS,MA 01923 Undersecretary Not valid without signature .:. a......... .... .�..w-.:v.-�.-w,,.. =:. ... �. a Massachusetts Department of Public Safety �Y Board of Building Regulations and Standards License: CS-054882 Construction Supervisor T111e.rand awe gas'rtAatOlp rent ha*14 ensiuuy completad a la tl oQueoceppatron Owety and tieawInIailtng Courao in * ' BRIAN ALEBLANE L�\ Cnn36uctlpn Safety irrte Faith 9 TIBBETTS AVE $ DANVERS MA 0992 - BRIAN LEBLANC ' Ftftbeft PO�B2�2�2014� l Expiration: u �7rainername panto type) (6x111rse end date}. , Commissioner 09/17/2017 �:.a.�..ye-r-.�..n-x:: x� _«•',�a-�- :". ..�,, �."' `-;+rya' .. .. . .. . ._. _. ._.._. ..._. . A�C�oRo CERTIFICATE OF LIABILITY INSURANCE D9�i4iDD 5`) 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 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). PRODUCER CONTACT NAME. James Tarpey, CIC, V Pres Tarpey Insurance Group PHONENo. (781)246-2677 ac No:(781)224-0973 442 Water St nooalEss:7@tarpeyinsurance.com PO .Box 567 INSURERS AFFORDINMan Wakefield NA 01880 INSURERA:HSSBX Insurance C INSURED INSURERB:The Hartford InsuCo,A.C. Castle Construction CO.Inc INSURERCContinental Casua 9 Tibbetts Avenue INSURER D: INSURER E: Danvers HA 01923 1 INSURER F: COVERAGES CERTIFICATE NUMBER:GL 15 WC 14 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. ILTRR TYPE OF INSURANCE AIN DDL R POLICY NUMBER MIDDY EFF POOLIIpY EXP LIMITS X COMMERCIAL GENERAL LIABILITY NGENE�L RRENCE $ 1,000,000 A CLAIMS-MADE F OCCUR RENTED 50,000 Ea ocwrrence $ 3EB0728 7/20/2015 7/20/2016ny one person) $ 5,000 ADV INJURY IS 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GREGATE $ 2,000,000 X POLICY PEA LOC -COMP/OP AGG $ 1,000,000 OTHER: Is AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BJANY AUTO BODILY INJURY(Par person) Is ALL OWNED X SCHEDULED OSUECAX3361 10/6/2014 10/6/2015 BODILY INJURY accident $ AUTOS AUTOS ) HIRED AUTOS $ NON-OWNED PROPERTY DAMAGE $ AUTOS Per awIII I PIP-Basic $ 8,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE Is EXCESS Lim Id CLAIMS-MADE AGGREGATE Is OEO I I RETENTION$ Is WORKERS COMPENSATION PER Ul AND EMPLOYERS'LIABILITY YIN - X STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA C (Mandatory in NH) 6S59UB9638L41614-AR 11/13/2014 11/23/2015 E.L.DISEASE-EA EMPLOYE $ 500,000 M yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached B more space Is required) CERTIFICATE HOLDER CANCELLATION kebeldesign@yahoo.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE J Tarpey, CIC, V Pre ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025nmenn ro�pozaY C4 'rin� % I'MBBB A.C. CASTLE CONSTRUCTION CO. INC. 1V0 1Qcdr� Telephone(800)505-LEAK(5325) " Fax (978) 777-7750 v � MEMBER Brian LeBlanc, President Please mail accepted proposal to the office located at: 9 Tibbetts Avenue • Danvers, MA 01923 Unrestricted Mass Builders License No. 054882 Contractors Registration No. 166565 PROPOSALS 41TE O C PHONE / I c/� DATE r / / STREET - JOB NA / ^ � _ J J CITY,STATE A LP DE JOB LOCATI - DATE WORK IS SCHEDULED TO BEGIN TE WORK IS SCHEDULED TO BE COMPLETED JOB PHONE Iv¢ i9TOpOg hereby to nish material annddl llaabc -complete in a,c rdanccee with ecificati s below for s_um o1: n P � M !L� / J � �/ r57 dollars($ / ) yment to be as follows: 1/3 down the balance due upon completion y36C) NOTICE: All home improvement contractors and subcontractors engaged in home Authorized improvement contracting unless specifically exempt from registration by Signature: provisions of Chapter 142A of the General Laws,must be registered with Agent the Commonwealth of Massachusetts. Inquiries about registration and Note:This proposal may be status should be made to the Office of Consumer Affairs and.Business withdrawn by us if not accepted within days. Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116. WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: A ROOF STRIP We will cover the siding, bushes, and grasses with Blue Tarps in order to protect the property during stripping. We will Strip up to 2 layers of roofing and remove all nails, screws and staples down to the Bare Wood and renail all loose boards. The Ice and Water Shield will then be installed at the bottom of all Edges,under all Step(lashings, under all Roll flashing, / J around all Chimneys,Skylights,and into all Valleys,in heated areas only. We will install 30 lb. Synthetic Deck Protector Underlayment to all other areas of the-roofdeck. kf The 8"aluminum Dripedge will then be installed to I foof edges.A p�)stin Pine will be e�red i ew A Rub Fleas. The roofing material to be used will beLd� r licit The bottom of all roof edges will have a Pre Starter course with a glued_edge for wind uplift.We will Storm Nail all shingle ,using 6 nails per shingle. All the Debris will be cleaned and Dumped by us on a daily basis.We will cleanout all Gutters,Downspouts and Elbows Magnetic-brooms will be used to extract all nails from your property.We will protect your property as best we can,however some foliage matting,breakage,or marring could occur. We cannot accept responsibility for possessions inside of the house,or debris falling into attic areas.Customer should protect personal belongings. EXTRA WORK IN WHICH A,COST WILL BE AD D T THE ABOJVE_� Replace Rotted Roofboards 7s O �S Ir1I al mi m Gutters Re lead Chimney(s) 6 �5 n I um Downspouts Replace Facia Boards Install Skylight(s) .n Install RidgevQ ' Rotted Roof To Wall Fleshings Install Roof Louver l7 Gutter Repai s NOTES: iSJ jilz D./ Warren manufacturer to b free of defects r ye see manufacturer's warranty for exact warranty performance. A11 lab rfor ed under th ntract shall be of good quality and free from defects not inherent in the quality required or permitted for a peri d ofyears� I arranty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient maint nance, Improper oper ion,or normal wear and tear under normal usage.This warranty shall be limited to the work performed by .. n n r+....e..r•..n..l.u.a;nn!`n Inn �! iTc'enle rliertraTinn CITY OF SALSA MASSAaiUSEM BLaDING DEPAR7)aNr 120 WASHINGTONSMEET,?Dkom TLL(978)745-9595 %II FAX(978)740.9846 v18ERI.EYDRISOOLL MAYOR THCMAS ST.PMM DmEcroRofPLaucPROPERTY/BtzaDmoDMbIIS omit 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 00, 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, 5150A. The debris will be transported by: (name of hauler) The debris will-bee disposed of in: (name of faifity) GNU (address of facility) Signature of applicant � d v Date . The Commonwealth of Massachusetts Department oflndustrialAceidents I Congress Street,Suite 100 Boston,MA 02114-1017 www.masxgov/dia Vivorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FU ED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Itidbly Name(Business/Orgeniration/Individ a] Address: 0. City/State/Zip: Q . Phone#i: �' Z Are you an employer?Check the appropriate box. Type of project(required): L I am a employer with employees(fid)and/or port-time).- 7. ❑New construction 2.01 am asole pmprlalor or partnership and have no employees working fro me in any capacity.[No workers''oomp.insurance required] 8. Remodeling 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9. ❑DClnolition 4.❑I am a homeowner and wig be hiring contractors to conduct all work on my property. I will ]0 Building addition er5ure that all contractors either have workers'compentation insurance or are sole I LE]Electrical repairs or additions pmprietms with no employees. 12.Q Plumbing repairs of additions 5.Q I am a general contractor and I have hired the subcontractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurmce3 13.Q RoofTepami 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance requirW.] - - *Any applicant that checks box#1 must also fig our the section below showing their workers' policy information.... .-_ t Homeowners who submit ads affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating suck rContraetors that check this box must attached an additional sheet showing the name of the su6<ou6aabrs and slate whether m not those®tides have employees. If the sub-conractms have employem they must provide their workers'-comp.polity.mwber... I am an employer that is providing workers'compensation insurancefor my employees. Below is-the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: i Job Site Address: City/State/Zip: /O Attach a copy of the workers'compensati n olicy Achuration page(showing the policy number and eliblFaV6 date). Failure to secure coverage as required under MGI.c. 152,§25A is a criminal violation punishable by 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.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 an ies ofper'u th the information provided above is true correct Si mature: 77 Date: / Phone M -7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit(Ucense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dqg license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02 1 14-20 1 7 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia