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15 LARCHMONT RD - BUILDING INSPECTION (2)
The Commonwealth of Massachusetts Ulf Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 78pp ( rBECEIYED SALEM I" OVAL SERVICE 3 Revised Mar2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use y Building Permit Number: Date Applied: s if Building Official(Print Name) Signature I U0 I Jate SECTION 1: SITE INFORMATION 1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1-5 J—AR ZA. tian-,% ?-J 1.1 a 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 ft) Frontage(tt) 1 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? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: LpV"4v. R.+�r�l� 'Ir htr: 'T6oa. *", S J4A% r M iA 191 Name(Print) City,State,ZIP Or Lo.r t.•. r Yu-i IR+! 2.01- s.rl _6.11,- lNo.and Street Telephone Email Address ` ` SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units OtherAl*`Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (I VAC) $ List: . 5. Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ �( Z 0 ❑Paid in Full ❑Outstanding Balance Due: mF�IL.ev 571 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) , No.and Street i'- Type Description U Unrestricted(Buildings up to 35,000 cu.tt R Restricted 1&2 FamilyDwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) n HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address 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 .......... ❑ No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i I,as Owner of the subject property,hereby authorize LOU y> to act on my behalf,in all matters relative to work authorized by this building permit application. n✓�I�' TJM SU vs / I rIPU V •'L'_'' y 1�%U I'e;.1 �l l,_,.j611 J�f,/i��r��7 iNSf' 1�' .iU Print Owner's Name(Electronic Signature) 1 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 contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: l. 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. ovg /oca Information on the Construction Supervisor License can be found at www.mass.gov/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"maybe substituted for"Total Project Cost' ` Document Ref.Russell HIC-1 ITT DEGEOGGE HOME IMPROVEMENTS HOME IMPROVEMENT AGREEMENT Date: April 28, 2015 Contractor: Louis DeGeorge 7 Upton Lane, Boxford, MA 01921 617-901-1414 CSL: #106682 HIC: # 173144 Customer: Lauren & Matt Russell 15 Larchmont Rd Salem, MA 978-835-3004 Estimated Start Date: May 1, 2015 Date of Substantial Completion: May 28, 2015 Scope of Work: The full scope and sequence of the construction is broken down for this project, as outlined below. This job is being supervised by a state licensed Construction Supervisor and Home Improvement Contractor. DeGeorge Home Improvements holds a $1 million general liability policy. Dino 4 of S Document Ref:Russell HIC-1 Project : Bathroom Remodeling ❑ Pull all permits and manage project and all sub-contractors ❑ Demo bathroom removing all tile on floor, walls and ceiling. Removal of all fixtures tub, toilet, sink etc. Removal of all sheetrock walls and ceiling. ❑ Plumbing to include shower, sink and toilet. (fixtures provide by customer) ❑ New Electrical plugs, switches shower fan, and placement of vanity light. (fixtures provide by customer) ❑ Tile floor (tile provide by customer) ❑ New trim around window, door and baseboard ❑ Plaster and sheet rock all wall areas and bathroom ceiling ❑ Clean job site and dispose of all waste from job site Estimated Schedule: 5 days demo 5 days electrical and plumbing 3 days sheetrock and plaster 4 days tile 5 days finish work, shower doors etc. 22 working days Estimated Investment: $9,200 Initial Deposit due upon signing of this document $3,066 Second payment due completion of framing: $3,066 Remaining balance due at completion of job Y© DISCOVER' ERIWI EmFESE We accept cash, personal checks, Master Card, Visa and AMEX Disclaimer: In all cases, the unexpected can occur. With your involvement we have done our best to prepare ourselves for the unexpected. Additional labor or materials and costs due to unforeseen circumstances that are not outlined above will be discussed with you for prior approval before proceeding with work. Din. 9 of A Document Ref:Russell HICA Removal of all personal items from the construction area is the responsibility of the homeowner. Contractor(s) will not be held responsible for damage to furniture, fixtures or personal items left in these rooms during construction. Homeowner and contractor will be responsible in assuring that a safe work environment is be enforced and maintained during this work project. (Pets and children should be kept away from work area at all times) We have discussed the above-mentioned items and agree to all terms, conditions and scope of work. Louis DeGeorge Date Lauren & Matt Russell Date General Contractor Home Owner Customer Suggested purchase list: ❑ Tile: Tony Tile, 607 Main Street, Stoneham, MA 781-438-5790 Contact: Richard La Rocca ❑ Bathroom Supplies: State Plumbing Supplies, 195 High Street, Ipswich, Contact: Moe 978-356-7950 o Toliet o Pedestal Sink o 48x34x72 Shower o Sink Faucet o Shower Control Valve and Shower head ❑ Painting: Tom Moore 978-360-9516 Dine 4 of S 0 uwnd W.R.1 HI i Removal of all pemonal items from the c,nW dion area is the responsibility of the homeowner. Contractor(s)will not be held responsible for damage to furniture,fixtures or personal items Will in these rooms during construction. Homeowner and contractor will be responsible in assuring that a safe work environment Is be enforced and maintained during this work project(Pets and chi/Wen should be kept away from work am at all times) We have discussed the above-msrrboned hems and agree to all terms,conditions and Scope of work. OU y xS I�3e� IS o eor Date lain ❑ate Mothers]Con r Xome Owiror �aaf..a t ul, , 2„s tell T Mart 1lv mtu+7 Customer Suaaesotl Purchase list ❑ Tile: Tony Tile,607 Main Street,Stoneham,MA 781-4385790 Contact Richard Le Rocca ❑ Bathroom Supplies: State Plumbing Supplies, 195 High Street, Ipswich, Contact.Mce 978-35&7950 o Tolist c Pedestal Sink 0 48x34x72 Shower o Sink Faucet o Shower Control Valve and Shower head ❑ Painting:Tom Moore 978-360.9516 r Document Ref: Russell HIC-1 ! Msstac6uscat.OePartment Ot Puhik safety �1 6otld of Ruil6lny Rt91iOloDt aM1 Stei � L'�w.rrum�n SrM�'n i.nr LM.enle:CS-110"42 e (,ODISDFOEOIiG4t rM1 N UPfON I.LE, '1 _ &avd M,1 01421' P; adOn 4u�.mt�ontr r . ,•—•- - .. - +':Gn'(:a..rr..w:.mwN.G.1t'.:f�nvr�..rl/ Oro"tl ftorlm.\IGIn N iftrimm"ah we IQIDNI!INPROYlfAE1R fAANT0.ACT00. ReptaVabtn: 17 Tom' �F EaArvo.n: W1G17018 100"-I LOINS J.OEGEOROF LCUIS DEGEOAGE E up[ON LANE ':S.s--.hL/<--. BOXFORD.MA 01921 LnOerucrruis OSRA;r 11-09A065913 Ihf LBIUY.YMMNr-1P%1wI Teljmv wana,C mrfleRea 1wvwOsweNa+I SrNNafttva nFtrtlt Caree In a4uelion SaftN tnd NonIM a naey� abY'r� 11W-L— iC�wrl�M� 1 Din.A of r. Document Ref:Russell HIC-1 ACORR, CERTIFICATE OF LIABILITY INSURANCE °10/08 201.4' 1D/DB/2Du PRrxu-- 973.887.4900 FAX 979.997.2404 TH6 CERTIFICATE L4ISSUED ASAMATTEN Uh INh UHMAIIf)N Edward F. Senllott Insurance Agency, Inc. ONLY AND CONFERS NOR IGHTS UPON THECERTIFICATE HOLDER.TI05 CERTIFICATE DOES NOT AMEND,EXTEND OR 16 South Plain Street ALTER THE COVERAGE AFFORDED SY THE POLICIES DCLOW. P_ 0. Box 457 1 Topsfield, MA 01981 1 INSURERS AFFORDING COVERAGE NAIL# wewm Louis OeGeorga N3LRER;• Travelers Casualty Ins Co/Amer OBA: dha: DeCeorge Neale Ieprovealents rllL« kb 8 Upton Lane �rvslnexe Boxford, HA 01921 re:u:rl... �— rvxatrtL COVERAGESA'J _... LiF R-alJIRE CP IR�UTAANNC CONO 6ELOfBFFNACT OR TD THE IKSHR2D HN-0LD AUU'!C I i`If 111C FUIJr)Y PCR UD ININ:aTFn NDTYlndaTANDNL IJAY RFDDINEr$NI I EI<n 1:4i CONDfi.DIJ OF AIJ1'CONTRACTOR GTHFR ROCAILIEA i`.I'll H HiSR}UI I V WlYial 111Pi GLHIII IGTF IAaY 3E lSS.IEDAR 0.W-'MR. AF IHLIHAURN.CG1-IriM DRAL PDI HkOUFSCRI6EDD CLAINGAJUJLCI(VALL TILL TCrfLIS.rxry LlSxiNRaM fANRI'u IfPNE(JF"+IR:H PJL131LU.hOGREGATE 1 aiTA 9Mri,4NdNY HAY£f!EJJ NtbUCLD UY PAID CLAIMS. Pn1Y.Y Crirl.T1F RT¢YC[PR0.rISl ..He - L<R x MMI TNrnr rl•.InV.ncc YWCl11YY6ER pq IC 1YWWTYYY WTE(A1YyPYY(YI, OERERALLMERn T 680-3C7786S9-14-42 09/24/2014 09/24/2015 Ywal«::avucr<L a 11000,00C twurr menrt'o t X 300.0 LCAM1EP.tli1'fl.EIL.LL4.3LT' Y.D.t£E£:IE:4KVIm'Mt _ �aan::rAai X cc.UR Lr_DEO l.Y:rrlrx x) c S,0 A ME fLLLa NYJ NILAY I L.000,OOC rrrvru.ar.OnEu-E 1 2.000.0 OE6tA0AEOA$lL1T.APR1 r:�ra whwCTS.D H%,OP'aZ E Z.000.0 POLIO PF: AVINWYIIt Yaa{RY OOVLL`HCO'uwOeClnr ALL MNEDAVTa rty1:`•r):ulT� —. BGHEWL>LIfCL '.M��'B 1 rw:u:w+fx: y'JULL•INURI' I:r.(:N:IM1N it 111111E ':.J.:Y>lll r t - rnn caw:.E 1 � •::u�nl eR1G0EL1GEINY Y%uTO LWLY I:A.V't111 h1 C i aN±.UII`J EA:.CL i O1HER THSN Av.T00NLY ACC I F EAtE66f LWBPfiUALY.uIATY TA:]I IX:tvwnMC t IO:LIR LdaNS NaT b:y4Sl'fpR t t 1 LlLL,`lwl 'I FIr11B[I S _ t YMRM[itC[LI..PCMLPTCN N10 rYROYrItJ UMYn Y1t1 _ f,::iSn UYnS ':R a NPiOFRET9RPARTMRINIAUlmI I EL EKn!vnn-Li t 4FFCERI.MME;MW!ri7 ul -'- IL'�.mrnrvn.xHl :_LOISEAseSr, EofYq TaT f r nl..a 'N73H EdeeuLPR3vmow,r»:.. 1 e�.uxe Foucnran t OTHER nrlL.l®n>Id OP[xAllnRLtLCR 11M31VCxICLIB!EKCIU&Ox8a00EDBY EAD.Y28EYFMIufrCAl R rinws C ERl11iCATE HOI.DFR CANCELLATION 9NWIA N1Y(6 rHr artYhnFP StPmern Nlixn[eanf rr m etrais Y':2 eRllwLlvl CAT[nlcRLer,11e145UNGNI4URERLHLLDJOELWPiO Nall 3�B1Yy YFniFN TUrm of Newbury xnnx To nl[c[Rnrcnrtlrn:vLTtr+AaYv rOlnc:EFl.aJiFffiURE TOUOEAEMRLL Building Inspector p6'QjPNn WICdTY1x CR VAmm NPAMRXCUOv rtt N4J1{£R r4ACExISOR 25 high Rd accgcscrrtamlcx. Nev.6ury. RA 03953 AUTH,wrpoTF :A:YTATM Sennott ins. Aciency ACORD 3612009RIii PJ 1964.2009 ACORD CORPORATION. All HELM tesemd. The ACORD mane and logo on,M91eiela0 mats n1 ACORD D�nc r of G Fri May 8 11 : 26: 44 2015 From: McEvoy,Fran To: 91978740984EPage 1 of 2 NI.V/V i, v1 I 1 11.01.- D5/os/2DlS PRODUCER 979.087.19Oo FAX 9�9.987 .24ae THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 South Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topafield, MA U1383 INSURERS AFFORDING COVERAGE NAIC# INSURED Louis De George INSURER A: Travelers Casualty Ina Co/Amer DBA: dba: DeGeorge Home Improvements INSURER B' 8 Upton Lane INSURER C. Boxford, MA 01921 INSURER INSURER E COVERAGES 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLI VYYCY EFF POLICY EXPIRATION LTR NSR DATE MMIDDIV DATE MIDDNYYYI LIMITS GENERAL LIABILITY 68D-3C778659-14-42 09/24/2014 09/24/2015 EACH OCCURRENCE $ 1,DDD, 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence $ 300, DOD CLAIMS MADE OCCUR MED EXP(Any one person) $ S, DOG A PERSONAL A ADV INJURY $ 1,DOD, DOR T GENERAL AGGREGATE $ 2,DUD,DOD GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMPIOPAGG $ 2,DOD,000 POLICY 7 PRO LOC PRO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO O EA ACC $ AUUTOTO O ONLNLY.AN ACC e EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN T RYCI S TU ER ANY PROPRIETORIPARTNERIEXECUTIVE� OFFICERIMEMBER EXCL EL.EACH ACCIDENT $ UDED? (Mandatory In NH) E.L.DISEASE EAEMPLOYE $ I yes,essence under 5PECIALPRVV15I0IN5UsI. EL.D13CA3C-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURERWILL ENDEAVORTO MAIL 3U DAYS WRITTEN Cif' of CI NOTICE TO THE CERTIFICATE HOLDERNAMED TD THE LEFT,BUT FAILURE TO Do SO SHALL 120 Washington St IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 3rd, Floor REPRESENTATIVES. Salem, MA 01970 AUTHORItEDREPRESENTATIVE Frances McE- l•FRS ACORD 25(2009/01) FAx: 978.740.9846 OO 1988-2009 ACORD COPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Fri May 8 11:26:44 2015 From: McEvoy,Fran To: 91978740984EPage 2 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009101)