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5 LAUREL ST - BUILDING INSPECTION (2)
00 Che Commonwealth of Massach=dA TY OF Board of Building Regulations"'iliLEMMassachusetts State Building Code, d M1ar 70I1Building Permit Application To Construct, Repaid One-or Two-Family Dwellin This Section For Of ttcial Us Only Building Permit Number UMICAPIted: l DuilJing ORicial(Print Name). Signature- Date SECTION 1:SITE INFORMATION' LI Property Address: 1.2 Assessors Map&Parcel Numbers S LN () )?l--L SI I.I a Is this an accepted streetl yes no_ Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(It) LS Building Setbacks(R) Front Yard Side Yantis Rear Yard ReyuircJ 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private Cl Check if yes13 SECTION2: PROPERTY OWNERSHIP' 2.1 Owner of Record: 1WLt2EL 51- SHLE�.t �fuLi A BF�CZTLE-IT NN nne(Print) City,State,ZIP 5 LRU2EL S'7— 9 7F .335 68R$ No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction❑ EBistmg Building❑ Owner-Occupied ❑ Repairs(s) O I Alterntion(s) Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ I Number of Units Other Cl Specify: Brief Description of Proposed Work-: ti><iSTiNG ,9i9G/e POR-CLt W;f-i 131 A A)/) tZF-a),LJ 57 i r 0 IU�W O/UE /9� BUILT 04 TNr_ j�2A[uiNG.S ��%t/� /CLAN ONLY / /9/Vd ? El-ov/Z To RCM JAI SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ I. Building Permit Fee:$ Indicate now fee is determined: ❑Standard Cityfrown Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2`P 9ther Fees: .$ 4.Mechanical (HVAC) S List: 5.Mechanical (Fire 5 Total All Fees:$ Suppression) Check No._Check Amount: Cash Amount: ❑6. 'rutal Project Cost: $ Qr C1W Paid in Full ❑Outstanding Balance Due: MAIL, -4-D cc)K�i �&n)C A :5F-F o F 11xNs Yh AL Lt= I� G©NT SECTIONS: CONSTRUCTION SERVICES 5.1��Construction Supervisor License(CSL) 0 �Q 3-9 3 /Z— j�/ rA( IST( Au CD MEZ Q License Number Expiration Date N:une of CSL Holder List CSL'rype(see below)_LJ 2 t > y/ �7,e l'✓IU t!l� 5�.5 G t )Z -Type. . . . `.. `: Description . No. :ard Street / Qa0 N' 8� 9(' C9 U Unrestricted 2 Family a to 35,0t10 cu. It. R Restricted 1&2 F:unil Dwelling Ci yfrown,Stat ,ZIP - NI Masonry RC Rooting Coverin WS Window and Siding: p p SF Solid Fuel Fuming Appliances ?i`4,r,9 IELaVAf5jJ. I Insulation T¢le hutu Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) D 53 ��a8-lrp M£L O-S L-e9illST teuc r,e V LL C- MC Registration Number Expiration Date IIIC Conipan ame or t11C Re istmnt Name F :j 4 �dA/41 r k Z!, G-.e IZ _ l a U57 N0.�"I�Ca /�*5 ti/. Gow... No.W940Z ADO/g�U -7 S-S Email address City/Town, State,ZIP Tel cohere SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.L:c.ISL$ 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. Signed Affidavit Attached? Yes ..........C No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED.W H EN� OWNER'S AGENT OR CONTRACTOKAPPLIES FOR BUILDING PERMIT` I, as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Dale SECTION 7b:OWNER'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 i t t is a�ation is true and accurate to the best of any knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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(1-11C) Program);will n�f have access to the arbitration program or guaranty fund under 1I.G.L.c. 1 d2A.Other important information on the HIC Program can be finind at svww mass.eov:'oca Information on the Construction Supervisor License can be found at www•.ntass.sov%' _ 2. When substantial work is planned,provide the information below: 'total floor area(sq. R.) 'r (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 'rypeofcoolingSystem Enclosed Open 3. Total Project Square Footage"may be substituted f'ar"'rutal Project Cost" The Commonwealth ofMassaehusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Mworkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): CUMDUUG?iJA) LLG Address: 34/ 16 A/itvGS G.e OA City/State/Zip: B17B o/96o Phone M 9 7 9-- S 3 j — OS-) J Are you an employer?Check the appropriate box: Type of project(required): L7 a employer with Z employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working forme in g. ❑Remodeling any capacity.[No workers'comp.insurance required] - 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition ]0❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑ m I a a general contractor and I have hired the subcontractors listed on the attached sheet. These subcontractors have employees and have workers comp.insuisamt 13.❑Roof repairs 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Otber 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 most also fill out the section below showing their workers'compensation polity information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContracmrs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractms have employees,they most provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and jobsite information. Insurance Company Name: NOt2T# .Sf/o2E ;7W5V94 A/C,6 Policy#or Self-ins.Lie.M 1-N UB 7 9) tf lla t/ CS j Z Expiation Date:_J Job Site Address: ,S LAUILhL ST City/State/Zip: SFILFM mA• 6Icf7� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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 certi nder twins andpenalties o erjury that the information provided above is true and correct Sienature' Date• Phone#• �t/�?Er 5.37— 00 1/ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.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 02114-2017. Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia -�.re .e'a-rir.irv.errr.-tier//✓ C !/ff:.I.•ff� �- ula License or Office of Gonsvmer Affairs&Business Regulation registration valid for individul use only ' .-- W- ME IMPROVEMENT CONTRACTOR before the expiration date. If found return.to: az W�agistmtion: 108953 Type: Office of Consumer Affairs and Business Regulation xpiration: W812016 Lid Liability Corpoi 10 Park Plaza-Suite 5170 r> Boston,MA 02116 MELO'S CONSTRUCTION'` f Faustino Mein Peabody.MA 01960 Underseverary - Not valid without stgeature Massachusetts -Department of Public Safety Unrestricted-Buildings of any use group which Hoard of 20cling Roguiations and 8tanaaras contain less than 35,000 cubic feet(991m)of -i)nitr utiii�n .iL lerCisrir enclosed space. License: C"$M3 E•AUSTINO 1V MEj)[D 34 JENNINGS Peabody MA 019-90 - r Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. JUL.��8� .:pita�ior: Commissioner 03/01/2017 For OPS ticensinginfonnationvisft wwnr.Mass.Gov/DPS Melo's Construction LLC 34 Jennings Circle Peabody, MA 01960 Telephone: (978)-531-0811 Email: FaustinoMeloC)msn.com Faustino Melo, General Manager Unrestricted Mass Builders License No. 80393 Contractors Registration No. 108953 Proposal Submitted To:Julia Bartlett Job Description: Deck Address: 5 laurel St. Salem, Ma Date of Proposal: Aug/15/15 Phone Number:978-535-0977, 978-335-6898 We Hereby Submit Specifications and Estimates for: Existing back porch will be removed, and reconstructed into a new one as built on the drawings of the plan. All debris will be removed, and properly disposed by Melo's Construction LLC. )e OF 'DwIG i. �+ NLY GJ;.2�. I r1/cc,a c1b O � v A0 / �c fL If CL� the deck is to be made of only Pressure Treated wood [PT] the cost would be $15,000 Fifteen thousand dollars. If the deck is to be made PVC [non rotting trim wood] then the cost would be $20,000 Twenty thousand dollars. Authorized signature: /d n Date: Aug/15/15 Acceptance of Proposal: The above pri s, specifica ions and conditions are satisfactory and are hereby accepted. Signat Date: