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18 LAUREL ST - BUILDING INSPECTION (2) y � I he Common %%cakh of NIJSN.tchuNCIIN -- t lloald of Budding RcculmlollN and SIunJ.lydN I t tlt •� \ ' Nl:t>sa�hu.etu SIJIC 13uilding ('ode. 7Sll( NIR. 7�" cJnrou I ,I "\ RullJinu f remit :\Ithl .Ilium To ( )I I>lr IL(. Rel-ulr. Rennt.tlr l)r I)etu1 li.h .I \\ r (1nr- ttrTut -ltunilrOu(/11rr mil' — -- — -------- — ----.. _., �— --- I his `.ec on 4tr 0It laI !'se (,)it IV ButlJtng Prnnn .Vunthe D:ue Applied Scn.tturr _ `__b�7"� f7 Hud J.nE 'nrnill met: In ur of utldme. .C'f1ON I: SI OF INFORM:\TION 1 1.1 Propt-M, \ddr•Ns: I 1.2 \ssesm rs Map & Parcel Numbers SMW t� tl;;, .In \la Number l.,i. \. t•;h:. _, I .t .1LCCple J_:b u, �[N� _-__ nit_.__—___� r ;,} T tome Information: I L", Properly Drnec.^.vuns: Sv�taoz if-) Fnnu Nara NiJr Y. ., Rear 1:trJ Requited Pntwwed Rey ur;eJ PrurtJetl Raywt ed Pn•,iJcd . 1 'ti Water Supply: t�i G L. »u. §i1r 1.7 Flood 7mtr ,R,orm•thon: LN Sc y.age Disposal Sy Ntcm I I Zone Outside Flood?one.' I Pr-d h: ❑ Prt,.ate C1 ._._ _ _. Nhunupul ❑ On aue Ji+t>u .I n�: ❑ r ('net tl yrNr] _.._.. --- SECTION2: PROPERTY ')W';vPs;IIP' r'(' (1wner' tf Record: '� tr.:.:,:'rmt• Wl (Or Ser�ice: - - ---- - — OM -17S 'tqK ier:rnn, Telephone . j SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply New Cnnsuucunn t, Existing Budding ❑ Ors nee-Orcupted ❑ Rr.p:urNl N) Q3. :\I;cr;,u:r,r ❑ `,.I c!tu. n ❑ j rDe-nolm,m 7Lc cessoty Bldg. 0 1 Number of Units Uther- ❑ S,, oy ! Br;el Dys:.r�puon t - Pr `jt tied Work_Z-*_r -51N1 4 - M _p_q-_, l0..11C -51 , - 1------ tic't"rrc)t+ S• FS'rrm.ti1..f1 c' N i :,. :t ti7N iS Official Use Only _ I I.ahor.tnd Malec wlst I _ l IiurlJutg y I. Building Penmt Fee: $ -11 ndicate hoa frc tN J,aa nuncJ. —� ❑ S(Jrdard City/fown :\pph.an,m Fee f2. Fleevtcal 7 -- 0 Total Pm3ec1 Com' (Item GI N trtuluplier } Plumbing 2, 1)Iher Fore: S 1 Nkc'hamcal IH\':\CI Y S Sfrchamc.11 if-ire N T•�r,tl All Tres 5� ..r• nt -- -- - �� )'heck No (-hecA .1 m,:unt _('.t.h \ne nlnl 0 rotal Project Cost i J\ 11LA00 0 F'.ud in Full _. _ 0 (hn>(and utg B,I l,m.r Uue SECTION 5: CONSTRUCTION SER ICES - -— — 5.1 licensed Construction Supervisor IC'SI.1 LL:me Nu fuller \.Im. S1. IIoIJer V_--- \ql� Lnl l Sl 1,pe„echiluw l _ l l nlr,ln•IeJ 11111 l0 ".I NI(I it I'l Rr,l�, F.unlh D'\01,Ile llen.Litit Hl f.'Irph�ntr —_ _ F\\1�-12 r,i.h nll.d NniJ� �� .0 J l I n • . _ .-. _ SF--�R..IJuuLJ S�IIIJ f wl IS umu�\LL, ul Im1 I ,I. I, —D H;aJi nli.il DrIII��Lti� u ' 5.2 Regisle a Il t �napr6sement Contractor (111C) S2lel� — - - -- lily Conq,am ss - or HV Regutranl ,Name Kcguu auun Number z n.a,r 4qh veci�lM(� O\qIS Tf13�2a�1(� \Jdres, O,$ qZ"1 $9ISb Fapu au,m Date Slgnalue frlcphonc i SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1M.G.L. c. 152. § 25C1611 Workers Compensation Insurance affidavit must be completed and submitted with this application. 17:ulure no pn",tde this affidavit will result In the denial of the Issuance of the building permit. - Signed Alfidavit Attached" Yes .......... ❑ No -. .. . ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby iauthorize to act on my behalf, in all m.mteis i relative to •,".n k authorized by this building permit application. 5l pllatUre Ot Ownl•f 'Dale SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I. CSh%n1\ 46-MAl\ as Owner or Authorized Agent herehy declare I that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and heh' If. `. - Pr t . ame F(Fwned ture of Owneror AuthorizedAgent Date under rile am,and valuesof (u INOTES:An Owner who obtains a budding permit to Jo hulher own work or :m owner who hoes :tit uniegnlc•led contra. no (no( registered In the Home Improvement Contractor 111I0 Pmgraml, will not have deers, to tne .uhitrauon j program or guarumy fund under SL G.L. c. 11_A. Other tinport:mt inhormaton on the IIIC Pror�r:un .Ind Supervisor Construction Su Licensing WSLI can he found In 780 CMR Regulations I M R6 .md 1 IU R5. rc,peco,ch' P � s When ,uhmantial work Is planned, provide the Infurmanon below: Vaal IL-ors area tSy. Fr nncludmg garage. finished hasemenUattics. decks or p,nrh, Gnus httne area ISy. Ft.I Habitable room count -----_--_-- _. Number nl turpl:Ices_ Number oI hedro,,m, Number or hathtoom, Nuinher of li,lith.Ilh, I ,prcolhe.mme ,v,fem __---.—.._.___—_ Nutnhcrofdeck,/ p,,nhc, 1_ "honal Project Square Footage" Ina. he ,uh,onned for "filial Prr,lect CITY OF SALEM ?' PUBLIC PROPRERTY tiet„� DEPARTMENT KIMBERLEY DRISCOLL - MAYOR ' 120 WASHINGTON STREET'# SALEM,MASSACHUSE'ITS 01970 TEL: 978-745-9595 • FAX:978-740-9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Bu �ysiness/Organization/Individual): �n f" (NI ( cti, t Address: LAci t,, City/State/Zip: M6 1019 11 Phone #: 0\"A% qZ"1 Are you an employer? Check the appropriate box: Type of project(required): 1.91 am a employer with 1 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] -Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �- Insurance Company Name: b6psAl M AV-_A G fr) D Policy#or Self-ins. Lic. #:WrA 'kIS LVS 't VS WM Expiration Date: 1&6hexa Job Site Address: `FS l'n t rQA �t City/State/Zip: Sa`t R-io 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 of criminal penalties of a fine up to S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Anci�- 1\ D Date: Phone #. ri TZZ OR-1 eQ 5 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 dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. , The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE [revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia , arr.,-¢ da r � r .tX'h'✓.,,��y°fssx r .; r Y=M r n} t z � ; & k F _ g/te&r o Building egulaoons aid Standards One Ashburton Place - Room 1301 Boston, Mass"achusetts 02108 Home Improvement:Contractor Registration Registration: 104352 Type: DBA Expiration: 7/13/2010 Tr# 270077 GLENN BATTISTELLI CONSTRUCrtfbN. _ _ ___..__—__.:._- Glenn Battistelli ------ PO BOX 496 Beverly, MA 01915 Update Address and return card. Mark reason for change. Address ❑ Renewal n Employment Lost Card 'S-CA1 0 50M.07/07-PC0490 �/�ee �amv�nm+uirea/.!� o�✓�,nauu�r+.ieetla Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Reglstretlon 104352 Board of Building Regulations and Standards One Ashburton Place Ron 1301 lug Expiration: 7f,,13/2010 Tr# 270077 Boston,Ma.02108 Type: DBA GLENN BATTISTELLI CONSTRUCTION Glenn Battistelli t� �l 11 BROAD WAY REAR /P.O.BOX ti -� --"�� -" ge Not valid without signature veriv. MA 01915 Administrator - La9V 1V/ LJ/ LVVO J. 1V rrwc. vvc/ VVL aJa'av Liberty Mutual Group p "Utum. berty P.O. Box 9090 Dover, NH 03821-9090 Telephone(800)653-7893 Fax(603)-245-5330 October 29, 2008 MARY O'LEARY 18LAURELSTREET SALEM, MA 01970- RE: Certificate of Workers Compensation Insurance Insured: GLENN BATTLSTFT T GLENN BATTISTELLI PAINTING CO PO BOX 496 BEVERLY, MA 01915 Policy Number: WCI-31S-455968-058 Effective: 5/11/2008 Expiration: 5/11/2009 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liabib 'mits): Sole Proprietor/Partner Coverage Election: Bodily Injury By Accident: $ 100,000 Each Accident The workers'compensation policy does not provide Bodily Injury by Disease: $ 100,000 Each Person coverage for: Bodily Injury by Disease: $ 500 000 Policy Limits GLEN BATPISTFLLI As of this date, the above-referenced policyholder is insured by Liberty Mutual Insurance Company under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions, and is not altered by any requirement,term or condition of any or other docurnents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This certificate is not m insurance policy and does not amend,extend, or alter the coverage afforded by the policy listed above. If this policy is cancelled beforethe stated expiration date, Liberty Mutual will endeavor to notify you of such cancellation. a-u is . • n AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Cenificaae is e=med by LIBERTY MUTUAL.INSURANCE GROUP as respeess smh ma rtao,as is nnba7n4 by at Dw companies. cc Insured: Producer of Record: GLENN BATTISTELLI STERLING INSURANCE AGENCY INC GLENN BATTISTELLI PAINTING CO P O BOX 493 PO BOX 496 BEVERLY, MA 01915 BEVERLY, MA 01915 L llu 1V/ to/ LvvV o. lv a-awl:. vvc, vvc uaa� ACORD CERTIFICATE OF LIABILITY INSURANCE DATE /D ) 10/0606/20082008 PRODUCER (978) 922-6600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sterling Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 306 Cabot Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 493 Beverly, MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Commerce Insurance Co. COM Glenn Battistelli Painting INSURER B: Battistelli Painting Co. I INSURERC: P O Box 754 INSURER D: ,Beverly MA 01915— 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PDAITE CY MM/DD/YY) LIMITS ON LTR INSRD ( 1 1 A GENERAL LIABILITY WV1751 02/26/2008 02/26/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ,r0 000 PREMISES Esaccurtence $ CLAIMSMADE 7X OCCUR / / / / MED EXP one person $ 5,000 PERSONAL B ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY JEC LOC / / I / PD AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident E ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE UABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ RRETENTION ESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ Is DEDUCTIBLE / / / / $ $ $ WORKERS COMPENSATION AND TORT LIMBS OER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? / / / / E.L.DISEASE-EAEMPLOYEE$ If Yes,descnbe anger SPECIAL PROVISIONS below ET DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONVLOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (979) 921-9202 Fax ( ) — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Mary O'Leary FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 18 Laurel Street INSURER,ITS AGENTS OR REPRESENT VES. AUTHORIZED REPRESENTATIVE C Salem MA 01970- - ACORD 25(2001/08) ©AC RD ORPORATION 1988 O.0 INS025(0108).05 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 Glenn Battistelli Estimate Painting, Roofing, Siding & Carpentry DATE October 29, 2008 P.O.Box 496 Quotation # 100 Beverly,MA. 01915 Customer ID (978) 927-8956 ( 617)-962 1235 fx ( 978) 921-9202 Quotation valid until: November 8, 2008 Prepared by: Mrs Danielle O'Leary 18 Laurel St Salem Ma 01970 978 775 2898 927 9346 For every job we : 1) If necessary, secure Building Permit from the City or Town. 2) A clean job site will be reasonably maintained at all times. 3) Contractor has all necessary Public Liability and Worker's Compensation. 4) All work will be done to code. Comments or special instructions: "5 �.. -Descrl matron -� " ° n,�'" x,..NRL xC ;^AMOUNT +si Repair roof at eve of roof- approx 150 slate Remove old skylight and install new roof boards and new slate $ 4,500.00 Strip the existing ashalt shingles far left side of home Apply ice &water shield at 3' at base Apply 15lbs felt and 8" drip edge at rakes and base of roof Apply Certainteed 3 tab roof shingles to same area Re lead chimney $ 4,900.00 Small flat roof $ 2,000.00 TOTAL If you have any questions contact Glenn Battistelli 978-927-8956 Unofficial Property Record Card Page I of 1 Unofficial Property Record Card - Salem, MA General Property Data Parcel ID 33-0106-0 Account Number 0 Prior Parcel ID 52— Property Owner NOT AVAILABLE Property Location 18 LAUREL STREET Property Use Two Family Mailing Address Most Recent Sale Date 11111900 Legal Reference 4073-559 city Grantor Mailing State Zip Sale Price 0 ParcelZoning R2 Land Area 0.103 acres Current Property Assessment Xtra Features Card 1 Value Building Value 201,500 Value 0 Land Value 120,900 Total Value 322,400 Building Description Building Style Multi-Garden Foundation Type Brick/Stone Flooring Type Hardwood #of Living Units 2 Frame Type Wood Basement Floor Concrete Year Built 1690 Roof Structure Gable Heating Type Forced HIW Building Grade Average Roof Cover Asphalt Shgl Heating Fuel Gas Building Condition Fair Siding Vinyl Air Conditioning 0% Finished Area(SF)2734.5 Interior Walls Plaster #of Bsmt Garages 1 Number Rooms 11 #of Bedrooms 2 #of Full Baths 2 #of 314 Baths 0 #of 112 Baths 0 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 0.103 acres of land mainly classified as Two Family with a(n)Multi-Garden style building,built about 1990,having Vinyl exterior and Asphalt Shgl roof cover,with 2 unit(s),11 room(s),2 bedroom(s),2 bath(s),0 half bath(s). Propert Images b E Disclaimer:This information is believed to be correct but is subject to change and is not warranteed. http://salem.patriotproperties.com/RecordCard.asp 10/29/2008