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28 LEAVITT ST - BUILDING INSPECTION (3) The Commonwealth of Massachusetts sib CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR Revised Mar 2011 f W Building Permit Application To Construct, Repair, Renovate Or Demolish a One or Two Family Dwelling S=This$ectttin ForOffictal U'se':Only" Building Permit Number - D5t e Applied - y :. Buiiding Official(Pnnt NamB) ' Signature Date' SECTION 1 SITE INFO I 1.1 Property Address: 1.2 Assessors Map & Parcel Numbers 2 9i Ipo, i � } 5 k L l 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(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Require 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 ElPublic❑ Private ❑ Check if yes❑ p SECTION 2: P.ROP RTY OWNERSFIIP'`'. 2.1 Ownert of Record: A V S t S A F d p �a0'4 e2 8 Name(Print) City, State,ZIP No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK',(cbe,ck all that apply New Construction❑ Existing Building ❑ Owner-Occupied � Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': S-T `t' % `P Yo a .SECTION 4:ES)I UTFD_CONSTRUCTION COSTS7777777777777 Estimated Costs: " Official Use Only Item Labor and Materials 1. Building $ 1 Building permit Fee',$ Indicate how fee is determined. 11 Standard City/Town Application Fee 2. Electrical $ ' ❑Total Prbj@ct Co 3t.(Item 6)..x multiplier x 3. Plumbing $ 2 Other Fees $ N h > List 4. Mechanical (HVAC) $ G 5. Mechanical (Fire $ Total All Fees: V Suppression) Check No. .CheckArnqunt ` CashAmount:f, 6. Total Project Cost: $ (j ❑Paid�in Full* - 0 Outstand ng Balance Due Ob ocvc e� , SECTION 5: CONSTRUCTION SERVICES 7Street Supervisor License(CSL) � / CS 5 C - ©�i96s f S a '✓ ol-av^^�-O License Number Expiration Date rList CSL Type(see below) r 'fF'av � QA. TYPz�.r - Description - -e ( i to U Unrestricted(Bwm ld s up to 35,000-eu. ft.) R Restricted t&2 FamilyDwellin City/Town, Stale,ZIP r52G ' er M Masonry I RC Roofing Coverin WS Window and Sidin 7 q SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement^Contractor(HIC) t.. 6 r—s kik.CAI,HIC Registrant Name HIC Registration Number Expiration Date HIC^�Company Name or No. as Street P'e I Z k► �-p 9 a S 8 a 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 ..........e2r�, No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . Fenterinnamne'l er of the subject property, hereby authorize I my behalf, in all matters relative to work authorized by this building permit application. d � �0. ��0. :7C / Z er's Name(Electronic Signature) Date SECTION 7b: OWNER.' OR AUTHORIZED AGENT BECLARATION g my name below, I hereby attest under the pains and penalties of perjury that all of the information in this application is true and accurate to the best of my knowledge and understanding. r's or Authorized Agent's Name(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. I42A. Other important information on the HIC Program can be found at www.rnass.vov/oca Information on the Construction Supervisor License can be found at www.mass.eov dos Lliving substantial work is planned, provide the information below: r area(sq. ft.) (including garage, finished basement/attics, decks or porch) g area(sq. ft.) Habitable room count f fireplaces Number of bedrooms f bathrooms Number of half/baths ating system Number of decks/porches oling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" i� CITY OF SALEM, NLAsSACHUSETTS v BUILDING DEPiIM WNT 120 WASHIINGTON STREET, 3"a FLOOR TPL (978) 745-9595 FAX(978) 740-9844 KI,,1BFRl FY DRISCOLL �UYOR 'I�lohus Stl?lFnRf3 DIRECI.OR,OF PUBLIC PROPERTY/BUILDLNG CO\L%IISSIONER Workers' Compensation insurance affidavit: Builders/Contractors/Electricians/Plumbers auplicant Information Please Print Legibly �1I VRn1C lBusitwssUrganizatioNlndividual): �(/�» f'�I�,.1/�_'P a r�fa( ( if t,.f AY eA�C•_'(`Q 1JJ Address: .2 0 City/State/Zip: TCS S F� ( f Phone H: 2 '51 Y SJ Y2 5—S 7- 0 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 4, am a general contractor and I employees(flrll and/or part-time).* havehired the sub-contractors; 6. ❑New constrsution 2.0 I am a sole proprictar or partner- listed on the attached.sheet I 1. ❑Remodeling ship and have no employees These subcontractors have S. ❑ Demolition working fur me in any capacity. workers'comp.Insurance. 9, 0 Building addition [No workers'comp,insurance 5. We are a corporation and its 10.0 Electrical repairs or additions required.) officers have exercised their 3.0 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 of repairs insurance,required.]t amploy"s.LNo workers' comp. insurance required.] l - Other •Any appllsam the ducks box al must also till out the welloo below showing thou wmkan'cempenutiun pulley inlinmatloo. 'I6vnuuwtxts who submit this affidavit indicains iher am doing all work and Am him outside contractors must submit a now affidavit indicuing such :Cuntmtom thug chsak this box trust attached an addilfund shot showing the name or the sub.-ontrscars and Ihots workan'comp.put icy infamutlon. I um an anplayer that Is provldlnA Ivorkara'co1»ptnuadon lnsuranee jar my e/nplayeex Below Is the polley and Job slle information. Insurance Company Name: ( a `e J `y tJ I Policy 4 or Scif-itu. Lic. 11: 6 W C !S O 3 el .3 Expiration Date' 2 S 3 lub Site Addruss: < 0 �_ O Vi I + S City/Statr/2ip: Attacb a copy of the workers' compensation policy declaration page(showing the policy number and expiration data). Faiiuro to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of tine up to S1,500.00 und/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine orup to 5250.00 a day against flit violator. Ile advfacd that a copy of this statement may be furwarded to the Of ica of Investigudom ul'tht DIA fur insurance coverage veriticuliun. 1,10 hereby certify under di pubis attJ r tables of perjury 11rut rite brfunnurlon provided ubuve is true wrd c'orrece _ t Sionroure, _ r Data; // Z Phonc IOJJiciul use uu1y. Da nat write in dab urea, to be cuutpleled by city ur towns alitclud cityor'ruwn: Perm IV1.IcCNe'� `__ Nsuing Aulllurily(circle one): I. Board of ilealth 2. fluilding Depurhnent 3.Cityirown Clerk 4. Electrical Inspector 5. Plumbing; inspector 6.0aher ..... Cunlact Person: .._ .__.... ._._ Phone 4: I I CITY OF SAL.EM, NLUSACHUSETTS BuILDLNG DEPARTMENT N 120 WASHINGTON STREET, 3AD FLOOR TEL (978) 745-9595 FA.r(978) 740-9846 KI,%tgFRt F.Y DRISCOLL IkVLAYOR THo.%w ST.PtERRB DIRECTOR OF PCBLic PROPERTY/Bt;mnNG COUJIISSIONER 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 c 40, 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 disposal facility as defined by MGL c l 11, S 150A. The debris ?will be tra nsported by: (name of hauler) - The debris will be disposed(of in : f (name of facility (address of facility) c= signature'of permit applicant Z C / 2 date l � rr�e. ® CERTIFICATE OF LIABILITY INSURANCE °"'�'�"6/25 ' ACORD 6/2s/lz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE GOES 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 palicy(�)must be endorsed. If SUBROGATION 15 WAIVED,subject to the terns and conditions ofthe policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such eadorsemen s, PRODUCER A A T pp Circle Sll91ne99 Ins. Agcy, Ina PHONE f976) 77 -5619 AIK No: (918) 771-4898 247 Newbury Street E ss: PaulaHalas@CireleInsurance.net Danvers, MA 01923 INSUPE SAFFOROING COVERAGE NAICH IN6URERA:ThO Hartford INsuaEo I suR a: Turnpike General Contracting INsuRFAc: _ __ Company Inc 1 suaEao: _ 4 New Pasture Rd INSURER E: -_ Nawburyportr MP. 01950 INsvRFRF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI915 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMTHSTANDWG 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 ANDCONCITIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR� TYPE OF INSURANCE A e Sep PDUCYNUMBER M MMIO UNITS GENERALUABIUTY EACH OCCURRENCE S COMM ERCIALGENERALLIABIUTI OAMAGETORENTED S CIAIMSN,ADE ❑OCCUR MED OT n Ano rem S PERSONAL&ADVINJURV I& GENERALAGOREGATE S GEN'LAGGREOATELIMITAPPt1ES PER PRODUCTS-COMPIOP AGG S NLICY P El LOC is AUTOMOSILEUABIIDY nl¢ccl M CYE IMB S ANYAUTO BODILY INJURY(Per paam) S A OOSNED AUTMRULED BODILY INJURY(PeremcMent) S WNED HIREDAIJTOS _PIO.IIN'OS 'Terri enpPMAGE S S uMe EUA LIAB OCCUR EACH OCCURRENCE S IX'm LIAB CLAIMS-MADE AOLIREGATE b am RETENnONS S A NDRKEP9 COMPENSATION ,. 08WECCK0343 6/2R112 6/25/13 WC STATII- R OTH- ANOEMPLOYERS'UABlurr ANY PRDPRIETORJPARTNERlEKZCUTNE YIN EL E COTE R 1,000,000 CEFIrERIMEMBEEqq DUME07 � N I A (MY.MaWry In NH) - EL.OIS SE-EA FJNPLOY EE S 1 000 0D0 UE9�RIPPm) OFOPERATIONShalow EL.OISEASE-POLICYLIMR S 1 OOD 00U OESCMPnON OF CPERAnONS I LOr MOMS I VEHlCLEO (AVach ACORD iel,AtldlSonAl Ror,eHm Smhetlele,lf more slate lerogUretl)' CERTIFICATE HOLDER CANCELLATION SHCULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORQED PEPRESENTATNE 1 mpm,ev.xwr.m.w Paula Halasd°�K°�MeNeW� a Paula Halas my(hnaw .�a,.r,v„w„ ©1988-2010 ACORD CORPORATION'All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORO Phone: Fax: E-Mail: f 7m, m-r -amp s. HIC#167567 Roofing • Siding • Painting • Masonry EIN#27-3470462 D id Machado Turnpike General Contracting Inc. 28 Leavitt St. Salem. MA 01970 (978)590-9932 October I, 2012 Dear David. The following estimate is for the roof installation for the property located at the above address. The following paragraphs describe the work that will be performed. Installation Procedure • Remove existing shingle roof on the entire house • Install an 8 inch drip edge on all leading edges • Install 3 feet of ice&water shield on front leading edges&valleys • Install 15 pound felt paper on all areas not covered by ice&water shield • Install new ridge vent • Install new vent pipe flanges • Replace any rotted or damaged roof decking plywood(we allow 32SF a no charge,$65.00/sheet thereafter) • Replace any rotted or damaged roof decking ledger board(we allow 30ft. at no charge,$5.00/ft. thereafter) • Replace any rotted or damaged fascia or rake boards a $12.00/ft • Install new GAF 30-yr Architectural shingles • OPTION 1: Strip and re-roof garage with 30-year Architectural shingles • OPTION 2: Remove existing wooden&aluminum gutters(approx.64 feet)and replace with new aluminum seamless gutters and downspouts • OPTION 3: Replace rotted fascia(approx. 100 feet) - Additional S eci ications • Homeowner to choose color of shingles COLOR: yvJ • Our dumpsters are sent to a recycling facility;therefor'no additionaT trash may be placed in them. The transfer station will charge us a fee which will be passed on to the homeowner. • Transition walls are an option,and if the existing flashing is in good shape,usually do not require replacement • We are not responsible for any of the cracks that may arise in any walls or ceilings • Please cover all your floors in your attic to protect from dust and debris • We will remove all of thejob related debris • Permit costs vary from town to town and are not included in this bid Initial lire options You are ehooshm below: Cost for Labor& Material for New Shingle Roof(House): $4,900.00 t,� Cost for Labor& Material for New Shingle Roof(Garage): $2,900.00 Cost for Labor& Material for New Gutters: $1,050.00_ / Cost for Labor&Material to Replace Rotted Fascia: $1,300.00__4G Payment Terms: 113 deposit due upon signing contract: $ a y/ 113 payment due upon start of job: $�- 1/3 payment due upon completion of job: $ Total Amount Agreed To Be Paid: $ Please sign and date all pages. Remit to: Turnpike General Contracting Inc-P.O. Boa 365, Topsfield,MA 01983 The following schedule will be adhered to unless circumstances beyond Turnpike's control arise: Work Scheduled to Begin:_TBD Job expected to be completed within 60 days of actual start date. Warranty: Turnpike General Contracting Inc.guarantees all work performed for a period of one year. If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customers satisfaction. Terms and Conditions: �-� Th' act is subje to the terms and conditions of paragraphs I through 14*actr hed 11 creto incorporated herein by reference nni Ma iati ,President yid Machado umpike General Contracting Inc. Date Homeowner Da Tel: (800) 535-4312 • Fax: (978) 887-5875 0 239 Boston Street • Topsfield,MA 01983 71. \ office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registration .1167567 Type: Expiration 10/4t2014 Supplement Z kr TURNPIKE GENERP.Ly�C.ONTRAQTING INC. RAMON PERDOMQr ,v ,va- 239 BOSTON STREET t3gX,365 TOPSFIELD,MA 01983- _J=� Undersecretary 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty w License: CSSL-099651 RAMON H PERD9MO,WAR-91 321 TEORDAV BELLIN i1:._ ` BELLINGHAM Iy1A 0201 ' 111+0" Expiration 05/30/2014 Commissioner