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15 LINDEN ST - BUILDING INSPECTION (2) t Ilj �. 0 O t/ The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY / !7 ) Massachusetts State Building Code, 780 CMR, T"edition OF SALEM Revised Janmvv Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 2008 One-or Two-Family Dwelling This Sectio4 For Official Use Only Building Permit N mber: ate Applied: Signature: �� )0 011�Building Commissioner/Inspector ofBui in Date S$ ION 1:SITE INFORMATION I.I I Property Address: S�t��N111�V11 1.2 Assessors Map& Parcel Numbers $ linden Sd' _ I.la 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 R) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provtded 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 yesE3 Municipal O On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownerl of Record: idla�rfe1� 0Tetbllp �S I14cyl �AJl vl Idol N9,/�p/nc(print) Q Address for Service: q Signature J Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ I Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Qf Specify: Tr Brief Description of Proposed Work'-: CPVVt r q .f I'I t R l e$' /g C I IS I IjE4a[ n w %r a ri SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official U Only Labor and Materials a Use n y I. Building $ to I. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (FIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: S 7 ❑Paid in Full ❑Outstanding Balance Due: otvi SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 99 7- Z n License Number li.<pimli n Date Name of CSL-I lulder d List CSL Type(see below) Ito oti il;�s s� low I 6i T Description •'� 's U tJnrestricled u to35,000Cu.Fl. R Restricted L@2 Family Dwelling 'i nature M Mason Onl ' J 7 I ' RC Residential Roofin Covering Telephone WS Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvem nt Contractor(HIC) 3 9 ' ' I t/ C Registration Number HIC Company Name or 111 'Regislr. t Nam i l hn f d 11 01 G — � � ' Zoo A ress Expiration Date Signature Telephone 1� SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT D I i 0 _ as Owner of the subject property hereby authorize �p(>e( �m mo nS to act on my behalf,in all matters relative to work authorized by this building permit application. Si ature of O wner Date SECTIO 7b:OWNEW OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Qc)btrf 0 LnffxyS Te Print m e - 5 - 2010 Signature of Owner or Authorized P#nt Date (Siy,ned under the pains and penaltiM of 'u 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 Mal have access to the arbitration program or guaranty fund under M.G.L.c. 1 d2A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and I IO.RS,respectively. 2. When substantial work is planned,provide the information below: Total floors 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"may be substituted for"Total Project Cost' ,S CITY OF SALEM j PUBLIC PROPRERTY DEPARTMENT .1111i MI hl !•MM I''1I I1N1.;0N51'1tLL'T •).\I I N1.M.\+i.U - 771;V711•N 9i9S I'.\x:978•7404846 Construction Debris Disposal Affidavit (required flur 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 p _ is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c I It. S 150A. The debris will be transported by: (name of hauler) 'I'he debris will be disposed of in D tJ (nameuf aciny) � 1 (address ul'1'acilityl +ignature of Ixrmit applicant If '?d 1d date Lh .�li,:,w • ACORD CERTIFICATE OF LIABILITY INSURANCE DAToana2009 Y' TM. PRODUCER Phom: (978)475-0400 Fac (978)47&2171 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION THE HOWE INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 PUNCHARD AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ANDOVER MA 01810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: St Paul Travelers ROBERT EMMONS JR INSURER B: DBA E B GENERAL CONTRACTING INSURER C: 16 PHILLIPS STREET --- — LOWELL MA 01854 INSURER D: 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. I INSHU TYPE OF INSURANCE POLICY NUMBER POl1CY EFFECINE PoucY EXPIRATKW LIMITS DATE M Mni GENERAL LIABILITY I EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PHEM �I S 1 CLAIMS MADE OCCUR MED.EXP(Arty are parson) S PERSONAL S ADV INJURY $ I_ _ _ GENERAL AGGREGATE S GE� POC CYE T I JECLIMITPRO APPLIES PER:LOC PRODUCTS-COMP/OP AGG. $ j AUTOMOBILE LIABILITY COMBINED SINGLE LIMB ANY AUTO (Ea erdearR) $ -- t ALLOWNEDAUTOS BOOILYINJURY j SCHEDULED AUTOS IPA ParaDD) S II HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS IPer acrJdeaq .—_—........__ I nD PROPERTY DAMAGE S (Per GARAGE LIABILITY _ AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ _- AUTO ONLY: AGG {S EXCESS I UMBRELLA_LIABILITY EACH OCCURRENCE_ S IOCCUR r_I CLAIMSMADE AGGREGATE S -- S -- — DEDUCTIBLE $ RETENTION S _— --- S uff U WORKERS COMPENSATION AND To OTHER EMPLOYERS'LIABILITY UB744$A017 04H 8109 04/18/10 roar urrs A ANY PROPRIETOVPMTNERIE]IECUTNE E.L.EACH ACCIDENT $ 100,000 OFFKERNEMBEREKCLUDED7 E.L.DISEASE-EA EMPLOYEE $ 100,000 IIya;aPEtMLPRO aPIN YISMIOIONS aeIRw E.L.DISEASE-POLICY LIMB S $00,000 OTHER: li I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION FOR PROPOSALIESTIMATE PURPOSES 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 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: JUCWhnstine J. range ACORD 25(2001108) Certificate# 5366 ©ACORD CORPORATION 1988 ✓7ia•�ururoumrrr///s r�'.%�rurrr�rra•ira ju' V Board of Building Regulations and Meador& License or registration valid for individul use only NOME IMPROVEMENT CONTRACTOR before the expiration date. N found return tol Board of Building Regulation:;and Standards Regletrallont 1307BB One Ashburbm Place Rm 1301 Expliatlont•e/lel2000 Tr# 132608 Boston,Ma.112108 Type; CBA 9.13.GENERAL CQNS.TRACTINO ROBERT EMMONSJR. 1S PHILLIPS S.T.. LOWELL,MA 01804 Administrator Not valid without signature , De parimen of TuDlic �arct� ' f3uard of Building Regulation. anti �l:uular4. .r License: CS SL 99723 Restricten to: RF,WS ROBERT EMMONS 16 PHILLIPS STREET LOWELL, MA 01854 E.:i iration: 9/22/2011 f mm�i• i.m.'r Tr=: 99723 EMU. General Contracting g A complete Real Estate Solutions Company GENERAL CONSTRUCTION & CONSULTANTS a G.A.F CERTIFIED ROOFING SPECIALISTS 23 Boston Road Billerica, MA 01862 • Tel. 978-459-1578 PROPOSAL SUBbffr=TO: p PMNE R: Nl a r^c e0o Tro ba Pas#: 918 3/T »7 9 DATE. STREET: t F l i e /i S ,jam JOB LOCe,TION: CnT,STATE AND ZIP CODE: C /1 L E AA /IA(�SS ESTIMATOR: d �"t C�t �_G CONTACT: we hereby submit spaiscatiom for: Re-nailing any loose boards as needed and replacing up to_�sq.ft.of roof board. Any additional boards will be at a cost of$2 per square feet. New shingles will be tied into flashing and will be counter flashed as needed. An industrial try-polymer sealant will be used for all crevasses and protrusions. Installation will include but not limited to the following: ❑ Removal and disposal of layers ® Roof over existing j—ZI edges will have t6 feet of ice and water barrier. Valleys will have 3 feet of ice and water barrier. 8"drip edge will be installed over the ice and water barrier. WYear shingles,three tab(basic)or laminated(architectural) 15-pound wrinkle free felt paper. Quality ridge vent for proper roof ventilation. ❑ Soffit vents to be installed. Vent pipe flanges to be installed. All labor will be guaranteed for ten years from the completion date. A Please make check payable to Bob Emmons Jr. ass lie a�, 101RaPOMbemby to fmnfsh material and labor—complete m so=&ce with above specifications.for the won of. r � DOLLARS $ Payment to be made as follows: 1/3 Deposit—1/3 Upon p half canipletion—1/3 Uponco letioa ase0 — .? 6 O St90 Authorized Signature Accep nce of proposd lbe above priees,speciseshoaa asd co.dm.are satisfactory and are hereby accepted. You are wabmimd to do as specified. Psymeot will be made as outlined above. Z Date of Acceptance: ` 2 0/ a Signature: t�tfit s All material is guaranteed to be u specified ALL work to be completed in a wodmsadika roamer according to sWWad p acdoes.Any alteration or dwiation fiam above apmiseadom involving extra costs will be exewdad ody upm written orders,and will beeomo an exha charge mar and stow the estimate. ALL agreements are centinSW upon sN7ces,aseidents w delays beyond our control. Owner to carry fire,tomedo and other necessary insu . Our workers art fully,covered by Workmen's Compensatim htwuanu. CITY OF S.U-&Nip NLA.SSACHi;SE-M SL mDLNG DEPIIRT%IL%T 120 WASHINGTON STMKIfi )ao FLOOR TEL (978)745.9595 F.%X(973) 740.9846 IpS®E1tLZY DRISCOlJ. T4io HAYOR tdAi ST.PIERRIt DiRP.croit oiF Pt,:eLlc pRoPERTY/et:i2.DwG CONOUSSIO:rER 1Vurkers' Compensation Insurance Allldavit: guilders/ContracterdElectr(clonsiFlumbers Annlicant Information Please Print Letzh_lo_ NatncIBujin+ OrgynrarioAlnJrv,dwi): EtB' " eVlere. l Con ,YClc/ tlt Address: N ehi1111C Sir City/s tdZip LLIV1,11 , (�1T h 0 I R �� Phone N: 28-7 71 Are ou to employer.'Check the appropriate boa: Type of project(required): 1. I am a canploya with—�L—L 4• ❑ 1 am a general consactar and 1 cmployeve(full and/or pan-time).• have hired the subcarrracmrs b' ❑Now constnrctios 2.❑ I am a sold proprietor ter partner- listed an rke attached sheet,: 7• ❑Remodeling ,hip and have no employcm 71tms sub-contractors have L ❑Demolition working for me in any capacity, workers'comp.insurance. 9. ❑Ouilding addition [No workers'comp insurance S. ❑ We art a corporation and is 10.❑Electrical repsirs or additions required.] odkdn have exercised their ).❑ I am a homeowner doing all work right oreaemption per MGL 11.❑Plumbing repair-or addhioro myself live waken'comp. c- 15Z 41(41 and we have to 12, f rs MIT insurance required.)► crnpkyem lNo workers' 13 CIA comp inUWUW mquited j •Any.4 rams IW dur4 ban Of made alas as as Ihe mom bake aboeisg tkdr reAw'mnparodwt policy indianrtlea. 'If'. ditaa�he ruldow ads aMdnit indlotiq they w Joke tU wart and than him ansift eeauaesaa&Vann noting s new anWwa Mianing sank T.wift a d W caret Aid boa mud aaadwd an aJAdiad,Am shoring dub trot eretr nt►esattaatara me Ih*raA -racy.pinky iarradowim. l um an etwpfeytr that is p oviddt;workers'compensation lnsartnce ja aq taapleyata schm,is fRe pNb y endM ales inf"Ne ion insurance Company Name. ] 1 P u I L IrOI vet,e 5 Policy e or Setting.Lie.she ��� �Iy.S�d ��7 ��j� Expiration Date In II lub Sire Addkcu: I5 L I nae fl ST '2GYA,/��,n[�4TJ"- City/SutstZip .%track a copy of the workers'compensation policy desldratlon pep(showing Ike policy number and aspiration daft)6 F•ailurs to x"urs coverage a required undo 3ectioa 25A of MGL c. 172 can lead to the imposition of criminal penalties are fine up to S 1,500.00 and/or ant-year imprisonment,as well as civil penoitim is Ow form of a STOP WORK ORDER and a Btu Of up to S250.00 a day against the violator. lie adviwd that a copy of this statement maybe furwarded to the office or Inv.,nyatium of Iha MA for insurance covcrop v%witicatis o. l de hereby err un/ar the pains and prnadles o/pn ti rhel rM inleralu/oa prorilaaf chew is era ant earned t il� 05 - io 4 7 L6 3 OfJlcial urn only. /!a nor write in this arras to be a utnpkid by city or tewm ufllaiat 1 City or fuwn: Permit/I.Iernu Atuint Authunty(circle une): I. Iluard of IlvaUb 1. nuHdlnt Mpariment J. Citytrown Clerk 4. Hlectriul Inspector 5. Plumbing Intpeetor 6. Other l..nlaet Pcnan: _ ._ Phone C