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152 LORING AVE - BUILDING INSPECTION (2) a , e Commonwealth of Massachusetts ° Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: I?pk A plied: rr Building Official(Print Name) Sign e Date SECTION 1: SITE INFORMATION ].l Property Address: 1.2 Assessors Map& Parcel Numbers Lla Is this an accepted street?yes__ no Map Number Parcel Number - 9-3-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 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: ';PY&4_n64S&O Manna Z, S//1em . A'SS' 0/g70 Name(Print) City,State,ZIP ' 159 L0/un ve �7S'-59�-1 i3 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s)CW Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: .BriefDescriptionof Proposed Work2: O/3 bae O v [ns a a � G SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building $ g,00 s 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ 6.Total Project Cost: $ Check No. Check Amount: Cash Amount p� �(� _— ❑Paid in Full ❑ Outstanding Balance Due: CFaI�.�.ti'17 i2�121t"') L 3 2-q - fiz) Flu SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �� 6��'/ d y O�f �o �Cl d/bae Z License Number Expiration Date Name of CS h Holder / �_ /lala �� List CSL Type(see below) No.and Stre/ett1...���000sss;;;l���--- Type Description ®�g—�d Unrestricted(Buildings u to 35,000 cu.ft.) J L Restricted 1&2 Famil Dwelling City/Town,State,ZIP M Mason ty RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 78i-)15=325 jJ(w1 SGt)Pr4fjued,pnl I Insulation Telephone Email address G D Demolition 5.2 Registered Home Improvement Contractor(HIC) '�?��(� �Q� /HIC Registration Number Expiration Date HIC C�i�y Nnine-or�%wR�gislr�it�Name ' No.and Street Email address 51J/&rn �+C�s� .ol47f� 78/-7I5 3Lf6� 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 .......C- d, No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Q 6"es eo to act on my behalf,in all matters relative to work authorized by this building permit application. /I1�nets� A& eZ /a-t0-13 Print Owner's Name(Electronic Signature) - Date 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 in this application is true and accurate to the best of my knowledge a understanding. 4 - 4� - 10-/0 / 3 Print Owner's Qf 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(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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 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"may be substituted for"Total Project Cost" DANTE'S CONSTRUCTION 8 WHEATLAND ST SALEM MASS 01970 PHONE-781-715-3298 dantesconstructionl2@yahoo.com PROJECT No. 229 CONTRACT No. 869 THIS AGREEMENT IS BETWEEN: Raul Baez Jr. Francisco Hernandez 8 Wheatland St. 152 Loring Ave (Contractor's Street Address) (Owner's Street Address) Salem Mass 01970 781-715-3298 Salem, Mass 01970 1-978-594-1593 (City,State,Zip) (Telephone) (City, State,Zip) (Telephone) A. Construction Funds holder: Owner (Name and Branch Address of Bank, Savings and Loan Association, Escrow Agent, Joint Control or Other Construction Fund Holder) B. Description of project/work to be done under this contract: Contractor will furnish all labor and materials to construct and complete upon the project/work described on page 2 in a workmanlike and substantial manner Von the following described property; 152 Loring Ave. Salem Mass. 01970 C.Property Lines: Owner shall locate and point out DMperty lines to contractor. Contractor may, at his option require owner to provide a licensed land surveyor's map of property, D. Payment: Owner will pay contractor the total sum of 2800.00 in installments as follows: Deposit of$ 1400.00due on time of contract signing. Balance of$1400.00 due at time of completion of the iob. E.Time for Completion of Work: Within 30 days after the execution of this agreement owner will have the job site ready for the commencement of construction and shall there after give contractor written notice to commence work Contractor shall commence work within 10 days of the notice and shall be completed in TBD working days after commencement subiect to permissible delays. F.Terms and Conditions: The terms and conditions on the reverse side are expressly incorporated into this contract. DANTE'S CONSTRUCTION _� LIC# CS 106464 15� 4�7 / Z_ -�o y (Contractor's Company Name) 3 (Property Owner Signature) (Date) (Contractor r Agent Signature) (Date) ( If More Than One Owner, Additional (Date) Property Owner Signature) Page 1 of 2 Page 1 of 2 DANTE'S CONSTRUCTION 8 WHEATLAND ST SALEM MASS 01970 PHONE-781-715-3298 dantesconstruction l2@yahoo.com PROJECT No.229 CONTRACT No. 869 PROJECT/WORK DETAILS The following project/work will be completed in accordance with the building codes set forth by the Commonwealth of Massachusetts 780 CMR: 1. Contractor to obtain Building Permit from City of Salem, Mass. 2. Re- enforce the small deck back of the house, (bring back to code) 3. Frame of 3 cross beans to support the roof. 4. Install heeders in all windows, to insurance all and support the structure of the addition. 5. Install Panels inside the addition with insulation. 6. Contractor responsible for the debris does to the construction work. DANTE'S CONSTRUCTION LIC CS 1064643 (Contractor's Company Name and License No.) (Property Owner SiYur-e) ��4t�(�D�ate) (Contracto or Agent Sig ature) (Date) ( If More Than One Owner, Additional (Date) Property Owner Signature) Page 2 of 2 9 J <` Office oS Consmner eltfaire&Bnsmess Regulation - I # �� pME IMPROVEMENT CONTRACTOR - �gistratlon 173214 . Type: ., V? zpirat�on:.. 9/17/2014 Individual . RAUL B:Z �= - d RAUL BAEZ I y... BWHEATLAND ST. a SALEM.MA 01970 I - Undersecretary - ? 'A � fitassachusetts -Department of Public Safety Board of Building Regulations and Standards - - Cun:structinn Superviwr=License: CS-106464 ` r; RAULBAEZ 8 WHEATLAND STREET 'A - Salem MA 01970� sNP O "s cX-^i'otiOn Commissioner 0910412016 - CERTIFICATE OF LIABILITY INSURANCE DATE(M191201 YYYI T TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES 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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: METRO BOSTON INS AGENCY PHONE FAX 96 CENTRAL AVENUE CHELSEA (A/C,No,Ext): (A/C,No): CHELSEA,MA 02150 E-MAIL ADDRESS: 76KXM INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY BAEZ,RAUL DBA DANTES CONSTRUCTION INSURER B: INSURER C: INSURER D: 8 WHEATLAND ST INSURER E: SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED'BELOW 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY UP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY $ CLAIMS MADE OCCUR. DAMAGE TO RENTED $PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT❑LOG PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR .EACH OCCURRENCE - $ EXCESS LIAB H CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-5B601448-13 09/18/2013 09/18/2014 X LIMITS ANY PROPERITOWARTNER/EXECUTIVE El OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.deaedn under OPERATIONS 0elow DESCRIPTION O E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESC DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR BAEZ,RAUL. CERTIFICATE HOLDER CANCELLATION DANTE'S CONSTRUCTION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 8 WHEATLAND STEET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS/_ AUTHORIZED REPRESENTATIVE �__ SALEM,MA 01970 \.. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP ORX 'ONF 'il§fiiis reserved. Aco CERTIFICATE OF LIABILITY INSURANCE °°'�'""9/18/' 9/18 13 III THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES 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: N the certificate holder is an ADDITIONAL INSURED,the polic es) must ba endoreed. If SUBROGATION IS WAIVED,subject to the tsmre 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 endorsemen PRODUCER CONTACT NAME: Q1r19 Metro Boston Insurance Agency, PHONE FAX (617) 884-6467 617 BBG-5480 N.: % Central AMs JL11NE�. Chelsea, MA 02150 INSURE 5 AFFORDING COVERAGE NAIC0 ItSURERA:Atlantic Casualty Ins Msance Co INSURED INSURERS: Raul Baez INSURER C C1ha Dante' s Construction INSURER D: 8 Wleatland St INSURER E: Sales(, MA 01970 INSURER F COVERAGES CERTIFICATE NUMBER: - - REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. POLI LTRR TYPEOFINSURANCE INSRSR AWL SUER POLICY NUMBER PY�rYEFF MMA)U EXP UUIS A GENERALUABIUn L117001209 9/19/13 9/19/14 EACH OCCURRENCE E 1 QOQ 000 DAMAGE TO RENTED X COMMERCIAL GENE RAL LIABILITY E 100 000 CLAW NIADE aOCCUR NEDFYP(Ary one person) E 000 PERSONAL S ADV INJURY E 1 000 000 GENERALAGGREGATE E 2, 000. 000 GEN'L AGGREGATE LNOTAPPLES PER PRODUCTS-COWIOP AGO E 2 000 000 POLICY PRO- LdC 1 E AUTOMOBILE LIABILITY O L IT (CEOe acciderl E ANYAUTO BODILY INJURY(Per person) E ALLOWNED SCHEDULED BODILY INJURY(Per axideM) E ALTOS AUTOS HIREDAUTOS _AUTOS NON-OWNED PeOP I DAMAGE y E UEBRELLA LUB OCCUR EACH OCCURRENCE E EICFSSLIAB CLAWS-MADE AGGREGATE E DED RETENTION WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXEWTNE 7 NIA E.L.EACH ACCIDENT OFTICERh£MBER EJLCLUDED7 (Mandebry In NH) E.L.DISEASE-EA EMPLOYEE Wdmaibearder DESCRIPTION OF OPERATIONS b low E.L.DISEASE-POLICY LIMD E IUESCRIPTIONOFOPERATIONS/LOCATIONS/VEHCLES (MarL ACORD 101,Add4enal Renerlm Sche"e,N mere spew is MqU red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N Dante's Construction ACCORDANCE WITH THE POLICY PROVISIONS. 8 Vbeatland Street Sales, MA 01970 AUIHDRDFD REPRESENTATIVE Chris Matarazzo ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: cIante9COn9tr11-'tionl2@yahoo. com I CITY OF S:1LENI, NLkSSACHUSETTS 13UILDING DEPART\[F—NT %Q,zc� 120 WASHLNGTON STREET, 3se FLOOR TE1_ (978) 745-9595 F.A.0(978) 740-9846 K .%BFRL F.Y DRISCOLL T VIAYOIt t�foi<tAs ST.PIFeRs DIRECTOR OF PUBLIC PROPERTY/BL:ILDLIG CONNISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractorv/Electricians/Plumbers Applicant Information 1 r1 Please Print Legibly VumC (Business Organizatioro'Individulal): :b CtrijQS �O✓1 S ^� f U I' Address: w C `� ti � S l City/State/Zip: S / I f^ G SS Phone Are you an employer?Check the appropriate box: "type of project(required): 1. r 1 am a employer with 1—� 4. ❑ 1 am a general contractor and 1 6. ❑New construction .❑ employees(full and/or part-time).' have hired the sub-contractors 2 1 am a sole proprietor or partner- listed on the attached sheet. 2 7• ❑ Remodeling i ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9_ ❑ Building addition [No workers' comp. insurance S. ❑ We are a corporation mid its officers have exercised their 10.0 Electrical repairs or additions required.] of 3.❑ I am a homeowner doing all work right of exemption per MGL I IQ Plumbing repairs or additions myself.(No workers' cutup. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant fair checks hex HI must also fill out the 5ectian below showing their worked compensation policy intbrmation. '16+mcownsn who submit this artirkwit indicating they arc doing all work and then hire outride contractors must submit a new a?davit indicating such. :Centncrors thus chcvk this box must anached an addifluma,hcet showing the noire of the sub.on actors and their worker'comp.policy information. I unt an employer that is pravidinK workers'compensation inaurancefor my employees. Below Is the policy and fob site information. Insurance Company Name: �l•< 'd—(%t /� V Policy Nair Self-iris, Lic. N: Expiration Dale: lob Site Address: City/State/Zip: 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 uf,IIGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the, form of a STOP WORK ORDER and a line of up to S230.00 a day against the violator. He advised that a copy of this statement may be forwarded to the Office of Investiguiions ul'the DIA for insurance coverage verification. -. I du hereby certify nder the pains and penuttles of perfury that the information provided ubuve is true and correct Date: / —! ! —/3 . Phone N: OJfie ial use only. Do not,write in this area,to be completed by city air town offlclal CityarTown: _., ._ Permiul.lccnsek Issuing Authurily(circle one): 1. Board of Health 2. Building Department 3.Cityfrown Clerk J. Flectrical Inspector 5. Plumbing Inspector 6.Other . .--- Conlact Person:__ _. „__ Phone A9: