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26 LYNDE ST - BUILDING INSPECTION y r t L.. -'(� �\V\1 The Commonwealth of Massachusetts Town of ►—� Board of Building Regulations and Standards Massachusetts State Building Code. 780 CMR, 7"edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a tdt ' One- or uv-Fanidl-Dwelling This S ction For Official Use Only Building Petmit Num ec l Date P�pplied: Signature: Building Commissioner/ Inspector of Bu dings ' Date SECTIONIJ4: TE INFORMATION 1.1 Pro erty Address: 1.2 Assessors Map d Parcel Numbers Ma Number Parcel Number 1.1 a Is this an accepted street?yes_ no p 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Arc.(sq it) Frontage(R) 1.5 Building Setbacks(B) Side Yards Rear Yard Front Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,554) 1.7 Flood Zone Information: 1.9 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public O Private O Check if vesO SECTION 2: PROPERTY OWNERSHIP' 2.1 caner of Record 'z (—YN r P S.T Name(Print) s-rs ~J Address for Service: 9 r1 O 6 a O Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Buildin Owner-Occupied ❑ Repairs( Alterations) ❑ Addition O Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': cLTMW ± ROo �' _— SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials 1. Building f 1. Building Permit Fee: f Indicate now fee is determined: O Standard City/Town Application Fee 1 Electrical $ O Total Project Cost'(Item 6)x multiplier x 3. Plumbing f 2. Other Fees: S 4. Mechanical (HVAC) S List: S Mechanical (Fire S Total All Fees: f Suppression) OO Check No. _Check Amount: Cash Amount:_ 6. Total Project Cost: S ' 31\400 0 Paid in Full 0 Outstanding Balance Due t SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) ^q Y-7 r 3 ( j r 1 �©4j b t,�S Liceme Number Expiration Date N,4me ot'CSL liylder Lint CSL Type pcc below) a q � A t.7J Sr e LroF AJdrrs T' Descn Ion U Unrestricted u to 35,000 Cu. Ft.) Signamrr R I Restricted 1&2 Family Dwelhn N Masonry Only A -I RC Rcs:dcnual Roofin Covenn Telephone WS Residential Window and Sidra SF Residential Solid Fuel Bunning Appliance Installation D Residential Demolition 5.2 Registered Home 1 provement Contractor(HIC) l r Me 7 t ( / Da8 ( 1 HIC Company NameF�lC Registrant Nam Registration Number Addle( (i7—� . >`- 0C1 - S3 j (,� Expiration Date Signature elephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 2SC(6)) Worker 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. Sighed AfTidavit Attached? Yes .......... O No...........❑ SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner of the subject� property hereby authorize to act on my behalf,in all matter relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b:O�WNERt OR AUTHORIZED AGENT DECLARATION C,,�✓ as Owner o Authorized Agen ereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner c, Authorized A¢ent Date Si ned under the pains and penalties ofperjury) 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 3f have access to the arbitration program or guaranty fund under M.G.L. c. 141A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectively. 2. When substantial work is planned,provide the information below: Total fl oor area(Sq. Ft.) (including garage, finished basemenUattics,decks or porch) Gross living area(Sq. Ft.) Habitable room count. Number of fireplaces .Number of bedrooms Number of bathrooms Number of halfbaths Type of heating system Number of decky porches Type of cooling system Enclosed Open 1. "Total Pro)ect Syuare Footage"may he ,uh%tituted for 'Total Project Cost" ♦ 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 u,p www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electri Please Print Leatbly A hcant Information 1, Name (Business/Organization/Individual): L Q -./ y Co Address: City/State/Zip: q Phone #: 9 9 9 5 l $ a 3 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors sheet. listed on the attached sheet. 7. Remodeling 2. I am a sole proprietor or partner- These sub-contractors have g. Demolition ship and have no employees employees and have workers' working forme in any capacity. 9. ❑ Building addition comp. msurance.t [No workers' comp.insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs c. 152, §1(4),and we have no 13.❑ Other insurance required.]t employees. [No workers' comp. insurance required.] 'My applicant that checks box#1 must 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 must submit a new affidavit indicating such. lContractors 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-contractors have employees,they must provide thew workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: F--. (01 0 9 , 9 ® l q Expiration Date: 1 a Job Site Address: 2 (!, LVti D.� S�- City/State/Zip: SA�M 116 0 %,q L) 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$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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true andcon ect. Srenature Leo'^ e- �— Date- Phone#: Cj5 3 1 _-2-3- Official only. Do not write in this area, to be completed by city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector rson: Phone#: ir. a. ,. • , Q�L ISSUE DATE 07/31P009 RODUCER ' '" 'divard F Sennett Insurance THIS CERTIFICATE IS ISSUED.IS A NIATTER OF INFORMATION ONLY AND CONFER!';NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Agency Inc DOES NOT AME\U.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 16 South Alain Street POLICIES BELOW. opsfielcl MA 01983 COMPANIES AFFORDING COVERAGE NSUHED =n Glbely ContractinR Company Inc commw A AI.M. Mutual Insurance Cc �r m THIS IS TO CERTffT'THAT THE PO WCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POWCY PERIOD INDICATED.NOTWITHSTANDING ANY REQLIRafENT,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 POWCfES. LLMITS S1-10 MAY HAVE BEEN,REDUCED DY PAID CLAIMS. co nTL OF I.\CV1Wsrcf POLRNEFFICTIVF POLIGTESTIPArION LIN POLICY NUMBER UATELMN/DDlnT O.ATE IIAWOIVrn LIHITI "NLFA L LIAPILIFY OLVERX.ROOF CGSR I o GLIILYAL LlAblllll GFOD\TIS.Cq MfirV AG4 t'VLIML.C':At O�CLJIA+MAvt=mcV 1 F P=IAVIAI t AUV.III!VF1' �JGW11_F.':3 CCai:1RC35 PF1,. FPS DAHA4!IAw:n:lir;l A VTUMOMEL1 111S1' 1!C[•FdsGG[vai>..Pmzj COMTIHFD[INOIL LIMIT MIv A1w : ALLOWMAVM- - WNLT VUUP.1' - 1 SCHEDULED AUTOS Lin Purol I I Nle_F•AVTOi I VOIIOMT4OA�Ji vCDILI'IIUVP.1' - �cAFAO!11APILRT 0,,oi6nl iP.OFrin bm,(Aa MCI STLIABILITY GCN OccOPA!tl! UMB SLLt MrN � IIMDRL"FOW Accluc I MU. AU , 4., S� ;i' _ •A ._pj �:.xv_ , IVORAFJtS CONIPENSATION A.ND .AT Lt\t({5 STATE TBEA LIU LOXMIL5 LWILITI' ALA bE PPwr�ETn.-v A EL EACH A[CIDEN 500,000 I :IiICRF9 AF.t —I cL �cc 601097901'009 08/03i2009 0Sl03/1010 EL DISEASE-POLICI"LMIT 500,000 EL DLSEASc_EACH EAIPLOYEF 5OO,OOD I I I I gtich'fETf;: a :t"�rar y.1 HOUM ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEIIED BEFORE THE EATOLATION DATE F,THE ISSLING CONPA.NI WILL EMIFAVOR TO LIAO,IB WTITfEN NOTICE TO THE CERTIEICATE OLDER NAFIED TO THE LEFT,BUT FAO.URE TO ALUL SUCH NOTICE SHALL IMPOSE NO OBUOATION R'LABOJTY 01`11M•END UPON THE CONIPAN V,ITS AOFNTS OR PaRESENTAITM 0 WHOM IT MAY CONCERN SIrrTI0R1].EO R[P0.ESEN ATIVE 6169 `-I.EN GIBELY CONTRACTING CO., INC. P RO POSA L se 149 Main Street 1' - PEABODY, MASSACHUSETTS 01960 All home improvement contractors and subcontractors (978)531-8234 engaged in home Improvement contracting, unless FAX(978)531-9304 ..pacifically exempt from registration by Provisions of !// Chapter 142A of the general laws, must be registered Submitted /'I ( L // p 7 J J//r. with the Commonwealth of Massachusetts. Inquiries To: �J/I r'I +T'ta✓I'j'�J 7E I MCVI Cl( C/ t/� 46out registration and status should be matle to the 6 ` L Director, Home Improvement Contract Registration, Z L N 4 dZ One Ashburton Place, Room 1301, Boston, MA 02108 c (617) 727-8598. Owners who secure their own J M o i 470 construction related permits or deal with unregistered - / contractors will be concluded from the Guaranty Fund Provision of MGL c.142A. ZP�ION�qE� GATE nEGISTXAiION XD. 7//7 Q z_36 3C.�n MA.REG.100811 JOB N/AAMFJNo. b !— JOB LOCATION sAM "Wo her submnspecmo lions p°�rmete work to be performed and materials to be used: �aL�S ci' I arC06� S7P. a \rI M anS� r"06� d!LQ. l �„ \\ "S yri any 3Z�f Ise �d ,s �3, o/cF ��ee�er�. Ts4t~11 <— ( �1_4 �C : a« 3� ai-c�- 1-e -k,J 5(des o Ci/Q rvkRiS tC PS l �j cI 410 1 //t d _L�S I ride T UPp,,,r e- to(,,,e/ pc/lp k,- a I Jlt, S / r COAd t41on l r ;-Clot � repyl 'CDnstrpptiGnjr9ate(lta:� f (tool /441 / I / /- r� I AS+� C�(tool .f r44 hi&0 S'ff 90JG'� 7� C7 s l O e(S)A � 3 v 7s, oG //0 WORK SCHEEI coo" Ira �yn��oayy��I�. he work or Oder the mammals act,If Imm d.y lot owing ma signing of tors Agreement amass real hamin a, .col .rut eog�n too foes„n or .b t .i( ldser.earring delay caused by c mstancos beyond Conuan January Cenral,too work will be Completed by _n ouml.Troy owner nereoy ."a tl grill mat mescheaulingdates are approve ate and that such dekrys that are nor adepaMe by thecontractor shall not be consibaratl a(nolallons of this AgNamonl. WARRANTY To.Contractor warare flat In.work famished hereunder shall be free tram cane in material and workmanship for a period at- y,P 1y.P1 following comple(on and shall Comply with then dirmems at this Agreement.In the event any Will in workmands,ra sands,m ura based byma Confacmr.Meepabantrecfes,employees...... ts.a discovered within n.Year after completion of any job Including clean up.the Comracmr shall,aril his own expense.forthwith remee repab,correct,replace,or cause to b.amomed,around or replaced, such damage or such tlelec In materials or workmanship The foregoing% amies shall sui any lospectmnp dormad in connection with the agreed-upon work We Propose hereby to fuj/FA�materiallt. 1 laplo�� complete in accordance with above specifications,for the sum of: YlY Id//Y h lam{.f dollars Payment to be made as follows: d-H uPon slgnln9 Contmc Nam.al //re'canr,,,�ra,rooAr %f$jupon cAmpllarrnol areas AW:e24 ss / is—//—)upon complerton of omrsf.f. / Ian ($ / tcompletion om h0made work under upon P o //— hole efio ad thavi Jrtlis conuan. Feder. D 0.n Cs Notice: (a agreementancdeposit) sit tome improvement contracting work snail require a tlown --RCy��OA payment(advance deposit)of more than one-third of the total mwarro pricy or the total amount of all deposits or payments which the contractor must make,in advance . m order andtor otherwise obtain dralw ry of special order materials and equipment, fort cneve oun er Nm..Ins permit on,no widens—ry us.hapI aQepaa wham aays. Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated,I understand that upon signing,this proposal becomes a binding contract. You are allthorized to do the work as specified. Payment will be matle as outlined above. You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the dat of this transaction.Cancellation must be done in writing. DO NOT-SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Sgnurw,. Dare an e 61gna ro D IMPORTANT INFORMATION ON BACK I► t � ���}J"hr'3 ,✓+ ;j�, ,-/{ea {ppiroiluirabeut!4L U� C��tt(�q BOARD OF BUILDING REGULATIONS I z: License: CONSTRUCTION SUPERVISOR Number. CS 094763 Birthdate: 05/14/1943 Expires: 0 5/1 412 0 1 0 Tr.no: 94763 Restricted: 00 - THOMAS R DOBBINS - 19 CEDAR HILL DRIVE 0- DANVERS, MA 01923 Commissioner �-\ 8 rd f Buil�omdig R�i�ou�tandaruds -" HOME IMPROVEMENT CONTRACTOR Reglstra,ft\ 100811 E7cplrati0fil-03/2010 Tr1! 268971 Private Corporation � { it°= /� '• LEN GIBELY Co C. Brian Dobbins r -' 149 Main Street Peabody,MA01960 "' Administrator