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27B MARION RD - BUILDING INSPECTION (2) -5- ► t4 -1 5 3(,� GC 10T 'I 4q5,D The Commonwealth of Massachusetts t 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: Date Appliek p. Building Official(Pant Name) a Date SECTION 1:SITE INFORMATION 1.1 Przoeer tgAddresss: o /z 1.2 Assessors Map&Parcel Numbers Lla 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 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? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Record:, // Name(Print) City,State,ZIP Z7 b MWIi44 /23 977•W1 • /G4$ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other R Specify: grMcc- peck Brief Description of Proposed Work: 2?t /s, o u� r•- ��i0/a e y CX •`Sxi'� o �rr � Oai y�� L'IC•Sf•N5 Tovf.� �� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 7 7 8"� et' 1. Building Permit Fee: $ 11 Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑ C Total Project Cost'(Item 6)x multiplier o K x 3.Plumbing $ 2. Other Fees: $ T.00 4. Mechanical (HVAC) $ List: 4DM,, vi4rafiVt_ fat 5.Mechanical (Fire Suppression) $ Total All Fees:$ Q3; Check No.1#_$7Check Amount:IL--Cash Amount: 6.Total Project Cost: $ 77 B(o ❑Paid in Full ❑Outstanding Balance Due: S r r- --co 01 ) Z2- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) fig,3 y� g Z `(v 13 Zi'_I/ L;, M E /� Y License Number Expiration Date Name of CSL Holder q lc� Y � List CSL Type(see below) LA No.and Street Type Description IT 70 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding � �� O zw �' y �� SF Solid Fuel Burning Appliances 4 S O N1 CD' I Insulation Telephone Email address D Demolition 5!..2 Registered Home Improvement Contractor(HIC) C-M,er- L"orv5'�r-Grlo-J f�le]' &her y • 17�G Z� /O ZD Y HIC Registration Number Expiration Date HIC Comp Narmy o HZ Registrant Name 11 11D �, GWtrr� � CdwlaS�- /YcT No.and Street Email address Sir/Y 1Y1.e 0(ef70 �y� sPo 2G 38 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 the building permit. Signed Affidavit Attached? Yes .......... 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 ARe//• - S. /✓Jt/s y to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Nawglectronic Signature) Date SECTION 7b:OWNERS OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contai in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Author 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 m2LN mass. ovg /oca Information on the Construction Supervisor License can be found at www.mass.gov/d�s 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" CITY OF SM E,.N1, NWS.A.CHUSEM BUILDD4G DEPIRTJENT 130 WASH .NGTON STREET, 3� FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KI\fBERLEY DRISCOLL MAYOR T Hows ST.Pmm DIRECTOR OF PUBLIC PROPERTY/BUUM NG CONMaSSIONER 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 111, S 150A. Thh�e debris will be transported by: //Rf Al io I�CC�/G Ny (name of hauler) �— The debris will be disposed of in .v><o Re- cY c/`ti a . (name of facility) (address of facility) signature of permit applicant date JcbriwO:Jce A�® CERTIFICATE OF LIABILITY INSURANCE 9/814 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: 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 an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT NANE' INGRID Benevento Insurance Agency Inc PHONE 781 599-3911 FAX. Ne: (781) 581-7200 497 Humphrey Street EAWaL O6 ESS: Swampscott, MA 01907 INSURER(S) AFFORDING COVERAGE NAICO INSURERA:Commerce Ins Co INSURED INSURERB:Guard Ins Co Emery Construction LLC INSURERC:COmmerce Insurance Company 19 Kelly Rd. INSURERD:NcrGUARD Insurance Company Salem, MA 01970 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 ANDCONOITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POUCY EFF POUCY EXP LTR TYPE OF INSURANCE POUCY NUMBER MWIY MMoarrYY UNTS C GENERAL LIABILITY BDSJXD 9/5/14 9/5/15 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENE PAL LIABILITY DAMIAGETORENTED $ 100,000 CIAIMSWADE rXI OCCUR MEDEXP(Anyompersan) $ 5 000 PERSONAL B ADV INJURY $ 1 00Q 000 GENERAL AGGREGATE a 2,000,000 GENLAGGREGATELIMITAPPUES PER PRODUCTS-OOMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE UABIUTY COMBINED MBIN D L LE IT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWMED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-0WNEO PROPERTY DAMAGE $ HIREDAUTOS _AUTOS eracadent a UMBRELLA UAB OCCUR EACHOCCURRENCE $ EXCESSUAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION EMWC535364 9/6/14 9/6/15 �{ WC STATU- OTH- AND EMPLOYERS'LNBIL YIN ANY FROPRIETOR)PARTNER/EXEWTNE NIA EL.EACH ACO DENT $ 100,000 OFRCEWMEMBER EXCLUDED? 00an mry In NH) EL.DISEASE-EA EMPLOYEE $ 1QQ QQQ DMes describe under DESCRIPTION OF OPERATIONSbelo. EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,A3lhbnal Rerre4m SchedWe,Wnworespace IamgdM) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BRENDA ZIELINSKI ACCORDANCE WITH THE POLICY PROVISIONS. 27B MARION ROAD SAT M, MA 01970 AUTHORIZED REPRESENTATIVE Bryan Benevento ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: i CITY OF SM. .N1, N-LXSSACHUSETTS • BL'ILDMG DEng-r%I NT \ of 120 WASHINGTON STREET,San FLOOR 'I'm_ (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL IMAYOR THOMAS ST.PMM DIRECTOR OF PLBLIC PROPERTY/BCILDING CONMUSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business:Organintionllndividual): 4F;-- erY l0^�S71iNL�• D ✓ ��G Address: /1 lCe 1/Y City/State/Zip: SA�fr / /iIi) DI If 70 Phone#: 47-,Fk' aPPd -ZG 3-3"— Are yo employer?Check the appropriate box: Type or project(required): 1. I am a employer with 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.: 7. ❑Remodeling 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 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 I L❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§](4),and we have no 12.❑Roof repairs ees \� insurance required.]t employ . [No workers' 13.X Other. At6r.�� t/C c'f comp.insurance required.] Any appliranl that chxks box#1 must also fill out the section below showing their workers'compensation policy informatiom l lomeownen who submit this affidavit indicating they are doing all work and then hire outside contractors main submit a new affidavit indicating such :Cumsaton that check this box most anached an additional sheet showing the name of the sub-comrecton and their woken'comp.put icy infaama ins. I am an employer that is providing workers'compensation insurance for my employees. Below Is the pulley and job site information, T Insurance Company Nam Policy#or Self-ins. Lic.#: Ee"t Expiration Date: ! / !ob Site Address: z �r 13 City/State/Zip: 54 r Attach a copy of the workers'compensation polity 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 S1,500.00 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 rho DIA for insurance coverage verification. I do hereby t n certify tit eppa'ins and penaltiesof perjury that the information provided above is true and correct Sa lure G�J r ^�� Date 9 /A /Phone#: < 7p • ��O • G g OJrciat use only. Do not write in this area to be completed by city or town ojjtcia t City or Town: PermitILIcense# 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#' Emery Construction, LLC Estimate 19 Kelley Road Date Estimate# Salem Ma,01970 6/25/2014 e14-153 978-880-2638 Brenda Zielinski 27B Marion Rd Salem,Ma.01970 Description Cost Total As requested,we have prepared an estimate for deck replacement at the above mentioned address. Remove and dispose of the existing wood deck. 0.00 Frame the new deck with all P.T.lumber with the same layout as the existing deck, 0.00 using the existing footings. Install Azek pvc decking with hidden fasteners to the deck area as well as the stair 0.00 treads.(color to be determined) Install post sleeves to cover the P.T.railing supports.(color to match railings) 0.00 Install Azek pvc railings around the deck as well as down both sides of the stairs.( 0.00 color to be determined) All code requirements will be met. 0.00 Permits will be obtained and insurance certs will be issued to the owner. 0.00 Total Stock&Labor 7,786.00 7,786.00 Option 2 is all P.T.decking and rails that would need to be stained.This cost would be$4650.00 Option 3 is Cambarra mahogany decking like 5D Halsey.This cost would be $5475.00 Total $7,786.00 CORP.CONSTRUCTION . . 0 -2638 . . . Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor t License: CS-059344 3 N' BRETT S EMERY- 19E I)R (—n 1 SAL M EM MA 01990 t\\!1(JjIJ !;i14.. Ilk Expiration Commissioner 09/25/2016 �DRII�ERSLICENSE }Qh i1 NI ttie a1MY {I rm 'DS?34013 09 251 `8' i a Y fir LASEREST e47� a r9t m a s 'EMERY /�" 1 .19E A ' SALEmM,NA' ��e�irrrrrronmen�(�n�Grlr��n��aie/h . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only q ',[A,0ME1MPR0VEMENAT CONTRACTOR before the expiration date. If found return to: jtegistration: 776626 Type: Office of Consumer Affairs and Business Regulation Expiration: 9/1 01-2 0 1 5 IDEA 101ark Plaza-'suite 5170 Boston,MA 02116 EMERY CONSTRUCTION BRETT IE R 19 LEL 0`1 SALEM, Y MA D MA 01970 Undersecretary Not valid withou ure