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89 MASON ST - BUILDING INSPECTION
i+1.1kf�SiilliS��EfH.� A�'PROVE{) $Y �aiE �,p�T� ,PF31DR 7P A p��T ��� G�NTED - CITY OF SALEM . :�_-� 3 a-� o � No. '��—/�� ,�,�" '� �i \ Date � s�.i(+ � A '\a�;'�i . r � � � Located In Location of �g ���� S-�'. Is Property guilding � the Historic Distrid? Yes_No_ Is Properly Loceted in Yes_,No� �� the Conservatlon Area9 BUILDING PERMIT APPUCATION FOR: Permit to: Pool, (Circle whichever apply) Roof, Reroof, install Siding, Construct�Deck, Shed, RepaidReplace, Other. ���'`�"' � pLEASE FlLL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to buiid according to the following spec'rfications: Owners Name ���'� `5����� Address & Phone af �����s s,. �1� i 9�� s�r��9aa-- _ Architect's Name ( ) Address & Phone � Mechanics Name ( 1 Address & Phone ar b�ild�nyv 2�s,� �i�cL/ s � What Is lhe purpose / Materlal ol building4 �o�"� If a dweUing, tor how many�amilies4 WIII bulldng coMortn to law9 �'e� Asbestos? Estlmated cast .� Uv27 Gty License x N �'' stat ucsnse � �' � �=��nt X � �`• � ignature of Applicant Sli'aFdED UF16�R �iiE �E� � , OF PERJURI�O DESCRIPTION OF WORI6 TO BE DONE ��-� �� ���ti�"`-' ,���, ��"a°-� _c��� ,o�,��%.� �'���-' � �`�`���'`�'� ��� ,� -r� � ,l� , 0�.� � � ��--- MAIL PERMIT TO: G�/��G ������ � o�S— "Dcarr s�ls- s� Sa1�/�� /�IfJ- �i 9 Z O ., � ,` — , No. Q.6 APPUCATION FOR � PERMIT TO � � ,�e � �.� ' . � v�✓i T t�v�BiZ �-/ ,ec��,.�s LOCATtON • ��.�Y30nE' �j7'- PERMIT GRANTED .��,a�e�� Z � Z(�o,� APPR V�D � P OR OF BUI DINGS .,� �. �/ti CITY OiP $ALEM� MASSACHUSBTTS • • ' PUBLIC PROPERTY DEpARTM6NT �20 WASMINGTON STRH[T, 3RD F1001� SALEM, MASSACNUSETTf 0197Q sTANL[Y J. UWvic=, ��, Ts�gpMON[: 978-74S-9S96 Ex7. 380 NAVOA FA%: 978-7CQ98,d � .S8�EI11 BU�(�IIQ DCD�rtman► ' Debris Dtsnos�_I Form ' In accordance with the provisions of MGL c40 S 54, a condition of your Building Pem�it ia that the debris resulting from this work shall be disposed I af in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: %��s-�..�� - �-S (L.ocadon of Facility) ��� � "/ S er�+ ` ��/.�f/S � , � . �����.�.. Signature of Applicant � -�/`�y Date i � - - - ...`�`.�. '�� �a����.���� s BOARD OF BUILDIN REGULATIONS�,� `� icense: CONSTRUCTION�SUPERVISOR� r N , Numtie�;��, 040748-.: I � BItrt,KQ�D9�� O�FFft956 - � E��[e8 OM1/�0- Ti.no; 11610> � ����4 Re cte� OB �. � �.._ BORIS ZEMEL ���r.} 20 EVERETT PAINE-8L1(f'}� 1'� G-- ., MARBLEHEAD, M!1`0194 '� � � � � � � . Cammiesioner �� � �� . � z; , , -;�_.��� . .� . _ �..��_...�,� ' ..� . . � _ _ . _ �.°?'IYe Co�oxx�ealtAi ojM�socltuse� Depara,u,a ojrnd,�MOI Aa�lda�a � • ���� - 60o w.��,sa�a 8��� os�» .�...�.. ;�.�..,�.. . __ .. _ �_ . _ . __ _--- -- - - ww�.ws�✓R�� Worl�ers'Campe�adon Inaunnce A�davt� Bu�deRl'Contractors/Eledridan�/Plambeis A 8 . . . p� Name .�--� � .'��yh h q �'�ern��e/,h ti Add�s: � o �d�i'�T f��i�� 73G�� CitY/S�u/Zip�f�in'�6/�J,�i-�-� /�J�s- Ql9��s P�ane tM: �i l?- '7/Cj' - �/'�-�1' � �—s�.— Me yo�a� , Cled�tlriipproOriue basr' ,� . . _ ..��. ,, .,. 'ry'PQdP�'e1��9�� 1.� I am s employer wiTh t. Q I a s�meal oo�otselor and I 6: ❑New o�uactba �4bi"��(�aod/a�PaA'dme}� Lsve�ra���btae�traelon 2 0 I am a�okpmpriator ar paAoa� li�oed aa�e atuemed�Yeet s 7. �Remoddi� ' s3ip aod L�e no e�noplayea 13eae�have E. ❑Demolidoa w�od3e�,�armei�.q�rc�P+ci�►. �a►'.�� 9. Q��on (xo w��aomy,� s. p we a�e��'md ier' • . ,...� ,. *«Ni�ed.?,� ,� . .:; o8fan brye au�ireq�ett ��Electriul�epac�or additiamr 3.D I�mabomeow�s.domfallwoat *�cot ` hy,ra�� ii.Qre��s�,ar,aa�on. my�elt[No�'.o�p�; c. ts2,41(X ao� ,:hsve'm �tebave 12QRootre�n ��a��t� . . ��.;,_- „.r: 13.000�ct •Anr�wNe�m.�bb��r��s d..o en a9s4��1��o�{�.k.�a�'ao�pe..ao.ydtar ma�oubr ' tHom�mw�sw�o�6m�AY�dwku'dialfoR�a�ddo��A�at��Ejij'aaeid�metliAa��rtabnit�aw�vlt�meh tCam�cdn A�td�ettW 1oa'tmt�heL�O��ddMae�t�beu�ovm�mr umbt�kw6eo�eat�dA�i w�o�n'ea�Yoli,7 iolorm�tlaa .I �/Ir�P�lO��P�����0��btfUllpfefrNll�pl��alj011bfAffl�lJll��J�M •.Ia�x Comp�N9ma /Vi9l�!� / ��.!S S�: S�L�E'.9'/�G` � Poticy i or Se�mr.Lic.!1: �/G�!' 30�S� g�D�. �—��—U G �sm aamw� �'I lr»-,o,� s T ' c�r�s�: �-���,, y�/'7— a19'7o IAayer a oop�af tse worten�eo�..no.yoll�aedantlo.v+s,e(�mrbc ere poHe�,omber..�c�ptratlo,aace� Falm�e oo aaore oovaa�e ai ro4�ed�da Satba 23A of MGL a 132 caa lad b ma myoridon ofa�mal penaitip of a 6oe up oo S 1,Sa11.OD ad/ar onaYe�a�ri�e�,at wr,D s civ0 penalda is Bie fmm of a STOP WOR[ORDER aad s 6ne ofup�o 5230.00 a day a�ut 9�e viola�or He�dvired th�t a ccpy ofthi�ao�temat mry bs�waNad b the OfBce of Iavati�ationt of tLe DU far�a aovrn�e vai&adob I Jr Aarb� tbtp4�t Palwp t8st 1Arsleja+�o�provfds!aborr b Irrt�nI e�rncs � �' ��-- o� , l �/�� 71�� GoLy'�r. PfiDDC N: O,QleW uu a�l�t Di eat xr4Gt 1��lib�rry ti bv eow,pls�ijbp edd a►Mrw e,o?d�L Clt�a To�viu ?ermlUi.lame M Is�ali�Aotlark�(drde oae)s 1.Bovd d Hahi i Buildla;Departmeat 3.Cky/fow�C1erk 4.Eleetrleal in�pator 3.Plnmbiu�Inspector 6�Ot6er � Costad lenoss ?hone N: � «wnr�s=�r2a�A�5n�r�aet:+W.� a.w�.o..., ..-..., . Inforraation and Instruct�ons ,�c,�.ii.�w.��ss �n�a���:�����:. ,. an ew�lr9�n defmad"'...evaa►pas� gt'°°tba � �'a �t b t4i�sbonf4 _ �„ p�w ot,a�Pbed'�a1�wnms� : �ar aopr tao ae moce . Aa�yl�Ya i1 de8ned �s �����������0°�0����a� of�e t�!nt�V� � �powtioa a o�a lepl edrtY.e�bYmt�PbY�' �'�!be c�vua ci dareltini hoos���m��e��ee�pa�aoa wlo:aida tsa'e's.or tbe�dar�elH�s� �Louf�otmoth���P�P�b do m��°°����bbe�a emPbY'�� ' aaafie�abm7dIDt��slaUmtbecao�ofmdmPbY� Mc�,cha�ls�4��'L°smta mu"e�+'7�e ar tod��7►�•deeral/ue Nw..a or re�ewd da ikea�a or P��t0°�°��ar te eodtr�d�V tie coa�mo�weallY for a�7 �t w�o�r ret Prod�ee�ae�M aWaee deom�+��tYe Iwn�ae eava�e R4�°�~ Aaeitimanr,���is�4a3C�s�+"xeima a►e ao�mo�ral�mc avY otil�voNdal mbdiviri°a"b'9 eata mto anr�Sor me P��t�uo wmt mt�aoc�bie evidme°oroomruaea.vi�e�e�oeara� �Of thif chaP�a hsvebaapraea6ed to iaoa�i�•" , � . _ , ....... _ . � 8�ebo:a that apgbr bYo���'� Pleaee SU;� �e audcen'oompems�°atBdavit comP�'�bY �sG`)�1�s�their�d�)or �.�P'P1Y �)nrmR{�b� )'�P� �oe; Lim�ed�C���or Limioed L�a�li�Y��(��wi�uo emP1ol�'ee�otLu tbs is i ��paAnet,ase not re4oiced ti c�Y��00�06�O0' If an Ii.0 a��osalal II empiayw.s Po1�Y��4p7Q0a' Be adviead�at ��.'?����date the afndavit. '11w��'�sb0°� ���of m�aaa oovaa�e. �Laaee's bem�re4aa�d.�the Dep�ot be reouned oo�c atY ar�oays that�a apptication�br�e pamit laa ot�tyun ue raqa'sed t�abmia s aw�lce:s' �upiaipecidmd. S3vu1d Y'oa Lsve anY 4aodom r�°1i . beb�t Se1t-marad�map��ho°Id eater thdr ��p�y�plwa caII the Deps��tb0 aOmbR.� sel����°°�e . � pq or Towr OfIIdab , b lete wd pimtad 1e�b1Y• The D��p�ed s spux at the� pkate be sare t�at�e sBdsvit� aomP of tLe ai6davit Loc Y�m 6ll oat in 1Le aat the O�ca of Im'oetiptiom hat to coniact yon���� p�ea�e be sure to 60 in the pamiNliCeuu�which wdD 6e nud at s rcfereace�nbec. indiatmi aurent �t m�t sabmit�1�P���1°���yar����one at�dsvit ��r�oa(if nxaeary)wd uadar"Job SiLe Addra�"the aPPlicmt e�������to� a � t�w�n l"A o c P Y ot�E s8ldsys�t�bero�ci�AY�oi��'- �_ appHaot s�oof t�t a v�atBdavit s ou 51s fat 6�mre Pqm�b a�N c e m a. A n c�r a�I d a v f t�ftbe Alled�t acti . year.Where�bome owna a adaes i�ob��haoie a�pamdt mt rdsoed ao my bu�a��m�'0 (ia a do`�a pa�mt a bius]wva ctc.)said Dasos i�NO?n9oaed ti oa�P�t�+'�vic would 1�7ce m th�ok yaa m advanu foc yout coopaation and slauld}�on hm anY 4ue�� Th�OflSa ofiava 'o�m �'� pk�e do mt hamta i� 1'he Dcp�rf�ddrea�,ui��aod fa nomba: , 13e Ca�monwealth of Massachnsetts Depumieot of Iadustrial Accidenb O�a�Invedt�adom 60o w�neco�s�c Ho�on,MA 021 u TeL #617-727-4900 ext 406 or 1-877-MASSAFE II Fax#617-727-7749 Reviged s-26-os www.mass.gov/dia l � __ __— � �.. ,i _ � `� - '�1�`� ,.11� 1t � t.5 s ��,-�,�° � � , .�:�:,_�, -�:� � -.J��� ;_�.:M��:.:_ �:�,���et�W...�_ ...�_.w._...__r ._� . .�.__._aA.�..��_ ..,�. . , .�.� �._._..._._.....a..��...�.. M .., ._. _ __ . . _..__ �_____..� _ _.�_:__. _.___._._...____ _ W:_w�_ � _ r _ ..�'_�.�_.�. _ � _ _ ' V � ._—�----� ; � I � ; ���' �--�'� ��'e=�. 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'Ibe a�d�vrt sbaald pcddmti fb�ao�m�oi�OOY� ar��bdoi r�.�tba D�pas�t ot be remaed oo me�►��avn tbac�e app�sr�a��aw az ityon m�qaa�ad to obffia+�'' ��p� Sbyoid yoa�va aoY 9�� . �p�1�f4��caII�e D�D1R��t�e�oba 11��1�'• Sai[�otad� �a�o�p��a1d mUer�eir x������ � Ciq ar Tan�OfOd�N . leoe aod yrmted 1e�bb�• 'I��P���°d°��at t5a bot6� pleste be em�e th�t�a a�davit s oomP of tbe afBdavit 8x Yoa m�1 out m the evat tha O�ce of Iavatigatiou�Las�o eantaet Yon�e�dfi��°aPPb� plea�e be sure oo�m the pam�t/Hceose�w�h w�71 be neod ar a refamce�. In additb4 sa ePP� �m���Yp�:�on1Y submK one atgdavit iadicstim8 umeot t h a t mo�t saDmit ad6P�P�� Po1ieY��'f nocasa�Yl��"1 o e S�o e a a d r a s"t h e a p v t 3 c a u t�w r b°�Io�°'�,idad to tbe °� ooan}»A aaPY o��e a����bea o�ei�►ri�po���b7.',. ����oOl�t�vatid atSdsvit i�a��a t'a mmre pam�b a�licemea. A ot+v a�dav��1t��vmmre �WhE�'6�b0�aW0![�qt�a����Cl�OiO���Ot idiLOd m�I bYf�Y (La a do�ltcema a p�b bars lesva eoe.)faid patoa$NO?n9aa�ad 10 aomPl�e Ihb s�dsvit '1'he OtSoe of Imrdti�Om q1O0�v7ce oo t�olt yaa m advaoce for your wopaadoa aod sbould yoa bave anY qu��s. please do mt�eiate 1�����a9. Th�DeP�imeat't�ddr����aod ta�mbe: The Ca�mmonwealth of Massachnsetts pepartment of Iados4i�1 Accideob O�ae�Invad�stton� 60o w��s� Bo�on,M,a►oZi i� TeL#617-727-4900 ext 406� 1-877-MASSAFE Fax#617-727-7749 Reviaed 5-26-os �rvr►.mass.gov/dia C�TY OR 3ALaM� MASSAGNNSeTT! PUBLIG PROPtRTY D[pARTMtNT 120 WAfMINOTpN STR[R. �AO �ppR 4wltM. MAftACMuf[77S 01070 T�Lt►HONt: i70.74S-OSY3 [xT. 390 FNts Y7�-7td�� I s�lD!B� e�DEwerfnrnf ��LO�� AAl�M � �rdance a+i�h the provisiona of MGL c40 S 54, a condition of your Bnilding Peiarit is tl�at the debris nesuldng from thia wor]t shall be disposed of in a properiy licensed solid waste disposal facility as defined by MGL Chapter III, S 1 SO A. The debris will be disposed of iu: � ���� ���� (I.acation of Facility) I s gnahue of pplicant �IZ �I�� b ' Date � � �, • . ARCHITECTURAL DESIGN AFFIDAVIT PERMIT NO. TO THE COMMISSIONER OF INSPECTIONAL SERVICES DEPARTMENT: I STATE TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF, THE PLANS ACCOMPANYING THE ATTACHED APPLICATION CONCERNING THE PROJECT LOCATED AT New Civilitea - 318 Derby Street, Salem, MA INTERIOR RENOVATIONS ARE IN ACCORDANCE WITH THE REQUIREMENTS OF THE MASSACHUSETTS STATE BUILDING CODE AND ALL OTHER PERTINENT LAWS AND ORDINANCES. Paul R. Durand 8615 Architect- MASS. Reg. No. ��IED AR�y�l Fc, Winter Street Architects, Inc. PA�� � 209 Essex St�eet, Suite 300 R' Salem, MA 01970 UR � 5 ; �1 �o�� Address � �'P 978-744-7379 Phone April 17, 2006 Date THE ARCHITECT OF RECORD PERSONALLY APPEARED AT THE SITE OF THE ABOVE NAMED PROJECT AND MADE THE OATH THAT THE ABOVE STATEMENT BY HIM IS TRUE. Before m " - >, , � - 12�1 I2 . My Commission Expires ; ` II/ � _ � > - ' �` ,� 1 c,� I�Y �- 3�8 � ���a���' �`` . . . . �se� !.c'�i, r��. . . � �� 3� y . �j�, ��� � � � �+s�s���.t�� ��oveo $r � ��� , J��� p�JpR 7p.A.PEF!lAIT 9F.1NG GRANTED � y 3 CITY OF SALEM No. - �—\� � Date '•�`l �� I `?�� i: � , �j <� f�C' .. \ ♦ _ I , � .. � P�y��� h I.oeatlon of2 tlw Hletoiic DblAcl't Yan_No x Bulldin8 �7I� �Y� It prcpwty t.ocatad h V , •� tlw ConsarvWqn Mes? Yas No /� BUILDING PERMR APPUCATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Ins Siding, Constru�ct, Deck, Shed, Pool, RepaidReplac e . h���L l,,�' PLEASE FlLL OUT LEGIBLY 8 COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINCaS: The undersigned hereby applies for a pertnit to build acco�ding !o the following specificatio�s: - Owner's Name NF,3i� a , /�blo'i .5 LL� g � i.sE/C,� Address & Phone �.��A �i9� (Q78) 71/�3 Archftect's Name L���T�2— � �s�` s` 47�3� z��7379 Address 8 Phone sk�� .�lrt ��970 1 Mechanics Name D. R��d ���'o. Address & Phone ! � wiw�m.w,m�.o a a,+a�� R�'T�� vsE- • i� s�P" Maww a a,ran������T' n a dwow�, t«r,ow mar►y i�+�� ww a,u��«ao�,o�W� Y�5 A.c�os� ND eaweatad cost J?z� 5se cay uca�ea r N P` Sta � ear Iaprovomt ' r.ic. 1 �gna Ag�tcant SIGNED UNDER THE PENALTY OF PEEi.IURY DESCRIPTION OF WORIC TO BE DOPw� � iP�L ,QdlldDv! i D �°L� �fl/lS B.t�./�LJK �i4au%// ' C . _ MAII PERMIT T0: ��1�� ' / f U '► , No. ��/-O.6 APPLICATION FC��1 PERII�T TO � ' • L.� �v�,��� �<,.,,�� �� y� LOCATiON - �� ��. . �� y PERMIT GRANT'�D � 2 ��30� APP OV�D ' � � ��;� � ✓� '� : S UR OF B IN�S i • . � . f�, ' � i , � � r ! � �