101 1-2 MASON ST - BUILDING INSPECTION . fL1r1IB R VSG 8Y WE
ARI NG GRANTED elf,
] y
CITY OF SALEM
�r
Is PApNq Lmom in Imatim of
rt Hd"mom YiL_No./ mmin :
In wapwh LooMd In �'M
M OanwN"M Afed Yak..*
BUILDING PERMIT APPLICATION FOR:
ftmk tm
(Ckft whi&~appo . InsWl 8tdYq, onNruat.l Shad. Pool. L
M��ep
Oth«''. Jn�c1L�,�cl•`P+'� 4r Crhm.. � ✓10 V�0•k=,7e
UQS-�u-s �✓,mow .
PLEAD RLL OUT LEGIBLY a COMPLETELY TO AVOW DELAYS IN PROCIIIIIIIIIIIB
TO THE INSPECTOR OF BUII.DINGS:-
Ttw
r@WWnlpr W honby appNoo for o pom* to build sa� ft to Nu inimm r 9
�
Owner's Namo WPo�y
Address A Pharr poi Ptas�n St' ( 1
Amhbft Name �' f
Address A Phone
Mechanics Now tilt
Address 6 Phone ( 1s<
VIw M sM pup000 01 Ou1d11a1 /,eyctem cv
Dat
AtotwW a t+uldtigt t r ad, for now awny 1-maoo9
\ a� Y( W �LI C U 21 p
LUlm. 0/1 Swours of Applicant
SIGNgD UNDER THE PEII "
OF PERJURY
DESCRIPTION OF WORK TO BE DQNE
�a bAek GJl1 fi� a nflS�,1J aw\ `� c-,.,ov4e Sib
r � �
Ir�4'f`
"u MAIL PERMIT
tqb� Y kkA plS'7�
{
a
' rF r♦ .ean..r.'4• Y.Yn�r — a. u .4 �{.�.�_i:. i ..,y,n.•[.w`-Sy w. 4
'Xl I
R +'
rp. f. is r
14,
4
`C � Y
{ �• V
iL. . � � '
PUBLIC PROPERTY DEPARTMENT
L 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O 1970
TEL. (978)743-9595 EXT.880
FAX (978) 740-9646
STANLEY J. USOv1cz, JR.
MAYOR
DISPOSAL
IS OSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge that as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGM,c III, S 150A.
The debris will be disposed of at: P-,W So4 ((),+ 24
Location of Facility
Signature of Permit Applicant Daft
FULLY complete the following information;
(PLEASE PRINT CLEARLY)
(�nc,o I_lGrc.�z �hc
Firm Name,if any
a
Address, City&State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of bu it ' or structure be dreg disposed in aproperly-licensed solid-waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the Estill .
ty
MORTGAGE INSPECTION
PLAN IN TO THE HERITAGE COOPERATIVE BANK.
I CERTIFY THAT THE IS LOCATED
AS SHOWN AND CONFORMEDN TO THE ZONING
SALEM, MASS. SET BACK REQUIREMENTS OF THE CITY OF
SALEM WHEN CONSTRUCTED, OR IS REID LAND SURVEYORS
NT
365 CHATHAM ST., LYNN, MASS. ENDER FROM VIOLATION 4. 40A SEC.
UNDER M.G.L. TITLE VII CH. 40A SEC.
W
N NOTE: SIDE PORCH ENCROACHES INTO
NOTE, WHEN OFFSETS ARE ONE FOOT RIGHT OF WAY.
OR LESS A FULL INSTRUMENT SURVEY
IS RECOMMENDED.
NOTE: FENCES. WALLS, SHRUBS,
DRIVEWAYS, ETC. DO NOT NEC.
N/F ESSARILY REPRESENT PROPERTY
BRETT & LAVOIE LINES
4.30' 21.93 � PARCEL A
4 703' \
1440f S.F.
I� \
\ t 1/2 STORY
RIGHT NYL SIDED
OF WAY
\\� Co. N/F
TALBOT
BYORS � \
St: #Ip,J N/F
' ti4i�wi � E 4.40'\\ 14.58' MELANSON.
7SKID
�, I 1't
19.92'
1014 MASON ST,
1. HEREBY. CEFY TO THE BEST OF MY GE
THAT THE PREMISES SHOWN ON THIS PLAN ARE NOT LOCAT-
HAZARD AREA AS DELINEATED
ED WITHIN A SPECIAL FLOOD NOTE: THIS PLAN WAS PREPARED FROM A
TAPE SURVEY AND IS INTENDED FOR
ON THE MAP OF COMMUNITY #250102-8 PREPARED BY THE MORTGAGE PURPOSES ONLY. OFFSETS SHOW
FEDERAL EMERGENCY MANAGEMENT AGENCY OR ITS ON OR SCALED FROM THIS PLAN, ARE
SUCCESSORS DATED 8/5/85. PANEL 1 . ZONE C ." APPROXIMATE ONLY AND SHOULD NOT BE
I FURTHER CERTIFY THAT THIS INSPECTION WAS PER- USED TO DETERMINE PROPERTY LINES.
FORMED IN ACCORDANCE WITH THE 'TECHNICAL STAND-
ARDS FOR MORTGAGE LOAN INSPECTIONS" AS ADOPTED SCALE: 1" = 20' DATE: AUG. 16,'2001
BY THE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS
AND CIVIL ENGINEERS BOOK: 15849 PAGE: 130 CERT.#
THIS CERTIFICATIONFENCES OR DRIVEWAYS AS THEY DO NOT ALOES NOT INCLUDE WAYS INDICATE CONTROL #:PO1-1046 L
PROPERTY LINES. HCB
I
co �e01' I:f�Cif»4Ckwaffi
,' 1Jepe�euaf ./.J.dasGial�crid.afs•
boo W"Lie9irn Jlresl
Jamnxamooet !�,►�� /ll..aet 02111
Carnrssaonr
Workers' Compensation Insurance AffidaAt
(mil
. . wiih.a principal place of business at:
o! MG 11r rTe�yVc CA T>eC,60e�j rVb+ -
. . fuertler✓7aq
do hcreby'certify under the pains and penalties of perjury, that:
1 am an employer providing workers' compensation coverage for my employees working an
this job.
L1�y.H,rt.><.£ �vC5-31S`3is�11 -L�73 '
Insurance Company Policy Humber
1 am a sole proprietor and have no one werk'utg for me in any opacity.
() I am a sole proprietor, general contra
etor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' comperasatson po►icles:
Contractor Insuran4e Company/Policy Humber
Contractor Insurance Company/Policy Number
Contractor insurance Company/Policy Number
() I am a homeowner performing all the work myself.
I uweruane wt cool of dCo aueemern.+a b: ion+areee to the Offce —1 im klmm of du t>"k 1W coerrate .eA aden and ow blare w secure
coate as rewero onoer SKdon 2SA of MGL 15 2 can kae w Me irnooawoe of crr'enai cenames corsadni of a tee ed w oai I,SOOAO sewer eeK
.er
rears•irarwnmmni a-at as ci.i ""feel in me loan of a $TOP WORK ORDER ant a brae of S 100-00 a ear ata:w WA.
Signed this day of —
�iccnseciFermaEtt cuilcing Depamn,ent
uceruin€ Ecard
Seiectmens Office
�,•<fth Depar*mcn.
l ,�
Liberty tNfutual Group
Liberty PO Box 7202
MUtUc11_ Portsmouth.NH 03802-7202
Telephone(800)653-7893
Fax(603) 431-5693
May 12. 2004
WENDI MERCADO
101 1/2 MASON STREET
SALEM, MA 01970-
RE: Certificate of Workers Compensation Insurance
Insured: DANCO MANAGEMENT CO INC
2 MARGIN TERRACE
PEABODY,MA 01960
Policy Number: WC5-31S-318611-023 Effective: 11/30/2003 Expiration: 11/23/2004
Coverage afforded under Workers Compensation Law of the following state(s): MA
Employers Liability:
_ Bodily Injury By Accident: $ 100,000 Each Accident
Bodily Injury by Disease: $ 100,000 Each Person
Bodily Injury by Disease: $ 500,000 Policy Limits
As of this date, the above-referenced policyholder is insured by LM Insurance Corporation under die policy
listed above.
The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions,and is not
altered by any requirement, term or condition of any or other documents with respect to which this certificate
may be issued.
This certificate is issued as a matter of information only and confers no right upon you, the certificate holder.
This certificate is not an insurance policy and does not amend, extend,or alter the coverage afforded by the
policy listed above.
If this.policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such
cancellation.
AUTHORIZED REPRESENTATIVE
LIBERTY MUTUAL INSURANCE GROUP
This Ccnilicalc is ex=wd by LIBERTY MUTUAL L INSl1RANCL GROLT us nspeds such insunmee us is:tforded by lhme comp:u ies.
cc: Insured: Producer of Record:
DANCO MANAGEMENT CO INC DAN HURLEY INS AGENCY INC
2 MARGIN TERRACE SEVEN FEDERAL STREET STE 24
PEABODY, MA 01900 DANVERS. MA 01923
MA50N Qi
1-10
W - MEr-CA
r l
Fill,
-------------
.............
ASoN UT
� . Mcrzc�Dp
T
i
i
i
i
� � �pUTVt � iJL
----
K
t
I
i
i
I,
i
l