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58 MOFFATT RD - BUILDING INSPECTION
� � ��- das-.� � ^. Thr (�umnwn�c�allh uf�\-I�ss:ichusrlLs --�� -- - � � ' . � liu:ird ul 11uilJiug RrguLuiuns ;�nd SwndarJl I � ilt ; � � � ,��a . M:issarhusrtts St;Wt� 13uilJing ('uJe. 7till ('!�iR. 7'�' �•�itiuu 111 Vlc 'IP \I I I 1 '' �_ . • '..,....' I �SI�. � 4 � 13uil�ing Prrmit Applir�tiun Tu ('un.u.urt. Rrpair. R�nu�atr Ur I)rm��lish u Hr���rJJ���u��u� ' )nr-ui� T�ru-biuiiihOnrl/iit,q l '��t�,� � 'I�hi� Sertiun F��r Offiriul I;se Onlv - � Huddims P�rmit Nwnhrr: D:ue .-� lird !O --� PP __ �.0�---_.__._- ._... _ . —----- ----� s�_�,:,��,� __ � ,1(, o b -- - - -- 13wl�ii ununi..i��nr �riur��l Bwldwgs U;ur ; __._-_____. _._ .. tiEC'1'ION I: Sf'1'F: I`'FOH.�I:\'1'll)N 7�j ��,�-=�-�fe�Y `� ------ 1.2 :\ssessurs .�l�p & Parccl .\uwbcn --------- � - . � Ll:i 1� ihis un :icrrpleJ �IreCt? yes_ nn ____ .�1:ip Nunihrr Par.rl ,\unih,r--_._ _ . � i 1.1 ;,n�ing biformution: I L�i Property Dimeas:uns: --j � ----------- i � 7,oct U� �c. P�opu�Cd l,�sC � I w 11:•.a�o li) ' . -'-'_ � 4 t:uil� . ��t! ___� ��.�nvcn�'�r� Srtbacks lftl --- -�--- .—.-.. ... -- i._..----------- : �--------- ., �----- ------------------ ' � :�.um `.'aid � � ; ; --'-'-'--'---- ----i : '-.___-.--------- � ...... iwr Yad. ; �rt::i Ya�J ' -- _' __ . -_.�. . .--_.--.-�_- ._ � ...- I --____ '___.. :' yi :c,� . f•rc -.dcd � Rc�.- vi,i Plc�:�icd I ✓ �,u.:r^ . P� .�.ucJ ' '__.__. . _. _... . ._ . _ _. _." _-.-... .. .f _ "- '_ _ '_____'_�-_'_._-'_ ___'._' . ' ' ___" � -1-- - ' . . ._ •--- � � ---i -- ' i : , � . �._ __ �. � � i.(r '. .: itinpl}• '.f.G L . +u t.�_�� I i.7 Flond 'T me {rzfa tra�t :: � t.N Scv.a�r ?`'.�>��:J 5�.�� +;i� � -- Yub!i� 7 '-7,�;_lc ❑ ' Z�m.r�. __ U.:tr. le FL,nu Gnnc'' i � . , •': , i ' I ('hrcF�. 1 ves❑ I iuniu, ! � �.rn .� � 5sjs � c.. ,I.n:� .:_' , '. � ..... . .._L________ � S [ON 2 YP.Ui'EF � F t7ero:�r RS}11Y' - __ _ — - _ _ — -- ' ' ? O�� .r�of R wr�. — � - — -- � --�� -- ' . — x - ��S�- ���✓�- e �� --��_l�,u�'�j�- ; I �� i.:c,}�r:n±l .--.�,�J� � Aca� lor S..ry ce� -_— _ . -_ _ ___ � j _ --- ---------_ _;_. __._ �l" :�p��2'��---------- ; � �:_,�.r.,,,. __ r�i,.�,n��,�1- , � --- � _ _ —, --- - -- —.-; �---- -- --- �F!"1'eON � x't�C�lPT1UP! t:F Pft'1Pt7ti1;7 \vt}RKZ(.hr� k ,,3� .ie�:f ,t����9y) ----- , :_ �i-+_uclioiiiJ j F.�isini 3��ildink["� . �)�.i :ar i) cup�c.i d I h�E�.ins(.) C �� �;ic,:�� ;��u',i Ci, ; _.lii����� �.. - t �-- . . . _. i __ . .._ - ci �. � � ''T '� r,•_�esti t b!�g .� � iJur� �ru �ui:its.2 � .`�h�r C 5 uly -- - _. --- - __ P � ��4X�Q�..---. _ . . — . - . __I _. _ . —. � � � �� i. t.�ipii�m �l P up,_se � �✓��.k : � ---- -- � ---------------- ---------- ---- - ---- � ?� � - -..: ----- --��_�>.-�it4%K'PF�z �.S ------------ i � ---- ------ ----_ --------- � - � ---- - - - -- -- --- --- ------- -- -- --- --- __ _ _ _..._ -- - - - --------{ ..----- ti(f i[(1N J ! ::I7�iATh.l: i�0i�'-T�i IL,T�pnt !'•���i � . ___. . . , . . i � ' � ! � .�c3� 1.; -_' — — . . _..... � ------- ----i , � r: _ rl �hur inl Mei i;:,Ln � Oif�ial I,;e Only i ��-------- - -- --- - I. Buil�ine `$ I 6ui�Jm Pe.i �it f'c� . . -�- --' �' � $� IndiC�te h�r�v �rc u �rlerntinrt!: '. Flectriral g ❑Standurd City/Puwn :ippliwti�.inFer O Tutul Project Cnat' 1(tem 6) x multi li�r_ r 1. Plumbin� _ S 2. Other�Fees: S P /J � - ' ---=b4y��---- I -t. ;�lerhaniral iH�':\CI 5 Lisr. i. :biechaniral (Fire � --------- , i .Su� re�.�i�ml � �fr�t:�l :111 Fre.: ti � � d (�hrrk N�i. _('herk :lmnunt ('.i.h :\ni��uni Ci0 ' ' i �� f�Hal Prnject CosC S � - _ __. _ ; , ( ( �v PaiJ in Full ❑C)ut��anJin�� 1?:il:inre Uur: � '+ ------ �. ll�` �l���"c���f/%�E?����� G�2 Gm-i-na�a-�� wrr�n/ ��� �� ylt7 !S T�Y tiEl"CION �: l'ONSTRUC'PION SP:RVICES ---____� . � 1 �(' S.1 Lic�•,J1scd l'unstruction Super��isor ICSI.) ----- ------- ,. � �� -i %�� / , // q(/��� 1`.�nrauan 1).ua . /JC�7 � / Liranec Numhrr I •. S/ � l / _� \ainr� I C�SL ul�cr � �/'9 Lui CSI..�f�pr i.�c hclo��1 —____ �`�, �`;!b-«J � � �/ Tv c Daxn �lurn � Wdrc�• �+ A- 6 z 'Z d L l'nri�lricl�d�u�l�� J�.1N10 Cu Pl i _ _� V/ �/ R � Rr.u�i.ird I.@_' Fanuh D��:Ilinc --J I Sipnatur� �1 >I:.uonn Unlv —_— �� RC Rc•id:nualHo„lincl�u�:un� � S r/ r/ \�'S 12:.i�rnli.d \\'inJu�� .inJ liiliii�__ __ _-- ' _-__.� � I'�liri��nc � ��� ✓U �// yr � iF R:.iJ:u�i.d SoI:J fucl ISuiniu=\ ���_In.i.dl.ii���ii � O —� D R:.idrnlial Urmuliium � �.2 Registered Ilome Impro�'rmen[ Cuntr�ctor IIIICI ---_-_ ,_- I . - Hc�i�ti�uun Vuwbir Hll' Compan/1iO�p^'r FIIC �_is� anl Nam• � -- :1��r�i� �Gy � , S/ �� / �! ��/ F.��i�rsti��ii U:�t� Telephune Si�nuWre SECTIOb E: H'flRKERS' COhIPENC.ATlON INSURANCE AFFIDAVIT lM11•G.L. c. 152. § _'SCI��� �Vurkers Cumpens�tion Inaur;;��ce affid�vi: �rust br cumple�ed :�n� submitted wi�h �his :ipplir:itiun. F:iilure i�� p�����J� I I this affid��it will result in the denial uf the Is�u�n�e �(the building permit No ._ _. ❑ Si�ned Aftldavit Attached? Yes ........� ..... . -- SECTION 7a: OWNER AUTNORIZA"PION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I , �s Owner uF the �ubjtct pruper�y hereby 'I L --.-.--— __ io act un my beh:df. in :dl in:itten � Iauthnrizr _ � � relative «� v,..>�c authurized by this bui!ding permit apolicatiun. i __ I �- Date ---�-------- —_ � Si newre ul Owncr SECTION 7b: OWNER� OR AUTHORIZED AGENT DECL:IRATION ���� �1�1G{.�/�a ` , as Owner ur Authurir.ed Agent hereb)' Jecl.irc � 1. �hat the statemznts und infnrmation un the luregomg .�ppli�auon ere true and uccurate. tu �he best uf my knuwledge and behalf. Pnnt Vame / � . � � � � I i � . � ' �- `d-Sl�i I' _" D'1IC � Sien�turc � .. �Si ned undcr�Be mns and enalties ul er�u �'1 NOTES: I�. An Owner �vho ubluins a building permit to du his/her uwn �����rk, or :m �����ner ��hu hirc+ :in unrt�si������ "1O�°���"� (not regismred in the Hume Impruvement Cnmractor (HICI Prugraml, will nnt ha.e :iceess t�.� ina :�rhin:uu�n prngram ur guar�n�y fund under M.QL. c. I�'_A. Oiher impurtant inf��rmuti�m �m the HI(' Prngr;un :�n� � Consvuctiun Supervisur Lieensing(CSLI c:�n be fuund in 730 CMR Regulalii�ns I IOR6 and I IO.RS, rc.pteu�cl}� '� ' When .uhstanual wurk is plunned, pru.�iJe �he inlurm��iun beluw: i � - Imcluding garage. finished bu>emenUatnc�. derk� ur purch� � � T��tal thn�rs �rea(Sy. Ft.i Hubiiablt n�om c��uni — --- I (�ni.+s living area iSy. Ft.l Yumber nf hrdn�um, ----------- . . IVumber ��f fircplaces � Vumbtr �rl h.Jl/h.uh, ------------_. __ - I `umber ��t hathruunu . — Vwnber ul Jtrk�/ p�,r.hc� ._.-----.-----._.. �� ��'vpe ��f htaune �y+ttm - li�n:ln,ud -----Up�n - ------ — -- �fype ����u��ling �r�tem � i. 'T�,�al Prnjeet Syu:irc Fo��ta�t' may he �Ub�UWied !nr "���I;d Pti��CCI (����t�� _� ACORDm CERTIFIGATE OF LlABILITY INSURANCE �A����0. � PRODIICEq THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAI , ONLV A(tlD CONFERS NO R►GHTS UPON THE CERTIFIC � HOLDER. THIS CERTiFICATE DOES NOT AMEND, EXTEND . C4Gverlusarance7nc ALTER THE COVERAGE qFFORDEO BY THE POIJCIES BEL 20 Centrnl Strect Saletn,MA01970 INSUREHS AFFORDING COVERAGE -muuaee —. —.. — . — — Ni�aeaa: PennAtaerica — — — �— Wilber Vjllatorio weuaea 9, ��ve�ers Propem Crmalty Cnmpany_ _ �54 A F,utaw St#lb , wsua6A c: _ _ _ �'89CBMfOR.1�� 021.28 . . �a511RERo: _ _. _ _ �_ '— — 1�.1$UflEA r: coveRnGes THE POUC7ES OF INSURANGE LISi'ED BEI.OW HAVE BEEM 1$$UED TO TNE INSURED NANIED ABOVE F�R THE POLICV PERIOD INp�CATED.NOTYYITHS7ANC ANY REqUIpEMENT,TERM Oq CONDITON OF 0.NY CONTfiACT OR OTHER DOCUMENT WITH pESPECT 70 WHICt� 7HIS CERTIFICATE �1q1' BE ISSUEO MAY PEpTA1N,THE INSURANCE AFFOHOW BV THE POLIGIES OESGRIBED HERFJN IS SUBJECT TO AlL 7HE TERY75.EXCWSIONS AND CONp1710N5 OF Si POUCIES.AGGqEGATE LIMlTS SMOWN MAY HAI�E BEEN FiEDUCED BY PAIO CLAIMS. � �p 7YPE OF INSUHANC.E i POLICY NUMBEq POLICY E�VOIJCY EXPIppTON� � �—� — '— u�nns GBNERqL t1ABILITY _ . ' � I � ! . E_CHOCCUFA�NCG l5 X COMGFACIA��fiNEqqLLU1Hi1.ITV .�� � ( �FIqED�G1A(i=(qn c�emey —5 a�04 A , �cw�nte n+noE L(occuR 1'AC6fi854l4 �06lZ1/07 � OC�JZ]IOS I`AED EXP(AnV anw'pHfiO�i)�_s _�.� _ Penn America ; I � ?c-ason.4�s no•�r iu�uav �:s SOR 000 I � ! �3EN�R4L A33flEG4—F_ �^ 1,��,0� GEMLAGGHF�iT''1ELIMITFPPLI�6PEP: I ; PRCWCTS_C�JtAPIOFACiG _�U�• �� VOtJGY .. 1 PRO. `x . + _' __� (AththUULlOBLL.ELUIBILIfY � i � � j I i �=03REalliE7 SING'E LIA11T .` �r1M!AllTO �' (F2 dccitlm�l ` PLLOWVEDAlfTO?. _ .. — — .� ..— . S`OHE�ULEDAt1T05 I ' I i .I BODF^r,R�uUnY �_ ^o� ' MeEO Aura; I I ; ' —' — "— -- — WJN-0WNEOAUTOS i . � � QOOLLrroWJqr . i c i (.ar a.civncn —�_. �—_ -- — —. _ I � � FPO?EF-v Dd6faC2 ' S — — I , ;P9raccW9nq ,. GAFAOELI0.81LtIY I i � �AbTJO>Jl'+-EAeGCIJ�A_� I: _ _ �4yY4lITD I . � -`iA_�-' _ __ OTNE9THA8 � � I.au10 e,�,.,-. na3 ! i occExeuaeurtr ! � . � : ' � E^.c:+Orcc�SE..ic� � �OCCUF I J CLaMS h1.4OE I � � � t hG.>.=^AT= _ ._ _ — � _' — oEvucna� � � — — = — — i— flElEM10N S I � _— —' — .—�-' -- — X WOPKER9 COMPEN9pT10N qND I ' +./C STATJ- : GT� i B dNDIAYEP6'UI191LRV I 687589 I � ; _!T'J.RYIJ'JIl>_' I _q'� I Traceiers Proper[v ' � �E�EAen aca�cu- _��i70�v0�,000— pG�ZZ�o7 052?/OR � E.LC[SFqSE-�A�(�fp�0_/F�5 `",'•'� OTHEF I . ! �.L.OIScn3E��OL�Cv Lf.11T�c �—. � I _ � � � ' I OE9CqIPAON OF OPFJypTON90,OCATIOtVSNEHICLESIEXCLU510lJS qOUE�9Y ENDOpSEMEN VSPECIA�pqOvig�ONS «hfmtt0[ CER7IFICATEHOLDER ( q0UR10N4LIN5UqEp•WSpRpqCETTEp� CRNCELLATIOIV ' StfOtllD aNP oF iHE ABOVE oE5CR1FED POUCIE,a BE CANCELLEO 9EFOFlE THE ExPIqdM x UATE THEHEOF,THE ISSU�HG INSUREP�VRLL ENnFqY0i1 TO f-0AR _. _ pAVS Ylq�� NOYICE TO TI1E cEHTiFICpTE HOLOEG MqMEO TQ TryE LEFf.9U{f-AILUNE TO DO SO SHG� . IhIPOSE m0 OBLIQnTON OR LIA9ILITY OF 41iY KINo uCON THE I}ISURER f�AG[MT9 O REPHESEfRAT1Y25. �^ ,�� 4U ORIZE�FEPRESEM '�- (� / � �' / � ( (` f � / ACORD 25-S(7J9� t�ACORD CORPORATION 191 " .�__w. . -._�,,� _ -�m_ � / ` '��o��a3'�a�i���`�ofis'�`d�m��slre ' 0 � � �� ConstructianSupervesorLic:�se License: CS 8Z51�9 � "` �' Birtfidate: 5J9119Y7 � r y�., Expiration: Si9i20D9 Tr7C 14298 � ResYriction: �OD' � ' 1NdJ.SER A VILLAT�1?O � � . 64hEliTAW STG�B��', ., ��•G— �` i� I ' �E BQ$�QN.{�Q/���ZS"�� COID015904N . k' i i f `� i _ _ _ ._,_ _ . - .__ .._._ �..,s� ._ . � � � ,P� ✓lsC"[9Ma�Ofu� ���Ofd?.fl�/G� �-\ Board of Building Regulations end Standards - HOME IMPROVEMENT CONTRACTOR _ Registratwn 147177 � Eicpiratlon ��15l2009 Tr# 263003 � Type: {'arinership CONNECTION CQ. � " WII.BER VILLATORO � 64 A EUTAW ST#16 , - � �. � ' � E.BOSTON,MA 02128 . Administremr ,�_� CITY �)F S.�LEM � PLJBLIC ['R��PRER'I'Y �;��r' � + DEP.aRTtiIENT __� , ..,:., . � : � . . ' \I ��• �n I'= \L �.��:�.�.., �� i. :� il • ��... �i, \I �..�, �. . . � . .1 ��: . ��� � �i'M.'�;.,;�i: � h ��. �'A_'�_.'�.V�u � �� urkrrs' (�umpc�������i� ����uranrr .�Itid•rcit: 13uilders/Contr•rrtorsiElectriciansiPlumbers \ i �lic•rnt Infurmatiun Plr:�se Prin[ Lr ibl � � 1�n� � �(a�� `.Illli ilfr.m:.. � h::.�nit.�w�n In.L�:Ju.il�: 1 � �,�.��", G�/ �G�-� S�f ��-� � y- ,y ��7 �'.3d`�� ` ('it� tit.it�,Zip: C—i - ��r` I�D�Oli�ZU Phune �: � / \r. �uu rn .mplo�cr" Chr.k the apprupriate buc: �fypr uf pruject(rryuired): � J. ❑ I ;wi a gcneral eomracwr anJ I n. \ew cun�truction I ❑ I :un a cmpluyrr«i�h ❑ , ,;inployers Itull and'ur p�rt-timel.` . h�ce hirc� ihe sub-contracton ?�-d-.rm a ,olr proprictor�x parnur- li;te�l on �he �itaehcd ;hcet � �� ❑ RemuJeling ,hip �nJ h:n�� nu empluyers Ihrse sub-cunrzaaurs ha�t 8. � Dem�Aitiun �<<,rking tiir me in any cap�ciry. w��rkars' cmnp. insurance. y. � I3uilding addition �yu workers' r�mp. insuranra 5. ❑ \Ve urc a corpuration �nJ its �p Q Electriul repairs or additions reyuircd.� ��t'tieers have ezercisad �heir ri �ht of cxem �ion er h1GL I I.Q Plumbing rcpairs or additions }.❑ 1 am a homeuwner duing all work S P P inystlf. (No workers' cump. �� �5�. ��l'�)� �nd wt have nu ��.Q Rouf npairs insuranee reyuired.J � �mployers. [No wurken' �3.0 Other cump. insurance rcyuireJ.� •;�ny ,,pplic�m ihat ch.eks bux nl mua�alau till uul�hr sectwn beluw ahowing Iheu wurk<n'cumpens��wn policy inlurmut�on.- � I Lmieownen whu.ubmil thu d�f11I:1V111OlI1lJ�ll1��I1tY JIC�IUIOb':III WUIK JOA�IICO IIIIC U11�lIdC lUlllf]CIUlS TLLIf>IIbT1I OIICW J�IIILIVII IOIIII'Jllfl�SUCA. �(',nnr:¢lurs�hal:h¢.k ihis hua mu.�ana.heJ an�ddninnal..heri.howing ihe name ol�he sub-contrac�ors anJ ih.ir worken'cump.pulicy in(nrtn�tion. /mn �m employrr thut is pruviJing wnrkrrs'ramprn.ruti�n insurunce far nry rinployrrs. Br(ow is d�r po/iay anJjnb site . iujornwf���„• In;urance Cumpany tiom�:___ Policy � ur Sel6ins. Lic. p: Expiratiun Dare: 1��6 Siic ,\JJres.: City,State/Zip: . ,�etarh a copy o(the workers' camprnsalion polky decl•rrutlon p•aKe (shuwing the policy number and eapirallon date). , Pailun to ,ceurc e�n�cr:ige as rryuireJ unJer Sretion 15A ul'�I(�L c. 152 can Icud tu ihc impositiun uf criminal pen�lties of a ' lin� up tu S I.�iI1L011 :miL'or .,ne-year miprisonment. ,u �.�ell as ei�il penultirs �n the fimn nl a STnP \VORK nRDFR`�nd a fine „(u�� n� \_50 i�tl.� .I.�� .ieain.t thc l IUI:IfUL ISC :ItI\15C1I IFldl 8��>(1Y of ihis sia��mrnt inay hr t��n��ardeJ to �he Ufh� Ir�c.lia.tli��n: �dihc UTA G� � . ir.mee :o •r;ige �en�i:amin. ' l Ju /�rrrAy rrr�i/1'� der d� p��n. J or�llir����/pe�jnry rhw d�r in/inrnufion pruciJeJ��h�n�r ie trur�nJ a orrrct � U;itc • <�,in,uura. I'I-.��r.c - .-_ IU//iriu!u�r u�Jt'. n� �i��r ���rirr in �hi� arru. ru hr.,��nplrrrJ 6�• riry ur m�rn of/ia iuL ' ( in nr fu��n: .. . _ . _ Pcnnibl.i.cm¢ q _ _ . _ . _ . _ _ -_ _._. ..— . I��uin� \whnri�� I.ircic unc�: I. Ifnurd nl Ilcuhh 2. ISuilJing D�•p�rhncnt 1. l�il�� fn��n Clcrk J. F:Icc�riivl In�per�or S. I'lumbink Irtcprctor 6. l)Iher _ _ � -- -�- -� ---- �-�---� -�- ('unfactPcnun: _ , ---- PhonrM:_.__ --.--- �-- ---�---�------ [nformation and [nstructions \I.i,,.ii�`u.ClloliinCr.�l 1 .���.i!:.��qir I `� �i��uili. .�Il �in�11U�C1. i����rU��Jc ��irt��rs� i���ll��in..11l��nli��rrlllilt'Cnl(11u�CC1. I'w.u.ini i,� ihi.� .t.iiwr. .in rinpl�irrr i. ,lillr:�l .�. �� .•�:n prr.�rn in ihr .ri�i..• ��(.ui��ihrr unJ:r .im :�mtr�:t ol hire. :����:.. ,�t un��!i�J. �v.J ��r ��iin�n �' . . . \:: ru�plur.•r i, .I:�inrJ .�, ��.in :n.ln:,lu.�l. ��.uu::r.liip. .i.,a:i.ui�m. .��rp��ran�m ��r ��ih:r i:_�I .•nnn. ��r .m� i�..� ��r ini�rc .•i ihr f��i:coin� :n_.ipr� in a I��ull eniripn.r. .�n� inilu.hnC the k�,al rrprc.rnlaenr. ��(� Je:c.ixd cinpla�er. ��r iht :�.:n:r ��r tru,i�r ��t,in ui.L�iJu�L p.iitn:r.lup. .i„o:i.��i�n �,r��dier Ir��l rnun. .•mpl.i�m� cmpl��rrs. I luuc�er ihe .��.�n.•r ,�I.i .I��rllin� housr h.��in� no� m��rr ih.in �hrrr .ip.irnnrnts .m� �J��� rr.i�lr, iLrn•in. ��r �hr �i�.updnt �il ihe . �I��:i:ui� h,�u,r ,�(.imnhcr ��h��rny�l���. prn�m, i�� Jo ni.iint:n�nre. :��n.,�ruen��n .�r rrp.ur ����rk on ,u.h .Iwelling h�iust „r ��n ihr _i„un.l, ,�r builJin� ,ippwir�i.int iLri:t.� .h.�ll rnn hr:.wx ,�r.u:h �•�npl���n�rni be Jrrn�cd i�� br .m rmpioyer.�. �I��L �h.ipicr I>'. :''Ci�,) �I.o .i�te. ih.u 'c�cry .t�te ur la.al lir.�n.inK agcncJ' .h�ll �.i�hhulJ ihr issu•rnce or n•n.��al u!� lic¢nse or permit tu oper�ic � busin.ss ur to ronstruct builJings in �hr .ommun.��cnith fur �ny applic�nt ��ho hu� not pruJuc.d acceptablr c�iJence uf.umplirnce with ihr insurance co�er��;e rcyuired." - � .\.lilin��ndlly. .\IGL chaptrr I SI. �_'`('1�l .oi�e. �"\�ruhrr thr c�m�mumvealih nor any ��f its p�din.dl .uhdi�uions .hali :war inn� �ny e�m�ra�t f'or thr perl��um�nce��I public ����rk unnl �ccrptabk r�iJrnrr ul r�mplian�r ��uh ihr insur�nce lCi�Ull'il)lillf5 VI II715 iI1:1PICf �1J\'C bren presenteJ ro �hr :�mtrac�ing :mth��riry." .\pplicantf � - 19r:�se till �mt th� wurkars' romprnsatiun altiJavit cuinpletely, by C}ICCICIIIs (I1C bU%L'S II1Jl JPPIy IU YOUf�IlUJfWfI Jlll�, IP ❑CiC5):lf)'. �lI�P�Y SUb-CUlllf:ll(Of�S) I1:II11C�5�, dJa�fCSS�C>)JOI�rhUOC pU1TIbCf�f).:1�U11�Y WIIfI If1Cl[1C111�11dIC�5)Uf insurunce. LimitrJ Liabiliry Companies ILLC1 ur Limited Liability Partncrships�LLPI wilh no employers uther Ihan ihe members or partners, arc nut rryuircd w carry workrrs' rumpensation insurance. If�n LLC or LLP dues h�ve cmploy�rs,a pulicy is reyuireJ. Be a�viseJ tha� �hi� atfiJavit may be submitted to the Drpartmtnt of Industrial :\rci.lrnts for cunfirmation of in.urance cuveraga. Also be sure to sign rnd d•rte the al'fidaviL The affidavit ,hould be rcmrned iu�he c.iry ur tuwn thut ihe applicueiun for�he prrmit or�ic�nse is being reyuasteJ, nut tho Depurtment of In.lustrial Accidrnts. Should you have �ny yuestiuns rcgurJing the law or if you are rcquired w ubtain a wurkers' a�mprnsation pulicy, please call the Depanment at �he nwnber lismd below. Selt=insured cumpanirs should enter their ,clf-insurance license number on the appropriate line. City or Tuwn Offlci•rlf � , Pleasr b�surc �h�t the affidavit is eompl�te and printed Irgibly. Tht Department has proviJed a space ot the bottom UI II1C :IIIIII:IYII �Uf yUU 10 �III nut in �he event ihe OIfice of'Inces�igations has lo cuntact yuu regarJing the applicant. Plr�sr he surc to till in ihe permic license number whieh will be uxJ as a ref'crcnce number. In additiun,an applicant , ih�t mu�t submit multiple pemvulieense applicaiiuns in any given year, nceJ only submit une allidavit indicaring curtent � policy inti�rmation I if nece�sary) :mJ under'7ob Site AJdresx" the applicant should write "all locations in (ciry ur n���nl." A cupy oFthe aftiJaoit that has been utficially stampeJ ur marktJ by ihe city ur town may bz pruviJed to rht �. .ipplic�nt as pruof that a v�liJ aftiJ�vit is on tilr fix f'uture prrmi�s ur licenscs. A ncw af'tiJrvit muat be lilird out each }rar. lVhcre a hume u��ner ur citiien is obraining a licrnse ur pcnni� not rcl�tcd tu any busincss ur wmmcrcial venrure 1 i r. a J��g licen:e ��r pennit w burn Ica�cs ctc.l,,iiJ person is �OT fCI�WR:II IO 1U111�ICfC fI115 dI(IiIJ�IL � I�li� ��i7irc of hnrsiig:ui��ns wnulJ Ilke n, ih�nk ���u in .iJ��:uice ti�r y��ur cuuperaiiun anJ zh�rul� ynu ha�e ;my yur�huns, ��I�.i.c �lu noi hr.u.uc ru gi�c u.. � c�IL • . - I hr I).�,unnrm': .id�lrc,s. �rlrph�me.md t:ix nwnber: The Commonwealth of Massachusetts Department of Industrial Accidents ` Oflice of Invesdgatlons 600 Washington Street Boston, MA 021 I 1 Tel. tf 6I7-727-4900 ext J06 or I-877-MASSAFE it�. , �,i � :��-�r� Fax q 617-727-7749 www.mass.gov/dia .��° � �;;� CITY OF SALEM ;,,,; .���, ��i PUBLIC PROPRERTY �9� `" `^ %� ' DEPAIZTMENT ��.�UM� ;,,��.,.�:��., �.�,�,, ,,��. ��I��.i nr 12G W.�,;i u�'l;�ro�u Sitaeer � ti.�i r��. M,�tii,���.i u sr.T�iv G 1�i7� 7'rl.:v7H-7i�:J;95 � I�:�s:7'S�N��9tiaG . . Construction Debris Disposal Aftidavit (rr�luired (ur all demulition anJ reno��atiun work) In accurdancc with the sisth edi[ion of the Statc Bttilding CoJe, 7S0 CMR scction 1 11.5 DeUris, and the provisions of MGL c 40, S 54; [3uilding Permit # __ is issued with the condition that tl�e debris resultin� from this work shall be disposed of in a properly licensed waste disposal facility as deti�ied by MGL c 1 I l, S 150A. The debris «�ill bc h�anspo ed by: � VC �� --- lnume �hau er) � The debris will be disposed of in : ��� ����� �. (n3me ut fauluy) - ' C/�/`�l Q� �I �address o(facilityj . �-----._.__._..__ �� signaWreofpermit:ipplic�nt � . �/�s`" � �— a��r �� d�i���;❑iTd��< � . .;� � �� , $�' . DIII�DI�D�I�I�fl�l � 58bOM0�FATT RO.aD COiYDO1�VI0M�IS�B��'�p,,;� : anisiaa�ias�:e� aeo n m F1RST A1V11�1'DiS6e5'P TQ MASfER DBBD �la G.Cdwdl and Olise T.Cutweell�Douglas I.Nd�aad I�h Nd�u�bao8 all of d�e Umt own�s m 0e S86D Moff�Road Co�mi�aamd by Mast�Deodd�edSept�6ea6,1990,�wi�E�esSm�D�tridR�yof Dee�at Book 10565�Page 187,@ereioafter��emended,�e°Aias�Deed'�and etso b�gall ofPoeTmd�of8�e58WMo6etB�dCoudomiui�mderDecla�alianot 7}ast dated Sq�t�6a 6,1990�d ncmd¢d wi9�said Re��of Dceds m Boot 10565. Page 154,haebyam�6uMest¢Dced�tto A�Grde 8 as follaws: 1. 1Le Sile Plen�ta m Article 2 w]nch was�cmded wiPo�e Me�ta Dced is ttplaced wiW Eie p1�recoided lmewiPo eatitled`P1m of Leod'm Sal� pnepamt�Ot 5860 Mo�t Road Co�ommiam"by Nath Shae Sevey Coipwa6on a� dakd Dee�ba 11,2Q06 @a�a�'�te Plau'�. 1Le fo�owmg mav pa�a�aph is�ded as pttagteph C of Aiticle 5: C. IJm�f8�d60�allhaea�clusivauso of8�ps�g spaces as�own am�e Sito Pl�,�ovided�et m�ce�d rep�of fhc ad'ne �g�d driveway�ea[mclud'mg mow�nva�sUell wulinue to be 9ie�biliry ofPoe C�m�mn'ltust.lbe a6ove gmnod sw�Pool md smo�d'mgdeck shallbe for 9x exda�veose of Umt�as s6own an Poc�ita Plao,Qrovided�t mamt�e aod�epair of the p�l and dxk shaIl be 9�e tea�b�7ity of�e ow�of Unit 60�d pmrided 5u&ra�at if�e pool is�oved Poe�ea wLeae 6te�ol is laated dmIlbceame s eal�nat�wi8to�d ra�ivetigfib.Umt 58 steli have�e rigM to conshact a d�k in�te�rz dai�ted oa dx Site Pl�aa'Reseaved fm the Fadue Bm7ding of a Ikck for Uuit 58"�d s6a11 have ffie exc(uaive use of sac6 deck,provided Poet mamtena�e�d�epair af 6ie de�shall be the re�'bility of 9ie ow�of Uail 58. ' 2 'fhc[�amdaofffie9tiidaihpa�agiaphofArtide1FollowingPoe "guesfs"is delefed e��lecedwiihthe fodowing: . "�dEorcammacielv�iclecowcedbyaifirtOwuel' writaesso�n��a�m;g L6�- a�yorr�y,zom, u (S�lesG.Cohuell u�as . �.2.,�, . � � � '�s�.., OliveT:Colwe t Dma�Al�n �oX �� "�.,����„�.�. • CO�rl1����1011 C0. � ` � Gensral Contr�ctors ,- . . . - •- � �- - CeIC(617)778-3878 . . 64 Eutaw St. 7 B-East Boston, MA 02128 � --- _. _____.__ . �_.. ... -,_ : ' i FULLY INSURED&LICENSED i .New Homes I .Additions I .Decks & Porches i . Dormers I . Kitchen 8� Bath � . Roofing � .Siding & P�ipting � , . Plumbing � . Heatieg 8. Electrical . Demolition � �i Connection Co. i Gerreral Contractore i _� -�,�....�..�—�_____— . ,.�— _ _— _.., _ . ..- _�_ _ _ - -_ a,F.�:� r . ,, k, - __ -- — — _- — _ _ - y.�� �t ��„ a ��. � � L y,��...`°` i . 5. 1`,y� ..+u fl�`" Y� , b�" . �IIIIBI��� �».�� � se�oxo�nTrxo:w co�mos��811��:��� 1 s m�s�an a:s�:r ano n in �AJ6 t� � �msra,i���rro�nsrasn� `( a�All� o� Uh.►-r 6�b (�adaG.Coiw�mdOLveT.Calwell�dDoa�eel.Nds�aodDaomA S'bfao M��/1-T �1�d Ndso4�8 all af�c ilmt mvnas m the 58�1 Moffat Bmd C��a�d 6y MaelaDeedd�edS�ptanbc6,1990,ri�edwiAiBeseaSo�DislridRc�yof t p I I 1 I 0 g n���to���e7,t�,��a,m�°►�n�,am� �,� I n��n at m�r��re�ssso r��x�e��n���r Tmetedadsepc�6a4199o�dioomdedaimeaialte�roFnam mBoot to56s� Pa�I54,lu�ebyemmd�eMes�aDadpmo�itoArt�B ntolbcrs q�� - �� � - 3y �a i. �s�rma�emm�z�n��a�m�� ' naam�a�m�p��an�m�uaaa�r�or�ams� ��- t�o . � �acpa�ed�Or 5860 Mo�Road Camd�'6y NMh Shae S�vey Cmpa�an md danedDeamba 11�2QDbl�anaflc�e`5"�P�. ' 1Le�0owiogaRpma�aphisaddcdnpara@rephC�A�S: � (;�� � q��� ' C. IfiimS6�d60ehellheve�vero�of�epediogsp�eaesshown � CC>Q �v �� � on�eSiDoP�,�uvi��m�md re�ir of the mme � n��ddtivewn7ae+f�s�wt�rd)�mu�abe GU�L'LQ�YvI.P�,� l.L� l�"�� ' the�b�3'tyofl6aCw�nitap.11xe6oveg�amd i . eai�ingPooleodamo�dmgdadcsLallbeta�eeaclo�veuaof � d����-�-�/Yt-� I Ihrit W a d�m on 9x 3ihe Plau,providad mat m�t�ana and repair of h,I�} thepoolandda�Cshatlbe�rcepouab�7ityo[meownaofUmt60�d � 1 � �� """^ j �nvided�r�atif�epoolie�ovedPoeueaafiaeA�epoolh �� �„►y� � la�ad�e➢6o�acon�onffieaw�tac�siverig�iJmtSB / I �nu��ri�a�o�aaaat�m��a��ao�m�s�� vt,/ (,�t,ts(-� Pl�es'Resavcdtart�FuhueBw7d'mgofaDakforlTuitss^�ds6slt � l he�t9xexdwiveuseofw��k,�ovi��t���r � Q ofPoedak s6all be Poen�bilityot�e awua ofUuit 58. ��� � � � 2 The�emda af 1ha 9�ird�6 ofMicle 7 Fallowing Aie "guesls"ia dekted eod�laced with t6e 6odowing: "e�d for oo�a�ad ve�icks mvmd 6y a ifi@ Owoer' a ' wrir�s�e��a�e� L6� a�yott�y,soar. (9�ke G.Colwell � � � � �� OliveT:(blwe! DmamANehun - � �✓ �X L � ♦ > � WOOb N01�5; G�N��AI� N01�5 '� � � I. ALI.I.UM6E2 SHAI.I KAVE A MOISfI�?E LLN1ENiGF NOf MLKk hWN 19%, I. 1NE C�N"IP.AC7Op IS RE51'ONSID�.E FO�.�D7iVNIN��b PA111JG FOI'.AI,L � � 2, AI.I-PP.AMINGLIIM6Ep,5HAI.I.OE #2NEM-ri?,q?6p71ER,FtqVINGAMINIMIIM: p��ZMITS�Q�,�I��bfOI�1N151'I:O.1�CT� "'� Fa-i,2oo�si,Fv-�o�,e-i,�o,000�. 2. iNE CONiRACtOP IS 50LEY PESpON51C�E�0�MbANS MEfNOnS,7ECNNIG�ES, � � 3, n�.��,v.�.�unwep neNonn ad�.v�sWai�w�veAMwir�uM: SEQUENQNG,SCNE7lII.ING ANJ 5A�E1Y�0�1NI5 pROJ�CC1. � �o Nor Mcr.e rw�e-a o.c, ' 3, ALI.WO�K SHN.I.6E GERFORMED IN CONFORMANLE T01rE MASSAC�L5ETT5 2"�t pr i 5fA1E OUII.171NG C07E ANI7 ALI. 01NER AnPI,ICA�.E C07E5 ANI7I.AN�S. 2x4 71 � q. ALI.JOISi 5PAN55KALl.KAVE ONE ROW OF I"X 3:CRO"-.SG�dnGMGAf MIJ WAN i� 2x2 716A1.UY7ER � n�n Nor Mwe m�e�-o��o.c a m� coNmacrop swv.�visir n��sir�nNn r�r��ouca�,vaawi�rrn 2Ka pr � 5, ni,�srun nerd;wG wA��s snn���ave a�e�o�va�v�zcNra a�oawGAr WIiN 1NE PROJECi pPIOR t0 SU6MIffING A PRIC�.N7DITIO�NL MOI�Y N4LI.NOf z 6E GI2ANiED FOP WO�K NOf CLA�IFIE7 Gf�OR f0 DI7nING j� � I/Z SND NEIGNf,ANb NOf M0�MNJ b'-0"O.C,M1MXIMIIM. � � � �V r ihlE CONIRACTOR SFV+LI.�CPOF'f ANY nL`CFSF'ANQES fyM�EEN I�;FlWIPJGS - SL � b. R:OVIDE AND INS1All-AI.I.NECESSM.Y 11MDEI:CGNNECiG�51MMA17E0LW1E Sif'.eNGM: `,° . I SPECIFICATIONS OR FIELI7 CONI7ITIONS TO TNE AnQ�IItECt IMME71A1EI.Y. <3) 2xI0 Gf � \ ,� `� 7, F1'.WInEnOLI�I.EJ015T6EI.OJJ7AR11nON5PP72PLlEI.TOJ015fF2nMING, �` Z � T b, fNE CONiRAC70R IS PE51'ONSIDI,E FOIZ REpAIRINGANYWO�I7AMPGEI7 6Y �— 1� 8, �zavine 50�In 6xInGING 6e�0�v pnellna�S�ENnlcau„a�;70Ja5fr�w�ING. NIS�OKCES WNII.E PER�OIZMWG 1NIS CONiRPLT 5/a z b Pi nECKI SIMp50N N1.35PC W/ 2-5/8"QJ � Q � I � 9, H'.OVIbE f.-q,ln 6RIbGWG 6EiWEEN J015ffPPMINGMEM9E�4lM1�N6EA�NGGN �. 'I'I�I� ��NiRACf�R 5�'�A,�WAkf'.fNITEE N�5 W�.FK F�A{'EI'.I�b���NE GALV.LAGS��.1'��LICd�l6�I-TS � � re � � srun pr�nnausa;ae�ns, YENZ FPOM 7�IE nAT�OF FIW�CONJ�LE110N. N EACN F�ANGE Q � gi �,' � io. wwine n cONnNuous nnNn �asinr exr�pia>,srun w��s , 2x10 PT@ I6"O C � � <0�EOUIV.)@ GJ,I.f�AM/POST O � � ;:1�`I � ii �zoviee ninGONn�Mern�smnp r�s,cwGAra.���c�s�nw�� CONNECTIONS(1YP> fY� l � \ MfERSECfI0N5,A71NE IN5117E FACE GF SNbS,R'.OM f01'R.AfE fOFLOq?R.A1�Af � GPLV�S E�JOIS7 � v� ��> �J 45'.51MFSON NPE��GWE�� LREQLW., 2., KANG"GIZS C'IYI'.) 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