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3B NIMITZ WAY - BUILDING INSPECTION (2) i Wha the current uss oPthe.BwWirq? Un i ' Material"at'Bu�idlrW? � d O� :. : H dwslling.tirni!many un'its2 - fomn.to t:avr'1 +�sbestoa Cori yVfll"the.8uiidinp°. prehiLecd's Name Atldrea'and.PhoM� . t � �M Y)d1 �n Mechav+ie's;Nart+e W a rze .. IM1 O� t 7b _ (8 ('(o�L_5 qLfl C Address'and.phpn• b i rPrn a CcrisWctfo�Suwvi Ucan�s's:.a�Y�1aS©tP-N HIG Regist'ation EstGnated'Cost= 91ea — =� Pertnft;F.ersCaleulalfon Fee';` EstimatedICont X.$71/i000'Reaideal nti Pertne Eatlma3ed.Eoatlt,ittllS� An Addfflonai=46.00 da.,added;iW ah Admiriistrative,r3tar0e:: Make sure'that alf;.I W*ars 060D IY and 1e41W'"Me^to avoid delays-In,proceasing• The und"lyned=does hereby ap*l forAa iiuliding Permit=toobuild'tq;<thnX*boove Stated Si nedunder;penaftyaf-perjury peciflcatione. � - I n i b o. F- 41u, pq o / I TY OF PUBLIC PROPERTY DEPAR'Y11 �1T I:I�WF�n.`vw rt. wvoa" ' t30 Wwsrm+ .iiw 5ffer4'suu+4M..ssAud:seas 01910 . - 1tiL•9?47iS939!�FiuC�97L7J0:9M�:. APPLICATION FOR`THE REPAIR: RENOVATION [''ON$TRi�CTION.• DENIOLITION.OR 9A40wzw..R OCC[7.PAN FOR ANY ISM BUII.DiN( . 10 SITE.aNFO fiON 17 Lotatlon Namt C{/�� ��0.f1 CT ,,T`` Bulldtn ' -.__._.. �S7 NMI .. `Propedy W�l4ddr9asv - Property i berated n a;'Conservatton Area Y/N Hlatoric Otrbfd YM � 2z0 OWNERSHIP;INFORM/1TION �1 0rynor-of Land' Nams o Add;;; a t✓ Telepttona l -, 5q -5q fv--I. 3:0 COMPC'ETE THI'$ SECTION FOR=WORK IN E]c�ATfura BUILDING8 ONLY Addition, Existing Renovation, -Number of Stories Renovated€ Changein-Use New Demolition Existing Approximate year of Area.per floor (s ) Renovated COnstructionor renovation of extsting,tuil din g�„� New Brien ,esen ption of`A sed:Work: o V>✓ `7- �f � i Mail Permit-,to: -Irb tv avTv ;, h.'1 ro5-e Zt�� Ct1Y OF SALEM h PUBLIC PROPERTY DEPOT �. t21.�a.ratotstmaaetiKxesoasats0l+t. coas&ucdo. Debuts Dtspoed AfWavu (e.gµ�ad aw a1t dsaoGdos�nas,►,t1aa.Moa� Ls scootdsoa with tbs silt!sdhlas dId Sues Builam codtw,7"CUR sedtas tll.S odm%d&@psaw d=wat>Iis;1L444S% smuft tdi r b isrssd adtr tsss eosatuos teat tsts ds- - muwm iboo ds wat shell be disposal atlas peopatW ltoasasd wsals digo.d Ad><gt ao dsQasd by UCL a Th.ddxts aria b.asmpoead bin l� Tha dells wilt be dtaposd otin: qq teams atT 1'asii M tl e)nn�n� �� �1��� ���t • �2C�(o taJdnae a<se�f >,s.,s,a a<vem�s,00tte„� � 1 dtos CITY OF SALEM 1 PUBLIC PROPRERTY DEPARTMENT ¢nt.mrtnt ttatscou. NAYoa M WA2W4GTMSTMr*SAMS,WSMACtRR6mol"o TZL-97a•745-"" a PAx:97a-74o g" Workers' Compensation Insurance Affidavit. Bui daWContractor&Mecbidana/Plambm AQullcantInformation Cork+nee.+iwM Spigensoa., Pie•••Print Emehr Name(Busine worgenira�duai): P.O. Box 53 ftonvmam, IOU Address: City/Statemp: Phone Are 7j�■as employer?Cbeck the appropristo best Type of protect(required): 1.[�"I am a employer witb g te 4. 0 I am a a(eoomang,anti I employees(NU and/or part-time).• have hired the win cona�ctorg 6 ❑New COO Oa 2.01 am a sole proprietor or partner. Hated an the attached sheet. t 7. OR ling ship and have no employees These win cant:actaes have 8. 0 Demolition working for mot in any capacity, workers'comp,insmaaea. [No workers'comp.insurance 5. 0 We ate a corporation and its 9' 0 Ong addition rem.) odlcees have exercised their 10.0 Macerical rapaira or additions 3.0 I am a homeowner doing all work right of exemption per MOL 11.(]Plumbing repairs or additions myseM(No workers'comp. a. 152.41(4),and ws have no insurance required i t employees.[No workers$ 0.13 13. F� ;Any wP"M duo dmb lox e1=0 dm AN ON do steaea below reeve"Oak wwlns!oompmmdoaDdiey�nbmatloiL _Aemeowaos wee nieoit Min-eetdevtr t dwy an doing so wank and aim eevmuide eemstoss mnaoaeseY•now ntltdtvk rCoOtrseewo Mu test Mix boa ess uvee.d m.dmagnnt sect slowing Mo asmo Oran mbmaaksesen and Met ssakus'amp rsuca . I am an moplOyer that laprovddlws workers'cawpewsadow Iwawrawci jot.ary earplaysea, Below 4 the Jwjornce Q poUry awdJob iW Insu Company Name /-+ Policy#or Self-ins.Lic.N: W C/ (0(atn�2- (j(p O O Expiration Dated�02 0 9- Job Site Address 3 1> A Qj t i City/3tatsaip: nC C*--, MA( ®i QtrTD Attach a copy of glib workers'compensation policy declandon page(s►o the Failure w secure covers es �rtng p®ke1 number and expiration does} p raWlted under Section 25A of MOL a 152 can lead to the imposition of erimiaai penalties of a free up to$1,500.00 and/or one-year imprisonment.As well as civil penalties in the fore ofa 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 Oflice of Investigations of the DIA for insuranca coverage verification. I do hereby ctratJy under As palm and penahlar ojper/ary that the injorwadow Provided above 4 tree and correct Signature: �/l� ��C� paw I �S I 1 Phone o lelal use only, Do not write In this area,to be coatplsW bib city or town oQie," City or Town: Permit/Lieen"N Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Citylrown Clark 4. Electrical Inspector S. Plumbing Inspector b.Other Contact Person: Phone p: I I 00-35.000 of enclosed space - j (MGL C.112 S 60L) 1 1A-masonry only - .J 1G-1 &2 Family Homes ,I `} Failure to possess a current edition of the _ i Massachusetts State Building Code is cause for revocation of this license. I ( ) r DIG SAFE CALL CENTER: (888).344-7233 ` ;//te L anepnaiiaVElsbUt a �'/4L�+.kt/Y4' ' ! . s BOARD OF,BUILDIN�REGULATIONS�, License CONSTRUCTION SUPERVISO�t . Number CS 053897, `r ., a� Blrthdate 0510 . ` Ezplres 05/02l2007 Tr no. 12Z07 f. .1 TIMOTHY J FINN` j 8, ALDORA DR/PO B ,53 - �j" 5' STONE HAM, 'MA 02180 Commissl 7 p PROPOSAL CONSTRUCTION SPECIALTIES UNLTD., INC. P.O. BOX 53 STONEHAM, MA 02180 Phone (781) 665-4410 Fax (781) 665-4411 L E N N OX BROAN-NUTONE HEARTH PRODUCTS A N O R Tl K COMPANY YYI b' C' /,(J l Q�� S- l q U Lz*e� a Su_ a�, l M A , o t Q o ? rze.:' okjy4z' cow , "33Z_6e n QemL�cC, "� � q'�1 �Yi v(1X ((>(a - 8 �o IN Coco py y(ac-� , �i,aeAl aylt 2S Ol III -I n We propose hereby to furnish material and labor - complete in accordance with the above specifications for the sum of: AS ABOVE jPayment to be made as follows: For special orders a 50% deposit is required. For central vacuum and intercom installation, half is due upon rough-in and half is due upon completion. For all other work,Pay"ienr'is'due upon job completion. Authorized Signature NOTE : All plumbing hook-ups, carpentry work & building permits are the responsibility of the job site general contractor or homeowner. Prices are effective for up to 3 months from date of proposal. Acceptance Pr s The above pngR rn' u conditioru er .uysC.ct��e(,C ad You ere euNoeved to do he wo k g / M/p«ifi d.�mmi J be made u o U d ebovu Si natur Date: // If accepted lease sign and P gn return. ox>'1C3CQS`�CiC. . 1(�ei �c7tl 0� � 7 a �j