Loading...
4D NIMITZ WAY - BUILDING INSPECTION PUBLIC PROPERTY DEPARZII�MNT whoa 13D 1f/ uewTiiN SneQr•3u�+4:Mwss�iiL �r�s 0497a'': . 747:97b74S.11 �F 97L2 9NF: AP�LICA'TION.FORc1`HE:REPAIR RENOYA�I'I' 1�T C�IUS'T13YJCTION DE�iOLI'TION.`bR CHANGE OF USE:O_R_O�_,�>�Cy,FOR �4NY F�XISTIN" ; S UCTtJRE:ORsBi1ILDll�iG LacagonNamr. � 0.,(1 C7�+' tjufldinge; P'opeity Address.- .. � ri1•; 0."� Prupaly'fs locafed.N a:'Conservatlon Area"Y/N Historla Dht+lct YIN Z OWNERSHIP;INFORM/1TION 21 OwnM:of L and Name: i Address `I-6iJVli Z .. cSalem WIFk- Telephone .. IDS -ly ( 83�2 3 O COMPLETE.Tkl SECTION FCjR WORK-IN��'�TiNAyBU1LDINGB ONLY Addition Existing Nuniberof Stories t2e Renovationi novated+ Change.in Uss New Demolition Existing . Approximate-yearof Area per floor (sf) Renovated' co renovation o/existing:buitdirig^ New �Seadrd,oean ot`PAposedW rk:. . oi,"� � ��C&S� t��e�t`� ♦ �' ' �i �"`.�"�`-1 s��� + ��ca-sue ai✓ b,�- _' tom, `� -.: -_ __ -- -- Mail Permit to! Crnt OF SALEM PUBLIC PILOPEMN DEPARTMENT MOVE tsw,00�atts�wetwata ww.oa�tsotsrb Coustrucdos Dsbrb Wsposat AfDdsvit Is umdom with dw 3i odblift s d4 G(dwgbft dy,Co 7'o CUR SWIM 1113 04bdol addw ptwvtsLons BttiWiy 1.noit i+ is b m d vAh dtw.oedidos drat dew ddmk nmul es Don this wwk drd be dtVord otbt - Bestwi wrM dlVaal dtdggt as drdad by 1([it.s 1l1.!I O& TTtw debris wiII bw tutWoetd byt /1 I yy Wr al TA.dd %U wig be diapottd of in iw, lytsiwrs a!�+ttM S*84Uw alprnis-Ml&-- � 1 dw �a�xy. CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT MAroa uo mwstm�ercu,s�.esT.s�F,r.at,�ss�awser�so197o Tku WS-745-9S95 .PAx 97i.7 Coto Workers* Compensation Insurance Affidavit: BuDders/ContractorsMeetricians/plumbess Apolicaat Information Cnngfruction Specialties Piea_aw hint i�oihhr Name iBuwneasr P.O. Box 53 Stoneham, M*; ww1elw asvnCntams ms+. vi s Address. City/Statemp. phone Art 1�gas tmpieyrT Check the appropriate box: Type of project(required): 1.0 I am a employer with 0( 4. 0 I am a gamal contractor and I employees(&H and/or pattrtlme).• have hind the sub•wotractors 6. ❑New construction 2.01 am a sole pmpridor or parmar• listed on the attached sheet t 7. ❑Remodeling ship and have no employees These a&oonaugaa have S. 0 Demolition work ��W i.n�y&! g f�or we in any capacity. wo:irors•comp.Insurance. 9. 0 Milding addition ..(No 'comp.insurance S. 0 We ate a corpomdoo and its required.2 ofilcros have mweiaed their 10.0 Electrical rsPa=or additions 3.0 I am a homeowner doing an work' right of exemption per MGL 11.0 Plumbing repairs or additions myself(No workers'comp, a. 152, 1(41 and we have no I LEI man pp inacr required.)t empiayeas.(No warkaq• 13. f 11 comp.WWII"requiral stir wat+nu�etreb iwa rt tome eteo as out Wr reetloa t.tor rhoay ihdr aatrs�eoe�.se,loavoires xam.o.o.s.seweetruer.aa..tna,m�iesmreAss•a.oaraeaeaear.amia.ameaora.mos.�beaam MINWO raeiwisewaV rcomrrma e d dwk dtr ban num so eeee o,muiamai AM d wIft dw mw of mr an am n,e a.w.s ta�oemv war r __ Worwasfow o aUat4.provtdLrg workers'eowpexrrtlow ttsr+uaxeefor rwy employs" Blow 4 My poetry axd job star Insurance Company Name: Policy M or Self ina.Lie.M AU`W C I 00 '—p(p f7 fD &Pkadoa Date• ®n7nn Job Site Address _�� 0 City/State/Zip `�A ` 1` 1 (} �q o Attach a copy Of the workan•eomp""doa pollsy declaration pap(showing tbo policy number and expiration date} Failure to Mecum covetap as requited under Section 25A of MGL a. 152'can lead to the imposition oterimbW fins up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER aannd a fbu of up to S250.00 a day spirit the violator. Be advised that a copy of"statement may be forwarded to the of &of Investiptions of the DIA for insurance coveralls vadkzdon. /do kwrby crrtfb axdii sits palx�aAd pexa<yy oJper�ary IAwr tkt 1xJoriwmfow provldsd above J+a�a and coned Signature: re., Date (e a� O� Phone M: 1191 — fo ly S ` 4`41,0 OJJfeJd use only. Do not write Jw tkls we;to be eompfeted by clq ortoww oQkig City or Town: Permit/Lieense M issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Clty/fown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.other Contact Person: Phone M. PROPOSAL CONSTRUCTION SPECIALTIES UNLTD., INC. P.O. BOX 53 STONEHAM, MA o:.180 Phone (781) 665-4410 Fax (781) 665-4411 H NNOX BROAN-NUTONE HEAFtT�$i A NOPp.TEK COMPANY de # I cSP ct {�.5 f L We propose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of. AS ABOVE Payment 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,payment is due upon job completion. � II 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 f proposal. Acceptance Proposal Tln Wvh q;o,y+w.' .. {��'pwpM Yw uewWdoWwoh.. w I J+► � Y�I..ill h„mrM Y W WnM bu.e Signature Date: P e sign and return. ©�s�2�e.. Wc9rlL i 00-35,000 cf enclosed space 11 (MGL C.112 S.60L) 1 A-Masonry only 1G-1&2 Family Homes - t't Failure to possess a current edition of the `i Massachusetts State Building Code 9 is cause for revocation of this license. I .! Ia{ 37 DIG SAFE CALL CENTER: (888).344.7233 BOARD OF BUILDIN REGULATIONS:* License: CONSTRUCTION SUPERVISOR �" ( :v ..' .. Number CS 05389T Birthdate 05/02/1962-2 Expires 05/02/2007 Tr.no: .12207 - "'LL"" Restrictedr 00 TIMOTHY J FINN " 8 VALDORA DR/PO BOX 53 . STONEHAM, MA 02180 }� Commissioner $_ �+ Whac Wthe current uss oPthe Buildi� �9? 9 units? Un" Material-ar=.eUWON? � l7 � G I(dwelun ,how mamr' Coritonn to taw? Asbestos?. wuru+..euitauq' ArctiitscCs"tlanie Adit",an&Phone�, l ) MiideNa Y1 d1 �nn� Brie ��(� rt+e C Addro„&4 ehone Construction SuPervisors license,il eo pom F.ewq' !d latlbn Estlmated`Cost ofP►oled S PertnftFae3 -- Estimated`Cost$7,/s1'000 ResidentiW - __ _.._ - Estltnated:Cost•X:'S�`1/ST000`Cammemlal---_ ___..._ - _ An.-AddkionaL16 oo.io added;asran Ad Whistrattve 04*. Wake wro=that alf<fleldi aro pfopsrly..arWiegibly'writte^to;avoGJ delaga-Gr proeesssinp• The unde[iiigned"dose`hereby-apply'fora.8uilding'Permit��to bulld,Ad-,he:abovs stated specifications: Signed under=penalty 61;PedutY Date 421 E- a V r.