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5C NIMITZ WAY - BUILDING INSPECTION �jhat is the current use-'of the Bjilding? Material of-Building2 If dwelling,how many units? Win the BuildlN Conform to Law?; Asbestos? Architeces•Nams Address"and Phons machanles-Name , 5-M O AddPes&and-Phone. - - ConsfruCfiW Supervisors Lioensis#,C .R 6 053LI HICegiStretion Estimated.Cost ofPr S �0 Permft Fee Cakirlatbn Permit Fee:$ -- Este X S7/51000 ResWential -- An AdditlonalfS5Ao,�ls=added�as an Adniniatrative ohaige. Mako.sure that all fields are.properly an6legiblywrden-to avoid delays:in;proce*N- The undersigned does hereby apply for tBuildingPernit to build to the above stated speCpcations. Signed under penalty of pedury X Date J _ s � 3 UV 6k- Or CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT MAYM 120mAstffVTWSTaaWa Skins,MASaACtnJS M01WO Tat;9W45.%" a PAM 9W40.96% Workers' Compensation Insurance Affidavit: Bnn&uwContractors/ElecMci"t/plambera Apalkaut Iaformadon please prim I. filti. Name mzineWorpaisadee/red dine): Construction Sp eciaities Addtess: 4+AM_��a■* w City/statemp: Phone VAre o■as emphsynd Cheep the appropriate host I. I am a employer wiffi 11 _ 4. ❑I am a Smaai contractor and I ZYPe otpwoject(require4' employees(&11 and/or part-time).• have hired the sub.-contractors 6• ❑New construction 2.[31 am a sole proprietor or partner, Hued on the attached sheet t 7. ❑Remodeling ship and have no employees These>ub wunacmes have 8. DemolItio■ r working far me in any capacity. worker'comp,ins rso [No worke 'comp,insurance J. ❑ We ue A corporation and its 9' 13 Building additIoa required.] offieaes hays era cised dick 10.0 Mocwcai repair or additions 3.❑ I am a homeowner doing all work right of exemption per MOL 11.[]Plumbing repairs or additione Myself.[No workers'comp, 0. 15$41(41 and we have no 12.0 Roof inatrnee mqukod.]t employees [No worker' 13.0' /e Z �P•inana■a tequirtd.] ;tin duidochboaetmoata4e4aantheraetlaabdawAmWgaaakwa =oeoegimago♦pd(% xomaowan d*WsWameinkbrtleatlaacitywsiltydlra�ktiedsit■biwsnowamaceaaRams.,beteaewafadwit rComaemn■r obaek tltla bo amar.fare.a as Rammed dra dnrfy w mos ofd a rub coanadnig wA *%ata.'romp lager an saapGryer that bprovfd/ag wo►k=*Cowpewrodow lwawraaci Poky ishiawas, or /gforwatlotr. /� f wY eaaploye" Below Is tkapoUe>and Ijob aW Insurance Company Name: �1 Policy N or self-ine.Lic.M_ I W C, L 10 6 077 g rpintion Date p Job site Addresa:_5C N nn�TZ Ci /S ew, 0 Zl7 P 14' Attach a copy of Ibb workent compensation policy deeLratle■Page(showin the Failure to actor cover asg Policy camber wad a:plratlon daq} fine u to SIum C 0 and/or requirted under Section 23A of MOL o. 132 can teed to the imposition of criminal penaltias ofs of up p Y imprisonment,as well IS civil penalties in the form of a STOP WORK ORDER sad a line investigations Sions o a city Afore i the violamr. Be advised that A copy of this statement may be forwarded to the OtEce of gatioos of the DU for insurance coverge veritkstion !do hpcbr cadb Radar de poles and panaNm ojpsrJarydkattke In joraaadow provldAi w 4 and tarred Sienatureo ZZq"`o 1 Phone 00cid Pate 081A Do not write IN skis area,to be eospletedlgrC4 arOwn ofJk/aL City or Town: Permiumease/ Issuing Authority(circle one): i. Board of Health 2.Buildin De 6.Other ` partmen t 3.CityRow■Clerk 4.Electrical Inspector S.Plumbing Inspector Contact Person: Phone M: CrrY oP Smam :i PUBLIC PRoPEmm DEPAXrMENr waos tswwoio:arltat�sKa�x�aaamot+t� ConslMdon Debrb Oblm t AMAVItt . (esgNind a+t,it daptldoa god rsnevataa wadi is m=WW os wi&dw alst!SMW dabs Shft Bot{dto0 Codas 730 CUR Sodltaa 1113 O&N6 and dw pioAdw dMGL s d4'St gay ftwa B it good witL to eooddaa dW dw drbds mmftg be �wait dnq es disooMd dis s piops�►tia�eaad wwMs dyad Aeii[q ao daAntl by!<t3.s 1 t 1.!130A Th9 dabrb wM bs blnapoebd byt J � Weadboo" - The ddsia wilt be di��po"d o[ie: (mmacham wo `Tre4-110.1 - S�, c �rn�;uaf psi ZG era i 00 95,000 cf enclosed space (MGL C.112 5 60L) 1A Masonryonly _ � ..] IG-182 Family Homes 't Failure to possess a current edition of the I Massachusetts State Building Code is cause for revocation of this license. I "{ DIGSAFE CALL CENTER: (888)344.7233 _ BOARD OF BUILDING REGULATIONS'%* License CONSTRUCTION SUPERVISOR a. Number:'CS 063897 ' 1 Birthdate.o1/o2/t s62 f: • -;Expires 05/02/2007 Tr no: 121107 Restricted,�00' TIMOTHY,J FINN 8 VALDORA DR/PO BOX 53 G-7- STONEHAM, MA 02180. *' Cgmmissioner' PROPOSAL CONSTRUCTION SPECIALTIES UNLTD., INC. P.O.BOX 53 STONEHAM,MA 02180 Phone(781).6654410 Fa:(781) 664-4411 LENNOX GROAN-NUToNE FiEMMPR3MUM A NORTEK COMPANY mouk l.avol(e, 3 - al - a1 5 Q, P We hereby submit specifleations and estimate for; 5C N ` 4-e- 1blOQZ V (�iS 4SO_ ©� Y G\ref l C-�'1�mnes� ��s�m . ia,s�.Ll Lei��oxB2iam- - 3(, (0s- C 60 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%non-refundable deposit is required. For central vacuum and intercom installation,half is due uponrough-in and half is due upon completion. For all other rk,payment 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 date ofproposal. are effective for up to 3 months from Acceptance of Prop al r"W "Wp Wm y W e m IrWY�oO Ym.n Wvfe.OmblM wwtu Signature / led please WW.W Won Date; /.� / /7 p sign and retum, � a erSJ��� or v(" - eg� CI r� u PUBLIC PROPERTY DEPARtmtNT 120 WAiwWes'cw S`[eE6t�'S 1t1L,YASs1a LSkT,is 019I0 R7:97l 7iS 9S9s=4 F UC 9 yJ0 9146: AP LIGATION Olt!'I'HE.REPAgLREN YATION �CONS1__.N DEMOLITION OR!C GO E SE OROC ANCY'-FORANY EXISTI>r1 F U CiTP G STRUCTURE.OR`_BUILDING 1.0 SITE INFORMATION - _ Location Nam6: ;e t ulnas _ t .. .-_ 84iklln enY - 4 sa Properly brlocated In a:Eoriaervatbrt Area:YN Hldtoric`DItUk t Y4N 4.11'OWNERS . HIPYNFORINAtO'N 2.1 Owner of Land Name: Address: q Telephone: 9Z :-?W.I -.a 3.&0 3.0 COMPLETE THIS $EC ON'FOR WORK IMIQTrN& UILOINGS ONLY Addition Existing Renovation NumberofStories Renovated Change in Use NeW' Demolition Existing Apprtiximate;year of Area per floor,(sf) Renovated construction or renovation of existing boilding New acid Description of Propos Work: F?tee ��ace ikvw Mail Permit to: _L k(o 1v 9 o a -I'(Vl (v bye, W-k I3-2i tb