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6B NIMITZ WAY - BPA-07-1102 $iA Q Whatas the current use ofthe Buldirg4 Un l� _ N.dwelUng.hove!many units? Mater!al-of Bcildtng� Asbestos4 W M�AM Mdd nq'CQAWM to law? , pvcMitect's Nseme Addtea arWPhoM Mechenic's•Nan» Q'be Address end°mom isors ucarm-M ��D iP,� l HIC Registretbn. Construction Supery . eamnatedCost of Project-s 0 °°�Permlt F«Caleuletion PannR F«' Es*nated"Cod X s7/i1000 R"IdentW . — -.. EsftatedCod-Xsll[si000canmwcla�---._ .._.. _ . . AnAMMonW SS." Is�added a. an AdminWrative ch&* tiAalts sure~thd elrow&are prilo' gM,ie ibly writtento.avoli!-delays in pnx esaing. .. The under"lihodidoes hemby;APWfor'8'BUIlding Permit td:bultd to.the above-stated' specftations. Signed und4W:penalty d N` ► ls�, u � 1 96 fff // CITY OF SALEM �. PUBLIC PROPRERTY DEPARTMENT KNIER21t DKISC A. N11DM 120 WA4macr3MStaELr a SALEM,I1t MAaa MM01WO TM 971P745.9S9S a PAZ M740.9W6 Workers' Compensation Insurance Afadavit: BuUdU /ContrutorsMectrletany Iumberst AnDUcaut Information Censtruc+inn Specialties- Please Prier imthl&r Name('Butw"I ` P.O. Box 53 Address: s city/State/Zip: Phone V An view an a®player?Cheep the appropriate boot: 1.Q 1 ace a employes with 4, 131 am a !!I contractor and 1 °f Prot (employees(rlrll and/or put-dMI lave hi 6• ❑Now consbuction al 2.p I am a sole proprietor or partner• listed ottached sheet,t 7. ❑Remodeling ship and haw no employees 'Thee aoracmes have 8. p Demolitionworking for me ht any capacity. wodttn Insurance.EM workers'Comp.insurance s. ❑ We am rsdon.and its 9• p Building addition req�l offersaereiaed their 10•p Electrical repairs or additions3.p 1 am a homeowner doing all work light of tiomper MOL 1 l.p Plumbing repairs a additions myself.(No workers,comp. o. 152,tnd we have no 12 iitnwrsace required)t ermploye worker#' 13. 6c t 'day apptirar dal daeisBoa e1 mar a n ea out dw aaedoababy I InSawro re�aompmuya policy tafbtaution.tRomw ewbm6mtrait&Mdr*teMeatliv6wyaa,dotsaaa.akst��ema.a6sms,ueasu.ee..tea rCaeaaefawtmtatraktM&tiaaaeaatantcAdaoaddftlamlabowsl w(aaMaewaofdwvA4aeaaeeo wddIwadmanu aamP ioNmatlaa Iamawearployerniatbprovfft workers,eomMnwlfoal+rsaraaeejoregraarpJoysa Below4tlie lajorwadow policy and job s1m Irauramce Company Name: Policy#arSelf--ins LIo N ` ^ ki�O � �O�U a irk Expindon Date. to_ 7 Job Site A l oa)" City/gtatdZtp _� i Attach•ropy of the workara'compensatloa polley declaration pap(aMowta the Fail=ue to secure rovers ma 8 poary number soli a:piratlos dabs 1te requhvd under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a time up to S1.500.00 and/or one-year impriw.nment,ss well as civil penalties in the form of a STOP WORK ORDER and a Rue of up to S250.00 a day against lire violamr, Be advised that*copy of this ststemeut may be forwarded to the OMIS of Investigations of the DIA for insurance Coverep veriRcadon. f do hereby cep=der rAy d pa—h an peeold"ojper/ary that dyln jorsmfoa provldepd above is 4rrra and carted Signature: f/- '- ��--'�� Da a• l0'(-�� Phone#: F au oafjt Do act wrke Jw thfa 411 to beCoapkild by c/o atowa odtda; Tows: Permlt/LteenssAuthority(circle one). of Health 2.Building Department 3.C10frown Clark 4.Electrical inspector S.Plumbing Inspector Contact Person: Phone#. Crry OP SALRu PUBLIC PROPEM DEPARTUDrr Ilk0&749496 0#AS 9MU& u Cam&uctl®a Eebrb dal AMAVIt G"#"bt,u a momm mdnes,►s"wad* Td u@oWwA*wtrb ilm r&SMml ddw Stdl DWHIOG Cod,,780 CUR A"am 111.5 Oduk d dwp wAdoos atUM 4 406'54 gwidbet."Nr iobuoy/WI&dwaom Mon disc desdebdsmmdbsAM rids work"bs disposed ditt s propwV SOMISdwrM dtgont ddgt as d.dnsi by 3dM s 'ihs debds will ba trsrrspmtd bP /�t l,l��'1s`I�` A—,&, The debris will be disposed o[in: (=Met& qr) Iwo `�r &,J U1I6• lytamr of hsiuq� L�aNnr of pereur a�lfraot � 1 due I �. 00 35,000 of enGosed space - I (MGL CA 12 S:60L) 4 1A-Masonry only 1G' 1&2 Family Homes ') Failure to possess a current edition of the t! Massachusetts State Building Code is cause for revocation of license. DIG'SAF.E CALL CENTER:. (888)344-7233 - } - BOARlS OF, I DING REGU '710TtS '• ,License CONSTfiUCT10N SUPE Number:CS89 } 7x �Blrthdate�Q5J0$/1662,4+-'e� i - - Expires p4102/20P7 � Th nod 12I07 'Restricted OOr TIMOTHY) FINN s ' 8?/ALDORADR/PO,BOX�-'�3 ' STONEHAM,AMA 02180 .w CommissioSef . r L - o PROPOSAL CONSTRUCTION SPECIALTIES UNLTD., INC. P.O.BOX 53 STONEHAM,MA 02180 Phone(781) 6654410 Fax(781)665-4411 L E N N OX BROAN-NUTONE HEARTH PRODUCTS A NORTEK COMPANY ��W.r� k VIA , vkgR 2© n15 �Q�e 1imn�2 ` t tos- o S � 001 Cxx 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 othe r work,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 are effective for up to 3 months from date of proposal. Acceptance of Proposal The abm prim apeu6®No=ad aondi i m are adea&ory d art hereby acc ptd You era wthodi to do the wo a epedld.Payment w be made a ww.d above. Signature a / a Cl' —Date: If acceptecTplease sign and return. Ell I PUBLIC PROPERTY DEPr1Rr'ItiiF. iT: uo �I.Noa 13t11t+�tiur�ci�iw�rv?3uu�y;�aa:srrnoi9iG 'I4i:,9'L7iSi9s%-�Fi�iC 97L9(0.96/f• APPLICATION FOR,THE REPAIR::RENOY»ATI"= N CON3TRU4'TI<ON . . DEMOLfTIO&OR CAANmF USE OR OC 'FOR..A Y.EaQ3> STRU�TUR� OR BUIIDIN . 1'd0 SREINFO TION . L=tlon Name C q/t C�. Buildln¢ Properly AddressF__(0 nip Propsrt I locatedIn a:'Caiearvatbn Area"YAV" HlstaAc Olstrk t YlHI fAd 0"OWNERSHtP;IN1 RAMTION dress: (0 t'nn Z= 14Zo 3 OCOMPLETE THIS!SECTIbN FOR'1NORK IN©nAT�Nrn BUILDINGS ONLY Addition Existing" Renovatbn Numberof Stories 4enovated Change in use New'' Derriolitlon Existing . Approximate-year of Area:per floor(tQ ` Renovated conatrudon,or"renovation of existing"building,' ;_ New BrieL De pticn of"Pr sed"Work: pK�M�Vfp c 'C, � Mail Permit to: