6C NIMITZ WAY - BUILDING INSPECTION (2) Wftat is the curtent use ot-
thwBuilding?
Material of Building? It dwelling,how many units?
wifl he Building:Conf.brM o Law?: -
Asbestos?
Architeas Name
Address and Phone
Mechanic's+Name
Addfess and Phone�
CSD63�1 , HIC:Regstratiom3E - --
ConsWcNon"SupervWors Ucense#.�_.
Estimated Coat o Pf�ylact$
1 a� 'Permit-,Fee Calcuwdn
Permit Fee t � / Estimated Cost X`S71if000 Residential
An Additional S5 O.-I adaeil,as an'
AdmtnWtrative charge.: _
Make suro,that all fields are properly and':legibiy written to avoiddalays ln;processing:
The undemlgned does:hereby apply for a'Building pennR to buildpto the above stated
spediflcations. Signed under penally of podury / �N
Date
°d. M
o � N
fie,
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0. . . �42,-
CTTY OP Saam
' PUBLIC PROPERLY
DEPARTMEWr
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Cans&uedo. Debris Dbposd MWsvu
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is seeeWkm wide dw AA WWN atdw Shft cos Cody,780 CUR see8om ItIJ
Odmh6 and dw psowWkwA o UGL s 14 s 54
g�>hnnlie� b isssui wide dM eosdldest dut du d�lsis cewddiy•os
�srei!duU bs disOosd a<is s psopsrt�No�see wnls digeed dud>i�ss ds�d byltOL s
Thedandewill bs au+vond bye
The daM win be disposed otin:
corls�41c�l spe a-cs
(Ammar bad"
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(oranu a!ISGuM p-Z�'l b
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due
CITY OF SALEM
n. PUBLIC PROPRERTY
DEPARTMENT
ttotasatav natscott
I,ttroa IIO p�smuGTONSiaE[T.Sncew.Mwa�ctrtttelZSG1970
TIL M745.9595 a FAx 97P7e0.9"
Workers'Compensation Insurance Affidavit: Bullden/ContraMorglkcMciamfflb mbera
Aput eant Information Cnnafrrut•_finn $DeCialtleki
Please Print r ..awl■.
Name _P.O. Box 53
vwncuwn■i ma+■ 02160 -
Address:
City/Statemp: Phone#
Are yy�a employer!Cheek appropriate bbost
1. I got a amployat with 4. 0 I am a geaerel contact and I Pe of prnlad(ragnirad):
employees(1IrB and/or part-time).• have hind the a:beoateaatoea 6. 0 Nowconstrucpcn
2.01 am a sole proprietor or partner. !Coed on the attached sheet t 7. 0 Remodeling
ship and have no employees There sub-eoutracmn have 8. 0 Demolitim
working far we is any capacity. workers'comp,hLINSMnce,
(No wodrera•comp.insurance 5. 0 We are a corparadon and its 9. 0 Ong addition
req*4) Offlcm have exercised their 10.0 Electrical repairs or additions
3.01 am a homeowner doing all work right of userption per MOL 11.0 Phunbing repairs or addition,
myself(No workers'comp. a 152.11(41 and we have no 12 0 q
imurance l t employees.(No workers'c 13.Q l0.
ep.bummer reynired l '
;AnY 4PvUcar this etretrs bag 01 sans an do as dw sad"batawatnaiog arkPOW khr.mmka
•ad aa'
;C66ftsclus Odids�bboa�anaa adadam sbeft�wakmdmNneaaWaom q� aai
drorisr dr a■ma ofdr sob comaemu gad drk wo*= eomP t0U%'tafi=ss"
1 oar an eaaploya abae Ltprovidlnj workers'cosrpenmdon brsaroacf for,0 P earploysa Bdow b&O informa" I Polley andfob site
Insurance Comp me
Company Na :
Policy#or Self-ins,Lic,ta�(,t�C�616o 0 C9(o p7
ra n F.xpirsflon Date: D R D
Job Site Address tOC i�1 t ��2 oa City/Stataz* &Q M, MP( ()N'zz
Attach a espy of the workers'compensation polky declared"pap(showing the policy another and and
Failure to secure coverage as required under Section 25A of MOL a 152 can lead to the expiration date}
tine up to SI,500.00 and/or oaayear imprisonment,es well es civil � ti0°of uimfaal penalties ofa
of up to$250.00 a day against the car WVr Be advisedt,se that a Pities is the fora are STOP WORK ORDER and a tine
investigations of the DIA for insurance coverage vadleadoa SPY of statement may lot forwarded to the OtlZce of
/do ksisby eaKjy anger airs pairs and naldw 0 Per/aJ'dw A*11 arsrsdon provided above it One end correct
sivarurw �N�
5- 13- 87
Phone 0,
F
e only, Do not wrke in tilt areat to be eamkte/by city a town oQkiaf,ws:thority(circle one):fHealth 2.Building Department 3.Cityfrown Clem4.Electrical Inspector S.Plumbing Inspecter
.
IL-Sontact Person: Phone 0:
i�
Paul Surdam PROPOSAL
Construction Specialties Unitd.,Inc. 'ION SPECIALTIES UNLTD., INC.
SALES&INSTALLATION OF GAS& WOODBURNING
FIREPLACES WITH MARBLE&MANTEL P.O.BOX 53
CENTRAL VACUUMS&INTERCOM SYSTEMS rONERAM, MA 02180
GAS&OIL FURNACE VENTING AND GARAGE DOORS 5-4410 Fax (781) 665-4411
Office 781-665-4410 Cell 781-389-5985
A B$91�NUTONE
HEARTH PRODUCTS pf r}}dd�>�IrrNN��' COMPANY
Louise St. Cyr
6C Nimitz Way
Salem, MA 01970
Re: 6C Nimitz Way
I
Remove and dispose of existing fireplace and chimney system.
Install Lennox BRI-36 wood fireplace, chimney system, and new chase flashing.
Patch any holes in wall. $ 2095.00
Salem Building Permit $ 25.00
�e—�esfic!/
Optional Stone Surround and Paint Grade Mantel $.79g gg cusla*ers oe.ro
Price is contingent on inside inspection.
Condo Association is responsible for$ 600.00 for a single chase and$ 745.00 for
a dual Chase.
We propose hereby to furnish material and labor- complete in accordance with the above
P P Y P
specifications for the sum of:
AS ABOVE
Payment to be made as follows: For special orders a 50% deposit is required. 1
For central vacuum and intercom installation, half is due upon rough-in and half is due upon
completion. For all oth6r 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 above prima,specifimnoms and condiuom are sansfaamy and are hereby accepted You are amhodad to do the work u specified. Payment aid be made to om1mW above.
Signature xe7u:d, ,, it �/ Date: 9-�71107
If accepted please sign and return.
CITY OF —
PUBLIC PROPERTY .
DEPARTUtNT
��. o. ,
MGvoa. 1 WASWNC[[YJS17uaT SAIIJA,�/\SSA 010
[7�:;9TbTiS 959Sa P976�49646
APPLICA 40O TOWTHE REP4,2 RENOVATION CONSTRUc"110-
DEMT QLITI014. OR':CHAN..GE�OF USE!OR.00CUPAPTC+ 10A ANC":EXIST UNG
�STRUCT[ERE.OR BUILDING
1'0 SITE INFORMATION
Location Name: _ 'ckmR�
�— - -
Property Addres . ; t-2 m�
'r Wty 4 boated in a;COitaarvetlon•Aree YM Hlstorlo OlstriCt 1FM . -
2 O OWNERSkil .1 FOR ],:
2A Owner of Land
-Name:
Address:
t) Q O
Telephone:
FA
MPLETE THt8 SECTIONTOR WORK IN RX1*11 'BUILDINGS=ONLY
n Existing
tion Number of Stories Renovated
.in Use New
,Demolition Existing:
Approximate-year of Area per}loor,(sf) Renovated
ction or renovation
ng buildingscription of Rroposed Work: I�K.r`k' �e; cs��ce cirR�� i �IM�
Mail Permit to: iob a raft✓ 02 t�lo.
I 00-35,000 cf enclosed space
'I (MGL CA 12 S.60L) -
1A-Masonry only
1G-182 Family Homes
! Failure to possess a current edition of the
}}}1 Massachusetts State Building Code
,I is Cause for revocation of this license.
�7
qq�
'f DIG SAFE CALL CENTER: (888)344-7233
7 '[Ooma�m4F**-rrz a .% XC✓ndE�
r BOARD OF BUILDING REGULATIONS
License CONSTRUCTION SUPERVISOR k
Number ES 063897
;- Birthdate 05/02/106z&yPr
Expires.,b5/02/2003' Tr.noi' 12Z07
1
Restricte6-00, �• •_
TIMOTHY J FINN °
8 UALDO D BOX G-
- STONEHAMAM, MA MA-02180, .
Commissioner f
a