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6D NIMITZ WAY - BUILDING INSPECTION what wths current use'athe Building? Material o(Building? `l'a J, If dwelling,how many units? WiU,the BuAding^C d' onform to.L,aw?` Asbestos? Archites Name ss Addre and Phone. Mechanic's Nams .M. n•, O Address and'ehon• a S3 Qm (`(1(� o2t$:o , �1.-6b S 4�i Construction:'SupervisorsUcense'#; C���O � HICRegf§traitionil Esdmated'Cost of Project S a Pertnit:FerCala latioe Permit Fea i€� Estimated Cost X S741000 Residential _ An Add!tional'S5 001s=added as any - Adrhinistradve;=bhar9e. Make sure that all fields are.propery and'legibly written to avoidde14ys7lnprocessing. The undersigned does hereby:apply for wBuildinglDennitAd build-W the above stated, specifications. Slgned'under penally of perjury "Date S` 7P-7 of 04 - N 4 \ � T F , •� a C7 � �' Crry OF SALEM PUBLIC pItOPEM DEPARIUE T Construction Debris Dlspad Aflldavit . (ngµi�.l ibraxdimltdos,olneorsdor� Ts s000sdea wide dw sbub adWos aldM ft*SWI ta=Codk 70 CUR acda 1t1.! Debds,aid drp wAskmeofUM44%S.% gUa ft pM=h Is Is tsssad W%dM amd"dMt dw M&n dit&a tMa matt dMs bG dual otbt•peopsb SOMM draw dl9"s a f s defied by tit.s I u.s tsar. ZMd&&Millb4trwVft adbF C,Ol,*j�an '�eb�A-q wan abs" TM ddxW win be disposal od to: A, m l•�s� ' M f+wwaotpm*.0016 CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT ttatarat,ar auscott, MAYM tM WARO crootSUM a SAUK MASSAM serrso1970 TEL 978.745-9595 #Fext 9M740.984 Workers' Compensation Insurance Affidavit: Bu(iden/CoutnetonMectr(danyphlmbera AnQiicant Information s� Pie hint a � Name(Businew/omm sdowindivi&w): ( `ns`�rOZ6, Sp2G?ca� Address: �� C b3 cityistatuzip:_ �%reeA\al�cl Phone#: FINO ne u tmpbyar?Check the appropriate boss Iamaemployerwith 4. 0 I am a general contractorandIFRenw&IjnS �O�d1:employees(!fill and/or partdime).• have hind the wbcontrack nuction I am a sole proprietor or parmes,. listed on the aaacbcd ship and have no employees These sheettrking for me in c have wo any opacity. wasters•comp.insurance.worker'comp.insurance 5. 0 We am a carpmatim and its gadition R4 ] eae oEkan have ocised their 10.13 Electrical repairs or addkiona 3.0m a homeowner doing all work right of mtempson Per MGL 11.0 Plumbing myselL(No worker'comp, c. 152.41(4),and we have no �of addit(oor insurance required.]t employees.(No worketar 12.0 Roof re sin r comp.insurance requitod] 13.©'Ot6 C� r�4�6 ;Any applivau that cbaeks bat el moat also a0 atr tb aeetbm below 1— t ltaataoatm w4ta aubeb ub.nkbvk ibay sag�.ak� ekeseodda, �y rCaetraeews that c6aek tbb boa moat anaebed m add( and bat abm*do onto•s<& maeaeten atrt""a awr attldwk 6tdkatlea sari absaaoactga add ate Warkta•camp Paiq blhrma" lam an enaployp that tr provlding trorhersa eowptnsadon h+taronee jar my ew lerjorwatlosa I p/ayea Below b thepalley aad jab sJ& Insurance Company Name: Policy#or Self-ins.Lis Ca 1 b (o a(o (o O Expiration Date: b Si O 7 Job Site Address (o i M"` Z Attach a copy of tha works ra•com twtloa City/Statd2 ip;_S�`UM �m (� (�(Z D Pe Policy declarades page(showing the pulley number and explrades dab). Failure to seeun coverage as required under Section 23A of MGL e. 152 can lad to the imposition of criminal penalties ola Fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statemem may be forwarded m the ORDER a Investigations of the DIA for insurance coverage verification !do hereby eadj&under the pa/M!Ndplauafthx a jParl , Ice dw At joraeadon provided above 4"a and conecd �IYdlllure: r , r� <- I a Phone#: "0 Ofjl W rase o`s1A Of not write be this area,to be cowpkW by c4 or/ows oalelaL City or Town: PermiNLiceasa# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.Cityfrowa Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person Phone#: 1 r 66-35,000 cf enclosed space ( I (MGL CA 12 S.50L) 1A-Masonry only IG-1 8 2 Family Homes .) Failure to possess a current edition of the I Massachusetts State Building Code is cause for revocation of this license. f a ' ;-.. DIG SAFE CALL CENTER: (888)344-7233 - _ y;_ BOARD OFBUILDIN6+REGULATIONS) License: CONSTRUCTION SUPERV#SOR Number CS 053897 OaRestricte Birthdate 05/02/196Expires 05/02/2007 Tr. not 12207d• 00 +� _ TIMOTHYJ FINN 8 UALOORA DR/PO BOX 53 STONEHAM, MA 02180.1 .f• Commissioner 05/02/07 11:29 FAX 800 222 4306 CONVERSE ACCT MGMT WJ UUz PROPOSAL CONSTRUCTION SPECIALTIES UNLTD., INC.. P.O. BOX 53 STONEHAM,MA 02180 Phone (781) 665-4410 Fax(781) 665-441 t LEN NOX BROAZN-NUTONE HEARTH PRODUCTS April NOR COMPANY Bianca Squitieri 6D Nimitz Way Salem,MA 01970 Re;.6D_Nimitz Way . 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 Optional.Stone Surround and Paint Grade Mantel 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 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. Authorized Signature NOTE : All plumbing hook-ups, carpentry work& building permits are tie responsibility of the job site general contractor or homeowner. Prices are effective fa.-up to 3 months from date of proposal. Acceptance of Proposal T � Priwb�P�mdmu and�l/ w utu ory wd ve baeby easpted YW ve wmorixed�0&the weeY u p.Wa P.Mm[ U be vude a owk d ebova Signature—��2� fi Date: S Z 2007 If cce please sign and return. EI`1'�OFgXLE -- PUBLIC PROPERTY DEPr1RT�IE►4T KI%MERLEY ORMAXi. MAYOR 130 Wwunanw SIRF=*JALEJ/,X&\S.1f3R5hl13 01970 TEL 972-745-95"9 FAX 976740-95" APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION e- Location Name: O ;mi+Z Building: Property-Address•-- i — - ---- --- - Property Is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.t Owner of Land d Name: Vmqca t-y-rL Address: _�aleu� VY1Pr. o1q�� Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN FYICTtuc: BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use Now Demolition Existing Approximate year of Area per floor (so Renovated construction or renovation of existing building I New Brief Description of Proposed Work: C�PSe{�os�� Mail Permit to: 1,to 6 1✓e)c-on•� }m D Z I L o What is the current use of the Building? Material of Building? if dwelling.how many units? Will the Building Conform to Law? Asbestos? Archited's Name Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost of Projed$ Permit Fee Calculation Permit Fee$ Estimated Cost X$7/$1000 Residential - — -- - - - ---- Estimated-Cost X$11 11$IOW Commercia.' An Additional$5.00 is added as an Administrative charge. Make sure that all fields are property and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of penury /- Date 5 C � N 1_ 3 i�Mt 1