0 N PINE ST - BUILDING INSPECTION pL-ANSjM *T-gEftL-f. M APPROVED BY T44E
juspunm p.WR TD.A.PEjBMIT WNG GRANTED
CITY OF SALEM
No. �� ' Date 2,7
is
Is Property Located in Location of
Ow Hlstodc Dletdd? Yes No_ Building b -444 W,rot ST
is Proparty Located in
ow Cansenrtllan Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
Siding, Construct Deck, Shed, Pool,
Install ,
I 9
(Circle whichever appy) (gmpf.^
Repair/Replace Other-
PLEASE
therPLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name C a twwr-
Address & Phone O Nd>~jvA Vlo r- '5 -740 a2 3 4
Architect's Name
Address & Phone f
Mechanics Name
Address & Phone 1
what is the pwpoee d buildbq? IZ> 5
Mals"d buldrq? N a dweWng,for how many lams? OtJG
WW bukkV conform to law? YjiS Asbestos? /JD
Estlmated cod `L j Gd,J cay ucer"r N P` state user"a �3(nZCo
Barge Loprovanant
Li`. if Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
-FGACr;Z 5AR,�J rbaRr� Gil rRcN7L of gc'L,5.P-
�GDL�'C- KRon�� 1�ov2
MAIL PERMIT TO: D C�C
•t
No. Z —O
APPLICATION FOR
PERWr TO
LOCATION
PERMIT GRANTED
/
07. 2.006
APPROVED
ECTOR OF BOILDINGS
t
•1
1
I�
1
ROBERT S. SMITH 12 9'6 F'O
151 Bellevue Road
Lynn, MA 01904
(� (781) 581-5001
PROPOSAL SUBMITTED,TO PHONE DATE
9-78 Sao 923 { -
STREET JOBNAME
CITY,STATE and ZIP CODE JOB LOCATION
54t-rn
ARCHITECT - DATE Of PLANS JOB PHONE
We hereby submit specifications and estimates for.
U(7o2- AAjD 511 S YYA Ill T2►nn
7) fZf 105T A L,L ov'TSLVF, —, V-WK
cA%t
We Propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
6-,r; •("d%AA .lT7 ot,4 H j O U N A,� X�" / f dollars($
Payment to be made as follows: '
atbg. S 1x A:r i1+r.F of av3 slra a-: M17 xy-
CCc�-.Yi�FY�G.J
All material is guaranteed to be as specified. All work to be completed in a workmanlike authorized
manner according to standard practices. Any alteration or deviation from above specifications Signature
involving extra costs will be executed only upon written orders, and will become an extra g
charge over and above the estimate. All agreements contingent upon strikes, accidents or
delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our Note:This proposal may be
workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days.
Acceptance of Proposal —The above prices,specifications
and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature
work as specified.Payment will be made as outlined above.
Date of Acceptance: 'tI �� Signature ,
®11-804225-8388
} _1
m 0
Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT.311 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District, as per the requirements set
forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance.
District: McIntire
Address of Property: Tern North Pine Street
Name of Record Owner: Corinne Geary
Description of Work Proposed:
Replacement of entry door (not carriage door) with Brosco F-7132,painted Essex Green.
Dated: April 6, 2006 SALE STORICAL COMMISSION
C/
By: � ?
The homeowner has the option not to commence the work(unless it relates to resolving an/outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals)prior to commencing work.
I
ROBERT S. SMITH
151 Bellevue Road
Lynn, MA 01904
0j. (781) 581.5001
']8i1 25'K 810`{
PROPOSAL SUBMnTED PHONE DATE
cots- � TO ,,;'' 2 9'78 '14o 9Z3y 1
STREET .-.. JOB NAME _
0 Nom I REYI,PfiE (;k bE SAZ►J V00
CITY.STATE and ZIP CODE._ _ - JOB LOCATION _ -
S w SAVYZE X5 SFT
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
RER CCOC, I IAL.56: GA¢rJ 9o025 Nu tNJCLu7F `
2.�fLIbVF orb �oo12S — �-.A�Itin��-j 4JEft,lfr,�G_5
Urn,) Ucxy2g 'tv LJISU t 7
1 XCo r�U1J 1x8 �itiJF �Z
158 P12.ti59ve.F ��.E/iTE-b wY��
�� G.�S�a wt,L�t� r3 A t]�U F rL o,�t r xPrJS F�L'7 1-4ocJs E
lam/ fLEnnloyr T2�4S1rh
- �cE ASF t�oT l���r c��7E 4Rl�Si IsJh CO A7 oN-t 1200&5
We PfOPOSe hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
FIJIfjf? oc_jfyMRJ- UfNI AN-eb �* �Gv dollars($ cii,50-.^ ).
Payment to be made as f cos:
mol/! R�iD^� Ar Cempic.61-foJ of �a1;;
y
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications Authorized
involving extra costs will be executed only upon written orders, and will become an extra Signature
charge over and above the estimate. All agreements contingent upon strikes, accidents or
delays beyond our conlrol. Owner to carry tire, tomado and other necessary insurance. Our Note:This proposal may be
workers are fully covered by Workman's Compensation Insurenco. withdrawn by us if not accepted within days.
Acceptance of Proposal _The above prices,specifications
and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature
work as specified.Payment yAj
� , 'X
b�e�made as outlined above.
L^'
Date of Acceptance: Pt4'X' Signature
® To Reorder Cel
7-800.2258380
a e
r
r
CERTIFICATE OF NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other Work
as described below does not involve an exterior architectural feature or involves a feature covered by the
exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic
Districts Ordinance.
District:_ McIntire
Address of Property: 0 North Pine Street
Name of Record Owner: Corinne Geary
Description of Work Proposed: .,
Repair/replace barn doors to replicate existing. No changes in color, mA!rial, design. location or ounrard
appearance. Non-applicable due to being in kind maintenance/replacement.
Dated: January 11, 2006 SALEM AL COMMISSION
By:
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals)prior to commencing work.
no COMmOmPu th ojhfilssoehusdb
Deporbnewl offmNsW Aceldenb
Offla Ofd"
6"wahine"sired
Bostow,MA 92111
WWIRMOS j WAN
Workers'Compensadon I mmee AfWavit: Bu&krs/Contractor&Uecbi is w?kmbers
ADD11CM t Infgj MU&N Please Print Leal
Name �L aa3 FrLY S rwti nn Cor si'
r
AdtinsLo VC;-1 t�-t-Gjz- yuF_ Zoh7�
tity/Std&7* em 90 Ph= 7.5'
Are you s•t er!C tkf ipproptiata boas' Type o fpro1ed Vie:
1.p I am a employer with s p I am a smug as usdor and I 6. ❑New oomsksedon
m4baa hD od/ar �eie}a >tava>tied ms saliaeaes�io<t
2.0 I am aYsob(1pmpriselor o<ppaattnma� lined ON do&U shed sheet t 7. p Remodeelhig
ship and havem employee lheae bxw S. p Demolition
wothift 4 me is esOt capaci4ll. ►'�' .: 9. q Bm7dbg addmon
( •comp hwa� 5. p We nee&oosppratr�i and he .
lap a
reaEbcpialrwh or additions
oJlioa�*6ese thea
3.0 I am a homeowww'doing an wak T*of petrmazz 11.Q P1tmMng rgah at additions
myself(No westop'.comp x132,41(, a> i�ehsve'no 12.QRcoftepaur
raluke"t, .
0° CMVL 13.0 Omer
•,►ny 4�ppdea roe aecbboa it md.i.o fie oy{4e.eisia.edov�o�vS�Aekw�e m�m.ao.yolk?ioa�imNor
tttoo==vttoww*gdi Sdsvita11 11 doing4waitadAmoaddraaaoeeotaatottaladt•new offAvititdf nA
tCaaat�nAatdactAbbea'un�ateahad add,danaiand dowing oam"= ad&*sv&='coop toftfaftwi udos
ens eoeesplo wda teptwriAws tno *="compse ddON 6ttwswe+ ffr my eil� Bdow h ewpe fy endJob afte
hOww"
Insurance Ccmpayxam«
Policy N or Self-ins.Lic S Expftadon Date:
Job Site Addtrasy/Smip;
Attack a copy of the workers'compensation policy deciarwing pope(showing the policy number and esplration date).
Failure to ascots osvera�ti as regoQed tecta Section 25A ofMGL a 152 can lad b the imposition ofaitual penalties of a
ffoe up to f 1,50QOo and/or one-year finprisonment,s well a civil penalties in me foam of a STOP WORK ORDER and a tine
ofup io$250.00 a dry against the viohtswr. Be advised that a copy ofma statement may be forwarded to the Of&c of
hsvesdgem of me DIA for insurance coverage verification.
I do hd reby eve WAAWIJ"p4w eaJpeneWa 000*7 that flit bfannwkx provikd above h aw and carreca
Sirnataee< S C '�' / D L4 'bc4 'o&
Phone 0. "1 I ZS N
QQlctel tare oelp Di ad tvrlft h!lilt arae,d br coarptdtd bl'ct�at7ntw oalrtei
City or Towne PermWLloesse N
leasing Authority(drde one)!
1.Board of Health L Building Department 3.Cityfrows Clerk 4.Eketrleai Inspector 3.Plumbing Inspector
IL Other
Contact remont phone tit
Information and Instructions
. . _,.: ,anon for
yl General LA" 152 reg11ires all empioyauP !�0 of hirq
putauat to m;,abtnl0.� s defined as ..-every Daaon _.
CVM of implied,and or writlea
sandshoes.Capon AMC"dr legal miry,at nary two or more
An mplo w is defined as"aa iodivid11al,partaashiP. s decated eatpleYer4 a 00
ertPW to a jO eawpsiss,send ittchtdutg tits legal r mph ,g tLe
of as forego og modatins or other legal crafty,eMbYini
reoeiva of ittuma o a mi ��spartmenex and wM resides&a�eb6 or the ooar�t OM#
owner of a dwelling COO tion a repair war#on such dwefifai hence
dwepuog bourn of sawha who employs P�aa t0 do mom.of"� eat
bymbe deemed b an be emPloya:"
err on the Wouada a btaft aPPawam thaeb:haB motbocaase
ds 2SCM alae sbta tits aeq state er Wead geeadq ageae7 shad withhold the lassamm or
MGL chaPbr 4 opgrate a badam a to eosstre t bdWbW V the commoswCd&for acs»
renewal d a lteeaee or p�aeeeWahle adem alb with the worm"nova lies requi L"aha6
Applicant whe has sat P
AM*Dsfiy,MGL dopier JSZ 123C(7)states"Netdter the ao>®aonaaltlt tta asy utile polidal
cow into any mwety for the paftmana ofpnblie weds 111111 acceptable evidesxe of Cosrpfitmce w&the ben aace
regttiremaus of thio chapter bsve bees prese11md a the Coathaoting aptlhooq►."
ApplicantsRema that VPIY*Yen am sdoa and. f
Place SU o the workers' affidava Comply,by chal®g wig their eadficaods)of
neccum,jvpIY sub co �)20*4 addras(es)aa¢ltd acmtlerG)alaaf with m tasplWM
insurance. Limited LWnl r Car"M(LLC)or I.ended Lift Putoatb1Pa(1.LP) other the the
An not required b cart weike 'cutin knot H m ILC or LI2 dna have
aappOa W M required. Be advised that fhb affidavit maY be aabntitted to the DePartmmt of Industrial
caVloycM Accidents fm oaniirmat+ns of iatarance coverage. Aha hit.in"to d>p asd date the affi ISITL the affidavit should
DVartmentof
be rets mod m the City or towa that the application for the permit a liaoee a being mgaested.sot�a
ledasniai ACcideda, Shgaid you have am gaati6s regarding the law a if yon are requited to obtain.a woll[Cle
,,ft plgm caII the DapoWW at me mamba lW bcl'' Self- companies should arta their
selfri11amaaee ticra+e 6umba on the MPMELM fines
City or Tows Offfetalit
complete and printed legibly. The Depamtea herr Domed a space at the bottom
Please be sine dug the affidavit it Come
of the affidavit for You m 0 oat m the sem the Office of Itnresused as has reference contact boa regarding the applicant
please be nae to fill in the permtt/Hceme number w�will be used as n Only s number. In.addition,i as aPP�
that mut submit multiple p applicadees in any given Yah mend only submit one affidavit indicating current
policy iefiotmanon(if meCMWY)and under"Job Site Address"the sppHcW sb writs"all bcadons is—(City or
town)"A dcPY of1hE affidavit gist has bets official>y abmPN by.. . lot tows may be provided to the
aDPfi s proof that a valid affidavit is on.Rtes for Ame Permits Of licensesA nervi affidavit mNtM titled oo<each
err.Where a barns owner m ci&m is obbiabg a Beene a Permit not related m nary busing"a commercial venture
(in.a dog Seems of patent to baro leaves ere.)said pasoa it NOT required 10 ComPkie this affidavit.
The Offioe of Investigations would low to thank you m advance for your cooperation and should you bave any questions,
please do not belt W to give nes a c21L .
The Dcpmuncnt's address,telepbow and fu numbs.
The CommoaweaM of Massachusetts
Department of Industrial Accidents
Ogee of Invesdadow
600 Washington Sued
BmWv6 MA 02111
TeL #617-7274900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26.05 www.mm.gov/dia
CITY OF SALEM9 MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASNINGTON STREET. 3R0 FLOOR
SALEM. MASSACNUSETTS 01970
STANLEY J. USOVICZ, in. TELEPHONE: 978.740-9599 EXT. 380
MAVOS FAX: 978-7409848
Salem Building DeprW of
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in aPmP�1 licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
LyraN
(Location of Facility)
Signature of Applicant
4-i�-OCv
Date