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125 NORTH ST - BUILDING INSPECTION (3) Page 1 of 2 oT—e:� Jane Guy From: Jane Guy Sent: Wednesday, July 11, 2007 1:21 PM To: Thomas Stpierre Subject: FW: Garage demo Tom, Lynn and I have reviewed the application for demolition of the garage at 125 North Street and concur with you that the garage has no historical significance. I also ran this by the Vice Chair of the Historical Commission and her concurrence is below. Issuance of a demolition permit is appropriate. Jane Jane A. Guy Asst. Community Development Director City of Salem Department of Planning & Community Development 120 Washington Street Salem, MA 01970 u G (978) 745-5-9595, Ext. 5685 Fax: (978) 740-0404 jguy(a salem.com �/� �Ik- www.salem.com (� -----Original Message----- From: Jessica Herbert [mailto:Jherbert5@comcast.net] Sent: Wednesday, July 11, 2007 12:29 PM To: Jane Guy Subject: Re: Garage demo Hi Jane, I looked at the pictures of the garage, and it appears to be a non-distinct structure of no historic significance in my opinion. Regards, Jessica Jane Guy wrote: Since Hannah is away.... Attached are pictures of a garage at 125 North that the owner wants to demolish. According to the Demo Delay Ordinance, the building inspector can ask the City Planner and a representative of the Historical Commission if the garage has historical significance. If 2 out of 3 (building inspector, city planner, representative of HisCom) feel it is significant, it will go to the full HisCom for Demo Delay approval. If no significance, then the building inspector can allow demo to proceed. Tom and Lynn feel it has no significance, but would like your opinion. I think it is safe to allow demo without having to go to the full commission, do you? 7/11/2007 n � PUBLIC PROPERTY (978) 745-9595 EXT 385 120 WASHINGTON STREET 3RD FL SALEM, MA 01970 PUBLIC PROPERTY (978) 745-9595 EXT 385 120 WASHINGTON STREET 3RD FL SALEM, MA +� 01970 I ' nber , n Deliv sP, e Reference l Metho /Ternls end Department/Locatiort 4` PUBLIC PROPERTY Unit/at mm. _ ,a Cost Each rwi: `=z Extended Price=W 1.0 1950.00000 1,950. 00 Each )0 rot Zyt7� Sy LY�� �o Gatc lofoJog (�PpVS AD So 40 5 %v �'7 a PUBLIC PROPERTY (978)745-9595 EXT 385 120 WASHINGTON STREET 3RD FL SALEM, MA 01970 PUBLIC PROPERTY (978)745-9595 EXT 385 120 WASHINGTON STREET 3RD FL SALEM, MA • 01970 Deliver MethodfTerms ,m SM De artrnent(Location PUBLIC PROPERTY 'Cost Each w."i.`^sq "'q*M,Extended Pricetk—laui 1. 0 1950.00000 1, 950.00 Each 0 r EBERSOLE CONSTRUCTION LLC General Contractors � /1 C�2JC �A Andre Ebersole 10 Kittredge StreetBeverly i MA 0 915 i I ph 978.790.4095 —fax 978.927.7409t CITY OF SALEM PUBLIC PROPRERTY w r . DEPARTMENT XtIXII:iRITY URIsCOM MAYOR 12C WASHING ION S-rxeeT •SALEM,MASSACI ll.:%I I'll 01970 Tw:978-745-9595 ♦FAX:978-740•9546 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / / t Please Print Legibly Name(Busimxs/organizatiotdlndividual): �10�✓/S d�/ Vim^ 7 !� G Address: ( � ,//�� City/Stare/Zip 61 v t l Phone 2 '6 t2 9 iS Are von an employer!Check the appropriate box: Type of project(required): I„!R I am a employer with 1 4. ❑ I tun it general contractor and 1 6 ❑ New construction employees(full and/or part-time).` have hired the sub-contractors 7. ❑ Remodeling 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub-contractors have 8. demolition working for me in any capacity, workers' comp. insurance. 9, ❑ Building addition fNo workers' cum insurance 5. ❑ We are a corporation and its I P• 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work g P right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. LNo workers' 1311 Other comp. insurance required.] 'Any applicant that checks box lit must also fill out the section Whole showing their workeri cumpensatiou policy inturnution. t I Wmeuwrwrs who submit this affidavit indicating they are doing all work and then him outside coumctoro must submit a new affidavit indicating such. �Contmcwrs that check this box must aaached an additional sheet showing the name of file sub-contractors and their workers'comp.policy information. 1 nor an employer that is pro riding workers'compensation insurance fo•my employees. Below is the pu/icy and job site informutian. insurance Company Name:, Policy 4 or Self-ins. Lic. #:WCC 5C)0/'/G"� �/ S_Q.J_..�_Q6 2 Expiration Date: � I"(� 20 Job Site Address: I D-S /Uv- T"t ST- City/State/Zip: o= /�1 y]� a l � �6 Attach it copy of lite workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to SI,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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of I,vest iga tions of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true uml correct Sicnmure: o Datc 6 .1 —G "(09 [Fofficial ruse only. Do not write in this area,to be completed by city or town ofjicia/. rTown: .,.--__._--- Permit/Licenseg Authority (circle one): rd of Ilealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector er —_ Contact Person:---- Phone d: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an emplgree is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract foi the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pennit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under`Job Site Address" the applicant should write "all locutions in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any,questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/(Lia ----------------- CITY OF SALEM • t�` ; ' 1 PUBLIC PROPRERTY DEPARTMENT .,ACt.KI.rA!'Ki1CUl 1. \1A WK 120 W.\91IN1::0N S:BEET •SAL 0.1. NI[M.AW al >L l l]::97C T¢I:978.745-9595 #F.":978.74G9846 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CNIR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # _ is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by v1GL c 1 11, S 150A. The debris will be transported by: (11ame of hauler) I'he debris %illll-be disposed of in (name of PaciGty) l adilres+ lt ti�iLly) ,:ata ` pk sti 9 r I I yp¢ ` aate � - Rp I a ' 4 Xi ${ xk r r 9 wry l� t � 4 �a� •� 4 f e rA 9 M t rg v �f � I }h 1 Ar Y [ rtr 4 i ) .ter- "p1: _ ..�-- •-�. � 1 •�1 / � f i Y t+ 1 I t✓ f � rc, '�Yyq' A PUBLIC PROPERTY DEPARTMENT KIMP. WII DOS[W1 130 VI AUUNG+W billt6 0 SJV uu WSSACK LShrM 01970 TU.VW745-9M•FAX M740-96K APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: Building: - Property Adeesss 1 5 - Properly Is local l in a;Coneervatlon Area Y/N Historic Dlsirkt YIN_ed.l 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land ` Name: Address: Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTINQ BUILDINGS ONLY Addition WRenovated Renovation Number of Stories Change in Use Now Demolition � Approximate year of r rea per floor (sf) construction or renovation I v , of existing building o New Brief Description of Proposed Work: / /� ,I ! U Mail Permit to: to 7` -- 4 What is the current use of the Building? Material of Building? Wo�� o� if dwelling,how many un'ds? Will the Building Conform to Law? v Z-' 42 Asbestos? y o Architect's Name Address and Phone Mechanles Name Address and Phone ! G L� 9 C/ Construction Supervisors License# U$ G H- 5 Z C Registration# Estimated Cost of Project Permit Fee e Calculation Permit Fee$ 3o '� Estimated Cost X$7/$1000 Residential -- -- - ------ - - Estimated CostX$41/S1000 Commercial-------- An Additional $5.00 Is added as an Administrative charge. Make sure that all fields are properly 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 perjury Date 6 ' U' J 7 d y L � a y 2 ^ 0 S � ' s a� �-