2 NURSE WAY - BUILDING INSPECTION L
} r
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALENI
WE'
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number ' Date Applied
Official Pnnt Name
Signature.,
Date
Bu ddm g
g
SECTION li SITEINFORNtATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1 o{r a l �a�e u�A I `/'03AY-O
1.1 a Is this an accepted street? yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private ❑ Zone: _ Outside Flood Zone? Municipal don site disposal system ❑
Check if yes❑
SECTION 2 PROPERTY OWNERSHIP"
2.1 Ownert of Record:
ScFler, wc>mo. RiAAe rt , L-I—C- %�>o ucri4 MA 019t5
Name(Print) City, State,ZIP
k0b Ccti4JvV J�Z C¢ ��i�a� `too-as4q TeCT _ IFJII O�UnCI M�Qni tS. CoM
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF.PROPOSED WORK'(check all that apply)
New Construction lid Existing Building ❑ 1 Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work: wb�) 4or,, —
SECTION 4: ESTINUTED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only-,' .
Labor and Materials '
1. Building $ 1 Building PermitFee S Indicate how fee is determined:
77-77
?. Electrical S ❑ Standard Cityaowa e Application Fe
❑Total Project Cost.,(Item 6)x inultiplter x
3. Plumbing S 2. Other Fees: $
4. Mechanical (11VAC) S List:
5. Mechanical (Fire
Su ression) Total All Fees: S
Check No. Check Amount: Cash Amount:
6. 'l'otal Project Cost: S
000 0Paul in Full ❑ Outstanding Balance Duo:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) -7 _3LI 6 _ C I ;01
License Number B.epuatton Date
Name of CSL Iloldar
List CSL Type(see below)
S 0 J� or,
No. and Street ' Type -, Description
U Unrestricted(Buildings up to 35,000 cu. ft.)
Ua, R Restricted 1&2 Family Dwelling
City/Town, State,ZIP NI Nlasonr
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
?7�(�-)(00'�aa I Insulation
11e hone Email address U Demolition
5.2 Registered Hone Improvement Contractor(HIC)
HIC Registration Number Expiration Date
Ii1C Company Name or FIIC Registrant Name
No. and Street Email address
City/Town, State, ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L, e. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........N No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
[, as Owner of the subject property, hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) --- Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program can be found at
%eww.mass.eovioca Information on the Construction Supervisor License can be found at swww.mass.cu ;'dw
2. When substantial work is planned, provide the information below:
Total tloor area(sq. ft.)_ _(including garage, finished basement/attics, decks or porch)
Gross living area(sq. ft-) _ Habitable room count
Number of fireplaces_ Number of bedrooms - -
Number of bathrooms _ Number of half/baths
Type of heating system __- Number of decks/ porches
1'ypeofcoolingsyslem-- - --- Enclosed---_-----.Open --
3 -I_otal Project Syuare Footage" may be nubstitutcd r0i'" OMI Pro'lect Cwt"
iIiI - ' ) CERTIFICATE OF LIABILITY INSURANCE DATE 1/2013 Y
`,� •� ozrovzola
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endomement(s).
PRODUCER Phone: (978)744- 33 Fax: (978)744-3575 CONTACT Deb Tournas ✓
GERALD T MCCARTHY INSURANCE AGENCY, INC _PHONE'_EA
92 NORTH ST .IxG..ay..Enr (978)744-6433 (978)744-3575
P O BOX 839 DREss: deE MAIL bbiet@g[mccarthy.com
SALEM MA 01970 PRODUCER
sUszOmER D 537
INSURER(S) AFFORDING COVERAGE NAIC M
INSURED HOLLORAN DEVELOPMENT LLC INSURER :Acadia insurance Company
C/O JEFFREY HOLLORAN INSURERS
41 FAIRMOUNT STREET INSURER
SALEM MA 01970 -
INSURER D:
INSURER E
INSIIRERF
COVERAGES CERTIFICATE NUMBER: 22728 REVISION NUMBER:THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LIS'i ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH P IIJ SLIOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR ADD'L SUER POLICY EFF POLICY EXP
TYPE OF INSURANCE INSRWy0 POLICY NUMBER _ IMMIDOnTIYJ MMAe➢(YYYYL_ LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE To RENTED $
PR MI SIEaAxicav4eI _
CLAIMS-MADE OCCUR MED.EXP(Any one person) $
PERSONAL$ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $
POLICY PR�L�OC
_ _ $ _
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
BODILY INJURY(Per person) $
ALL OWNED AUTOS
BODILY INJURY(Per accident) $ ,
SCHEDULED AUTOS
PROPERTY DAMAGE
HIRED AUTOS (Per accident) $
NON-OWNED AUTOS $
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKERS 'COMPENSATION I WC2020001688 11/06/12 11/06113 WC srpru- oTH $
AND EMPLOYERS' LWBIUTY YIN
ANY PROPRIETOWPARTNERIEXECUTNE E.L.EACH ACCIDENT $ 100,000
OFFICERB4EMBER EXCLUDED? NIA
(Mandatory In NHl E.L.DISEASE-EA EMPLOYEE $ 100,000
Ityea.describeunder
DESCRIPTION OF OPERATIONS Ws. E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Anach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
93 WASHINGTON STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SALEM, MA 01970 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE �///
Attention: (`//`�`OR// /� Kah- Q-��/f'4_y
c . All ri-gHts reserved.
The ACORD name and logo are registered marks of ACORD
The ---
1
How
To Salem Building Inspectors:
gy,
Holleran Company has secured me as their HERS rater for building on Nurse Way and
suroundings as of 1/1/2013. e
I am currently processing the Projected HERS scores for these homes.
Thank you,,
Ian Rex
�_f
13
Ian Rex,Principal 978.233.1433
11 Broadway,Suite 3,Beverly,MA 01915
email:Ian@TheEnergyHound.com
www.TheEnergyHound.com
F,-..n Dorhinic Pezzulo
::-ub Fwd:Holloran Companies
31e January 31, 2013, 11:47 AM
ro Jeff Holloran
Sent from my Phone
Begin forwarded message:
From: 'T"e Energy -fcu,id\U lan Rex,Y'�
DaW �ao�ary 3`, 2Cil 3 29 18'M,�
I o:
Subject: RE:Holleran coilmlirvea
Ian Rex
Energy Efficiency Analyst & HERS Rater
978-578-1782
11 Broadway, #3, Beverly, MA 01915
The
MET,,, ,
This e-mail and any attachments are intended only for use by the addressee(s) named herein and may
contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail,
you are hereby notified that any dissemination, distribution or copying of this email, and any attachments
thereto, is prohibited. If you receive this email in error please immediately notify the sender and
permanently delete the original copy and any copy of any e-mail, and any printout thereof,
From: Dominic Pezzuio
Sent: Wednesday, January 30, 2013 1:40 PIO
To:
subject: ljollownCmpol
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Item/Cost Name 5 X.,permits $ 1,135-00 pull permits based on 145k=$1595. $11
city water and sewer hook up fee $ 250.00 - Per$1000+$5=1600
architechtect $ 1,000.00
engineering $ 2,000.00
windows $ 4,368.00
utility water and sewer
final grade rough loam
perimiter and basement stone
excavation,backfill,rough grade
excavate for foundation
tree clearing and stump removal
foundation $ 8,500.00
foundation coating $ 400.00
concreate floor $ 2,500.00
framing labor $ 9,000.00 81k usher
framing lumber $ 16,000.00
decks $ 1,500.00
trash removal $ 1,000.00
hvac $ 8,675.00
plumbing $ 9,175.00
pump sewer $ 3,500.00
bath vanitys and tops $ 1,000.00
water heater $ 650.00
fire place $ 1,400.00
fire place mantel $ 500.00
electrical $ 10,370.00
insulation $ 4,000.00
sheetrock $ 9,149.00
kitchen cabinets $ 2.500.00
finish floors $ 6,400.00 hard wood carpet vinyl
light fodures $ 500.00
trim and stock $ 3,000.00 doors trim stair parts
finish carpentry $ 3,000.00 install all doors,trim,kitchen and bath cabinets and vanitys and microwaves stairs
painting $ 2,400-00 -
appliances $ 2,500.00
cleaning $ 400.00
jiffy john $ 200.00
mailboxs $ 100.00
siding labor $ 3,500.00
siding $ 3,200.00 3200 labor tucci
roof $ 3,700-00 18.5 square
garage doors $ 2,000.00
countertop $ 2,300.00
landscape $ 3,000.00
drive way $ 2,500.00
misc labor $ 3,000.00
contingencies $ 4,728.00
$ 145,000.00
Subtotal Subtotal
Real Estate Taxes
Light/Electric
insurance
Total
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Board of Building Re4;Ul.rtiilr1ti arrtt ��.Ir►��.IE�h
Construction Supervisor License
a.
�r.Vti License: CS 76746
THOMAS J BRYAN "
84 SOUTH ST FLOOR #1
MEDFORD, MA 02155 z
Expiration: 5/14/2013
Tr#: 14491
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CITY OF SiU.E,)vI, l'L1SS:ICHLSETTS
3
BUILDING DEPARTJIE.NT
120 WASHINGTON STREET, 3iD FLOOR
TEL (978) 745-9595
FAX(978) 740-9844
KINIBFRT EY DRISCOI.L
�1 YOR T HOMAS ST.PmRm
DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CO\LL<IISSIONER
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Piumbers
Annlicant information Please Print Leeibly
N;iiiie(Busiiwss Orgtnizatiamindividual): Xn1�M H'O Mo rl�,, S L,LL
Address: mo cFook- 5} crp_t
City/State/Zip: �X oCr�� \ 0101 1 Phone hi: 9lR - 9U)_ - a5-y y
Are you an emplayer?Check the appropriate boxy 'type of project(required):
1.0 1 am a employer with 4. 0 1 am a general contractor and I
employees(Nil and/or part-time).• have hired the sub-contractoo 6. New construction
2.0 I airs a sole proprietor or partner. listed on the attached sheet t Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
workingfor me in an capacity. workers'comp. Insurance.
y P h 9. ❑Building addition
(No worker'comp.insurance 5. ❑ We are a corporation and is
required.) officers have exercised their
f 0.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.(No workers'comp. C. 152,$1(4),and we have no 12.0 Roof repairs
insurance required.)t employees.LNo workers'
comp.insurance rcquired.) I3.❑Other
;Any appllcum that clueka box rl mutt also ell uut the uctioo below rkowiny thew workers'compensation policy infurmatloo.
I hmuuwner who tulmtir this affidavit indicating they an doing all work and then him eatsideeantrat".mtel suland,a new allidavil indicating such
:Cunimtors that Ovek this box meet attached an additiut d eho t showing the nama of the rubcuntrnkus and their worker'enmp.policy infomnsnos,
l um an emplayer that is providing workers'compiurarfon/Jnrnra\nce for—myyeempluyeex Below Is the pollry and Job site
insurance C t o , M l I)A y Insurance Company Name:Sze� C 6.r
Policy 0 or Self-its. Lie. N: (7 WC a.Qn17 I E7 Expinrtion Data:` O(n
Job Site Address: LA a l s N s Y`SQ_ \6)cx!4 City/State/Zip: 54? nn i MA 01C1710
Attach a copy of the workers'compensation policy declaratlan page(showing the policy number and expiration data).
Failuret to securo coverage as required under Section VA of MGL c. 152 can lead to the imposition of criminal penalties of it
tine 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 line
of up to S250.00 a day against the violator. He advised that a copy of this statemunl may ba forwarded to the Oil tea of
Investigations of die DIA fur insurance coveraga veriliealion
/du/rerrby e•rrrify uudn rho puln.r mid pro des of perjury/flat the btfurntutlon provided!above is true and c orreeC
��sutlure. ��� ss7�r Date: c�! 1 I
Phone,* co S>Ari o3. '^ c.
U/)iriul use mdy. Ou not wrist in r/dr area;lobe completed by city ur town alliciud
City ar`ruavn: __.. _ PermitR.kc ae N j
Issulag Authorily(circlo one): - -----
1. Board of health 2. Building Department I.Cilytrown Clerk 4. Electrical inspector 5. Mouthing tuspector
b.Other
Contact I'crsnn: Phone it:
Lo 1 215--
3i
«r CITY OF SU1 EM A-1SSACHUSETTS
BUILONG DEP.�RTNIE.4T
�• TMla,t oy{: 130 VU.ASHLNGTON STREET, 3° FLOOR.
TEL (978) 735-9595
KIJiBERL EY DRISCOLL F•{-`t(978) 740-9846
,&LAYOR THO.%W ST.PIERRS
DmECTOR OF PU13LIC PROPERTY/1312MO 1G COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR 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 MGL c
111, S 150A.
The debris will be transported by:
(name of hauler
The debris will be disposed of in
(name of facility)
(address of facility
sign to dof permit appliean
ay t �
late
dcbris.il�d,x
ii
CITY OF SALEM
ROUTING SLIP
New Construction
Certificate of Occupancy c�
LOCATION o L1'a N✓ps4,`9 /DATE /3,113
ASSESSORS DATE
93 Washington St
CITY CLERK DATE
93 Washington St.
PUBLIC SERVICES104_('--_DATE ul G3
120 Washington St. ) 1
WATER �/ DATE 4C
120 Washington St.
CROSS CONNECTION DATE L� h/d
5 Jefferson Ave
PLANNING �� DATE Z 13
120 Washington St.
CONSERVATI N DATE
120 Washington St.
ELECTRICAL DATE
48 Lafayette St.
FIRE PREVENTION DATE
29 Fort Avenue
HEALTH DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.