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5 NURSERY ST - BUILDING INSPECTION (3) y I� a The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts Stale Building Code. 780 C'MR, T"edition OF SALF.M Revisrt/Junuu!v Building Permit Application To Construct,/Repair, Renovate Or Demolish a L :IRAY ( e)or Two-Fum' v Dwelling 'this Section for Official Use Only Building Permit Number: Date Applied: �f Signature: Building Cum issioned In4pc/tufoMdin#9 Date ON 1:SITE INFORMATION 1.1 Property Address 1.2 Assessors Map& Parcel Numbers NU r S e St s I.I a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use La Arm(sq 11) Frontage(11) 13 Building Setbacks(B) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.C.I,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: _ Outside Flood Zone? Check if es❑ Municipal eOn site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' rNcwConstruction Owner of ord: 1 4 C l,Prr l ne- S^ �rr P'S2�.r �� �A lc,.•v Address for Service: -64r - 3 y q - 4-1 2 R Ll Telephone SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition O Accessory Bldg. Number of Units I Other ❑ Specify: Brief Description of Proposed )York=: ` lc SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building S It, Q Ou I. Building Permit Fee: S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost(Item 6)x multiplier_ x 3. Plumbing S 2. Other Fees: S 4. Mechanical (tIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No._Check Amount: Cash Amount: 6. Total Project Cost: S 0 Paid in Full ❑Outstanding Balance Due: SECTION S: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expirallun DJIC Name of CSL- I IuIJ r I.isi CSL Type lsee below) r Description :W ss U Unrestricted u to 75.000 Cu.Ft. R Restricted Id2 FamilyDwellin S' ature M M Only — 7/,( RC I Residential Routing Covering fdvpinme WS Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installaliun D I Residential Demolition S. vemealCoatractor(HIC) IL1 �-6 ( �I S'('ruc I a - Registration Number g rant Name Q _ rX& _ V C( 1!r Expiration Date Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 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 ..........0 No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 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. - sigrusture of Owner Date ;— f�10ON 7b:OWNEW OR AUTHORIZED AGENT DECLARATION [be;hal ; xrla ,as Owner or Authorized Agent hereby declare eation on the foregoing application are true and accurate,to the best of my knowledge and iIlndAgent helties ofperjury) NOTES: pOwnerer who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor istered in the Home Improvement Contractor(HIC)Program), will W have access to the arbitration or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and ction Supervisor Licensing(CSL)can be found in 7R0 CMR Regulations 110.R6 and 110.RS•respectively. bstantial work is planned,provide the information below: area(Sq. Ft.) (including garage, finished basementlattics,decks or porch) 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 Type of cooling system Enclosed Open ). "Total Project Square Footage'may be substituted for"Total Project Cost" CITY OF SALEM . tr PUBLIC PROPRERTY ?, -r DEPARTMENT o �I�xre I4C WA@11N(LIONSTI(!LT • SAUNI,MASSACIIt-sr:Its0197.^ Tta.:77S•"15-9395 9 F.sx: 978.710:/846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 1 ylicant Information Please Print Levibly Naine lllucilHsslOrganiratinNlndivtduulC_ �d� �hA- Address: 02 City,Slale;/.ip c rr �f M q Phone"": R1<6 - 24L - 09 7-1 Are you an employer'.' Check the appropriate box: 'Type orproject(required): 1.El 1 mn a employer with 1•J 4. ElI am a general contractor and 1 6. 1 New construction enh Ili ces(full and/or art-time).` have hired the sub-contractors p y P" 7. ❑ Remodeling Ir- ' listed on the attached sheet t 2.lYl I ani a sole Proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. Insurance. 9• ❑ Building addition INo workers'comp. insurance 5. ❑ We are a corporation and its ME] Electrical repairs or additions required.] ot?Iccrs have exercised their right of exent tion per MGL 11.❑ Plumbing repairs or additions 3.❑ 1 um a homeowner doing all work � p p myself. [No workers' cinrlp. - C. 152, q 1(4),and we have no 12.❑ Rout'repaiirrs�[, insurance required.] t employees. LNo workers' 13.❑ Other J r`-0- comp. insurance required.] •Any:ghplicanl that chucks box ill must:dao till out the section butuw showing Iheir workers'compensusion pulicy inllanuriun ' I lomuuwra:n who submit this;,Mdavil indiunng they are doing all work and dien him outside coillusers must.ubmn a new al'fldavii indi"mg.rich. �C'omrwlo s char check this box most attach(d on additional xhcel showing rho nano of the subcontractors and their workesd comp.pulicy information. I ain lilt employer that is providing workers'c•ornpensadon insaraitee for illy employees. Below is the pu/icy ant/job rite inf rrmatian. Insurance Company Name: --...__ Policy N or Self-ins. Lie.ti: . .. ._.__ Expiration Date: Job Site Address: Cityislate/Zip: .\ttach It copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1.500,00 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 it day against the violator. lie advised that a copy of this statement may be Ilimarded to the 0111ce of Invrsogaoons ul'thc DIA for insur:u:cc coverage ccrilicaliun. /do herchy certify trader1lie paiics r td Bel n ties of perjury that rite information provided above is true and correct. Sir:,atitrd: _ Date. 9. 9 re Ojlicial use only. Do mar mite in this area,to be completed by city or rorvn official. City or Towns Issuing Aulhorily (circle one): 1. Board of Ilvalth 2. Ruiidim' Dcpartincut 3. Cilyi riviln Clerk 4. Liectricnl Inspector 5. Plumbing Inspector 6.01 her Coutact Person; ._ . .__. Phone q: r , Information and Instructions .V assachosetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee 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 t0regoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,piumership,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 for the performance of public work until acceptable evidence of compliance w ith 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) namc(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 sigh and dale 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 question 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 OMelaIs 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 pennit/license number which will be used as a reference number. in addition,an applicant that must submit multiple pennitflicerse 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 locations 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 chat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled 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. I he Odice of Investigations would like to thank you in advance fur your Cooperation and should you have any questions, please do nut hesitate to give us a call. The Dcparunent's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of Investigations 600 Washington Street Boston, MA 02111 Tel, la 617-727-4900 ext 406 or 1-877-MASSAFE xcviscd 5-26-05 Fax 11617-727-7749 www.mass.gov/dia CITY OF SALEM S { PUBLIC PROPRERTY DEPARTMENT .I'r Construction Debris Disposal Affidavit (rcyuired lbr all demolition and 1'cnoYatltln work) In accordance ill, the sixth edition of the State Building Code, 7S0 CMR section 11 L5 Dcbtis, and the provisions of:.viGL c 40, S 54; Building Permit h is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as detined by MGL c I t 1. S 150A. the debris will be transported by: Jam. T.,__La_ I nantc of hauler) I lie debris will be disposed of in (namr of lacully) IuJdress ul'1]cllity) enolurc of pi nni , ppl can !0 l�a(e MA- PLEASE READ THROUGH ENTIRELY just sheds inc. THESE PLANS ALLOW YOU TO BUILD ON A CONCRETE SLAB,A WOODEN FLOOR www.just-shods.com SUPPORTED BY CONCRETE PIERS,OR A WOODEN FLOOR SUPPORTED ON SKIDS SEE OUR FREE ON I LINE CONSTRUCTION GUIDE FOR MORE DETAILS / � J rm II a LEFT SIDE 8'-2' WALL AND FLOOR HEIGHT 8'-8" FRONT 10'-2" I ' RIGHT SIDE WALL AND FLOOR HEIGHT 6'-0" BACK 10'-2" CONTENTS PAGE 1 ELEVATIONS PAGE 2 CROSS SECTION 1 PAGE 3 FLOOR PLAN ELEVATIONS SOME E-MAIL SOFTWARE MAY PAGE 4 -EANGRE+E-PAB— SCALE CHANGE SCALES SLIGHTLY PAGE 5 SKID FOUNDATION /°=1'-0" PAGE 6 CROSS SECTION 2 DRAWN PAGE 7 LEFT WALL DETAILS JUNE 2005 PAGE 8 RIGHT WALL DETAILS SIZE PAGE 9 FRONT WALL DETAILS 1 O'XH' THESE PLANS ARE FOR PAGE 10 BACK WALL DETAILS PERSONAL USE ONLY PAGE 11 RAFTER PLACEMENT PLAN PAGE 12 RAFTER CUTTING FREE © 2002 Just Sheds Inc. PAGE 13 SPECIFICATIONS All rights reserved PAGE 14 MATERIAL LIST PLUS 2 TEMPLATES 1 � r � r v gLy G A Vic !s r *Propoo 1 Page No. of Pages Leo and ,John Lee Belanger John Tanzella 24 Mechanic street 29 Eastern Ave. Beverly, MA 01915. Beverly, MA 01915 978- 578-2992 . 978-766-0929 PROPOSAL SUBMITTED TO PHONE DATE Lee 08-. - STREET - JOB NAME 5 Nurse y street- CITY,STATE AND ZIP CODE JOB LOCATION Salem Ma ARCHITECT - DATE OF PLANS JOB PHONE We hereby submit specifications and estimates tor. To build a 10'x10' free standing, ground level deck (railings not required). Built using presure treated 2"x8"joist stock and Latitudes gray solid decking........................$ 1800.00 To build an 8'x8' shed as discussed would cost.....................................................$1600.00 Both structures to be placed on block material for future movement. Procurement of building permit included, fees extra. WC TWOPOBe hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of Three thousand four hundred dollars(s 3400.00 Payment to be made as follows: All material is guaranteed to be specified. All work to be completed in a Authorized workmanlike manner according to standard practices. Any afleration or Signature deviation from above specifications involving extra costs wilt be executed g Qnty upon written orders,and will became an extra charoe over the estimate. l agreements contingent upon strikes, accidents or delays beyond our Note:This proposal may be ntrol. Owner to carry fire, tornado and other necessary insurance. Our whhdravm by us if not accepted withinayorkers are fully covered by Workman's Compensation Insurance. �t t r ZAcceptance o1 'PrOPOSal —The above prices, Signature` — specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature M ' ♦la\�,achuxCW- Department of Public Safct+ R Boairil of Buildinw Rt!ufatiturs and Standards Construction Supervisor LlCense License: CS 86937 _ „ 1 Restricted to: 00 1 pr i 1 JOHN V TANZELLA 29 EASTERN AVE BEVERLY, MA01g15 Expmafr , Z B12011 i atwnh+i+uwrr Trtt: 12406 Office of Consumer Arrxir.A Busine>r Nrx ulxdoir License or registration valid for indix'idul use only 5, &ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: E Office of Consumer Affairs and Rusiness Regulation egistrahon: 1480t9 Ill Park Plata -Suite 5170 Expiration: 824f2Ot t Tell 287374 112116 Typo: OBA TNNE ILA CONSTRUCTION JOHN TAN2ELlA 29 EASTERN AVE BEVERLY, MA 07918 .1 ndrrxrrr'an Vol ,.InI sCithuu si.mtWrev J. J