51 OCEAN AVE - BUILDING INSPECTION .a
-the Commonwealth of Massach setts
i I Department of Public Safety
1 S •• j ..\Lun,lchu,vtls Stdfr flu ildin7;CoJc(7811 ..\II
Building Permit Application for any Building other than a t wo-Family Dwelling
(I his Set tion For Offir ial Use Ooly)
Iluildinl;Permit Number: - Date:\pplied: .7 /_Z_ 0udding Official:
SGCnON 1: LOC A I ION (Please indicate Block N and Lot p for locations for which a,trcet• ress is not available) —
S�_-�.C�ti(''(___�t)Zr Sa,�wl Y�� C71S70
,im Slmrt City ;town Zip Gnlc ;Vantc of Iluildinl;(if applicable)
3EC1'ION 2:1'ROI'OSED WORK
Fdilion of.\IA Sfaly Code used _-. ..-. If New Construrlion rhvck here❑or chcck all that a411111' in the two rows Nelow
I%%sling Building 13 Repair Cl :\Itcnllion Addition Dcmolilion ❑ (Please fill outand:ubmit Appendix l)
Clwon vof C'se ❑ Change of Oceup,lnry ❑ Ofhur ❑ SpecifYl
Are building pIdIIS and/or runst rut:tit n dtku men is being supplied Is part of this permit application? Ycs ❑ No p/ - ---
Is un Independent Structural Enginecriug Peer RC w cyuired? (� ` - v O Nu
Urivf Description of I'm,1)eed Work: 1t C.� H �"VCJ'� v,)C-k_\ • )vs --
ftv\O s/c,�V O 1 ---- — —
SECTION J:COMPLETE THIS SL'CI-ION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Chvck here if an Existing Building Investigation and Evaluation is enclosed (Sue 780 C\IR.\l) ❑
r.\uling Use Group(s): M
ProposedUseGramp(s):SECTION 4:BHT AND AREA
Existing PEd
loStorIeccls)hArca(sy. ft.)anal romi Height(ft.)tiECPION is USk as a licable)\: :\ssem,ly:\-I ❑ A-_'❑ Ni7;h lclub p A-1 ❑ U: Uusiness ❑ E: Educatinnal
10 Facto F•I ❑ F_'❑ fl: Ili hflazard 11•1 ❑ H-20 1h1 ❑ 11-4❑ 11-30
I: Institutional 1-1 ❑ 1-2 O 1-3 p 1-4❑ \I: Mercantile❑ R: Residential R-Ip R 2❑ R-1 R_a p
S: .Sturage S•1 ❑ S-2❑ U: Utility O Special Use❑and +lease describe below:
Spai.tl C'sc
SECTION 6:CONS 1'RUCrtoN INVE((-heck,is a liable)
1Aa Ilia 11,\ ❑ Hli0 IIIAp IIIIf ❑ IV ❑ VA13 \'B ❑
SECTION 7: SITE INFORNIAI ION(refer to 7,Yti C.\IR 111.0 Farr details nil each item)
\Va Rv Suppl IluuJ Lune hdornmtiultc Sewage Disposal: trench Permit: 17cbris Removal: ---
Public Chnk it nutvde Plrnvl Lone❑ Indiaale nnmiaip.d f3� \ Imnvh trJJII Ilot ba Liransrd n,al�ih•❑
PmmvC I „r indenhlP /i�nr or on ,rtc+\dru, ❑ n•yuinvl H1�r lrooclt Or,pecdt'
prrnut i,rn,In,rJ ❑
1(ailm I I right-ufwy; Ifaiardc to.\ir .\lw igation:
PI I, 'Irm hlry nithin.n N'rptvr.y +math .lrca' I Ic lhrlr rceir,e,rngdelrJ'
v'C •i nrn l 6'III I dd r Ill In,rd ❑ lr,0 „r o tl� ),.,❑ V. Cl
�IIU.V 9: ON IE:.VT()F t'f It Llll(':\LG 1)E t A'CL'1'.\N'CY
( I .1,n„n,�I l• dv (, l.nnlq,) Itl•, , I lvl,nu,llrm. t0ul•.wtl .id
I,•,r, Ihr Dwldw Il.un .m� rmAlrr tic.IrN'
ION '): PROVER I Y("IN I,jt ,\u 11 JOI(IZ,%I[ON
\..... Ooncr
r,�..ne-(Pr I I It) -No and Street City/ rowt I V
Proporl), Owner C onta,I lolornmiton:
C-11hul addres,4
(business) (elephant Nil (cell)
I i1lL 1'ejel,thone No. (bus
It Ipplicablv, the propett), owner hervIii-authorizes
Street Address city/ rowo state zip
Name ilit applic'Itiol,
on tht-Inoperly owner's behalf, in all matters this buildingLem
SECTION 10;CONS I ICUL I IUN CON'I HUL(1']eJSC rill out Appendix 1)
If of VoCjo.jed jV,jCC and/of 11011 U011Vf Construction celitrol then check here(3,111d NkillSection In 11
,(),I Registered professional Res ponsible far Construction Control
91 9�
RAttr ILIV4
Nome I-vie No. V-mail address
(Registrant)
_,Z�2S2�&
64A t,"Z -xpirati6n Mite
A — Stale Zip Discipline
titrrct Addrvss �:Ily/Town
10.2 General Contractor
- NL2?q Oe&l�
Cot 1111y N.1111C.
1�9' VzAn� Nug
Name of Person Responsible for Construction License No. and type it Applicable
,;Ircet Address l City Town Zip
-0—nj State
., Telephone No. cell), C1miladdre4s
rely ,hone No businessSECTION 11:IN � s I '<- I k',1 - I ' I I ' . I I M.G.L.c 151125 C(6))
must be completed ',;it
—Workers'ConIPCIISM1011 Insurance Affidavit from the'NIA Depart tit of Industrial Accidents
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
is signed Affidavit submitted with this application? Yes 0 No 13
— SECTION 12:CONSTRUCTION RUCTION COSTS AND PERMIT FEE
Item and
Costs: (Labor and \Iotcrials) total Construction Cost(from Item6) -
—
1. Building S Building Permit Fee'Total Construction Cost x —(Insert here
2. Electrical S appropriate municipal factor) ' 3—
LI Plumbing
iL� Note \Iininoon fee- 5---(contact"111111"Y'll"O
\W1.111ital 0 IVAQ
i. \Icclt,utic,,I (Ithvr) I:oklosv div,k imi.,We to
f, lotalcost (contact . i.......IM,md I,rite t heck no mber here
s L c r 1 oV 13: 11 G NA I U R E OF BUILDING 11 E 16 1 IT A 11 V L I CA NT
I,vinaltics of perjury that.111 ot[lie"If-11106110 11 .1 ,1,,
M. clit"ring Ins ranee below, I hereby mtv.st under the pools.111,1
s best oe, kIj,,I\le,Ige,mJ oodvritooding.
Ippli"Itwo I trut-mid �ltkur.ltc`ill the
I c1cphoov No, I)MV
No,i,o Imot and 'IMI10
t I t 0 L 11
I n, I
o fill()ot this QNIioII upon I)plication al,proval:
%lo,licilml lo,pmor t to IvPro17 N.mw I),I Iv-
CITY OF S.VzNf, NEUS.wHUSETTS
t3l'tLDLVG DEPaA7ntE`T
I .0 1Y7URLNGTON SruET, 1'O FtCC t
K1Jt8EAI RY OIUX0111 P.�c(918) 1447846
.MAYOR f axwST.?MAU
D(AECTO A OP PC BLlC P ROPEA7Y/at:MDLYC COSL%I,SjlON EIt
Construction Debris Disposal Atfidavit
(required for sU demolition and renovation work)
rn accordance with the sixth editlon otthe State Building Cade, 180 CMR section 111.J
Debris, and the provisions of MGL a 40, 3 54;
9uilding Permit,* is issued with the condition that the debris resulting from
111 work shall be disposed or in a properly licemed waste disposal racility as defined by&IGL c
1 11, 3 I JOA.
rho debris will be transported by:
\ CcrSon �yr.Sl
(name ut'hauler)
The debris will be disposed orin :
(name 0fr4Q1lj1Y)
(,Jdrefi ricrhry)
' ulnanrrs ofpermif rpp6crnr
"'�` ��.� CITY OF SM-Elf, Akss.\CHUSETTS
1 1'1i ULILDING DEPAwrNLENT
�') 'i� `' t(`/ 120 \ A31-ILNGTON STREET, 3w FLOOR
�,�. ,.
1 (978) 745-9595
Rex(979) 7449816
t<1_%IBF RI RY DRISCOLL
Akyox I uobLiis Srlsm Rs
DIRECTCR OF PL'OLIC PROPERTY/0I:I1DMG CO\OIISSIGNER
Workers' Cumpensatlon Insurance A17idavit: Builders/ContructorwElectriclan+/Plumbers
;1rt1)Ilcant Information Please Print Le-Aly
.V;1111C lBueilly.+s,Urgamratiomindividu•II): /(V�/•/��/'>�/P/�
City/Statc/Zip: afJ Phone M: 9?� ��S� $ S�dd
Are you an umplayer!Check the appropriate boat 'type ul project(required):
I.❑ I am a employer with 4. a genera!contractor and I 6, 0 Now construction
employee(ILII and/or part-time).* have hired the subcontractor
2.❑ lama sole proprietor or partner- listed on the attached sheet t �• ❑ Remodeling
.hip and have no employees These sub-contractors have 8. []Oentolition
working lilt ma in any capacity, worker'comp.im ce y, Building addition
(No worker comp. insurance 5. 0 We are a corportian and its
required.) officer have dxa cised their 10.0 Electrical repairs or additions
5.Q lain a homcuwner doing all work right of exemption per MGL 11.❑Plumbing rep�Irs or additions
myself. (No workcra'Gump. C. 152, 11(4),and we have no 12.❑Roof repair
insurance required.)f employees.(No workers' I5.❑Other
comp, insurance required.)
-,vuy appbcurx IlW ellwitt but rl mlur alwt fill uw Ihv wetiw 6uWw ahawiny Ihair.akm'eomptnutiun pulley inaumtaon,
'I hvnaurlan•wha,uhnlil this atlldavit indlea(ng They am doing all wart and Ihce him uultidacantnctdn mint nlhmit a new,atlldavil:ndiaing,uch.t'.minywn Ihel chest Ihit box mall machad un.Wdlliunul.heft.hawing Ihr nand of lha mb.emruwn and IAtir wnrkm'comp.paltry Inrwrnaaoal
fain an enrpluyrr that is pruvldhog Iverkers'cumpenratlun lnsurance%r my employees Below/s rite pol/sy and jab$lle
information. p
Insurance Company.Name:
Policy y or Self-ins. Lire, d: Expiration Date'
Job Slid Address: Gly/Slate/2ip:
Haab a copy of the workers'compensation pulley declaraUgn paKs(showing the policy number and expiration date).
F.liluro ut weti coverage its required under.Suction 2JA ot'MGL c. 152 can lead to the imposition of criminal penalties of a
rims up to 11,500.00 und/ur one-year imprisonmentv as well as civil penalties in the tarts of a STOP WORK ORDER and a line
or rup to 52i0.00 a day against ilia violator. Ile advised that a copy of this,ralement may bet furwardcd to ilia Ol'tica of
Inve,ligaliuns ni the 01A htr insurance coverage veritic.11iun.
/d41� -
i�Y ender dre air unJ pena/7lr.r u�prrju /rut tilt Lr�unnudun pruviddJ a veil true and correct
Uata: _
rr
U//icia!rue,mly. D,r nor Lvile in drLs area, to he rumpletad by my ur lawn ajjlciat
Gry,lel'nwn:_ __ _ __. 1'crmirii.leumed
h+aio-Atjllwrily (circle une)t _. _..__ .. .
I. !bard al Ilcalth i. Iluitdlm"Ucparlule"I I. ( ityi row" Clerk 6. other 1. (ihctrittl hlgmchlr i. Pinmhinl; hllpx(or
(�rull.ld Pcr\nn:
l Voile I:
FROM : MURDOCH ENTERPRISES PHONE NO. : 508 535 5400 AUG. 09 2012 05:23PM Pl
09102-012 16:1,1 � 1° ' . _.T,:. DUFF, TI.•=�1 iF ,-.r�., _ ..,..._,.,..:...e.m,.�...,.
- ]E �a..,J PAGE hl
ACORD,P CERTIFICATE OF LIABILITY INSURANCE1.
THis c1=RTIFI AT IS NOT
AFF AS A MATTER OF INrORMATION ONLY ANb CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEROTHIS 12
CERTIFICATE DOES NOT gFFIRMATIVELY OR NEGATrvELY AMENOT EXTEND OR ALTFP TH{E COVERAGE AFFORDEO BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE UUF,5 NOT CONSTITUTE A CONTRACT BETWEEN TWE IySl INSURER(SI,nuTHOR12Eo
REr'RESENTATIVE OR PRODUCER.AND ,THE CERTIFICATE HOLDER.
IMPORTANT: If the ce ificate hOlder!S an ADDITIONAL INSURED,the p0lfcy(ies)must be et7dorsetl.
the terms and condifivn of the p011cy,csnam Pciicies may rDqulre an e ndpTsement. p LT SUBROG 710N IS WAIVED,subject to
Dtrtiricata Avlder in IIEUD of such endomament(s). sletemertt on this conificvta deoc not Fonfer r',ghts to the
PRaDUCF
Duffy Insurance Agency, Inc, NAt"'e'
317 Broadway AC Ie Er :761.593.120 Aic791.s99.7260
WyQma Square A°° S;
Lynn, MA 01904-2602 INS IIRER18t AFFORDING COVERAGE NAIC<
INSURED Mur OC Enterprises, LLC — ° Q ?, TrayeTers Casualty Ins Co of A
c/o Kevin Murdoch INSURER e:
7 ConnorS Road INDVRe"°,
Peabody, NA 01960 MsurtER D:
INSURER E: -'
OOVl;RAGES INSURER F: .._—...
CERTIFICgTE'NUMBER;02D REVISION.NUMBER:
THISI57 NOT T HAT—THE PONYR OF INSURANCE LI5iE0 BELOW HAVE SEEN ISSUED 70 BIN$URED NAM AO. NUM THE POLICY PERIOD
INOIOATEC. NOT'MTH3TANOIrvG RNY RegNREMENI', I ERM UR rJONDITION OF ANY CONTRACTOR D1'HER DOCUMENT MATH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM$.
EXCLUSIONS AND CONDIT;•ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE$SEEN REDUCED gY PPiD IMS,
�Ti TYre Or M3URAreCE :INSR VND POLICY NyMOER
GENERAL LIABILITY �0"' ° nN�•m IIMIT3
-580-1A184766-ACJ-12I06101!20121061Q1!2073�•EACH OCCURriENCE !s 1,000.000
COMMERCIAL CENERAL LIABILITY tr�A
�CLAIM$.MAOE C OCCUR r i PREMIseS- fS 6 300 QGO
A -..._I' I!ME0 ExP IAry o.a paecn7 IS 5,00
!PERSCNALaAOV+NJURY S 1,000 DQD
L
'GENL AGGREGATE UM 6ENE AGCREWTEITAPPLIE$PER: I I �$ 2,AOO DOD
X FoLlcY'I��E I�LeD i �cRaoucrs•cOMP!ePADa s -2 000.00
IAUTO reoarzcuatsx.m-
^ —PEA WIdpN' r 5
HI IV N Ada I DODILY INJDRY(PB!p.O f
Afi:OVmEO '`,SCHEDULED _ :
H REOAUNa N NO ASa.NeO 'I .,,....
BOD2Y Mau rme le p
AUTOS i I ! Per .. r6;.
UkaneLlA Lun �,000UR 1 - I EACH $�
OCCURRENCE !
EXD[SSIIAB GLADA3MAOE
CEO I `RETENTIONS _l AGGREGATE g
WORKERS COMPEN9AT N r S
AND EMPLOYERS UAIIILITY I -
Y!N r TORYLIMRB ER
ANY FROPRIETORIPARTN�R�EXEotn
OFFlGERMIEMBER ExCLUOED7 NfA• I E.L.EACH ACCIDENT Is
I(M.mamory le NH} e.l.DISE45E•EA EMPLOYE i
II-SCRMtrIGN Or tt r¢,L,DI56A$E-POLICY LIMIT!S
r D_SCRIS:ION Or OPERATIONS bel(w
D46CRIPTION OF OPERATION$(LOCATIONS I VEHICLES fAttanp ACORD t%.Aemneem Rmm�b.sM,ntl.:la,Rme,.eeaea r,j.oP�neal
arpentry
CERTIFICATE HOLDER CANCELLATION
•SHOULD ANY OF THE A&VE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVCRED IN
A DANCE WTTH THii P01'(Y PRDV1910' .
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CSty of Smem a' ID' 6 tM CiImANVF
'Cf YY Ha77 "
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1C0R02y RDl UfU51 ,�5, THG'AC11HIn AaiMO Hed lnen'erd Y'AjDid NN1NIve fAPniit]