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57 OCEAN AVE - BUILDING INSPECTION �NIIIB10111BR'18�� APMIOYip IW M •Ill�lll mA�•OBB+�pip CITY OF SALEM am"OWN_ Loodwm � omen n.L.w F`°. "�� o .. . wq,_w MOM Ponnit 1oc Runs o PEW APPLICATION POI! (Chb IMNo WW opply) Roof MliUGA O W SWft Corlel�W pools Mod. Pool, KUMNLOWLEMLYAWWU LYTOAMMOILAYANPHOC� TO THE 94PROM OF BNWAING&speomonv `. orw�e4Md hefty +Ip m for a pe t b bum a000rdi+Ip b tlM.foNowlrp Ad*m A Pho w Ll DJ 1 (4- MkL t>s*l (7?s 11 �� _ �y (o b' Adaars A PhOrM ( 1 W010 0o NanM Ada n a PhOW ( 1 Ilan a te�ip► r•Me■no,for mw mm -A& wm kmq ogre.a kw AW..r,., bameraeet to,"o Anta,11e.o_umu . o ,5 off$ ZZ 80tr* B M PBIw" pEBC1I/fION OF TO '�_ �jJ �4�T �+L �Q,0A1 6ll7 JNP J(' A-AiD Z FvK (.� �i��'F.. Z ��lt�w �iN99'w 5 • 2 IAOL PENT' I ;ft o Pla--A . ?oIl-CL — $, E LyvW-L ask — F I Lt " 4s0NAl7'UU 3 - LI I by G Rd o Ono Na APPLICATION FOR PEMW TD �!c/I/Ul�kTE Z r.S LOCATION S—f QCeAAl �f. PEFO NT GRANTED APP OV�D �a rorlECMR w Of NP LOPM ar of Bu Rilding egul�atdons andStandatds - ' S+NOMETIMPROVEdAENTs'IANTRACTOR- r- Reglstra4igP- 133594Y ' � Tyype: Individual LAERCIO P.VIGOLO , i ,,,.�LAERCIO to VIGOLO �sr ... i1 "SCHO0L'S,T `f.,�'✓,%? i! ,� e.� ACTON,MA£01720 Administrator BOARD OF BUILDING REGULATIONS w iaensa: CONSTRUCTION SUPERVISOR , Numbe�S� 078722 '"� tZL3St988 Bi}R 1 -- 6, 49t2.0 ` y E � Z(3 . Re l LAERCIO P. VIGOIr 154 SCHOOL ST "�&—m—�jsmsgeon�e!rACTON, MA 017 Is The Commonwealth of Massachusetts Department of Industrial Accidents OM$dluYesmbgBas 600 Washington Street, 7u Floor Boston,Mast, 01111 Workers'Com ensation Insurance Affidavit: Buildio lumbin lectrical Contractors name, "l h" 1`+G 1 f7 v address ) s y GcLx oo L S-t city TO AJ state: M A_ zip: ©q zo phone# 611' 9 S l� ' } 2 S w . 15-+ ©c „1 A-\)F_ Put ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction aRemodel �am a sole proprietor and have no one working in any capacity. ❑Building Addition ❑ [ am an employer providing workers'compensation for my employees working on this lob 4 C ° .'+i_'Mfg, x,3''. • .:� . _. 7777 address; City' - e nitatlRi♦' Pt. ik b.. 'A 'K' ' `�:. e try kid iEN ca oeBer M 19/1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: ))company name: address: city ahooe th 1 .! � UUVX V. company name: _ _ .. `.%t�r�xY r .a i`jr#`t.,i'',ys•�$"' ,E o-r �, y,�� s address. city: ohoae t. Wit• �X1 f e �Y'^�z. 71 1 is ARIEi' Failure to secure coverage as required under Section 25A of VIGIL 152 can lead to the imposition of criminal penalties ora Me up to 51,500.00 and/or one years'imprisonment as well as civil peus tl in the form of a STOP WORK ORDER and a Rue of S100.00 a day against me. I understand that a ropy of this statement may he forty bed to the mce of Investigations of the DIA for coverage verification. I da hereby certify er t an pe erjury that the information provided above is true and e/rrrecL Signature ,(��-\ Date �J /1�� /��, I Print name ri''1a- 0 `��� v t`�D Phone# (0 I '7 ' "I s3 - L_ZS official use only do not write in this area to be completed by city or town official city or town: permit/Iicenw a ❑BuildiJIDepartment❑Licem❑check if immediate response is required ❑select❑Healt contact person: phone 0: ❑Other IttKJ$Cy1 JAI)I CITY OF SALEMp MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MA O 1970 TEL (978)745-9595 EXT. 380 40 FA% (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition of Building Permit 0 .all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility,as defined by MGL c a S150A. 7�j The debris will be disposed of.x A C Q ,Jle D i 5 [plc?t ( jf 1p�4er� Location of Facility I og- MITZ"oIS PCR"V"kL SignaNn QRSWt Applicifit Date FULLY complete the following information: (PLEASE PRINT CLEARLY) Name of Permit Applicant l4'q6(--LCk &H'I LLC Firm Name,if any Il ►J�ra cS�.a ma�en uhA Ck�l`{� Address,City& Sti The above statute requires that debris from the demolition, renovation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cIll,S150A, and the building permits or licenses are to indicate the location of the facility. ter® 4 ' • �� � � � �a� ifp �. �j `� ems,:,:' APPROVED f Subject to approvdb. any etiaex authority havingjurisdictioa. CITY of SALVEM,1lJ . FEE, D' �MNT80Nd U-Z2AU lb EYa2�-- -: Q PLA-2 ARC APPROVED SOLELY FCd iC:'lmF:C,T:C::.F TYFE A%D LOCATION OF FI.'.' MOT:Q'T. i E�';;C 3. " .ALL F:RF PROTECTION DEN!CES ".SC CUBJCC1"10 A i'N TESAND INSPECTION,FOR COMPLETE CS�ti•�'L1� MLL WITH THE FIRE CODE QL) Or Y CL O 5�ke C� I 40 oDc 1 s-- t ...tom_ .. I 00 51 Rooms I hem �o �OD Ftoo� DR � v