Loading...
15 OLD VILLAGE DRIVE - BUILDING INSPECTION i The Commonwealth of Massachusetts CITY OF 1� e<L Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR Revised Mar 2011 N Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section F&Official Use Only Building Permit Number Date A hed Si ature =r ` Date Building officiaf(PrmtName) n g_ SECTION 1 SITE INFORMATION ` ° 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers i hlYf 1 1fo01 150tL1 V1 l)►tie 2�UA��� Parcel Number Lla Is this an accepted street? yes_ no. Map 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: Zone: _ Outside Flood Zone. Municipal ❑ On site disposal system ❑ Public ❑ Private ❑ Check if yes❑ SECTION'2r PROPERTY OWNERSHIP?°' �2.1 wnertofRecord: 5�.L-eve 1M�e 2nL�►vP �1taA Name(Print) . City, State,ZIP ru I 1,6[)1 is OldVtik"-e tc.0 5m, -'Oi 30`7"I No. and Street Telephone Email Address SECTION 3cDESCRIPTION OF,PROPOSED WORK, (check all thafapply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ I Addition Cl Demolition ❑ I Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief�Description of Proposed Work': SI ?c , d t SECTION 4: ESTIMATED,CONSTRUCTION COSTS Estimated Costs: Official Use Only;. Item Labor and Materials $ 1 Building Permit Fee $ Indicate how fee'i-determined 1. Building ; ❑,Standard City/Town Application Fee 2. Electrical $ ❑Total,Project Cd'st (Item.6)x multipliet x ' 3. Plumbing $ 2 Other Fees: $ 4. Mechanical (F(Vr\C) $ Ltst 5. Mechanical (Fire � Total All Fers: $ Su ression Check;No Check Amount: Cash Amount. 6. Total Project Cost: ❑ Paid in Full '. ❑Outstanding Balance Due: C � h a�eortil�, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) es�aa 7 r(v I l - y9m 1 \ License Number r E.e ira[ion Datc Name of CSL I-[olde �� �S{�ee �� Lis[CSL Type(see below) No. and Street f Kra Type, _ Description - („ I /� ,J t f�„q_ ©'G�� U Unrestricted(Buildings u to 35,000 cu. ft. VyN r V�rP� R Restricted 1&2 FamilyDwellin City/Town, ate,ZIP NI Nlasonr RC Rootin Covering WS Window and Sidin SF Solid Fuel Burning Appliances I Insulation Iblz hone Email address D Demolition _ 5.2 RIeeg�insteerreddHome Improvement Contractor(HIC) 1 / ) j4o2©3 1Z h'� �L� HIC Registration Number Expira ion Date HIC�C(mpary Nam or Reyj�ame ru No. n ,�d Street \, [,, hob, /A( - tAS Wll Frl zs4 �-iP-C Email address City/TovXi, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 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 .......... No ........... ❑ 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 VOQUI ,r to act on my behalf, in all matters relative to work authorized by this building permit application. (ac-tom I lw2 1"r R-A KD V lS, ZU I Z Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW 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 gin,this application is�true and accurate to the best of my knowledge and understatnAdi�ng. Prmt Owner's or Authctrized 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 ibI.G.L. c. 142A. Other important information on the HIC Program can be found at www.Inass _>ov/oCa Information on the Construction Supervisor License can be found at www.mass.eov'dos 2. When substantial work is planned, provide the information below: Total Floor area(sq. ft.) (including garage, finished basement/attics, decks or porch) Cross living area (sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halt/baths Type of heating system Number ofdecks/porches _ Type of cooling system_ _ Enclosed _Open 3. '"Total Project Square Footage" may be substituted for"Total Project Cost" PROPERTY (�] MANAGEMENT EAST COAST a SECTION PROPERTIES, LLC NATIONAL ASSOCIATION OF REACTORS® AUTHORIZATION TO DO REMODELLING WORK DATE: NOVEMBER 8,2012 RE: UNIT#1601,15 OLDS VILLAGE DRIVE, SALEM,MA OWNER: CAROLINE LENA FAX TO: CIT OF SALEM,BULDING DEPARTMENT 978-740-9846 This letter will confirm that Caroline Lena,who lives at the above unit at the Highland Condominium at Salem Trust,has approval from the Board of Trustees of the Highland Condominium at Salem Street,to have a contractor renovate the half bathroom on the first floor of her townhouse located at 15 Olde Village Drive,Salem. East Coast Properties,LLC,Manager BY: - "I — Cyn` y selmo REAL ESTATE AND PROPERTY MANAGEMENT 400 HIGHLAND AVENUE,SUITE 11 email: EastCoastProgaol.com Phone: (978) 741-2003 SALEM,MA 01970-1777 Fax: (978) 745-9684 CITY OF S.U.F-M, N-LkSSACHUSEM BL:1LDNG]DEPARTMENT ' ° N• 120 W.-%sHL'IGTON STREET, 3" FLOOR TEL. (973) 745-9595 F.A x(978) 740-9846 KIJigERI.EY DRISCOLL IrL.%YOR THo.%w ST.PtFRRs DIRECTOR OF PLaLIC PROPERTY/6CILDNG CON12MISSIONER 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: U�t1UY1 Gow��YA.c�wt(, 35a�uw�1-hrt.¢,cr✓. (name of hauler) The debris will be disposed of in (name of facility) N � k, 00 --PeA oQ � ddress of facility) Lsign:a�ru of per pplieant date i� CITY OF SALEAM, ltLAsSACHUSEM _ BUMI)ING DEPARTMENT p. 130 WASHINGTON STREET, 3'o FLOOR O TEL (978) 745-9595 F.Ax(978) 740-9846 KCI3[BFRi EY DRISCOLL MAYOR � TTiOh(ASST.P[fiRRB DIRECTOR OF PUBLIC PROPERTY/BCIIDLNG CONMUSSIONER Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers AnnlicantInformation Please Print pLegibly Name (Busmess,Ordanizatiory Individual)�IT�r�o s cep V Ci(f U t� kl h��fF�1 e/C /t Address: a fF) SV IM p'T City/State/Zip: wW=t- Its dC vi" o Phone #: _7 S - ' 5'� Are y an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with -z— 4. 0 I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers'comp. insurance. Y a Y 9. Building addition (No workers•' comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. (No workers'comp. C. 152,§1(4),and we have no 12.0 Roof repairs insurance required.)t employees. [No workers' I3.❑Other comp.insurance required.) •Any applicani that checks box of most also all out the section below showing their worlmas compensation pali y inrurmation. I baneowdes who submit this affidavit indicating they arc doing all work and then hire outside contractors most submit a new amdavit indicating such. 'Contracwn that chuck this box most attached an additional sheet showing the name of the subeonuaacion and their workers'comp.policy infommtion. I um an employer that Is providing workers'compensation insurance for my employees. Below Is the policy and job site information. t�y fy Insurance Company Name: /,y&`" "tA `_—w`SV Diu P Gtov f� Policy 4 or Sclf•ins. Lic. 0: -A VWC.34(aOZZ Expiration Date:Wl f4-L� qS' Job Site Address:UlUcrI (.,oI )Sd<<C,�tl�tkf/2_ t-(gyp-t'f/ City/Statc/zip:�✓C "L Attach a 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 MGL c. 152 can lead to the imposition of criminal penalties of a 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 fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigu6mv;of the DIA for insurance coverage verification. I do he y c 'y under the pulns t enultl of perju t the hiformatlon provided above is true and correct. Sie t Ir • [)aid: 14 nO kS r �ZQ(Z Phan ;t Ojjiciat use only. Do not write in this urea,to be completed by city of town ofjiclul City or Town: 1'crmit/1.1cense Issuing Authority(circle one): t. Board of Health 2.Building Department 3.Citylrown Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone#: { fi a�@ �>G'Gc�ac�u�e� Office of Consumer Affairs and Buz ness Regulation '. 10 Park Plaza - Suite 5170 I Boston, Massachusetts 02116 Home Improvement Contractor-Registration } Registration: 114203 II Type: DBA t Expiration: 8/12/2013 Tr# 215414 ANTHONY VENUTI CONTRACTING`, 1 s ANTHONY VENUTI I 918 SALEM STD, ` ". �' �I•/ LYNNFIELD, MA 01940 C/ Update Address and return card.Mark reason for change. [j Address Renewal Employment Lost Card SC 1 Ca 2OM-05/11 Office of Consumer Affairs&Busihess Regulation EOME IMPROVEMENT CONTRACTOR Type. egistration: 114203 DBA xpiration: 8/12/2013 ANTHONY VENUTI CONTRACTING, ANTHONY VENUTI n 918 SALEM ST LYNNFIELD, MA 01940 Undersecretary u 1 Massachusetts -Department of Public Safety 1 Board of Building Regulations and Standards Construction Supenisor - License: CS-022287 1 ANTHONY J VENVTI 918 SALEM ST : LYNNFIELD MAY 019a01, if ` ��,�,., fJ/C�c.. " "' ♦ Expiration Commissioner 06/06/2014