20 ORIENT WAY - BUILDING INSPECTION --- ---------
The Commonwealth of Massachusetts
r
j 9 Department of Public Safety
:\hus,trhu+rlls ti1,nt wilding Cutic(7'ty C:\IR)
""'• ISuildingPennitApplicatimnforanyHuildingotherthanaOne-orl'wtr
Family Dwelling
(Phis Section For(lf(ici,d Use Clnly)
Building Permit Nuntimr: _--- _-.-- Date Applied: -- Building Official: _ __
S ECIION t: LOCATION I'Icase indicate Muck #and Lot#fur IocttL)ns fur which a street address is not available)
;No.,III,[Slrcrt CiIV /lotvn /ip Code Nance nt Building(if atiplicablc)
SFCIION 2:PROPOSED WORK
tli,liliurt of\L\S61 to Gnlc uscJ_...__ If Ncty Cunslmction rhukk here❑or chuck all Ih,lt apply in Ihy hvu nnvs below
FXisling Building d- I Rvpatr❑ 1 Altar,niun d- I AJdilion❑ 1 Demolition ❑ (Please till(,ut,md sm bill it:\ppynd ix 1)
_Ch,rngc of Use ❑ Change of Occupanry- ❑ Other ❑ Specify:----- ___
Arc building plans and/or construction d,K'umenis being ski as part of this permit application? Yes ❑ Nu ❑ ------_
Is an III,L drnt Structural Engineering Peer Review required? Yes ❑ Nu ❑
6ricf Desc +lion of Proposed Work: _
—
SECTION J:COMPLETE TIfIS SECTION IF EXISTING BUILDING UNDERGOING RENOVA"FION,AUDITION,Olt
CHANGE IN USE OR OCCUPANCY
Check here Jan Existing Building Investigation and Evaluation is enclosed (See 780 CNIR 4) ❑
Existing Use Gruup(s): _mm
—___. -__—._SECTION 4: BUILDING HEIProposeds/Stories 011chide basement levels)4Area Per Fluor(sq. ft.ft)and Total Hcight(ft.)
SECTION 5: USE GROUP(Ch
\: :\ssembly A-1 ❑ A-'-❑ Nightclub ❑ A-1 ❑ A-4❑ A-5❑ 1 B: Business ❑ r•.: Educational ❑
F: Facto F-I ❑ 1:2❑ 1 It: High Tlaatrd H-I ❑ H-2❑ Ii-t ❑ Ii-4❑ 11-5❑
I: Institutional 1.1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-t❑.- R-4❑
S: Storage 5.1 ❑ S-2❑ U: Utility❑ Special Use 13,111d please describe below:
Special Use
SFCHON 6:CONSI'llUCTION I"YPE(Check as app I[cable)
IA ❑ IB ❑ Il,\ ❑ IIB ❑ IIL\ ❑ IIIB ❑. 1V ❑ 'A �❑ VB ❑
_ SLCT ION 7: SITE INFORMATION(refer to 740 CNIIt I I1.0 for details(in each item)
Water Su I Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal:
PP Y
I'uHit Cl Cht•,k it„ulade Ilooil Zunr❑ Indicate municipal❑ .\ In'nkh will not be Licensed Ili+pw,il tiih•❑
Trivaty❑ or mdcnlily /are: or on site st stem❑ m•yuin'J ❑nr tnmkh or stick .. "
prnnit is rnklasrJ ❑
Railroad right-4-way: ILvards lm .\ir,Nac igation: • i .i , , .
.\',;t:\ppl,cablc❑ ktitnikturc,vl6in auport.q,pnoarh an•u Ir lhrir rrvict.r,mgdclrJ'
.I Cnncnt to Iltuld it,lasc,l❑ 1 cs Cl „r.No❑ ),•s❑ .No ❑
tiFCIION Y: CON LNI'OF CPR I'IFICA 11:OF UCCU VANCY
C.r Group l c nelrw teen: trt up,ot L,,,el prr Phoor
1 Its(-. Ihr bnildinl,,,,nla in.m til,nn Alr r tivdrin'. '-peri.il '4IiPulolions:
OI'liit'IYO\VNFIt AUI'iIORfZAIION —
tiLCIIUN+) Ili
\ tine uul Adds Ss ul Un nor ok90 op-4
._._- Nu. and Street city/fawn Lip
Nome(Print)
Pro wlty Owner Cont I, nhonnalion: /
fillu Telephone No. (business) -relephone No. (roll) c-mall address
If applicable, the property vner i crcbv authorizes
�� c
Name Street Address City/Town Slate Zip
to art on tilt.property owner's behalf, in all mattvr.s relative to work authorized b • this building permit application.
SECTION 10:CONS'I RUCTION CONTROL(Please fill out Appendix 2)
If bit III in p is ICl9 than 33,I)m cu.ft.of endured s pace and or not under Construction Control then check here O end skip Section I0.1
11).1 Registered Professional Responsible for Construction Control
060 f i, ✓*s y, t k)y>
Name(Registrant Tcic hone Nu. c-mail ada r O/ ustrition Numb;
r 3
Street Address City/Town Stale Zip Discipline 8xpiratiun Dale
10.22nGeneral Contractor //�' M,,zL
Con uay Name n
Nanoof Person RRespunsibl•for Construction
.,lll, LLic�esnse No. and Type if Applicable
Aa Street Address City/Town State up
Tcie+hone No business Telephone No. cell e-mail address
SECTION li:a�,�i f l �.• t r I,HA v,.y I p,N I'V4INANt I AI I it l i M.G.L.c. 152.§ 25C 6
A 1Vorkers'Compensation Insuranu Affid wu[from the AIA Department of Industrial Acadents must be completed and
Submitted with this application. Failure to provide this affidavit will result in the denial of the Lssuance of the building permit.
l9 a 9i fined Affidavit submitted with this a lication? Yes O No ❑
SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost((rum Item 6)'S_-__--
I. Buildil p S O Building Permit Fee'Total Construction Cost x—(Insert here
2. Electrical appropriate nuuaicip,d factor) 'S
1. Plumbing, S co
;. \Icchaniral (f-IV:1C) S Noh: \lininnnn fee=5—_—( ntact numicipalily)
i. \It.rh,u,icol Other) S Fit,lase chttk payable to - ----_..--_.--
n. total Cost 5 !�g i/ (contact municipality)and write check number here
SECr1ON 13:SIGNAIURE OF BUILDING PERMIT APPLICAN"r
Its entering n,y name by low I hereby ancst, • lilt. pains mid penalties of perjuryI that Al of the in funn,i t it'll tontaimd `n Ihis
.i pphration is true and ocaurale to Ilse best t'l Illy rn ,s le, It dent coding.
fleas,-print and .i);r, lame Dille Alfrlcphi It. 't'. Dail•
I �trce1 \dPr'•ox C ily; I,pwn SLu i
..\hu,icipal inspector hp fill out this section upon application apprucaf: -..-, . . _ -.. _... .._ - 2I/dII
.N'amu Pate
C(TY ()F S'UZNf, AUSACHUSETTS
t3t.'tl'.pf.YC DEP.IRT?tF.\T
1 20 'O.UNNGTO,N$TA8$T, 1'e FZ.00It
I�Z1. (973) 145.959S
1C13WFAIMY OUSCOLL FAX(973) 114. &W
.tifAYOlI rRosw ST.PtU
0rucrOIt OP PL atjC PROPEATY13I.A vc COSMISSIO.%Elt
Construction Debris Dispose! Affidavit r
(required for all demolition and renovation work)
rn accordance with the sixth edition orthe State Building Code, 730 C�ti/R section I
Debris, and the provisions or ma o 4o,
Building Permit AI 11, $ I10A. is issued with the condition that the debris resulting from
1 I I
1 work shall be disposcd of in a properly licemed waste disposal facility as dctincd by,b1GL c
The debris will be transported by:
I/O v 6 1 � �
(name of hauler)
The debris will be disposed of in :
�2 46r\-3 11
(ma a or raciluy)
( ddrefrorf��il,iy)
f aR+ro of perms rpphcrnt
C C[•Y O F [I 11 WSACH US E"ITS
1J OCILOING DEP.hIMMOST
1 0 WAiH6VGT ON STREET, 1D) hIUUR
TM (978) 745-9595
F.AA(978) 130.9846
:,I Itlt'iIEY DRISCOII
�LAYO t TFiOSL\3 Sr.PtEaRB
DiREL7URUF PULIC PROPERTY/OI:iLDr\r Co%L llSSIUNEa
Workers' Compensation (113IIranCe AMILlavit: Iluilderi/Contracturv/ElectricianUPlumbers
16 s Ilicont Informutlnn Icaae Print Leaihl
.VII Inc lnuritte,.i.Orgamrltion iiindividu.11): Q00 & r-✓2�-/S�,
Address: f/ r/ / ✓J—� S / "l/Y�j\
CityrSiatc/Zip: L.4 U/Lrjp p 0/I hone M
Ar (you an emylayer'!Cheek th appropriate boo
I,r1 YyssLemployer with a, ❑ 1 an a genrral contractor and I type of project(Acquired):
employees(ILII and/or p�•• have hired the sub-contractors
6' Q N°w,construction
2.❑ lama sole proprietor ar partnur- listed on the attached.rhect t 7• Q Remodeling
,hip and have no cmplayees These iub-conlracton have V. Q Demolition
working tier me in any capacity. workers'comp.insumaciL
(No worken:comp, insurance 7. ❑ We are a corporation and its /' ❑Building addition
required.) officers have exercised their IO,Q Electrical repairs or additional
).❑ 1 am a homeowner doing all work right urextinpliun per MGL I I.Q Plumbing repairs;or additional
Myself. (No workers'comp. c. 1 J2, 11(d),and wa have no 12.Q Roof n pairs insurance required.) t employees. (No worken'
comp,insurance mquir- .1 ll•Q Other
'.v-ry:wi llr:ue tlw ehnks but hI m W1 atra fill out the 41aies billow+howinI their"pure'campsnudon pulpy innrmlotlan.'I Lwnuewas who whnlll this arfldavll indlcalnal thry.re aaind all werk and then hire wtW rallaarbre moos n,lonle a new al
t\ mew inINlotine rush
,nln that.h vk this box moil All ached an.1,kWlurtol.hest rhuwinal the nwna arthe rub•e ltdarilemraelws And tAair waAm'comp.pvllry Infifrnutlae. -
/urn un eurploya that/s provB/brX worken'cumpruraNan lusuraneelor my empluyrra Below Isr/u paltry and/ub Wifeiu/orraatlnn, ^1
1'aligy 4 or Selrios. Lie.to: Expiration Date:—Iub Site Address: ao V I-4 hJ �rg y CilyiStute/Zip:
.\ttacb A copy of the oorken'compantatloo policy deciarallon paXI(showing the policy number snd nplrstlon data).
F tiluru to.ectira cuvera,a:rs required under Rection iSA ot'bIGL e. 172 an lead to the imposition orcriminai penaities ors
time lip to il,sca.00 untl/ur mu-year imprisanmcn4 as well is civil penalties in the town era STOP WORK ORDER and it lino
.:sup to 52i0.00 r Jay Against the violator. lie adviacd that i copy of this aatcment may bu turwardcd to die Qliiea al
L nv,ligmunx,ti ihu f7L1 Glr insurance Voverayc veritiratiun.
/du hereby cerri of rota pu/a1 mr penvltlu�r/p vjury 1/tut the in`urorurlmr pruviJaJ uGuvr it true'wd correct,
ill/kill rr.e•ndy. /I..,tof wife he Aber inn, to Se rumplddJ sy Airy ur toun,r�/lrivC
City nr Vwvn: __ _ i'crmiUi.la•nre i
h unity.\ul hvrily (circle u,te); .—._. . ._
I. !Ioanl nl Ilralth !, Iltifdln•, Uclrarhneut 1, ( ilyr'rnnn Clem J. liltcrric tl ht, mrht S. Uth.•r I r i. I'I!tmbim„ hilpacrnr
l i tlnil i'enmr
TheJ LamCet
Condominium `dust — —
VIA FAX#978-940-9846
To: City of Salem—Building Inspector's Office
From: Phil Sherman,Crowninshield Management Corp., As Managing Agent for
Hamlet Condominium
Re: 20 ORIENT WAY—Renovation Request
Date: July 6, 2012
Please be advised to accept this letter as approval for proposed bathroom renovations to
be conducted by Doug Hurd (contractor) on behalf of the homeowner (Tom Fauls)at 20
Orient Way in Salem at Hamlet Condominium.
The homeowner is responsible for all interior work, as well as obtaining all necessary
permits. It is our understanding that the contractor is licensed and is fully
insured.
Should you have any questions,please contact this office at 9078-532-4800.
Managed By Cnr1a, is Croivnf'o-sh.iecd street, 7'cafody Ma 01,960
Thane (g78)532.4800 • Tax(978)532.6023 • ivww.cro'ortirL5hiordc0n1