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31 OSBORNE HILL DR - BUILDING INSPECTION L04-45 G�— �n, IG $ ( -lsooa �1et(b-1 fY�de� qq�� The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for'any Building other than a One-or Two-Family Dwelling �O (This Section or:Offrcid Use Only) C3— Building Permit Number. Date F pplieiL• :Building Official: SECTION I.LOCATION(Please indicate-Block Cand'Lot.#':for locations for which a street address hajot available) No.and Street City/Town Zip Code Name of Building(ifpljcable) SECHON,Z PROPOSED' ! 2,n, Edition of MA State Code used_ If New Construction check here or check all that apply in the�Sva`' below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out an ubm�t;i�i'ppendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes rr3„Jo ❑,OW p Is an Independent Structural Engineering Peer R ew r �_ired?`' (� l [ f ❑ c/No 1� Brief Description of Proposed Work: f^,An fUC]` SECTION 3:COMPLETE THIS-SECTIONAP:EXISTING BUILDING•UNDERGOING RENOVATION,ADDITION,OR CHANGfisIN L75E:OR OCCUPANCY Check here if an Wsting:Building Investigitiomanil. t*ation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): - Proposed Use Group(s): SECTION•4'SUILDIN,G;HElGHT AND:AREA Existing Proposed No.of Floors/Stories(include basement levels):&Area Per Floor(sq.ft.) t lS SCV U( Total Area(sq.ft.)and Total Height(ft:) 1 SECTION-SsUSE:GROUP(Checkas.a plicable) A: Assembly A-1❑ A-2-0 Nightclub ❑ A-3 ❑ A-4`❑ A- ❑ B: Business ❑ E: Educational ❑ F: Facto - F-1 ❑ F2❑ M'Hi- Razard H-1 ❑ H-2❑ H3 H-4❑ H-5❑ 1: Institutional I-1 ❑ I-2❑ I3❑ I-4❑ Mr:1llercantile❑ R.- Residential R-1 R-2❑ R-3❑ R4❑ S; Storage S-1❑ S-2❑ :U: Utility❑ I Special Use❑and please describe below: Special Use: . SECTION 6:CONSTRUCTION,TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ MA MB ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE,INFORMATION{refer to 780 CMR M O'for-details on each item) Trench pair Debris Removal: Water Supply Flood Zane information: Sewage Disposal: A trench not be Licensed Disposal Site Public @' Check if outside'Flood Zonel7 Indicate municipal Private❑ or indentify,Zone: or on site system❑ required cl trench or permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Pnxess: Not Applicable O. Is Structure within airport approach area? Is their review corn ple d? or Consent io Build enclosed❑ - Yes❑ or No❑ - Yes❑ No V sEcnoN 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:-8t�—Use Group(s) Typeof Construction FAS, Occupant Load per Floor: Does the building contain an Sprinkler System?: h10 Special Stipulations: i' __ SECTION 9 PROPERTYOWNEIi AurHoRmATION Name nd Address pe Owner # ae. , T, q8o_ CIA ot +� Name(Print) No.and Street C' /Town Zip PropertyOwner Contact Information: X- i sp_ Title Telephone No.(business) Telephone No, (cell) e-mail address! If ap licable,the groperqywner hereby authorizes , P,,o. &)( 780 _MA 0194p .Name f Street Address ty/Town State Zip to act on the property owner's behalf,in all matterst.relati re to:work authorized.b. .this building ern-it application. SECTION 10:CONSTRUCTION CONTROL;(Eleasefill-out Appendix 2) (Ifbuildi •is less than 35,000 cu„R-of enclosed ace�ii iirnot-finder consfruchion Control then check here O and skip Section 10.7 10.1 Re 'stared Profesaional:Res onsible=for Consti3klic Conti ol: TTul l' sQ 781-X'4' A9 4 80 Telephone No 'maila s Registration Number �. Street Address Cit#town State Zip Discipline Expiration Date 10.2 Qeneral Contractor Com any t)�Namnee itt JJL&OL'e C5 271149 Con q So(- ame of Per n Responsible for Construction' Lic No. and Type if Ap licable IF O. . x # 7 S 0 Ly P ACM— Street Address '�c��1 1' Town State Zip > - a-fir oz-" �Y17 ianp. oYYIP,s. nanS__ Tele hone No.- usiness Tele hone,No_.ce t e-mail address SECTION 11r WORKERS' o&—iipE—N.SATfON-ihTsmANCE AMD&yIT; G.I:c.T52§2SC 6 A Workers Compensation l isurance'"Affidavit from thezl3IA DepartImmt of Industrial Accidents must be completed and re submitted with this application. Failu to';provide this affidavit will result in the denial of the issuance of the building permit. Is a.signed Affidavit submitted- application? Yes 0 No 0 SECTION 12 CO1V$.TRUCI'IOl I.COSTS A ND,PERMIT FEE Item Estimated-Costs:(Labor - and.Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 42 050 v 0 guflding Permit Fee=Total Construction Cost x_(Insert here 2 Electrical $ $" oo U appropriate municipal factor)_$ 3.Plumbing $ T OO v S O O O Note:Minimum fee=$ (contact municipality) 4.Mechanical (HVAC) i 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (7 060 (contact municipality)and write check number here SfiC1TON 13:;SIGP1i1T[JRE;OF BUIIS)11VG.�PERMIT A•PPI:ICANT By entering my name below,I:hereby attest-under the pains and.penalties of.perjury that all of the information contained in this application is true and accurate to the best of-my-knowledge and understanding. Please print and sigvF ^ X 78 0.H.R.1. t Ti ,nfjt- _ _.f�State Zip No. Date Street Address m CJC, Ci L own Zi Municipal Inspector to fill out this section upon,application-approval: "" -- t'1'+' 112, O�/� Name Date AC<>R& CERTIFII!T E OF LIABILITY INSURANCE °ATE'MM°°"... 4/2/2014 THIS CERTIFICATE IS.ISSUED AS-A::MATTER OF INFORMATION ONLY AND CONFERS NO,RIGHTS-UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES'.NOT AFFIRMATIVELY ORa'NEGATIVELY , END,' EXTEND OR,ALTER.THE COVERAGE AFFORDED BY THE POLICIES ' BELOW. THIS CERTIFICATE OF,IN§URANCE DOES NOT CONSTITUTE`A'^CONTRACT'BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR'PRODUCER'AND%THE CERTIFICATE'.FOLDER. IMPORTANT: If the certificate holder IS.an ADDITIONAL'INSURED the pollcy(les) must be endorsed. It SUBROGATION 15 WAIVED, subject to the terms and conditions of.the policy;^certain policies may-requirvi ii dorstiIiA A-statement on this certificate does not corder rights to the certificate holder in lieu of"such�endorsement('b)_ PRODUCER 'NAME T SeleCt Dept ext 66807 Eastern Insurance GroupLLC ':PHONE _J508)651-7700 FAX .(7e1)$ss-ezaA 233 West Central Street �"DORE selectmork@easterninsurance.com INSURE- NAICN'AFFORDINO COVERAGE Natick MP. O17fiO .NSURER'A-ACadi:a Insurance COm an 1325 INSURED INSURER'B: DiBiase Corporation, DUC Residential LLC ?-IN`soReec: Osborne Rills Realty Trust ';.INsuRER'D: P O Box 780 - TNSURER.E: Lynnfield MA 01.940 -1NS6RER'F COVERAGES CERTIFICATE'NUMBER3dasler„-14-15 ,/,;GL-:Only REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OFJNSURANCE LISTED'SELOW'HAVE�BEENISSUED TO THE-INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY'REQUIREMENT;<TERM,OR+CONDITI.bW6F.'ANIY.CONTRACT OR16THER'.DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY,PERTAIN„THE iNSURANCE.AFFORDED!'BY THE POLICIES.DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF`SUCH POLICIES":LIMITS SHOWWMAY HAVE.BEEN'REDUCEO-BV PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLCY.NUMBER "MMmCYEFF 'LIC EXP DMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PR S aorulrte ce $ 250,000 A CLAIMSWADE 7 OCCUR LX0191229-17 /23/2014 /23/2015 MED EXP Any one parson) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 TGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO E 1 000,000 POLICY PRO- LOC $ r AUTOMOBILE LIABILITY OM 1 E INGLE IMIT Ea Acc Ida nI ANY AUTO BODILY INJURY(Per person) $ ALL OWNS° SCHEDULED AUTOS AUTOS' BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY AMAGE $ AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE g DEC) I I RETENTIONS $ AND EMPSCOMPELIATIONILIT - "02B6788 TS /23/2014' /23/2015 WC STATU- OTH- ANOEMPLOYERT TORIPATNEW YIN. x ANY PROPEMBERIEXCLUDR/EXECUTNE 100 000 OFFlCERMIEMBER EXCLUDED? M NIA E.L.EACH ACCIDENT S (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100 000 qA'da""ender OE$CRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Soo 000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (AeeeKACORD 101,AddRionil RemmkaSofddIIle;If more apace is required) CERTIFICATE HOLDER _ ,?CANCELLATION- .SHOULD•ANYOF THE'ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE- EXPIRATION DATE. THEREOF, NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCEWRH THE POLICY PROVISIONS, Salem, MA 01970 AUTHORREDREPRESENTATIVE John Koegel/KAB1 �c� 0 ACORD 25(2010105) ©1988•2010-ACORD CORPORATION. Ail rights reserved. INS02R mm�nen m Th.Ae.f%*n mma and Innn aro ron:ebrod mar4a nF s(,,%pr1 Professional Land Surveyors & Civil Engineers ESSEX SURVEY SERVICE. 1958 - 198E OSBORN PALMER 1911 - 197C BRADFORD 8 WEED 1885 - 197; PLOT PLAN OF LANM LOCATED IN SALT ICI MASS. ZA, Sl1/l &ZaG l�7- LcT-M 0/I,/fEo In&t'Ac fJ1�a Buyer Date kIA" PA LOSBGQtLC ///ZZ 012iveE Buyer Date I hereby certify to the Building Inspector that the pro- ZONE LOT AREA: LOT FRONTAGE: ti2/AZ- posed construction shown conforms FRONT YARD: /SKj SIDE YARD: IGr'- REAR YAM: 3G�, to the dimensional zoning of Mass. SCALE: /i/ 'J� DATE: Alill%/ L S L/g REFERENCE: P1 BK W6Z PG 7�7 Christopher R. Me110 PL5 31317 104 LOWELL STREET PEABODY, MASS. 01960 (976) 531-8121 FAX: (978) 531-5920 CITY OF SALEA MASSAC RUSE M BLHLDING DEPAR7MENT 120 WAUMgGMNS7MT,3RDF1.OpR 7kL(978)745A595 KD BERLEYDRLSCOU FAX(978)740-9846 MAYOR 7)X MAs STYMM DntEcroRoppLaucpRoPER7y/BumD,maxmmom 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 c40, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: Nof►WId e CRrNno (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signature of applicant Date CITY OF SALEM ROUTING SLIP .New Construction Certificate of Occupa c� LOCATION 3I DSbaftt �% 0Ve. DATE ry ASSESSORS DATE �S 93 Washington St. � ��f;,,RK5u2 �'I 1 yf+ a 3 t^ f' �,iar^aT � hM"' 'n^• ,).%„. 9frl,gto-n 5t. PUBLIC SERVICES_Q�DATE 'I b f 120 Washington St. //�. WATER 0ry\� — DATE ��yl 120 Washington St. II CROSS CONNECTION DATE �Y Liu � 4 � 5 Jefferson Ave PLANNING T, DATE �] S 120 Washington St. CONSERVATION DA I E 120 Washington St. Pi L3Lai CTRI �ALMT ma YSh' �,� S S . 48 L'37ay�'@Y''t�5"t` FIRE PREVENTI N O DATE 15 29 Fort Avenue H E�aLTFI a ITT r 4 `� a 70 �V�as��iiigtont. �a BUILDING INSPECTOR DATE 120 Washington St. bz?yf .s ' ��40�i bead ��pt�O�J 0�30Q��40�3a nOQo Professional Land Surveyors 8 Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN SALE/Li MASS. / L cT 92 3lt - i _9 Buyer Date L�5_A 2&125 Azz 06V& Buyer Date I hereby certify to the /� ZZ-R I LOT AREA: /�G/GG Building Inspector that the pro- ZONE LOT FRONTAGE: A�4Z- posed construction shown conforms to the dimensional zoning of FRONT YARD: /5 / SIDE YARD: 16r-- REAR YARD: J�Gt� 51IZif9 Mass. SCALE: 99' DATE: Alljlll ZS LL lI - REFERENCE: h BK We PG 7S Christopher R. Me110 PIS' 31317 104 LOWELL STREET PEABODY, MASS. 01960 (978)531-8121 FAX:(978) 531-5920