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33 OSBORNE HILL DR - BUILDING INSPECTION 1C4 #-yroc, The Commonwealth of " it 'a��gl?u'LAkwICES Department of Public Safety Massachusetts State Building C g� ��� q 'n p �� Building Permit Application for.any Building other k#t (9rt �r tI WtStF�irlly Dwelling (11us Section For`OfficiaE_Use Only)' Building Permit Number. Date P:pphed: Building Official: SECTION 1:LOCATION-(Plewe'.Lm catelBlork#'ertd'Lot.#for locations for which a street address is not available) ' No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2tPROPO5ED WOR I Edition of MA State Code used_ If New Construction check here or check all that apply in the two rows below �n Existing Building❑ Repair E3 I Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: 1 Are building plans and/or construction documents being supplied as part of this permit application? Yes No o w 66`1 Is an Independent Structural Engineering Peer Revirw uired?`1 (� ff }�-Y ❑ No Brief Description of Proposed Work:�1, rQLs. cu 1 sinaI� � mdy IIW �i11Q SECTION 3:COMPLETE THIS SECMO%IFBXISTINGiBUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE3iV tISE:OR.00Ci7I'ANCY Check here if an•Existing:Buildinglnvestrgafion,an&.,Eyaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING;HEIGHT AND AREA Existing Propo ed No.of Floors/Stories(include basement levels):&Area Per Floor(sq,ft) Z' sto Total Area(sq.ft)and Total Height(ft) p'LI4b SEcnoN-S:U$E?GROUP.Checkas.ap licable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-10 A-5❑ B: Business ❑ E: Educational ❑ F. Facto F-1❑ ffigh Hazard H-1❑ H-2❑ H3 H-4❑ H-5❑ 1: Institutional 1-1❑ I-2❑ 13:❑ 1-4 ET M:,Mercantile❑ R Residential R-1 R-2❑ R-3❑ R-4 O S: Storage S-1❑ S-2❑ U: 'Utility❑ Special Use❑and please describe below: Special Use: . SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ Ill ❑ HA ❑ IIB -❑ MA ❑ = ❑ I ry ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780-;CMR 111:0`for-details on each item) Water Suppl Flood Zone Information: Sewage Disposal• Trench Permit:. Debris Removal: Public Check if outside Flood Zone-O Indicate municipal- A trench��`'`/�'('not be, Licensed Disposal Site Private❑ or indentify Zone: or on site sys permit is enccll tem❑ required trench or osed❑ Railroad right-of-way: Hazards''to Air Navigation: MA Historic Commission Review Process: Not Applicable❑. Is Structure within airport approach area? Is their review comple d? or Consent to Build enclosed❑ 1 Yes❑ or No❑ Yes❑ No t SECTION fi:CONTENT OF'CERTIFICATE'OF OCCUPANCY Edition of Code:_8'h Use Group(s): Type of Construction: - Occupant Load per Floor: Does the building contain an Sprinkler System?: —Special Stipulations: SECTION?'P,ROPERTYOWNE 'AUTHORIZATION Name rid Address ope Owner OS (r1P,� Ir. x �8o Lin elf . �1A Wcffha Name(Print) No.and Street SW/Town Zip Prope Owner Contact Information: � 7 l-$��o� mps c ry\ Tide Telephone No.(business) Telephone No. (cell) e-mail addresg If ap licable,the prope owner hereby authorizes P.Q. .fix ?8 0 MA--Q 91 . Name Street Address ty/Town State Zip to act on the property owner's behalf,in all matters•relative:to work authorized.by.this building permit application. SECTION 10;CONSTRUCTION CONTROL:(Pleaseffll-out Appendix 2) (ifding is less than35,006 cu.;ft o£enclosed ace axid or no#'under Consiraction Control then check here O and ski Section 10.1 10.1Re 'stered'ProfessionalRes 'onaibleforCon"stsuc[h1*1A-ihtini Telegh'one No -'mail s Registration Number Street Address Cit}cf� own State Zip Discipline Expiration Date 10.2 Cpneral Contractor Company Name ,� ilk i 11 j��&OL—e %�5 2'71 ► F�7 �on4,uAon. Mrs' so ,Name of Pe Responsible for Construction' �.t No. and Type if Ap licable o, ��.�x * 78 0 *jL"l+i e M �Lgy O Street Address �ty/Town State Zip Tele honehone N� Tel hone.N0, cell � I e-mail address SECTION'lE:WORKERS'olMP SSATION'IN3FJRP; CE'AFFID V1TE: G.IL c.152§25C 6 A Workers'Compensation-liisurance:AEfrdavrtfiomthe<MA Departnientaf-Industrial Accidents must be completed and submitted with this application. Failure topmvide thus affidavit willfresult in the denial of the issuance of the building permit. Is a signed Affidavit submitted withHvs;a lication? Yes O No O SEC7I0NA2.CUNS7'RUCTiS)lV;COST&AND PERMIT FEE Item Estimated-Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ S o U Building Permit Fee=Total Construction Cost x_(Insert here 2 Electrical $ o p 6 appropriate municipal factor)_$ 3.Plumbing $ p O 4.Mechanical (HVAC) $ C p Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ D p p'p -(cantactmuni ' and write check number here SEi TION33::SIGNATf3R$;OF-BUIWING�PHRM&APPLICANT By entering my name below,I.hereby attest,"der"the'painsand;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 si ame it o'•H.R.1. Tit Telephone No. Date Street Address Ci own State Zip / Municipal Inspector to fill out this section upon application approval: Name Date ACm,RhP CERTIFICATE QF LIABILITY INSURANCE DATE(MM/DD YYVn THIS CERTIFICATE iS:ISSUED'AS A R OF.INFORMATION ONLY AND CONFERS NO-RIGHTS.UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES:NOT AFFIRMATIVELY OR,-NEGATIVELY AMEND;-,EXTEND OR4AL'TEW 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.EERTIFICATE HOLDER: . IMPORTANT: If the certificate,Bolder is.an ADDITIONAL INSURED the Pblicy(!as).must be'entforsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,eertaln 're policies;maygill and -A statement on this certificate does not corder rights to the certificate holder in lieu of such endorsement(s).`.;; PRODUCER -NAME CT:Select Dept ext 66807 Eastern Insurance Group LLC ':PHONE -.{508)i651-7700 Fax 233 West Central Street ' u alss•seleetmork@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC M Natick MA 02760 _INSURED INSURER-A'-ACadi:a Eriaurance Company Conpany 1325 DiBiase Corporation, DUC Resiciantlal LLC ,IN SURERC-: Osborne Hills Realty Trust :':INSU.RERD: P O Box 780 INSURERIE--: Lyanfield MA. 01.94.D. a:INSURER'F: COVERAGES CERTIFICATENUMBER`31aster 14'-15 ./, GL;-Only REVISIONNUMBER: THIS IS TO CERTIFY THAT THE POLICIES OFINSURANCE LISTED BELOWNAVE'BEEN ISSUED TO-THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RED UIREMENT;•.TERM OR„CONDITION OF,ANY CONTRACT OR`.OTHER-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 SHOWN=MAY HAVEIBEEN REDUCED BY,PAIOCLAIMS. IITR TYPE-OFINSURANCE - 'POUCYNUMSER� r - PMILICY I FF (P0'QCVIDE .EXP LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000E-T�RERT- PRE S Per c $ 25 ,000 A CLAIMS-MADE �OCCUR �' 7A0191229-17 � /23/2014 /23/2015 MED EXP Anyone one Person) 5 ) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP qGG E 1,000,000 7X POLICY PRO- '.LOC $ AUTOMOBILE LIABILITY OMBINED INGLE IMIT Ea accident ANY AUTO - BODILY INJURY(Per person) $ ALL ONMEO SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOSWED P O EERd nt AMAGE $ AUTOS E UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERANDEMPSCOMPENBATIGN 0286738r15 Y23/2014 /23/2015 WO STATU- GTH- ANpEMPLOVERS'DABItnY YIN: x LIMITIR ANY PROPMETOR/PARTNER/EXECUTNE 100 000 OFFICFPNEMBER EXCLUDED? NIA E.L.EACH ACCIDENT E 11 en de,-n NH) EA EMPLOYE $ 100 000 Ii yas,desdibe untlar E.L DISEASE- DESCRIPTION OF OPERATIONS belay E.L.DISEASE-POLICY LIMIT E $00 000 DESCRIPTION OF OPERATIONS/LOCATIONS I VENICLES-(AMneh-ACORD 101;AddlUonal Remadn`SeKedule;H more'spaee Is required) CERTIFICATE HOLDER _ - :CANCELLATION: :SHOULD ANY;OF THE:ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCE-WITH THE POLICY PROVISIONS. Salem, MA 01970 AUTHORIZED REPRESENTATIVE John Koegel%RABI ACORD 25(2010105) ©4988-2010 ACORD CORPORATION. All rights reserved.INR025 rvmm�s m TNe Ann 1 name anA lnnn em mnleremrl martra of of npn f/Z�4�-45 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 SAZeX MASS. �P�iv SB�cc A $z,oa 11,T 98. 0 a �Z�ioix � ��s49 1075 fa /6 P/?"OP p ti $Z•oo CLU57�(L I hereby certify to the 5WL1, 1 Building Inspector that the pro- ZONE: p/ LOT AREA: &&E' LOT FRONTAGE: kot E posed construction shown conforms ) to the dimensional zoning of k FRONT YARD: IS(T SIDE YARD: Mr REAR YARD:30r-/ $A[Eq/f Mass. SCALE: `IO DATE: AM(H I q Z0J3E REFERENCE: P6 BK 402 PG 7� UirjOl5pher R. Mello PLS-j3. .317 104 LOWELL STREET. PEABODY, MASS. 01960 (978) 531-8121 Cnv. rnIM rot cnon Professional Land Surveyors & Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN SALE.Y MASS. GP�N S��Cc A 82,o a �o T 98 BZ�ojsr f0 :� �Q�GcSEn ti �q b L.C-cUe- lbt $2 oo D58a2a H/ LL�Sr�2 I hereby certify to the S9lE,R Building Inspector that the pro- ZONE: h7l IAT AREA: &MALL" LOT FRONTAGE: k0be posed construction shown conforms to the FRONT YARD: Xfr SIDE YARD: 1()� REAR YARD: 30//`/ 5XIEensio maoninvy of mass. SCALE: a 9a DATE: M/1 f2L I C1 ZDIIF . REFERENCE: hG BK 4a PG 7% -ChiAl5pher R. Mello PES-31317 104 LOWELL STREET. v' PEABODY, MASS. 01960 a;t (978)531-8121 CA V- MIO\ CO1 COOn Professional Land Surveyors & Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD 8 WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN 5,4L.~10 MASS. Gp�ti SB4cc A SZ,00 l�T 98 r b2�a a sr <LT7 � LGT�7 /a b�C-LUe- /be v 3c 1a, 8200 A//« 0/?/ CL057�2 I hereby certify to the S1fZ1510 Building Inspector that the pro- ZONE: LOT AREA: &445r LOT FRONTAGE: &0k,5 posed construction shown conforms to the dimensional zoning of FRONT YARD: SIDE YARD: 10Fr REAR 1ARD:30/`/ id1,Flo Mass. SCALE: a qa DATE: AM(P I C( Ailj . REFERENCE: P6 BK 46Z PG 7 'Chjiltl5pher R. Mello Ns M317� 104 LOWELL STREET PEABODY, MASS. 01960 (978) 531-8121 ❑AV- MIM "0 CnOn OSBORNE HILLS REALTY TRUST 3195 City of Salem 6/10/2015 Bldg Permit-SWC#48 1,750.00 Cash - Banknorth#74 Bldg Permit-SWC#48 1,750.00 r CITY OF SALEM ROUTING SLIP .New Construction Certificate of Occupancy i v4 * 45 LOCATION Dx #'I�\ r. DATE ASSESSORS &V )�1 DATE 93 Washington St. �a 93 �/ashi, PUBLIC SERVICES �/�1�" DATE 120 Washington St. l WATER DATE 120 Washington St. 1 CROSS CONNECTION DATE �6U' M0 _5 Jefferson Ave PLANNING DATE 1 I S 120 Washington St. CONSERVATION DATE 120 Washington St. z sEE L� f�. _.-._ 48La�la � 't1! G ��pp " FIRE PREVENTION(024,,,,�,_SC,t DATE :Zj/ir 29 Fort Avenue 70W5sHtig<o BUILDING INSPECTOR DATE 120 Washington St. .. Professional Land Surveyors B Civil Engineers. ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 19Z0 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN 5,4ZLO�10 MASS. �o�ti S9�cc A 81,06 Zo T 98: o / 6Z 06 ;, P/lo�iFEt7 a �lq bGt'cU� lbt` c 3c 10'. 82•00 CL05 I hereby certify to the 54ZL'10 Building Inspector that the 'pro- ZONE: P/ LOT AREA: 448 LOT FRONTAGE: hDtiE posed construction shown conforms to. the dimensional zoning of FRONT YARD: 9ft SIDE YARD: Ion;- REAR YARD:'30/`/ 5,(L Mass. . h ' SCALE: DATE: Aid(k I cff ZO)-4 REFERENCE: n6 BK 4OZ PG 7 Chr• opher R. Mello PLS �g��317V 104 LOWELL STREET 1, PEABODY, MASS. 01960 �Gn SUS (978)531-8121 - - FAY- MR) F31-fi97n