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35 OSBORNE HILL DR - BUILDING INSPECTION WU The Commonwealth of Mt�aS$ps�Fhl eftsRVICEs Department of Public 9�1'cty 1 U v Massachusetts State Building Code(780 CMR) /� �(� Building Permit Application fortany Building other thanlfj0Si dr�[WO�FdittAy Dwelling - fTim—"Se;dion For''Offchtr lse.Onl ) Building Permit Number. Date IA He& Building Official: SECTION 1:LOCATION(Please indicate`*Block#andLot.#forlocations for which a street address is not available) 11 V% yq ShAem MIN 01 tiro I� No.and Street City/Town Zip Code Name of Building(if applicable) 1 SECTl ZP.ROP,OSED-WORK t I\ Edition of MA State Code used_ If New Construction check bere or check all that apply in the two rows below U Existing Building❑ 1 Repair❑ 1. Alteration O Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) i Change of Use ❑ Changeof Occupancy ❑ Other ❑ Specify: ( Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No ❑/ON \ Is an Independent Structural Engineering Peer Re ew���ired?``11� (� y�Yeg ❑ No Brief Description of Proposed Work: rifwi�ruF'" 1 -t) Jinalp�I/GIPl�irxQ SECTION 3:COMPLETE THIS=SECTION-IE EMSTING B MDINQG UNDERGOING RENOVATION,ADDITION,OR CHPNGE�]N�USE:OR OCCUPANCY Check here if an Existing:BuiIdingrinyesp'gati"owand Evaluatiimnis-enclosed-(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): _ 'SECnON,4:-BUMDENGIMGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels):&Area Per Floor(sq.ft) Total Area(sq.ft.)and Total Height(ft) 2400 SECITON,!c USEGROUP ,eckas ap licable A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3'❑ A-4'❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto - F-1 ❑ F2:0 :-He•Hi- Hazard H-1❑ H-2❑ H-3 H-4❑ H-5❑ 1: Institutional I-1❑ I-2❑ I3'❑ I.4❑ M:;�Mercanh7eG❑ R Residential R-1 R-2❑ R-3❑ R-4 O S: Storage S-1❑ S-2 D U- Ulili#y-❑ I Special Use❑and please describe below: Special Use: . SECTION 6:CONSTRUCTION-TYPE:(Check as applicable) IA ❑ IB ❑ ILA ❑ IIB�❑ - MA ❑ ME ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7.SITE,INFORMATION(refer to:780,CMR MO for details on each item) Water Sup Flood Zone Information: Sewage Disposal• Trench Permit:.. Debris Removal: Public Check if outside'Flood Zone-❑ Indicate municipal A trench not be. Licensed Disposal Site 91 required or trench or Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: 'I3azards'.to Air Navigation: MA 14istoric Commission Review Pnxc Not Applicable Cl Is Structure within airport approach area? Is their review comple d? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No SECTION 8::CONTEN70F'CERTIFICATE'OF OCCUPANCY Edition of Code: L13"—Use Group(s): Eft, Type of Constriction: % Occupant Load per Floor: Does the building contain an Sprinkler System?:,HQ—Special Stipulations: i-' SECTION 9 PRQPEIITY`QWNER AUTHORIZATION Name nd Address P pert Owner al� -r. - ;X q80 olt+n Name(Print) No.and Street /Town Zip Proper Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) e-mail 4addre DrA If ap licable,the props owner hereby authorizes P.°; Address`l80 L Q�MA g194 Name ty/Town State Zip to act on the property owner's behalf,in all matters.relative:to.•work.authorized by this building ermit application. SECTIONIO CONSTRUCTION CON TROI (Pleasefill ouf gppendix 2) (ifbuilding is less than 35,000 cu..R-of enr]osed s aceand orrnot:uudei :mistructionConteol:than check here 13 and skip Section 10.1 10.1 Registered-Professionnall:Ites rnrnrnrn RonsiBle for Consfiti cttonCoatrol oul tyn�(Re ' ant) # no Tele hone No -„.- I `atails Registration Number Street Address n Ci V `: own State Zip Discipline Expiration Date 10.2 General Contractor Company Name Bul_ .-DL&asfk CS 2'714r1 N' sor ,Name of Pe n Responsible for Construction' i No. and Type if Applicable Street Address ty/Town State Zip &-. —°L89�_ 781-8 1 702 In�c� c i}Zclse Omec). f^�r,m Tele hone No.- usiness Tel hone Nm cell - t e-mail address SECTION;II:�WORKERS'C NMM,15A,1'fON:IN54IRANCEAFFIDAVITt: LG.T-c.152-S 25C6 A Workers'Compensation-insurance''tlfhdavitfrgat the IvIA'D'epartMentof industrial Accidents must be completed end submitted with this application. Failure to..provide this affidavit will result in the denial of the issuance of the building permit Is a signed Affidavit submitted with,this-a E lication? Yes O No ❑ SECTION 12iCONS I Ri7CTiO1V COSTS--AND PERMrr FEE Item Eshmated Costs:(tiabor . . and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ O 00 Building permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ o O appropriate municipal factor)_$ 3.Plumbing $ o D 4.Mechanical (HVAC) $ S O Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ sp- (contact municipality)and write check number here SECTION 19:SIONAT.i7R:E•OF:BLJILDIN6�PER GT APPLICANT By entering my name below,I.hereby attest.vnderthe'gwt4',and;penalties of'.peirjury that all of the information contained in this application is true and accurate to the best of my"knowledge-and understanding. Please print and s= n ( MC Q.H.R T Ti eN -LAllabdi _ _ „Telephone No. Date Street Address [7U Cit Town State_ Zip Municipal Inspector to fill out this section upon;application approval: Name Date ACQRbPCERTIFICATE OF LIARILI.TY-.INSURA'NCE DATE(MM/DDYYY vz 4/2/2014 THIS CERTIFICATE IS TSSUED.AS A-MATTER OF"'INFO"RMATION ONLY-AND CONFERS.NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR`-NEGATNELY AMEND,?F)CTEND OR:"ALTER.THE.COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE)TOES CON$TITUTE`A 'CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,,AND THE.CERTIFICATE;HOLDER IMPORTANT: If the certificate holder-is an ADDITIONAL INSURED-the POilcy(les}must b0 endonsed. if SUBROGATION IS WAIVED, subject to the terms and conditions-of"the policy;Certain podoles;may requIre, endorsement A statement on this certificate does not corder rights to the certificate holder in lieu of such endorsement(a);-, ... PRODUCER NAME- Select Dept Iaxt 66807 Eastern Insurance Group LLC '-PHONE •sal; .._(SOB),655-7700 FAx T A/O ( 81)586-82dd 233 West Central Street ooale elet6iork@easteminsurance.com INSURED INSURER S AFFORDING COVERAGE NAIC k Natick MA 01760 _.'iNSURER"A•Ac3dia Insurance Cc m an 1325 YNSURER:B: DiBiase Corporation, DUC Residential TLC r'�iNsURER C: Osborne Hills Realty Trust :IN'soREeD: P 0 BOIL 780 :':INSORERE: Lynn£ield MA 0194;0 ''INSURERF; COVERAGES :CERTIFICATE+NUMBER3faeter 14=15 /, GL:Only REVISIONNUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE,LISTED;SELOW'HAVE"BEEN"ISSUED TO TryE.INSURED�NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNATHSTANDING ANY REOUIREMENT;:TERM OR::CONDR'ION,OF ANY"CONTRACT OR_OTHER_DOCUNIENT 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 HAYESEEN.REDUCED BY PAID CLAIMS. LTR SR TYPE OFINSURANCE •POUCY NUMBER POUCY;EFF -MPM pCYEXP UMRS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY A�`€TSlFER1- PRE oaunence S 250,000 A CLAIMS-MADE OCCUR 0191229-17 /23/201d /23/2015 MEDEXP Any one person $ .5,000 PERSON ALB ADVINJURY S 1,000,000 GENERA LAGGREGATE S 2,000,006 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/pP AGG $ 1,000,000 X POLICY PIFCTRO- .LOG- $ AUTOMOBILE LIABILITY OM INED INGLE IMIT Ea accident ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED F7SCHEDULED AUTOS AUTOS BODILY INJURY(Peracciden0 S HIRED AUTOS NON-OWNED AUTOS PROPERTY nt A AG $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIPS CLAIMS-MADE AGGREGATE $ DED I I RETENTION AND KERS EMPLO RS'LIATIDN C 0286788-15 /23/2014 /23/2015 WC STATU- OTH- $ AND EMPLOVERRIPART ERI YIN: 1L ANY PROPRIETOR EXCLUDED? S 100 000 (MendeRrMEMBER EXCCUDED4 NIA E.L.EACH ACCIDENT (Manddoryin NH) 300 000 If yes,tle3piba antler E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAneih ACORO40I,Add1[orRfl R ule�Nmore'speee is required) CERTIFICATE HOLDER "-CANCELLATION: SHOULD•ANYgOF THE;ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEI EXPIRATION DATE_THEREOF, NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCE WITH THE POLICY PROVISIONS. - Salem, MA 01970 AUTNdMZE0 REPRESENTATIVE John Koegel/KABl ACORD 25(2010105) ©19M2010 ACORD CORPORATION. AO rights reserved. INR025nn, nw ni The Ar!t*I*n..on.anA In-n ero roniekurod„,a,he ni ACnRr1 Professional Land Surveyors & Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 .BRADFORD R WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN SXZZ�71 MASS. G�EYv S�i✓���" - a � Z4 40 Drt�D�s�n Is �s _u 0S�G2L�t //iLL Milf- CL�S�"CdZ I hereby certify to. the 2 LOT ilOdL"� Building Inspector that the pro- ZONE: LOT FRONTAGE: 1116,41L posed construction shown conforms to the' dimensional zoning of FRONT YARD: IJrr SIDE YARD: IIJG/ REAR YARD: 30�i 7` FZz-:w mass. SCALE: ! `n wf 99 DATE: AF/`Rl G I Lf//5 ' REFERENCE: BK J0Z PG All Christopher R. Mello PLS: 31317; 104 LOWELL STREET PEABODY, MASS. 01960 (978) 531-8121 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 5XZL-;71 MASS. G 1�E71i SP/✓CE"� - L��99 o 40 ORahs.-O M Zs 'f _u �ZriG OS�a2�t tip« ✓�2r�e CLUS�"Cd2 n ,ll I hereby certify to the S�L�l9 ZONE: 2 LOT AREA: / Okt LOT FRONTAGE: /YOfLG Building Inspector that the pro- posed construction shown conforms to the' dimensional zoning of FRONI YARD: lsr SIDE YARD: IDG REAR YARD: 30Pl SAL[ p! Mass. SCALE: DATE: REFERENCE: BK 4,�2 PG 1G/ Christopher R. Mello PLS�31317 . 104 LOWELL STREET PEABODY, MASS. 01960 (978) 531-8121 #; 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 5X Z ZF11 MASS. o 40 N nvcef�:. Zs Z" Zug OS�o2�t /�iLL_ ✓�/1il/C-- LL�Srrrz n pf I hereby certify to. the SALT/ ZONE: /� LOT AREA: lhlt"t LOT FRONTAGE: /LOOLL Building Inspector that the pro- posed construction shown conforms to the dimensional zoning of FRONT YARD: SIDE YARD: BOG REAR YARD: Mass. SCALE: 9 DATE: An kl� Z015 REFERENCE: BK -l(1Z PG JCJ Christopher R. Mello PLS:'31317 104 LOWELL STREET PEABODY, MASS. 01960 (978) 531-8121 CITY OF SALEM ROUTING SLIP ,New Construction Certificate of Occupancy_ L64--*41 LOCATION 35 QSkit(kC• ill d k-%ljt DATE ASSESSORS DATE 7 1S-- ISM 93 Washington St. 1%f «Eltay . ..... PUBLIC SERVICES DATE 1120 Washington St. WATER DATE 120 Washington St. CROSS CONNECTION —DATE 5 Jefferson Ave C, 1 7 157/ t PLANNING _DATE -7_ 120 Washington St. CONSERVATION-- DATE 120 Washington St. Z z tt'E vill 2�4 FIRE PREVENTION� DATE 71 r 29 Fort Avenue ITE wma; f ZDnaampn BUILDING INSPECTOR DATE 120 Washington St. hai Professional Land Surveyors Et Civil Engineers - ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN 54ZZ/71 MASS. LG�49 Z©U 14, 1�r4� l�s 40 0(IuP�SEO Zs 7 05(3,4 11)ZL ✓ 6vf- CLuSY"�EZ I hereby certify to. the 5VZZ;W ZONE: 2 LOT AREA: lfilku LOT FRONTAGE: ll'?IAiL" posed Inspector show the pro— posed construction shown conforms to the' dimensional zoning of FRONT YARD: Av y SIDE YARD: REAR YARD: Mass._ SCALE: I �v n DATE: /9 pklI Z(11 + aT PHER o R. �. REFERENCE: BK �&Z PG 1CJ Christopher R. Mell_o LSH31�31770/ : 104 LOWELL STREET 3 g PEABODY, MASS.01960 ? (978) 531-8121 FAX: (978) 531-5920