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25 OSGOOD ST - BUILDING INSPECTION (2) y - ?ulCuAC_ iu� .i ,•.jnuI • >visi, AI .v III >j I `i70 I i 97$145.9r+95 # Iles,o-s.-.in.9e.io APPLICATION FOR PLAN EXANIINATION AND BUILDING PERMIT LA—Ll, 13UILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS INIPORTANT: ,1 r tlicants must complete all items on this pa ge SITE INFORMATION " Location Name 2.4 Clsi nnrk fit• Building Property Address Loaned in: Conservation Area Y/N Historic district APPLICATION DATE Use Groups (check one) Group Humes R3 R4_ Residential (3 or more Units) R2_ Type of improvement Residential (hotel/motel) R1 _ (check one) Assembly (Theaters) Al _ New Building _ Assembly (restaurants & clubs) A2r_A 2nc_ Addition Assembly (churches) AI Alteration Business B_ Repair/ Replacement Educational E_ - Demolition_ Factory (moderate hazard) Fl _ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building Institutional (residential care) 11 _ Institutional (incapacitated) 12_ Institutional (restrained) 13 Mercantile M _ Storat,'e Sl _Moderate Hazard Sturafle S2 Low Hazard OWNERS11111 INFORNIATION(I'lease type or Print Clearly) OWNER Name `tMteNnoa.\ S��poreX Address 2S C se�eod S� Telephone 4 6 zto2 Signature DESCRIPTION OF WORK TO BE PERFORMED rm ESTIMATED CONSTRUCTION COST l09'15.(n ') fJ CONI'R.Wl'Olt INFORMATION , 1 i Name K 1,\ - 1-.uu\6t0 C O Qnf-CA Nrtt1 Address 2dKs GUa. 54. 5 _ 91h Telephone sOs �q�tii567) Construction Supervisor's Lic # 5 I O t/T Home Improvement Contractor # t a 60 a 3 ARCI11'I EXT/I:NGINEER INFORMATION Name Address Telephone Mass. Revistration # PERMIT FEE. CALCULATION Estimated Cost x $11/$1,000 + $5.00= 82.67b COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knoivlerlge tinder the penalties f perjury Signed (owner (ascnt) APPROVED BY : DATE APPROVED: » The Commonwealth of Massachusctts Board of Building Regulations and Standards 'Town of " y Massachusetts State Building Code, 780 CMR, 7"edition Building Dept , - Building Permit Application To Construct, Repair, Renovate OrDemolish ar ` dd _.- .. One- or Two-Fancily Dwelling o-a.. doom& This Section For Official Use Only 3 ' <s, Bwld in,gPe_m:n.N mbe ,�_ A=..ux Date Applied: � a :. Signature - -BuiidingCommissionerbinspectorof Buildings Date SECTION 1: SITE INFORMATION xp ' -d 1.1 P.rope?S ddress:�.` w 'f - 1.2 AssessorsMap& Parcel NumbePs o �,d sk. - :, s ? r I.1a Is this an accepted street?yes no Map Number , {, ParceLNumber„v, F 1.3 Zoning Information: 1.4 Property Dimensions: . r . Zoning District Lot Area(sq R). 7Frontage,(ft) a G - 1.5 Budding Setbacks(ft) _ T- =>?rr �,lp , , •rq Mtn i$R� t r.,.t a" Y_ a ''3 h _Front Yazd > Side Yards Required - Provided - Required - Provided - Required Provided 1.6 Water Supply:(M.G.L c.40,§54) .1.7 Flood Zone Information: - F' 1.8 Sewage Disposal System: ` - A 'Zone: - Outside Flood Zone? -s'" <` ' t+'.: '• "' -"'";, F Public❑ - Private❑ - - — . Municipal❑ 'Oii site disposal system ❑ '.. Check if yes❑ _ SECTION'2: PROPERTY OWNERSHIP[ 2.1 Owner of Record: , Mke\r.i%,V 25- "['BSc e�c,c1 T . r:wr .�.:•ier'ti,y ; Via'? ".- " I . Name(Print) -_ - - - - Address for Se e: 4 Signature - Telephone - # 4 .• -,-,� - -�„ ,A SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that epply) _ New Construction❑- +Ezistin Build n ❑'' '-0wner-0ccu ied-,❑ Re airs s „❑_;:;Alterations ❑n 1,—;Addition:0 B.. g P P O O ti,c'G •6 OflnitS"" Othei S cm n . ❑ Ary Bid ,'❑ 'Number :..... Brief Dwri Lion of Proposed Work': TiQ ,- ai-A 4et_ CtI -rxs��nA* s�wT Ca a.ln F 1 .A r - SECTION I: ESTIMATED CONSTRUCTION-COSTS+ tk 7 Item -Estimated Costs: Offi Use.cial U Only ., tabor and Materials) yx.'+'a at . 1. Building t+ - �. r ;$.: L. Building Permit Fee: $ Indicate how Tevis determined:, ,} 0 Standard-City/Town Applica[ioii Fee ' "`' t ";"' '"` 2. Electrical $ , O Total Project Cost'.(Item 6)x multiplier n.ys x, 3.Plumbing $ 2. .Other Fees: $ A. Mechanical (HVAC) $ List: •5. Mechanical.(Fire Suppiression). : r*� ' . Total All Fees: $' _- . _. - r . S "t _ � Check No. - Check Amount: 4 � Cash b:ToEahProject Cost. '$- (¢.Q�6:� ❑Paid in Full r❑Outstanding Balance Due .n P•.- 2n n+ ''G n'°y M 4 fiR'R Y 'PA '�' `•St "& rw v[pE M�+vy. , rr t _M. c"➢ ..tn ✓ �b , Nn it s'+,y.,ayd i�.m sZ !f S"t " ` s ^ rNR Y � 6 $b.Si 'Y- I P. l .�'.l ^MB-' K •r.,v ,i. Y b+e +Y '4!'1 r SECTION 5 CONSTRUCTION SERVICES lr,�Licensed Construction Supervisor(CSL)+� ` z s¢z+„z't�-tN-r'"tad �`ix + „ o gmax er"ak�'1°'}I I" I.T. "n.`, TA &v 7.r License.Nuumbert€�"m«.;'(7 u.Exp;ra�tt n Date;zS ..a.° Ider i i =..nix-,r"' .' sx x3 x -s ' 'tl.� t�4*' ` <List C3L Type(seetbelow) <tiae":�a sK "c'''^" S .+-, ti.#• a '<k ¢:-.. n fiLlaR 4tc nt xircosfw r� -�, T : u: Y Unrestricted =�R Restricted I&2T Famil Dwell in •ir Y. K ��, , rtRC' Residenhal RoofinCovenn �+ x"2^ux�' .f��" ">ra ,-=r' W-W s t'Residenttal Window S z, R. "t4'SFW. Restdetitiel Solid Fuel.Bumm A" Nance lnstall�ahon^n�* ���; $;-D� tRestdentiAPDemolmon�+ W 4hXn Y 'i f .1'I=rv'v FFa"} Y4.R T+{3, �! f a3 d i! y a5 2Regrstered Home ImpravementContractor(HIG7rI� a� �J ��, EA `x`u���'" ,yeµ -t^ , HIC Com an Name ordH}lC Reptstiant Name "� G } '��, '; Regtstrahon Numbers �_. " q.G.�i� Mi ddres �.'. ' xpironDatIhone'* ^.wy.� w '' _ 4 �^^,v;- s,..,-srvf '�i o-ve^ Y� t ES CTION 6 WORKERS'�COMPENSATION1INSURANCE AFFIDAVIT�(M,G L-ac ik ,C^ '" p .c *+C x.�""aYX�*$'L-sF'a V AL•"e4rat�'-w.«.+aryn. ., e... a wai > ,r.w. 1^9. Workers Compensation Insurance affidavit,thust be completed and submitted with this application ure Fail to provide 1 ;this affidavit{will result m t}ie detital of the:Issuance of the buildmg'peimite r ' d h Signed1AvttAttaCIV -VI ffda - r> F =SECTI01__t,7s OWI IE& 'UT,HORIZATI.ON TO BE.COMPLETED WHEN :. r Kr �y OWNER'_S ACENT'ORiCO1VTRACTOR RPPLIES FOR BUILDING PERMIT ef� MT, r � , ='wk x ;.Gn'� t .� as Owner of the subject property hiiipby� , 4. authorize "Il �'�''i":',tyt,(k t vact'on - behalf;in all mryatters% r . relative[o work autit,,nzed by this building permit application _ F,•# ems, �e s a -was SAiT.s Yk" 3yF"°,�='«i7': 3^ -Si atureof T -":.Date SECTION 76 OWNERi OR AUTHORIZED AGENT DECLARATIONt 14'1o() as Ownei or Authorized Agent hereby declare r Lthat the statements and mformabon on the foregoing apphcati erano�triie and accurate to the best of my knowledge ani - e .5,a'C..vTT t behalf .Y'.�t�. .�''Nr?".•"ar^ ' xL�w-_w {- '�t'L-:-.a �, xyfca. 'c""." F yg T U . '.,a ,st. a'"t __ -:-...`a'.3 ham+ Y' r , tick x.»Twt- d x ]Y i+l•-_ .v- .ar r a.t: 5 f .a.r»�"+s 'ir-ae.++ce -»!'+W win 5. � i b, y, .,,--�.;a M- •kv-. P-N..gr.. .8�� ."L y N w,«..,e�. S.Aw e - CT 'v Prm[Na,ii!: v :+` tr,t. r e'.rw^•.iwx. =� ss •s�w+ a Ott - +e uxs „&x y* a+ k+. S.y�s�aicc..*".-rr #, ` ti "1t ' �" Si nature oaf Owne or huthonzedA ent""'a '•"'i " : a �s Date -' s'-,". 's --'- t '"r - x x, r , '-nw i �e n •. b� Si ned under the ams and enalhes.of er u -'s,' ,.� * s ;rv3,.w 's '.L... � -+ _ `"�" x: i i . _ ,s c�^.r+ s: * + .wr �s "'�,v .. _. NOTES r, .• ` -e % , 'r.`� .rt. -...'�Z "�- .,. E� :1T An Ownenwho obtains a bmldmg permit to do his/her own work or aniowner who hires an unregistered contractor k k , ,, `n°(not egiistered in Ili Home Improvement Contractor�(HIC)Pro'gmm),'will'not have access to the arbitration fir* prtigramor�guaranty fiindlurid�eraM G L kc 142A Other impotfAn[,infotmation on the HIC Program band z W �'� �} ���.2�+ Wheri substantial work isLilabned'�(roS id)e the mfoornia[ion bOoc`MR Regulabons 1 IO R6�` I�IO.RS�r�especc�ti�ely a .4, k r �e? ;Total floors area(Sq Ft)�. � :�'� �* (including garage finished basement/attics decks or porch) �' _- E`t.-T G. w::'^i"*7'x a _,4� ,t .;Gross living area(Stj..Ft) x" -. •�.•_ ]..:`�Habitable room count. , .� 'Numberofbathroomsr - -"' Number ofhalf/baths - - Type of heating system , Number ofdecks/porches - :;_,.. ,Type ofcoolmg system ,Gi =k F<.�:�.x » '�":=1 - ' :Enclosed =' Open "`f r 32 .. . _. . .. • r .. -; •-3 TotalTro/ect Sqtiare Footage'may be substituted for••Total Pro)ec[Cost'- t' 1r CITY OF $ALLM PUBLIC PRc)PRERTY , DEPAR-I•MENT i. l r • \\II \I. \bN..•+ I . . i'+ construction Debris Disposal .affidavit (reyuircJ liir all demolition and rcnu\ anon %%Otk) In ❑ccunlancethu si `th edition of[lie Slate Building Code, 7S0 Ch1R section 1 I 1 .5 Debris, and the pro\ isiuns tit MGL c 40, S 54: Building Permit t is issued with the condition that the debris resulting from this \\urk shall he disposed of in a pruperly licensed waste disposal lacility as defined by MGL c 1 l I. S 150A. i The dchris Will be transported by: tunic nt hauler) I he debris will be disposed of'in ..K44A rO%A /ru ws i ew S F a c6r 1 t nulnr +t ludlty) . 'T'lE0 �oedwc.y Nle��a�— < t .mnulu� If pcmu( 'ly?phi ant CITY OF S.0 ENI PUBLIC PROPERTY DEPARTMENT Iu wwALU,r,,.KU,., Vwvo. 130WASMrwMow sTILErtr• S,uFx NwssAoa'stTn 01970 TEL 97.474S4M • FnIL 979.740-9M6 CITY OF SALE. PUBLIC PROPERTY DEPARTNMENT MAYMXHOMM , W*GrON STRE=• SALEK MASIAoa'sa7'is 01970 TEL 9'8-74S•959S • F.tX 97S-740.994 ENSE EXEIMMON Please PriDate lob Locati Home Owner Address Horne Owner Telephone ?resew Mailing Addrw The current exemption of"Homeowners"was cx ad to include owner-occupied dwellings of two Units or less and to allow such ho wners to engage an individual for hire who,does not possess a license,provided that the er acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides r intends to reside, on which there is, or is intended to be, a one or two family dwellin attached or detached structures accessory to such use and/or farm structures. A person ho constructs more than one home in a two year period shall not be considered a hom er. Such "homeowner"shall submit to the Building Official, on a form accept le to the Building Official, that he/she be responsible for all such work performed under Building Permit. caner" assumes responsibility for compliance with State The undersigned "homes expo ty p Building Code and other applicable by-laws and regulations. The undersigned "homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that h e will comply with said procedures and requirements. HOMEOWNERS SIGNATURE ,APPROVAL OF BUILDING INSPECTOR See other side for state code CITY OF SALEM �,r , PUBLIC PROPRERTY DEPARTMENT ,11Ic, N 11':)AM ,'I I \1 Ni,m 11C W,I,tt1\,:1,1.\51s1:1,1' • SAt Fill. M.t\1.t4 III it I Is i)07- I'IA y73-7t3-1595 • II Is 97x-74C'ss46 Workers' Compensation Insurance \fffdavit: Builders/Contractors/Electricians/Plumben \ 1 Ili\ant Information ` Please Print Legibly V i11TC lOu.Iuc,sa)rgan lr:uinu/I ndr,o luu h: V%A& lddre,ti: 3`2]b MM %V She q\U Cily,Starc,Rip 1 lroart✓ UX+ O\lg( Phonei':�tn .\re you an cnsployer? Check the appropriate box: 'r)po of project (required): I.((�l :fin a employer with IS- 4. ❑ 1 am a general contractor and t 6. ❑ new construction ' cnsployccs (full ansL'ur part-ante).• have hired the sub-con(racturs 7. ❑ Remodeling 2.❑ 1 ❑nl a sole proprietor or partner- listed on the attached sheet. , These sub-contractors have - g. ❑ Demolirion I, and have no employees working litr me in any capacity. ,workers' comp. Insurance. 1). ❑ Building addition INn workers' cum . insurance 5. ❑ We are a corporation and its l p 10.❑ Electrical repairs or additions I required.] officers have excrcwcJ their - ri'ht of client tion per MOL I I.Q Plumbing repairs or additions 3.❑ I ant a homeowner s*doing01 all work c y152, <l 4 ,and w have no myself. [No workers' comp. � O 12.0Rtiufrepairs insurance required.] r employees. (Ko workers' 13.0 Other coinp. insurance required.] •nm .ygshcuul Ihul chseks boa nl muss alwu till ion the secuan Iwluw shuwiny Ihcir wurktus NntpunW WIl puhey mit1rnWIlUM1 ' 11om.uwrcn who subnsiI this affidavit indicating they ore Joinp all work and I cn him uulwide cutumaron mual.uhmit anew uirJ"a indiuOny..wh. -f',mlcwwr,Ihul dseck thts box must atgchsd an additional.,h stl.huwiny IN n:unc of the sub-eontraewrs and then aurksn'comp.ptdlcy mfurman(in. i. fain fill c•ulpluyer thug is pruridht g wurkers'rttnspen.vntlon his"rance jar uty eutployeev. Below is the pulicy all job vile iujurastuiun. n I r,surancc Company Vmne: Agnox-t eo-tn \ h� \ahc'j.... I'ulicv a fir Sclr-ins. Lic. d: CC) 7LL14 3 b^% . .. _— Expiration Dam: JAI 2 to � u� job Site Address: rZS OVA 41-N' —_— C•ILy;StatetZlp: �o.Q.9.Nn tJ✓P .Mach it copy of Ihe—workers' compenxutiun pulicy Jeclarallon page (showing file policy number and expiration date). I;ailure to,ccure coverage as required under Section 25A u1'\IGL c. 152 call lead to the imposition of criminal penalties of a tin: up to 51.5110.00 unrl/or one-year imprisonincnt, as well as civil penalties in the l'urm of a STOP WORK ORDER and a fine of up m S250.00 a day against the violalor. He advi.<cd that a copy of this statement may be lurwarded to the Office ul _ Im.,Iie.+u,nu uY:hc Ul,I, :or ❑ ,marcc an s.lgu tcritication. Is /du hereby s ertijv under the pain a, tat s/nev ujprrjury that the injurtnution provided above is true and correct. rl, T6%-7 9sffa U/jiriul live aady. Da not write itt this area, to be cuutpleted by city ur town ujji4ial. ('itv ur futon: __ Permit/License 0, 1,,uinp .\ulhurily (circle onc): I. Board of llc:dlh Z. Iluildiu-4 Dcparmiciet .i. (:itj,•fonu Clerk 4. Electrical lnipcctor 5, Plumbing Inspector 6. Other Contact l'c nutr. .. ._ Phone 7: ncoRON CERTIFICATE OF LIABILITY INSURANCE F 1DATE(MIN/COIN W) 9/2/2009 PRODUCER •(5'08) 699-7511 FAX: (508) 695-3957 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ` R. S: Gilmore Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 27 Elm St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 126 N. Attleboro MA 02761 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Gemini Insurance Kidd-Luukko Corporation INSURER B'Pboenix Insurance Company 25623 340 Main Street, Suite 910-13 INSURERC.Evanston Insurance Company INSURER D'.AXIBr.iCan International Group Worcest r MA 01609 1 INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, 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 ORBUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD POULI'EFFECTIVE POLICYEXPIRATION TR INS D P N POLICY NUMBER LIMITS GENERAL EACH OCCURRENCE $ 1,000,000 III X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocamenra $ 50,000 A 'I 'r_I CLAIMS MADE OCCUR GP009694 9/1/2009 9/1/2010 M ED EXP(A,Ore palmn) $ 5,000 I'X Contractu zd PERSONAL 8 AOV INJURY $ 1,000,000 IX{ Wa1Ver of Sllbro_ GENERAL AGGREGATE $ 2,000 A000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPPOP AGO $ 2,000,000 j POLICY X PR6 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMrt $ 1,000,000 1 eNY AUTO (Ea a¢Wen[) B I_.J ALL OWNED AUTOS 111,66191,390 9/1/2009 9/1/2010 BODILY INJURY $ 20,000 X 1 SCHEDULED AUTOS HIRED AUTOS BCOLYINJURY $ 40,000 X NON-OWNED AUTOS (PeraPPOeM) PROPERTY DAMAGE $ INCL (Per actleerrt) GARAGE UANUTY AUTO ONLY-EA ACCIDENT $ r ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 51000,000 b C DeOucneLE Cotew107308 9/1/2009 9/1/2010 $ RETENnpJ 4 $ D WORKERS COMPENSATION WC STATII OT14 ANDEMPLOYERTUABILI YIN ANY PROPRIETORRARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERM.EMBER EXCLUDED'+ N❑ (Man" In NH) AC007443058 4/2/2009 4/2/2010 EL DISEASE-EA EMPLOYEE S 500,000 II yes,n 11'P,urger 3PECI AL PRO✓ISIONS[ Io E.L.DISEASE-POLICYLIMa S 500,000 E BOTHER Hub. PrX.p Pio, 10,000 COF4gRCIAL PROPERTY 5275440 4/2/2009 4/2/2010 Hub. Pex'aonal Pmy 25,000 20,000 DESCRIPTION OF OPERATIONS I LOCATIONS I V EHICLES'EXCLUSIONS ADDED BY ENDORSEMEW I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE 0 UM INSURER WILL ENDEAVOR TO MAK_ 110 DAYS WW ITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLGATON OR LIABILITY OF ANY KIND UPON THE INSURER, US AGENTS OR REPRESENTATIVES. Aim Gilmore/TGI M � � M Tim Gilmore/TGI LINO ACORD 25(2009101) 01988-2009 ACORD CORPORATION. All rights reserved. INSO26(moeol) The ACORD name and logo are registered marks of ACORD �l.n.,iC hind l. - Urpa rl mrnl I Public �.il r�� � Rnaiil IRuildm Hc_ul,il iim� .uul >i:ulJanl� Lir,ensc. CS 8104E Re stnr.t eel m: 00 SEAN G KIDD 233 EIGHT LOTS ROAD SUTTON, MA 01590 11/13/2011 r 7426 Restricted to: 00 00- Unrestricted 1G- 12 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Referto: WWW.Mass.Gov/DPS :a J , oar l� o B m t mg eCu inn ts' nd Standards Construction Supervisor License jj License: CS 81045 d� t y Explr ton _7.I1/13/2009 Tr# 10133 Y ., I '-.,F{estflcttpn Qp;. SEAN G KIDD 233 EIGHT LOTS ROAD SUTTON. MA 01590 Commissioner _ �e 1Gio�.>vnxcnuuo.�/I ��/L�a.�uzc�uroetYe Board of Building Regulations and Standards ' m HOME IMPROVEMENT CONTRACTOR 1 Registration: 136063 , Expiration: 5/6/2010 Tr# 267239 ;Type: Private Corporation KIDD-LUUKKO CORPORATION SEAN KIDD 340 MAIN ST. WORCESTER, MA 01608 Administrator