13 PATTON RD - BUILDING INSPECTION S
�L*IIAS VEO aw T44E
� ��� P AVINO GRANTED
CITY OF SALEM
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BUq.D9Mi PMfT APPLICATION FOR: '
• Ponnk t0:
(CkoN whlo WW apply) Roof, Rwwt, In" 81dk Congn:ct.Da0 Sled, Pool,
RopaldRoplaao, Ovw.
PLEASE FILL OUT LEOILY A COMPLETELY TO AVOID DELAYS IN PNMMW K
TO THE INSPECTOR OF BUILDING&
The ur4w@*W hereby applK for a ponnk to build aowrftq to ft fokawirls
O a Name Zen". 4•�� JUln�i C�L,D��rO �% fLG.�
Addreaa A Phone (979 1 7Sr5 _C�7 9 7
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wa is to PAPON ile"of �il`es ��2 �u•p/��9 ,rir
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ad�rd ood' 3 y9 ckv uo r N A aa.Uo r
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SIQNF,D UN®ER liM
OF PERJURY
DESCRIP'i10N OF WORK TO BE DQNE /
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MAIL PERMIT TO•
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ll�1 h _ Todd A.Niemasryk,ME`
{l`r OwneUGenera/Contractor
Tel:9T8d55-565
Fax: 55-199T�
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E-mail:todd@atlanticbuilder.com
www.atlant/cbullder.com
Consbuclion Supervisor License#:CS O79678 Fully Insured
Home Improvement License#:139121
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PUBLIC PROPERTY DEPARTMENT
120 WASH INOTON STREET, 9RD FLOOR
SALEM, MA O 1970
TEL (978)745-9595 EXT.980
FAX (978) 740-9646
STANLEY J. USOVICZ, Jot.
MAYOR
DISPOSAL OF DEBRIS AFFMAVff
In accordance with the provisions of M(X c 40,S34,I aclmowledge that ss a condition
of Building Permit N . all debris resulting from the construction activity
governed by. this Building Permit shall,be disposed of in a properly licensed solid-waft
disposal facility,as defined by MOL c III.S150A.
The debris will be disposed of at
Location Of Facility
Signature of Pe®it licant Data
FULLY complete the following inf madm.
gLEASE PRW CLEARLY)
Name of Permit Applicant
zzc
Firm Name, if any
1-11�91Zlv146H z�
Address,City dt State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility 88 defined by MQ,CM S 150A,and the building permits or licenses are to
indicate the location of the facility.
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Commonwaahk01 frla�achu3itt.4
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James J.camooal a>oN.w, /1/eassc�i+wfb 02111
Comnssiaw .
Workers' Compensation Insurance Affidayit
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. . wither principal place of business at:
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do hereby'certify under the pairs and penalties of perjary, that
() 1 am an employer providing workers' compensation coverage for my employees working on
this job.
_Tafh# =s « ct
Insurance Company Policy Number
I am a sole proprietor and have no one working for me in any capacity.
I am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who-have the following workers' compensation policies:
Contra r Insurance Company/Pol'tey Number
Contra or Insurance Company/Policy Number
Contra or Insurance Company/Policy Number
() I am a homeowner performing all the work myself.
I untie ne"I a coot of"wan m wa t, is Maroed m taw Orke of 1"Vakawm of the OIA 'or ce.eeate r--idle"a"e an b1m ed"cWq
eo.rrnr as rrowro unea Swdon 15A.el HGL 1 S 2 can kid w Ow inoewion of o+a"a,oehfm eorasdnt of a hw of w w4I.S00A0 A"VW one
yea",iaoroonnml v.eea a ei,i ea mL;ej in the form of; STOP WORK ORDER area fine of $100.00 a car ,ra:ue are.
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Sirned this • �����ev� i day of / _ a005",
._ictr.5ct/'Ferrtiltet cuildirtg Depar-LTent
'iceruinq Ecare
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Attach ledger board to house with flashing (2x8 PT)
Dig 4-ft deep hole below grade for cement tube (10" dia.)
Pour cement and install J-bolt
Install 4x4 post and secure to cement using cement to wood
bracket
Install all hanging brackets on ledger board
Install 2x8 joists
One 10" X 1�2" J bolt for Install all 4x4 railing posts
Install Correct Deck Signature Series Cedar decking
securing post to footing Install Correct Deck Classic Series Cedar on stairs
Relocate railing to match existing deck
10" sauna tube Install new railing section to match existing railing design
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MOR - First Floor Plan
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I.ANDCOURTSURVEYS SUBDIVISIONS REGISTERED LAND SURVEYOR REGISTEREDCML ENGINEER
LOTSURVEYS MORTGAGESURVEYS - CONSULTING
fin/ 5'73 -7�a7
PARSONS AND FAIA, INC.
60 LEIMIS STREET LYNN, MASSACHUSETTS 01902 -
/L) 593-79J27
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See attached sheets
for details on deck
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See attached F � ..``
for details on house house S.r�'f'� 1sEm
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