14 PHELPS ST - BUILDING INSPECTION 1 .
The Commonwealth of Massachusetts
® Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 20H
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 0ate Applied:
Building Official(Print Name) 1 Ire 3 Dat�
SECTION 1:SITE INFORMATION
1.1 Pro Address: 1.2 Assessors Map&Parcel Numbers
}� Ke S
L l a Is this an accepted street?yes_y no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Prov4 ided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public❑ Private❑ — Municipal❑ On site disposal system ❑
Check if yes❑
p SECTION 2: PROPERTY OWNERSHIP'
2.1 OwnI ^V i rl rr n jt fprdNS - -r-r 4±7 9►- Sa&44, M 0 I A b
12/ l.Y.,l n 1. � 9
Name(Pri n) City,State,ZIP
No.andNo.and S� Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
BriefcRPosed WorV: a Q,
SECTION 4.ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $$
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 5 �0 11 Paid in Full 0 Outstanding Balance Due:
r UU11C.ncatttt riututt rRut - rage 1 of
SUMNational Center for Chronic Disease Prevention and Health Promotion
Cardiovascular Health
a.....pa. Home 1 CVH State Program I Publications I Contact Us
Cardiovascular Health Program A Public Health Action Plan to
-
-
• About Cardiovascular
Diseases Prevent Heart Disease and -
• About the Program
• CVH State Program - Stroke -
• Statistical Information - -
• Cardiovascular Health Maps Introduction � ..
• Publications " a .,
• Proiects Purpose of the plan: To chart a course for the
• InterResources
Centers for Disease Control and Prevention
Resources
• Announcements (CDC) and collaborating public health a .z kmd
agencies, with all interested partners and the
public at large, to help in promoting
achievement of national goals for preventing
heart disease and stroke over the next two
decades-through 2020 and beyond. T
Heart disease and stroke are among the on this page...
nation's leading causes of death and major Introduction
causes of disability, and these conditions
can be expected to increase sharply as this Contributing Partners
country's "baby boom" generation ages. view/Download the
Yet these conditions are'largely Executive Summar/and
preventable. As expressed in the Steps to Overview
a HealthierUS initiative from Secretary of View/Download the Full
Health and Human Services Tommy G. Report
Thompson, the long-term solution for our Order the Report
nation's health care crisis requires
embracing prevention as the first step. To
reverse the epidemic of heart disease and stroke through
increasingly effective prevention, action is needed now.
A Public Health Action Plan to Prevent Heart Disease and Stroke
addresses this.urgent need for action. Key partners, public
health experts, and heart disease and stroke prevention
specialists came together to develop targeted recommendations
and specific action steps toward achievement of this goal,
rh.ough-a-pr-ocess-convened-by—D6-and4ts-parent agency,—th
U.S. Department of Health and Human Services (HHS).
Back to too
Contributing Partners
The special contributions of the following partners to
development of A Public Health Action Plan to Prevent Heart
Disease and Stroke, through representation in the Working
http://www.edc.gov/cvh/Action_Plan/index.htm 4/29/03
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) la52 3
Aed top s License Number E rrat' nDa[e
Name of CSL Hol r List CSL Type(see below)
15 opIr,yq Q
No.and Street T3= Description
Q 1 Unrestricted(Buildings u to 35,000 cu.ft.
IJ lv�, R Restricted 1&2 Family Dwelling
City/Town, e,ZIP M Mason
ry
RC Roofing Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
e
tfPd �IPDS� UAf12L11.rlL I Insulation
e one — I mailaddress D Demolition
5.2 Reg' tered Home Improvement Contractor(HIC) `I 5 l
_,6 7 11o�S I Z, 1 L
f Com or III Registrant Name HIC Registration Number Exp'ratio Date
f'(fJ—[loaD S PV&I QJ14. n 04
N and S et —�L-- Email address
M74s
City/To City/Tova State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No...........19
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PE�R%MIT ///��, _,,
1,as Owner of the subject property,hereby authorize Aki odyAn ./E C-t'/pky l rt[� -1 9
to act on my behalf,in all matters relative to work authorized by this building permit appl ca� alion. 1
2A v; N l ran Lt 1 1 Z
Print Owner's Name(Electronic Signature) Date
SECTION 7b: O t OR AUTHORIZED AGENT DECLARATION
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.
Jr. A Tr IANS a G� 3113 12-
Print Owner's or Authorized Agent's Name(E ctronic S' tore) Daze
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
Public Health Action Plan rage i of z)
• • Summary Recommendations
• Implementation
References
Back to too _
A Public Health Action Plan to Prevent Heart
Disease and Stroke — Full Report
B HTML files PDF files
Acknowledgements/Citation PDF (395K)
A Message from the Secretary
A Message from the Directors of CDC and NIH
Executive Summary PDF 127K)
Overview
• A Comprehensive Public Health Strategy
• The Challenge
• The Public Health Response
• The Action Plan
• Fundamental Pe uirements
• Summary Recommendations
• Implementation
References .
Section 1. Heart Disease and Stroke PDF (127K)
Prevention: Time for Action
• Summary
• Introduction: Planning for the Prevention of
Heart Disease and Stroke
• Heart Disease and Stroke: Scope Burden
Disparities and a Forecast
• Myths and Misconceptions
• The Knowledge Base for Intervention
• Evolution of Prevention Policy
• Healthy People 2010 Goals and Objectives
• The Present Opportunity
References
Section 2. A Comprehensive Public Health PDF (87K)
Strategy and the Five Essential
Components of the Plan: A Platform for
Action
http://www.cdc.gov/cvh/Action_PhWindex.htm 4/29/03
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BUILDING PERFORMANCE INSTITUTE, INC. /
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CITY OF SiuLEmll Akss.1CHl;SETTS
13CILOING DEPARTMENT
120 %V.h3HLNGTON STREET, 30 FLOOR
TEL (978) 745.9595
Fla(978) 74t .9846
<1 113 Rt EY DRISCOLL
MAY0:t IHOJLIS ST.PiERRa
DIQECTOR OF PUBLIC PROPERTY/Ot:Ii.Dr%C,CO.WMISSIONER
Workers' Compensation Insurance Af 1davit: Builders/Contractorv/Electricians/Ptumbers
Allllileant Infortnatinis po^ p C Ptepaee Print Legib)V
.N;11114.tnuaii�:.�Urgtnlratian,lnilividudll:FR�l'� \�J �� Q - G/f 9, 0 Ol�{(�/yO aP4�F>
Address: l Yd61LCGZ7
Cily/State/Zip: P61/2W , 1, q Dl slit Phone M:
Are you an employer!Check the appropriate bolt 'type of prn)act(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. Now,construction
cillployees(Rdl and/or part-time).* have hired rho sub•contracton
2.0 lain a sofa proprietor or partner• listed on the attached sheet, t 1. 0 Remodeling
.hip and have no employees These subcontractors have V. 0 Demolition
working for me in any capacity. workers'comp. insursnct. 9, 0 Building addition
(No workers:comp. insurance 5. 0 We are a corporation and its
required.) ofticcrs have exercised their 10•0 Electrical repair$or additions
).0 1 am a homeowner doing all work right of exemption par MCI
no I I.0 Plumbing repairs or udditions
myself.(No workers'comp. c. 152, )1(4),and we have 12.0 Roof repairs
insurance required.) t employees.(No workers' 12,�Other
comp,insurance required.)
nny applkwd nua duaka boa el mats alaw fill.al Iht aaeliaa balaw,showing Itlfis woakeW Compensation pollcy inlllrm011on,
'I h.nuuwnun wha.uhwia this amdavil indfcaaing Ihay am doing all want and then hire"laid@ Canmeaa`$mina rohmit a flaw anldavil indioling inch.
m IC- vaolun that chalk Ibis but most ill.achod an a1Willunal.hots.hawing the ni
ne ine of Ih m a bcumraCtara and ihalf wnekort'Comp,policy u iniorneon.
f allr on ewpluyer shut is pruv/ding workers'cumprurorlun inruruner/or my emp/uyrrs Br/uw/s llu policy and job site
h1foonutlee,
Insurance Company Name:
Policy 4 or Scif-ins. Lie 4: Eapirution Date:
Job Site Address: City/Slatlazip:
Attach a copy of the workers'compensation policy declaratlan page(showing the policy number and oxpintlen data).
railurs to w¢ ure coverage as required under.Section SSA of,(GL c. 152 can lead to the imposition of criminal penalties of s
fire lip to 11,300.00 undlur one-year imps i.ennment,as well as civil penalties in the form of a STOP WORK ORDER and a lino
of ull to UX(la a Jay against the violator. Ile advised that a copy of this..fatemenl may be forwarded to ilia 011ica of
1,1%"ligaliuns"I'llle DIA for insurance coverage vcrilicalion.
/du hereby vertafy surd ' r wld prnolder�a/perjury 1/tut r/ro injunnudun pruvideJ abuvr i.r vor and corrreR
Dater
U//iciul rece a,dy. /La rror ivrirt in r riv area,to be rumpleted by uiy ur town a//Iola[
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03-13-2012 62:09PM FROM-CLEMENT ARCHER INS. AGENCY 978-922-9276 T-251 P.001/001 F-845
ACORD CERTIFICATE OF LIABILITY INSURANCE 7POLICIFS
/2012/2012PRODUCER (978) 922-4600 THIS CERTIFICATE IS ISSUED AS A MATMATIONONLY AND CONFERS NO RIGHTS UPIFICATEARCHER INSURANCE HOLDER. THIS CERTIFICATE DOES NOTND OR271 CASOT ST ALTER THE COVERAGE AFFORDED BY THLOW.BEVERLY 14A 01915- INSURERS AFFORDING COVERAGE
INSURED INSURERA WESTERN WORD INSURANCE
Frederic Hopps INSURER B:HARTFORD UNDERWRITERS
15 Walcott Rd. LNsuRERc:SCOTTSDALE INS. CO-
INSURF.RO:
Ineverly NA 01915- INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU RED NAMED ABOVE FOR TFIE POLICY PERIOD INDICATED NOTWITHSTANDING ANY
REQUIREMENT,TCRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEIN T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB ECT TO ALL THE PERM$, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADVIL POLICY EFFECTIVE POLICY EXPIRATON
Ll'R INSRD TYPE OF INSURANCE POUCY NUMBER DATE(MM/DD/YY) DATE(MMMDM!) LIMITS
A GENERAL LIABILITY "P1304450 04/24/2011 04/24/2012 EACH OCCURRENCE b 1,000,000
X cGMMERCIALGENSRALLIASIUYY PREMSES ROEtGien S 50,000
CLAIMS MADE FxIOCCUR / / / / MED EXP(Any One parson) 5,000
PERSONALAADVINJURY b 1.000,000
GENERA AGGREGATE 2 2,000,000
GENL AGGRECAYE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000
POLICY JkOCT Lac / / / / INC'OPED
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If yes,descnoe under E.1-DISEASE-POLICY LIMIT $ 500,000
SPECIAL PROVISIONS 0-11
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DESCRIPBON OF OPERATION6ILCCATONSNEHIOLESIFXCLUSION5 AWED BY ENDORYEME qTfSPEmAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
( ) - (508) 870-9933 SHOULD ANY OF THE ABOVE DESMUED POUCIES BE CANCELLED BEFORE THE
EXPLBAMM DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOME TO THE CERTIRCATE HOLDER ED TO THE LEFT,BUT
NSTAR GAS CO. FAILURE TO DO SO$HALL IMPOSE NO 06LJGATION DABILI C ANY HIND UPON THE
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pDTHORQED REPRESENTATIVE
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