88 PIERPONT ST - BUILDING INSPECTION vend ie the anent use of the Suldi fl? 1
Matsrtd of sutldtrq? ty D 0 l — If dnwslki&how MOW units?
WM ft&dkb 0 C x*m le t atoll Asbestos? -
AtdfteCs NatM
Ad&00 and PhOW I 1
medmies Name
AddrOm and Phone HIC RepMtatlon S -
ciao Lleenae S
d slYndad cod Of Proja s 3 Pena yN c4tw on
E
Pema vets Eatin.ted cod x s?eaeOO ReaiderM
_- . -- - - Eaundad cod x$11/s iooa camrnenh
M Add Bond S&OO is added as an
AdmrmtmtrdNe dwg&
Make aura that ap fields are propwv and wg"wmm to avoid delays In Drodaai^0-
The undarstpned done hereby aPPty far a OuUdkq;7zv—s,
o the sta
Signedted
sWditWWm under pWgft of ParJury G�L`�/
Dat* 3
i
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—CrrY-OFg T.Pry
PUBLIC PROPERTY
DEPARTMENT Ka...�o.
sK+n.�.r.ar�sti„s nts7.
fir:t+r<T+ewsfrs..ss ens»+.r.
DEH0—- - ION.OR CHMGS 01 U3s Olt 2QWA1#if'V_ W1>Z ♦1W p q�N�•
REAM
1.0 UM MFORMArCN
Laeadon Name t�uY4rge
fh"a%g Y bmbd in a;Consova*m Am Y)N a N@ft DkWd YIN
2.0 OWNERSHIP INFORMATION
2.1 Oww of Land _
Warm 4
Address:
TeNpf10f1it. t' �io,(1 /y Q
3A COMPLBT!THIS SECTION FOR WORK IN Elf ISLlIp BUILDINGS ONLY
Additlon Existlrg
Renovatkxn Number d Storks Renovated
Change in the Now
Demoadon Existing
Approximate year of Area per now (so) Renovated
construction or renovation
of existing building New
Bad Description of Proposed Work:
Pell t10 LA
--- -- ---Mail Permit to �/pon Sfc cue f P5 So�I� �� • 01160 -
i
CITY OF SAI.EM
PUBLIC PROPERTY
DEPARTMENT
�foF.....tuwtti.
MANVU I�AwA9pN .RONS�7GR[ SM�yAtSAOR.'36TR01970
Tm-97L74S-9S9S 9 FAz;97L740.9"
HOMEOWNER LICENSE EXEMPTION
Please Print
Data
Job Location 7L --
Home Owner Address
Home Owner Telephone
Present Mailing Address
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on
which there is, or is intended to be,a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures. A person who constructs more
than one home in a two yea •period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official,on a form acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State
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 pKoc edures and requirements and that he/she
will comply with said procedures and Voe,
ents.
HOMEOWNERS SIGNATUREv
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CrrY of SALEM
PUBLIC PROPRERTY
DEPART.,AEM
,.vim a�t•'�i.J7iL
a4t��� lit r.�N::�tcS 7rlT�iu.:>ti 1Lwtww*4-114iAr.
Construeden Debris Dbpast Af idsvit
(reyuiml for all den otition and renovation work)
in arcordstoce with the sixdt edition of the States Building Code,730 alA soctias It l.S
Davis,and dw provisions of M. GL a 40.S Sk
Building Pwtnit 0 _ I _ is iswaed with the condition that the debris resulting Rota
this work shall be disposed of in a properly licensed waste disposal tbcility as dented by MGL a
111.S 158A.
The debris will be manspo"ed by:
y
_. laa�ae wr hoYletl
rho&--bris will be disposed of in :
+d.rum •U't. IV)
b�•..fYi S.)i,X(It.R.H'j1.IC J.1t
••J6f
_cn-y-OPSITIM —
PUBLIC PR4p1 'I'Y ,
KiwWJU"Dxucou
MA 1�6V{Ci�YWiu,Zt»13`1'R�ly'$�t.k }-,LY't.�L'i1's"1T19�10;. .
TM,;476fii95�=�F�9 Yib9edk.
If APPLICATION:VOR 3'AE REAATIi:RENOYA'11±IbIr COP1S'TON
DEMOLITION. OIt;CHA�iGE OF �SEadR f)CC> I* TG`Y� FOB AYXIB` 10
LS•`1�RUC" .OR BtJII1�1`N�.`.
x
�.Q SITE INFORtiRAT`ION _ . . -
Las atlopJ�lams:
Mo
Ee (A
Property b kxatted"in a. Cn'` atronAre�f 1/N Htatork:Dlslrkt il/N
-�.-_
OWN,Ett3FTIP ItV�dR (rION°
N2.fmOew: r,,Or, eNll1
dres :, 6re
_
\r] .
ePnotre: 1'Y1� . .;�tQ2�?
3:nCOMPLETE THI9:SECiIION FOR-WORK tN EYt$TtNQ�UtiLINGS'Ri`tJVY
Addition Existfovi
Renovation -Number of Stories Renovated"
Chango-I Use Plaw,
Demolition EKisftng. : .
Apprdzimate year of - `Atea'per`tTaar(s"f) F7arf�}vte J„
construction orrenovation
of-existing;bulding' Neer`
77
Sdd-DescriptionofProposa4'wdrk� e .
vAar-co �E' i ern, �. (c1c cb
nS`T ��. P�11✓� � QCkC��O t a� PQ�
CIT
Maif Permit to: 7-i 0 n
I
�.n ? CJ
di
ng?
f
what 1s the current use• the s g �r
H of-Building? dwelling,how many units?
Material T
Wit the Building Contorrirto,Caw?, -
p sbestos?
Architect's Name ,
Address•and'PhonsWE
..
Mechar WS'Narne '^ n✓�.., m2r�ASP 1M/ b4i. D ZI
Address and Phone-� °`�
ConshucUon Supervisors liceqn�s�e.�#- S HICRegistraton ft"
EStimated;Cost of Projecs S Permit'.Fe•Cakxilation
-Pennft Feesi - -- Estimated Cost XWS7/;1000'tieaklential
-
--
An AddfttbnW',U,.'00'-'18-,"iddOd�as,8n4.
AdministraUve�Charge.
Makesure=that all?leids are;properlyand legiblywritten to avoid delaypxin:prccessing:
l
The undersigned does herebyapply for aSuilding PermR to:bulla to the a
bove+stated
speciflcaUona. Signed underpenaKy of;perjury X 1v
III
Date
Oc
2
N
s
x
i
' CITY OF SALEM
r. PUBLIC PROPRERTY
DEPARTMENT
ttnent:ataYtxslscat
MAYOR 120 WAS1 WGMNStaear►SAT 04 MAUActeLWM01970
TEL.M743.9595 ►FAX 978-740.9M
Workers' Compensation Insurance ABidavit. BaUderstContmctOrSMeeOr dant/Plnmbers
ADDlltant Information CnnOnewt onn @naw�ftl.� Pleme hint Legibly
Name HusioeW P.O. Box 53
Stoneft
i deartedividtral :
am
1
e
Address: '
City/Sbt&7ip: Phone# ' ( n - 4410
Areoo as employer?Cheek the appropriate best
I. im a a employer with � 4. ❑ Ism a general contractor and I Pe otpro�eet
6
employees(tarnand/or part-time).• have hired the sub-contractors
❑New eanstntction
2.❑ I am a sole proprietor or parman listed on the attached sheet.t 7. ❑Remodeling
ship and have no employees These wb•eonhacton have 8. ❑Demolition
working for me in any capacity. Ww arks='comp.insurance. 9. �]Building addiu�
[No 5.'comp.insumnp ❑ are A corporation and its
required.] otllcars have exercised their 10•0 Electrical retain or additions
3.❑ I am a homeowner doing all work tight ofexmmttion parMOL i 1. Plumbing 1eP+ln or additions
myself(No workers'comp, c. I5Z I1(4),and we have no ❑
insurance required.)t employees.(No worker;' 12.13 f
comp.insurance required.) 13.[ F�
;AAY wdeval dui chocks ban s1 mess Apo IM our ew seedaa below showing Wir.a nna.oampensedoaydtry iatbratatlao. _ - - ,Hamaowners who solmak ikkamdav@ kdlmlea they a doba as work sod de•hka-anddi aaaasetrn mwit nrhoh•es afIIdatt s reel..
rCamaam drt ehseh this boa now athehd m sddidae.t shoe sbowfeg tls acme of rho mbeoehasaa sod their workna'comp 00110 ins nomike. .
1 am are empkryer'har hprovifins workers'compentsedom insatwroejor my employee& Ba/ow/e tkepodey and Job sloe Information
Insurance Company Name: A G
Policy#or i Self-ins.Lie.#: (L C/g 2- (0(Q 0_ l �� 0 Expiration Date:
Job Site Address C' t-'L VV10lc PCQ Ciry/StateJZ;p: �1CYr . M'L 0 PTO
Attach a copy of the workers'compensation Polley declaration page(showing the Polley number and explMdon dab).
Failure to secure coverage as required under Section 25A of MOL a. 152 can lead to the imposition otcrimins!fine up to 31,500.00 and/or one-year imprisonment,a.well as civil penalties in the form ofa STOP WORK ORDER a�aftfae
of up to$250.00 a day against the violstor. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage veritfcadoy
1 do kereby cerdo ender the pains and penaltfi ojper/mry that the injaneadow provided a eve Itree and eorreea
immature: �✓�/�` ~�i l a�2�
Date-
Phone#•
F13osirrrd
084% Do not write In Ah area,to be completed by city or town oQkloL
a: Perm(t/License#
hority(circle one):
Health 2.Building Department 3.City/rows Clerk 4. Electrical Inspector S.Plumbing Inspector
Phone#•
Contact Period:
Qw OF &U EM
PUBLIC PROPERTY
DEPARTUENr
MAW& 13SWAOalIMMG +s4.lAta��AiAO��ot.1�
i
Consbvedoo Debtb Dbpossi AM&vtt
bevy"ON ammum and m"Vadit«o ff
F Ia umdmm W dr sbcs!sdldon otdw Sties BmUdlnt CW%780 CMR wcdom III.!
Dabllq d ds•P od3idL�4a S Sdt
Buaft tomb r is lm d wft dw eddm drat ds dat mmd&f Dos
IMs was dbslt be dapowd of In s peopub 9 uad vrwo dlspmd Dmdft s.deow d by UM o
ttt.�tson. ,
i
Tt»debriswW bS tmVoMd bye
n IAc -
(a d
Tbm debris will be dispoasd of in:
lrks�e.. A-
(ysa�..eaor�e�ultry
>aPaa w otvamie lolk�
� 1
- due
oard oiByliding R@gulationa and Staydardad,,
�nnstructli�n SupeFdtser license r^:. Liyerase CS 53897
Bltifa M 5/91,1
�i,��tlon "3/2`I2009 Tr# 92955
Restri¢tian Otd
TIMOTHY) #4
8 VALOORR DiilPO
STI N H
l Commissioner-
PROPOSAL
CONSTRUCTIONPSPOEBCIALTEES OX UNL" INC.
` 53
STONEHAM,MA 02180
8(781) 664-4411
Phone (781).665-4410
LENNOX BROAN-NUTONE
A NORTEK COMPANY
HE RTH PRODUCTS
t t�
&Iekn
We hereby submit specifications and estimate for:
YTno>e �iQe l vri: n2� �N1 (rsQp ��1�
i n -
L(
We propose hereby to furnish material and labor- complete in accordance with the above
specifications for the sum of-
AS ABOVE
Payment to be made as follows: For special orders a 50% non-refundable deposit is required.
For central vacuum and intercom installation,half is due upon rough-in and half is due upon
completion. For all other work,payment is due upon job completion.
Authorized Signature
NOTE : All plumbing hook-ups, carpentry work& building permits are the responsibility of the
job site general contractor or homeowner. Prices are effective for up to 3 months from
date of proposal.
Acceptance of Proposal
TW.tow P••'.gdemsb..W oondWoe,.n,y40gay uA,n h�,yb Yw.n m6o.4M a Oo 04 rwk u ydUW. Pq'maM wIG M.mW,a a,uued.mw
Signature Date:
If accepted please sign and return.
gr PstGl
e, . �DJ f QDcS rUV 7 00.8� r �e�F4� MQrLO