48 PRINCE ST - BUILDING INSPECTION 00 _
C !u-
IMAM IAUST-BEf%*B-AND APPROVED BY T44E
jWPECTLIA PWR TD.A PERMIT AWNG GRANTED
C CITY OF_SALEM
NjA� ^J \ '�\ Date
%-&ie
Is Property Located In Location of
Ina Historic Dlstrid? Yes No Building
Is Property Located in
Ow Coraerwdon Area? Yes No //
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
air/Replace, ther: Arch4(5cokC. ',c(ous Ce( aIc✓.�/s
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name ��'^`� s �rPef tee--
Address & Phone /9J, &3)r fSi-j SS le,-. AA 3.,2 6 SY3br
' Architect's Name
Address & Phone L )
Mechanics Name fi e n n Tti 6 .
Address & Phone 1'2 Fe,-*-, jSr eg Fic, 4 DO a l jso s- ) a -SY 3�-r
What Is the pirpoae of building?
Mandel of bWkWe? f Uzi M-e If a dm&V,for how many famMies?
WW bWlding conform to law? e- Asbestos? A/'D
Esfknated cost Rio,��� Clty License tt N �'' State wanes K OL
gains Iaproveeant y �'
t t ature of Applicant
Lie. SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�/��/G c� / ' l�rG/� (�r.1�1�v -S'/f �/1/�'�- �n f�2 i, ( ✓ �' •/�%�"ws:.
lLL��� (.� ..yn 1�� 0,� f�o%•G1 t,�orl/..S- r/ '�1.�. �C> }!{Zi, '� / ��%r ,
MAIL PERMIT TO: J
No ��� ��
APPLICATION FOR
PEFOW TO }
LOCATION:Dp
PERMIT GRANTED
APP D
INSPECT. OF BUILDINGS
i
.�o CITY OF SALEM9 MASSACHUSETTS
�! PUBLIC PROPERTY DEPARTMENT
3 q 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O 1970
TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34, I acknowledge that as a condition
of Building Permit# , all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III, S 150A.
The debris will be disposed of at: SG, �e wk //,-+^5 e� �fG1 f ayl
Location of Facility
3,/
ignature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
�c/��c1Mc�lG, �!�'fiti2✓� C7✓�Sf, � ��Z �.�ncref��o.-�-f:
Firm Name, if any
/� �fnfo /1S� f%/gym in7/ 411.1 .. ^ /f^ 0% / 0r
Address, City & State / 1
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 as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
r-�
The Commonwealth of Massachusetts
Department of Industrial Accidents
office ofin .SIIgagens
'yF l 600 Washington Street, f#Floor
gz Boston Mass 01111
rt Workers Compensation Insurance Affidavit. BmldmgTPlumbmg/Electrical Contractors
Apolicatit rat, On: -` Please PRINTleatbly'
ry..
name-Kenneth G. Dal 1 amnra o
address 1 7 Fenton Street - -
eity FraMINGHAM state.MA Zip 01701 ohone4508 326 5438
work site location(full address)-
❑ 1 am a homeowner performing all work myself. Project Type ❑New Construction®Remodel
❑ 1 am a sole proprietor and have no one working in any capacity. ❑ Bail n Addition
""",", "..S,t?'Yy..+uLa
® 1 am an employer providing workers' oompensation for my employees working on this job.
commit yname:Dallalnora Brothers Const/C & Z nonrrp♦-p . Ccyncf-r„r1-;nn
.'faddress: 17 Fenton Street
Ctjramingham, MA 01701 phone#: 508 326 5438
insurance co. Guard Insurance Group policy# CZWC554708
❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers'compensation polices:
company name:
----
address: -
city: phone M
insurance co. - policy,#
... ,;i}`. ,_�,.....�-.:e.,:c.�.1 ..e. _t ,_:.. ..::�' wr..�r a ra3t...�:_ ,?-.°"�.:'�.�. ,5:.'"�rs�.�i• °�-'"' .""�'".....,��."sue' �-ixr=st -.
company name:
_. address:
city: :. .. >- _...Phone.#: -
insurance co. - uolicv# - -
A�UFISFrldUrtl§jiP . ^`ate- =¢s'x •$E''t
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment es well as civil penalties in the farm of a STOP WORK ORDER and a fine of$100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certifyr the pains nd penalties aj erjury t�nation provided above is true and correct
Signature^/ _ Date 3 10/O S
Printna&enneth G. Dallamora - Phone# 508 326 543R
official u c only w it.not write in this area to be completed by city or town official - -
."-, city or town: permittlicense# ❑Building Department
- ❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
s� ❑Health Department
'4K9 contactperson: phone#; ❑Other
y 1 useJ S p �w ll
nw35h�.Stry.],2^Y'h'l+i._x.3 -....:^:'W.r!-eR>:}x"r.� 'p..:sG _y. ._..�'_ •. .:.. - .. . . ..-9^'Ys ._e:.=v.
w
f
NUM BER DRIVER'S LICENSE
S00235979 '
BATE aFBIRTH CUSS REST HEIGHT SEA
0 :30-1939 n sAs M
�f Ofi SC)21708
� DALL.AMORA
y
KENNETH G :
17 FENTON ST laao-was �•`_� - i
FRAMINGHAM,MA 1
01701.7712 - I
--------- .. .:_..._..____.__ .___. ... .. ..
/f(: E�d!)NItO'It[/M.2C�I O�✓(//.?d'HLf/l�iaGi(p _
lugt• n Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
' Board of Building Regulations and Standards
-�.• Registration: 107484 One Ashburton Place Rm 1301
Expiration: Private
Corporation
t Boston,Ms.02108 4 '�
' Type: Private Corporation _
DALLAMORA BROTHERS CON.,I
V€NNETH DALLA0012A
17 FENTON ST _
FRAMINGHAM, MA01701 AdministratorNot valid without signature '—
Board of Building eqqulations �i7 � �r 057S
( One Ashburton Prace, •f�m 1301
Boston, Ma 02108-1618
Q License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 06/30/1939
Number: CS 000195 Expires:06/30/2005 Restricted To: 00
KENNETH G DALLAMORA
17 FENTON ST
FRAMINGHAM, MA 01701
Tr.no: 11189
Keep top for receipt and,change of addresi;notification.