81 PROCTOR ST - BUILDING INSPECTION What is the current use of the Building? how many'nits?
dwelling,
Material of Budding? Asbestos?
"a the Building Conform to l
Amhitads Name
Address and Phone
Drees and Phone
Construetior►supery license ti
l�' ! HIC Regfstratfon N
S� PermM Fee Cakwlatlon
Es*"Wd Cost of project S_�- Estimated Cost X$741000 Residential
gyW,.tisd Coat X S111S1
An Additional$5.00 is added as an
AdminislraWe charge.
Make aura that all flelda are properly
and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building permit to build to the above stated
locations.ations. signed under penalty of perjury x +
Date
c s
i
EITY-OF-SALE _ .
PUBLIC PROPERTY C
DEPAR'i wNT /
u IAV
pro.
I I WAvuH[.-n,N srW" 'UAK YA9A0*,ShTM 01970
1%L-97L7iS 9595 FAX 976-740.9W
APPLICATION FOR THE REPAIR.u RENOVA'rrON CON TRUCTION
DE�`aa"iiaii"c� CRANE O OR
S FOR EXI 'PIN
B
1.0 SITE INFORMATION �.
Location Name:Prop" Building,
Addreac-- -- . _
Property b boated in a;Conswv8tlon Area YIN Hbtarlo Dbtrid Y/N
2.0 OWNERSHIP IN
2.1 Owner o1 Land
Name: f C /c
Address:
c--.v
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN E><RUW BUILDINGS ONLY
Addition Existing
Renovation Number of stories Renovated
Change in Use
New
Demolition
Existing
Approximate year of Area per floor NO
construction or renovation Renovated
Of existing building New
Sdef Description of Proposed Work:: _
1-7
Mail Permit to: ® - -
UELIAULE CCNSTUUCTICN
Remodeling All Professional Carpentry
Decks
Sun Rooms
Kitchens • Finish Work - Richard J. Morrison • 603-898-0984
PROPOSAL SUBMITTED TO < PHONE DATE
STREET JOBNAME
CITY,STATE and ZIP JOB LOCATION
177
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for.
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---......-----------------_._------._.. ..__.....__.....-.....--_...__...._.-...._..
........................................................ _.__...�.�........ ..�Z .._._a_ . /� .Ci ..:...........................................
........___...___...___............. ... ..-------------------------
, -�.......... �------°% ....................._......... ----- -...__.....----- ...-----
- - ------ ...-.---------------..__........................- - _
jw
....n �� - /_L� .4 'ern/.�........._.��.........- -s-�Ai:-'......... ------- ..................._..
---------------------- -- ----------------------- -----t
We pr0}IO a hereby to furnish material and labor-complete in accordance with above specific at'ons, for the sum of:
�S66 0 d 1� �ds� dollarsrZ
Payment to be made as follows: / -)
Cf
All material is guaranteed to be as specified.All work to be completed in a workmanlike Authorized
manner accordingto standard practices.Any alteration or deviation from above specifications Signature
involving extra costs will be executed only upon written orders,and will become an extra
charge over and above the estimate.All agreements contingent upon strikes,accidents or Note:This proposal may be
delays beyond our control.Owner to carry fire,tornado and other necessary insurance. withdrawn by us if not accepted within days
�CCe}1tdtCCC OfTOpO0dC The above prices,specifications and
conditions are satisfactory and are hereby accepted.You are authorized to Signature
do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
7�
F,P�vn c -------
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
MAYM
1103►aamv�ornsrassr.su�,r,',/wsssatt:arrsat9ro
Workers' Compensation Insuraaee Affidavit: BopditWContraetoyFjgctrj b
A
Name tHmieauorgr' artmividualy
Address:_ 5l f �i
City/ststtflZip:�a9��i� - Phone#:
An you a•saphsyeri Cheek the appropriate lost
1.0 I ar a employer with 4. 0 I am a Small contractor and I ��Proles
=PioYeca Mil andlar past-done).• have hired the wbsontractors 6. 0 New suction
2R 1 one a solo proprietor or partner. listed on the setached shoat t y. 0 Remodeling
slip and have no employees Those sub.00maeeon have 8. 0 Demolition
working for me in soy capacity. watltets'comp insu ence.
[No workers'camp.insurgent 3. 0 We ors a CarParstiae and its 9' 0 Building addition
required.] offices haw m advsed their 10.0 Electrical repairs or additions
3.❑ I am a bomeowner doing all wale right of murnpel par MGL 11.0 Plumbing mp do or additiau
myself:[No workers*comp. a 132.41(4);and we have no 12.0 Roof repairs utwrance:evired]t empkyosa[No workers, 13.0 Otbsr
camp itauaoct reepsited.)
*Any APPUMM*0 d mb two et ms air do ant do wear bdme tgawtae ark aaaktna
F/ma.arra vqe nukelt etr amdralt"ados ear ate daiq d sank ad sir an raids or znW alaeit MM MMdwy
et'omaetwe dre etrek th4 two rote amaeAad r addtdarl attaw dnrlq dr actor aftha aoeKaraaetan rd igak radw'cry,Pwky kdssatlr.
loan an employee rhd Ar providing workers'corpenaodoa huurasc�jor sry e r
Jajorrodra rp/oy n ROkw b the po ft sad of sAtr
Insurance Company Name:
Policy 0 or Self-ins.Lie,M
Expiration Date:
Job site Address City/State/Zip.,
a copy of the workers'eorepetudoa policy dechrratloa page(sin the
Failure to saute coven as wing Po1M;y number and asphradoe date}
fine up to$1cure cO anNoemP u trader Section 23A of MGL G. 132 can lead to the imposition of criminal penalties of a
ru up to s230.00 a a one-yearimprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a two
�Y ii+�the violator. Be advised that s copy of this statement may he forwarded to the Ofitet of
Investigations of the DIA for insuraecs coverage verification
/do hereby girt andp the ano psaaldes of wP that me lnjontedta provided above Is eve and earners
Phone3
OJJlelaf use on1A Do not wdfe im hil area,to be compGtd by din or taws offleArL
City or Town: Permibutaso M
Issuing Authority(circle one):
I. Board of Heslth 2.Building Department J.CltyfTowe Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone 0:
I
N'
r- -�
CITY OF SALEM
PUBLIC PROPRERTY
: y
DEPARTMENT
120 WASH INC: STREET •SA LF\t,
Tn:978-745-9595 ♦PAx:978-74C-I 4m
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
in accordance with the sixth edition of the State Building Code, 7S0 CN1R section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # _ _. is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
OB
tname of hauler)
The debris will be disposed of in
(name f laeili[y)
"""�--�""_- laddrcss otFacility)
r.aturcof;;enttitaryiicaat -
,:ate