84-86 PROCTOR ST - BUILDING INSPECTION DATE:
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PLANS INIUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location ofBuildina 6PY—,fj( 6P0G7i9o( cS'%•
Building Permit Application For:
(Circle Nviiichever applies) Roof, Reroof. InsL_..11 Sidiig Constn!ct Deck, Shed, Pool
Addition, Alteration, P,epai /Replace roundauon Only, Wrecking
04`ter:
PLEASE FILL OUT LEGIBLY & COi1IPLETELY TO AVOID DELAYS LN PROCESSENG
To the Inspector of Build ngs:
The undersi=-red hereby applies for a permit to build according to the following specifications:
Owners Name: David Soulard Contractor: Frank E. Obey
Sweet 84-86 Proctor St. City Salem . Street 81 Centre St City Lynn
State. MA Phone ( 97§ 744-1925 State MA Phone (781 ) 599-1353
Architect: n/a City of Salem Lic= 1042
Street City State Lid: OS 027156 HIP 403699
Stale Phone ( ) Homeowners Exempt Form_}es xx no
Structure: (please circle) Single Family. Alu:hi Family;. 2 Other
Estimated Cost of job S 25,000.00 155 00 G!=
F zwi
Will building confirm to law? s no
Asbestos? yes xx no
Descriptioa of work to be done: Remove existing decks, columns and railings from
1st and 2nd floor; replace with new.
Drawings Submitted:des no xx Mail Permit to: Frank g E. Obey
Xt�
Signature of Application, SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX (6) MONTHS OF PERMIT ISSUED DATE
Department use only: Permit id/01-ZO011Zoning 'Lvfap/Lot
Perini fee S /JCS Oro C4-- Z I I (p
CO. S:
No.
APPI_ICA-FION FOH
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i LOCATION
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APP OVrD
INSPGCTOP OF BUILDINGS
i
z BOARD OF BUILDING'REGULATIONS
Lice nse:.CONSTRUCTION SUPERVISOR 1 �{
Number"CS 027156 [.
- a &rthdate:A6i24%4941
Expu�30,Fd24fZ004 Tr.no: 25708
� . ResMete�: OD
FRANK.E OBEY '
81 CENTRE ST
LYNN, MA 01905 Administrator
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Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registrati 103699
lug Expiration..-7/9/2004
T e IndMdual
FRANK E.OBEY
Frank Obey
-_ — 81 Centre St. � z.a
Lynn, MA 01905 Administrator':.
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iIJ9445-5555 Ez. 3H13
DiS?DSAL OF D- .IS AT
In accordance vith the provisions of rGL c 40 , 534 , 1 acknowledge that as a
condition of Building Permit G all debris resulting fro= the
construction activity governed by this Building Permit shall be disposed or
a properly licensed solid waste disposal facility, as defined by ;(GL c III,
5 150A.
The debris will be disposed of at: 225 Commercial Street
location of facility
Lynn, MA
Signature of Pert✓t Anpiicant Date
Fully co=lete the folloving inform2tion:
(?lease print clearly)
f Frank E. Obey
Name of Permit Applicant
Firm Name, if any
81 Centre Street, Lynn, MA
Address , City L State
The above statute requires that debris from the demolition. renovation. reh
or other alteration of building or structure be disposed of in a properly
licensed solid waste disposal facility as defined by MGL cIII . 5150A and zh
building permits or licenses are to indicate the' loc2rion of the facility a
18 ( ommonawaa& of V&.1achttielb
-UeparlmenE o�J'rsdicsfria ccs rsfs
600 ww4irsylo,s -E1.1
James J.ICampbell [�,oalon, y//asaacLalls 02/
Commsssroner
Workers' Compensation Insurance Affidavit
1, Frank E. Obey
(gvasavPermiscee)
with•a principal place of business at:
81 Centre Street, Lynn, MA 01905
(usy/sawno>
do hereby certify under the pains and penalties of perjury, that:
6t 1 am an employer providing workers' compensation coverage for my employees working on
this job.
A.I.M. Mutual Insurance Co.
VWC 600464001 2002 000
Insurance Company Policy Number
() I am a sole proprietor and have no one working for me in any capacity.
i () 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:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
V
Contractor Insurance Company/Policy Number-
0 1 am a homeowner performing all the work myself.
I understand that a cony Of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure
coverage as required under Section 15A of MGL 152 can lead to the imoosition of criminas penalties consisting of a fine of up to S 1.500.00 and/or one
years'korisonment as well as civil oenalties in the form of a STOP WORK ORDER and a fine of S I00.00 a day against me.
Signed this day of 1A&, G-v.t'r Or -0,P-7'
Licensee/Permittee
Building Departmem
Licensing Board
Selecrmens Office
Health Department
TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 37S