3 PURITAN RD - BUILDING INSPECTION \ �
,� I�he Commonwealth of Mass�chusMts ��.�-y, U�
�i�� Buard of 13uilding Regulations and Standards yqLG�1
a: �� Massachusetts Stare Building Code, 780 CMR ,
a`.�:� � Reri.red.11ur_O!!
'a.,..
Duilding Permit Application To Cons[ruct, Repair. Renovate Or Demolish a
Onr-ur T�vu-Funiilv Du i!(i�i,K
� This Sectiun For OfTicial Use Onl
, , 1 6uilding Permit Number: Date Applied:
��/
1 UuilJing OlTicial(Print N�une) Signamre � �«
SECTION 1: SITE INFORMATION f
� 'I.I Property AdJress• L2 Assessors Map& Parcel N mbe s
z a �1� Q,( —
I.I a Is this an accepted street?yes_ no N���P Number P cel Number �
1.7 Zoning Infonnafion: I.J Property Dimensions:
Loning Districl PruposcJ Usc Lol Arca(s'y�t) Pronlagc(�t)
I.5 BuildingSetbecks(ft)
Front Y;�rd SiJc Yords Rcar Y:vd
Reyuircd ProviJcd Requircd Provided Reyuired ProviJed
1.6 Water Supply: (M.G.I.c.40,§51) 1.7 Flood Zone Informetion: 1.8 Sewnge Disposal System:
Zone: Ouuide Flood Zune? Munici al O On site dis osal s �atem ❑
Public❑ Privutz❑ Check iFycsO P P }�
SECTION 2: PROPERTY OWNERSHIP�
2.1 Owner�of Record: � I �//� /1 O! � 7 v
Pn' i� � f'P 1 G livr. �� ��� ,
N:mm lPrint) City.Statc.'l.IP
�,e,,� ;�-,� ,,—�� 97d� z3�i �lr,s9
No.ond Sucet �Pelephune Email Addnss
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that upply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairsls) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specil'y:
Brief Description of Proposed Work': e
SECTION 1: ESTIb1ATED CONSTRUCTION COSTS
��` Estimated Costs: Oflicial Use Only
Labor and Uaterialsl
1. 6uilJing � � I. Building Pemiit Fee: E Indicate how fee is derermined:
❑Standard City/Town Application Fee
'_. Glecirical 5 , �
❑Total Project Cost (Item 6)r multiplier r
3. Plumbing S ��� ?, Other Fees: $ /J��,/� .
�1. \lech:mical ll I\'AC) 5 ��� List: �[��__ i
5. ;Vechanieal (Firr g .�� 'iotal :111 Fees: 5 �I
Su �ressionl
Chcck Nu. Check Amuunc C;uh:lmuunt:
�/ G. Totnl Projcct Cost: S �` � ❑ p;�i� in Full ❑Ou�standing L3ulance Duc:__ _
`��� �'_ " ,� VL(.��
i , '
SF.C'170N 5: ('ONS�fRUf.'f10N SH:RVIC'F.S
SJ Construction Supervisur License(CSI.)
' �-�a c�_9�--- �/aola
�� �� CQ'^^y._____ I.iten+u Numhcr 1[cpuatinn Dalc
Nmnc of CSI. I IolJcr
�' a R � I.isf CSL�I)'pc Iscc hclu�vl
_��-1 w(�VIC�—.—_�— �
Nu. :md titrcet — Te� Ucscriplion
sC��Pµ'� (iv�(,�+ . �t� '�Q U Unrcslric�cJ 113uiIJin�s ii �0 35.UU0 cu. R.1
Cin�/fu��n.Stntc.LIP - Rcstric�cd I&?I'amil D�rcllin
M Musun
RC Rou�in Cuvcrin
WS Window:uidtiidin
�,�_ /��^ p f 7 5.� tiF SuliJ Fucl Iluming Applianccs
J l l i� GPv�Pf��CoHihl��r9 I huulatiun
l'cic hono I�:mail aJJress e�p� U Demolition
5.2 Registered Ilume Improvemen[Contrac�tor(HIC)
J 5c C-,�e��r-s� coh��c �}i�9 iSaCJ�iro
I IIC C om �ny Namc or I IIC Itebistran�Nome I IIC Rcgistrnlion Numhcr :spira-�- ,����,�
� 4w nCQ .S� � �i"i-� �
Nu wiJStrect �JC G(�fq COn�/S(���^c�q�
�S�P�� �G. O�c('jG Q��'�p.�Cii �c� l:mailaJdmss �{�`C �
Ci[ /Town, State,ZIP 1
felc hone
SECT►ON 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance atlidavit must be comple[ed and submitted with Ihis application. failure to provide
this aflidavit will result in Ihe denial of the Issuanc of[he building permit.
Signed AfTidavi[Attached? Yes .......... No,..,,,,,,,, ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COAIPLETED WHEN
OWNER'S ACENT OR CONTRACTOR APPLIES FOR BUILDINC PERM►T
1, as Owner of Ihe subject property,hereby authorize ��0 h v� l�/r.�. 't�
to act on my behalf,in all matters relativ��authorized by this building permit application.
CJevP /�G .S.O i � �e Z( �
I nnt Owner s Nmne(Electr me Signawm Date
SECTION 7b:OWNER' 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.
�o�,� c4�, '� � ��� ��a� ,�
1 rint O��ncr�ur�\uthonecJ Abcnt s�to U�Jc�trunic Signulurc) n�t�
NOTES:
I. ;\n O�vner who obmins a building permit to do his�her uwn work,or nn owner who hires an unregistered contractor
�not regisrered in�he Home Improvement Cuntractor(HIC) Programl,will iiot have access to tht arbitntion
prograin or guaranty fund under AI.G.L. c. I�?A.Other imponant information on the HIC Program can be fiwnd a�
�1>f��,��1��>�.^ov�ne:i Information on the Consiruction Supervisor License can be found at n���v.ncu:.�_m �,�p_
'-_._.
-------..._ . _..._
_'. \Vhen subst:mtial work is plonned, proviJe the inf'unnation below:
Toial Fluor area�sy. fl.� _�including eange, tinished basemenCattics,decAs or purch)
Gross living area 1 sy. I1.1__ Habitable room count
\'umber uf tireplaces-------- Vumber uf bcdroums -- ---------
---
Vumbcr of bathroums --------------
--------.--- — VumberufhalG'b:tths
1)pe of he;�ting systent _ - .--------------
- ----------- Numbcrul'JecAv purchcs
�fype uf eouling s�stcm . ___ __----------
- -- ------- - r�,�i�„�d _ opc�
-- ---- _... --- —
i. "fiHal P�oj¢�l Syu:tre Puu�ngc"may be substitutcd tiir"Tulal Prujtct Cosl"
1
� -� �t:�ssachuscth- Dcp:utimcnt nf Pub�ic �;dct�
� Bo:�rd uf Buildin;; Rc�_ulation.:ind St:�nJ:�rds �
Constructio� Supervisor License
License: CS 95895 � , �
n
JOHN CAMIRE ��
62 LAWRENCE STREET' �
SALEM, MA 01970 y'� �.
��
o�,.G_ �y/iy� Expiration: 7122l2012
. ('�.mminsionrr� Trti: 1174
. . ...y...,.... : �-- .-`..we......r.+ . . .. .
•_ �' e �anrmo-nmieall.� o�✓llamamE.�ael� �
�� � . Board of Buflding ReguleUons end Standard5'
;� HOMEIMPROVEMENTCONTRACTOR
Reglatretion`.� 152096 , �
? . - - - . EzpiratlCn .:7/28I2010 . �TAi 27144�8.
� . .. � '� Type DBAL..,. ... ., . . . -
r i% i�£ �I� ..
JJC GENERAL CONTRACTtNd,;,,�
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JOHN CAMIRE �„�. , � � +';f �� - �
82l'AWRENCE STRf�T��/ � �-��_
�SAIEM,MA 01970 . � � Adminiatretor ,
..it'� ,��.-.-..A. .
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.;� �' ��A CITY UF SALEM
:" ��' /� PUBLIC PRUPRERTY
a�.��
�''�° DEPARTNIE
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�Vurkcri' Cumpenaatlon (nsurancr AI'Oduvit; liuflders/Cuntractur�/Ekctrlclyne/Plumberf
� ��ic•rnt Infi�rro•rtion
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Z•Q I,�m a eulu pmpricmr nr pannur- lisred un rhe attachcJ�hact � 7. ❑ Remalelin�
xhip anJ h�v�no mnpluyc�y The.w eubcontrocton have
��orkin� ti�r mc in;my capuci�y. wvrken'¢omp. inyurnnca. �' ❑ namoliriun
I Ke waiitch'cum , inyur�nc� J. 9• ❑ DuiWin�.�JJitiue
nyuircd.j r ❑ W�°ro n 0°'p°ntion;md iis
ofT7een Iuvc u�r•rci.ra!ihci� lO.Q Electriea!�epairf ur additionf
J.Q 1 ;m��ha�muwn¢�Join��II wark riyht uf exemption p�r blCL � I I.Q NlumbinY rc�uira ur aJditinni
mys�lf. (�'o workun'cwnp. c. 131.�!I 11).anJ we hirv�no
in.ruranco rcyuirad.J� .mpluycc,�.(�o wohtn' 12.0 Ruul'n�win
com�►. incurancareyuind.J IJ.QUdier
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/���n un ea�pfaye��hut/r prov1JlnX�v�rArra'vuinpan�nNan L�.mrnnra/'ai ixy iinp/uprrx Br/uir!r�hr pu/I�y unv/u1.rilr
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Pulicy 4 ur SulGitw. LiC.d; . -- —
µ,(�.� - E�piru�ion Date:
IJI7 SII� A{I{IK'SY.� r c.r� a-a,r. (�c0, -�Q ��,,,� --�
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of up ro i?SQ.l�;�J�y.���ii��i ilie vi��la�nr. Ile a�vi.kJ rhut a cupy uf�hi►siut��ncm may be 1'urw�JaJUu he UI'1�"�rR `nd� fint
LI\'iiII�J11U11!UI lll� UTA I�r i��,urar.�¢a;�¢r�yu �.i�ilicoUurl. �
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Il'�nu.�cl Pcnwc I
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[ntormation and Instructions � '
\I.l5i.ICI1UiCU5llC�rf�I �.J�VS CIIJVIC( i JZ 1��{WKtl JII CPI�lIO)CiO�n IIIC iCf�'u�Jf]�UIMCfCU 1 ICf'nlly'CU IIOCI Jf F1�Re5•
I'ursu:uu w ihix.��w�e.an rmOlu��r�is dctined as". .every �n
;�preas or �mpliud, oral or wriuen." two or more
�n„nplu�mr�s Jciin¢d as"an �nJiviJual.punnenhip..��airnua.carporaiiun ur uthar I�gal cnnry.or�ny
�m lo «�. Haw¢ver che
,�i ihe I;�regom�{ anb�B�d �n a�umt emerynsa, and induJin��he legal repreaen�aeives u(a dae�saJ cmpiuycr.or i e
,«erver ur uua�aa uf.m indivY�+In«�nare choa�hreel�P�+�^'anuemJ who�raiAe�ehercin,ar�ha acup�t uP�
�wner oi a Jwellin�{hwu�e ha li ��ons w�u m•rintenuncr,cun.vuciion ur repuir wuek un :uch Jweilin�{huusa
,Iw.Iling huuia of ana�her whu emplaya(+e .
ar on �he ground+or builJiny�+ppuRen�nt�hercto shult no�because of fuch employmcnt be dnameJ w be an a�npluyu..•
renew I uf rrll�Af�'Uf P�f1YI�fU O�1�fif1�AY n�u o�to coos�'ruet buildin�f Inh�ommolaweutth fo��arr
:rypllennt nba has not produ�ad 3CrP��brusv Neuher he on monw�Irh�t any of u p li cal�xubJiv sred;ihall
' .��I1�IIIJII:IIIY, �IGL chupter t5_, �- ( 1 . .
eneer into �ny cumr�ct Por�he perfomwnca uFpublia work uniil uccp�abla eviJenca ul'cumpliwice wich�he insuranca
reyuiromenu oF ihiy chupiar Imve 6een presenced ro the conerac�ino•ruthori�y."
AppUcon�� pp to uur riwa�ion an4 if
pl�:u„Q fill a,A �he warken' compnurtion aPfSJavit cotl+p�d yhone numbee{s)v�O wi h thek1cartittcute(r)��
nec�iy+ry.�upply su�contrrc�or(s)n:une(.�).+d��l 1' P wiN nu em lo ��+uthar�han th�
in�ur•rnca LimiieJ Liabiliq Cmnpanius(LLCworken'�eon panw������0n w`If an�LLC or LLP Joer havo
memben ur puMan. ure not requirad w cury �yubmincd to�ha Depur�ment af Industrial
cmploysat.u�wlicy is roquircd. Be u�vixJ that�hi�+tRdavit m�y
�ccidenu for contlrtnatiun of ineutseco cov.rn�{e. Alw b���� lo yl�p asJ JuN Ih�u111J�rIL Tlu allidsvit shouW
uatioor rc�rdiny�he �uw ur iC yuu+ue ro4uind�o ob°'n u workcri
h,���:iumaJ iu�he city or rown thut�he•rpplieuion for the peonit a licenae i�bcina requasmJ, nol ehe UcPaR�nt o
InJuyviu�������rnv. Should you hava uny y ies�hould enter theit
cwnpen:�aeion poliey.please eall the Dapu+tment rt�h�nwnber liyted bdow. Self-inyuceJ oomp�
,��f.in.rurana licenee nwnbar on che a ro riuto lina.
ci�r a�•rowp om��.i.
�,P�I�a aif�+v t11ur yuu tu tll out in the�vnnt �ha ORice uF[nvesi�rt'��Ona haa to euni ct yuu re�urdin�ihe`applJ���
I'I:aa� ba curu co lill in iha purmiVlicenya ��w�b''iany in an,I�{��c�Na�eedeonl csubmitonc':ntl duvit i��d c•rc as cunene
d�at muat submil multipla panniVlicm�ve app �
y y Y
pulicy inYormr�ion lif nacaasaryl �nJ undar"Job 5i�e���e`�ut matrked'b �I e cii,vor�ownl may be �roviJuJ tu ihay ur
townl,••,\cupy��f�he uflfdnvit ihut hai been offlciully sump
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y t��'��Yhtre�huma ownetlo ciuzcn is obta�nina a ti�en����tnnit not relateJ to ny 6u'Y na�1ur�menerci I vaneurt
�i.�. :i dug Ucan.se or permit w bum laava ete.)+�iJ parvon iy VOT required ro comple�c thi�ul'fldovit.
� I Ilk �)IIIC� ��I IllVi%�Iy�t1Uf14 NJUW AAd W UIJIIIf)'�lU 111 7�IVAl1C� Yur your:oopera�i�m and shuulJ yuu ha���:�ny yue►uons,
pk�+e Jo nw hedicare eo grvu ua u c�ll.
fhc U:(�:If11f1CI1l�V J1I�IfC`I4. rc�cphuna�Th C^�O^wealth of Mossathusett�
pepactrnent of InSustrial Accide�u
O[Re�ot lsvatlQadona
6pp Wuhington Street
8wton, MA 02! 1 I
'fel. p 617-721�4900 ext�06 ot 1-877-MASSAFE
Fax M 617-72'1-7749
e,•.�,�� :.�a.us www.m�t.gov/di�
� CITY OF S.�L.E.�t, ��L�SS.�ICHCSETTS
Bl:[I�LYG DEPAR'I�IE.vT
' I 30 W.1SHL�IGTON STREfiT, 3iO FLOOR
� T�L (97� 7�5-9595
FNt(97� 7�9&16
Ip��ERIEY DRLSCOLL
,VIAYOR �I�t0.1(AS ST.PIEJt1tH
D(IIECTOR OF P1:8[1C PROPEA7Y/Hl'IIDLYG CO�O((SSIONER
Construction Debris Disposal Affidavit
(requircd for all demolition and renovation work)
In accordance with ihe sixth edition of the State Building Code, 780 CMR section l l I.S
�ebri�, and the provisioru of MGL c 40, S 54;
Buiiding Pertnit # is issued with the condition that the dcbris resulting From
this work shall be disposed of in a properly liceosed wnste disposal facility as defincd by MGL c
l 1 l, S l SOA.
The debris will be transported by:
� un� �e�o+
(n:uneoYh u�
The debris will ba disposed of in :
� �� � o�.
(name of acdity)
/S3 9 ,�ra���„�u �-�'S'.
(�ddn�e oF facilitY)
��
siynature of permit applicant
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, EXHIBIT C
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3 PURITAN R�AD
7 5 0 15 RECORDED W[TH ESSEX COUNTY SOUTHERN
�� DISTRICT REGISTRY OF DEEDS IN PLAN BOOK 104,
` SCALE IN FEET PAGE 55(SHOWN AS LOT 1)
EXHIBTT C-PROPERTY SKETCH
_ . Alliance Environmental Group, Inc. � 3 PUAITAN ROAD
100 Jefferson Boulevard, Wanvick RI 02888 � SALEM,MASSACHi1SET"CS
Telephone:401.732.7600;Fa�c:401.732.7670 R7 N: 3-25076
AEG Pro'.#1643
File: 1647.EXHIB1TC.dwg Drawnby:lHB Checkedby:MFG
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i Northwest Elevation � Northeast Elevatiion � _ '
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SCALE: 1/4"=P-0" SCALE: 114"=1'-0" I
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SCALE: 1/4"=1'-0"
Project Name: Rev. Description: Drawn By: Checked By: Date: Job Number. 001
; � � 5 Bonpel Drive �p110ri B �eV1t10riS
North Reading, MA 01864 AC�C�lho�1 to � °ate: ai9i"
�� � t101�l 1,1�1C . Phone: 978-836-0034 3 Purltan Road � s�ie: �ia� = ��-o^
� � Drawn By: CB
Email: carmen.bonfiglio@yahoo.com Sa1em, Mf�i �197� Q cne�kea BY: �0
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. NOTE:
'' RECORDED WITH ESSEX COUNTY SOUTHERN DISTRICT REGISTRY OF
DEEDS IN PLAN BOOK 104, Pl4GE 55 (SHOWN AS LOT 1 ) '
� Project Name: Rev. Description: Drawn By: Checked By: Date: Job Number: 001
, , 5 BonPel D�ive N Optiori B P1ot Plan
North Reading, MA 01864 Addition to � °ate: 3r�ai�� I
�� � t101�l 11�1C . Phone: 978-836-0034 3 Pt�1Y�.n RO�1C� � sca�e: ��s• _ ��-o• '�
� Email: carmen.bonfiglio@yahoo.com � °rai"" BY� �B ; ,
' S�eI11� MA 01970 Q Checked By: �Q � '
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