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18 PUTNAM ST - BUILDING INSPECTION (2) - City of Salem VVwd APQUeAnON PERMIT TO BUILD ACDITtON, MAK .I1LTERATIONS OR NEW CONSTRUCTIO mpomxmr•AppYeant 00 a/Uanu h asotlona 4 K N,and DL L ATLOCJUIOas V�psv R' r — LOCATION A BULDUdO SUBWASM LOT ILL o xx �"SM- Ea — L TYPE AND COST OF Bua.4M•AN;;j;;'j; ParbA-D A. F awnovEratr _ .. ¢ uus FOR vosoumw usE M06r.Rwpff usE Y ❑ AMMNIaw dnwsrw O w wrwwwwof w - I2 QMM Oawwa - - Is❑ MM ANUM &M MMMW mw h W u a adoM at ww 0 ow10.131 _ Q CI11110 Gow Mwabtw tf 3 Aawwon 4 w 7.Mw+I " ° �i r aD Q &wmww. ❑ wo.. .oro.a.r. 14 ❑ br �bla�or ewwYOn a w Q swwwwwomwowom Fir•r.nwdar.b . a ❑ vowomq p wuw x wm=ow ~nw r Z! Q tioaw►+r dIMW:,. d uMaa w.Muwiwo-PlwrA 14!_ . 16 _ Gow.. 24 Q OoOa CAL Pdm01r a ❑ ma vvuvp w" _ Is Q cww"t. r- 7 ❑ . . .. aam.- nQ sL WmM1M�~aaaoMwe L s © AMI&Wa 9 P.M. 4OKW O{wl oarowaMalL Mwo.dr. Q QIwI.saw* MaaaalM at1 _ 9 ❑ Puab WGdwaL 91wa a but wwwwww. _. .. . 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Yee-- No:_ (H Yes.&&W d=mwftft) AAasassduseNs Stab Co*acw Liaetme s So"L" Hotiieaartss Euelnpt farm(if appicabk) Yes_ ND - �':'CONBTRlx710N'TO BH t',O E91M i ( OF ISSUMdCE OF BULDIWI PEAMIT,, . po cjU� Oct �o Man a�aiwmiwr is netxsa!!Y. atbmM CONSTRUCTION IB TO BE COMPLETED Sy.. V. I Z in id this a V. 1DeNrIPIcATaN- To bs completed by aM applicants ar wer,- rr r,t ,r.. ma"m.r•m ...avasarerr CO�alaefer r "• - LANWIr• . q417 M EIVIM I hereby Oanllif that lh- it tIM avatar of retard and that)I have bun audVOUed aY tlt-awry pmalt-1M � grq b d na!o!mK5aWlw ohburd:s -� tx? DO NOT WRITE BELOW THIS LINE VL im"Tm Fan oO+wrMe+r usE awr 8uidirp Pam*number um&00 1t� Fn awOYq g�idyq LiN ladies Permit Fes s oeaomev Low Certtticste of Owupo" s AWWKI by Drain Tft ft g, ma \ Phan Pleriew Fes m� Nt7TES AND Data•IFor dspartr WW L" PERMIT TO BE MAILED TO. DATE MAILED: CArgla cbm to be started by ComoMW btr. i VI ZONING PLAN EKAMERS NOTES DISTRICT USE .._ .. ,.. FRONT YARD SIDE YARD SM YARD :. .e REAR YARD NOTES UM OR PLOT PLAN•Fo►ApocW Use - O N I _ URP is , L6 t CITY OF SALEM ROUTING SLIP ' r' NEW CONSTRUCTION CERTIFICATE OF OCCUPANCY LOCATION:ISRA aInn - DATE - 3- APPLICANT-.�a G 1� ASSESSORS \ FRANK KULIK DATE: 'A—�d (93 Washington Street) CITY CLERK CHERYLLAPOINTE e O` DATE: D( (93 Washington Street) t PUBLICE SERVICES BRUCE THIBODEAU DATE: S (120 Washington Street)4d oor nfrm i`� WATER O ��— DOTTIE THIBODEAU DATE: (120 Washington Street)4i°Floor CROSS CONNECT SUPERVISOR BRIAN THIBODEAU �/t/f DATE: (5 Jefferson Avenue) PLANNING 4Nq, /ate pp�1 FeN� A a.:.;.1/G ' �w�wv .F &45,DATE: (120 Washington Street)3 d Floor CONSERVATION COMMISSI FRANK TAORMINA DATE: (120 Washington Street)3`d Floor ELECTRICAL JOHN GIARDI DATE: 7 (48 Lafayette Stree FIRE PREVEN I N y� ERIN GRIFFI RJc _ l t1 DATE: �� q (29 Fort Avenue) HEALTH JOANNE SCOTT DATE: (120 Washington St t)4''Floor BUILDING THOMAS ST. PIERRE DATE: k (120 Washington Street) 3 d Floor a a CITY OF SALEM,, MASSACHUSETTS a PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 Thomas J. St.Pierre Director of Public Property Inspector of Buildings Zoning Enforcement Officer RE: CONSTRUCTION CONTROL: Permit# Gentlemen: Please be advised that the construction authorized under the above permit is subject to 780 CMR Section 116, CONSTRUCTION CONTROL,of the Massachusetts State Building Code. All construction documents, including but not limited to, working drawings,shop drawings,and specifications shall be prepared and approved by a registered professional architect or engineer. These documents shall be submitted to the Building Department for permit review purposes. Progress reports shall be submitted by a registered professional architect or engineer to the Building Department on a weekly basis. Reports shall contain all information regarding the readiness of the project to proceed and any comments pertinent to problems encountered on the site that effect compliance with any and all codes. Deviation from approved plans shall be brought to the attention of the Building Department. At the completion of the project,a report shall be prepared by the registered professional architect or engineer commenting on the readiness of the project for occupancy and listing any pertinent deviation from the approved building permit documents. Also, at the completion of the project, the general contractor recorded on the permit shall certify to the best of his knowledge that the work has been performed in accordance with the approved construction documents and in a safe and satisfactory manner in accordance with all applicable local, state, and federal statutes and regulations. Failure to produce reports shall result in a cease and desist order placed upon your project within five(5)days after an established due date has passed. Please feel free to contact this office if there are any questions. Respccc� Ily, Thomas J. St. Pierre Inspector of Buildings JEB:TJS r` CITY OF SALEMv MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RO FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. LISOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 CONSTRUCTION CONTROL AFFIDAVIT Project Number. Date: Project Title -4�( �N Ll Fa )53� Project Location: 2G�� 2 ( t Name of-Building: - Scope of Project: C �"r � U f'-L('( `-rQZ3yly A) a '�' IN ACCORDANCE-WITH'SE^CTION 116.0 OF THE MASSACHUSETTS STATgBUIDING CODE, I '�'. C 1A1TI 1)I7a MASS. REGISTRATION NO.. 'BEING A REGISTERED P OFESSIONAL ' R& Y CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE A N OF ALL DESIGN PLANS, COMPUTATIONS, AND SPECIFICATIONS CONCERNING: Civil Architectural ✓ Structural ✓ Mechanical Electrical Fire Protection ✓/ Other(specify) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2. 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required control materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix I. PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE BUILDIN INSPECTOR. UPON CO N OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS T E SAT Y O ION AND READINESS OF THE PROJECT FOR OCCUPANCY. Signs SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 2004 My commission Expires: Notary Public \ DOMESTIC S FIRE SCRMCE FIELD VERIFY LOCATION VF PU i NAM S TREE T EKISINL MAIN • • iBfM n LAs _. Sc-I ACE O 'Iv 1.35.uS F I - --- - -- -- - - -- -- : I e• v eE BE I BURIED 6• BELOW MADE I -- i I I 1 I I B• PVC DRAIN (SON 35) I L.124'l. S-O.SX I • I INIVANCC MR001 .9.So 1 I I 1 1 1 31Q BASIN L35.1. 50 �, V 13 IS � L - LI 11IG" c.` �o VIC 11' CONCRETE WALL TIC I - T' W/ 36 NILM FENCE BRICK LEOCIE �... ——— • F 1 n�3 PJ4 N ..t I I I I CITY OF SALEM « ' PUBLIC PROPRERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHI IGTON STREET *SALEM,MASSACHUSETTS 01970 TEI:978-745-9595 •FAX:978-740-9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibl Name (Business/Organiu`tion/lndividual): Address: �I�Mn t Win, City/State/Zip. O C(� Phone #: M) Are you an employer?Check the appropriate box: Type o roject(required): L❑ employ I am a em to er with 4. El am a general contractor and I 6. New construction employees(full and/or part-time).' have hire the sub-contractors 2.❑ I am a sole proprietor or partner- listed the attached sheet. t 7• ❑ Remodeling ship and have no employees Th a sub-contractors have g. ❑ Demolition working for me in any capacity. orkers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors most submit a new affidavit indicating such. (Contractors that check this box most attached an additional sheet showing the time of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby U nder th a an alties ofperjury that the information provided above is true and correct cak ;a Phone MIS] —Z k (_ Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia 4DCITY OF SAL ZMg MASSACHUSBTTS PUBLIC PROPERTY DEPARTMENT 120 WASHINOTON STRZZT. 3RO FLOOR SALEN. MASSAONUSSTTS 01970 STANLZV J. USOVICZ, in. TZLSrMONE: 978-745-9593 EXT. 390 NAVOR FAX: 975-740.9949 Salem Building Dm ardment Debris Dimmal F rm In accordance with the provisions of MGL c40 S 54, a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: c- (Location of Facility) Q 5 Ignature of Applicant Date