Loading...
4 QUEENSBERRY DR - BUILDING INSPECTION 1 The Commonwealth of Massachusetts ` Department of Public Safety ^�.,-+�•r \lassachusrtls State Building Code(780 CMR)Seventh Edition City of Salem Building Permit Application for any Building other than a 1- or 2-Family Dwellin (This Section For Official Use Only) G/1Building Permit Number: Date Applied: Building Ins; fir: S_j SECTION l: LOCATION (Please indicate Block M and Lot 0 for locations for which a streethd4ress is n tIIvaj le) No.and Street Ci • /Town Zip Code Name o Building(if a p ) SECTION 2: PROPOSED WORK If New Co ruction check here❑or check all that apply in the two rows below Existing Building❑ Repair Ef Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) ..Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: —� SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ ' Existing Use Group(s): Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly AA ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business Cl E: Educational ❑ F: Facto F-1 ❑ F2❑ H:-High Hazard H-1 ❑ H-2 Cl H-3 ❑ H-4❑ H-5❑ l: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ 11113 ❑ IV ❑ 1 VA ❑ VB SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit:; Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal ❑ A,trench will not be Licensed Disposal Site❑ 1'ri%ate❑ or indentifv Zone: ur un site.�strm ❑ required ❑or trench or,pecil%: permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: \IA I li.u�ri.Gnnmi,,wn Kv,ir„ Pn,r,•,,; .Not Applicoble ❑ I,Strni Cture within airport approach area? I, their rer iew completed? n'Consent to Budd-cnCloned ❑ Yes❑ or No❑ Yes ❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY liduion of Cock: L',e Group(+): Tope of Construction: Occupant Load per Fluor: Does the building;containan Sprinkler Svstem'. Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION r Name.mdit`dres',Pruperty Owner f _ Name(Print) No.and S reet City/Town Zip Property lAcner Contact Infurmaliun __�-(Lt'rL� Title Telephone No. (business) Telephone No. (cell) e-mail address If applic, , the p rt •owner hereby au hunt v Ft Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit a p plication. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (If building is less than 35,1XN1 cu.it of enclosed s pace and/or not under Construction Control then check here❑andskip Section I0.0 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date f10.2General Contractor i t 15' Compa y a e: ­14-72 J2 J Name�noni1blejurCu n o. and TY ei Applicable St{eptt,Afi r ss -- City/Town State Zip Telephone No.(business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 2506)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes O No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ — Building Permit Fee=Total Construction Cost x—(Insert here 2. Electrical $ appropriate municipal factor)=$ 3. Plumbing $ 4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical (Other) $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application i. r and accurate to the best of my knowledge and understandin poe Please p i�t_.tn m name Iele 11 Fdephune No. Date Meet Address Cttt'i Town 1 State Zip .municipal Inspector to fill out this section upon application approval: Name Date 10-JAN-30 01:03P.4 FR04-ylome Depot 2083 qTA 7401 A02 T-013 P.001/004 F-447 IfO7.IL'L-"ROVEMFNT CONTRACT' 1 PLEASE READ TM Sold,Furnished and installed by: j �, �.p O FHJnle Services,Inc. Brapch Name: Boston Date: i�--- THD Adtb(n The Home Depot At-Hams Services 345A Greenwood Srrect,Unit 2,Worcester,MA 01607 Branch Number:37 Toll Free(300)657-5182;.Fax(508)756-S823 Pederal:iD r 7=269E4CD;M&Li^-j?C 02439;RI Cant.Uetl 16427 .CT Lin B 565522:MA Home lmpmvemeot Convactor Reg.N i 26893 5 a l��U installation Address: '- City— State Zip .. Parchaser(s): - Work PMno: Hamc Ph6ae:' Cell Phone: I ftc ] [ fa1 --2 44 Rome Address: � Ci State yip (IfGiC,ercvcfrocrl aa!tc^en n`.' -. $-mail Adt!re6a(tG;eceE:•e,:eject cnmmLmicanons and Home Dep6C updates): `� t11 DO NOT wish to rece;ve aiy marketing elnails from The fiam�Drnot - -/ nr¢oeM Infarmatlnn: TJndcrsigned("CusWmer'�,fire owners of the prapeny located at thr a6 e in�tailat'son address,n :es m buy: and'CHD At-l-lomc Services,Inc. Cho Home Depot"}agrees w fitrnis!r,delrvcr an..,.•••.:-s,--or fi-insrsl7sriot is Contract I of is ail materin!s dcscribnd on Cite L'ajow.and pp ;be t'ef r^:ced Spe.:$heet(s), all.of wbicil ate mcocporau:d thin this Gourmet by tivs rifts-ca,olPng v.^'th any applicable State..5upUlenten[and Pa-ymeni Sun:mety attached herein and zny Glrange orders(coliecnvely, "Contract"): Soh#: a-.==a^ter^r+t PeMnata_ 'See Shectb #' P`roI'ect Amount ]Roofing Siding inflows ❑lvsulxdon� I -7 7 'Ifl b fo ❑Goners/Covers ❑Ea,ry'Doors [] t Imo•-'—�Q7Loofatg. Siding ❑Windows Q1nruta4o¢ $ . [iGuucra l Covers Lf atry Doors ❑ �'— Roofing S,dlug ❑V,'inamvs U[nsaLttipn : I. `I � j ❑Gutters/Covers.❑Erny Doors Q ;_ �� IT❑Roofing SitlinG 'a Windows �1 Insulation $ ------------------------ I� ❑Curren/Covers QEns7 Doers ❑ ' I I Miaimum 25%DerAstrof Connact.kniuodue upon cxecaUaa Of(big eanty ort I 'TnC:11 COaiC2CtAmennt � $ r-}at-t� 1 Maine Purclwsers flY td p s[t martth tl"dorm Cn ton 1'A'inurL� L_� 1 ;mmetlia2lvutroo-eanmletjorof tbc'warlrfo=edch product,Customer will.execute a Completion Cerir:,ea' (doe for each Product as.defmcd-by-an individual Spce Sheet),and,pay arty balance due. AS applieablz,Carl^Istcin's under tits Contract agrees to be jointly and scveraily obligated and Iifible bereundcr. The Homa Depot reserves the right to slue a Change hider or mrminatu this iyonvact or any ind,vid«al Pr:dvct!s)t""-cluded hrnt.ui,at its discretion,if The Home Depot or its nu$Wrized Service provider dc^.- ,ins=that it cannot perfnim it:obliInI ions due to a structural prob':em with the home,covironme,uaI hazards such as mold asheestns M lead Paint.other safety concerns,pricing errors or because work icijnl[ed s,coinpte t 1'•- !:c job jr not inchrded;n the Contract. - payment Sun:rns,:,« �60 5 2 :included as part of this C417Laer,-sets ford, the total Pavmont gamma"' '±ne Cautract amount and psi mear'a^=^,uir" fo*the timositc and final Paymemi by Product(as applicable). . • NOTICE TO CUSTONTER -sou are'cntirle'.ma complete!,filled-in xpv of the Contract at the time you sign. Do not sign a Completion Certificate(note; there is one Completion Certificate for each listed Product as dei:ned by individual Spec$beeis)befa"c work.con t}.at......-.t is complete- In the event of terminntion of this Contract,Customer agrees to pay Tire;hoer Depot the casts of matarials,lahor,earn es and services provided by The ixome Dtprt or AnLuCrlT:d ce.,,iee Prpvider throuRb the date or termination, plus aul other amonats set firth bt this Agreement or alhmved under applicable law. THE fi031F DEPOT MAY,':ie'ti* E, WITFtOUT OWED TO THE IIONTE DEPOT FROM TUF DEPOSrr PAYMENT OR OTIM, rA N- _T.. ­A DE, i nn R_-COvt•Ry OF SUC',H AMOUNTS. LIMITING THE HOME DEPOTS t]T71G1(ecisire ua^ua.a:'.-.....•-...�.-._._ _ •:. Ap A •n[snce and Atidrnri2atfnn: Customer agrees anti nnelersi:mds;:..:: n.__nent is.ttre enure aor,ecment between Customer and Tne home Dcpat with ie gaza m'*e ProdnctS and Installation services and sepersed,-s a1t Prior dise,rs�sians and agrceme¢t5,cinc�T oral or w*;aen,relating to said Products and Tnstallation.This Agreement cannot be as amnd or amended e�-ept by a writing sicced by Cusmmnr and The Home Depot Crumtncr aclmowI dgcs and Races that Cusotn -h?t--d,und"-.- as,voluntarily accepts the terms of and rut ree.Nzd a'oi)y oFthiS Ag-ement -�) In v r I Submit by: vT mer's Stgnature Dat> Sales Consults vs S1 3 P v Telephoue No. 7 - - Custom r's Signature Date Sales Co undtam License No. - tee uPPiicnhie7 CANCELLATION: CL ISTOMER MAY CANCEL THIS AGRVEMENT WITHOUT PENALTY OR OBLIGATION 13Y DEUVERIN'G WRITTEN NOTICE TO THE HOME DEPOT 6Y MIDNIGHT ON THE T'FffRD TSUSTLMUS � I DAY AFTER. STGT,r;G THIS AGREEMENT 'ryM 1 . . STATE, SUPPLEAM-NIT ATTACHED !3!ERETOI CONTAINS A FORii TO USF IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN'' ' CUSTp'4910S STATE. n n rnr lm)uanT 1OTICE:apnrl'toNAL TE&MS. "CONDMONS wRr..a Rn otv ri; amv�,S-.ZMLI,_.C.__-._-.Or;THIS CObMUCT 7.16.0e CSC White-Branch-File Yellow-Customer Pink--Sales Consultant' ' Feb 01 10 03: 20p Michael Bedard 1 -401 -2413-2868 p. 1 02-0I-2010 1319 FROM-THD AT HOME SERVICES f508 756 8823 T-757 P.001/001 F-306 � I,rGiYro LaBelle, David y�s)�abb From: Phil Sherman [psherman@crowninshield,comj Sent: Mon 1/25/2010 11:48 AM To: LaBelle, David Cc: Subject: Hamlet Condorniniurn Attachments: Dave: As per our discussion,the Hamlet Trustees permits the installation of new windows Hamlet Condominium upon owners requests based on the following. The Board requires that windows be installed by a licensed and insured(liability&workers Compensation Insurance)contractor,the replacement windows must be"full view"(no divided light)and the color of the frame must be white,the contractor and or the owner of the units responsible for repairing the area(damaged clapboards,landscaping,trim,etc.)affected by the installation and to restore common areas to the condition prior to the window installation,and the Hamlet Association accepts no responsibility for any damage and or personal injury to any persons or property as part of the window replacements. All agreements for window installation are between condominium owner and contractor. Phil Sherman CROWNINSHIEID MANAGEMENT CORP.,As Managing Agent for Hamlet Condominium https://www.thdathomeservices.conVexchange/dlabelle/Inbox/Hamlet%2OCondoMinium.E... 1/25/2010 1 The Commonwealth ofAbusachuretts Department oflnditstrialAccidents , - Office oflnvestigations f` 600 Fashingtan Street 13osiDr,Y_A 02117 Workers, Compensation JL31_LranCC A�nd"F,: TSB'�''��.=rs�COn+?'2Ct02'S!�.leC{I'IC1aIl=r1�1'�DeT A licant Information Please Print Legibly �I alne (Business/Organization/Individual): Address: o?/ C I r 1t� ¢i 1 6 City/State/Zip: C 1 Phone#: Are you an ployer? Check the appropriate boa: Type of project(required): 1.❑ a employer with 4. ❑ I am a general contractor and I 6- ❑New construction have hired the sub-contractors employees (full and/or part-time).* 7. Remodelin 2.❑ I am a sole proprietor or partrler- listed on the attached sheet. ❑ g These sub-contmctu�s have g, �Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑Building addition comp.insurance.t [No workers' comp.insurance 10.❑ Electrical re airs or additions required.] 5. ❑ We are a corporation and its p 3.❑ 1 am a homeowner doing all work. officers have exercised their I LE] Plumbing repairs or additions right of exemption per MGL 12.❑Roo repa rs myself. [No workers' comp. c. 152, §1(4),and we have no insurance required.]t employees. [No workers' 13. ther comp.insurance required.] 'Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicatmg they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they rqust provide their workers'comp.policy number. Jam an employer that is providing worlrets'compensation insurance for my employees. Below is the policy and fob site information. Insurance Company Name: ^— �^� Expiration Date:_ )� Policy#or Self-ins.Lic.#:_ a 1 Job Site Address: t-A ,n.yG City/State/Zip: Attach a copy of the workers' compensation policy eclaration 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 $1,500.00 and/or one-yeaz imprisonment, as well asi civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der h in nd enaltiies of perjury that the information provided above is t ue and corlect. Date: Si a ore: t Phone# 1 01 53 Official use only. Do not write in this area, to be completed by city or,town oj]leial Permit/License# City or Town: Issuing Authority(circle one): tyffownClerk 4.Electricallnspector S.Plumbnglnspector 1.Board of Health 2.BuiidingDepartment 3. Ci 6. Other Contact Person: Phone#: ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYV) OJT 2E I" 0 PRODUCER , 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE � NAIC# INSURED INSURERA:Steadfast Ins Co I26387 The Home Depot, Inc. --- ---- - Home Depot V.S.A., Inc. INSURERS Zurich American Ins Co ,16535 2455 Paces Ferry Road NW INSURER C'NATIONAL UNION FIRE INS CO OF PITTS 19445 Building C-20 Atlanta, GA 30339 INSURER D:New Hampshire Zns Co 23841 INSURERS'Illinois Natl Ins Co 123817 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR DO' POLICVEFFECTIVE POLICY EXPIRATION LTR N R POLICYNUMBER TE M DDATE HVIMIDDNYI LIMITS A GENERAL LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $4,000,000 j X COMMERCIAL GENERALLIABILITY LIMITS OF POLICY ARE EXC S3 ETOR N PRREMIEMI SES Ea o[ourence 8 1,000,000 CLAIMS MADE IT I OCCUR "OF SIR: $1,000,000 PER CC" - MEDEXP(Anymepemon) $EXCLUDED PERSONAL B ADV INJURY $4,000,000 GENERAL AGGREGATE $4,000,000 N'LAGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMPIOP AGG $4,000,000 POLICY PRO LOC B AUTOMOBILE LIABILITY HAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT g $1,000,000 ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Perperson) HIREDAUTOS BODILY INJURY $ NON-OWNFD AUTOS (Per accitlent) -X SELF INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHERTHAN EAACC $ AUTO ONLY: AGG 5 A EXCESSIUMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 1 EACH OCCURRENCE S5,.000,000 X OCCUR CLAIMS MADE AGGREGATE $5,000,000 S DEDUCTIBLE $ RETENTION $ S C WORKERS COMPENSATION AND 3566916 (CA) 03/01/09 03/01/10 X WCSTATU- OTH- TDRY LIMIT JE D EMPLOYERS'LIABILITY 3566915(AOS) 03/01/09 03/01/10 EL EACH ACCIDENT $1,000,000 ANY PROPRIETORIPARTNEWEXECUTIVE E OFFICERIMEMBER EXOLUDED1 3566917 (FL) 03/01/09 03/01/10 EL.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe vnder I SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER D Workers Compensation 3566918 (KY, MO, NY, WI, ) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10 ccurrence/SIR 25M/2M C Workers Compensation 4801323(QSI) �03/01/09 03/01/10 BE SCRIPTION OF OPERATION SI LOCATION S I VEHIC LEST EXCLUSIONS ADDED BY ENDORS EM ENT SPECIAL PROVISIONS *FOR EVIDENCE ONLY CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2455 PACES FERRY RD., N.W. BUILDING C-20 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE USA ACORD 25(2001/08)ia26o142n_hd 000 ©ACORD CORPORATION 1988 :�-.. Nlassachusetts . Departntent sir Public Saferc 3 Board of Buildin-, Reetilations ,tn:: Standards - Construction Supervisor License License: CS 74722 Restricted to: 00 KOSTANTINOS,S VAITIS 16 HANSON ROAD SAUGUS, MA 01906 ice- f'f� Expiration: 7/5/2011 <-inunisimrr Tr#: 19412 ✓/ce '�omvn..aosu�ea./.C/c o�,.' ir�aclweaLG Office of PROConsume, Affairs& Business Regulation HOME IM -VPROVEMENT CONTRACTOR Registration 729206 Expuation 7122/20,11 Tr# 290357 Type ;i DBA AEGEAN CONSTRUO,TION Kostantinos Vaiti3 ' s . - 16 Hanson Road `= � -- Saugus, MA 01906 Undersecretary 1 I y cti?il;1kiff,C`t"�ia<4i>G7 �U-Facoc — Solar Heat Gain Coefficient . .p�� .CuzA rtGuwdada Enryi¢`alar '. . /0 . 32 1 . 6 0 -' 29 ADOMONAL PERFORMANCE RATINGS - (\GU114'ION auaLt�+tx':=u.oe atrca►�MO Visible Trammnittance ' Ttanrm2Jan da Ll¢Wm4 0 . 52 YfaAc4ry�bts full aar�4 asaEm m mytYi 4 C 7.,M b'*wft*"'*naw Pm'd wbw ' WK r¢icp>n ymRM+d kt s Rud asl d mivrtvrrtal ax00rs rd•c�Pia b.liPC dma rart rammeM.try Trill'. pd dm re wvrvrt cv U%WN f Pt'd:hr mr P-15c,a Cu"ot�m emn�>•rmn h aelr jfona.pnenwn ':- a(�r - Em•larbv��Y m"��cancan m+b P���a h IfPL Pr¢da�m}��m�rdar�bol hl. piA,m In•aEras�Ga ora KPC m ertrrM.da Ran oxyrrb qo h�.�arhlneYa f ui trroro h Pafm ..apxdkt WAC ro OM do*gun Jd®'7 PT=Y 4 Xaft-cb W 9"w m6ro Gd]b1sA pR AD vs'XhX h Oft V-a=a'.'a+dry4 - .. .._:: ., UnLt E.ILLEL,3 fai _eN6 ftCY 9ClR c ay Loicfi6 No'<an'¢cn, No•cn - C.nt.al. :vo_cn'r��t.aL, [�.e�LGaO as Llf Lca,p a.a Ltf•) . cxq Len(.a) aHanat.eru: Hoch:. . Noc Ga Cancca L,'S�c CanGcal, 9.c. ' ' aun: R,IA. 00/CLiaa 3/3I'(K-ft17 fla f..acxo 00/Yldc to 2.31 u/K-.R47 p p i 4 5/ - 4 5 t Cana e eEado: 1L.a . I90 �,: . E595C95JC'.. aain . s Kaccun 23JLIla. M4 low h1 pnaEn elm SUP n5aln.To Im eon'em w+.m•grTzpw_ rlaaldautarf�,Mpmogaa�lensmbahot01fl6TSf7Chmmrocv�rmaolmbruA.lhllrrrw,nr�lucpcc . .. r..- •• ✓/[e L�o�ncmo+v<ealUc o�.+��amar.�udt�d r . �-\ Board of Buildiog Regulations and Standards i pI HOME IMPROVEMENT CONTRACTOR Registration:. 126893 t r Expiration:_Bl312010 Type Supplement Gard - .E The Home Depot Al Nome Service RICHARD FALLONE 2690 CUMBERLAND PARKWAY S _ ;��� CITY OF SALEM • PUBLIC PROPRERTY DEPARTMENT o,s,oi j"W: 81 PA \I'. nt LC Vi`.�il ll.\G;i1V)rNEL'T 4 S.0 I'M. NfAsi\1111 Tf1:978-,'4 9i95 • 1'.%Y:978-7449MM Construction Debris Disposal Affidavit (required I'ur all demolition attd renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR 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: (flame of hauler) The debris will be disposed of in (name ul ac1 It ) (address of I'acihry) ,ig1 wre of( rmit applicant d e