Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
35 RAYMOND RD - BUILDING INSPECTION
r• i r The Commonwealth of Massachusetts � Q Board of Building Regulations and Standards �J Massachusetts State Building Code, 780 CMR• T"edition Building Dept Town of a Building Permit Application To Construct. Repair. Renovate Or Demolish Town One- or Tiro-Fmnih Dwelling � This Section For Official Use Only Building Permit Numb (.- Date Applied: q Signature: ✓ 477z-a V /& Building Commissioner/ pector of Buildings Date I SECTION 1: SITE INFORMATION 1.1 Psope Address: 1.2 Assessors Map& Parcel Numbers N 1.la Is this an Iccepted street'?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(R) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private ❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP' ki%gnatA .1 rOwner'of Rlord• c�IS (RI- :eIV)dJJfl � i ) Address for Service: &-2 - L/ FCC Telephone SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) tBriefDescriplion :ofPropo xisting Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ ccessory Bldg. CO Number of Units_ Other Specify: s d Work": -S 1 . r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building S 5�Q0 .()C) 1. Building Permit Fee: S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: S /� 4. Mechanical (HVAC) S List: /CJ 5. .Mechanical (Fire S Su ression Total All Fees: S .` Check No. _Check Amount: Cash Amount: 6. Total Project Cost: S 5{�v lJ 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) n NS (0 " License Number Expiration Date an � An?�r sin N4roe of CSL- Helder 'L. eiol List CSL Type(bee below) Addr• TYDe Description Unrestricted(up to 55.000 Cu. Ft.) R Restricted 1&2 Family Dwelhn Signature M Nlason Only SSA RC Residential Roofin Coverin Telephone IF Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 eglsteredHomelmprovementContractor(HIC) �� 0-3 HIC Company Name or HIC Registrant Name Registration Number A O 01— I A V/2c�,/1 Ad v-zn sci(, 'Lssal Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 151.1 2SC(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes.......... No........... O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Laa'ut;horize /V , as Owner of the subject property hereby to act on my behalf,in all matters o r uthorized by this b ]dingpermit ap ton. nature of w er Date N SECTIO 7b: O ERt OR AUTHORIZED AGENT DECLARATION 1, ` ci-� /-�/1 c�/•eF� ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. A Print N Signature of Owner Jr Authorized Agent Date Oy (Silgined under the pains and penalties of perjury) NOTES: i. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will no have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.R5, respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/anics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of hearing system Number of decks/porches Type of cooling system Enclosed Open J "Total Project Square Footage" may he substituted for"Total Project Cost CITY OF S.U_ N, , LkSSACHUSETTS BUI DLYG DEPART.%I&NT 120 WASHINGTON STREET, )so FLOOR TEL (978) 745-9595 FAX(978) 740-9846 K1_%fBEjUEY DRISCOLL I MAYOR fiOb1AS ST.PIFaRt3 DIRECTOR OF PCBLIC PROPERTY/suiLDLNG CONMIISSIONER Workers' Compensation Insurance Affidavit: Hui lders/Contractors/Electricians/Plumhers 4nnlicant Information Please Print Letibly Nalne (9usire 0rglnintion lndcvtdual): SQr r1 Rn clerSPn Address: (3,J ,,A-rJa.t Sk• City/Statcaip: inn$ /v«� O j'If 2 Phone q:��s�) 0-9 25-" Are you as employer?Check.the Appropriate box: Type of project(required): I.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).• have hired the sub.-contractors 2A 1 am a sole proprietor or partner- listed on the attached sheet. : y ❑ Remodeling ship and have no employees These sub-contractors have 11. ❑ De olition working for me in any capacity. workers'comp.insurance. 9. wilding 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 MOL I I.❑Plumbing repairs or additions myself.[No workers'comp. c. 152.§1(4),and we have no 12.❑Roof repairs insurance required.) t employees. [No workers' 13.0 Other comp. insurance required.) 'Any applicant that dWcka box 01 must als,fill out the section below showing their worker'wmpatution puliey,information. '11, n uwrnaa who suMnis this affidavit indicating they are doing all work and then hie otmide cantroctes must submit anew affidavit indicating suck. du1 chink this ban must attached set addinianol Onset showing Oho name*(*a mbsvnunctors and their wurkera'romp.policy information. i am an employer that is providing workers'compensation Insaronce for my employees. Below is fire policy and fob rife information. insurance Company Name: .P44-toA S -J/ Con.02n�J Policy Nor Self-ins. Lie. N: C-FQ-C�,0IO[L4 ys Expiration Date:: Job Sire Address: q!5 MAJD A 9/9C ek. City/State/Zip: J "W ,itttacb a copy of the workers'compensation policy declaration page(showing the policy number and expinHon data} 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 S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00.a day against the violator. Ile advised that a copy of this statement may be forwarded to the OIPce of I m csu gat ions of the DIA for insurance coverage vcrificalion. l do hereby cerlify a r rho pains tfd pen aldes of perjury that the information provided above is true and correct p.r. Date: Phone 4: l O.S7 � O f— 2S85 iOfficial use only. Do not wrier in this Brea, to be cunipleird by city or town o/J7ciat City or Tuwn: __ Permit/License hsuing Aulhurily (circle one): 1. Board uI Ileallh 2. RuildlnV Department 3. Cilyfrown Clerk 4. Electrical inspector 5. Plumbing Inspector 6. Other _. CunUcl Person: _ .. __. __ phone ill: S r ` CITY OF SALL'.M =rhs PUBLIC PROPRERTY DEPAIZ"I''.10ENT III 'I'9.'1:. 14�: • I �\ 'iA 'J: 'n1.. Construction Debris Disposal .affidavit (required iur all dcntuliuon mid rcnocatiun \vurk) In accurdance %%ith the sixth edition otthc State Building Code, 780 CAIR section 111 5 Dcbris, and the provisions ut MGL c 40, S 54: Building Permit H is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal I'acility as defined by MGL c I11. S 150A. The debris will be transported by: (numc of hurler) I he debris will be disposed of in (ualnr ul laclhty) 61,4 - LIJJre.. or l]cllilyl a�ndlulc of I till[ al'i Meant •IJIc h�Cus� L.J Prat k f 2�g V Its Go" S©QAb� I 2lZsctO 3/ZX/L Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 162103 Expiration: 1/14/2011 Tr# 279788 Type: Individual SEAN ANDERSON SEAN ANDERSON 81 GERTUDE ST. LYNN, MA 01902 '� Administrator ni �lua�•iii r .ettc'- Department of Publict1'�t� Board ui Buildin Re ule[iun+ and standards Construction Supervisor License License: CS 99M Restricted to: 00 SEAN ANDERSON 81 GERTRUDE STREET LYNN, MA 01902 Expiration: 102&2011 Tr#: 99866 -. 07/16/2009 09:45 7815985957 DIVIRGILIO GROUP PAGE 01/01 xa r CERTIFICATE OF LIABILITY INSURANCE DATE'7/16/0 ACO,fIO® 7/16/09 PaoB DEa THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Divirgilio Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 270 Broadway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 8065 Lynn, MA 01904 _ ;1NSUFMR& ERS AFFORDING COVERAGE NAIL# INSURED --- patson6 Mutu31InBULance SEAN ANDERSON R B: BIG AtS HOME IMPROVEMENT INSURER0. 81 GERTRVDE ST INSURERO LYNN, 01902 INSURER E: COVERAGES THE POLICIESOF INSURANCE LISTED BELOW HAVE SEEN I SSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHBTANDI N.., ANY REOUIREMENT,TERM OR CONDITION OF ANY COMPACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED SYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TOAD.THETERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED SYPAJD CLAIMS. _ _[NSRAW' POLL wNUMBER PO [FFcCTVPOLICY FJiPI 110N LIMTS GENERALLIABILITY EACHOCCURRENCE S 500000 D TO RENTED $ 50,000 X COMNERGIAL GENEMLLIAGIOTY CTRODID46S QV �• CIAIMSMADE EZOCCUR 5/23/09 5/23/10 MEDEW(Arwem ereB, a 5 000 PCRSO NAL6 AOV INJURY 6 SOD,OOO GENERALAGGREGATE S 1 000,000 GEN'LAGGREGATE LIMITAPPUES PER PRODUCTS.COMPIOP AGG 6 1 OOO OOO X POLICY PRO, LOC AUTOMOBILELIABUTY COMBINEO8MOLELIMIT 6 (EeeeWeN) ANY AUTO PLLOWNED nUT05 BODILY INJURY g ryn pn6o ) F SCHEDULED AUTOS -- HIRED AUTOB BOOILYINJURY 6 (Per Aadebm) NON-OWNED AUTOS PROPERTYDAMAGE S •— (PAr AmIdMt) GARAGELIABILITY AUTO ONLY-EA ACCIDENT 6 ANYAUTO OTHER THAN EA ACC 3 AUTO ONLY: AGO 6 EXCESS I UMBIELLA LIABILITY OCCURRENCE S OCCUR CLA ASMADC AGGREGATE $ DEDUCTIBLE S RErENTIQN <M1OSTMKKERjAL OTH- ANOEMPS YERS'UABILITOMPENSATION IGRYIJ ,_ELL ANOC•MPLOYERB'LIABILJTY yIry OFFICE PEMBERIPACLUCEE%ECUTNE B_L,E/�O,Ii ACC DENT S OFFICE RAIEMS H)IXCLLAE07 (MendAfAry In N . EL.DISEASE•EA EN.A LOYEE 6 IfVyes c1mvibauflBer E.L.DISEASE-POLICY LIMB S SPE6AL PROMSI.QNSbelOw OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECSAL PROMSIONS RESIDENTIAL CARPENTRY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHEASOVE DESCRIeEOPOLICIES SECANCELLED BEFORE THEEXPIRA DON DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN SHAWN NEWTON NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SOSHALL 35 RAYMOND RD IMPOSE NO OBLIGATION OR LIABILITY OF ANY MND UPON THE INSURER,ITS AGENTS OR S.ALEM, MA 01970 REPRESENTATIVES. AVINGRIZED REPRESENTATIVE ELIZABETH ANTONIO ACORD 25(2009101) 01980-2009 ACORD CORPORATION. An rights reserved. The ACORD name and logo are registered marks of ACORD