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19 ROCKDALE AVE - BUILDING INSPECTION (2) , � _ - --- I'hr Comnwmeeahh ol'biassarhuseits - . �j 2�/ y; ,� Ifu;ud �if 13uilding Rcyul:uiuns;inJ SiandarJs CI I'1'l)F %t/✓ �� ',,, � ��fass:irhwrtts Statc Duii�ing Cod�. 730('MR �,�LI:�I' 'L,,.� /fa���i.,��i/.ILu�_rll l 13uilJing P¢nnit Applic:ition 'fo Construct. Rcpair. R¢nuv:u�Or Dcmulish a (Am•ur T�ru-Pu�nN�' D�r��lfin.�� fhis Saction Fur 011ici�1 Uso Oid UuilJing Pem�it Numbcr: pa .\ lic ; �►G�u.�.�rczN,���t,l -- S / UuilJiny Olticiol�Print N;une) � .'i�yiatu � . Ualc SECTION 1: SITE INFO �IATION I.I Pro erty AJJr er. 1.2.laaeseun Siap So Purcei IVumben i�t ��kd�� "`• I.la Is Ihi�an accepted street?ye�_ no btnp Numher I'urc�l Nwnlxr iJ Zcs!cg !:!e::r.af:cr.� ^ S.d P:opa:e� �:r.ecs�e.:s: Luniny Diylrict I'ropo,aJ Uvc I Lot Arcu fsy It) Proaluga 111) 1.3 Bulldlns Setb�cka(f1) Fnml Y;vd SiJc YurJa Nuar Y�J Rayuired I'mviJcd Reyuircd I'ruvided Nryuind I'roviJeJ 1.61Vxter Supply:�M.G.L a JU, §!�) 1.7 Flaad Zone laformallons - I.S Stw�Q� Dl�posal Syatem: Pu611c O Pd��ule O Zona: _ Uuuide Fload'[un�? Municipd O On�i�a Jispurul i�v�em O Chack if �a0 SECTION2: PROPERTYOWNERSHIP� - S.1 Owp�r�of I}qcord: ��� ��a �P/S �� «'�h� i N;unalPnnq � Ciq•.Siata.21P t a Gc�ir�� ►� ��s-979�6� Nu_:ud Stnm� , felrphunt Email�ddnss SECTIOIV J: DfSCRiPTtON OF PROPOSED WORK�(cAecM�II that opply) New Canstruction O E.�isting Building O Owner•Oceupied ❑ Repain�f) � Alteration�s) Addiliun ❑ Oenwlition O .iccrseory BIdy.O NumberaFUnib O�her � Sp.cily: Orief Oexription of Proposed Work': , �uviaUe., lo i(t4 OecIL c�" �S- _ vt 1�r L.I�f SECTIO�V �; BSTI;�I.�TED COVSTRUCTIO�V COSTS I����� Euinm�ad Costr 0111c1u) U�t Only I I Lahur and .\lalrri�ifl I. UuilJing S � I. Building Pertni�Fee: S Indiwte huw fee if detrnnineJ: ❑St�ndard Ciry�Tu��n Applic�tion Fee i ?. likcuical S ❑Tuml Project Cus�'1 hem 61 x multiplier _.__ x � 1. I'lumhinq S ?. Uiher Fas: S (/�/^� - � J. \lach.init.d ill�� \('1 5 List:.— •---- t—(/:�—��i��. � Vrcli.mi:,d iF�ro --------.-- ---� .__ .._ . � 1u�+�essiunl S (�rt:ll \II FC¢S: S—'------ -' _ Ch�:A \o. (�hcck AmaunC l�,uh �\mounl: ; �� Tulrl I'rnj�cf Cn�C 3 ❑ p.iiJ m Full OOw:umJiny Il.il;mee Dua: �v"L � ��_�il�-�'�� St:<"I'ION S: ('1)N51'RI�("flON tiF:RVI('F.S ' , SJ Cbaslructimi Supcniaor l.iceast(C'til.l ��_���53 C�_ �!�,/t� P�nr;m��u I);n. �� /�O�.. . I iceiue Numh.r i !7 /`_"'.-.. __ ..._.. . .....---- , 1 ' \;un.ul'C.� . I InIJ.r (J �Q I wt C51. I'��he.hclu��1.—'—V--'_ _.�3. 3���I���LJ��Q71���.--�--- 'I'�p0 I]�x•ripliun � No/.�.ind��tr.ct �/��'^ /j� �i l�nrcstrid.J�IfuilJin r ii w 15,U0Q eu. 11.1 RJiYI � /�l/'tl- �✓�i�,S. ./ R R¢.tricl¢d I:�_'I'.�mil D��cllin ��f�����n.\I.i e.L I I' .�I .\lo:uu � p�/ �"'. �I /� ^� HC' N�M�iin Cinerin p/��tC,.V'�v�Vh,�'f°� K"� µ�g N'in�u�r,utJ.\idin � / `/� � / SF tialid fuel Durning i�CPli�lil'C! v CJ I Insululiun 'I'cl�• hunu 19n;iil oJJn,a D Dcmoliliun 5.2 Rr�bteroJ 1 ume Improyrment Cuntrnctor�HIC) J�� � 3 / � .���� ��'lllP' IIIC R¢ylalraliun Numtw� P.cpirnliun D��a I�C l'om �n �Ndmo I IIC'H. I:IINOI NY1111f ,��.°( l�.l �4oz,k.�t,�., A�-�- ��y "„' ,� m�:/-� u�n . G�.� �NO. ' 1 SIROI � Ittt1Ull��IIM1•59 )M �m 1��114-P/L� �I ci /Town. �te zIP ralc nuna SECTION 6s WORK61iS'COMPEN9ATION INSUIIAIVC6 AFFIDAVIT(M.G.4 e. 1�7.� 2SC(6)) Worken Compensa�ioa Inwrence offidavit muet be completed and submitted with thif applicetion. Failure to proviJa �hi�ofltdavit will result in�he denlal of�ha Issuanc of�he building pvmit. SignedAfTidavitA�tachtdl Ye� .......... No••••�••••••� SECTION 7�:OWNER AUTHORIZATION TO BE C0111PLET6D�VHEN OWNER'S ACEIVT OR CONTRACTOR APPLIES FOR BUILDING PERM1IIT L aa Owner of tha iubject propeny,hercby authorisa 1'�/M�"�V-e�t7�1'- to act on my behnlf,in all mutten relative to work authorized by�hi�6ui ding permit opplication. Lz- �. -�y�z Pnnl U��ner'f N nn(Eleetnvde S gnulurc) Duta SECTIOIV 7b:OWNER� OR AUTt10RIZED ACEIVT DECLARATION By entering iny name below, I hereby a�test under the puine;uid penaltie�of pery'ury thol all uf the infurmnliun containad in this app�ica�ion i�true�nd occuraw to the baet of my knowledge and understanding. -l� 3��1 � . .L . I'riml)wnur'�nr:\whii 'icJ,\�cm'vNt11tlYIIiI�ClIUI11C.C1�0111UR) DJlC ' vo res: I. .�n O��ner��hu obi�ins a builJing pennit io do his.hcr uwn ��urk,ur an owner��ho hirc�an unrcbist¢rrd cununcwr ��w� regisiered in ihe Hume Improvement Conuacwr IHICI Progreml,�vill no have acas�to iha ubitraiiun program ur gwr:mty I'unJ und�r\I.G.L.c. 11_'.�. Uthur impun�nt inl'urmation on the HIC Program can br IbunJ a� ������ n�J•.. ��,� ,�. � Inform;i�iun un �he Construction Supen�itor Licanse cin be Pound a� ����`� n61.: �.�� ,I��. � ��han subsiamial��ork is planneJ, pro�iJt�ha inl'unnmioa bclow: I'aial tluur arco 1 sy. 11.1 . ----..-I incluJiny g;vayt. linishtd basemcnt a�tics.dccks ur purchl ! (�n»ili�ing ,vraiiy. lt.l ___.. _ Habila6leruom.uunt _ _ ,.. . _ . � \wnFcrol'lire�+licas .. ... ._ ... _... '--- �umhetolh.JruumS . . .. .. . . I \uinher��YhaUvi+unis . , . . . \�umbe�ul'h;dth:uh. . . , I\pe al hr.uing >�.h�in . . . \'umh¢r oFdecks� porclies � I!n.I�,.eJ (���cn � � 1��l'���������Illy i\tlClll �� , ! 1. "f��l.d I'n�j�'el S��uur¢ I'a��l.iyd' nl;l) b¢ :uh�ii�uicJ IUr..I',�t,d I'rnjtCl C���el" ' �� CiTY UE S.ILE,ti[, �tiL1SS.ICHL'SETTS t��u.o�vc Dea.�x�n�e.�r I'0 W.�.iHLVGTON STAEB'C, }iO�ppA � '� TLL (97� 1�l-9S9! 'ct�mERLBY DItLSGOLL F,�c(9'7� 1a49846 .�UYO� I}{O.VA!SL PTFf�f D f AF.GTO4 Q P Pl.BClC PRO PE�7Y/8C Q.DCV C C01G11153lON HR Constructlon Debrl� Df�posal At'fldavlt (rcquired for all demoliUon and rcnovatian work) In sceardanea wi�h the aixth editlon otthe St�te Buiiding Cade. 180 CMR section 1 l I.S Debri�, and the pt+ovi,iorLt of MCL o 40, 9 J4; I Buildiny Pertnit !/ ia is�ued with the condJtion t ha ihi� work�hall be diapaacJ of in a properly licenaed wmts dtapoaal faciliry� doBncd by,1qCL� l I i, 3 I JOA. Tha deb�� will be tran�portcd by: GattQ.<c: g�a��. /, �- ow� ��z<< (e�,�„a ol•no�la.) The Jebri� will be disposed of in : � �� (n�m1 0/f���lily) . . .. . . �,k 1 �ea,��Z y , (�� (�ddr�acrr,cdi�y) . . ' C����C�^�-7A u�nanueolp itipplic�nt --�_— J��a I , ,, .�f � . „ ::`,"� C CI'Y U P S.1LE.�(, 1�L1S5.1CH[:5 E'ITS , t� t3Li�i�:c Dea.�Kr>i��r ���i 's���� I�O 1'�/.{SHL�IGTO� $T11EET, 3iD Ft.oaa ���.;�*a'•.' -I�L 978` 735-9595 ����J�> . :. � I - F.�'t(973) l i0-98�16 ��[pt�iL�Y DRISCOLI. 7lyoai,�sST.PtExxs �L�YOR DIAECTOR UF PL'9LIC PROPFRTY/BCRDI\C,CO���II�fUNER Wnrk�rs' Cumpensadon tnsurance ��tRd•rvit: I3uilders/ContructurrlElectrlciane/Plumben �nnlic:�nt Infnrm•rdnn Pfc:tqe Print Lea_Ihlx V;1i11� lllu�iiw,�Urg.tninii��nlmliviJual): dJ//'f” �o !/�iZ�[//"'/�� �dK-Q ;��arcys: �y3 �2� �iRl�t�K?crr�i /�-v—Z_ CityiStatc/Zip: � S� Phone M� 7,�/—/S�—�1i3 �+ ,�r¢ynu +a cmpioyer7 Cheek tha rppropriate bar. fyp�u!prnJect(requlnd): 1.�m a employc�with_ � +. � I;un a gcnural cuntactor and 1 6. ❑Nuw cunytnuiion ampioyca(fLll anJ/or part•time).• have hircJ iha subcaniracmn 2.0 I am a eala propricror ur p�utncr. lis�ud on ihe auached ahect = 1. ❑ Remadeling .hip unJ have nu cmpluyeey Thes�subcontreeton have 8. ❑ f7emolition wurkin�{ li>r ma in any capacity. worken'comp. ineurnnaa. ��. � OuilJing�dJition �No�wrkcrY:wmp. ineurance 3. Q Wa ue a rnrpamrian md iu rvyuircJ.� oiflcen have axnrciecd thair �0.� Electrio�l repsin ar additiaro � 7.0 I�m a hamcuwnur duing all wurk right uf axampliun per MCL ��•� P�umbing rcpuirs or uJJidonf my�elf.(\o workcn'cump. c• ISZ,�I(4),anJ wa have no 12.Q Roof mpain insur�ncereyuircd.� � .umpluyaea. (NowarYen' U.Q Olhe� cump. inxurancanyuinJ.J •.��ry upplh:un Juw diw W baa 11 muu alyu�II uw iM�ec�iue bulow�+lrowiny i�air�rmt�d cam�rnudun puli�y inMlmuUan. 'I hvnvuwnen whu.ui�mii tl+i��rildnvi�indieainy ihry�n doiny ull wurlt md ihen Aim uW�iJ�eammaro�m�u1 ai�hmil�naw a0lJaril indiolin�wek �C�m�er Wn�hal ch�sk ihi��ua mwl�nahud+n.WJ�iiurvd.haM ehowiny ilq nwna o(t�0 abwaNneWn anJ iAal�watM�tn'wmp puliry InfwmaHoq. /u�e un nrtpluyer�huNs pruvldlnX�vorken'rumpeuaaNun Luu�unci�ar my empluyerx Be/uw/�du pollcy und fob s�ff� injuinrurlan. /�p,., In.,ur.wttConipany Vame: �'T•2�U�1.✓17�(17_.�/✓--E�%� . ! a � ,�/� Poliry 4orSelf-inn. Lia d� Iif/U t', "D/J '%A/,f_�/ Erpira�ian Dote:��/C+� !� lub 5iia,�d�r��y: /�1 �c/l,on c.:i .r�-�i-c CitylSt�triZi�?�Yl.�.... oYi ✓oJ- .\ua.b�i cupy af Ihr+.orken'compan»tlos puller deeluallan pagr(�hawing�h�polley number and�splrtUaa data). . h'.iiluru tu wcuro cuveraga:u�rcquired unJar Ruction?L��I'�(GL c. I52 c�n(�aJ to Iha impoaition of criminal�enaltiaa of a � rire up io i I,SaU.UO unJ/ar mie-yaar impriamm�cn4����ell as civii pcn�itins in�hn Fartn uf n 5TOP WURK UKDER anJ a iina ,:r up tn 5_'�0.(70 i J�y �gainst ihe violamr. Ile�dvixeJ�h�t�cupy ul ihie.�rttemcnl m�y ba furwardeJ ia iha OI'lieu oP ' lavi�,iig�iiuu.��dihc nIA iur in.tunncu cov�ragc vcrilicalion. � /du hrrrby cnrij nuJMr�ht o iu uuJ prnn/11r.t,i�p.•ijury J�W thi Gr�unnudun pruviJrJ o�u/vr is�rue,u�J�'urrrot ��� i�.. ., r i Uat . .j //l�- I r :,•. � 4C��1 s�' � r,_,,�, � ..��__ . Il//ici�!rue�+nly. O,�nof roii�t in dn:r n�eri. la ht tuapl�/�J 5y rity ui 2wn nf/Iriu[ � � CIry nr 1'u�vu:. . _ ._. Permirif.lernre � . —_. ... . ....._ .. _.. f.�uiiiy,\uihurily (cir¢la nnc): I. L'U'.�fJ ul'Ilr��llh !. Ouildin� Ucp-,irlmcnl .1. f'ilyi fnun CI¢!k J. fil.[trkdl (n+pcclnf i. l'hinlbin�; Iu�p.cfar � �. 1)I�IBf � I —_'"' I l�ni1l.LLf I'C!{nil: _____'____' I�hiltll` �f: � ��� BTADE-7 OP ID:AM "�R�'� CERTIFICATE OF LIABILlTY {NSURANCE DATE�MMIpDf/YYY� 05/04/12 THIS CER'fIFICATE IS tSSUED AS A MATTER OF INFORMAlION ONtY AND CONPERS NO RIGHTS UPON iHE CERi1FICATE HOLDER. TH19 CERlIFlCAiE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIGES �ELOYtl. THIS CERi1flCA7E OF INSURANCE DOES NOT CONS7ITUTE A CON7RACT BETMEEN THE ISSUIt� INSURER(S� AUTHORIZED -REFRESEN7ATIVEOR�PRODIlCER,AND 7HE CERTIFlGlTE HOLDER IMPORTANT: If the certificate holder is an ADaT10NAL INSURED, the policy(ies)musl be e�darsed. If SUBROGAT70N IS WAIVED, subJect to the tertna and co�itions of the policy,certain policies may require an endorsemerrt A statemerrt on this certificate does not confer rights to the certficate Frolder in lieu of such endoraemeM s PRODOCFR COMACT Estabrook&CMamberlain�irre 508-697�963 �E: P.O. Box 277 FAX-697-5809 P�G Pb Etl: (M.Noi: �Id OWdtCl��A�Z�-�� EIAAIL �IB RONf�(0�C� RWRESS: HISURER(S)AFFOP�PIGCOVH2AGE PoAICi �r,suneen:Westem World Insurence Co. �� . BTADevetopmentCorp - ir�suaEae:Commercelnsurance 34754 AlexBezanson iNwa�ac:AssociatedEm lo rs 11104 943R BmckLon Avenue Abington,MA 02351 ����o� WSURER E: INSURER F: � COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TFitS�5 TO CERTIFY THAT 1HE-POLICIES 9F 1NSURANCE tt3TED BELOW HAVE eEEN iSSltEfl i0 iH£iNSUREO NAM£U AeGtE FOR iNE POf:ICY PERIOD � INDICATED. NOTWfI"HSTANDWG ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WfTTi RESPECT TO WH�qi THIS CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLIqES DESCRIBED NEREBJ IS SU&IECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT�OMS OFSUp1-POLICIES.'L�MRS SHOVJN'N1AY-HAVEHEEN REDUCED�BY PpID CLA�MS. INSR ryPE OF WSURANCE POLICY EFF POLICY E%P LTR POLICY NOMBER MMNDIYYYY ' MNIDDIWVY � LIMIT9 - GEMER/LLIABILIIY EACHOCCUftRENCE � S �.0�� � A X connMERciat cENEa.�iiaeiury NPP7299805 04l17/12 06/11l13 p�M�sEs Ee occunencs E 50,00 CLAIMS-MPDE X❑OCCUR MEDE%P(MyoneOerson) - $ S�O � PERSONPL&ADVM.4IRY E ��OOO�OO GENEFPLAGGREGPTE $ 2n.�00. GEN'LAGGREGATELIMRPPPLIESPER: PRODlICTS-COMP/OPAGG § r.�OOO,OO � POIICY PR� - LOC L I.UrOMOBIIE LIABILIiY COMBINEO SINGLE LIMIT � Eeacqtlent B � - r.Nv.wro C . Q&DSI!] . 08/05It2 � �aooi�rw.uar(aer.versoN � ; 500, ALLOWNEO SCHEDULED AUTOS X AtJlOS BODILYINJJRV(Peracdtlent) $ SOO,OO X HIREDPAITOS X NON-OWNED PROPERTYpPMP�'iE f .250 AUTOS ' Fere¢iOeM $ UMBRELLA LIAB .�OCCUR � EACHqCCURRENCE $ E%CESSLWB CLAIMS+APDE AGGREGATE E DED � RETENTION$ . t WOPo(ER9COMPENSATION WCSTATU- OTH- ADDEEAPLAYER3'LIABILRY YIN � T9$YLIMITS C ..MIYPROPRIE�ORPARTDIER�CUPVE . CCSOO9B'IS-'I . OA/O7/�I . M/O7/�S . .E.L.ERGH.AGCIOFNT ..E BOO�DO OFFlCFRIMEMBFREXCIUDED'! -��NIA �x.wmary;�rwt e�.oiseose-Eneena�ov� s 5�, � rryes,aesmne�naar �ESCRIPTIONAFOPERATIONS.Ealwr E�_DISEASE-.POUCYLIMR .$ 6OOr� OESCR�TION OF OPERATIOtS/LOCAiIONS!VEHCIES (f�Ceci�ACORD 101,AUEItlmtl RemaX2 SchW We,l!mae apaee le roqWRdj . CERTIFICATE HOLDER CANCELLATION SA1E120 SHOIR_DANYOF-iHEABOVE-DESCRIBED-POI:ICIES�BECANCELLEDHEFQtE � CI of Salem TME E%PIRATION DA7E 7HEREOF, NO710E WILL BE DELIVERED IN �Y ACCORDANCE MA7H 7XE POLICY PROVISIONS. 120Washington Streei ��� Salem,MA 07970 au�.wqiZEon�Prs�s�urarnE '. Cl�,.�� ,e�°� I ` � O 198&2010 ACORD CORPORATION. All rlghffi reserved i ACORD 25{2070f05) . The ACORD name antl logo are registered marks of ACORD '�, . . _.. . ,,.. _.. ,,..... ... ..... � „ ... .,.,. . _, . . r ,,, , ,, �. _ �_ .. .. , illlfi I� ms:uuri .AIl.uivh�i{Luuqlte�;W�ibuu . . ' . . ; i I IOML IIVIPItVVEML-Nl"CONIRACTOR - � . . r:i -�'I.� ����i.,l;a(ir,n: 1�y�q?4 Typ�" iH . = �c-r,pirntiun. 3PI91:'01:3 I'ilvale Oaqiorolioi � � . � � . IlIF�.UEVL-L!rl'N1LIJf COh'P � � � . - � �LE<: RF�AfdSflhJ � ' . � .. : � . - . ��i7��Rj 5ii�iGl�I'ON AVF. � - - � . . ' .. .. .. , .. . _ ARIPIL;-fOld, MA U2351 � ' - - - . �. � � . . . . . . . - � I�udercctri•I:u,�' � . . . te �' u.i/� l�� �/�-.i � riJp/iJ � . . ' OI'fi��e.ulCuurnma'All'airs.YlSdsincssKe.(;id:ilion � � . . � � . ; � h � �� FIOMCIMPROVEMENTCONTRACTOR� � � , � � � . .��� 4 y .';- Rc�istration:� '138030 . . Type: . . . � � . �e � fi �� r� Expiralfun: �2/4/2013 . Iridividual � . � . . . . � - � � - � � � AI_FX A. f3FZANSON . I.. . � . . . � � � � . � � . . � . - . AL�X 6EZANSON . � . � . . . � � . . 7G1 RANDOLPH ST . � � -1u'�},''fY�.t.t� �,.i';,, u �. i .. � ,. .,� � , ��' � r ,i _p��i � � .?Ii'?ip�i�, . _ i . :..i" . , . .. � A6INGTON, MA 02351 �-� . UnAiruni�uy � � . � . . 7� � I t .'1�`tlt `^_ _L,r`�` ��. . �, �ri �M �`�_ ? � . � . _�'a. `al .>�� .�Ily'" .J�J^ 1.4T�.ICu � �I¢. � . � � � Cunviu.�iuuSupit�i.ut � . � ii, � _.CS-082534 t _e � i� �� � � .� i.� ; ':; �'�;.�� . - ALEX A BEZANSON 'r - •-- - � � � .� � 943(R)BROCKTON AVE. . ` • � Abiugtan MA�02351 �; . - �. . ^t r � �. J.�.- �ll/S�F`�« ' _::a'.-�rr �.nr-,.-,:s::r;-F:=:, 01124l2014 :__._ ' ' - '1'-. ' -- _ � � � � � � { � � � . . . ; � - i ��. 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