3 ROSEDALE AVE - BUILDING INSPECTION iL1dIS1Akl6T�EfKa"AD APPROVED BY T44E
=PJ:C=PRIOR TOA.PEBMIT BEING GRANTED
CITY OF SALEM
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) R nstall Siding, Construct Deck, Shed, Pool,
Repau/Replace, ther.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
t�wr►er s idame J�Q t o MN/e
Address & Phone �S �e f 978) 7 I S- 14 L 7
Architect's Name
Address & Phone
Mechanics Name
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Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO 13E DONE nn,,� J ,, •
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MAIL PERMIT TO: M V- -e.. 3
No
APPLICATION FOR
PER MT TO t�
LOCATION
PERMIT GRANTED
INSPECT OF BUILDINGS __
BOARD OF BUILDING REGULATIGNS
License: CONSTRUCTION SUPtRViSOR
` Numbet C§.. 056432
Bin(ulatei? /31(,1962
�a ft-'0"1(2006 Tr.no: 1322.0 ,
Re9�dctdtl._.tG ;
KEITHA MACDONAtD.ii__..
253 CENTRAL ST ' , G-
GEORGETOWN MA`01833
Commisai
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Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration:_111834
Explratloe 2j4/2007 -
Type:: DBA
KEITH MACDONALD CARPENTER/WOODWORK
KEITH MacDONALD
253 CENTRAL ST
GEORGETOWN, MA 01833 Administrator
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GRANITE STATE INSURANCE COMPANY 21397-0000 WC 278-10-64
13102 ---------------------------------------------
013-66-o6O5-00
a- PENNSYLVANIA
..•
KEITH MACDONALD Member
253 CENTRAL ST. �/� Companies of
GEORGETOWN, MA 01833-0000 `, r American International Group
EXECUTIVE OFFICES:
70 PINE STREET, NEW YORK, N.V. 10270
SEE NAME AND ADDRESS SCHEDULE - WC990610
I.D# MA . .s.•
TARPEY INSURANCE GROUP
WORKERS COMPENSATION AND EMPLOYERS PO BOX 567
LIABILITY POLICY INFORMATION PAGE WAKEFIELD, MA 01880-0517
IN
ND I V DUAL R NIEWAL ous POLICY Nu
00 274961
OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - wc9go610
ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's
mailing address FROM 06/10/05 To 06/10/06
ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed
here:
MA
B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3A.
The limits of our liability under Pert Two are: BodilyInjury b Accident $ 100,000
j ry V each accident
Bodily Injury by Disease $ 500,000 Policy limit
Bodily Injury by Disease $ 100.000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
SEE ENDORSEMENT - WC200306A
ITEM The premium for this policy will be determined by our Manuals of Rules. Classifications. Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Estimated Total Rate Per Estimated
Classifications (' Code Number Remuneration 1100 OF Re, Premium
Annual O 3 Year muneration 0 Annual ❑3 year
SEE EXTENSION OF INFORMATION PAGE - WC7754
TAXES/ASSESSMENTS/SURCHARGES $146
EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $264 MA
MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $3,252
If Indicated below, interim adjustments of premium shell be made:
11 Semi-Annually 0 Quarterly Monthly DEPOSIT PREMIUM
ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612
o6/16/05 ASSIGNED RISK 66
Issue Dale Issuing Office Authorized Raprasentstlye we 00 00 01
39887
INSURED'S COPY
L_
CITY OR 3ALtMq MASSACHYltTTS
PUBUC PROPURTY CZPARTURNT
110 Mw"'MoMMI S"49T, 308 FUmm
S"S"e MA"MMUS"M 41970
TRLCPNONa 978.749-0646 LsR alp
'AXI 678-74Os"&
Ia accordance with the provisions of MQ.c40 314, a condition of your
MW Ofthat
9 NMI is the debris i ff�om this work shall be disposed ill A properly licensed solid wss"sposal facility as defined by M40L
Chapter HL 31 50 A.
The debris will be disposed of in:
rFaality) u Ir IvA-
3ignawn of Applicant
Dare
Main House
A
B
� N
D 96 in
B
A
156 in
Keith MacDonald
253 Central Street
Georgetown, MA.01833
978.771.6738
May 10, 2006
To: Ray and Bonnie Muse
3 Rosedale Ave.
Salem, MA.01970
Re: 3 season room
Scope:
• Provide all insurances, licenses and permits necessary for job
• All debris to be removed promptly
• Save existing foundation and roof structure
• Remove all windows, door,wall framing etc.
• Frame new walls to support roof structure with openings per plan
• Install windows per plan following schedule below
• Upgrade electrical to include outlets to code, 4 recessed light fixtures
on dimmer, 1 ext. light fixture, cable jack and phone.
• Insulate walls and piaster interior
• Exterior trim to be white PVC with white vinyl siding to match original as
closely as possible
• Interior trim details match main house
• Price does not include int paint$8700.00
Window and door schedule:
• A-Anderson Tilt and Wash double hung in white perm shield ext. and
wood interior, full screen and snap in 6/6 grills ( custom layout grills also
available)TW 18410-22" x 60"
• B-As above TW210410-36" x 60"
• C- Picture window unit, no grill or screen. DHP410410 60" sq.
• D- Insulated steel door with 15 Lite insulated glass panel by Thermatru.
32" x 80".
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