25 ROSLYN ST - BUILDING INSPECTION (3) �, II
The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Fami
(Phis Section For Official Use Only)
uilding Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address i t available)
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No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building Repair❑ Alteration ❑ 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 Engineerin Peer Review requd?ir Yes ❑ No ❑
Brief Description of Proposed Work: vx�q�(, -
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA j
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 A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1❑ 1-2❑ I-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage Sl❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Debris Removal:i h Pe
rmit:ermt:
Water Supply: Flood Zone Information Sewage Disposal: Trench
Disposal Site❑
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ m No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
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SECTION 9: PROPERTY OWNER ALTFHORIZATION
Name and Address of Property Owner
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Name 2�i No.and Street City/Town Zip
Property Owner Contact Information:
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Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owners behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
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Name(Re strant) TT hone No. e-mail address Registration Number
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Street Address City/Town f State Zip Discipline Expiration Date
10.2 General Contractor
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Com/pa�ny Name
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Name of Person Responsibl for Construction License No. and Type if Applicable
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Street Address I=(t,Ol,��`�, City/Town State _ Zip
_"
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C 6
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❑ No ❑
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 JhA
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ tO 000, (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 is true and accurate to the best of my knowledge and understanding.
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Please print and sign name Title Telephone No. Date
../
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
,
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
N l'.rl I Y-Ir114191
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•• 11+1. 91t.;IY/i'+S • I'l.v v1N•;IC•'ISM
Workers' CumpensolJon Insurunce %inti vit: Uullders/Contrac torsi llectrlclans/Plumben
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.Iry nu an vuglloycr:'Chvck tho;ipproprluto box:
I.❑ I .un umpluyur wish 4. I am a yunural cdutemlor and 1
2•❑ I S1H°f pru)uet(raqulnd):
v upluyecs(tall,ntYur pdn•lin e).• huvu hirvd the.vuh•clmaauufrs ti' ❑New construcliull
1 am solo prnprictor or panner• tilfcd on rho anached.nccut 1 >• Q Retnodtling.hip;Inll havv no umpluyuus Theo subcontraetors have
Ivorking file my in Any ca ucit • ,v rken'camp. Inyurxnee. d• ❑Demolition
I No wurkerl'cutup, insuranet 1. Q WI an a enlpontinn and its 9• Cl Oudding addiliun
rcyuircd.) unleen have uwreivcd their 10•Q Electrieal«pain or additions
�.(] 1 ,tut l h N**%or vi Joint'all work ridhr of usvnlptinn par MOL 11.0 Plumbing rupuirr or additions
myself h'o wnrkurs'camp• C. 132.it(4).and wt h Iva no
invurancu required.)t clnpluy'AM Ift'o%vorken' 12•0 Ruurmt airs
crnnp, invurancu mquind.J 13 Q Other
1 fir.,;Iplw'uAi Ihr1 thueks lira III mum.day Hit uW IfN Wrllup Iwfuw dwwgl I
I I.,nyllrrwn ytul rl,f/mir this a111esv11 iMlluline,l,p p duin a brit wwllaa'runrrrn„yl„p IrJiry Igh,r,Iaail,ra
'r\Mlelalllq?hot ahrri Ikls Eat M. All;llre da Addlll + e ill,vur and Ifµa him gullies r1atlAtar•mul aglrnlr 4 a"Affidavit indl
uiud AM•knwin Ilm"A"Wallfle lubcolklairk".led lhow withers' aylneg,rh,
verployer/has le provlJ/nd worAers'rurnprnrnrloe lvrvnuat/w/aJI ern t. ` I"'t{y mllwlsangs
i///ururofG/lx p/J er.R Bllelr/r 1111 JWII{Y Yp f JeI.11/I
Inaurancv Company,Vamp:
Policy V ur Svlr•ins. Lie.h! —
�--' Eapirallun Data:hub Sao ddJruvs: �'---�
\lraub a cagy of ntt Irorktn' t
culnpenlattun pulley duclurallun pug#(showing the policy nuulbar and cxplrarlus date),
I;allura to wcure cuvOruyt a!required uodcr ScLtiun:1A ul'.NGC u. 132 eau lead i210 M a 4.
1 , Jilt to tlq.imposition of Criminal panoitie of a
61killel SI .IM l uil u
1ue•yea nnprimnuncnr, u1 evull.Is civil flcnalhus in the turm ufa STUp 1VORK ORDER and a line
Drop rn y iduinit qIt vlol,Iror. liC!dv/u'd that a alpy of Ihlk lmemcm may bu Iurw irded lu Ihs 011iuo ut'
Ins.,Il,uuIm uY;liv I11.\ ;or m.or.u:ev:uvcra;u \curia uli,n.
l Ju/rcrchy 1;qi/`rur,/av der pninr surd//rnn/Iivr-1 pvlJflry/h0I the iv unevf/oe
prltrldal uOlfre is/eve and corrvcL
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r 1//Jeiu/q,I rn/y, pd ImI twirl in Ihil JAW. lu Ar rgnr Q7fd D
Y Y ufy ur robe n/�/liuL
( ifrur 1'alrn: _
Yannif/l.lta'nle 1
I,.uiny .1ulhorily (Circ10 fines:
I IL .u'J of IIe.JIh t. Ihuldur: Uap.lrll„rnt I. l itl.'I'olru Clerk J. l•Icctrival (Ilylcvfur
PlunlDin
6. UIJIa•r N Inlycclor
,I l' u.,cl I'1 hgn:
I'hunc I.
I
[ nformation and Instructions
-tiled as". every pctson in the wrvtce of mother miller.wy contract of hire.
V.uruchuseus t.icnena in r rr`P/rtree is Jvu yutres all euydayers tr provide workers compensau„n lot thou otployces.
I`unu.uu to uus .tatu
:%press or imphcJ, oral or wriuen." araaon ur uthcr fugal cnnry, or any two or more
urt'anhip,•tssocunuo,Cory lu a ur the
to Clovis yr n JcfincJ as"an individual.p lam 4nlplayees. However he
�t the t,,regontgYngagcd in a faint enterynsa, and utcluJing the legal representatives of a decease entp ,
c IN 1, or uuatee ul'.m indinJual, pssmenhtp, asseatauoa of other legal cnmy, s d Y
ilint house
la v Portions to do tnoi because
erg o f such employment be deemed rube anaetnployer
owner r a Jw:c# 'a Qoh�whu emp haw ing tyn M hail three apartments and who resides theretM or then uch ill at the
.Iwv lhng ham appurtenant hereto shall not bee
or,,it the ground$or building
\lGL chapter 132, 4?1C(6) also slates that"OvarY Hate or local ilcensla$a Willlags i shag win old the issuance or
aired.'
renesval of a license ur Permit to Operate to s business or to ce Of ,PUaac with l@ la tot'iu olilitic I subdivmwelillb isions+hall
Applleant wlte has not produ.ed�C►Pl,lilies'Neither ht onuronw�lth nor any rare Dcovara$e►l t
1JJitiunully, MGL chupter l S., i-S
untar lino any contract for the parfamtuncs of public work until aecepctble evidence
ufeantPliastce with he uuuronea
requiremcnu of his chapter have been presented ro ha onuactin$awhoriry."
applicants apply to our to
mtd it
ero letd Phone checking
the
along with then certiAcale(s)or
Plc,tse fill out the workers* caor(,)nation a, dd it cempand p by checking he boxes iwatA o employuas ulhrr than the
necessary,supply cult-contrutel(s)mina( L adJr Li
workan' compemwtion insurance. if an LLC or LLP does have
imw-anee. Limited Liability Companies(LLC)or Limited Liability Partnerships(LL
members ur pwut+O, Lite not required to carry be submitted to the Department of Industrial
employees,a policy is required, 9e advised that this Ise belt tre gr y nested,not the UOPottmcnt of
\cciJenu for centlrmatian of inattrasteo c heatian for th porn for license is being requested.
n Th.alltdavit should
his retained to the city or town that the tin uestions regarding the low or if you ate rcyuired tpanies should enter their
InJusuiul,\ccidents. Should] have any y
compensation Policy,please call he Deptumtent st tha number listed below. Self-insuredcomp
scl6insurance license number on the a ro Aura line.
City or Totes OMelals ment has provided'A sPac's he a lieano
rfetha aifiJavJ four you turtl�ll nuesinuhe evtenl the 0 Ties of Investigations has to contact yuu regard"'$ at thDp ours
I'I wac bit aura to fill in the purtnitliicense ntunbir which will bs mad ax a reference number. In additioindicalinill n,an upplicuu ur
lieu must MilAubt 1 t ill in h penniu'licettse applications in any given year,need only submit one atltdavit raviJud to ent
policy iuformatiof he need vi�hat has been officially stamrpud or mass"the rkedliulltby+he city at towrite n tnay be 0 in.(city
tuwnb",\ spry
applicant y proof,that a valid t thataffid has
is on file for pamia or licenses. A now aflIdavit must be filled nut eae
y ear. \0'hans a hwns owner or citiacn is obtninin$a license or permit not relined to any business Of commercial venture
I e. a Jug license of permit to burn leaves etc.)said person is SOT required to ompleto this ujj yo it.
i uesuont,
Inveaigativas would Itee to thank yvu it' aJvance full your couperotion and should you haw.,ny y
i,lea>e du nut hesuala to gtvc is a call
fhc Ucparnnent's adJrars, tclephune and fax number.
The Cofrunonweelth of Massochusetu
Department of Industrial Accidents
OfAee of lev"dallidons
600 WashdnBtOA Street
Baston, MA 02111
fel. p 617.727•4900 eat 406 of 1.877-MASSAFE
Fax N 617.727.7749
'✓YWw,mus.joy/dis
f
. :.bier<:dxtsctls - D¢piu-tmcnt Public Sdard
9 Board•ot Buittlin!, Rr_ulations and Standards
Construction Supervisor License
License: CS 84822
GREGORYJ MAYNARD
27 WESTON ST
DANVERS, MA 01923 '
Expiration: 12120/2012
Trp: 9399
Analysis Ag Agarous Gel Electrophoreses:
Katie
9N2010
a Activated Calf us DNA lot 128K6268
Samples:
Repar 1aa sh wn in the pbk bem
Dye:SX Swp Dye-S0%Glycerol,50rOd EWA,005%Bmn o hmol Blue
laddv NE WO N3270 Tri-Dye 2-Ing DNA ladder,l5uL IoadcNarm
Gel:1%Agamse,IX ME BuRcr(Try,Boric Acid,EDTA)and Edudum Bmn ide
Runring Buffc: IX TBE Buffcr(Tris,Boric Add,EDTA)
30uL ofeacd samPk was loaded impfhegel.
Run 1 hr®200V
I
A-1 ALM I ul N 1=2
1 NEB N0469 Q11kB ladder 10 10 0.50
2 Slgnma D4522 Act.Calf Thymus DNA 027K6038 NEB 121107) 2 2.5 47.5 30 30 2.S0
3 Slgnma D4522 Act.Calf Thymus DNA 0431(9105(NEB 032409) 2 2.5 47.5 10 30 2.50
4 SI nma D4522 Act.Calf Thymus DNA N71(6091 NEB 051909 2 2.5 47.5 10 30 2.50
5 5 nma M522 AR.CaB Thymus DNA 1281(6268 2 2.5 47.5 10 30 2.50
6 NEB N0469 Qi 11,13 ladder 10 10 0.00
] Slgnma D4522 Act.Calf Thymus DNA 027KW38 NEB 121107 2 5 45 10 30 -5.00
8 Slgnma D4522 Act.Calf Thymus DNA 0431(9105(NEB 032409) 2 5 45 10 30 5.00
9 Slgnma D4522 Act.Ulf Thymus DNA 067KW91(NES 051909) 2 5 45 30 30 5.00
10 1 Slgnma D4522 AR.Calf Thymus DNA I 128K6268 2 5 45 10 1 30 5.00
11 NEB N0469(I-L SkB ladder 10 10 0.00
12 Slgnma D4522AR.Calf Thymus DNA 027KW38(NEB 121107) 2 10 40 30 30 20.00
13 Slgnma D4522 Acf.CaltTh mus DNA 0431(9105(NEB 032409) 2 10 40 10 30 10.00
14 Si nma D4522 AR.CZN Thymus DNA 06]K6091(NEB051909) 2 30 40 30 30 10.00
15 Slgnma 04522 AQ.Calf Thymus DNA 1281(6268 2 10 40 10 30 10.00
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Gmail-condo approval https://mail.google.com/mail/?ui=2&il--dd6555d45e&view=pt&searc...
Gmail-
Katie Black <katblack4578@gmail.com>
I'jGvKIgle
condo approval
Josh Gray <joshg7308@hotmail.com> Mon, Nov 28, 2011 at 1:54 PM
To: condo <katblack4578@gmail.com>, David Hamel <dh@premierpropertyma.com>, marccalder@comcast.net,
Condo Jenny McDaniel <mcdanielJ@yahoo.com>
Hi Katie,
As discussed in previous e-mails, you have approval to go ahead with your kitchen remodel. Just remember to
contact Premier to notify us if you need to shut off water and etc. All the best in your efforts!
Regards,
Joshua Gray (Current Janette Condominium Board Member)
Date: Mon, 28 Nov 2011 13:46:17 -0500
Subject: condo approval
From: katblack4578(")o gmail.com
To: dh@premierprooertyma.com; marccalderC&comcast.net; mcdanielJ@yahoo.com; ioshg7308(")a hotmail.com
[Quoted text hidden]
t
1 of 1 11/28/2011 2:01 PM