8B RUSSELL DR - BUILDING INSPECTION pL*"SiN tl Kf**0 MID APPROVED BY T44E
MpECxDB PP" TD A.PERMT BEING GRANTED
CITY OF SALEM
Date
\ 1
is Property Located in Location o f
the Historic District? Yes_, No_ Building v IB
is Property Located in
the Conservatlon Area? Yea No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof Install Siding, Construct(D Shed, Pool,
ec'
epair/Replace Other:
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:
Owner's Name LtJ t i ( , aw w e 1
Address & Phone CP - a 2"s 5 e (/ r• I i
Architect's Name /A
Address & Phone
Mechanics Name c obeA & j h eu
Address & Phone J - !3 NFa W (97� 5 �- �1 v
What is the purpose of building?
M"W of w1ding? (mod A _I a dwelling,for how many families?
Will hdici q contonn to law? -5 Asbestos? Aj O
Eatlmated cost S,Do o Clty License s N/IN state ucense# C S O 1 S 3 t36
Baerai` Isprovar snt (� J W of '�ae< i
iz �(�U( I v� (,v I' ' I Sign�atu`r�f Applicnt nt
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
J
MAIL PERMIT TO: C'JI k)
�. � •(2,.�sse I/ I�r,
Sd/� MA oj9�o
APPLICATION FOR
PERMIT TO
LOCATION,,�
ACc
PERMIT GRANTED
D 2.0
APOVFD
INSPEC _ R OF BUILDINGS
CITY OR SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STR[[T. 3110 FLOOD
SAL[M. MASfACNUi[T{f OIf70
fTANI[Y J. 1J[OVIC=. J11.MAYORT[L[►NON[: 978.745-9393 EXT. 380
FAX: 978-740.9848
Salem Bui�11n.�
��` oaetn+snl
11kb>rts DlsoeEg_=
In accordance with the provisions of MOIL c40 S 549 a condition of your
Building Pernrit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
/J (Luca. of Facility) S G
Signature Applicant
- 3a--66
Date
ne COMMOXWeA i ojM4ss4ciitasdt8
Depofte at ojlnomWd AwMen y
6O
Bosfo4 MA 02111
wwwmwzjwWAW
worker'Compensadon insunm a A®davit Baden(ContradonMec ridanslPlamben
Appffew t h&Maden Pigse Print L.es:ibly
Name �o b �✓ L eu r�u,�,
• - r
CityMaW7ia e- z '11A 01t Phonel6 �r7g- S 8- `�/ z
Are you se to !Chad thf ippeoorlate basr' 7yypa otp*ed"quired):
1.❑ I am a employer with 4 Q 1 am a Vaud omfraelor and I 6 ❑New comnsction
em"em(Man&orpa►*dm4* bsvehhedtoabkanuaclom
2.WimasolejapiMor or patneo- lisped ou the amrbed sheet t y ❑RemodeHug
TNahip sad bsve no employee+ These wD-con"clom have L p Demolitim
wadies llw me i.aft eapacilm. sv?"'.004p.•' .„, 9.. Q BuiVing addidon
(No wasimo comp.ioaraooe . S. p we aro i >mfl ile.
negnirna.}.� ,�
lop Electrical repaid or additions
3.0Iamabomwwow.doiag4wmk Tight I1.pPkmbio[npsasoraddition
myseK(No waketaa'.con* c. IS2,11 ae s pbave`ae 12.Q 2=ftepaht
to:or Iegoi[O"t r 13.�OtherE2 e�I a c. De c
•Any �mxbuoz/1 mos.Lo en a9ttk•�•tebv d�ovhy a�rirw�ao�goa ycsar moo.
lxomwM=.%0N*M*ft&M&vta�Sam ddna.Awo*mddm*p .och
�cmu.oas Ala d.olceY twa�s rere.d.�.dd@tmt.tlea vto.vted a.�a.erllr.iam.aa..t�f..odc..•ama v�r�+*+�
1.wgrserployarrAdrbpenldb:awwtiktrs'eoarpsasdoabuw+raeofoagrarpf�bt +.low6dltptlkjdalJoiall.
Aafirwalloa
Inamance CompaoyNama UTA
Policy 0 or Seh=ins.Lic. P k'1A Eq*adon Dade.
Job Site Addicts• 8- g u55e- l! Dr1 SdeY Mfg ofCt v
Aftach a copy of tke workers'eompeasadoe potley dedwados page(d owbkg the policy number aid esphadol date)6
Faiimt to secure coverage as required m da Secd n 2SA of MIE,c. IS2 ca kad to tho bWosidon ofc dmhw penalties of s
fine up oo S1,500.00 and/or onayear mopriacmacaf,a wcH as civil penalties in So form of a STOP WORK ORDER and a Sao
of up io M0.00 a dry agoioat do viotabr. Be advised that a COPY ofdds zMement may be 6orwwded to the OfIke of
Inveauguiew oftbo DIA for bmwma coverage verification.
!At Arwby7 ander$40064s dadPeadJAU tfpa/ary AN&*JdjarseNka provide!obow b sw and cones at
210= ' 3o Ub
Phone t. (3 -?
Odkid art&* Di sat w&*At tAb tine,to led asspldd bP cAyo►Mm golrld
Chy or Tows: PeradvUeeste 0
Issafag Authority(eirde one):
1.Board of Heafth 2.Building Department 3.Cltylrown Clerk 4.Eleetrkd inspector i Plumbing Inspector
6.Other
Contad Person: Phone 0:
Instructions
Information and
General Lawn chapter 152 reyoiree an MVWMP potria .wotktt' of
pWnw to this Bade,an ANP iy;'
is defined as•...every ver70a is ibts t�tvioe roomer
eaPeia or aophad.�°r wrists
apodaf %aospoesdea t9
dr Omer 1Cgd ca ,°r OW two or more
Aa s�prsw defiaod ,p"mwh,m nxe amg,ee 1 9(a docemea a a
oitha for>�oia[enf�°d aaociadoa a other hCga1 cut%eraPWM employ" lt°a!evig dw
receiver or true �m� mrm�e to fine and VAG msida saes.of�� ��
owner of a dwcl>mi who employs person to do to"0aace,aom><a or repair oak
ardor err bnr'!dmP appma� 1e�si+sari aotbeaose of a�miploYmeotlte daem°d to De an emPloy��
MGL Cbapaer 132.42SC(6)alp states mat"avert oft err toed Nemlag"MY am wlthhoN the issaaaoe or
renewal d a Nseaes or paw%to qa*e a bashers or to mow"befi"V the mm"wed*for an»
re"Wappseaat who has not produced aeeeptahia aldeaee'f .NY the harmers courage requhVd
Addition19Y,Mtit.chapm<IA JZC( )s ofp bfic wo the co�onswa>m evidcm of*Poll" �me an�ca
Cots iM aaY contr d fol the perfarmaaoa cfpnblle wod[tmtd acceptable
of mh chapter bare boas presented a then ce .ash"
• affidavit oomspletelyr.by�ekiagthebous that
ap*tayour aimatlloa sad.if Please filkout *,a nocess"Y" addr Lashed ado¢I t*)0 wids no lemplayets)cdw am the
miprascom does bxM
,anotrapWb °°�adm todesurw
members beor mat this afgdavjtmay
Cmp;WjcM a Policy u required �'�' map iasmmm CCAlp be:twre to dp sad date the afiidavM. TheAccidents affidavit should
be t d m tower mat appNeadon AN 11a Dam o law of if 1aer am to obtain a worlcera being mg191104 ad do Dvasmew of
h dostitd Aeeadsm, Should you Department at me>�abct IIsO� . Sex UM d Companies shouldinter their
compeasisdus go"gIMS Nos
sdf insarsroce license rmaba�c 0°dw
C*air Town Olfldda
pleasC be sure that de affidavit is complete and printed legiblY• The Mpartment ba'provided a spaCe at the bottns o
an appac ffi out in do
of the affidavit fbr 5"oa to do went the Office of Investigations bas to contact you nti lftg me applicant
Please be save to fu71 in the out nCmber w>nch will be used as a reference uumber. In addition, aot
that Waal submit naltiple Pie'
Nation is any given Yea:need only submit one afNdavil indicating current
mfArmanon(if ar�cessarY)and, "lob Site Addraa"theappNtamt should writs"ell loeafimns in (chY Or
poft"A copy ofinedodwittlobasbeesof Cidbrstartpelt(fi b--AiraraffidavitCity or ima�®wedoute to ach
yew.,Fpscad
where
a pine=o a valid dfidsvdthmn is m file for �not rdatod to say b°sin+s err commercial v�
eat.Where a home owner a daises it obtamiog
Y a bum lava ere.)said person is NOT required to complete thin affidavit.
(ie.a dog Hama er Perm
The Ogee of Imraugadona would&C to maok you is advance far Yom cooperation sod should you have'Y querdm*
please do nothcsWO b gm us a CS L
The Deparmrenes address,tetephoae and fa member:
The COMM011weahh of Massachusetts
Department of Industrial Accidents
Omtx of Ines Batton.
600 Washington street
Boston,MA 021I t
TeL #617-7274900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-2603 www.mm.gov/dia
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]PO: William Cornwell— SB Russell Drive
FROM: Jill Fama, Property Manager
RE: Deck Replacement
DATE: March 30, 2006
Please be advised,the Board of Trustees for Pickman Park does not object to the
i replacement of your deck. They also do not object to the composite deck proposed by
your contractor. Please be advised of the following requirements:
e You may not change the dimensions of this deck.
+ A licensed contractor must replace the deck.
i • A permit must be pulled prior to this work commencing.
• A copy of the permit should be sent to me-
* Once the work is complete and the Building Inspector has signed off on this
work, a signed copy of the building permit will be required as well.
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In addition, the Association will reimburse you or pay your contractor directly to install
flashing between the deck and building.
Should you have any questions or concerns, please feel free to call me directly.
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07.71i2006 08:54 FAX 6176230817 MWRA
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1-B Hart Way,Salem MA.
I Nhw :978,5784162 Robert
I FAX:508-872-7279
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Pax
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lro; City of Salem Building Inspector From: Robert J. L'heurBux
Fax: 978-740-9846 Pages: 2
(Phone: 978-745-9595 ext. 386 Date: March 31, 2006
qe: Deck at 8-B Russell Drive CC:
U Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
Y Comments:
;attached is a Copy of a letter from Jill Fama of APT concerning the replacement of a
Jerk at 8-B Russell Drive. I applied for the Building Permit yesterday afternoon, but
I forgot to bring this letter with me.
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E Please call me at 978-578-4162 iF there are any problems.
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