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8C RUSSELL DR - BUILDING INSPECTION (2) CITY -- PUBLIC PROPERTY o , DEPARTMENT \ t20 WmmxGwm S'rw=*SAL0kMAMcHustij m 0t970 TU;975-74"S"*FA=97e>74o."* APPLICATION FORTHE REPAIR RENOVATIO& CONSTRUCTION. DEMOLITION. OR CHANGE OF USE FOR OCCUPANCY. FOR ANY EMTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Lomdon Nana: -Prw e �ilern E)tq,7o - - property is located in a;Conservation Area YIN Histwic District YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: M('S_ R5 Yy-ZLY, i c-0 �q a Address: qc� S ° 'ScAe In fk. 6 VcT 0 Telephone: M"—`Z — 3 23& 3.000MPLETE THIS SECTION FOR WORK IN EXLS1 rs BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor(sf) Renovated construction or renovation of existing building Now grief Description of Proposed Work: rc�JC' r v (04ALI Ca�rUin�� B�s�e�, t c�h c$ C'Woreat "irtAzul vke� 1."in�x J6 aj b �sOc Mail Parma to: r ' . na& 0 -21 What is the current use of the Bu'dIng? Material of Building? 0 ifdwelling.how many units? Wit the Buiding Conform to Law? Asbestos? Architeas Name Address and Phone MechaMc'a Name �e"N c�i'l Z (o s-��{� U Address and Phone b " ^D n �Y�P�ra5 C' 9M © Z( Construction Supervisors License A CS �� HIC:Ragistratbrt# Estimated Cost of Projeet$ �' Permit Fee Calculation Permit Fee$. ._ Estimated Cost X$7/$t000 Residential- ------ - ---- ftdmated-Coat X$t1f$18t14 ----- An Additional$5.00°is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays,In processing. The undersigned does hereby apply for a Building Permit to build to the above stated spec&.ations. Signed under penalty of perjury X Date 9 1 o� x ° ' o N � a 3 y g CITY OF SALEM PUBLIC PROPRERTY DEPARTmENT Katuottsv tatreooct Mwvoa IM WAgMr MSTREST a Sa1aM,MaataclnWM01970 Tau 9W45_9S93 a FAa:97sg4G qg% Workers' Compensation Insurance AlMdavit: Buntiera/Contruto AnoNcant Information Cnnatructien S 'ieitioS Name P.O. Box 53 —@er�'satir+wsss MA A4�M Addresso— City/State/Zip. Phone 'Z 8 ( - (� 5-�E4 i 0 Are o■o.mplayerT appropriate boar 1. 1 am a employer with 4. p I am a Smug oont CW and I Type of peoL employees(tall and(or pasatime).• have hired the 6. p Now 2.p I am a sole proprietor,or p srman listed an the amwlw sheaf,t 7. Q Remodeling ship sad have no employees These sob-Oonhacten have g. p Demo working for me in any capacity. workers'camp.insurance (No workers'COMP iasturance S. p We am a corporation.and its 9. Q 10.❑Eloctr3.OI am�a homeowner doing ail work risen eta q"PetMOL I I.p Pmmhonsmyself(No worker■'Comp, a. 132•11(4b and we have noinsurance nhwhvd.)t employees.Qio workeW 12.p RoofCome human os 13.� -Paw Wacalff*A ahem ter el mart dw tid at We rwdm tdow eooq�etlea l+oVaY lebemella�rltoiaw.m.sow6.@ur.tlldr::=%e dwrmadye9WA&MOd�9ie�amm.oaa.�.moombeltaamamaavik rCoaaaerae sirs,aback dds,bur out s,kraebed ore addilaed dam dba1n9 ne■ems,ddn abmmaaroe red sirens werloes,•camp. an an a skim 4provfdlw workers Wormam '�wpiawafoa 4arvowcel�erl e+eP�Yea Beloks,b tktpollel ms/Ja i rA4r insurance company Name: a;tIe n m Policy N of S"im Lies.M t t) ' 00 -1 B"O S3 � .. F.ap"'don Date (c� Job Site Address city�stetrnJp• f'� • oia-ro Attach s copy of tbb workan'Companutiom I dtelseatb■page(Showing the po ft cumber and eapirstion date)6 Failure to secure Coverage as roTdred under Section 23A of MOL c. 132 can Ind to the imposition of taimioai pent of s fine up to S 1-500.00 add/Or oaa•year imprisonment,as wolf as civil penalties in the form ofa STOP WORK ORDER sad a fine of up to MOM day against the violate Be advised that s copy of this stetement may be forwarded to the Of&@ of Investigation of the DIA for insummm coverage verification. /do bareby crrrlJy rba poles paea/t! r ofperjwy chat rbe lafoaaadoa pr"Med JbO Dare ant cones Simmamre C� �, Dare O,Q7eld ass 0XI Of AN wMe L skis are44 to be eamplawbyCAV orJMM oJJICIaL City or Town: Parmit/I Icensa N Issuing Authority(circle one): 1. Board of Healtb 2.Building Department 3.Cityfrow■Clerk 6.Other 4.EleeMeal Inspector S.Plumbing Imptxtor, Contact Person: Phone M: CrrY OP SALEm PUBLIC PROPEWff DEPArruDrr MAWS tar VUmmasar Snow*lasa%XAmaAmw matt . Ilk M?4&SW a PAn sn74&" Caswutlan Debrb Dbpad AflWavlt (e+agµteetl tl,r ar duaoliiios and saeotrade�wadi 1a wearde me with dw si t OMM eddta UM poi Coda 7t0 C MI sedum IIIJ Oduk and dw p wAdotta afUGL a Ia•54 guamms lrenil M Is tmmi wit do eoadi W do dw&brb mattWtts ftm tMa wat,bail be disposed of 1a a poparty tloMMadd was M di paed dt HW as deAaed by>t M a t i i.�tsol►. . TVA dd x%wiD be battsported by: rust arbidda The ddsis will be disposed o[la: �N1��rose; MPr. ®zc Zb PROPOSAL CONSTRUCTION,SPECIALTIES UNLTD., INC. P.O. BOX 53 YYY STONEHAM, MA 02180 Phone (781) 665-4410 Fax (781) 665-4411 LEN N OX BROAN-NUTONE HEARTH PRODUCTS A NORTEK COMPANY Mrs. ReistmAn 0� g c k0554F l �� pesMo.re_ cL GQis�o`ce Ek ex��Tt�n� ` P �C3�eti �i (AiNyn oe Li sy she.r-, Itnst �l I -en�l�c !3P_1 3(0 c�vor� c� ��cel C�nimn � ne-)-o — �7 P,-e'_' cS ne 'S,N•ro",ncc q- lam. �,I�m� Pam.-t.�;�-- _ �ate• We propose hereby to furnish material and labor- complete in accordance with the above specifications for the sum of AS ABOVE Payment to be made as follows: For special orders a 50% deposit is required. For central vacuum and intercom installation, half is due upon rough-in and half is due upon completion. For all other.work, payment is due upon job completion. • i Authorized Signature NOTE : All plumbing hook-ups, carpentry work flc building permits are the responsibility of the job site general contractor or homeowner. Prices are effective for up to 3 months from date of proposal. Acceptance of Proposal- T11iWpvE 1.wr.�pflW,, (YIgY YIE♦'pbi110N Yi Y M�1n "^"'J�W YW YC WI�IMZId IO QO 111L MIXk Y IP��Rtd. P. IMIII�[IYt10 Y Ou11iKA EOvf Signature 1 Ltv o o�y �t�Date: If accepted.please sign and return. Et���c_iczitvn {N+1+nhc I��1t JC:cQt�� �QirnQ PYw'( Uccoc open Y-eknGf�•'� I z i r 1 la�.at'hucctl.- Department ul'Public Sal Co. r Buard of Buildin, Regulations :tnd SLtnd:u•ds i- ���/// Construction Supervisor License \'•4fi'�.- License: CS 53897Joe w Restricted to: 00 TIMOTHY FINN 4 8 VALDORA OR/pO BOX 53 p STONEHAM, MA 02180 's�4 '...Sy..f.�_f Expiration: 5/=il ('numi>.innrr Tr#: 15400 I I V4 >F �.r