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14D RUSSELL DR - BUILDING INSPECTION ~; CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT tcataaatttrn1USC= WYM 1M WAMC4M%NST1M a SA1 W MXUACtaJUMCI970 Tit WI.745-9595 a FAm 9W40.9w Workers' Compensadou Insurance APQdavit: Butidera/Contractor'sMeebictang/ptnmbesa ApulleantInformation Cnnstruc4innl Specialties Please rt,.rw►Legibly Name Iaue;e�e. P.O. Box 53 -- �•�1r1 -Stoneham, � MIND Stones ams noes. MI Address: City/SWAMP. Phone# A_ 9 at emptoyerT Check the approprlaq boss Type otprojeet(required): I.0 I am a employer withq 4. Q I am a smug contractor and 1 employees(Atli and/or part-time).• have hired the wb4ounsctorg 6. ❑Now construction 2.0 I am a sole proprietor or partner. listed on the anached sheet t 7. 0 Remodeling ship and have no employees These orb oonhsctarg have S. ❑DemoBOM workhig for ma in any capacity. workers'comp.huousnes [No workers'camp insurance 3. We are a corporation.and its 9' 0 additia® required•) o9icas have exert Led their 10.0 Electrical repa;rs or additions 3.0 I am a homeowner doing all work right of esemptionper MOL I l.[]Phunbing repaita or aAmttone myselt:[No workers'comp. a. 152.41(4),sad we have no inamanee required.]t employees.,,Ono f pp / comp means¢=roquired J 13. l�l 'AlyWPIlowrbetebeetebaastemmetwa0oadwandaabdordmWngr6ekwaw eompla"dosDd�y Raneowe a wbo wbmitwreffidaln bdleaiss obey am doing a vat em u.rbirarra.ema.eeer.mas.re�mY rCmuaaaa drr leek dale box awa machM w eddWood Aoo sbowkg*A now orrhn abeannaeoom and digit ',• . " emp�pay tefinedea I sae an sarpl07sr that Je providiwt worm'eowpaxradoa►+arsra+aesjar my esrploysa Below 4 the Informed" � po/hy andJob sUs Insurance Company Name: Policy Nor Self-in..Lie.w. 00 Zb(p a cr) (� F.spiration Date: Job Site Address_ b (��Sse(� �( CItytstate/lip.a ` -tip 1g7G Attach a copy of the workers mmpelur doe polley deebn&a pep(showln the Failure to secure covers sa g po11ry tarmber aatd expiration daq), gi required under Section 25A of MOL a 152 can lead 10 the imposidon of criminal penalties oft tine up to S1-500.00 and/or One-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to MOM a day&pint the violator. Be advised that a copy of this statement may forwarded to the Office of investigations of the DIA for insurance cOverap vaitkatioo l do ksrsb7 eeunder Ills pe" psnaUhi ojpsrjw7 that the Jnjormadosr provldsd eve 4/rwlfy1 rd onset g Sl¢n3Nfe' t 111 0-7 Phone N: Ojj7eld ors 0114% Do sat wrae in this arr4 to be eoerpfeted b7 eAV or/oww offle/4 City or Tows: Permit/License N Issuing Authority(circle one): I. Board of Health L Building Department 3.Cltyfrown Clerk 4.Electrical Inspector L Piuto Inspector 6.Other Coutact Person: Phone N: u •l Crry OF SALEM PUBLIC PROPERTY DEPARTMENT wVae tae.aes,tatott tttnsr.teta.>�sssoa�a,aot+1. t+.ssn�.e.esas.rnssrsa�►ssts Coustmdas Dthrb Dbpold Affidavit (Regpi�ei hr an asmotldos sad teeeVAMS wad* to aeeenhoos with the skth ad dos of dw Sher HsilAWS Cod,,780 CUR secdam 1113 peb ft and dwp wAdotw of UGL a 4a s A $yam Zr wu*N 1s tsstsed atth Ow Madam flat*A dims a mubs A ss tMs wal a1 be disposed of fs s peope ft Nowaed woes dtepaed dteiiigt ar►dedsad try!(GL e T m debris will fbe aiaspostd by: l�or The dells will be disposed air In: cam• �+» (&I* ee of&gal" � 1 due I 00-35,000 of enclosed space I I (MGL CA 12 S.eOL) I 1A-Masonry only � . 1G--1&2'Family Homes Failure to possess a current edition of the - - Massachusetts State Building Code Is cause for revocation of this1icense. ( } L DIG SAFErCALL CENTER: (888).344-7233 ' 2 ARb OFF � a©IMV�REGUi.7�v1 �C- License CONST,FtUCI'ION SUPERV)SOL < . . r Number CS Birthdatey 061021796��� �� r T e ExPjres 05/Q2/�P47 Tr ri~o 12107 ) TIMOTFY J FINN y. ' 8 UALDOR4 DRIPOBOX 53 �� ��, )_, - STONEHAM NIA=04Y,30 Corilmisslf•. 1 v' i7ttS Vtic�, PROPOSAL, dVvl.vl CONSTRUCTION SPECIALTIES UNLTD., INC. P.O. BOX 53 �i ,S i k c' v, v •./t STONEHAM, MA 02180 5 YIdS `�' Nis�` Phone(781) 6654410 Fax (781) 6654411 �a (�2- �V w LENNOX GROAN-NUTONE HEARTH PRODUCTS A NORTEK COMPANY ( o eL CS ecNs ";t t �r \ -} 0 I'�-4'V1.uvv . C< We propose hereby to furnish material anlabor - 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. Authorized Signature ll §. NOTE : All plumbing hook-ups, carpentry work& 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 ne above prices,epecEcedone re are eatiafi q and ue heoby accepted You ue eudtodrd to do the work u epoafied. prymmt w be o u outlined above Signature t,�2�;( — Date: If accepted please sign and return. �L}nc �SDC �� 21 �Ltl n -_S f6n Z�rJ E_ 37J. � 0 OJ���Z C�Jc7f� , -What-is the Current us*of the aiding? 1_ UnIIS7�. Material of Building? W O� if dwelling.how many Asbestos? VVIII Via Building Conform to law? Architect's Name t ' Address and Photo" Mechanic's,Narns+ 0 zi l O Address and Phone 1 to I�Q hn on Construction Supervisors license HIC Registration 0 Permit Fee Cakxilatiom Estimated Cost of Project 3 0 e_ 2�_� Estimated Cost x$7/s1 o0o Residential Permit Fee i --- Estimated CostX i?11s-1000 Commercla4---- An Additional 5.00 In added as an Administrative charge. It Make sum that allflelds are properly and legibly written to avoid delays in:processing. 1 The undersigned 'dose hereby apply for a Building-Permitto build to the above stated Signed specifications. S, ned under penalty of pe►lury X DCD ate 0 U N `o40 y g 6, C6. . CIT. ;; PUB`LIC PR QPF��'Y DEPARY' 'I�LF:`�1T 4�rhor i'36Vtix4uNctrw•sar c,�ytirso9ib • . :rb.:9:'{-zs95A3'y;F;uC9,7,{-'&�Oa9i�:. . . I"m tj A'TrON FnR REF.IIR.xRENOYr�FTt h CONS'!R�J DE�iOLITI01!�. OR CAANCEQUSE_OR, LE®R,' _ EI r ; G: »RWA ARE-O"R�BUIIDING. • 1.O SITE WFOR.,, TIO,N ' 9i . Locatlort t Name C av ] Q 01NNER'SIi1P?INFORM/1TICN Narnet. ,0� p/ 4tQ�4 :'Telephone 3 b COIMPLETB THIS SECTIbN+FCR�AIORK IN,EY�ioT�urfy$llIL�INGif,17f! IVY Addition ; ;Exiatlr�g- - Rennvation Number ot5toriee . ; "Renov�t - _ , Change in lass . , Netw Demoli8on Extatir�g.. Apploximate gear of Area=per floor.=(sf) Rertouated =construction orrenovaticn. ' o/exiaGng:;lwdding�",, New 9uef,Des ,'pticn oft.?i9Pos � & oUe, mil- Se. CiY1i m Ni i,V - - Ai1ailReRnit -_ ----._ �'tMc r� rOj 2 L�)