Loading...
43 SCHOOL ST - BUILDING INSPECTION (3) 1 9 The Commonwcallh of Massachusetts Board of Building Regulations and Standards Town of j Massachusetts Slate Budding Code, 780 CMR, 7's edition lmmm*WW J Budding Dept Building Permit Application To Construct, Repair. Renovate Or Demolish a 1kMMMdWft One. or Tun-Fmruls•Du elUng This Sec Aon For Official Use Only Building Permit umber: Pile A lied: o Signature: ' y Rio Budding Commusto r/Inspector of Btu Date SECTI I.AsTE INFORMATION 1.1 PT�r Agviny 1.2 Assessors Map 6 Parcel'Numbers 1.1 a is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning in 1.4 Property Dimensions: Zoning District Proposed Use La Area Isq R) Frontage 1 R) 1.5 Bullding Selbacks(R) Front Yud Side Yards Rev Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.1.c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public O Private O Zone: _ Outside Flood Zone? Municipal O On site disposal system O Check if sO SECTION 2: PROPERTY OWNERSHIP' i.l Owner'of RecordsS _ /,/✓s/ 1,23 Nab(Print) Address for Service: Signature Telephone SECTION): DESCRIPTION OF PROPOSED WORKS(cheek all that apply) New Construction O Existing Building O Owner-Occupied O 1 Repairs(s) O 1 Alteration(s) O Addition O Demolilion—lod Accessory Bldg.O Number of Units_ Other O Specify Brief Description of Proposed Work': L C SECTION♦: ESTIMATED COATkUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Budding S I. Building Permit Fee: S Indicate how fee is determined: O Standard City/Town Application Fee 2 Electrical S ❑Total Project Costs(Item 6)x multiplier x Plumbing S 2. Other Fees: S J. Mechanical IHVAC) S list: s Mechanical (Fire S Total All Fees: S Su ression Check No. _Check Amount: Cash Amount:- 6 Total Project Cost: S ❑ Paid in Full O Outstanding Balance Due Act"l 4o PQgd�JJr� �a. ©lR6o < e rl .� 47 SECTION S: CONSTRUCTION SERVICES 5.1 Licensed Constructlon Super%isor(CSL) S 17 7 'MI e Liccn,e Number Expiration Dale N uf('SL Iplder' Li,i('SL 7ae �l5 Cli IMfr,� ,�lA m ld�s, rpe(,v,he low) AJJrcss,A ^ T Description U Unrestricted(up to JS,IN)O Cu. Ft.) /1 R Restricted Ih2 FamilyDwellin S i6n �/ M .Mason Only I7-k-656-914 / RC Residential Roofing Covering Telephone Residential Window and Siding U Residential Solid Fuel Burning Appliance Installation D I Residential Demolition S. Reglst r Hom I r vemeot ConI for(HI ) ( oG � t H H mpany N or HI Regist 1 Name ' registration Number Address '32 -6S{s 3ry Expiration Date Signature Telephone—� SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 23C(6)) Workers Compensation Insurance alfdavit 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. Signed Amdavit Attached? Yes..........&Y No...........O SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ZC�IAI 71 as Owner of the subject property hereby authorize / c v ` (G r to act on my behalf,in all matters relative to work authorized b�y this building permit application. Si nature of Owner Date SECTION '' G I 7b:rhOW//NEW OR AUTHORIZED AGENT DECLARATION 1, A d G el J //W G ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application arc true and accurate,to the best of my knowledge and behalf. JJ r /tlr 6l�r1 C�� We,/e Print Name Signalurc of or Authorized Agent Date (Signed under the pains and penalties ofperjury) NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will 0A have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.1116 and I IO.RS, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. R.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half baths Tvpe of heating xystem Number of decks/porches T.�peof cooling cystem Enclo,ed Open 3 "Total Project Square Footage"may he,uh,lituted for 'Total Project Com- y, March 30, 2010 10:59 AM WILMINGTON INSURANCE AGEN 9786575724 p.01 CERTIFICATE OF LIABILITY INSURANCE OP ID JD DATE(MMIDOIYYYY) QUALI-1 03 30 10 PR TH15 (;ERTIFICATEITMtiUtUA15AMATTEKVFINFQRRqATION Wilmington Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Five MiQfl¢'esex Avenue unit 14 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O. Box 1010 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington MA 01887-0580 Phone: 978-650-3805 Fax:978-657-5724 INSURERS AFFORDING COVERAGE NAIC# INSURED IrIsuPER 4 Zurich/American Duality Additions k INSUPERR UPit.d Sp.Pi.lty In..r•.nP. Cc Remodelin LLC uJF.uPERC 314 Main Street INSURER D. Wilmington MA 01887 INSUFPR E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AOGREOATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER GATE MMIDOI POLICY EXPIRATION DATE MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 10D0000 B ][ COMMECCIALCENERALLIAEILIT' OS101836 09/08/09 09/08/3.0 pQEMISE6lEu en:urol'i:c) 41DDDD CLAIMSMADE ' IOCCUR MEDEA:PIAnyonsporcoo) $ 1000 PEPSONALCADVINJUIJY $ 1000000 GEr.IEGAL ACrpErATE 42000000 GFNL AGGREGATE LIMIT APPLIES PEP PRODUCTS-COMPIOP AGG 51000000 POLICY JECT F7 LOC AUTOMOBILE LIABILITY ccjiAvrqev 11r4t31ffLIMIT f ArfY AUTO (Ed Scridw)ciltlanq ALL OWNED AUTO`: BODILY IIJJLIRY 9CFiEOLiLEO AIJfMa (Per p616011) HIRED AUTOS BODILY INJURY N044.OWNEO AIJ70n9 (Per acchlent) '¢ PROPERTY DAMAGE $ (Per ealdent) GARAGE LIABILITY AL 40 ONLY-EA ACCIDENT $ ArFY AUTO OTHER TH,,N EA ACC R AI-PO ONLY. AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE 8 OCCUR CLAIMS MADE AGGRE,,ATE T $ DEDUCTIBLE $ RETENTIONWORKERS CO PENSATION B g AND EMPLOYERS'LIABILITY YIN X. TORY LIMITS ER A AW FFICERIMRFMgERF) LUDED7E�_JTIVE ❑ 6ZZUB0742N10209 05/16/09 05/16/10 E.L.EACH ACCIDENT $ SOOOOO (MAndatcry in NH) E -DISEASE-EA FMCLu IEE F 500000 t yes.descllta WDIs, SPECIAL PRDVIsd DNS r64bv I El-.DISEASE-Pou CYUMIT Is 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 014CINpE DATE THEREOF,THe ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS W RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 30 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR CMC Investor Realty Trust REPREBENTATIVE9. 43 School Street RI ED FigI'� AT E Salem MA 01970 �i �t1 ACORD 25(2009101) ®1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD sawaseenew CITY OF S.ULE.` . Niskss xCHL'SETTS BI.ILDLNG DEPARTMENT 120 WmmtNGTON STREET, YN FLOOR TEL (978) 74S.9595 F.ut(978) 740-95" KI,BERIE D Y RISCOL! MAYOREDR THOSLU ST.Jamm DIRECTOR OF PUBLIC PROPERTY/BL'ILOLNG CONMaSSIONER 1Vurkers' Compensation Insurance Affidavit: BuildersiContractors/Electricians/Plumbers Applicant Information /Plcase Print Legibly Naine (Busing Organuatiomindividual): Address: n t O DYC `61 City/StatcZip: UhJ - "laII oK67 Phone0. t78 '668-- 3b4 .1yA�greereyou a employer'Cluck t a appropriate box: Type of project(required): I ,1 am a employer with 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time).• have hired due sub-contractors b. ❑New construction 2.El I am a soft proprietor or partner- listed on the attached sheet: 7. ❑Remodeling ship and have two employees Thor subcontractors have 8. CKDemolition working for me in any capacity. workers'comp.inwrsax. 9. ❑Duilding addition [No workers'comp,insurance S. Cl We are a corporation and its 10.❑Electrical repairs or additions required.) otTlees have exercised then 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.INN workers'comp. c. 132.410),and we have no 12.0 Roof repairs insurance required.)t employees. (No workers' 13.0 Other comp.insurance requited.j •Any applicant iht rhocha but Of tutus aW no ud the menus holow showing their weakes'twrtganmtktn policy in6 1 dim 'I hartstwhhas who submit this affidavit indicting they ane doing all work and thus him outside cmoucion must"limit a mw anitltvit indicting suck :C.xnmtsn dui check ibis ban more attached an additional shml showing the none of Ike myb4 m lne'tam had their wothem'ramp.policy infatmYtim. 1 am an employer that Is provldlax workers'conspensadom/nstsroncr for hay earpluyaaa BNow is tho poley end jot dar inforrnasiota Insurance Company Name: Policy g or Self-ins. Lie.N: / Expiralion Date: Job Site Address: 5r,40911 d :: C&-- IA 0/Cf7nCityiStawzip: 7 Attack a copy of the workers'compeosadom policy decloralloa page(showing the policy Number sliffil esplradas date), Failure to secure coverage as required under Section 25A of MGL e. 132 can lead to the imposition of criminal penalties of■ fine up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a day against the violator. Ik advised that a copy of this statement maybe forwarded to the OlTice of Investigatiuna ofdre DIA for insurance coverage verification. I - 1 do hereby crrrify under the pains and petttrldes of perjury that the ioformsedotr provided above is truer and carrect ';wmiture_ /( ( will. J 3a—/t5 official use only. Do nor wrife in rhis dree,to be completed by city or town n/flciaL City or fawn: PcrmiUl.lccnst N Issuing.%ullionly (circle une): I. Ituard of Iteullh,I. Building Department 3. Citytrown Clerk J. Electrical Inspector 5. Plumbing Inspector 6. Other C.,nuct Person: _ Phone it: Massachusetts- Department 1 nt of Public hhc Safeh ` Board of Building Regulations and Standards Construction Supervisor License License: cs 58707 - - Restricted to: 00 MICHAEL J WELCH' PO BOX 8f9 WILMINGTON, MA01887 o-- l�- yf Expiration: 6/12010 Commissioner lie 1°ioonnriaieweo. ./�.oaa¢c/suaeQ2 W,�•.,•..•..-.. w...._.�,._,__....,.,__._w______ ------- Board of Building Regulations and Standards HOME IMP OVEMENT CONTRACTOR License or registration valid for fudividul use only Registraflot ., 121249 before the expiration date. If found return to: iran I9 Board of Building Regulations and Standards 0 Trk 265407 /201 One Ashburton Place Rm 1301 71 �T. Pe OBH Boston,Ma.02108 t - QUALITY ADDITIf90�I�P�ry1QDL ING - MICHAEL WELCH�3� 42 COTTAGE ST WILMINGTON, MA01887�� - Administrator Not valid / ut signature - • 'S CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT )1'14 L•R •SA I\I, l'FI.y71-715.9595 I°.\!t:978•740-9446 Construction Debris Disposal Affidavit (required lur all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR scetion 11 L5 Debris, and the provisions of MGL c 40,S 54; Building Permit H is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c I11. S 150A. The debris will betran,{sportcd by: Dame of hauler) The debris will be disposed or in (Ila"ul acifity) (addm..4 ul'IanWy) X 2�G� .igualure arlmnlit applicap date r ao CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR '/ SALEM. MASSACHUSETTS 01970 TELEPHONE: 978-745-9595 EXT. 380 FAX 978-740-9846 KIMBERLEY DRISCOLL MAYOR Section 116.0 DEMOLITION OF STRUCTURES 7u S{ w' Structures over fifty(50) years old must have approval of the Salem Historic Society UTILITY DISCONNECTIONS REQUIRED Authorized Agent Date of Disconnection Water (see attached requirements) Electrical E o1�J� Fire )KJ14- Health Sewer Salem Historic Commission X Dig Safe Number �c ~ E'IQ Pest Control: ***DOCUMENTATION OF ALL T ABOVE MUST BE ATTACHED BEFORE PERMIT CAN BE ISSUED*** Fee for Demolition $5.00 application fee plus $2.00 per 100 square ft gross area, Minimum $25.00 i 1 , Q T.Tu 172 � 1?T.T, �11c`r.=5uti?1I3EII� >���:,•��,�,-} ui:s �r_a.�_stni i?nD�ma:Lrs f Enid SFPR #29C In accordance with provisions of General Laws of the Commonwealth of Massachusetts and the Salem Fire Code, the following regulation governing the demolition of structures within the City of Salem shall be followed. This regulation is made in the interest of fire prevention, to prevent conditions which are or may become dangerous as a fire hazard, or are otherwise in violation of law. 1. Before a structure can be demolished, the Salem Fire Department Shall conduct a preliminary demolition inspection, to ascertain any conditions which may require a fire watch or other preventive measures, to be taken before, during and/or after said demolition process. 2. A permit to demolish or remove a building or structure shall not be issued until said inspection has. been conducted, and a report of requirements necessary for prevention of fire and life safety hazards shall be obtained by the applicant for the permit. 3. The requirements outlined in the report shall become a part of the restrictions portion of the demolition permit issued by the Building Inspector, for compliance with the Code. 4 . The inspection report shall include, but not necessarily be restricted to the followings A. Welding and cutting permit required. B. Fire watch to be maintained by a professional off-duty firefighter, with such equipment as determined by the head of the Fire Department. Per Order: Approved by: Lieut. David J ggi Salem Fire Marshal James F. Brennan, Chle= Salem Fize Department - - (8/76) \.c^ .._ srrs\, \rkt .. .^w'M" �T� vY 'W; 1 w- _:. _r��^R-.-.��•y�p,�� Y + .rw y.� -L. -=-- '°�s�Y3 y, •✓�Syw�,.: w� < _ JiJ•i+�I W,. j' .`t�..I,IN.KT.7\a � ' .� ,TFc�'�►� ^.r4i%. • t' :.lt•?-T'` c"��Y� +.i +le �• v�-��T�iC':. +a: �=�. W. r ;60 CMR: STATE BUILDING CODE COM14ISS1O14 '' .a•�'�s� . : SECTION 115.0 CONDITSON4 OF PERMIT ` o i1S.1 de: The permit shall be a license to Compliance with c y proceed with the work and shall not be construed as authority to v5mlats, cancel or set aside any of tmodification or !legally I coda, except as specifically stipula this ted by I , :�• granted variation in accordance with .ectitm 126.0. work shall conform to the I i 115.2 ComDcs with permit: All stamped or endorsed application and plansfor which the permit has been issued and any approved amendments thereto. 11S.S Change in sit* Plan: A lot or site shall not be changed. f: 1ncreesC or diminished In area from that shown on the official , as iminisspeci t 1n Section 117.6. unless a revised plan :.ram showing such changes accompanied by the necessary affidavit cd w ... i1 approved. .,� owner or applicant shall have been f eel and •�`�'4 xsptioat A revised sits plan will not be required if the s [r: : i mange is cowed by reason of an official street opening, 4. ,;4N street widening or other public improvement. ; F SECTION 116.0 DFdtOf1?ION O! SYAUt:TUAES 116.1 Service connecdonss Before a building or structure ran be demolished or removed, the owner or agent sha4 notify aD j vlca connections within the building or utilities having $es strae- t Lora, such as: water, electric. gas. sswee end other eta -, tip. A permit te deawWh or remove a'buiobtained the utilities. shah not be Issued until a release V obtained tans _ _ sutlng that their respective sarvla connections and e been �' �.L. ant equipment. such as: meters and regulators a� moved or sealed and plugged in a safe tma:utet• ( � has been 4....•,�,.. 116.2 Lot regulation: Wltea a btdldingoperation° not been II t _ damolished or removed vsceint llootgshd be filled with Ann' rojected or approved- with adjacent organic fill. graded and maintained fit conformity grades. The lot shall be maintained free from th* accumulate of rubbish end ell other unsafa or hazardous conditions dangw the life or health of the Pu blle: proviamag shall be en made to prevent the accumulation of wear or damage to an7 't foundatio on the premises or the mdjolnittg PtoPeat7l and the ns necessary retaining walls and fences shay be erected in accord Apra with the provisions of Article 13. I I r SECPSON 117.0 MOVED STRUCTURES '. 117.1 General: Buildings and structures moved of this moved into or within the jurisdiction shall comply with thethiscods. II• 19 9/1/80 CITY OF SALEM9 MASSACHUSETTS DEPARTMENT OF PUBLIC SERVICES 120 WASNINGTON STREET, 4TN FLOOR SALEM, MASSACNUSETTS 01970 BRUCE D. TNIBODEAU, P.E. DIRECTOR OF PUBLIC SERVICES/CITY ENGINEER TEL: 978-743-9795 ExT. 321 40) FAX: 978-745-0349 WATER &SEWER In accordance with provisions of General Laws of the Commonwealth of Massachusetts and the Salem Water and Sewer Department, the following regulations governing the demolition of structures within the City of Salem shall be followed. This regulation is made in the interest of protecting the water and sewer infrastructure at each domestic &commercial hookup location within the City of Salem as well as to prevent conditions,which may cause danger to public safety,cause water to be lost or loss of city or personal property due to water or sewer loss. 1. Prior to demolition of property,a licensed plumber shall ascertain where all water and sewer lines are located on said property. The plumber shall make a determination of use of such water and sewer lines,not limited to,domestic use, irrigation, fire suppression,or septic systems. After all water and sewer lines have been located,the plumber shall make a written report with diagrams of utility locations found to the Director of Public Services. A request to the Department of Public Services shall be made to terminate water services at the street after such notice of locations have been made but not before item#2 is completed. 2. Prior to demolition a licensed drain-layer, licensed by the City of Salem, shall cut and cap the water and sewer lines at the city main. In the event that water or sewer will immediately be used after demolition for construction purposes, a set of certified plans and drawings by a registered professional engineer must be provided to the Dir. Of Public Services/City Engineer reviewed and approved prior to the obtaining a demolition permit. 3. A demolition permit shall not be issued until items 1 & 2 have been completed and the Department of Public Services has conducted an inspection and signed off on the water and sewer portion of the Building Department prerequisite Utility Disconnections Required forth. Approved by: Bruce IJ. I lubWeiCf.E.- Dir. Of Public Services/City Engineer 11/05 (rd JAM (C�ld