4 SETTLERS WAY - BUILDING INSPECTION (2) 4 o
it1llN IAWIlEfKA1111 WD APPROVEB BY T4IE
mPscroB PIl R w A�vmw Agm aRANTkD
_ CITY OF_SALEMIs Plopmv Locomd in
vo midonc owed? Ym Now
tha Cmmrvoem AFm? Vofa No `f
Perk to:
BU LDMIa PERWT APPUCATION FOR:
(Ckok whMwm apply) Roof f Inetalf SkWo Cortetrttat Deok, Shed, Pool,
PLEASE FLL OUr LEGIBLY A COMPLETELY TO AVOID DELAt(B M PIIOCES>�Ip
TO THE INSPECTOR OF BUILDINGS: '
Ths�whereby applies for a pork to bukd as ordft to the following
Owners Name
Address a Phone `j Se f-1 (cn S W�7 .U-cf M�(IV) 33 7-9 2-�
Ankrkods Name
Address A Phone ( 1
� Name J\ WA6
Address A Phone k ( 1
What In tha pupwo it eu0anp?
mfhrw or www W cs+m N a dwwrp,mr haw„w y W~ i Dwwh sc
WE k Wig oorlorm b We�<S AvbMos? rJ v r—
EdMmW cW lav , Csy Uo r ewa r
Lie. ri j of
Applicant
� 1Nr>D!R THE PENALTY'
OP PBRNIR'Y
DESCRIPTION OF WORK BE DONE I
MAIL PERMIT M.
y =
Y _
r
a
PUBUC PROPKM DKPARTMKNT
120 WASHINGTON STaaaT. aaD FLOOR
SALaN.MA of S70
TaL.(975)74"595 t{Sr.aso
FAX MID) 7404M"
STANLEYJ. L%ov1CZ. .JIL
MAYCM
DISPOM OF DE =AFFIDAVIT
la lccm*==with the p:oviaicm ofMM c 4Q M4 I aclmowjWV that as a ca1md' m
of Bml ft Permit/ .aD debaia raa QkM8 limm the OMMUcdoaa ndvity
/ovaam d by this Bm'l ft Permit ahali be dill m d of is a properly}ia®aed aWb waste
disposal!rely.a.ddhW by MM c IliL ISISGA.
The deb&wM be&pond of at:
- I.oeahomalfFaaA7ity .
Nww
afPeo®itAppNe t Dab
OU ASE PRIN G' EA mfo om..
Name ofFenti t Applieaot
Fmm Name,if an►
Add mm6 City do State
The about statute require that debris from the donolitiam. ra w a wn,rehab or odw
akaadon of bo&ft or shuctum be ahapoaed in a psopaaiy-hcamted som"aste disposal
5aility err aieGned by MQ,clM Sl50A. and the bnil&g paamita or licm am to
iDdl W the location of the licdry.
r
Cofnm4/u0a16{iA 0/Md„ao"ttd
• 4 •1Ja at..ad .L:Iri.f era..b' .
boo g1al e�li.O.Slae.i
sane 1 G.m+ 8-d, ///.u.A..A 02111
Workers' Compensadoa Imuranee ABidv*
.i,
. . wkb a principal planer of bwifws ate
. . io.rw.rsnar .
do hereby'cerrify under the pains and pensldes of perjary, than
() Ia an employer providing workers' compensation covera fs for my siwploywses working eg
Insurance Cemapnw Poliq Number
I am a%sok propriewt and have no one working fdr am In asy capacky.
() 1 am a sok proprietor, Seneral conmcsor or homeowner (circle one) and have hired do
contractors listed below who-have the folknrmg workers' compensation po6deR
Com scam, Insurance Company/PolbW Number
Comrsetor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
() I am a homeowner performing all the work myself.
•I veowmae an a cm of a*sumam ws be fey areee s err Ofke it Isn'"know of Ow DIA fer cowwsff valaueM asa am MAT w wear.
cowranc so reaurw•era Seedee SSA of MGL 15 S can kad w ew irwwaeioo of a6dea eaeade cenrint eta bu s(ea sere 1 ICQ 00 abler eta
ten'is rvomm-M a sari oeaawo in the inn of a STOP WORK ORDER nee a fir of s 10CA0 s an a0ian aw.
Signed this . day of 9• / j _ZDO�°
:iccnscei F ermi tee isuiIdtnf Department
ucensinf Ecard
Selectmen Office
wealth Deparmer:
September 13, 2004
City of Salem Building Services Department
120 Washington Street
Salem, MA 01970
To whom it may concern:
This letter is to inform the city of Salem Building Services Department that the Collins Cove
Condominium Trust has reviewed the plan for the renovations and repairs due to a fire at 4
Settlers.Way. The work is being performed by Paul V. DeStefano for David King.
Respectfully,
K/aren M. O'Brien
Trustee
e
NSLicense: CONST4UCTIO
NuMWACS UPERVISOR
085458.
ux s.
Birthdate;01/15/1968
ExPiroa:}01/15% �07 Tr.1w: 85458`.
RestNe� OOt/ ��
., pAULL,�,N, Y.
259
NE INDEPENDENCE
WTON NA'-
'� Adminis` trator
f
�Board of _
i .t - _ •MOE NMPROVEMENi C7NiRACTOR.`,• �.�
i ht 1351.10 ss
;; r TIYIb: 1tiHJld�l "
J� PAUL.V DESTEfANO+ Iv _
PAUL DESTEFANO + r J.
i 259INDEPENDENCEDR �
+t. CHESTNUT HILL,MA 02167