15 SETTLERS WAY - BUILDING INSPECTION (2)F-W '.iNllll. . . ..nj, '.M,M'y'
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. lima �dtuaR � . .� ARINa GRANTED
CITY OF SALEM
Do
Is PRIP"L00ftd In
Location of '
M PlWmty Loaalad In /
IIw Qarnwd 9n Ma9 rare,.No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Carole whichever apply) Roof. Rwoof, Install Siding. Contract Deck, had, pool,
Repair/Replace, Other. 4 e
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROl
TO THE INSPECTOR OF BUILDINGS:
The unclemigned hereby applies for a permit to build according to the follewing
speclifintlow
IDOwmers Name s✓ I L M'c
Address APhone
Archkect's Name
I
Address & Phone ( ( l
Maohank;s Nam ��n--� ✓.
Is Photo ZSZ LlvCNIVt=C%Dcnc� ZN.
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wnr w►s.wva•w n~ n.as,�.,.c~... hw;,
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Mwdd al tn/wg9 I cry r.dwNrw for now mmy aonlwy I '
wr kdav OOIkn 10 law? bn Mao
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tar I�toaraat p _`-�'
Lao. /
Sighature of ApplicahtV
SIGNED UNDER THE JBIO i.
`
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
+wit
�h
MAIL PERMIT TO•
is
.. t. ,b. :._ .9 .._...
JL
APPLICATION FOR
PERMIT TO
LOCATION J \ 1
PERMIT GRANTED
APP7zO ,
INSPECTOR OF BUILDINGS
/' M
_ Cocm wt:aUh,moneo1 llla66aAc"Ud
s �/�
ia dt
W 600 ,ay .111m,SWA
Jam"I carnmas /1/[3a1,w, ...aeiL+oA 0.21 It
Commrstorafr
Workers' Compensation Insurance Affldapjt
. . with.a principal place of business at:
�-1 SrJgN�WahO
do hereby'certify under the pains and penalties of perjury, that:
() I am an employer providing workers' compensation coverafe for my employees working on
this job.
Insurance Company Policy Number
I am a sole proprietor and have no one working for me in any capaeky.
() 1 am a sole proprietor, general contractor or homeowner (drds one) and have hired the
contractors listed below who-have the following workers' compensation polides:
Contractor insurant a Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
() 1 am a homeowner performing all the work myself.
I rndera[and wt a cool Of thu wtemrnt wo be icm woee to &A Offre 0-1 inw8tavont of the DlA for ce.e,aKe r"ifiesdoa a^a Mae faattfe or
"core
co.watr n r,ourro unoer Section 2SA of WGL 1 5I can lead to one irwoarion of c oninat ceatarem corwdert el a Im of ao eei I.SflOCO adeaer erte
r,an'kwoor nmrnt m vs at eiri oaultlea in the iorm of a STOP W ORK ORDER and a Fine Of S 100.00 a aai' 89"t rate.
Signed this • day of -
:ictnste/Ferrniuet Building Gepartn,erit
-icensinf Ecare
Seieetmens Office
^,ulth Gep�r-men'
PUBLIC PROPERTY DEPARTMENT
• 120 WASHINGTON STRELT, 9RO FLOOR "
SAI N.MA 01970
TEL (97e)745-9595 EXT.800
FAX W11) 740-9846
STANLEY J. USOVICE, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge that as a condition
of Building Permit#t . all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed soH&waste
disposal facility,as defined by MGL c III.S150A.
The debris will be disposed of at � flnon .th '
Location of Facility
Si lure of Permit 40hcant Da
FULLY complete the following information:
(PLEASE PRINT'CLEARLY)
�R4 V.-
Nam offermit Applicsixt tiPu j kS c
Jet cam- S
Firm Name,if say
ZSR inn , fLkA 02116-1
Address,City dt State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of building or structure be disposed m a properly-licensed solid-waste disposal
facility as defined by MGL cIII,S 150A,and the building permits or licensea are to
indicate the location of the facility.
t
May 12,2004
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 is fully aware of the kitchen renovations being performed at 15 Settlers
Way, Salem, MA 01970 for Karen M. O'Brien.
s ectfully,
k Magee
Trustee
. . ,.
. .�
9
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06/11/2004 08:37 9784129421 MACDONALD & LAVERS PAGE 02
I
MACDONALD & LAVERS , INC .
By Fax
June 10,2004
Salem Building Dept
Salem,MA 01970,
RE: 61 Valiant Way
Dear Budding.Dept
.A s the property manager of the Village at Vinam Square Condominium, at the request of
the Boaxd of.Trustees,I am writing to tell you the following
The legal documents of assoc atwn allow for a unit owner to do construction on the interior
of his/her/their unit a9 long as it does not result in an architectural difference to the
appearance of the exterior of the unit.
If you need.anything further please feel flee to call the at 978-356-9091.
v
. Barbara G.Mac
Pre9idcnt
P: O. BOX 564 • IPSWICH, MA 01938
PRGNEr 978-412-9500 r FAX: 978-412.9421
barbra.micdonald®�amcas r.nel