26 SETTLERS WAY - BUILDING INSPECTION (3) �✓o �c�M, t 5 = — s
*71
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards
Ql- Massachusetts State Building Code, 780 CMR ALERevised Mcrr12011
Building Pennit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Dat Applied:
Building OI£eial(Print Name) Signature Date
' SECTION I:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I.[a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq fl) Frontage(Il)
1.5 Building Sethacks(ft)
Front Yard Side Yavds Rear Yard
Reyuirod Provided Required Provided Required Provided
1.6 Water Supply:(YI.G.L c.4o,§5d) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check ifycs❑ Municipal ❑ On site disposal systern ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1"-Qivn�erl of R,ecceC�/'i�rd�'�
—J c e-1 12_lYl1(J S 'l jne wl , All 01 "J 7 a
Name(Print) City, State,ZIP --
No. and Street 'felephona Enmil Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s)iUmteraticn(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Sprcily:_
Brief Description of Prop serf Work'-:_
J J �PxI� 1✓i (T
'Q!N W
SECTION 4: ESTuNIA FD CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building $ YOO 0v-- I. Building Permit Fee: $ Indicate how fee is determined:
$ ❑ Standard _It
/Town A location Fee
2. Electrical y PP
❑Total Project Cost'(Item 6)x multiplier x_
3. Plumbing S �. Other Fees: S
4. Mechanical (I[VAC) $ List: _
5. Mechanical (Fire --
Su cession S 'Total All Fees: $
G. Total Project Cost: $
Check No. Check Amount: Cash Amount:
0 0 �� 0�--1 ❑ Paid in Pull ❑ Outstanding Balance Due:
40 c Or�r�CV
J
,r
SECTION 5: CONSTRUCTION SERVICES
5.1 Con truction Supervisor License(CSL) '
License Number Bspiration Date
Name of CSL Bolder fJ — ��
List CSL'fype(see below)''=�—
V t d OI P c> T f Dcscri R'
No. znd Street yIn [ion P
< 440 lJ Unrestricted(Buildings tip to 35,000 cu. 11.)
R Restricted 1&2 Family Dwelling
CityMown,State,ZIP
M Masonry
RC Roaring Covering
WS Window and Siding
�j S I Solid Fuel Burning Appliances
3 p;2- 1 Insulation
'lelc hone Email address D Demolition
5.2 g' tered Home Im ovement ontractor(HIC)
�( HIC Registration Numtxr spiruE tion Date
FIIC Comp ry Ni or IiIC tstrant Name -_
S� -
No.;Jw Str [
9c� ,i �lc;,�>�� Email address
City/Town, State,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit 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 Affidavit Attached? Yes .......... No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING
/PERMIT
I, as Owner of the subject property, hereby authorize pe r
to act on my behalf, in all matters relative to work authorized by this building permit application.
.-40afs
Print Owner's Name(Electronic Signature) 'Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application
is true and accurate to the best of my knowledge and understanding.
?eL r lql - @-fA IJte _ 1 �
PrintYor Authorized Agent's Name(F:Icctronic Signature) )ate
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 not have access to the arbitration
program or guaranty fund under M.G.L.a 142A. Other important information on the HIC Program can be found at
tv�ov/oca Information on the Construction Supervisor License can be found at www.mass.eov;dos
2. When substantial work is planned, provide the information below:
Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch)
Gross living area(sq. R.) Habitable room court_
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system ____ Enclosed ---Open...- --
3. "-focal Project Square Footage" may be substituted for"'Focal Project Cost"
Collins Cove window approval Page 1 of 1
r
` From: Jeff Conley<sioonley@comcast.net>
To: mlutrzykowski<mlutrcykowski@salem.com>
Cc: Pele321 <Pele321@aol.corn>
Subject: Collins Cove window approval
Date: Thu, Dec 4, 2014 9:11 am
Good Morning,
Peter Michaud will be installing two Andersen sliders in unit#26 with the approval of the Trustees and
another in unit#13 also with the approval of the Trustees. Peter has always done an excellent job with his
installations and he is the guy we recommend to our owners to install windows and sliders.
Jeff Conley, Treasurer
Collins Cove Condominium Trust
https://mail.aol.com/38865-111/aol-6/en-us/mail/PrintMessage.aspx 12/4/2014
CinoF5
• �V-E•ti[, LtiL1S5:1CHUSETTS
SL•ILONG DEPARTMENT
V(/.1SHLNGTON SI-REE OR
T, 3' FLOOR
h TttL (973) 745-9595
K11L➢ERLEY DtUSCOLL FAUX(973) 7-W-9844
LUAYOIL T-tO.%Lu ST.PMgAS
DEUCTOR OF PUBLIC PROPERTY/aUM-OLNG MNLNUSSIONER
Construction Debris Disposal rl117davit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CD,(R section 111.5
Debris, and the provisions of INICL e 40, J' j4;
Building Permit tk is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal racility as defined by b1CL c
111, S 150A.
The debris will be transported by;
(nJme of hauler)
The dchris will be disposed of in
(narnc of raclhty)
(Jl essorrilcilit�) '
SISIIJrRlC U(JIC,"Rll(.1{)(7IICJ11! --
f C[TY OF SAU ENf, %L1SSACHUSEITS
4 BUILDING DEPd R"r>l .NT
120 WASHIINGTON STREET, 3to FLOOR
j TEL (918) 745-9595
F.t c(978) 740-9846
KimBERI F.Y DRISCOLL
,tLAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BL•ILDING CONNISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractorv/Electr(cians/Piumhers
Applicant Informatinn Please Print Le ibl
Milne (nn5111eYS tyf6,1111Zdilafli lnthV/llhlal1. / I f `y /'p7 '�,S yLl e
Address: Y I
City/State/Zip: Sc7 �Y��, Aa Dlg7/7 Phone Ik 7�/�! —r J' �'�
Arc you an employer!Check the appropriate box: Type of project(required):
I.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or pan-time).' have hired the sub-contractors
?. F-,iln tt sole-prepdaar or partner- listed the attachcJ.rhaut. t Remodeling
ship and have no employees These sub-contractors have 3. [] Demolition
working for me in any capacity. workers'comp. insurance. y. ❑ Building addition
(No workers'comp. insurance 5. ❑ We are a corporation mid its
required.) officers have exercised their IB E] Electrical repairs or additions
3.❑ 1 ran a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself. [No workers'Bump. C. 152. §I(4),and we have no 12.[] Roof repairs
insurance required.) t employees. (No workers' 13•❑ Other
comp. insurance required.1
•Any upplic n nut checks but xl most also fill cut the section below showing their workers'compensation policy intilrmutiun.
'I Icmeuwtmrs who,ubmit this alndivit indicating(hey ore doing oil work and then hire outside cuntmaton mtul submit a nmv afftdavlt indicating such.
l'I I nor,that chock Ibis box mint atlache,a m:WdWunui,hovt showing the name of the subaonlncton and their wurltcrs'comp,policy inflamation.
I ant as employer that is pravir/ing Ivorkers'cvmpeu,radon insurance jot my employees. lfelaly Is the polley and fob.rile
infrtnnminn.
Insurmce Company Name:
Policy II or Sclf-illy. Lie. H: Expiration Date:
lob Site Address: City/State/Zip:
.Attach a copy of the workers' compensation policy declaratlan pale(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa
tine 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 5250.00 a day against the violator. Ile advised that a copy of this,statement may be forwarded to the Wiled of
Invrstigwiuns al the OIA For insurance coverage veri tication.
1,10 hereby r rdcrthepaill uIllylvilaftiev of perjury that the brforntWlo,provided ubuvvee is true and correct.
y / 7—
Si n t e y Syr Uaid: -- J<//� •/
Phone
Official use only. Do"of Ivrite hr this area, to be cunrpleted by city ur town nfjhrivit
City nr Town: Permit/Llecaye N
Issuing Aulhurily (circle one): --- _-- ---
1. 0oard of Ileahh 2. Iluildlnq Ucpar ttnctlt l' C:ityffnssn Clerk 4. Electrical luspector 5. Plnnlbing Inspector
G. Other
f:U tl1'.l cl Pefte n: