2B SPRUANCE WAY - BUILDING INSPECTION �"Uhat'is the current use.of the Building? Un
I l� Q O if dwelling,how many un"?
Material Building? - Asbestos?
Wj the Building Conform to Law?
' Amhbd°s Name - - -
Address and Phot+e�1
Medtanles Name Ar\
Ibb
7( 'W
Address and Phony r d4= VVIA- oZt _ ' G—b6�=4�fla
Construction Supervisors UCense tl C,S 0 P 3N-7 HIC Registratbn M
o� 0' Pannit Fee Cak:ulatlort
Estimated Cost of Project i —�--- Estmatsd Cod X=71=11b0 Residential
Permit Foe i
Es*nated"CostX$iil$i000CammerCid-- - ___.... . .
An Additional$5.00 Is added as an
5
Administrative charge.
Mahe sure that alt!tields are prop"and lsgibly written to avoid delays In Processing-
The undersigned does hereby apply fora Building Pertnitto build to the above stated
Si under penalty of perjury
Specifications. Signed
Date
0
E• •� a (7 ; �� 3
.;�- - E--
�. CITY OF SALE#
PUBLIC PROPRERTY
DEPARTMENT
xnr.aatntuaaootl.
M"YM IM WAS Mac MS=MT►SAtr t.MASSACHU 7Ts01970
Tab 971-7459595 a FAra 97a•7e0.964
Workers'Compensation Insurance Affidavit: Builders/Contractort/Eiectridans/Plambers
Applicant Information nnetfructin $Ded ItteS
Pleaft y.t..►r.w,n.ti.
Name(ausinewas e;ntiaortn iivi e�)r P.O. Box 53
Address: f
eityistate ;p: Phone V.!
Area u empleyerT Cheek the appropriate boss —.
1. I am a aniployer with-_ 4. 0 I am a general contractor and 1 of proJee!(required):
employees(M and/or par9•tlme).0 have hired the aubsaouactors 6. 0 New construction
2,01 am a sole proprietor or psrmeo- listed on the attached sheet t 7. ❑Remaleling
ship and have no amployeea These wb•contrsctors have 8. 0 Demolition
worldag for me in any capacity. works='comp,iaasanm
(No workers'cornµ inansos 5. 0 We are a corporation and its 9. 0 Building addition
mgwred l officers bave na=lsed their 10.0 Electrical repairs a additions
3.0 1 am a homeowner doing an work right of e: pns MOL 11.0 Phunbing repairs or additions
mY (No workers'comp, a 152,¢1(4),and we have no 12,0 f qq
Insurance '' l 13. (etct �W--
;Any WVliaet dal ctrrbbos al mme Z an out dw ueMa btlw rhrvfo<�yry�ako!
xma.o.oa.vh.wbmnadr.elaavlrb los�6OYreddas�Y.aarsaa.b+maae &ern pbmB aa,re rCaaar�YamaMchebillr bar mwtudelydrrddittoed�hrwihortes�hrmmrotmrmda VXL
.
"� � tek�msera
I am as swploler AN Isprov/dlnj workers'eompextaka hrrwoaai jor AV ear s �
Injornanon, /'� pteY a Blow is rhspollcy and ob slu
Insurance Company Name: 6
Policy#or Self-his.Lice.W C I (0 2-(0 f)U Expiration Duo: V ?v O7
Job Site Add,,
O�l7 N(Xn tt, u)--" CIty/State/7ip -` 1 M1 -,D N970
Attach a ropy of the worksra compensation po ft declarstfu page(shoals the
Failure w accuse coverage as g polky number sales axplratlos date).
g° required under Section 25A of MOL a. 152'can lad to the imposidoo of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonmenk as wan as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this wtemaat maybe forwarded to the Oflice of
Investigations of the DIA for inauraace coverage verification
I do hsrsbr cerdA ynderths of and/psnaltla ojpsrfwy fhattlu lajaraeadoa provldsd above u era and coned
attire! e - Da w (o ( C)7
Phone#: 4,Lff'o
O,Q?eld use oa1J► Do not write la I"ar*4 m be cosrpfsftd by MY or town ohk&k
City or Town: Per ult/Lteeass#
Issuing Authority(circle onep
1. Board of Health 2.Building Department 3.Chyfrown Clerk 4.Electrical Inspector 3.Plumbing Inspector
6.Other
Contact Person: Phase#t
i
y,
�. 00. 35,000 cf enclosed space, 11 -
(MGI.CA 12 S.60L)
- to Masonry only
- 16-1&2 Family Homes -
Failure to possess a current edition of the '
Massachusetts State Building Code -
I Is cause for revocation of this license.
I I
I I
I
�DIG'sAFE CALL CENTER: (888)344-7233 -
0� V/ F F f .�` BOARDOF�(REGu•` d
License CONSTRUCI,ION SUPEs� ,
;. Number- Cs ( 1%7- -
. Blrthdate'�5f02ht967'-N�
b - ERfres,"-0510212007 Tr n a2T07
z � b
Restrfetedf 0¢
s� 'IMOTIiY J*FINN -
' 8 UALDORA;DR/PO B0�53
STONEHAM, MA 027✓3i):- t"
Ar 'corhmissloiia� ,
y.• i
PROPOSAL
CONSTRUCTION SPECIALTIES UNLTD., INC.
P.O. BOX 53
STONEHAM,MA 02180
Phone (781) 665-4410 Fax (781) 6654411
RTNOX
HE 13ROAN-NUTONE
HEARTH PRODUCTS
A NORTEK COMPANY
cuts 11 l �nv�o�c 1�2 f - l)t9ccQ
Y1 2 CQ;s c o� is'1 cyl� Yee, (cec e
� CQ
O v
V� �
a4c) A5roc'ca- n
We propose hereby to furnish material and labor- 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
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
The shove PH"%spedfic ow and andi6om ere mdsfaclory end ere hereby -
!ceepled You ve auNodzW m do dq Work y specjfisd. Peymenl will be made u ouiltral above.
Signature�D / Date: D� 23 7
If accepted ple a sign and return.
Crrx op SAtEM
PUBLIC PROPERTY
DFPAXrMENT
Cons&ucdloa Debrb Okpo d AM&Vlt
ON an 4m"m ad mova"woo
th words WWM
S M dy,Co 780 C�saed=IIIJ
elb<l4 sdp
D dw mvlslont
Buaft ftuft d it lmd w(d dw aoodit a do dw ddmk mftg stool
Lhk wwt dsn bs ditposd of Bt t ytapW%►toomd wm t dbp d&@ft m dsdnod by MM s
llw ddlft will bn trtnspoftd bP qq a
Tw dabds will be disposed of In: qq
(mms of Asil4rf
fawr�.rmeal"
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PUBLIC PROPERTY
, DEPr1RTN��1T
N.�1iat 13�CVsswrwltin S17Etti°r':
- ri:sti»sbts;7i1;
_ 't11:9?L7iS9SS1!'f FA1C:97L?W:96y
APPLICATION..FOR..THE REPAIR. RENOVA'Titniy )NSTRi7C 'ION
DEMOLITION. ORGHANCEOFUSE.OROCGI��N� y FOR.ANYFISTIN(,`
5= � UCTURE:ORrBUIhbily[:
1'.0"SITE INFOR. . TION .
Locatbn:Namr :. p�✓1 cy r SUMIng
_._ ...._ PropaY Address c
Froprty Ii bate0,in a;'Coris®rvatlon Arse'YIN . .-.. Hlstaic l3isbid Y/PI
4s'0 OWNERSHIP INF_ORAMTION
�1 Owoec.of tand ,r,'� ��
Name:
AddreasE �' Nav1C
Teleprwni: CZ 797-7 -Z b Ce( b�£ . 32
. 3�Q t7
3.0`COAAPLETE.THI$.'SECTION-"FOR WORK IN �ATtN� BUILGINGB'ONL-Y
Addition Exiatti� _
Renovation Mmltea,of Stories Renoyatetl
Change in Use . New
Demolition Existing
Approximate year of Area per floor(sf) Renovated
construction or renovation:
of existing twltling' New
Brief;Des pton of:`Pr sed:Work:
J�X� f�
Mail Permit to: I in