35 SUMMIT AVE - BUILDING INSPECTION � zb
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The Commonwealth of $4 7�L
OF
Board of Building RegulatioO and Standards CITY M
Massachusetts State Building Code 7 C 4'j SA Ma,
.tn,� ��` P 2 Revised Mar1011
Building Permit Application To Construct,R Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Officio,Use Only
(� Building Permit Number: I Date Applied:
' Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
v ) 1.1 Properly Address: 1.2 Assessors Map&Parcel Numbers
�L 3S S-f.Z7 AIe 01+1k �+ 3
L 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 R) Frontage(fl)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public H' Private❑ Zone: _ Outside Flood Zone? Municipal WOn site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: f�
Ta Y14 Zannino — Pe g t'r`isc-01c,
Name(Frio City,State,ZIP
9 Qrlsc',��g �� -7QI-(p70-054
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of ProposedWorkz: n 's4lvwgt.
Ne'w ki4ctie C- .Ipinejsj o er 4 mat.., n�_(ao wt
entry AO!G E�u�tz.cntn)G
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ /Z� 0o0 1. Building Permit Fee:$ indicate how fee is determined:
2.Electrical $ p�v ❑Standard City/Town Application Fee
❑Total Project Cose(Item 6)x multiplies x
3.Plumbing $ 3 00 0 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: ❑Paid in Full 10 Outstanding Balance Due:
G SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
' CS- io3zgv a Ze i'1
i- g U • r Q /' License Number Exp non to
Name of KSL Holder
List CSL Type(see below)__ U
q/ 43u+ie� s}
No.and Street Type Description
50.12 w. /y{�' fJ `('l () U Unrestricted(Buildings u to 35,WO cu.ft
R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
_ HIC
r, a!l( 15�aa�i-� G, o �_ /�at I to I ti
Registration
Number Exp n Date
HIC Cornpa4 Name or HIC Registrant Name Zzwvry1l va
141 11er si. S� Dfe evG3l OnS �/1 Ma 1.
No.and Street Email address
5. le+ 10-- W170 'I75-957-eOG'J
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.us 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 G JwN vs.2 Vle-•t
to act on my behalf,in all mau relative to work authorized by is building permit a plication.
Print Owner's Name(Ele�ic�Siiggnaal ) Dater' �
SECTION 7b:OWNW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I 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. -
K y 2R 5
Print Owner's o uthorized AgedCs Name(Electronic Signature) Date
NOTES:
1. 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.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns
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.ft.) Habitable room count
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. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF Sm.Em. NLAsSACHUSETTS
BUILDING DEPARTMENT
• P 130 WASHIINGTON STREET, 3' FLOOR
T-EL (978) 745-9595
FAX(978) 740-9846
1<1%,ffiERL.EY DRISCOLL
MAYOR T HomAs ST.PIERRs �
DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CO% IISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# 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
111, S 150A.
The debris will be transported by:
C oLenS Domsvi
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
s' ature of permit applicant
(lato
dcbri.lITA,w
CITY OF SM.E:�I, NUNSSACHL'SETTS
BI:IIDLNG DEPARTU&NT
p• 120 WASHINGTON STREET,3ra FLOOR
� TEL. (978)745.9595
FAX(978)740-9W
FRi EY DRISCOLL
ICI.tB S
I
'I}tOh1AS T P[ERR6
MAYOR
�
DIRECTOR OF 1'l:BL1C PROPERTY/Bl:1LDLNG CO.LMBSSIOvER
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Anplic2nt Information L {� Please Print Legibly
Name(Busiuc s Organizarionllndividua): LJyenq-
j
Address: J10( r 5jr- f
City/State/zip: S�n , MA 01-i-fo ('hone#: g-r-d 8oui
Are you an employer?Cheek the appropriate box: Type of project(required):
1.0 1 am a employer with 4. 0 1 am a general contractor and 1 6. ❑New construction
_pirployces(full and/or part-time).* have hired the sub-contractors2. 1 am a sole proprietor or partner- listed on the attached sheet: 7• ❑Remodeling
ship and have no employees These subcontractors have 8. 0 Demolition
workingfor me in an capacity. workers'comp.insurance.
Y P tY• 9. ❑Building addition
(No workers'comp. insurance 5. 0 We are a corporation and its
required.)
officers have exercised their 10.❑Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'camp. c. 152.§44),and we have no 12.0 Roof repairs
insurance required.)t employees.[Arc workers' 13 0 Other
comp.insurance required.)
Any applicm that checks box al most also fill ous the section below showing their workers'eompenruion policy information.
'I Ieaeuownna who submit this aNkkavit indicting they ate doing all work and then hire outside comr k"must submit a rtew affidavit indicting sudL
=Conuacton that check this box must attached an additional short showing the some of the sub-comractorn and their workets'comp.policy informarioo.
I am an employer that Is providing workers'compensadon Insurance for my employees. Below is the policy and Job slue
information.
Insurance Company Name, cotmp.4zCee IvlSurc�nt:Q
Policy#or Self-ins.Lic.#: B G D W R Z Expiration Date- 05 /
Job Site Address: 35 Sunnnntl' A'Je UAir #7> City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the polity number and expiration elate).
Failure to secure coverage as required under Scction 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and tar one-year imprisonment,as well 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 statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature, Date:
Phone#:
Official use only. Do not write in this urea,to be completed by city or town afciaL
City or Town: PermidUcense#
Issuing Authority(circle one):
1. Board of Ilealth 2.Building Department 3.Cilyfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Office of Consumer Affairs and Business Regulation
10 Park Plaza Suite�5170
Boston, Massachusetts 02116
Home Improvement Cb;ntr, for Registration
Registration: 177161
-` - �-� Type: Individual
Expiration: 11/6/2015 Tr# 246545
EUGENE PREYL
EUGENE PREYL
41 BUTLER ST
SALEM, MA 01970
AUpdate Address and return card.Mark reason for change.
Address Renewal Employment Lost Card -
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Marcia Kirkpatrick
From: Joanne Whitehouse <jmwhitehouse@netzero.net>
Sent: Thursday, July 30, 2015 5:31 AM
To: Marcia Kirkpatrick
Subject: Subject: Condo Association Approval
To Whom it May Concern,
I, Joanne Whitehouse, am the managing trustee for the 35 Summit Avenue Condominium Trust Association and
have recently become aware that a new buyer of Unit 3 is going to be doing construction to upgrade that unit.
The new owner, Ilario Peppe, has informed me and the other unit owner that he plans to begin work as soon as
possible and in that connection asked me to send an email to you saying that we are aware of the construction
that will be going on in our building.
At first I didn't know the purpose of the email I was asked to send and that led to some confusion and my
copying you on an email earlier thinking that he had given me his contractors email address. So please ignore
that email and accept my apologies for copying you on that before I understood what was needed.
Now that the owner has clarified the intent of this email that he requested me to send I hereby give my approval
on behalf of the condo association for construction to proceed in Unit 3.
If you need anything further please feel free to get back to me.
Sincerely,
Joanne Whitehouse,
Trustee
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