Loading...
96 SWAMPSCOTT RD - BUILDING INSPECTION (25) 1 s rC What is the current use of the Bw/ding? ---T Material of Building? ! e/ If dwelling,how many units? /Z1G ,/P Asbestos? S Will the Building Conform to Law?--.7._�— Architect's Name Address and Phone b �. /J�l/� `%�U/' f /��P��fZy Mechanic a Name q a/5 d3 - 7,Y-771Y Address and Plane 0 C GIP�.t�✓✓ sf P"S, /G76 77 Constriction Supervisors licenses O-Q a L7 HIC Registration p Estimated Cost of Projed$ 7� Permit Fee Caiarlation Permit Fee S Estimated Cost X$71S1000 Residential Estimated Cost XS411*100©Commemlal— - An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays In processing. The undersigned does hereby apply for a Building Permit to build to a above stated specifications. Signed under penalty of perjury Date r} I \ V 4a x _ L Errr-OF� PUBLIC PROPERTY DEPARTMENT ���AQILSh'Pls 01970 I'm-M715-9S".FA,C 97S.7404M APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: Building: - - Property Address:------ — -- --- ----- - - - -- -- - Property Is located in a;Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land U�i Name: ri'An.d 1 �� Address: �1 I _� wl Mt� S -�l /JG O PG. CY , RG- Telephone: ?•? - 3.0 COMPLETE THIS SECTION FOR WORK IN FV1i%TINp Su1LDINGS ONLY Addition Existing Renovation !� Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: 2GoA.', -- Mail Permit to: d7 -- r�i�+v 5 Tk &m .Illld o�✓ r�aac�uoe(la , BOARD OF BUILDING REGULATIONS ` License: CONSTRUCTION SUPERVISOR Number:CS 053841 Birthdate: 11/21/1962 - Expires: 11/21/2007 Tr.no: 9409.0 Restricted: 00 ROBERT C PIZA - 40 CHESTNUT ST G— DANVERS, MA 01923 Commissioner t ,. � ✓�TpOOJMiddlll//Egr(/d O�./!�!-trOdOtllllAB�A �, Boerd'of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegtslreUon: ,107877 Expiration 8/5/2008 G Lf Type DBA, ri BOB-BUILT CARPENTRY Robert Piza 40 CHESTNUT ST. DANVERS,MA 01923 Depu dmluistratorS 6u� T4 s 192" �fcets �... ...h ' O i CM k h �b i t •`A 24a' - 7C' 54' -- —30" 95 ia' 84 ' All dimensions size designations given are This is an original design and must not be Designed: 4/6/2 subject to verification on job site and released or copied unless applicable fee has Printed: 1 1/1 l/: adjustment to fit job conditions. been paid or job order placed. OLOOTAS,,. E�bad, CITY OF SALEM PUBLIC PROPRERTY — DEPARTMENT wlvtei"atlt/ttttntxeu leL�wt� 120 WAs1aVTONSTReer o SAttss,hLtsttAah ?7 t�O1970 ftu 9711-745."93 a FAX:970.740.9846 Workers' Compensation Insurance AffidaviC BuilderWContractors/Eleetrldana plumbers .Applicant o io Name(suvnesyOramizatiaul"v I: - (/)f �'sr�,�!/ . . Citylswwzip: Phone a:_ Z?k- 77Y- aJ`a V Aro y art employer)Cheek the appropriate host lyp.o/proJoet(regttdretn: I.EYI Lora n employer with 4. ❑ 1 am a gtnterai eotrtraetor and l 6. New c non empioyros(rids aruNor punt.time).• have hired the sub-eursractors 2.❑ 1 am a aok proprietor or partner- listed on the attached sheet t 7. ❑ Remodeling ship and have no employoea Thews wbeonsnaers hew IL p Demolition working for me in any capacity. workers'comp insurance, q, �addition (no canisters'comp inwracom S. ❑ We am a eorpant(m and its required) officers have examisad their 10.❑Electrical repairs or additions 3. 1 am a homeowner doing all work right of exemption per MGL I I.C] Plumbing repairs or additions myself.(No workers'camp. c. 152.#1(4),and we have no 12.0 Ruof repairs insurance required i► cmpbyaes.LNO workers' 13.❑Other comp inwuanoe requirod.) Ally applicant Mat clucks Oct in most alas Ite cut an calms below Acuuioa Ikv awrko•almposuak u tadiey iaarlrlwion l lumewewners who submit Mis aflldsrk iadioliq Inlay aM&V%aY were and Mo hke out"eoMmMma mot auhmis a nmr atnasvk HWIainig sues. •.10I7o'ItIn this clock this ki MAW altaabad as additiond AM 4owUle as nap ataYsubcoduaggentand Ilalr wareaM'eatlq.pdity Im1lMmmallua /air an rrnployer that is providing workers'compenradow Lusranee jar ray employers Below is rhr paHa grad ob alp irrfirrawrllka ,v.. _ _. _.e,. .. _ Insurance Company Name: Policy a or Sclf--ins. Lie.a: _ -- _- Expiration Date: Job Site Address: Citylstatrazip: Attach a cupy of the workers'compensation policy declaration page(showing the Polley number and espiratlon date). I'ai lure to wcura coverage as required under Section 25A of.IGL e. 152 can lead to the imposition of criminal penalties of a ri 4:up at SI.300.00 and/or one-year imprisonment,as well as civil penallics in the form of a STOP WORK ORDER and a floe .ef up to S250.00 a day atplinsl the violator. lie advised Mug a copy of this slatctncnt maybe forwarded to the Office of lu�.angauulu�I'the DIA for invurarcc awcrage vcrificmiun. 1 da hereby rerd0 ardor th «i rid r/nry rhW rkr Lr/orarrd/en provided cloaca i u�and Correct. 3J—d-V _ O/Jkiad art arrllt A*oral cadre/n/At$Ores.la be.rosrpWrsrby dry sr own s/)7a lmi City or'rown: Permit/IJeease a Issuing ,tulburify (circle onto): -- 1. iloard of liealth 1. Ruilding Department J. Citylfovta Clerk J. Electrical inspector S. Plumbing Inspector 6. Other C„ntaal Person: _ I'hone p• Information and Instructions - - - - - ,%j usochusetts Gcneral Laws chapter 152 requites all employers to provide workers' compensation for their errrPbYses. pursuant to this statute.an eayphJ^a'e is tuned as o••avery person in the service of another under any contract of hire, e%presa or implied.oral or written." aatxiadm aaePoeatioa or other legal a rite mpl y two ft man pt Ocesr.0 de Nil gage i its ist c eirp patnMfahip r senratives of a deceased employer'or the of the foregoing mtlf i is a joint ea rrinersh and including tie legal epth However the ssaoeiatioa a�other legal motY.eatploY1Ot��Y� receiver at umttee of an individual,n,re em du tied who resides therein.or the otxhtpntt of the owner of a dwelmW borne having not man than am do maintaparqenance. _ dwanittg house of another who employs persms m do maimm�ence, f pub tcaoa or repair ebe d work d to h s an employer" or on the grounds at building appmtenans theeeso shad not because of stuck empinyetaeot siGL chapter 152.42SC(6)also settee that"every state or bed Hembeg apney shMM tr"tueY the kuneaee or b o es a testiness or to construct buUd WW Is the eeseaatawealth fir ayr repeat of a license m P� wabY wfdaw of compasses with she Insurence coverage requires Ad&k at wlao Mee net prated nor arty of ib al eabdivisions shell Additiomlly.MGL chapter 152.423C(7)antes'Neither the commonwealthPolrr►o e performance of public work until acceptable evidence of compliance w its the insurance rcquirometus off this enter into say hi e chapter chapter ct ft the been presented to the contracting audtoeitY." Applteants Please fill out the wetken'compensation affidavit completely.by checking the boxes that apply m your situstion anti.if necessary,auPP1Y wb�earho actorta)narne(s),addresses)and Phom nurnbar(s)along with their cartifica�s)OfOth clan the insurance. Limited Liability Companies(LLC)or Limited Liability Pntrtetships ILLP)with not employ member or pattness.am not required to carry workers'compensation insurance. if an LLC or LLP does have employees.a policy is required Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage Moo ba aura to sign and data the affidavit. The afidavit should be returned to the city or town that the application for the permit or license is being requested, not the pepatament of industrial Accideaw Should you have any questions regarding the low or if you am required to obtain a workers' compensationcall the Depatese at the number listed below. Self-insured companies should enter their ce polity,Please ca tmline. self-insurance license number on the City or Town Officials . a..... .. _. _ ere has provided a space art the botmrA,.. . . -..please he sure that the affidavit is complete and prinited legibly The Departm of the affidavit for you to fill our in the event due Office of investigations has to contact you regarding the appl_' ant. e purmit/license number which will be used an a reference number. in addition,an applicant t'lease be sire to fill in th one that must submit multiple permitllicensa applications is any given year,need only should write u locations in testing current policy information(if necessary)and under"Job Site Address"thin applicant town►."A copy of the affidavit that has been officially stamped or marked by the city or town unay be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out cub year. Where a borne owner or c. . is obtaining s license or permit not related to any business"commercial venture (i.e.a dug license a permit to bum leaves am.)said person is NOT required to complete this affidavit. hit Otlicc of Investigations would "t to thank you in advance for your cooperation and should you have any questions ptcnse Jo nut hesitate to give us•a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts DepaMcnt of Industrial Accidents Oaks of favestlptlew 60 washingtaa Strict Boston,MA 02111 Tel. 0 617-7274900 ext 406 or 1-977-MASSAFE Fax 0 617-727-7749 ;tcviscd 3-26-05 www.mass.gov/dig �S ANOV-02-200T 02:48PM FROWPhil Richard Ins 078TT41318 T-14T P.001/001 F-88T CORD CERTIFICATE OF LIABLITY INSURANCE D 1/2 /07 W COMFCATE6M1MJ®ASANATTEPOFMORMATON —" Phil Richard a Associates O&VANDCONFEMNOFIGM UPONTIE GATE 491 Maple Stswt NDI.D7R THIS CBITN(CATEOOa9NW AMBQ EIITB�pCR _ - - - -- 9ait9-Y02- -- - _ ALT5t 7MCO1rMGE:RORO®BT TtiEPIX]CO>BB *R Debvese, Pa► 01923 M►UIMISARCRONBCOVe of �� "ARID MBwrn Asbella proG.�otion — Robert C Pisa d/b/e Ne1110tD 6raaitE state Ina Co — Bob-Dailt Catpaatry -- 40 Chestnut stxmet Fla pERTi Danvers, m 01923 -- saseR COVE THE POLICIES OF ROMANCE LISTW BELOW HAVE BEEN IsauED TO THB INSURED 0 ASOVE FOR THE POLICY PERIOD HIMATEO.NrnanTHaTANoING ANY REgW OC RVAMgT.TERM OR CONDITION OP ANY CONTRACT DR OTHER Oum"T Wily"RESPECT TO vA#CH WKS CERTIFICATE wr Be 19SUED oft MAY PERTAIN.THE INSURANCE AFFORDED BY M POUCIES DESCRISED HERE DI IS SYa1ECT10ALL DIE TERM EMILUSIONS AND CONDITIONS OF SUCH POLICIES.AGCRMATE UW M SHOWN WY HAVE WKN REOuC®Dr PAID CLIVie. INN amFgID11NRN1RMR l!•INS— .—. NNN UIBiNNr MRd100a1IwaleS 1 �000000 A X ciNsscsl N�rI tlDiiBr a500035106 9/25/07 9/23/08 P i 1 00O DANNSNNDE [x10CCDR u®Emwt, p—" -.a 10.000 FwNiilw.aADVNINRT s ,000.000 iEA�Y1LAaa1E0A7E i .oaon .DDo aertAmmmnlElrnANwesPac PROM)CM-CowroPADO i xlpomvl IMF ,000.000 ADIisoNaElwm N AUro "'Res"o eWAY • aaamxmADTTe — iCNImRREDAura H oeyNuq a Na►DANND ADNDA /ktlsmq � IreDNaaTrNniuEE i •. &VURMtassY W%o_ VY-VN-CM®NT iWNW _ ANIIAIND — FAACC Ran i EM EAu.oeaweueleE i �ocow CRARReNADe — ASGRINVITE DEDUCTIBLE MENTION t — s eDlseNi COBISNNM1011 NID EmLavvowt oulY7 D Requested rave B1 OFI miNE1MD1 IB� � Craa=lar KhE ce'p"VoIT t E doHoo BOmN X ElDSFABb-FA9D'wY� 8 OTlR eLDNEAE-ADIx rusr i D@MRPBONOPOIeamletLOMVOWiVMICL!nJE1LLDaMNBIMM OVOMMUMMITNQECRFRM01a EVXDNU= OF nUMRAMM INSUIM'S FAX i (973) 774-2524 CBlfIRC E ■I�lDMy6MAYdIEDtl W�DPC11�7iRBON1�llMD9blM E7E!WMR BA1@NNBd,�,11C®11MINNMIBINI4eNDeNON1ONML 15 DATIWpTID1 NDMETDTHECBRTHNGAREiID1BMt NAN®TOTNBN�►BDIFpLILEIODOBDMIALL dA R4MdDYOFAl1yMMD LIMN 7IMgMR1.RBADBRIibt N@RG991fAt1Y6. ADNIItlIQ®I�RANIyE ACORD29(30py0� C v� F ' NOV-00-2007 03:63P* FRO*-Phil Richard Ins 070IT41318 T-243 P-001/001 F-061 TMCBMIFIMCAMMIUMASA XM CF FT�q ROohra 4►AwociOu hN ONLYANO CONFERS NO RIMKm t1PON 71iE CgtTRFtGTE 4111 Um b 9t COV BY T}E OUCdB gEL(y F . Ata taz CONPAMA GPANrMffrATtbmRMANCECOMpANY Robert C Ft Dovbw ,MA M9234KI00 na9lStoeB[IIFr7lNrneFa*�CSWgJ1Ms utlm�,0ws6tlYE�Im11�m1sEssisimm milissARWAFOR - T1ePOu0vPeu0umm ►nAnorNRnOrA1gt0Aw MeR01RCOMU CF/1Mra0mnLwroRanE# : Ood�NrMSIXR8Prr8GTmMSiO1TNBCBrFp0I1761MY�!&ledtWlYP®tolllltfils /W+pp�gp�e . P01�81�I��BICrTOALLTIB7G�FJ�W0A11sMIDs�R101e CF�lpIP�' R.I�tII18110YIIM AMYIM M BEEN FAMUCot11f P1AOC/AM am 11IwOsr�ne aas�� � A AW"i-renvUNN" : Lima awaru� - L OsatO i 6442= 1 iit0000f s IM4120M annuroarume YI�O =mMomr i bweucsmwAnr l 8 eis� Mr � AE 1F6WpR�18 C01�B�7spN POLCY 00BO NDF•PRWMCWIMM FOR ROWWC PSI► PANMUTION NORTH ORT MCM R4tl31:M,CENMATMMR 71eN� Faegsowesueo�asTt! BOORM 81 HON AWAtAa O�r�ORT+`�raaaARwrsr►aAtaiasiort� 8At®t PRA01or0 onnrwr��NeTsne�Po�xaane�Tonessrior . • w�u..+owiam�.onaerwu.��oo.omroaui.e.a - 9� �;may CITY OF SALEM PUBLIC PROP-RERTY- -- -- -- - - DEPARTM. ENT •.vS•�1 aY 'dia'�1. ]l�u• 13C•.aew-:�t f 1rtT i�t:+4>Avcww�a�t�.:9 T1:vw4paw1•IF.%*9�sJ+0+lsN 0- Construction Debris Disposat Affidavit (reyuimi ttx an demolidon and ceaovadaa wosh) to wco mUm with the such edition of dw Sets tluitdin@ Code,790 MIR sWion 111.S Debris,and this pmvisions of MWL c 40.S 54 9niidhl{Permit 0 _ _ is issued with dw candidon d►st dw debris awuldns foss this wort shall be disposed of in a properly licensed waste dispwd &cinty as dented by MOO e tl1.$ 15" The debris will be transported by: Chfh,4 CA(KY rhedebris will be d ispase4 of in .51 L ticr of faaduy) 70 4.46-4-4f.. al im, Is W/ zo? ..4w - 4