9 SYLVAN ST - BUILDING INSPECTION (3) l� 'a - ---- l'he C'onunomve:dth of Massadutseus --
/ 41' Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
'L"•, Building Permit Application To Construct, Repair, Renovate Or Demolish a Rr rise).l Lu'2011
One-or Tau-Fanlill Du ellh.q
This Section For 01'Fiie' Use Onl
Building Permit Number: Dat 'Applied:.
lhnlding Official(Print N.unc) Signature te
Date
SECTION I: SITE INFORMATION
L I Property Address: OJ 1.1 Assessors Map& Parcel Numbers
L la Is this an accepted street?yes ✓ n- Map Number Parcel Number
1.3 Zoning Information: LJ Property Dimensions:
Tuning District Proposed tJse Lot Area(sq It) Frontage(It)
1.5 Building Setbacks(IT)
Front Yard Side Yards Rear Yard
Reyuircd Provided Required Provided Reyuircd Provide)
1.6 Water Supply:( . I.c.JU.§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if es❑ Municipal❑ On site Disposal system ❑
SECTION 1: PROPERTY OWNERSHIP'
2.1 Owner(of Record:
�7MAn;cv Aei r4Q /L r/u �t,.g.,„�s,so —r yr�i
Name(Pnnl) C iq•,Slate,l.IP
No.and Street Telephone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner•Occupied ❑ Repairs(s) IK Alteration(s) ❑ Addition ❑
Demolition d Accessory Bldg. ❑ 1 Number of Units i Other ❑ Spccify:
Brief Description or Proposed Work': Demo In re- v— n.- s rE ti,o oe/ 2 etgo4rf e
a14 n
SECTION a: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
I. Building S 4y qua I. Building Permit Fee: S Indicate how fee is determined:
'. Electrical S 3S00 ❑Standard City/Town Application Fee
i. PlumbingCI Total 1 Total Project Cost' Item 6)x multiplier x _
S �6u _'. Other Fees: S
a. \Icehunieol (II\':1C1 S List:_
\lechanical (Fire
Suppression) Total All Fees:
o. Total Project Cult: S Check No. _ _Check Amount:
/ S of 3 0 d ❑p;tiJ in Full 13 Outstanding Bul:mce Due:
SECTION 5: C'ONSTRUCrION SF.RVIC'F.S
5.1 Construction Supenisur License(C'SI-)
License Number FSpiration Date
Name of C'Sl. I lolder
List C'SI.1)pe lice below)
JZ 06s-7-0L Ave -- ---
No. and Street -- ------- --- —--- I)PC Description
tI t4lrestricied(lluildin's up to 35,000 cu. 11.)
.. 4vAy,i Ai Gp 7-7 Y7/i _r/ Jo�_—__. R Rc,trictcd 1&,2Pamily Dlsclling
C'itci form.State.ZlP M Masonry
RC Roolin C'overin
._—. W'S Window mld Siding
SF Solid Fuel Burning Appliances
yp rwe L 1 Insululion
'I'dc hone Enulil address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I ,s
FP r-rAb A o a 1h;H." 1 m prove 4--7- I IIC Registration NuniNr Expiration Dale
I IIC Compin) Name or I IIC Registrant Name
11- Ar'{1V2- Arf
No.and Street Email address
5t./4.-,1psu� r-r yAl 36a 6
City/Town,State,ZIP 'relc hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.1 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
1, as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nwne(Electronic Signature) Dale
SECTION 7b:OWNER' 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 a d accurate to the best of my knowledge and understanding.
rint Owner's or:\uthorizcd,\gcnt's None tfreetronic Signature) Date
NOTES:
I. :\n Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor
(not registered in the Hume InlprovementI Contractor(HIC) Program),will no have access to the arbitration
program or guaranty fund under.M.G.L. c. I42A. Other important information on the HIC Program can be found at
I Information on the Construction Supervisor License can be found at%%k%,%.ma,i
]. When substantial work is planned,provide the information below:
Total floor area(sq. R.). - I including garage, finished basement'attics,decks or porch 1
Gn»s living urea I sy. tT.l ____. _ _____..- - __ Habitable room count
Number offircplaces ._ —._ . .— Number of bedrooms
Numher of bathrooms - _- Number of half haths
f)lie of heating i),tem . .. ... . -. Number of decks porches
I\pe of iJU1111g i5 itdlll I,Ilcloied _ _ - _ __-011en
1, "Total Project Square Footage'mas he substituted tier Total Project Cost"
Nlassachusctts- Dcpatlmcnt of Public Safctr
Board of Building Re�ubuions and SGmdaI"
Coo.sttuction Supervisor License
License: CS 82161 . s
Restricted to: 00
DOMENICO,,FERRAGAMO }
32 BRISTOL AVE
SWAMPSCOTT,' MA 01907 1
o--
�_�_ Expiration: 1/26/2012
('onuuissiuner,' Trp: 16146
�T pomveyeonwuy�l�e a i✓ss Regu,'�
1 Office of/C Consumer Affairs&Bus�oe Reg
HOME IMPROVEMENT CONTRACTOR
— : Registration: �-138215 Individual`'
Expiration
315/2013 V `
�. OFERRAGAMO� _�(��
�.
DO NIC , '
DOMENICO fERRAGAMO�
32 BRISTOLAVE
SWAMPSCOTF MA 01907 -' Undersecretary
CITY OF SALEM
PUBLIC PROPRERTY
'° DEPARTMENT
\I%I.41
I!: \s'nvn.�l.ht.�ic4eur • intPu,Mn,,�.w.ln a I IIJIv7�
1 llicanle Workers' Cum mutlopensatlon Inwrunce Ulldavih UuildervCuntractun/Ele►•triclamy Plum bors
In nr
Naine I Ile y
ill w, ')raatvniury lnJtr11:
I I e 'AI
WtIres.i: 3 Z ac.,15ra
vC
c�ly,sl:lt�,ir�• s �,�� pS�a T r n,� r l
I .h ry y as an vulploycr' Cheek the appr,lprluto boa:
I ❑ 1 11111 vmpluyvr with 4 El I ill"a jcnunlcnnlraalorand I 1>M ofpnl)ve1(rvyulrrJ):
,�..�yynlpiuyu cus(lull antYur pert-aloe).' huva hirvJ the.4uh-alnaaclurs h ❑�LK'uw cunslrucliutl
1 2• 71, n a Sulu prnpriutor nr partner• lislcd on the anached.,hcut % I. d e1no11oiinE
.hip;Ind have no ampluywo These subeontrsetors have uurkin� Air mu in any capacity, These
camp, 'nsurince. d• ❑nomwirion
IN" wnrkuot'rump, insurance J. Cl we are a to'paration and its q' ❑ OuilJind iddiliun
).❑ 1 Jn1 v hobo awry
rcyuircJl alylcen have uiomilhid their 10•0 Electrical repairs or additions
Juind all work riyhr of vaentptioe par hICL 11.❑1 lumbin rc
mysvlr.(�'o t�nrkurs'rump, r Y pairs Of JJditions
C. 1 J2,¢I(�),anJ we have no,inrunncu reyuirad.J n .mpluyeus.(P'o workers' 12•❑Ruul•npairo
romp, invurm w rcyuircJ.) 12.Q Other
•1^r %i,aira i he altars ibis sl mt41.dw wi uW'M vrchou 4rvlr fiwwme nWir+wtus'eunge'n'tli,l,l Iwlier udurntwiws
'1Lwttatrveyrl why„armil Ibis slllesv6 iMllu'ina'Itrt rq aain C',�nrrl,lun thM'livVit'his tbia nurt.ua:hul.'a ledili adl,ru;air llNl Alro wrsids eusrnsro,e mats.ahnas Mw,III
,eld,Irbil,11utrin the narM s/1MI�Mlrinlle,tllr'hfn tlurkttre' Jevil irtJl�r1'na,twL '
r lion fill 011ployer that I1 pruri'lli werkerl'rutnpenrnNeln
/w illyen /u In.ranrnre . 'polrr tnMleuiva
iolunnwlo a P J te.R si/rely/s thepu//1y unll/u1 Jiq
In,uralcu Company .Vnlne'�__ .
11111icy our Svir-ins, tic.it:
E.ipirutwn Daq:
lob Situ hddrviii: —�_
.U1u a cul fir the worker/r llpunlatlue pulley Juvlarallun purse(showing rhslpolicy nunlbur and vipi►atlule date).
P.tllufu ru w ,ccura ruierufe isrequi rreJ undw Secliun:JA ul %IGL c. 132 eau lead to file imposition of Minimal penalties Ora
tine up fit it JuO.04 wndlur uue-year Imprivnlunrnr, Jn ,cell Js vial prnahly in the Iurm era STOP WORK ORDER and a Rno
,t(up rn i?!Q 14.1 Jay gaunt il'e Yull.uor. lie Will*•J that a copy urlhry.dglvmunt may be Iurwaj w the Ullicro vt'
Ln;.,l�yau�nu vl';hv I11,\ :or nt.nr.11'cv cuccrJ;v \:uli6altun.
/du hereby 1 arlih wider rhr p,rinr�urJ/tarnlNrr u
/per/nry Ihur rht in/bnnat/oA pryriJall u0uve is true curd rarrvrt
rr„ • , / 2 - z
Ill//riul 10 e wily, /Ja ant nvite in this wn•u, to At rumpt"led by ray fir/o'rli w//Iriu[
(ity if 1'o1ytr: _
I„vino .\alhgrn py pernial.let:n4e0
(Cifc10 inlrl;
I ,rJ ,dlle.dlll 1. Ilnddln� Il,p.trtuh•nl 1. Lill.] ),111 Clerk J. C'Icctric.11 Intperlur :, (`hunbiny In,petlor
� G. I)Illvr
I'hnnv 1•
information and Instructions
Ific
eve �,,,on in the ecrvtce of anuther un,ter Illy comnu Of hire.
�Lu,.ldw.eaa licaarjl Lawa:h+yter I32 Ic4tures all eu4ilo)en to provide worker' caulpensauon lore unfr1d Ofhir es.
an rein loran is JetineJ+a" cry p'
I`nou.uu to tits ,utule, p
as Or unphcJ, Oral or written•" or an two or inure
`pfe ur other legal cnnry, Y
Ufa11Uri
:o the
Ortnenhip.asauclauua, N lu �r or
\n !tAplu)•rr 14 dclincd L"an mJlviJual, p tom employees• Hawevcr the
eJ to a)Olin enterynsa, and utcluJing the lugal rcpcesauutives of a decease)emp Y' •
�1 the (Jret}Uutg engag' doll, lumanhtp,,nsoetauoa or ether legal gray,employing g '
tea of.al indtvr D ens and who resides therein or the xcupanw (line house
cetvar or um three+ arnlr n such J a {
Owner of a dwelling{house having not more than D
unenant theroto shall not because of such em to merit be deemed to be in mnpluyer."
,hvellmg house of+nathaf who employs persons w Jo mamtenunca,cunstructiPn yr repair war o
or ,it the grounds ar building+pD
%IGL chapter 132. 423C(6) also states thal"Ivory slate or local tuct bui ding$I shag ommcdithhold the 11141111111fan or
ulrsd.'
renewal of a license w p+rnsit to uy+rase a business or to construct buildings h the eommuawrult! or as
SC(7)araus"Neither the commanwealdf not any of iu political with he isi s shall
renotw;Ipplic+nt hb+ cal not prnducod aaeaplable evidence of cumpu+ncd wit! the Insttranu covarate req
WJitiunully,`IGL clluptar 131, �2
enter into Jay cuntmet for the fl rforotun' of
PIS PJbo the eonWadi i aluthorityviJanca ui cuntyliartce with the uuuranca
reyuiramcnu of this chapter have been p'
.\ypllcanes apply to our situation and.if
+s and hors+nurl,gsar(1)alone with their cartillcat+(s)of
Pteaa+ Ii11 Out the workers' cumpausation atlldavit completely,by checking the boats that a P y `,es Where than the
su 1 sulsoconlruclor(s)nsmefs),address( ) P with no ern loy
necessary, im Y
a(LLP)
workers' compansatian imuranee. If an LLC fir LLP fin have
insurance. Limited Liability Companiu(LLC)or Limited Liability Partrtars pdoes
dustrial
member ur puan+r, an nut required to carry,
employee,a policy is required. 9a advised that this in ensure to glen and date tAe al'lidn A to the vIL ttlltalaffidavit should
unit or license is being requested,not the DoPsnment of
\ccidenu far confirmation of insttrthe a plicAdge the low ur if you art required to obtain a worker'
his reutmaJ to the city or town that the upPlietui of at regarding
Industriul \cciddnu. Should you have any 4
ir
compensation policy.plea+call the DeptWn+nt at the number listed below, S+If-insured companies should enter the
sclf•insuranee license nufnbor on the a ro riate line.
CIry oe'rawn Offklnls
tOM
use to fill out in the leant the 0111as of Investigations has to contact yuu regarding the applicant
plea,¢ be sure that the affidavit is complete aJ printed legibly. 'The Department hw provided u spec+at the tl cam
Of 1 a1 tJav11 of y
Please ll sure tofor gill in the pI jut in
cent tl a which will M uaed,u a reference number, In additioindicating n,an JPP etl or
that inuat submit multiple pennit licmtse applications in any given year, need only submit una ,t A;uliort ro gdeJ to rho
policy inl'armuliun(if neceasaryhan unddir'jub Do ally suress"rri'lid
marked nt die c ihoulry oreeowe nay ba pin l' Y
Juvtt w a111Javil must be filled out each
the at as. A na
nt �tA UP lil:aria
v .",\copy Ora elms
wv nlis on file for Nrl P commercial-vanturt
at'that a valid aillJuvu ' not relate)to any business ur
ro nu
m as r en
apPlna D ifubmininealiansau P affidavit.
year. Where a hums Owner or cirizen r cam late Ihn
t i .. ,t Jug Ileeau or Permit w burn leaven cteJ sail Peraml is NOT requiredo D
I het)Ili"to luva.figatium twuld Itka w drank you in +Jv;ufce 1'ur your couperalion and shuuld you have.try 4144111atU•
ua+e Ju not hesitate to give w a tail.
fhc U: Will'cnt's +ddrars, tclephun++nd fax number.
The Carnrttonwealth of Munchusf
Deputment of Industrial Accidents
Office of Ieversd jadans
600 Wfshington Street
a(mton, MA 02) 1 l
feu. q 617.727•J900 ext a06 or t-877•MASSAFE
Fax M 617.727.7749
Hww,rnau.jov/die
CITY OF S.1!_E,Ni, Akss:ICHusETTS
13L'LWLNG 0EP.1RTtLVT
110 WASHNGTON STjM", See FLOOR
TLL (978) 711-9595
KI BERLSY DRMOLL FAX(978) 740.9&%
MAYOR TRO..%W ST.PMUS
DIRECTOR OP PC8t1C P40PFATY/BCQ.DC/G COJLS(ISSIONEA
Construction Debris Dis osal
(required for all demolition and renovation work)
Vit
rn accordance with the sixth edition of the State Building Code, 780 CMR section I
Debris, and the provisions of MGL a 40, 9 34;
Building Permit M is issued with the condition that the debris resulting from
this work shall be disposed of in a
I 11, s I soa. properly licensed waste disposal facility as defincd by NIGL c
The debris will be transported by:
-4�Z A' tPus
(name of hauler)
The debris will be disposed of in
(name o1jt"'—�
(�ddrea aY rac�hfy)
111n4mre ofpermrt Ippluant
lafe