15 SYLVAN ST - BUILDING INSPECTION (3) i
7 ----- The Commonwealth of Massachusetts
CITY OF
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CNIR SALLPI
IOU 'L,�•• Revived1Lrr_11111
1111ildin6 Permit Application To Construct, Repair, Renovate Or Demolish a
(hiv-or Tivu-Furnill•Divelli ig
This Section For Official Use Onl
Building Permit Number: Dal /ppliedt
Building Official tPrinl Niane) Si`yial� )al /l
SECTION I:SITE INFORMATION
1.1
Address 1.2AssessursM1lap4 Parcel Numbers
/sLiJ
I.la Is this ariaccepted street?yes no - Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 111 Frontage(It)
1.3 Building Setbacks(B)
Front Yard Side Yards
Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal y
Chock fifes❑ p posal s stem ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owneri of Rec d:
��F fro 2 2_ S�4 G L "A
N;une(Print) City.State.ZIP
No,and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ 1 Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ I Alteration(s) Cl Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ .Specify:
Brief Description of Proposed work-:
SECTION {; ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and.\taterials) y
I. Building S 1. Building Permit Fee: S Indicate how fee is determined:
'_. Electrical S ❑Standard City Town Application Fee
❑Tula] Project Cost'(Item 6)x multiplier — _x
1, Plumbing S 2. Other Fees: S
4. \lechanical! 5.
\fechanicd (Fire
Su prQssion) S Totai All Fees: S_
n p., P�1 r C'hcck No. Check amount: C;uh Amount:
t Total Project Cush. Y / p U U -- ---
❑ Pail in Full ❑Outstanding Bahuice Due:
f ,
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(C'SI.)
C'MM10 At— Imtli - c9G Y License Number Pvpirltiou Date
N'anteol'C.`I. Iluldcr _._ ocz
1�
r Lisl C51.11 Pe lice
carSX�r i __—____-- I PC Ocscriplion
No and.Street
Otrestrictcd(Buildings u' to 35.000 cu. IL)
� _----d—.-. R Restricted Ia2 Faint Dtwllin
Cil Town,51ate.LIP bl Mason
W'S W'induw:mJ.tiiJin
SI F Solid Fuel llurning,\pplianccs
Insulmion
'Talc hone Fmuil address D Demolition
5.2 Registered Home Improvement Contractor(HIC) lol
IIIC Registration Nuffiter fxprdion Date
IIIC' 01119an) N;u tc or I IIC Registrant Name
Nu. ;lad Street �l/ , -d—;t ' (�fy G Email address
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 .......... 6-- 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 .
to act an my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nmne(Electronic Signature) Date
SECTION 7b:OWNERI 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 its true and accurate to the best of my knowledge and understanding.
AI/(/AX//Cl��—/T G/�/�Cl C /V z l/
Prim Owner's o :\uthorircJ Agent's Nome Ililcclrunic Signauvel D'to
NOTES:
I. An Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor
(nut registered in the Hume Improvement Contractor(HIC) Program),will no 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 nl,l.. 1.0% 111d Information on the Construction Supervisor License can be found at p!s+s.nlaii ,,, t Ali!.
'_. When substantial\vurk is planned,provide the information below:
Total floor area(sq. ft.) _ t including garage, finished basement attics.decks or parch)
Gross livingareal sq. tl.) Habitable room count __
Number of fireplaces.-- . .._ _. Number of bedrooms
Numberol'bathroonu -- - - --_ Numberuf'halfb;nhs -
I\pc of heating s)stent -- - _ ... . .._ Number of decks, porches . . ._
F\pe of coollnL i\stem Fnclosed Opall
3. "fnl;d Project Syu;re Footage" nmly he substituted fir-I'otal Project Cost-
QLT IVY , EXPERIENCE
SERVICE � � - Insulations
HOME/d4PROVELLENT Hallmark - Siding
r - Roofing
LICENCE# I'PER Homes L.L.C. - Replacement
CONSTRUCTION SUPERV/SOR Windows Specialists
LICENCE#064068 479 BROADWAY,LYNN 01904 p
L k'AW BUILDERS LICENCE#470
(781) 592-5900
CONRAD McKINNEY, President - Established 1964
Member Better Business Bureau® www•hallmarkhomes.net
Serving Eastern Massaych�usetts( MMEMBB.EER OF THE LYNN.&PEABODY/A�R(EEA CHAMBER OF COMMERCE
Oimers name # / d —y�,/ ✓^ �� /
Job address " --Ck/ lr.-lam_
Specifications
t r�
Cash price of e _oods and services: ....... ........................................ t oO
Dovcn payment or payment at commencement: ............................................................... ............................ q1.iqkj..LDS
Paymentw hen 50%complete: .......................................................................:......................................... $aS...V.CY.Y.. O
p
Balance upon completion: ............................................................................................. ...... ....... . ......
Est. Start E . Com SUBJECT TO MASSAC IJS ,TTS SA EST X
Connector mill do all of.said work in a good ivorknranlike manner. The owner agrees to note theca tr actor'in writing,s'gned y the Joe,; of am defect in
workuuui.diip o, mate,ial, The caruracto,shall he liable Only if ti/ails to repair an'i specified defect, including defective repairs, within thirp,days of receipt of
notice. In not whenrise and in no event shall the connector be liable beyond the cost to it of labor and matertal required for an),repair work.
The c onu'acior shall be paid by the none,is), alf reasonable costs, attorney fees and evpenses in addition to the amount due and unpoid, that sholl be incurred
in errfoa aig the terms and conditions of this contract and/ar env lien in connection therewith
)nu near cancel tits agreemon(if it has been consonanated bra paro,the, at a place other than at address of the seller which may be his wain office of
branch thereof bi a it,area notice direi'red to the seller of his main or branch office by ordinmy mail posted, b5,telegram sent or by delivery, not liner than
midnight ofthe third business dai following the signing of this agreement.
o rorA to he done on this property other than species in this contract without additional charges.
This convect contains the whole agreement with is. Cmnpany mlI jtrnish warranty adjusted to the type of work done on above property upon completion of
dds contract.
0,,ner agrees this in event ofhis breach of this conn-act before work is started, Contractor may denimtd iwentyfive(75%)per cent of the conuwct price as its
slij elated damages for the breach.
This contract is su(ject to strikes, accidents, or other delays beyond our control.
Company furnishes insurance coverage
IA%e. the owner(s)of the premises mentioned above, hereby contract with and authorize you as contractor, to furnish all necessary materials,
labor and workmanship, to install,construct and place the improvements according to the specifications,terms and conditions,on premises
above described. +rhich we ++an ant and represent that we have good local record tile to as ow rss,, our own na
v in rrs.r rrher�of the pu' ' iah /to re nnmsi¢nrdlhei, 11n date....../&....... _ .. . ......... . . _......_ ._...._....... ......_....
C , It-AD l'P NT Sig ed.. ...... .. .. .... .... ..... ... ... .
wne
OR . .. . . ..... . .. . .... Signed.....................:....... .............. . ... . ...
Representative Owner
07-05-2011 01:32PM FROM-CLEWNT ARCHER INS. AGENCY 9T8-922-9276 . T-67T P-001/002 F-665
CERTIFICATE OF LIABI ITY INSURANCE 06105201°/201°
06/01
NwVCFR . (978) 922-4600 .THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ARCHER INSIIRANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
271 CABOT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
HEVERLY MA 01915- INSURERS AFFORDING COVERAGE NAIC#
INSURED- INSUP9RAESSEX INS. CO.
Hallmark Homaa, LLC - INsuI &LIHERTY MUTUAL
479 Broadway INsuRERa
MSURER D:
Lynn MA 01904- tNSLF RE:
COVERAGES
THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSL RED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUM T WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBPECT TO ALL THE TERMS, EXCLUSIONS AND CONDTTIONS OF SUCH POLICIES
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CWMS I INSR M1 POLICY
G
ND r e OEa L7R (NWOY® TIMD LIMfi3
A GE#RAL UAINUTY 3DUB694 09/07/2011 06/07/2012 enrla OCCURRENCE i -300,000
_QO)( DAMAGE TO RENTED
MCLANS ADV6i/LLLVIBRJTY PREMISCM ERoocunxl i $O,OOD
CLANS MADE I OCCUR - / / / / MED EXP one e $ 1,000
PER &ADViVURY s 300,000
-ggN6RALAOGWGATB i - 600,000
OEM-AGGREGATE UMIT APPLIES PEk - PRODUCTS-COMPJOP AGO i 600,000
POLICY SEpCT LOC / / / / N�
MITOM=LF UABSfTY / / / / COMBINED SNGLE UwT
ANY AUTO CEe emtlo f
ALL CMED AUTOS / / / / EDOiLYWJURY
SCHEAV=AUTOS (Per ftr ) f
HRED AUTOS / / / / SOOILYIWURY
NOPIOV^ED AUTOS (Pa.eca o f
PROPERTY DAMAGE
(PeT�maantl s
GARAGE UAMUTY AUTO ONLY-EAA=OENT i
ANYAUTO / / / / OTHER TFLW EAACC IF
AUTO ONLY. AGO $
E%CE4IU LIABILITY / / / / SAGO OCCURRENCE $ _
OCCUR CLAIMS MADE AGGREGATE 5
S
D83UCTIOLE
RST�NnON f S
B YION ANO w l 31S 332794 019 02/09/2011 02/09/2012 X TDRY ER
ANYPROPRIETORIPARTNERMM.CUTAG EL.CACH ACCIDENT i
CfFICEFAW-MmR IXCLLOFD7 I I I I EL DISEASE.EA EMPLOYE f
SPEOIAL
SEC L M wSO PRONB EL DISCASE.POLICY LIMIT I,
OTHER
DESCRIPTION OF OPERA MIONS AOMD SY ENDORSENIEN r9RIECIAL PROV'00M
CERTIFICATE HOLDER CANCELLATION
SHOW.O ANY OF THE ABOVE DESMBED POLICIES BE CANCELLED BEFORE THE
0f1RATION DATE THEREOF, THE IS9IlNG INSURER WILL VOR TO MAIL
10 DAYS WT4TCN NOTCE TO THE CERRRCATE NOLO ED TO THE LEFT.BUTCITY
HALL
CITY OF LYNN FAILURE TO 00 SO S IMPOSE NO DBLIGA OF VINO UPON THE
CITY HAT.T• INSURER 1T9 AGENTS OR BEEMEEKT
I CENTRAL SQUARE AUTHORIZED REPRESENI'ATNE
LYNN HA 01901—
A(�CORD 26(2D01/08) tAtOODCURPORATION 1988
P6T,i INS026 piw) 6 ELECDi C LASER F RMS,M.-(BWp2T-0645 Pepe I a/2
CITY OF SALEM
[PUBLIC PROPRERTY
'=1 DEPARTMENT
�11L M
• 1•U1'N, •143 U.11.1 it
I'lu. PS.;ISvi'+! a 1',a ell•.' v
Workers'1,1 Cumpenaatfan Inxurunca \lfiduvit: U
\ ) Illcan In unnu Al—oullders/Cuntnc torsi Eice PI triamAiPfumberf
'
Nome I Ilumk�rl7rpanuninrvinJwJuu11: Int Le 'hl
cily,Sr:uc.�i�• L�Ne� HIa'}— Phone ?,, / �p�Z
iP
.\r�re,1 flu an vsell) oytr"Chuck tht apprnprluto box:
lJ r•I,11+cmpluyur wills 4. I wn a jvncral contractor and 1 I
❑ y)PSorproleet(requlrod):
anpluyvut/(lull uul'/ur par6iinle).• huve hirvd IN lub•cunuracwrs 0' ❑Now cunnituclium
1,Im J,rule propricnlr ar partner- listed on the anuchtd.hvet hip;wd hove no umpluycw These tubcontracton have 7- RetnWalin�
warkiny tilt Inv in any i:apacily, porkers'tamp insurance
1' ntmotirion
I NO wurkors'comp. inaurancht 1. ❑ We art a cn,pontion and i 9, ❑011ddin1 addition nyuirud J txutrlcers 11.1"uwrcirv'd their
y, 1 am+hwneuwnvr Juind all work riyhr of vaam tion 10'❑Electrical«pairs or additions
mysolr,IIv0 wnrltvrs'cum 0 put&I I LCJ Plumbing rupuirs or aJJitinru
in.urunct reyuired.l t p• C. 1 il,1I(1),and we hilve no
:inpluyvvt. IN*workers'
11.Q Rwl•nlwin
'(1t1.„nI,rn wwrrnvwrvn iMAe r,Mrx mYap. mi% incur+nv yui nudne,ultlw er,,a,,ereWmmp,tnlW ivIy)(n.1n3un aeame!►rn>.,,gerrue mrchrckeY dw,in Ilur awril' vr+ hue.h,1,I+,lnir this air
ill,* ta davit imlk ,n , 1 ale Juina At"Ours cry Ikw him ImIlu
�n>,hee en oJatliurW.heel a,uwina 1M nrnM 0(Ity, wr.u1w,Y a,leer nQJave inJl a,rm
/,limp fill910 toylsirhuflrprvvld/nrwarArq'rulwprgrnr/owGrtoh/war/Lt ,M,har„uA,ae' a"mph.
io/uroru/ib 1 pI 1 rr.R Bdorr la rAr poq•y find/o1.,if�Incuruncu Company .Vamt•_�__
Irullcy/fir 3alGinx. Lic.M; -
--._ Eapirut,un Dart:
lob 5ilvtddn•,.e;
.Utacls a copy of Ill* workers'cumpvmatlon polluy Juclaraflun pug#(thowl N ill*
Mlpollcy number and vcplrarfua dart),
I,,,lure w wcuro cuceroyt ae required uuJw Sccliun?!!\ill.\(GL v. I SI eau lead to the fill
tine Ilp rrl.11 1110.IM undlur mit•yeir,ilnprivnninent, +� well '- civil
ai np In i?50 00.4 Jay Iluinit the vi'Allor. I le adVI4jo thus+cu position of criminal DER ii d ore txnaltiy m ihu lunn fire STOP tVURK URGER and fine
la,..a�yvu�,ltr vYaiv UIr\ .or�a.nr.u:cc awcru;u ,cl ilicunur6 PY ufthiv.lilcmum may bo Iurn+rdaJ,tu iho OW,:V of
/,/u/r,vrAy,.rli/(.(radar Jrr p,linrsl( rmdNr r/uhill
Ni I
in/ur(nvI/ow yrvriJerl abort it frills(slid rorrrtt
'1//leiu/rnr urdy. /)o nnI,r is d1i rru, ru rumy/rrrrey city fir/errw,r//li iaL
` ( hr fir I'll lr n:
L,viny \ulhanl
❑el; mi PenniuLfer l
y (tic,Ie 0
I IL .u'J r(Ilr.11fh 1. IlwhDn� I),Il.,rtl'irtlt I, l:ih.'1'mn Clerk !. C•Teerric.11 In, I.ctur i. .
G. I)Ihvr
I I'lumpinl Imyrtror i
('. II I\1 i'l hull:
information and Instructions
tyres all euyrloyen to proviJe workers' canpens+uun lItheirIract f hires
as nn lure Iy dctineJ Js every person to the scrvtce of another uudar any .
�Lus.reBu;euy licnerAl Laws chaster l it w4
1'„r.uanl W tits "j1u1e• ar lily two Of meft
.prey Jr tmphcd. oral of wnuen." arauun err other Icbal cnnry,
ulict,of
�n ,•mplupar is dctined as"An tndrviJual, purtnanhicludi is the gg.Corythe
legal rc rallon U vas of J deceased «s.l Nowwver e
'vd m a Joint enterprise, And Iicloyoa or other legal wriggly,emp(oyrn{employ.
,,t the t:,reyumg tn�a�'
ecerver err uua .0 of.m iudlvtJual, ptumenhtp, aysoe air work ern wch Jwailin{house
inert be JaemeJ to be in employer."
to � rsom w Jo mainlenancs, construction err rep
uwnar uP a dwelling house Navin{not snore than thra Jparonenu and who resides therein,or the oecupan
.Iwwlhny Iruuss of anothat who emp Y Ix
or on the grounrb err building appurtenant thereto shall not because of such emp oy
stets at local licensing adesey +had withhold the Issuance or
�IGL chapter 132. 423C(6) also states that"awry required."
renewal of a license Of permit w operate a huslneaa or to cow ptrina Nit`theslnsrrsronct evera0.ter ap
aypllcunt wlra has not produced acceptable erldeace f comp
of its Political subdivisions shall
\JJitionully, �ICiL chapter 1 S1, i25C(J) states"Neither the commonwc+lth our any
.iG ILch for the performance of public work until acceptable evidence ui cumpliartce with the insurance
coot into any ' reverted to the contracting auharity,"
rwquiremcnu of this chapter have been p'
{ppllctnts checking ilia boxes that utility to yuer situation all
d if
aJdreas(et)amd phone number•(s)along with then c mplcuts(s)Of
Pluasr Ii11 out the workers' compensation affidavit completely,by a LLP)wide it amplc lcatsoil other than the
nawwys uy, supply tub-contructos(s)n une(q, have
required to carry worksrs' eonlpansatiboen submitted to the Dap uobma a of Industrial
insuiJilce. Limnad Liability Companies(LLC)or Limited Ltabiltry partnerships
members err partners, are nut
,mployaas,a policy is required 8a advised that rho usll be s tray sriment of
,Uw be sort to sl{rt and dole the ul'lldavlt. Ter aepJavit should
ar town that the uppliction for the pannit tx liceme is bain{requested, not the L49
v6dsnu for conttrsnatiun of instus 0 a coverage Iht low err if you an required to obtain a workers'
he rctumaJ to du city nu have
any questions regarding companies should enter their
InJusuiul,\ccidanu. S'o,call Ilia Oapurcnent at the number listed below. Self inaurad comp
compen ration policy.V
vwlf-insuronet license number on the a re riots line.
eley ar'rawn Omelels Departmentrovided u space cat the bottom
the appliaanL
plcasa he ,ore that the affidavit is complete and printed Ic{rbly. 'The on era P heant
f dta affidavit fur you w till nut in the event the Office of Invest reference
has to contact
you regarding
liiber whin any given year, need only submit one atT)duvit indicating current
I'I:ase be lure Io lilt in ilia pemnit/licenya nwnber which will iv used`r',Ila ue+hnuldtvvrita'tril locations in n ati (' Y Or
Ilwt mual submit multiple pennio'licartye applications cad or marked by the city or town may be provided to the
Policy.. fthe ut7ldavil that has been We ally sumep the upp
town). \copy
ermia err licensaa. Anew atllJavit must m tilled nut each
applicant as proof Ihat a valid Affidavit i is ern file f,rlN+,�sa err penfill not related to any business err commareial venture
eaon is NOT required to complete this affidavit•
\Vhere a home owner err citizen is obminin{
I i w. a dog licetvsa nr permif Ica burn lesvea ate.)sail P our coo eratian and should You Nava any quuuens,
I he 'Juice „t lnvastiyatiuny would IIAa w Ihauk you in advance fury D
t+lwase du nut Ilwyitare Io ylve is a call.
f U.parunent s aJdrass, Ialcphuns and fax number.
hc
The Comrnanweolth of Mawchuwtu
Dap nee s
of IvaUQ tl sdenu
O
600 Washingttyn Street
9oaton, MA 02111
fat. q 617-727-00 cxt 02 o77d977-NiASSAFE
617 7
Www'Mus.dov/die ,
CITY OF S.1LE,Nf, JAksS:ICHUSETTS
9LMDLNG DEP.IRT\tEVT
120 W.kJHL`1GTON STxE$T, }'O ELOOR
rM (978) 745-9595
KENMERLEY DIMOLL FAX(978) 740-OW
MAYOR THo.�w ST.PtEtRs
DIRECTOR OP PL eUC PIIOPERTY/BC UMO'G CO-NNISSION Ell
Construction Debris D.Isposal Affidavit . _
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.1
Debris, and the provisions of MGL a 40, S 54;
Building Permit M is issued with the condition that the debris resulting from
l I I, S ISOA.
this work shall be disposed of in a property licensed waste disposal racility as defined by NIGL c
The debris will be transported by;
Ce^l� L
Inane ut'hauler)
The debris will be disposed of in :
(name oP facility)
I�Jdma or rac,l,ty)
ei rule o PermitJpp6cant
-Ile �_