29 TANGLEWOOD LN - BUILDING INSPECTION t ,
Q The Commonwealth of Massachusetts Town of
s Board of Building Regulations.and Standards
Massachusetts State Building Code, 780 CMR, 7"edition Building Dept
Building Permit Application To Construct. Repair. Renovate Or Demolish a �
\J One. or Tvty-Fumilt'Duelling
This Section For Official Use Only
MBu lding Permit Nun c Date Applied:
('1 Signature: ' w O
Building Commissioner/lnspectorof Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: / ! 1.2 Assessors Map& Parcel Numbers
MGT �% will
1.Is Is this an accepted street?yes Map p Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq fl) Frontage(ft)
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.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal�n site disposal system O
Public 4Y Private O Check if yell
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Re))c)�ord:)/ ^ p T
�^ 'E HF0.��G SG2rnO �( / TAn /I WGa� �an '-1
Name(Print) Address for Se ce:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
New Construction❑ Existing Building O Owner-Occupied Repairs(s) Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. O Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': Rc n! 9516- / A /A C2,—j rnTT—
r �
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Ofilclal Use Only
kMcchanical
277
Building Permit Fee: f indicate how fee is determined:
Standard City/Town Application Fee
Total Project Cost'(Item 6)x multiplier x
Other Fees: f
se
n (Fire otal All Fees: f
Su ression
Check No. _Check Amount: Cash Amount:
6. Total Project Cost: f 13 �&s ❑ Paid in Full ❑ Outstanding Balance Due:
1�
l 4t
if..( 7-
G�'2
I / �
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) e—l-el` /,/
S fan i:e a =.�, License Numhr Expiration Date
Nome ofof CS�r
,1--c ix List CSL Type(sec brluw)
nv� <
AJJrrss� _ RD
Descn uon
5��(/--vY♦ �r � Unrestricted u to 33,000 Cu. Ft.)
Signature Restricted 1&2 Family Dwelhn
979f— 7>9-DEJ0 Mason Only
Residential Roofin Covering
Telephone Residential Window and Siding
Residential Solid Fuel Burning Appliance Installation
Residential Demolition
5.2 Registered Home Improvement Contractor IHIC)
�G 'nr L in 4-es)rn l ra r 4T. 0 . rlC
HIC Company Name o HIC Kegistram Nifmc Registration Number
Address
-) 7gr— Expiration Date
ignamre Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 132.1 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...........f8 '
SECTION 7s: 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.
Signature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I. r. A -^r,i/ ru yV/l , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of per u
NOTES:
I. 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 W have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.R respectively.
8 S,
2. When substantial work is planned, provide the information below:
Total floors area S . Ft:) (including garage.
( q ( g g ge, finished basemenVattics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfbaths
Type of heating system Number of decks/ porches
Type of cooling system Enclosed Open
1. "Total Project Square Footage" may he ,uh,utweJ for"Total Prgect Cost"
wLc a,4n313 w,M Lln,3
J c
O.o,we�
�. o 4F Cv0l344?IT OF
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rf -
2
✓r
CITY OF SALEM
PUBLIC: PROPRERTY
^ss
>.._.,. DEPARTMENT
I:.
III 'r .4 '4;. ii.13 • 1 IN -,'..1 '4- 'rill.
Construction Debris Disposal Aftid n it
(reyuilCd lilr all 4.10110litiOn and renucaljun work)
In accurdance %%jilt the sixth edition of the State Building Code, 780 CNIR suction Ill 5
Dcbris, and the provisions of'v1GL c 40, S 54;
Building Permit It is issued with the condition that the debris resulting front
this work shall he disposed of in a properly licensed waste disposal lacility as defined by MCiL c
I1I. S 150A.
The 'debris will be transported by:
(emu Loe"A)C/)
I name haldc )
1 he debris will be disposcd ofin
r✓l r._/10
(name ul laahty)
94 An vv/7
I,Ir n:.. ul pcdltvl ..
.wulaluic nt prnnit apphi Jill
,lalr
CABINETRY
✓�y
DEMGN
Proposal
July 14,2009
Maurice&Heather Sarno
29 Tanglewood Lane
Salem,MA 01970
Home: 978-744-7097
We are pleased to quote you on remodeling your 2"d floor bath. All work is fully insured and all trash
created by Cabinetry By Design will be removed by Cabinetry By Design.
Carpentry:
Strip existing tub area to studs and wall up 42" in toilet area. Strip tile floor to sub floor. Remove
existing vanity and top,block open walls for accessories and insulate for sound. Ply floor in preparation
for owner supplied file & grout. Sheetrock, tape and spackle walls as needed. Shower area will have
Dura Rock up five feet. Patch base boards as needed matching existing. All work as per code.
Plumbing:
Disconnect existing fixtures and cap as needed. Rough waste for new shower. We have carried a$1,250
fixture allowance for shower pan, valve, lav, toilet and faucet, owner to select. Install all fixtures upon
completion. All work as per code using PVC on waste and copper on water.
Electrical:
Disconnect existing and supply and install new Panasonic fan light and wire fan.and install owner
supplied light over mirror and change GFI. All work as per code tying into existing service.
Tile:
Install owner supplied tile and grout on floor. Tile needed is 40 square feet. Install owner supplied file
and grout on shower wall to ceiling. Tile needed is 88 square feet.
Vanity.Top&Mirror:
Supply and install Yorktowne gold vanity, box storage and mirror as per plan; owner to select. Supply
and install mid price granite top as per plan complete with pencil edge and 4" back splash and two side
splashes.
Proposal continued on next page
56 North Putnam Street 1 Danvers,MA 01923 4 Phone 978-774-0002 4 Fax 978-774-7799
CABINETRY
✓�y
DESIGN
Proposal(continued)
Nothing other than stated above is included. No tile,grout,painting or accessories in quote.
Total Cost: $13,985
Terms: 30%down, 20%upon starting,30%after rough,20%upon completion
Thank you,
Rich Brown
Owner Date
ovu'_� � "f. 1
Owner Date
Richard F.Brown,President Date
HIC License#152838
Selections
Wood: Mnfi Door: (3rj,5,4-m„ Color: ,,,i4 r _
Hardware: M e-12 / Top:
Sarno—July 2009
56 North Putnam Street 0 Danvers, MA 01923 4 Phone 978-774-0002 4 Fax 978-774-7799
" d 3 73 7 CITY OF S.0 Emfi Axss xaiusETTS
1_ BLIIDING DEPARTMEINT
J 5 GI• 1'20VA5HINGTON STREET. Yo FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KI.%(B Rf EEY DRISCOLL
MAYOR Z?+oetAs ST.P�RRs
DIRECTOR OF PLSLIC PROPERTY/f1CQDLVG CONDIISSIONER
Workers' Compensation Insurance AlTidavit: Builders/Contractors/Electriclans/Plumbers
Anolleant Information Please Print Legibly
Name eBusi�Ortatttratiorvintbvtduaq: r'A./a )n ,. (> + 0e s 1�Al -
^ j
Address: Jr/ r Po n ea n S
City/State/Zip: t0a.n U , Phone _;i -
Area as employer'Check the appropriate boa.- Type of project(required):
17 am a employer with 4. El 1 am a general contractor and 1 6. ❑New construction
employees(full and/or pan-time).• have hired the sttbcorarsctors
2.0 1 am a sole proprietor tar partner- listed on the attached sheet. : 7. t!J Remodeling
:hip and have no employed These subcontractors have N. ❑ Demolition
workingfor me in an capacity. workers'comp.insunmr_
y pac ry• 9. 0 building addition
[No workers'comp. insurance S. 0 We are a corporation and its
required.)
officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.(No workers'comp. C. 152.41(4),and we have no 12.0 Roof repairs
insurance required.) t employed. [No wad&ars'
comp. insurance tequimdA I l.❑Other
•Any upphcanl that drab has e1 must also rill use the arctic.let"ahawtng their wttrkm'compsiandam policy inWmaarlon
'I I.matusmm who rubs k this a111dsvil indlaing they an doing all wale was than him t UNWIe eentrarwn muss sutxnft a twat allltlavil indicating a wk.
<'.mtm:u;n that chock this bat mum attached an ulduiwtal data ahewint the ttrtae of the Atb t ftaeewrs and shelf warhma'CeMp.policy isrmm aiaa.
f am an employee chat it providing,workers'compensadion lnsrranee fer ley esepfoyeea, Below Is tha p li:7 and]"shat
information.
Insurance Company Name:
Policy N or Self-ins. Lie. N: Expiration Date:
Job Site Address: 9—'3 7 0.�14 /, uy .iz� S a /e in M City/StawiZip:
,\hack a copy of the workers'compensation policy declaration page(showing the policy number and expiration dots).
Failure to secure coverage a&required under Section 25A of MGL C. 152 can lead to the imposition of criminal penalties of
fine up to 51,500.00 and/or one-year imprisonment.as wall 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 adviatl that a copy of this statement may be furwarded to the OtYce of
Inv"iglaiions of(lie DIA for insurance coverage verification.
l do hereby certify rntder rho pains amend pens/Nis o/perlacy that the informal/on provided above is true and corrres.
�i_n Dora: � Z
Palate a
Oriel age we/y. na nor write in this area, to be,atrrpleted by city or town a/flciaL
i
City or fuwn: _ _ . _ errmitgAccnse N __ I
hsuinr.%uthunly (circle une): — - — - I
1. Ituard of Ilrallh 2. Ruilding Department 3. Cityirown Clerk 4. Electrical Impector 5. Plumbing Inapeefo►
6. Other
l ,nUct Pcrion: _
From-978 745 9684 08/24/2009 12:47 #423 P.001/001
i I
To. Tom McGrath — Salem Building Department
Fax 978 740-9846
G�
From: CYNDY ANSELMO
EAST COAST PROPERTIES ji Fax number: 978-745-9684
�I 400 Highland Avenue --
Salem MA 01970
Date: 8/24/2009
I; 978-741-2003
l Fax 978 745-9684 i Regarding:
Highland Condominium 29 Tanglewood Lane
=..1 Pages: 21
i
Comments: €
Hi Tom
I
Please be advised that Cabinetry by Design (Richard Brown) is authorized to i
11 do the replacement of the kitchen cabinets at 29 Tanglewood Lane. Please letiE
me know if you need anything further from the Highland Condominium at
Salem Trust. i
I! I
r
!' 11
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E
1:' Ali
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08/24/,2009 10:28 FAX 9785322217 BKM, Inc R 002
ACORD-- CERTIFICATE OF LIABILITY INSURANCE 8"/2ai200 Y'
PRODUCER (978) 532-5445 FAX: (978)532-2217 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
B.K. McCarthy Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
10 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West Entrance
Peabody MA 01960 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:National Grange Ins Cc
Cabinetry by Design Inc. INSURER B:National Union Fire Ins
56 North Putnam Street - INSURER
INSURER D:
Danvers MA 01923 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AG;REGATE LIMITS SHOWN MAY HAVE REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR D TYPE OF INSURANCE POLICY NUMBER GATE MMIDD/ OATEIMMIDDMj LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERALLIABILITY DAMAGE TO RENTED
MIS
ES Ea dcnurence $ 501000
A CLAIMS MADE a OCCUR MSB34944 1/29/2009 1/1/2010 MED EXP one ersdn $ 5,000
PERSONAL B AOV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER: PR D S 2,000,000
X POLICY JECOT LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMB
ANY AUTO (Ea accldwi) S
A ALLOWNFDAUTOS M9B34944 1/29/2009 1/29/2010 BODILY INJURY
X SCHEDULED AUTOS (Per Person) $ 250,000
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Peramideot) $ 500,000
PROPERTY DAMAGE $
(Per emldenl)
GARAGE LIABILITY AUTO ONLY-EAACCIDENT $
ANY AUTO OTHERTHAN FA ACC, $
E—� AUTO ON LY: ADD S
EXGESSIUMBRELIA LIABILITY A $
OCCUR El CLAIMS MADE AGGREGATE $
DEDUCTIBLE
$
RETENTION S
B WORKERS COMPENSATION AND X I T CSTATU- OT
EMPLOYERS'LIABILITY LIM
ANY PROPRIETOWPARTNEWEXECUTIVE EL EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? WC6853337 10/11 2008 10/11/2009
yes, uncle,S
/ E.L.DISEASE-EA EMPLOYEE 8 100,000
SPECIALAL PRO PROVISIONS below E.L.DISEASE-POLICY LIMB $ 500,000
OTHER
DESCRIPTION OF OPSR nONS)LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Refer to policy for exclusionary endorsements and special provisions.
CERTIFICATE HOLDER CANCELLATION
(978)740-9846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of Salem EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Tom McGrath 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
120 Washington St.Salem, MA 01970 FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Sal
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
John McCarthy/RB1 9044,
ACORD 25(2001108) 9)ACORD CORPORATION 1988
INS025(oloe).oaa - Page 1 of
08/24(2009 10:28 FAX 9785322217 BKM. Inc Z 003
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an -
endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001108)
INS025 poa)ow Page 2 of 2