11 TRADERS WAY - BUILDING INSPECTION (4) fhc ( onunon%,calth of NlassachuscllS I
13uald (i lituldi;t_ ReguLt uus and Slandaids I ( )k
\I(-Nit IP \1 I11
Massachusetts u State 13tuldin2 Code. 7S0 ('SIR. 7" edition
, .�
I3utlding Pet mp Application To ('unsu act. Repair. I?,nnt.rle (hDrntolisl, a R, ��/ JJI-ti� u�
omr or Tinr-Ft;mth [)it ellin,q
-i
. Srruon Fur Olticial Use Only _
— —r___
Building Permit NUntbr l Date Applied: �_V__-
V 3ui1Jl g Culnnn.,Joner/ Inspccatr of Buildntgs Date
SECTION I: SITE: IN'F'OR:MATION
-_ ---- p @ Parcel Numbers-----_- -
LI Pn)per v .\ddress: 1.2� .\ssessurs :Nlu
: P:uccl 4.unhcr
I la Is i1115 all .i cCplcd +IreC(. )Cs Ito—_ Ala_ i p A'uwher
1.3 Zoning inforn ,r vu: 1.4 Property Dimensions:
__--- -
1.5 Building Setbacks (fq
j Front Yard SIJc Yards Rear Yard
! rcJ Provided Rrywrcd_-. Provided Requited Pnv,,:,d
Rryui
l- ---.. .— -- ---
1.6 Water uppiy: t\I.QL c. 40. §5.11 L7 Fluid Zone `n.formation: 1.8 Se:aage Disposal System:
Zone: — Out site Fluid Zo ' t -- -_ - -_- ---
1 Puhhc Private ❑ Municipal n site Jml>ttsal Svv;.cw ❑
Check ifyes
ECT►ON 2`PRt)Pr,RTY ON'NER511U
• ------
I
\'.ura t Rinit .or
1•,Idress for Service:
Slgneture T:lephone _-_,_-
SECTION 3: DESCRIPTION OF PR(,POSED WORK(check all that apply)
New C-mstruation CIExisting Building ElO••vner-Occupied ❑ Rapuire(s) ❑ 1 Alteration(s) dJit ii:ll ❑ I
{-Demulitio:t ❑ Areessory Bldg. ❑ i I or', of C'nits Other ❑ Speedy:
Briel'Descripti•onol Proposed Workr:_CQyy.SS�U57 /Cl� /,� CPi oAL
.. .. ) y _._..__
Ins
SECTION is ESTUMATED CONSTRUCTION COSTS
Estimated Costs: r
Item (Labor and Materials) Official Use OIl Y
__ i
I. Building '$ I. Building Permit Fee. $ Indicate h,nS tee is dctcmlm.ed:
-� l-�Q- ❑ Standard City/Town Application hee
?. Electrical SIs ❑'Total Project Cost' (Item 6) r multiplierr�___ .x
3. Plumbing - 'S Q_Q� t. Other Fees: S
4. Nlechanical MVAC) $ DDO -----
5 Mechanical (Fire Z ---- - -- - -
Su ) ression) 5 Ti000 1 Fwal All Fees: S -- -
Check No Check :\m,,une _ C,ish Aitiounc
• 0 Total Project Cost. 5 I ❑DOO ❑ Paid in Full ❑ Outst.indim-, Balance
GQrI WN�rt/ n
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL) t ^7
/•� J -- ----7-Zfa-O
Ll.olue Numher F\p1t won Dat
N.uue of CSL ItonW�cr A
F.ul C'SI. 1\pr I,rr helow I
"I, e DdKII I'[T1 n
Wdre,• -
A 1. l nrr,Incird till fo)i.IN)0 Cu hI
__ —I — Re,lnctrd I.@' P.unil\ D,oelhnc
Sign:uufe �I \laoonn Onl, j
I RC Rr,idrnual Ruolinc l'mrnng
frlrpl),me \C$ Re,i.1.'nli.J \\'ul.lu��_.ind .li.lu_1_
SF Rc,idcrnial Solid Purl Bunune \I�I)L.w. Imi.illaw u
D Rr,IdcnluJ Drnndnnal
5.2 Registered Home Improvement Contractor (HIC)
HIC Company Name or HIC ReULSiraw Name Registration NulllhC1
Address
F.xpnaoon Date
signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C'(6))
Workers Compensation Insurance affidavit must be co5ipleted and submitted with this application. Failure to pnn idc this affidavit will result in the denial of the Issuance the building permit.
Signed Affidavit Attached'! Yes .......... - Nu ...... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property hereby
__ to net on my b4:h;tit. in all nl.ltlers
i
relative to work authorized by this building permit applieation.�-- _ — •
I
Si nature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declm'c
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 Dote
(Signed under the 2ams and penalties of perjury) i
NOTES:
I. An Owner who obtains a building permit to du his/her own work. or :m owner w ho hires an unrcgI,tered comtr l nn
(nut registered in the Home Improvement Contractor(HIC) Program). will not have access to meal bitial Ion
program or guaranty fund under M.G.L. c. IJ'_A. Other important information on the [if(' Prigr:un and
` Construction Supervisor Licensing (CSL)can he found in 780 CMR Regulations 1 IO.R6 and 1 II).10. respecti%ck
' When substantial work is planned, provide the mtirmation below:
T )1al flours area ISq. R.) (including enrage. finished basement/attics. decks m porrhl
Gross living area tSq. Ft.) Habitable room count
Number of tueplaces Number of hedrum\, ----_--
Number of bmfuooms Number of IMIt/bash, -_-------
F pe of he:tine system -- _--- Numher of deck,/ p11rhe,
F)pe of cooling s\,tem Fri:lt"ed _._ ()pelt _ ____.._ ___ •
Z_ 'Toutl Project SCILIare Footage- rrial he ellb,tituted for Total Project Co,t-
JAGER MANAGEMENT, INC .
610 Old York Road
Suite 220
Jenkintown, PA 19046
Telephone: 215-690-3220
Facsimile: 215-690-3236
August 28, 2008
VIA OVERNIGHT MAIL
Doyle and Mattheson, Inc
Attention: Bob Doyle
14 Country Corners Road
Wayland,MA 01778
Re: Dr.Ann Isaac d/b/a Salem Dentist, Space# 5260
Highlander Plaza Shopping Center
Dear Mr. Doyle:
Please find the Building Permit Application to Construct, Repair, Renovate or Demolish a One-
or-Tow Family Dwelling.
Please note that Landlord acknowledges that Bob Doyle is the contractor for Tenant and Landlord
Authorizes Bob Doyle to work on behalf of the Tenant. Landlord is not responsible for any code
violations.
If you have any questions, please do not hesitate to contact me.
Sincerely, rlliam�s
'/W
enistrat een
Enclosures