48 VALIANT WAY - BUILDING INSPECTION �1�-1L4 - lG1 Z GK Lls6 - �3ST%13
The Commonwealth of Massachusetts INBoard of Building Regulations and Standardsq / Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Dem
One-or Tivo-Fmnily Dwelling
This Section For Official Use Oni
Building Permit Number: Date Af
plied
Building Oircial(Print Name). Signature
` SECTION t:SITE'INFOR6IATION
1.1 Property Address: 1.2 Assessors 1**Iap&Parcel Numbers
u R V/4111-1 ,i t,.. .,
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 'Zoning Information: 1.4 Property Dimensions:
Zoning—District Proposed Use Lot Area(sq tl) Fronmge(11)
1.5 Building Setbacks(R)
Front Yard - Side Yams Rear Yard
Required Provided Required Provided Required Provided
[11.6 Water Supply:(M.G.I.c.d0,§5J) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Z ? Munici al❑ On site dis sal s stelic Private❑ — Chk if s❑ p lm ySECTION2: PROPERTY OWNERSHIP!Owner'of Rfcord:
�fne(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Altemtion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work=: rZ a to Cve alp C g h;.t eT� 1 n1:A11 iye&l
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itcin Estimated Costs: Official Use Only
Labor and Materials -
1. Building $ Z 3� I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard CitylTown Application Fee
2. Electrical S St; D ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ - y" i%glher Fees: S _
4.Mechanical (l-IVAC) S List:
5.Mechanical (Fire "total All Fees:S
Su ressiun)
U Check No. Check Amount: Cash Amount:
G.Total Project Cost: .S % t?0 ❑Paid in Full ❑Oulstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES ,
_ 5--..1�1 Construction Supervisor License(CSL) 7
1�0 M en ; (-Li License Number Expiration I
Name of Cf7SL Holder List CSL'rype(see below)
5roi- Type - Description
No. and Sueet
U Unrestricted Duildin s u to 35,000 cu. It.)
Sj ,Al p5f,t7rr ✓1l, R Restricted I&2Fmni1 Dwellin
Cityfrown,State,ZIP M Masonry
RC Roolinp Covering
WS Window and Siding
/ /
SF Solid Fuel Burning Appliances
78( 6L-36 Z6 /'I�IUwt/tim NN,,t wt�nr �i�0l,tuf 1 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ( 19 Z 13- 3">- -/ 5"-
f / •-f A o f7 d HIC Registration Number Expiration Date
HI Cump;my Name or HIC Registrant Name
32 i3r'troi Avt -- l!/✓imeit"4t'0vtNCzr e 4,1L- e'
No. and Street 7�) %EG""JLLL Email address
S 7,c "Y
Ci /Town State ZIP Telephone
SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 Wuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED.WHEN.,
OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nmne(Electronic Signature) Date
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 and accurate to the best of my knowledge and understanding.
�✓ ��) ��� 12
Print Owner's or Authorized Agent's N:m (L•Iccuomc Stgnauve) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or anowner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program),will Lila 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.mass.eov'oca Information on the Construction Supervisor License can be found at tv�ov:'das
2. When substantial work is planned,provide the information below:
Total fluor area(sq. R.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
type of heating system Number of decks/porches
Type orcooling system Enclosed Open_
1. -rulal Project Square Footage" may be substinued for`,rutal Project Cost"
T° CI"I'Y OF SALEM, lass XCHUSE'ITS
BUILDING DEPARTIEJIT
3 �r� 120 \rjASHNGTON STREET, 3a°FLOOR
TEL (978) 745-9595
FAX(978) 7.10-91M
w.NtgFRi FY DRISCOLL
`,�fa1YOR TrtontAS Sr.PtFxRa
DIRECTOR OF PUBLIC PROPERTY/Bt:QDNG CO\LtIISStOV ER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluinbers
applicant Information e Plcase Print Legibly'
Naing: IHmimssOrganiration'IndividualY Dom P. ✓I/.GO 4 ,(�fJ JTi�9 L'
Address: 31 IG i S i e e- Ax e-
Cily/State/Zip: Phone N:
A
rean employer'.'Check the appropriate boy: Type of project(required):
a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
loyees(full and/or part-time).• have hired the sub-contractors
a sole proprietor or partner- listed on the attached sheet. i 7. ❑Remodeling
and have no employees These sub-contractors have 8. ❑Demolition
king for me in any capacity. workers'comp. insurance. 9. ❑Building addition
workem'comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical rcpain or additions
red.) officers hove exercised theft
a homeowner doing all work right of exemption per MOL 1 1.❑Plumbing repairs or additions
lf. \o workers'cum c. 132, §1(4),and we have no[ p• l2.❑ Roof repairsance required.) t employees. [No workers' 13.❑Other
comp. insurance required.)
•Any applicarn iu a ducks bur rl mutt also all out the scctien bclow showing Iheic welken'mmpensadon polity inl,nnattan.
,I h+mcou,ft"wha submit this affidavit indicating ihey um doing all work and then him ouiside rontmetan Craw auhmii a new amdavit indicting such.
$'.nurwturs that chick ibis box mtwt anachd an additiutul ahrat showing the name olthe rubtawacion and their workers'romp.pulley inr°rmation.
l unt un eiiipluyer drat 1s providing ivorkert'conipe,ttailan laturmice for my et»pluyees. helots,is the policy and job sire
ilt/ariautinn.
Insurance Company Name:
Policy 4 or Self-ins. Lic.rh Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation pulley declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 2JA orMUL e. 152 can lead to the imposition ofcriminal penalties of a
line up to SI.500.00 and/or one-year imprisonment,as well as civil penalties in the form of ti STOP WORK ORDER and a line
of up to$250.00 a day against the violator. Ile advised that a copy urthis siatement may be forwarded to the 011iec or
Invrstigwionx ul'the DIA for insurance coverage verification.
l Ja hereby verb wider rite punts mid pen ldrt afprrjury that the hifuraturlo s provided ubave is True and correct.
L 1
Sien.uur�c / �� .iqn�� a 1wt�-r�JiLy`— Date:
r7f/iciul use only. Ou nuI Ivrire io this area, to be completed by city ar ru run ajJ7rlul
l
City Of Town: — .- -- Permit/l.lceme q_-.._
Issuing.luthurily (circle une):
I. Board of llcallh 2. Iluilding Depai tmew .1.Ciiylruwn Clerk J. Electrical lnspector 5. Plnnibing Inspector I
6. Other
i I
Contact Vert°n:.._ _..- _ Phonc a: __ _
a
CITY OF SALEM, MASSACHUSEM
BUILDING DEPARTMENT12O WASERNGTONSTREET,31DFLOOR
'ILL. (978) 745-9595
KIMBERLEYDRISCOLL FAX(978)740-9846
MAYOR THomAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit# is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
�Ir)rrN 52 C
(name of facility)
AV'Iv� L'� r*` Lv 4
(address of facility)
Signature of applicant
Date
2014-12-18 20:51 FERRAGAMO, D & M 17815952681 >> 9787409846 P 1/1
Village atVinnin Square Condorrtiniumfr��So
Norman Sogosian PO Box 4523
Property Manager Salem,MA 01970
OMee(978)745-2225
Fax(978)745-2251
E-Mail: NomBegosian@Comeast.net
November 14, 2014
Edward Lydon
48 Valiant Way
Village of Vinnln Square
Salem, MA 01970
bear Mr. Lydon,
Pursuant to our conversation this afternoon it is my understanding that you, as the recent owners of
48 Valiant Way, plan on having the following changes made to your unit while you are vacationing in Florida:
1. Kitchen Renovation
As the property manager and on behalf of the Trustees of the Village at Vinnln Square Condominium Trust you have
permission to engage the services of a contractor to do all of the above renovations and replacements to 48 Valiant
Way providing...
1.You, as the unit owner, are responsible for actions of the contractor while on the property of
the Association.
2, The contactor must be o licensed contractor within the state of Massachusetts.
3. Your contracted renovations meets or exceeds the existing building codes In Salem, MA
4, Yaw contractor obtains the appropriate licenses and permits required by the city of Salem.
5. Your contractor provides proof of insurance to both you and the Association
6. Your contractor works between the hours of 8 am and 5 pm, Mon through Friday
7. Your contractor cleans up all debris at the end of each day
8. Your contractor makes the appropriate arrangements to have any deliveries of merchandise
(le kitchen Cabinets) stored either within your unit or your garage prior to their instillation.
9. Your contractor must park their vehicles in a location that will not interfere with other
residents from entering or exiting their unit or driveway_
If you should have any questions please call the office at (978) 745-ZZ25 or email at NormBogosian Comcast.net
Very truly yours,
/I
Property Manager
cc: Trustees - Village at Vinnln Square Condominium Trust
Bog"an and Company LLC(Property Management CO