56 VALIANT WAY - BUILDING INSPECTION (3) rt
The Commonwealth of Massachusetts CITY OF
1 Board of Building Regulations and Standard CEIV�� SALEtiI
D kill
Massachusetts State BuildingCode, 780 �A� g FV10E Revised.Llur 2011
d, ; ItSP� E
`Q Building Permit Application To Construct, Repair, Renovate Or Demolish A
One-or Two-Fmnily DwellinnP � 5
This Section For OfTcial Us y
�BuildinEgPcrmit Number. Date App ' d:
Building Official(Print Name). Signature.:
t� SECTION is SITE INFORMATtODF'
I.1 Property Address: 1.2 Assessors blap& Parcel Numbers
I.1 a Is this an accepted street?yes_✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Pniposed Use Lot Area(sq It) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if es❑
SECTION2: PROPERTY OWNERSHIP!"
Yf w rt o cord: jCo!It l G
t) City,State,ZIP
ihme ri t
No.and STmet Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
e am L • [ 1 O
SECTION 4: ESTUNIATED CONSTRUCTION COSTS
Item Estimated Costs: Oflleial Use Only
Labor and Materials
1. Building S /Ta 7 3 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard Cityffown Application Fee
?. Electrical S ra 6 - ❑Total Project Cosh(Item 6)x multiplier x
3.Plumbing $ o ?�Qther Fees: S
4.NIcchanical (HVAC) S - List:
5.Mechanical (Fire S "total All Fees:S
Su ressiun)
Check No._Cltack Amount: Cash Antuunt:
6. Total Project Cust: Sap rJ / ` ❑Paid in Full ❑Outstanding Balance Due:
1 S-75 tm(a\t_GND 10 ( 28'
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Cunstr 'tion Supervisor License(CSL) ql Fe ,/ sl &
License Number Expiration Date
Name orCSL 11 Ider
��++ / List CSL'Type(see below)
9? V,�/EG T °/�f �O .f e Description
No. and Street
Unrestricted(Buildings Lip to 33,000 cu. It.
a ?12! 4000 Tee ,!!7 _ R Restricted 1&2 Family Dwelling
City/rown,State,ZIP '7 M Masonry
RC Reading Covering
WS Window and Sidina
SF Solid Fuel Burning Appliances
1 I Insulation
Telephone Email address D Demolition
5.2 ltcgtstere ome Improvement Contractor(HIC) /, 77r
IIIC Registration Number Expiration Date
I IIC omp:my ,me or FIIC Registrant Name � /& O P�
�7 S�fe'}G�6✓ iC'ry
N1and Street ,J�Q p�� e /J z Email address
City/Town. State ZIP Telephone
SECTION 6.WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L:c.151.§ 25.0(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 Isivance of the building permit.
Signed Affidavit Attached? Yes ..........61l�- 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 nuthorize
t9 act on my behalf,in all cop rs r tive to work authorized by this building permit application.
Prmt Ownc 's Name(Electronic Signature) Date
SECTION 7b:OWNEW ORAUTFIORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
costa u:d t this applicatio i true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agen s Nano(Electronic Signature) Dale
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(FIIC) 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
�eww mass cov'oca Information on the Construction Supervisor License can be found at w�aw.nmsssov:'Jns
2. When substantial work is planned,provide the information below:
rotas floor area(sq. ft.) xz (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 healing system Number of decks/porches
Type orcooling system Enclosed Open
3. 'Total Project Square Footage"may be substituted fur"Tut:d Project Cost"
O sal - -
1 Z9 q(-
The Commonwealth ofMassaehusegs
Depaiftent oflndustrialAccidents
Mgmea 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FH,ED R7TH THE PER4I7TING AUTHORITY.
Applicant Information Please Paint Leetbly
Name(Business/Organizationdndividual): /LiJ .P Q4/[1 r
Address:
City/State/Zip:��v/a t,c ^. 2`f _ /4J,49� Phone#:
Are you an employer?Clock the appropriate box.
Type of project(rewired):
1. a errrployei wDti employees(full and/orpart-time).' ,7. []New Conatruch0a
2.Q Ism a sole proprietw or partnetahipand have no employees working forme in g, 0 Remodeling
my capacity.[No Workers'comp.iostmmce required] .
3.Q I am a homeowner doing all work myself.fNo workers'emrp.insmance required.)t 9. ❑Demolition
4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition
easme that all contractors either have workers'compensation insurance or are sole 1 I.0 Electrical repairs of additions
Fairmont with rro employeee. 12. Plumbing - air additions
❑5. I son a general connector and I have hired the sub-tonauxters listed on the attached sheet. ❑ g m
7bcw subcmtracm s have employees and have woziu s'courp.m coact l. 13.Q Roof repairs.
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other
15Z§1(4),and we have no employees.[No workers'eanp.insurance required.]
"Any applicant that checksbox Ol must also fill not the section below showing their workers'eompgnmtion policy iofamatioa . .
t Homeowners who submit ads affidavit indicating they are doing all work and then hue outside eomaetms must submit a new affidavit indicating such
lCormaciois that check this boa must attached not additional sheet showing the name of the subcouttaabrs and state whedmr or not those entities have
employees. Ifthe sub-contraums have employees,they mustpmvido their workms'emnip.policy mintier. .< -
lam an employer:thaltsproviding rwrrkers'Compensarion insurance jot my employees: Below is thepolicy and job site
information.
Insurance Company Name:_
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGLU c. 152,§2M is a ci mina]violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ida hereby certify under a ains and penakies of perjury that the information provided above is true and correct
i e: /O/ od— /3
Phone M
Offrcial use only. Do not write in this area,to be completed by city or town offWaI
City or Town: Permft/lUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or writtep."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the Insurance coverage required."
Additionally,MGL chapter 152,§25C( )states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation arid,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLQ or Limited liability Partnerships(I.I.P)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dqg license or pemtit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Deparhnent of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017.
Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
Norman Bogosian PO Box 4523
Property Manager Salem, MA 01970
Office(978) 745-2225
Fax(978) 745-2251
E-Mail: NormBogosian@Comeast.net
Oct 16, 2015
Bob Marquis
Marquis Contracting Company
97 Shelton Road
Swampscott, MA 01970
RE: Remodeling kitchen & Bathroom of 56 Valiant Way
Bill & Dorothy Papa (Owners)
Dear Mr. Marquis
It is my understanding that Bill & Dorothy Papa has engaged your services to rem Cdele kitchen and bathroom
of 56 Valiant Way.
There is no objection for you to remodel the kitchen of 56 Valiant Way, Salem, MA, providing
1. Your kitchen remodeling meets or exceeds the existing building codes in Salem, MA
2. Your company provides a certificate of insurance that will be in effect during your
proposed kitchen renovation to unit# 56
3. Your company works between the hours of 8 am and 5 pm, Mon through Friday
4. Your company cleans up all debris at the end of each day
If you should have any questions please call the office at (978) 745-2225 or Email at
Norin,Boaosiaai(iF�Comcast.iiet
Very truly yours,
//Oehrar &.0, W
Property Manager
Village at Vinnin Square Condominium Trust
cc: Trustees-Village at Vinnin Square Condominium Trust
Bogosian and Company LLC(Property Management Co.)
Norman Bogosian PO Box 4523
Property Manager Salem, MA 01970
Office(978) 745-2225
Fax (978) 745-2251
E-Mail: NormBogosian@Comcast.net
Oct 16, 2015
Bob Marquis
Marquis Contracting Company
97 Shelton Road
Swampscott,MA 01970
RE: Remodeling kitchen & Bathroom of 56 Valiant Way
Bill &Dorothy Papa (Owners)
Dear Mr. Marquis
It is my understanding that Bill &Dorothy Papa has engaged your services to remodel the kitchen and bathroom
of 56 Valiant Way.
There is no objection for you to remodel the kitchen of 56 Valiant Way, Salem, MA,providing
1. Your kitchen remodeling meets or exceeds the existing building codes in Salem,MA
2.Your company provides a certificate of insurance that will be in effect during your
proposed kitchen renovation to unit# 56
3. Your company works between the hours of 8 am and 5 pm,Mon through Friday
4. Your company cleans up all debris at the end of each day
If you should have any questions please call the office at(978) 745-2225 or Email at
NormB o eosian(a)C o mcast.n et
Very truly yours,
/IBPAYWdIB%Q4'
Property Manager
Village at Vinnin Square Condominium Trust
cc: Trustees-Village at Vinnin Square Condominium Trust
Bogosian and Company LLC(Property Management Co.)