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19 VICTORY RD - BUILDING INSPECTION (2) No 69'O City of Salem Ward - Z Call "8, RTs4 41?/ 5, 79 /a/ 3 �78 7q( 57(0 APPLICATION FOR- PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to oomplete'40Items In sections:b lid Ol, N,and IX. L ,.�Tq.ocA.roH►-.., O - G. : It LL zola . LOCATION �GrlCln �C(i OF BETWEEN-- ()l�lul �)�ie AM(CROSS art F£TI r/ CRoesstr�n p BUILDINGLOT sugonnsloN. 1_01` T/eI _SIZE -9 �K l IL TYPE AND COST OF BUILDING All applicants complete Pr9rtaA-D A. TYPE, �OF IMPROVEMENT D. PROPOSED LWE•FOR"DEMOlInW USE MOST RECENT USE 1 lU�—O''New building Rp,1�F0�M1�tl_Y• .. . .. - - NOrowWentW 2 ❑ Addtlbnld rBatdarrarnlsh enter rrumbaranew 12 IY1 vro hmiy - 1e_❑.MWeams0.�eatlanel r" housing units added,9 my,in pen D,13) TT is ❑ CMdL oll�er ielgbw 13 ❑ Two or mane family•Enter number 20 ❑ Industrial 3 ❑ Alteration(See 2 above) of units 21 4 ❑ m Repair replacement 14 ❑ TmnsieM hote6 l,aorm -mote d "- _ 22 ❑ Se Par"garage v Station• - Errw number of urea_._.::..:__..._. ❑ �e 'repair tPr210110.. 5 ❑ Wrecking(b nxAa W*MSdW ah enter number y 23 ❑ �P!��WSWAMonal of units in building In Pert a 13) - _ 15 ❑_Gamge . _. . _ -. 24 ❑ Calm Oankk pmtsssto nal i 6 ❑ Mwing(rebption) 16 ❑ 25 ❑ PubBe uti ty 7 ❑ Foundstbn only - 26 ❑..ad"WwW,Other educational 17 ❑ Othar•spew 27 ❑ Shores,rnwcardae� - IL OWNERSHIP 26 ❑ Tanks,toware 6 old I'rhahe owividuai,corporation,nonpmPo. - 29 ❑ O6w•SpxlY T msutulku4 etc.) 9 ❑ Pudic(Federal,State,Or local government .. C.COST (Omd Oft'" Nonoeidwdst•Dewribe in demi ppposed use Of buidige,eg,food pmOeertng Plerd. . machine shop.IaurghV Wilding at hosMldk elementary xhool secondary school college. to Cost of knprovemerd -----.— ---.—_ i parochial school park ro parking garage for depereMtor Se.rental office building,office building at indusMel plats.It use of existsg building 0 being changed,order praposed usa in dis above cost 0. a Hearins ail canditionmg.-------_--_—__ & a Other(elevator,ale).-------.---. 11. TOTAL COST OF IMPROVEMENTi Ill. SELECTED CHARACTERISTICS OF BUhMING •For new buildings and additions, complete Pans E L;demolition, complete only Parts J 6 M, ail others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRoll TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANICAL ddYYrr 30 ❑ Maeorry(wall beang) 35 Gas 40'j Public or priwfe WMPWY Will time be central as ! 31 Wood Irame 30 ❑ ON 41 ❑ Private(septic tarnk eta) conditions? '.. y1f 32 ❑ Structural steel 37 ❑ Eleci icity uR. "" 45 ❑ NO 33 0 Retrdaced mnaets 38 Coal H. TYPE OF WATER SUPPLY WE there by an ebvalriR 34 ❑ COW-spurn 39 ❑ Otlw-Speedy 42 a u ac Or Private campanY 46 ❑ Y„ 47 JZNO 'I 43 ❑ Private(waK cistern) i s , I MENslONs M.. DEMOLITION OF STRUCTURES: as Number of stones .-_.-._......_.-:_-i ._....._.......___ - . . as Tote)square feet a soot area, Hai ApprMal from Historical Commission been received a"0O °iSetl exterior ext - - erior 5 for ahy stricture over fifty(50)years? Yes_ NO— aimr�onel.-1-� 2- -- --�-`-' sir! G 6m * ' sa Tow tend area.w ti------..._....------ ..�..big Safe Number K.NUMM OF oFF smEr PAWJM SPACES Pest Control: 51. Enclosed ...._.__..__._..._..-.._.._---------__-- '' :.HAVE THE,FOLLOWING UTILITIES BEEN DISCONNECTED? sz. Outdoors....___.._..._..._.._2_...----....__.. . - Yes No L REaoornw euanews owr Water 51 Electric: Gas Fue__ .......___..._ - sa Number cr DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED baneoans BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes— Nos (If yes,please enclose documentation.from.Hist.Com.)._.. . . .. Conservation Area? _.Yea_ No— (If yes;please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Year No_ Is property located in the S.R.A:district? Yes_ No Comply with Zoning?' Yes_ Now (If no,enclose Board of.Appeal decision) Is lot grandfathered? Yes_ Now (If yes,submit documentationliif:no,submit Board of Appeal decision) If new construction,has the proper Routing Slip been enclosed? Yeses No_ Is Architectural Access Board approval required? Yes_ No-29'(If yes,submit documentation) Massachusetts State Contractor License # �7 6 9:k Salem License * Home Improvement Contractor* Homeowners Exempt form(if applicable) Yes_ Now CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)'MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary,please submit CONSTRUCTION IS TO BE COMPLETED BY: 07 m m in writing to the Inspector of Buildings. V. IDENTIFICATION • To be completed by all applicants N" Madir address-Number.09K city,and slate ➢P Code Tat.No. �t el S r� Dl9�Jv 2 Contractor rye ria4y Te F8r Architect or Figneer �S.li� r0/'vv.,• �Q /Li/-r I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to at applicable laws of this jurisdiction. Signatur licant Address /� Appl' lion date CITY OF SALEM ROUTING SLIP �I NEW CONSTRUCTION CERTIFICATE OF OCCUPANCY LOCATION: I9 I�l l f L feel G d DATE y � APPLICANT:MP-/// f& d- m I cAepe t . a . ASSESSORS FRANK IU,I DATE: q � (93 Washington SCITYCLERK CHERYLYL LAPODYT DATE: (93 Washington Street) PUBLICSSERVICEs , n f�� (N w 7N ATE: b (14-1 Washington Street)0 Floor WATER / DOTTIE THIBODEAU DATE: g 8 (120 Washington Street)4°FI CROSS CONNECT SUP BRIAN THHiODSAU � AfE (S Jefferson Avenue) PLANNING 174 J�^t al DATE:1 y (12t, Washington Street)3 d Floor CONSERVATION COMMI Ib CGte� q eS DATE:— l (120 Washington Street)3 d Fioo ELECTRICAL JOHN GIARDI DATE:.. (49 Lafayette Stree FIRE PRE ERIN GRIFFIN DATE: (29 Fort Avenue) ff 44 HEALTH JOANNE SCOTT DATE: 9"S O 7 (120WabhingtonStr 4d'FI ,# BUILDING Q C/_ 0 �J THOMAS ST. PIERRE �h/ � 22 DATE: / (120 Washington Street)P Floor REScheck Software Version 3.7.3 Inspection Checklist Date:09/04/07 Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation Comments: Above-Grade Walls: - ❑ Wall 1:Wood Frame,16"o.c.,R-19.0 cavity insulation Comments: ❑ Wall 2:Wood Frame, 16"o.c.,R-11.0 cavity insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with low-E,U-factor.0.330 For windows without labeled U-factors,describe features: #Panes_Frame Type Thermal Break?_Yes_No Comments: Doors: ❑ Door 1:Glass,U-factor:0.510 Comments: ❑ Door 2:Solid,U-factor.0.150 Comments: ❑ Door 3:Glass,U-factor:0.320 Comments: Floors: ❑ Floor 1:All Wood Joist/Truss:Over Unconditioned Space R-19.0 cavityinsulation Comments: Heating and Cooling Equipment: ❑ Boiler 1:Other(Except Gas-Fired Steam):80 AFUE or higher Make and Model Number. Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. ❑ Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5"clearance from combustible materials.If non-IC rated,the fixture must be installed with a 3"clearance from insulation. Vapor Retarder: ❑ Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: ❑ Materials and equipment must be installed in accordance with the manufacturer's installation instructions. ❑ Materials and equipment must be identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ❑ Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. Shea Page 2 of 4 Duct Insulation: ❑ Ducts in unconditioned spaces must be insulated to R-5:Ducts outside the building must be insulated to R-6.5. Duct Construction: ❑ All joints,seams,and connections must be securely fastened with welds,gaskets,mastics(adhesives), mastic-plus-embedded-fabric,or tapes.Tapes and mastics must be rated UL 181A or UL 181 B. Exception:Continuously welded and locking-type longitudinal joints and seams on duds operating at less than 2 in.w.g.(500 Pa). ❑ The HVAC system must provide a means for balancing air and water systems. Temperature Controls: ❑ Thermostats are required for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Service Water Heating: ❑ Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. ❑ Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: ❑ Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: ❑ All heated swimming pools must have an on/off heater switch and require a cover unless over 20%of the heating energy is from non-depletable sources.Pool pumps require a time dock. , Heating and Cooling Piping insulation: ❑ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. kg� I I Shea Page 3 of 4 Table 1:Minimum Insulation Thickness for CirculatingHot Water Pipes Pas �I Insulation Thickness In Inches by Pipe Sizes Non Circulating Runouts Circulating Mains and Runouts - Heated Water Temperature('F) Up to 1" Up to 1.25" 1.5"to 2.0' Over 2" 170-180 0.5 1.0 1.5 2.0 140-169 0.5 0.5 1.0 1.5 100-139 0.5 0.5 0.5 1.0 Table 2:Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range("F) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low Pressurelremperature 201-260 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD:(Building Department Use Only) � I � II I I, Shea Page 4 of 4 ' CITY OF SALEM t< PUBLIC PROPRERTY DEPARTMENT ri14181--RUY 11ANCOLL M(AYtxt Ir.WAiH11% fOKSUEET6SAIEM.MAs4Actn:sr:ttis0197 'rbL-97/-743-9595 4 FAX:978.74C-9946 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrlcians/Plumbers Applicant Information Please Print Leeibly NaMC tHuainrct/Organization/Individuall: U T Address:_ CityiStare/Zip: ® Phone /t: 9 7Vl 0 Are,you an employer?Check the appropriate box: 'rype of project(required): 1.Q 1 am a cmpioycr with 5— 4. ❑ 1 am a general contractor and I 6• ❑ New construction employees(full and/or part-ante).• have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. : 7. ❑ Remodeling ship and have no employms These subcontractors have S. ❑ Demolition working for me in any capacity, workers'comp. insurance. q• Building addition r, INo workers'comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ;. required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.[] Plumbing repairs or additions myself. (No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] r employees.(No workers' comp. insurance required.] 13. Other su •Any up plicaol that checks box#1 most also lilt salt ncc sacrian below showing 4xtir workers'cumpnnsation policy in[ornuaioa • l waus wnsrs who submit this affidavit indicating they are doing as work and than hire outside contractor,most sul+mit a new amdavit indieaing utch. :Cuntrxvrs that ch=k this box must attached an additional Aheat showing the name of the sub-contractors and their workmi comp.polity information. /um an employer thut Ls providing workers'compensadon/usurance for prey efnpluyecs. Below is the pat/icy an fab site inforinatioa _ _ Insurance Company Name: S S a y�J • +� �'9/lwJi� S �® Policy#ter Self-ins. Lic. #: 5� _euo6 z._ .. .._._ r Expiration Date: 3��5 Job 5i[c Address: / 9 // / !7 ^>' :iz &,L City/State/Zip: ��/i -t lQ Artach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of YIGL c. 152 can lead to the imposition of criminal penalties of a ri tic op to S 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 S250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of lovcsugatiuns of the DIA for insurance cm crage verification. /do hereby rerfify under the pains cord penuldrs of perjury that/he informufion provided above is true and correct. tip•:enure: .���� Uate• ��f/� � tt••a 9 '%S� �9� �� Official ase only. Do nor write in this area,to be completed by city or town official City or Town: PermitiLiccnse q Issuing Authority (circle one):I. soard orucalth 2. Building Department 3.Cityfrown 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, espress or implied,oral or written.- An emplo)wr 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 M.g25C(6)also states that"every state or local licensing agency shah 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(7)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 w ith 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 and,if necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)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 maybe 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 .elf-insurance license number on the appropriate line. City or Town 0MC1215 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. I'lease be sure to till in the pormit/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 tilled out each year. Where a home owner or citizen is obtaining a license or pennit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. I*hc 011.1ce of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigadons 600 Washington Street Boston,MA 02111 Tel. H 617-727-4900 ext 406 or 1-877-MASSAFE Fax #617-727-7749 Revised i-26-05 www.mass.gov/dia 3 "a CITY OF SALEM ` BUILDING LICENSE This is to cacti That �R„L GEo2 ;__� at., a fsk, Has bean g a license ON t�n 4_RC�Ins Kfor as a C ►G ( /5tK R - ' AHaH: .-... ' 1 O (Issued) Building Impactor .0wa s16(9n n ar &� onswction SuPeNor License License CS 47688 n�' Birthdate `81811959 Trlk 13783 '.. Expiration: 1812009 'Restriction:<1G _ � PAULW GEORGE ,� f 19 TAYLOR BROOK LANE Commissioner DERRY,NH03038 - i it 07/28/2006 10:22 18003084842 MFm EMPIRE SERVICE rAl$ Oil OD CUINTHINLODU AMM& INSURANCE BINDER OW21101 AN Is IM Old=is A 7011ORARY COMMACT, r TO IM CONDUKINS SWW ON THE REYERiESMSOF711RFOOOL raoeuceNINKNO 816451A3G0 eact*A0 noeta Hawes 4nsarartes j4pm.1, 1 "t r.Frayor a coat,me 231 Salina Meadows Partway 07inm 1201 X As X IMAM P.O.Banc 4743 Ps Now NY 13221 TN6�R Raun®TO®a®OC7�a1TEAGOWNMCOMPAir III FfR o0 NM spama ra mos s` 1�— auaeaes 114444 emes�cattaP eArAla�rateesoeb taum _ Custam MoWdar Haman o7 New Lori":224 East BL,MalltuaM MA 01544 Ettplerndho - dba P.Osergs Hanes 18 Taylor Brook tans PWMNH 63030 COVERAGES Lam •NOP" tIAU�NISOPLON Building $� smm aA M U am* )on Psraalrai Property 600 Sd S6A00 e9EaALUAeNn eApno BIDE f1 X Mteael &Gelmmumalnr Ileum rJAMmAm XQamn tnwPJ® aN s 000 -- - P@mQ*iLYAOVNai1' a lAQQJm_ _ ata�rALAs�ie s 000 HIn UATRFUR L1NONAa& PnpallCTa-OOl/1NA66 f AutaaoasauAwtn COYBa09at41Laa- f AMA= - _ taot.Y!"—Wrffmwl f ALLORISMAUMf - eoaWtUORr A .O i _ `SCHEMAMAUMe PROP9TT0ALMNE t _ HOWAUMR tEO1CALPAWGM a NONOWa®AUM - PtAeONALv&Km PFOR t UNtEUF®LWMWar f " f AUtOPNtWJILMYA86 VEOLWEILE .. ALLVDGMM Vi91t'J6a ACTUILLGRFIVAU1a COLUMM ffiATWAtONr OFEATNANOou. I UFHM CAFA'SUARKin AMOKY-MACCOEW t AWAMO OT mTmNAU OWft - s OteeB8ltAdatlr EAON 0=001M t ... UWsUtAPOPA A6® Is t TNANUNNISUArom RSMOMFORCLANSWAM rILiTA LNIIR wOl m cowOliBmimno r1.FAQIAECN@tT e e1NaAMtl1'iUANIM - P1.0SIMSE-M - t EA- s FM Name PAnted On DEC PW. . rA= s SaaWahed&qc CondltlOnaRMwCW48 PMQ s IMNreA6F£ ANDMOML NAWWe LussPAr[s _ LOAN* .a NOOOAPdtA'f10N 1893 ACORDl7.7AMODI11d 3 0109417 Nam MrmRTANFaTA7EMWWUIO�"7IWON REUMNSm DMR OAOC CITY OF SALEM 377 PUBLIC PROPRERTY �4 DEPARTMENT ,�:\t 3:NLnY!'Nil•:UI1. � fit.\11�R l?C W.1911NQ.ONS.-REET • SALI At• N1ASiAC.0 iL1'l5;1197^- rn:978-745.1395 *F.%-X:978.74C 9846 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CNIR section It 1.5 Debris, and the provisions of MGL c 40, 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 disposal facility as defined by v1GL c 111. S 150A. The debris will be transported by: L�y � � off• S G s.� (name of hauler) I'lie debris will be disposed of in : (name of facility) -_— ,aa,!rCss Of tac;lay/ 1i3 :atu�� ,1f,L:nrat app.ivat .iatr ,CD CITY OF SALEM PLANNING BOARD 71 7) Form A — Derivinn 12 Larkin Lane/19 Victory Road o _ o r,- Melissa_9 Shea NJ 12 Larkin Lane _ o 1--r;. Salem, Massachusetts 01970 te w fTl_ n q, N/IC The Salem Planning Board voted on April 19, 2007 by a vote of seven (7)in favor and none opposed to endorse "Approval Under Subdivision Control Law Not Required" on the following described plan: 1. Applicant: Melissa Shea, 12 Larkin Lane. Salem, Massachusetts 01970 2. Location: The parcel is located at 12 Larkin Lane, assessors map 42, parcel 0045. 3. Project Description: This Form A application requested to divide a portion of 12 Larkin Lane into two separate parcels. Parcel #1 (12 Larkin Lane) having frontage on Larkin Lane and consisting of approx. 6,900 sq. ft., and parcel#2 (19 Victory Road) having frontage on Victory Road and consisting of approx. 8,373 sq ft. The applicant obtained Variances from Waiver from Frontage from this board on 4/19/07 because the lots in this neighborhood Waiver from Frontage granted,these lots meet the requirements for ANR endorsement. Sincerely, Chuck Puleo Acting Chairman Cc: Chervl LaPointe, Citv Clerk l/ 20070�828I004I80IIBk:271141I�IPg:10 08/28/2007 14:04:00 OTHER Pg Ili "ems CITY OF SALEM �s PLANNING BOARD Waiver From Frontage - Decision For the Petition of Melissa Shea for _ E " Waiver from Frontage at 12 Larkin Lane/19 Victory Road r-3 Uj V; by A Public Hearing on this petition was held on April 19,2007. The Public Hearing was dosed on o April 19,2007 with the following Board members present:Chuck Puleo Acting Chairman,C- ristine ..,t Y Sullivan,John Moustakis,Pam Lombazdini,Nadine Hanscom,Gene Collins,and Tim Kavanagh. Notice of this meeting was sent to abutters and notice of the hearing was properly publish. ,jn the .D Salem Evening News. Melissa Shea,owner of the property,is requesting a waiver from frontage requirements from the Subdivision Regulations and under MGL Chapter 41,Section 81R�to allow the property located at 12 Larkin Lane to be subdivided into two lots (12 Larkin Lane and 19 Victory Road). This section states that"A Planning Board may in any particular case,where such action is in the public interest and not inconsistent with the intent and purpose of the subdivision control law,waive strict compliance with • its rules and regulations,and with frontage or access requirements specified in the law...' _ The waiver from frontage is being granted for the property located at 12 Larkin Lane/19 Victory _.._..� Road,as shown on the plans titled,"ANR Plan, 12 Larkin Lane/19 Victory Road, Salem,"dated February 9,2007,upon the findings by the Board drat: Lances exist which es ecially affect the land and structures involved and which are 1. S edal circumstances P P not generally affecting other land and structures involved; 2. Literal enforcement of the provisions of the Regulations would involve substantial hardship, fiiauual or otherwise,to the petitioner,and _ Therefore,the Planning Board voted by a vote of seven q) (Puleo,Moustakis,Collins,Kavanagh, Lombardini,Sullivan,Hanscom)in favor,none_opposed,to grant the waiver from frontage Victory Road. requirements for 12 Larkin Lane and 19 V ry This endorsement shall not take effect until a copy of the decision beating certification of the City Clerk that twenty,(20) days have elapsed and no appeal has been filed or that such appeal has been if filed that it has been dismissed or denied,is recorded in the Essex South Registry of Deeds and is indexed in the grantor index under the name of the owner of record or is recorded and.noted on the owner's certificate of title. The owner or applicant shall pay the fee for recording or registering. l hereby certify that a copy of this dec ision is on file with the City Clerk andthat a copy of the Decision and plans is on file with the Planning Board. tick Pule {T . Acting Chairman I?120 WASHINGTON STReer, SALEM,�ACHUSEITS 01�7 • i.r 978.745,9595 Fax: 978.740.0404 wwwsAi.eM.coM i hereby certify that 20 days harseXPW from the date this instrument was received, and that NO APPEAL has been filed in this 00ce._ /f { ieNew England vornOs 270 Ocean Road • Greenland, NH 03840 60 3 436-8830 • 800-800-8831 603-43 i 8540 (fax) • htt :/lwww.newengIandhomes.net P f Massachusetts Approval Number MC 050 RE: Certified Installer Letter TO WHOM IT MAY CONCERN: Be it known by this document that New England Homes Inc. (hereinafter known as the Company), a manufacturer of modular one and two family dwellings, is also the "Certified Installer" of said dwellings. All modular units manufactured by the Company then have the concrete filled steel support columns are transported to the site, bolted together, in the scope defined weather-tight within the intent and p reasonably gh installed and are made Site n 7.C.001-.012. New England SRM Section Site Re Reference Manual ( ) New England Homes ins tioned build Homes employees certified by the: Company to install the above-men a li product do all this work. If there are any questions relative to this subject, I may be contacted at (603) 436-8830, Ext. 323. Very truly yours; New England Homes, Inc. Michael q_ounus General Manager G:\ENGINEER\W RD\INSTLCRT.D00O3/05 Technology and Craftsmanship in Home Building New England 'Homes 270 Ocean Road • Greenland, NH 03840 • 603-436-8830 • 800-800-8831 603-431-8540 (fax) • www.newenglandhomes.net Massachusetts Approval Number MC 050 RE: NEH "A" Crew Letter of Certification TO WHOM IT MAY CONCERN: This letter is written in demonstration of the fact that the following Set or "A" Crew personnel have been adequately educated in procedures relating to the field installation of New England Homes, Inc. modular houses. Such procedures include the safe placement and attachment of all modular units to the field constructed foundation system (provided by others) as well as all other connection details within the intent and scope defined in the New England Homes Site Reference Manual (SRM) Section 7.C.001-.010. By issuing this letter, New England Homes, Inc. certifies that the personnel listed below are knowledgeable and competent to perform all work associated with the field installation of its modular home products. Francis Martineau-Crew Chief John Coggeshall Jim Rothwell Doug Hackney Michael Richardson Mike Knowles Jack Burridge Christopher Dumais Don Reynolds Barry Ryan If there are any questions relative to this subject, I may be contacted at (603) 436-8830, Ext. 324. Very truly yours; New England Homes, Inc. Michael ounus General Manager G:\ENGINEER\W RD�ACRE W CRT.D0003/07 Technology and Craftsmanship in Home Building 0:--- Ih1 07 Thomas G.Gatzunis,P.E. +• •f ©yypj�, r, �p � ,e ,�Q' Commissioner Deval L.Patrick 216t R �ddee& e?1Z7e16,� Gary a,P.E. Governor -��J Q' Chairman Timothy P.Murray i�oxe /G/-/S/cJ.G 9 v /61/�LL/-715� sandy MacLeod Lieutenant Governor Vice Chairman Kevin M.Burke Robert Anderson Secretary , / Administrator April 4, 2007 New England Homes, Inc. Dennis Jacobs 270 Ocean Road i Greenland, NH 03840 q i I RE: RECERTIFICATION FOR 2007—2008 Commonwealth of Massachusetts Manufactured Buildings Program { MC #: 50 TPIA #: 03 i I f 4 To Whom It May Concern: i p This letter is to confirm your recertification in the Commonwealth of Massachusetts Manufactured f Buildings Program as a producer of Manufactured Buildings for the period of May I, 2007 through April 30, 2008, i This approval is contingent upon compliance with all previously listed conditions of your approval, and compliance with the provisions of the current Massachusetts State Building Code, Massachusetts State Electrical Code and Massachusetts State Plumbing and Gas Code. f Yours truly, BOARD OF BUILDING REGULATIONS AND STANDARDS William H. Horrocks Director, Manufactured Buildings Program cc: Massachusetts Board of Examiners of Plumbers and Gas Fitters Massachusetts Board of Examiners of Electricians i This correspondence has been issued from the Board of Building Regulations and Standards 167 Lyman Street, Hadley Building, P.O. Box 1063, Westborouqh, MA 01581 WORKERS COMPENSATION AND EMPLOYEE-5-51—I&BILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington, Massachusetts NCCI NO 40959 (800).876-2765 POLICY NO. I WCC 6006216012007 PRIOR NO. I NEW BUSINESS ITEM 1. The Insured Custom Modular Homes of NE Mailing Address: lg Taylor Block Lane Deny NH 03038 (No. Street Town or lily caelty stalenpcode ❑ Individual ❑ Partnership ® Corporation ❑ Other FEIN 043573480 Other workplaces not shown above: 2. The policy period Is fmrrP�=007 a03252008 1201 a.m.standard time at the insured's mailing address. 3. A- Workers Compensation Insurance: Part One ofthe policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A The limits of our torbilityunder Part Two are: Bodily Injury by Accident$ 100,000 eachacoident Bodily Injury by Disease $ 500,000 pokgllmit Bodily Injury by Disease $ 100,000 eachemployee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A I D. This policy includes these endorsements and schedules: SEE SCHEDULE r i 4. The premium for this policy will be determined by our Manuals of Rules,Cassfieations,Rates and Rating plans. Ali information required below is subject to verification and change by audit Classifications Premium Basis Rates Code Estimated FM510a ESMMW Total Annual of Mnual IVu Ravonereaon Rem Mlien Premium INTRA 151502 SEEEXTINSIONOFINIFUK TION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 5,618.00 As indicated,irrtedm adjustments of premium shall be made: Deposit Premium $ 1.434.00 ❑ Annually ❑ Semi Annually ® Quarterly ❑ Monthly MA Assessment Chg. $5,179.40 x 4.1920% $217.00 03117J2007 This policy,including all endorsements,is hereby countersigned by ed Aelhor'metl Sigmime Dole GOV I GOV I KIND PLACING CLAIM NAME SAFETY STATE CLASS. AUDIT OFFICE OFFICE CHECK GROUP Boston Insurance Brokerage Inc MA 15606 114 505 1 1 1 24 Federal Street 4th Floor Boston,MA 02110 WC 00 00 01 A(11-88) IndeAes capyri9Med u.,e ola,e Hetmnal C cB m cmpanvibn Inse,ane. osetl WM its pemtlssim. Permit# Permit Date REScheck Software Version 3.7.3 Compliance Certificate Project Title: Shea Report Date: 09/04/07 Data filename: Unritied.rck Energy Code: 2000 IECC Location: Salem, Massachusetts Construction Type: Single Family Glazing Area Percentage: 159/6 Heating Degree Days: 6268 Construction Site: Owner/Agent: Designer/Contractor: 19 Victory Rd Salem,MA Ceiling 1:Flat Ceiling or Scissor Truss: 1282 38.0 0.0 38 Wall 1:Wood Frame, 16"o.c.: 2175 19.0 0.0 105 Window 1:Wood Fmme:Double Pane with Low-E: 290 0.330 96 Door 1:Glass: 3 0.510 2 Door 2:Solid: 54 0.150 8 Door 3:Glass: 80 0.320 26 Wall 2:Wood Frame, 16"o.c.: 246 11.0 0.0 22 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space: 1249 19.0 0.0 59 Boiler 1:Other(Except Gas-Fired Steam):80 AFUE Compliance Statement.The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the pernit applicetion.The proposed building has been designed to meet the 2000 IECC requirements in RESk Version and t� ply wit andato r uirements listed in.the REScheck Inspection Checklist. ` er/ esign�r mpany Name Date Shea Page 1 of 4 DO NOT WRITE BELOW THIS LINE VL VALIDATION r FOR DEPARTMENT USE ONLY Building Permit number use GMI,p Building 19 Fire Gra&V Permit issued Building Live Load ng Permit Fee $ Occupancy Load Cartificate of Occupancy $ Approved by Drain Tile $ 41-41 Plan Review Fee $ TnLE NOTES AND Data-(For department use) nTh AJ I t 1 1 Se- U 1 p/L N Ate)A 1 PERMIT TO BE MAILED TO: DATE MAILED: I Constniction to be started by. / m 7 Completed by. 1 dI 9 f a VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES Sr E OR PLOT PLAN-For Applkwd Use _ O N