The URL can be used to link to this page

2 WALTER ST - BUILDING INSPECTION (2) ��\ a The Commonwealth of Massachusetts J } Board of Building Regulations and Standards CITY Massachusetts State Building Code,.780 CMR, 7°edition OF SALEM Revised Junuury Building Permit Application To Construct, Repair, Renovate Or De olish a /, _'I108 One-or Two-Family Dwelling This Section Fqfi43ffiViaAUse Only Building Permit Number: D to p lied: Signature: Building Commissioner/Inspector of Buildin a SECTION 1:SITE 1 F RMATION 1.1 Property Address: T— 1.2 Assessors Map& Parcel Numbers 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 ft) Frontage(fl) 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP' 2.1 OwTner of Record: .`.]'b 4v rt� p.P 2 as s i r LtJ A L T-� Name(Print) Address for Service: 9"7 2. -7 ti Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ 1 Existing Buildin Owner-Occupied Repairs(spi Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work'-: L..4"'i-�t,b 1,..r•,� Q y'Vr .� ;2r Imo_ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building S 1. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Su ression Total All Fees:S r-© Check No. Check Amount: Cash Amount: 6.Total Project Cost: S S �3�J Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES o 5.1 Licensed Construction Supervisor(CSL) Tob t C License Number Expiration[late Name of C'SI: I lulder List CSL Type(see below) I <-( 4 M o r S�gpR 6afl f Description Address) U unrestricted u A0 to 350 Cu.Ft. A R Restricted 1&2 Family Dwellin Signature M Masonry Only RC Residential Roofing Covens Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D I Residential Demolition 5.2 Regbtered Home Improvement Contractor(HIC) Q ( , )_...a:..> �' C. O✓, Registration Number I IIC Companyy Name or t11C Registrant NamC_ 1 �1 `t Mnr� � r �Joab��nsV__ l�- 'Z3- I ? Address 9 7 Sit Expiration Date o-1 Signature 'telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e, 152.§ 2SC(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 ..........O No...........O 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 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 as Owner o Authorized A ent ereby 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 ofperjury) 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. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I0.R6 and I IO.RS,respectively. 2 When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (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/boths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Y The Commonwealth of Massachusetts Department of Industrial Accidents Off ee of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Print Leg A hcant Information ly Name (Business/organizatiowlndividual): L_ 12 n/ `3'1 L t ^ A` e A- • "' Address: I Lk St ^� City/State/Zip: Phone#: Ct 9 5 l 8 a 3 Lre n employer?Check the appropriate box: IF roject(required): a employer with 4 ❑ I am a general contractor and I construction oyees(full and/or part-time). have hired the sub-contractors Remodeling listed on the attached sheet. g a sole proprietor or partner- These sub-contractors have molitionand have no employees employees and have workers'king for me in any capacity. ilding additioncomp. nsurancet workers' comp. insurance ectrical repairs or additions ired.] 5. ❑ We are a corporation and itsofficers have exercised their umbing repairs or additions a homeowner doing all work ri t of exem tion er MGLelf. [No workers' comp. p P of repairsc. ploy ee(4),and or have nother rance requ red.]t employees. [No workers'comp. insurance required.] 'My applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hie outside contractors most submit a new affidavit indicating such. =Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they most provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. C Insurance Company Name: /�1 M t f.�L,A � S n Policy#or Self-ins.Lie.#: �, 19 9 ® j 4 E irationDate:_Q �3, Job Site Address: a � LT r S-r- City/State/Zip:�2v r-, P• A d t 7 0 Attach 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 MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided //above is true and correct. Date? Signature. �.� `�' Phone#: S Fuseonly.only. Do not write in this areq to be completed by city or town ojfciaLn: Permit/License#hority(circle one): Health 2. Building Department 3City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspectorphone#: rson: 1 z 'Y. ISSIJB DATE 07/31/7009 ,RODUCER • TITS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND Edward F Sennotl ImurBnce CONFER.4 NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Agency Inc DOES NOT AMEND.E%7END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 16 South Main Street ops6ckL AlA 019S3 COMPANIES AFFORDING COVERAGE SURED en Glxly Contracting Company Inc COMPANY A A I.M.Mutual Insurance Co THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P011CY PERIOD INDICATED.NOTWITHSTANDING ANY REQU[RafENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBIECT TO ALL TIIE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LUIITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. m TTTE OF I.VNFM'C[ DOLILY NUMBEF FOLICTERECTIVE FOLICYELTIPATION Lt. DATE IMWDDIn'7 CAR IMWDLYTY/ LIMM CFNFFAL LIABILITY GFII[FAL wDOA[OAT[ Dt.ODVCiSCOMFi`I'hGO. OCUNME.C'::.L G W LYAL t1AMUTY QQCWIAS LL:CEOUCDF DCESCYIALehUV.INJV0.Y t6CY DLYUF.),:JH7 U OW0..A9 A CONTAdCTOR'S FFOT AP2 DAMAC[gwv,,i,a AUTOMOBILE LIABILITY COMBINED:INOLE UNIT AltY AMI ALL O¢RI[O AV]Qr' WNLYINJ k.Y I FCYEDVLED AUTO$ Qnp-nml NI°MAUTOS �^1 ICILC•WILD AITO'> 50VILY RUUAY i IU CAFAC[LIheILHT V»uisel Fe.Dcon DUNAm 1 ��C[FB'LIABILITY GCE OCCLRFDICE UMPFiLLA MUN AOOFTOAII O1:iCF.THAN UMBPSLCA row. AM IYORISRS COBIPENSATION AND .ATLLIM I STATE 0 TITER FiYIPCOLTJtS LIADRIII' LU A AZF_cL. CUTIVE EL EACH ACCIDEVT 500,000 EPMIDFJLTDV 'I`ICILF'AFE 6010979011.009 08/03/2009 OSiO3/201CI J PLDLSEASF-POLICI"LOOT 600,000 W" Nam EL DLSEAS'EACH 500,000 HOUND ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ECPO ATION DATE THEREOF.THE ISSUWO COMPANY WILL ENDEAVOR TO MAIL JO R'PflTFN NOTICE TO THE CERTIFICATE OLDER NAMED TO THE LEFT.BUT FAILURE TO MAIL SUCH NOTICE SHALL LAPOSE NO OBUOATION R LIABILITY OF ANY F,LND LOON THE COMPANY,ITS AOFMS OR REPRESENTATIVES. 0 WHOM IT MAY CONCERN LLITHORIP-ED REPRESENTATIVE 6169 Page NO._LOI / Pages Ils LENG)BELYCONTRACO., INC. 20724 PROPOSAL 149 Main Street PEABODY, MASSACHUSETTS 01960 All home Improvement contractors and subcontractors • (978)531-8234 engaged in home Improvement contracting, unless FAX(97�531-9304 specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered Submitted i « f e. u f/ with the Commonwealth of Massachusetts. Inquiries To: h about registration and statusshould be made to the - - --Z_i Director, Home Improvement Contract Registration, One Ashburton Place,Room 1301,Boston,MA 02108 -_�� Q r_T 7d (ols) 72ion min. Owners who secure their own V contractors illebetl permit or deal with unregiGuaranty tered Fund / —" contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE pOTE RemmusenON. LA)74Y-8Z3S 3'�f '�� MA.REG.100811 nEmo aoo LocAsslan fryMt� e NAmilApprlf pars alto estlmema br na ba paMmled ad maalab ba W 7of �A(2 1 /iZCM !N/� AMAG 46 ---WALArs If ita/7L /e )aQ/Y _—""__.r�_�(i-_L(/.�L✓_� L. G✓Y1 AVf iL-�_�� /UM A�/GM 7C/OM_ __ oli All S r a t�1 S87 Cam° r00 �D C`.STI 'Z'SC >Construcan resat perm----iA / --. 00 `�..Jr - Mi /4 WORKtCHEOVLE aoa -1 eon peal h tle IM1 Cal N she aeY tllNm o Iha mining al Iona ABrwm t toes epwaliea Iwr I w t b 'll open the wnk m w about la ml.Be B delay a Cy umemncea Beyond Con4egor'e aonlrol N woh 111 C mis I a Ey 11.The Owner hereby WAPM pee epr el the acM]Wlnp aeln ere eppwlmelaeM Nat sots aalaye Net ere rotevdJepe l/Nec«aMor Nell mt Co[o reae lions of Nla ABroemenl THE comma warrenm Il,el IK work Nmiehea rgrwMer Nell Ce pas s«n aetxt6 N mamaal and woMmanNlp ror a pants a y IalovNe rompleeon a,N snail comply wiln Ne sure nmonml n6v ApeemenLNNo ewm arty mleolNwoMmenMlp«mele,bm,waemeee '"b)Its eanlmet«.nhe supoonbecwrs,empl%see w.,anm,la disco✓a,ea within one eeM1 acne e w aua�dela;f In met IroaMm«aw�vrY n-R he b ton«Mall'at No sent asperse,bNwW mmepY,Papal[aorta«,repmce.«wuee to be—seed,repaired.or,epl.ad, B P harassing wermntiea shell euMw any arepedbn parbnnea In eanrwallon with me agred-upon wor, We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars Payment to be made as follows: - (t/(g1/1/ �upon signing comm"; % '7'{7�—�—�7/ aklaaer�l %ISL)upon COmpleOpn 01 "s - — -- _ _. .w. �m / w(t l upon completion er cMlsuw / Prior/ %%It I shall Ea made In 0 aeon (/ c«nphapon of wort uMer Nl6 Contract. P+I,yw "- "'"' FGe,y He"' Notice: No agreement for home Impressment co mosong work Nell require own — payment(adv6nca aepo6l)of more Van mmNlra of me rate connotes pace Or the \ total.."he Of all aappose or payments ymIss the Contractor ma6t matle.In aaVeMe, to order and/or oth«wmo seism delivery of special order materials and eeulpment. e,waNw MrNitevar amount la omwter. Nara:iNapaWael^'aY the wltlgrawn ay wll,nte2eplea-Min soya, Acceptance of Proposal I have mad both sides of this document and accept the prices,specifications and conditions stated.I understand that upon signing,this proposal becomes a binding contract. You are au horized to do the work as specified. Payment will be made as outlined above. You,the Buyer•may cancel this transaction at anytime prior to midnight of the third business day after the date his arms n.C R "tin must be done In writing. D T GN T NTRACT IF THERE ARE ANY BLANK SPACES. slp,uw he siyien,re oow _ IMPORTANT INFORMATION ON BACK Massachusetts - Department of Public'Safet% Board of Building Regulations and Standards Construction.Supervisor License r ,I License: CS 94763 . . .... Restricted to; 00 THOMAS R DOBBINS 19 CEDAR HILL DRIVE DANVERS, MA p1923 Expiration: StW2012 ('unmiissiuner' Tr#: 23757. ...�•.. 0�ie �aomvnxonuaw o��/ rnaar�i«oeaa . Omce of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration:",'0100811 Type: Expiration__.8/23/2012 Private Corporatioi LEN GIBELY CONTRA ING CO!;iINC. i Brian Dobbins 149 Main Street ��.,•'-.��hc'�j'af .�.,�Q„ _ _ Peabody,MA 01960 "��,, 5 =' Vadersecretary