The URL can be used to link to this page

51 WARREN ST - BUILDING INSPECTION pi ...... ... ........b", .. .......... The Commonwealth`of slic 14 iftulatioTitAn_d St tndutds mads4cusetts� dd� ' _h -S "Hullaing-v, 790 .,to W 2� CMR T"edition USE Pc'i.init-Ap-11, To Construct, p iaktion tan ti AppliedDnie .4 ITWINFORMATION j, ...... '1�7 AgnaqmrS�Map:.&Turceil, Proper `...Adid �'_LZASSWWM .1�, L AAN Uil I I ilsthis awacceptc& 13 Zoning ..... as Dim' 16iii. brm ..... .. ................. zoning qst=z� .......... hoc 1.,5 Btiddhig-sit ai&. �F IiLq 'Wate-supP 1AM I L . ,M4phe ?� .... ... Disposal Zbne: "" Outside iqwa AM=- 5 w lt!y= n. �Fv lj.i�Rec -2.l- 0; .N nt).,,-- .SECTION...... ..... k New Construction O Fsriisnnng Budding Owner Occupied ERepstts(s) Altemud�t(s),O� Addttfnn`0`' is' „Specifyi mo Brief Oescripdatt A. f Proposed 44 ............ T Oftielau Only he'tn (Labor and Matenols) 'Plumbingi. List i6W(E(VAC)'!,, 1A...... A! 4 pet tew.,�,p, 01 A ............................ -a. MWS w RcsWfilial-WRWO urldSiditi Y R6i Acilda e. .... ..... d -T?�7..... I `2S IQ I ar l M!E?l !C9, mo, AUTHORIZATION TO IS taAGENT �w Nmnm that the eA and!WrdAia&-SNe the Zforegoing application ore Wa snd accurate to the best of my knowledge urd wz' � g awie of Owner or Authorized Agent e > � ;,- # , i Date , s tfherown work tr� ti lc�, " --�'q 1 h xKi Hi rwl" z . ........�� 66dan, a ct&.:(HIC)'Pm not;registered spy k Vni uU tio u isorLcensmg(CSLy can he Pound in R- ; . va. o th M .2.C he wor is '�Pfo WP.Amed i' n I'd- -finished b- nc u ing,garage., asemerftftics dcc sir TM cis '. CITY OF &U ENI, INVLkSSACHUSETTS • &1LDLNG DEPART.%mNT • 120 W\SHNGTON STREET, r FLOOR �j TEX- (978) 745-9595 FAX(978) 740-9W KI\iBERLEY DRISCOLL MAYOR T�toatAs ST.PIERR& DIRECTOR OF PUBLIC PROPERTY/BU:IIDLNG COMMSSIONER 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 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 MGL c 111, S 150A. �The debris will be transported by: r.9e.� �DoaBN C�"ov57.�GiCrrswc-C (name of auler) The debris will be disposed of in : (name of facility) (address of facility) signature of permit applicant date Jcbriut7.Jx: CITY OF S.u.EM, MASSACHUSE= • BuILDiNG DEPARnMNT 120 WASHINGTON STREET,3m FLOOR TEL (978) 745-9595 FAX(978) 740-9"6 KVXBERLHY DRISCOLL MAYOR DIRECTOR. ST.PTERRB DIRECTOR OF PUBLIC PROPERTY/BL'i1DL*IG CONWISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leelbly Name(Busim-ss:OrganintioNlndividual): Address: 75 City/State/Zip: JSw/C//, /yl!f li/9 3 6 Phone#: V7 Z Are you an employee Cheek the appropriate box: Type of project(required): g 1.�yo t am a employer with / 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-tine).• have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet: 7• ❑Remodeling ship and have no employees: These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.r❑]Roof rc Otber G7�AY insurance required.)t employees. [No workers' 13.t;J � comp.insurance required.] •Any applicaol that checks box 01 omst also all ont the section below showing theirworken'compensation policy tofottna[ioa t I I.vneowttss who submit this affidavit indicating they an:doing all work and then him outside cuatrnet'era nmsa submit a ncww amJavii indicating such =Cunim.•ton that chick this has must anachod an a.lditional sheet showing sit;name of the sub•cotaraetaa and their workers'comp.policy information. l am as employer that is providing workers'compensadon insurance jar my employees, Below is the pollcy and Job site information. ��-- Insurance Company Name:_ Policy#ar Self-ins.Lie.#: �Ns to G��3 Expiration Date._ O� _ Job Site Address: City/StatdZip:cJ��G/++./45;t�v Gy97 O Attach a copy of the workers'compensation poly declaration page(showing the polity number and expiration date). Failure to secure coverage as required under Sedion 25A of MOL a 152 can lead to the imposition of eriminal penalties of a fine up to S1,500.00 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. Bc advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify under titee�pains and penak/es ofppeerJary that the information provided above is true and correct i n gtre• �.l'.Jflli /!�!'/ Ct,�i [)are, �/5� 1 Phone#, oJfcdal as,only. Do nor write in this area,to be completed by city or town ofleciaL City or Town: PermiNtJcentle# Issuing Authority(circle one): 1.Board of liealth L Building Department 3.Cityffewn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: -_Boat�8f69ffBlflg�egnml�Orys a+f93tBx�� . >, HOME IMPROVEMENT CONTRACTOR Re ratlon� 07297 ExpixplraUon `7l30I2010 TrN 0 lug ..TjPq_-.L.1 ;Liability Corpor PARK WOODBURY CONS TR t TION LLC. s Kevin McGinness i 75 COUNTRY CLUB WAY.',,' �a IPSWICH,MA 01938' ' Administrator itrg t,.�� wr �'iGe �o-rwanoaw.ea�GG o�✓�isouraf�melta r ; ' Board of Building Regulations and Standards Construction Supervisor License Llt:ense: CS 32857 ExplraU4n 11/26/2009 Trill 12312 RBstrlction -04'!Y i — ri ro KEVIN E MCGINNESS-j, l 75 COUNTRY CLUB WAYS-,,' 'F IPSWICH,MA 01938 Commissioner t, r w + x . r 4ry .*t�LF a r rt e ' a 1 M ° a=r , y+ 02/05/2009 THU 11:01 FAX Q 001/001 ACORQA, CERTIFICATE OF LIABILITY INSURANCE D02105/200V1 02J05/2009 PRODUCER 978-887-8304 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION UGONE-JOHNSON INS. AGENCY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DALE JOHNSON HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 7 GROVE STREET. STE 201 TOPSFIELD, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A FARM FAMILY CASUALTY INSURANCE PARK WOODBURY CONSTURCTORS LLC INSURER B'. 75 COUNTRY CLUB WAY INSURER C IPSWICH, MA 01938 INSURER D NSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR AD D' POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIWIVY DATE MMIODIW LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A X COMMERCIAL GENERAL LIABILITY ED 2005XO368 11/25/08 11/25/09 PREMISES Ea ccurence $ 50,000 CLAIMSMADE OCCUR MED EXP(Any one person) $ 5000 CONTRACTORS PERSONAL a ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 1,000,000 POLICY PRO_ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO E.accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accitlen0 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY'. AGG $ A EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1.000000 X OCCUR E—ICLAIMSMADE 2005E1359 11/25/08 11/25/09 AGGREGATE $ 1,000,000 DEDUCTIBLE $ RETENTION 8 $ WORKERS COMPENSATIONANO WCSTATU- �. OTH- A EMPLOYERS'UABILITY 2005W6203 02/06/08 02/06/09 EL.EACHACCIDENT $ SOO,000 ANY PROPRIETORGARTNERIEXECUTIVE 02/06/09 02/06/10 OFTI CERM,EMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ SOO OQO II yas,describe under SPECIAL PROVISIONS below E.L.DISEASE POLICYLIMIT $ 590000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS LIABILITY POLICY INCLUDES GENERAL RESIDENTIAL CARPENTRY, INCLUDES CONCTRUCTION, RECONSTRCUTION AND MASONRY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SALEM DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN BUILDING INSPECTOR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL SALEM, MA 01970 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR FAX 978.740.9846 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE TP Dale Johnson ACORD 25(2001/081 ©ACORD CORPORATION 1988