57 WARREN ST - BPA 08-472 REPLACE DECK What is the current use of the Building?
Material of Building? If dwelling. how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone l )
Mechanic's Name L e 6 LJ/ C� C—
Address and Phone ) 9 M 4 1.0 -21— Ro e h t� M ICI y
Construction Supervisors License# 476.3 HIC Registration#
Estimated Cost of Project$_4 Permit Fee Calculatlon
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
,) The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury X
Date / D`- / 7- V 7
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PUBLIC PROPERTY
DEPARTMENT
Kl.%MFIIIEY olUSCULL - 7�
MAYOR 120 WwaNGrON S- "0 SAu w,X%'&SACH;Stnzs 01970
TEL-97&74S-9S9S• FAY:978-740.9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY_FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: 60,41yrn BrZ,4 CziEz Building:
Property Address: S • 4y A 2
Property is located in a; Conservation Area YIN Historic District Y/N X-S,-n 4 rTpk
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: rz,4 i Z+ P2
Address: 5 '7 4J .tq (L iZ o,✓ rj Telephone: q,-7 p
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: 5 7-F Lo o 2 R�.� v L..p
bl<,a e r WA Li
-----Mail Permitto: C 4 1 - Sr ogt'�f�10 i,tb-0
t4 v,`i#" rb 11ro off 5 '.. � n �� � •" � � +i'.�
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4 Salem H71�-istoricalCommssion h. .,. i 4 ptr r4 't k a,�t ry _
° + "• ' �^^ ` 120 WASHWGTOH STREET,SALEM,MASSACHUSETTS 01979: - 's
' .� it(978)745.9595 EXT.311 _FAX(97 8)740.0404 ..
C
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed: i
r, c
❑. - Construction # ❑ Moving
xF Alteration — < <
❑ Reconstruction. --- •,.
rl Demolition , 1 ❑ Painting
❑..i Signage t .. :_.❑ Other work
b...tv.a...+...x+.4:,+..,�n+`..«P,n.
as descnbed.bel�w will be appropnate to the preservation of said Historic District, as per the requirements set
forth in the Histopc District's Act(M.G.L. Ch. 40C)and the Salem Histoc_Disiicts Ordinance. i
u nt 4
District
McIntire
T+ddress of Property• � u, o.. etreet w } _ �. ���} � '��' .� ' ���'
Name of Record Owner: David Braizier
+ ' . %r.±w -. •yg•...,y«•. —».—•••., -f, Y+wi *E.'w
Description of Work Proposed:; 7t
). , ...
Repair/rebuild existing�rde wooden porch (visible from Broad Street)to replicate existingwith the exception
Ghat the 2" Jloorgrarling.and post height be increased.. Option to have either 36'.f high railing with 39"high
w' post or 42, high railing with 4511,,high post "`Balusters to be'2 x 2 with beveled"top and bottom rails as existing. a
Dimensio"ns altd desig»of posts to remain the same except for herght'increase Supporting columns to be -
1.1replaced i necessary., _. ^ _ t
f ry,,tn krnd.,�Entrre[o be palmed trim color.,
y ...� ��m'M,. ��YM �nf., 4.a •++..wlL�.N+Y�`?'Y�f�,^.Mj'1�1.,!F y.
d'j "r. n.w.aLmn.+^ .,H....q..�,wns.a.cyna+rt.++ •n.4`v/�n' ?'Y a+•'� ��'
Y a � '� +a � _ � .._........ ..�. n -- —w>.r.+M+.:hY•n1'u^m.YF,S't'.1,
Dated: December 7,2006 SALEM HISTORICAL COMMISS N
5
o outstanding
The homeh•ner has the option not to commeuce.the work it(unless -relates to resolving an o
P ._ t
"i iulationll •all work commencedfmust be completed within one year from this date unless otherwise indicated.
THIS IS XOiNA BUILDING PERMIT..P�easa be sure to obtain the appropriate permits from the Inspect or of
B`uildinas(or am•other necessary permits or appro4als)prior to commencing work.
�Y1S a. s,Y"xkY':�d« �� -,awa�.�..:wu.•..o+.*w+.....+.» ypN •i9w„V •&+� �.. �
q ^kz. "cY- `<, -tm"n...•—�Y �s r•--•� n •-.-•-•. ..gr�s- .. �u y ` ` " r:.sii.'"`'4,�.i:
�5
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Ulf 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): t Q ✓ Cs . .ham 1_1( CoN/ ST
Address: I Ll Ct M A t o 9M
City/State/Zip:?a CI .bo zr>4 MA 6 1 "1 L6 Phone #: q '] 8 53 l 8 Q3 y
Are you an employer? Check the appropriate box: Type of project(required):
1.9,I am a employer with 14 4. ❑ I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' cgmp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
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.] t employees. [No workers' ;'�
comp. insurance required.] 13�Other Q, 6t s t�
'Any applicant that checks box#1 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 hire outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheet showing the time of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. /� AI
Insurance Company Name: A M 1'1 t�T' A .v e C O
Policy#or Self-ins. Lic.#:_&O k Z) 4 n 010 1 a 0 0 `7 Expiration Date: n
Job Site Address: S-1 �. -a 2 SY— City/State/Zip: SALFal
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
tine 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 ofperjury that the information provided above is true and correct.
Signatuire:�_,� � Date:/ O ( 7- 0'-7
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permjt/License#
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#:
E yl,
. , FICA
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Ed%%srd F Sennott Insurance CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
DOES NOT AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
'ASe°"> la` POLICIES BELOW.
IF South Main Sum '
Topsfield. MA HIQS3 COMPANIES AFFORDING COVERAGE
INSURED
Len Gibeh Contracting Compan7ILIC
COMPANY A A.I.M.Mutual Insurance Co
LETTER
..LC�VERAC ? >� ` a5 s r 'tnL '•�' ;t "��.�, .�,.r -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT
TO 11NIC'H THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRTBEDHEREIN IS SUBJECT
TO ALL THE TERMS. E\CLLSIO\S AND C'O\DITIONS OF SUCH POLICIES.LIMITS SHOWN MAYH AVE BEEN REDUCED BY PAID CLAIMS.
C', ll I'LOFINNURANCE I.OLIC1,NUMRER POLICI'EFFECTII'E POLICT'ECPIRAI'IOS LIMITS
LTA DATEIMMDDl9'I DATE IMMIDDRI'I
CENERAL LIAHILIII GENERAL AGGREGATE
PRODUCTS-COMPIOP AGG.
GENERAL LIAIIILITI PERSONAL&ADV.INJURY
il.+.I'dS:dAOE Q^_Clrv. EACH•?'I CURRENL'E 11,
r I.NEE;SIiJSTRAIT'iR'S A-1 FIRE DAMAGEIAn,<n time
I!-1 `.IED.E'CPE.\SEIM•tne ltivnl
U.1(14(1NILE LI\HILT I\' il•.IHI\LD SINGLE
LIMIT
I_
_ Uppll.l I\Il R'i
•�^' .t J�.Lt i a71..
Imo'
I `.:�.'ivn L3;L:OE d•:::waJ:nn
PROPERTI'DAFLAGE
LACH�CCL'RRENCE
UMBRELLA FORM AGGREGATE
OTI IER TITAN UMBRELLA WRM
O'ORKERSCOMPENS.ATION'AND STATUTORY LIMITS THER ,*
EMPLOYERS LIABILITY A
EL EACH ACCIDENT 500,000
x' (jp 1097901'_007 0$!03/3007 08/03/?008 EL DISEASE--POLICY LIMIT 500,000
EL DISEASE--EACH
! EaIPL01'EE 500,000
CONIME\TS DESCRIPTION OF OPERA'TIO\S OR LOCATIONS:
CE_R-TIFIC`ATEHOItiE,[E:' •'wfiaP""�^`4°`+n ,•.'."i...t�'ii.- �..,- n�rep ..�. tom:`» 'gC ANCF.EI7A ON;• �.� ...� ..� ..,,i:
HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
HEREOF.THE SSUING COMPANY WILL ENDEAVOR TO MAIL LQW RITTEN NOTICE TO THE CERTIFICATE
OLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
IR LIABILITY OF ANT KIND UPON THECOMPAFY.ITS AGENTS OR REPRESENTATIVES.
Evidence .df Insurance
-- AUTHORIZED REPRESENTATIVE
_ Page Nc. or Pages
,ro LEN GIBELY CONTRACTING CO., INC. , ' "g't P.,ZQ POSAL
lssss
1,49 Mom Street
a •n. ,, r-.•rtr wr>--"�
PEABODY MASSACHUSETT3 01960 All home Impmvemem oontmetoro and eabdordradtom 1
d z. z , engaged In home Improvement contracting,unless
(978)53,1.8234 specifically exempt from registration by Provisions o1
FAX 5978)531.9304 Chapter 142A of:the ganarel levee,moat be ran ulded f l
Ubmiaad VI 41 -e"AJ�J ;r with the ComhlonWe9lth of Massachusetts.Inquirlee
To: A about.registration end etetue should be made to.the
Olrector,Home"Improvement Centrist;
Ragletratlon,
S7 �pr rr j]� One Ashburton Place;Room 1301;Boston,MA 02108
(617)727=8688:,Owner8'wlio'secure their own
sonntroeflon related permits or deal with amenty and '
` contractors will be excluded from.the Guaranty Fund 10
t Provision of MGL C.142A.
'xeoomerom ke ' •�' �r'+Vs o
RAKE Dos L MA.REG.100811 ;
-7Irs oss3 �/'21-0�
➢swNawp. - mewu*wN .r 4u( ✓J
, u
u
N°MreW submit epedlkeYom Wectlnufaeror warkmbe PmrOnnetl ens memnebmbe u°M: �' Dy- /� A..LA$/IL
�ST /oo i a Q
.;Ar,,.; -1.:r<tau /xy �...o,-� Ed � � t�0"a•�Lce>, .Lhs%rr
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r.d '`�oD • .d Odd �f/eleve:h;,
Taw
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e3T 6� ono a
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t�lh e,ra ui
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a
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or
MIN o" W Mk 'some..
boul't tl0 (Uau. Xna akY c°ueeE Wclrtumel°nw Eryo�N tl�iYluenolawMONep.egoorr MVIe aOnlmna eMllPicl�EOmregeleE O°vbIm1110m
° OM spies Msf nubMedmlN ENa°re OPPOd^rtro eM met wcnMM _ ,IKO IOytlon eM IwII wmPN wIM
0 Or esenae tllkm'ereO MNM
me Cmn°mw wmnntlW lM woA m�meKen�ub�l M�waMn MMm EOecb ln•metaW utl waMrumKlD bra POnOC rA wauu�omlavoarem '
wmerormb,w aemeeeu aeE W Me Cwvax'jr Kro be °tlkd Ixlre0.or.,regaYeE..
Me u001rem0naNMb newmenl. aasaurvne em'llu0ecs0^OenOmutlmOonna0lbn WM tlu°O�IP°^'�^OfK - '.�
Wm°nB Mmeb Iw�lunen p yIM Mgmtilw o'�m mmere0 mrnrdpi nriwM. ar1Bm•fOP -
euMEemepa0r �p /
WB PrOPOSB lieietiy to turnieh material`and Ivebor` co kplete In accordance with above specif`d d1ene($r the su01: —'
Payment to b j de ea Iollowe � ; :•� e' 'T"�.. „�<"+_<[•� t t 1 '
_15%li 3�ju'pun mmmw�°�� wwm.gww.e?wtlm.m � r .. 1 � �
_%ls "'• )wo m pletlon of� `✓ —" 'a so-«lum..
.• "s Wires*Io,eMM upon
is )oomyetlon of wors U rMh oordeol
Notice. NO agreement M Inrtre Impmwmem mniremlM work°lull raquln a emxnor ,
payment tmot aol mmerrK ueMm/Nora ll OepOslle w peym4etivery meoesete ntemle eimn PIeVmOnf.. bfutN.m,nWwnmrwmgoEw lMm
`�.,(aM0n0e a °O6IO en eMUm uiPM sPetlelortlm nete
oVarvveobu .
-x,ytY• r.vk»:+`.t•✓+•%s—>`` Iry�gtjons and conditions slated.I understand
AOceptance of PR)POsel I have reed both sides of this.document and pt he price&spec
that upon signing,Mis Prbp becomes a binding contract.Ymtare surnomed to do the Work es speci0ed. Payment wlll:ba'made es outlined above.
y.,b s
.You,the Buyer,may Dental this trensectlon at any timeprior to midnight of the third buslnesIT
s'day ettarc;
the date of this trensaetlon:Cancellation must be.d F THERE CARE ANY BLANK SPACES:
O NOT SIGN THIS CONT ..,4:.
e
IMPORTANT INFORMATION ON BACK
sgnebre - e �
...:._.......... . ... .....,...........:..... ..........
.... ...... .......... _.... � ... .._...,......._.... *;
Board of Building Re and Standards
HOME IMPROVEMENTENT CONTRACTOR
Registration: 100811
Expiration: 6/23/2008
Type: Private Corporation
LEN GIBELY CONTRACTING.CO:, INC.
Leonard Gibely
149 Main Street
Peabody,MA 01960 Deputy Administrator -
Ae 70orrtanosuoerr . o�./uaaadtrrywrl�
y BOARD OF BUILDING REGULATIONS
ti Weense CONSTRUCTION SUPERVISOR
s
Numbata pC9� 094783
i t i Ofi/14/�EY10 Tr.no: 94763
v R
,. THOMAS R DOB
19 CEDAR HILL D .
DANVERS, MA 01923
Commkslo
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