51 WASHINGTON SQ NORTH - BUILDING INSPECTION 10/02/200\088 09�: 2244 9787409846 CITYOF SALEM PAGE 01/04
The Commonwealth of Massachusetts
' Board of Building Regulations and Standards Town of
Massachusetts State Building Code,780 CMR, Th edition BuildingWilbraham
Dept
- 1 Building Permit Application T onstruct. Repai RenovareOr Demolish a 413-596-28DO
One Two-,F i)v Dwell! I xt l lg
is n For Offtial U only
Building Pcrrn' Number: sx A 4
i
Signature: b Lts s o 23
Building Commis. d in Of of Buildings e
SECTION 1-SITE I RMATION
1. P operty dd s: .2 Assessors Map& Parcel Numbers
L IA1!s this an accepted street?yes Map Number Parcel Number
13 Zoning Information: - 1.4 Praperty Dimensions:
Zoning Disnkt Proposed Use Lot Area(sq R) Frontage(ft)
LS Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.Lc.40,554) 1.7 Flood lane Information: 1.8 Sewage Disposal Systems:
Public Q Private❑ Zone: _ Outside Flood Zone?Check if p Municipal p On site disposal system Q �
SECTION2: PROPERTY OWNERSHIP,
Out er'of eeord: N
me(lrrinD Address rer Service:
fG
gg�iz� Telephone .-
SECTION 3:DESCRIPTION OF PROPOSED WORK'(cheek oll that apply)
New Construction❑ Existing Building Q Owner-Occupied Q Repairs(s)MI Alteration(s) Q Addition G
Demolition ❑ Accessory Bldg.Q I Number of Uri Other ❑ Specify:
Briel'Descriptioo ofProposed Wor
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
I, Building S 1. Building Penrdt Fee:S Indicate how fee is determined:
2:Electr cal $ p Standard City/rown Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Su ression Total All Fees:$
6,Total Project Cost S Check No._Cheek Amount: Cash Amount:
0 Paid in Full O Outstanding Balance Due:
10/02/2008 09: 24. 9787409846 CITYOF SALEM PAGE 02/04
,
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
� ^)rc, t.lccnsc Number Expiration Date
CM Litt CSL Type(sac below), _
Addrcs ^ � Description
Re
Off
Untes;rict to 35,c>DO Cu.Ftt
SiSi atu�l�� Restricted I&2 Famil DwellinMasonry Only
Residential Roofrn Cover'TelepMne Residential Wlndowand Sid;na
sidential Solid Puri 8umin A fiance tns[atlation
Residential minolition
Regsstercd Home Inc rovement Contractor(FII Ii Zr,nricNcrr cR
.tuC Comp y Name or HIC Registrant N e Re istration Number
J cC p �^ ran 1/y
A 7 D 1 3 J 7.7t%r Expiration Date
V T
gnature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c, 152.4 25C(6))
Worker Compensation insurance affidavit must be completed and submitted with this application. Failure to provide
this uffidevit will result in the denial oFthe Issuance of the building permit.
i Signed AlGdavitAttached? Yes......... No
SECTION Tat OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i, 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.
-signatmeofowner Date
SECTION 71s:OWNEW OR AUTHORIZED AGENT DECLARATION
1, )CtQ�{' ' ►Y1�Y��, ,as Owner or Authorized Agent hereby declare
that the statements and information on the fdfegoing application arc the and accurate,to the best of my knowledge and
blilaalf
Print Name
SiRnature of Owner or 7cd Agcrtt Date
(Signed under the pains and penalties of u
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?SI have access to the arbitration
program or guaranty fhnd under M.G.L. c. 142A.Other important information on the HiC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and I I O.RS,respectively.
2. When substantial work is planned,provide the information below: -
Total floor area(Sq.Ft.) _ (including garage,finished baaemenvattics,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 heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Tote)Project Square Footage"may be substituted for"Total Project Cost"
10/02/2008 09: 24 9787409846 CITYOF SALEM PAGE 04/04
CITY OF SALEM
'Mi'l .", i
;*- PUBLIC PROPRERTY
DEPARTMENT
%':,hilt.9 1
\I,,,of II:�•^,HI?aa,).�9St:,CL't•1vI tM.M.t]v.,.,t If c! 1 Ivv177:
11.1.'l74:ti'li•K • h,a •!7x•:/C'+sur
warkers' cum pensation Insurance li idavit: BnildcrsrContracturslEtectriciuns/Plumbers
i tti nl Infurtnalion Please Print Le ibly
r�r..
Nit Inc Ilhl.ilw.rl7rpsnlr+uon•Indtvdurl l:
Akldl oss:
Cilyr.ytarC•%ip• ln,� IrOLL C)rLS I'hunej': �9 3 7s
r.%rreer)nu an cloployer7 Chuck the appropriate We: 'Typo orproject(required):
I :ant a empluyur with—UL—_ 4. O 1 Inn a puneraI eNnlractor and 1 G, ❑ Now ew4svueUun
C Di111J)Cl'?(i Jll and'Jr pal n-tin;a).• havu hircet t)tu vuh-controcwrs 7. ❑ RettwJelinQ
2.❑ 1 aal a sole propriator or goner- These
o the nmached shave
ship ali,l have flee utnpluY;ros TThese suD•comractnra have tl. ❑ 17en101iriun
,vnrking fi)r tm: in any cap:n:ity, workers' eotrsp. Insurance. 9. 0 Iluildingaddition
Nis wntltvrx ralnp. insurance 5. ❑ We aee a e01•(laralion tend Its 10,0 Electrical repkira ur additions
rcquired.� olYcerx have swish d their
ri• of aaenl mn r MCL 11.0 plc nbing repair,or oJdilinrte
).❑ 1 and a homeowner doing all work l W
myself. (No,vprkcrs' oonlp. C.
152.§I(4),and we hove no 12.10o Ruvl'mputrs ) 1
insurancereyuiied.J' empluyvcs.lNn workers• 1).,ryl Utive )1
cmnp. itwurancc mquir,nit)
•.,ny.4i,l�cwn flow cheeks 00 111 man also till ern Inc Vo.w Woo,riwwine IArtv uwkwi vun,pfawliun pefwy Il,hlmoolkln
` t„mwlw�n who>Iattnil Mil sfadsvil inolea,lne llmy at aotaki all work wits than him wnsida cunlraettm moo•uPma a new a1Y.Ila•N inaiull nN vNh.
d..nlrrur.char.kck role kex IrhW snaehW g a<:16tiI>r.al dah Jwwine tlta ns)ne dnw wd-cemrxvals ana Ihnt aaRrn'comp.ryd,cy mfwmarl,.n
11un an rrnplaver that Is pruldrfinp rvewhere'tumpenreriffn inxurnnee jwr any elnployeer. Beluty it the pu/pay utrrpJab..%te
ilrfalMullrK —��
I rT11la11CC(Jnlpany Jfame:��_.._. •.• .. .--__...---_� q �i
Ih)tiuv As or Self•ins.Lie. M: . .. . Ewpirultun Date: I 7
t
tub Situ -lddn _av:� I 1�t2�7t`l T-n �(le�• City>>tuterZtp-a- 12fh y��COO
Alfach a copy of the workers'cumpenlathtn pulley deviarailon page(showing the Volley cumber and espiradun date).
1+ailorc tJ.,:curc rovemge as rrquired wltkr Souiun?5A of�IGL c. 151 cAt lead to the imposition or criminal penalties of a
tin.up h+91.500.r1n anllrur ana-year imprisonlncnr,as well as ri,al pcmAws in the I•urin of a STUD NVORK ORDER arhi a Tine
of up lot$250.00 it Jay aguirlu the violator. Ile advaxcd that a u)py uribit atakainunt may bu lerwarded to the 0111cc Nor
to,.•..ng.n,nts Jr;ln: Ulr\ obr wsur:u•.cc:,n cr.lgc ,erilicathm.
1 du Itrrc'ny.rrAfy Radar! r ' x mid lendiifs of perjary rho,role rarform wron provided above is tome and rarrecr.
I•h,..e r ��� - 9 — 7Sro r --
U//if,iur nxe urdy. nu ItM hrllf In f11ix Nrt'ar re be rYNff/prled i)y elJy ur loom ra1Jir'l0t '
I
f ifs or I'o,rs:_..,, ,^ Yermitll.icvmc M.
having.\ulhuritr (circle uac):
I. Rt•ard u(Ilcalih I. limiding IyullsrUwcttt .).l:it):1'uau Clerk a, CIccirial) luspvelor 5. Plumbing Inspector j
4.l)I lief _
G>olacl )rerso"l Phone q:
10/02/2009 09:24 9787409846 C'.TYOF SiCLEM PAGE 03/04
CITY OF SALEM
PUBLIC PROPRERTY
` DEf'AR"r TENT
'•;� ; . J; 1\ ,.gyp\r. . '.11J11 r . ,,,l I%I. \..1i •, 1 .I'r .
Construction Debris Disposal At'lidall
(re,luireLl I'ur •all demolition and rcttoration %Volk)
In accordance Aid, the sixth edition of the Statc Building Code, 7SO CAIR satiuo t ) 1 .5
Dchris, and the proaision$ of MGL c 40, S 54;
Building Permit tf is issued with the condition that the dcbris resulting from
this work shall he diiI)II or in a property licensed waste disposal I'aci lity as defined by %4GL c
t l f. S 15f)A.
The dcbris Hill he transported by:
)
manic of hauler)
1 he dcbris will be disposed of in
�I t
t n�rr,r ul Isc,hty) 1
�.m��dl g14
t addn'�<.J r�cUilyt
.r�n�ture ar'pdrn nr xjilt
t0 o�
CHA 10/8/2008 Pi03 AM PAGE 1/001 Fax server
COPY
�Wwdv`..A+• • 'fig• Cc[uber 3, 2009
1Ak5 °n Surely
LICENSE AND PEMT BOND
IC40W ALL PERSONS BY THESE PRESEA'TS: Bond No. ?CS961'r0
Thstwe,Boranno Gonatruct,i�}�Inc_._ --
of the City of Ar in tQr� —_., StateOfK hue tta ` as Principal,
arul WESTERN SURETY COMPANY, a rerporedon duly beensed to do surety brwinass in the State
114asac414net'-a as 6tuety, are held and 8rm'_y bound unto the
City of, Salem , 3tsteofT`assacbuoctts . as Obligee,in the penal
e;'m of One Thou9and and OO/lOC _ AOULARS(—%I.000.00 ),
lawful money of the United States, to be paid to the Obligee, for which payment well uA trtily to be made.,
we bind ourselves and our legal represem,atives,firmly by there presents.
THE CONDITION OF THE ABOVE OBLIGATION iS SUCH, That whereas, the Prindpal has been
licensed. GideMalk Contrector
by the Cbligse.
NOW THEREFORE,if the Principal shall faithfitlly perform the duties and in all things comply
with the laws and ordinances, including all amendmenta thereto, pertaining to the license or permit
applied for, then this obligation to be void, otherwise to remain in Rill force and effect
Go�obex 3rd _,..20r , unless renewed.by O'ontinuation Caztifioate.
This bond may be terminated at any time by the Surety upon sending notioe in writing,by Firer Class
V.S. M the. Obligee Find to the Principal at the sddreae last known to the Surety, end at the
erp' ve W) days 4om the mailing of said notio% this bond shall ipso facto terminate and
th eh upon be relieved from any liability fm any sere or omissions of the Principal
a e ' Rogardlem of the number of yew this bond shall continue in fomc, the number cf
c ads bond: and the number of premium which shall be payable ar paid, the Surety's
t of li all not be cumulative ftom your to Year or plod to prod, and in no'event shall
t t ty'for ell claims exceed. the amount set forth above. Any revision of the bond
am ��I�umulatiLe. '' .
Acted 6th day of October 2006 .
BONANNo CONsrIkUCTION, INC.
Prinetpal
Principal
COVNTEFBT. NEG W3STE?0TjR4TXn COMPANY
BY NOT NEEDED
-e^iaera anon SY —
Past T.brunat,SeAor Vice?reevient
��eaaara�
ACORD CERTIFICATE OF LIABILITY INSURANCE ON ID A DATE9/16/08
BONAN-1 09 16 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Commercial Ins. Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
30 Church Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Belmont MA 02478
Phone: 617-489-1700 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER Ama!. mtesnacioval G.O
INSURER B: Acadia insurance Company
Bon anno Construction, Inc. INSURER C.
12 Lonc�moeeadoN Road INSURER D:
Arlington MA 02174
� INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTIARTHSTANDING
ANY REDUIREM ENT,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 HEREN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHGNNN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR TYPE OFINSURANCE POLICY NUMBER DATE MAID DATE AMID LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,o 00,13
B $ COMMERCIALGENERALLIABILITY BOA-0192842-11 09/16/08 09/16/09 PREMISES Ea otturenrE $300,0D0
CLAIMS MADE ®OCCUR MED EXP(Arty One pereon) s5,000
PERSONALSADVINJURY $ 1,000,000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-OOMP,OPAGG $2,000,000
$ POLICY PRO, LOC
AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $1,000,000
ANY AUTO (Ea amiE IR)
ALL OIANEDAUTOS BODILY INJURY
B 8 SCHEDULED AUTOS AAA-0192845-11 09/16/08 09/16/09 IPer lmmn) $
8 HIREDAUTOS BODILY INJURY $
$ NON-0 NEDAUTOS (Per a¢itl )
PROPERTY DAMAGE $
(Pera.c rl)
GARAGE LIABILITY AUTOONLY-EAACCIDENT $
ANY AUTO OTHM'-LAN EA ACC $
AUTO ONLY
ADD $
EXCESSNMBREIIA LIABILITY EACH OCCURRENCE $ 11000 000
B 8 OCCUR �CLAIMSMADE CUA-0196221-11 09/16/08 09/16/09 AGGREGATE $1 000,000
$
DEDUCRBLE $
RETENTION $ $
INORKERS COWENSATION AND $ TORY LIMITS ER
A ESIPLOYERV UPmI WC 896-58-74 09/16/08 09/16/09 -EL EACH ACCIDENT $500000
ANYPROPMETORIPARTNER/ ECUTNE
OFPCERAHEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500000
R yeas tlexrloe u r
SPECIAL PROVISIONS a IM E.L.DISEASE-POLICYLIMIT $500000
OTHER
DESCRIPNON OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
INSVRANCB VERIFICATION
CERTIFICATE HOLDER CANCELLATION
NANCYBO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATETHEREOF.TKEI$ lU INSURERWILLENDFAVORTOMWL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
NANCY BOBS
16 ALBION STREET REPRESENTATIVES.
STONEHAM MA AUTHORIZED REPRESENTATIVE
Arakel Yacublan
ACORD 26(2001/08) OACORD CORPORATION 1988