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10-1 WEATHERLY DR - BUILDING INSPECTION (3) n I [3 -- Iu -Igos "Che Commonwealth of Mnss=k1 1?(QL S CITY OF r'1 Board of Building Regulation! d tandards SALEM Massachusetts State Building Cod��epp1yy78Q�(vlRa P Z Revised blur 20l! Building Permit Application To Construct, Repah`; Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Onl Einformation: Permit Number. Date A plied t. Official(Print Mune). Signature . . Date (� SECTION 1:SITE INFORNIAT1ON` erty Address: ��`� 1.2 Assessors Map& Parcel Numbers is an acce ted stree yes no Map NumberParcel Numlxr ng Information: 1. PProperty Dimensions: trict Proposed Use Lot Area(sq It) Frontage(11) ing Setbacks(R) Front Yard Side Yams 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: Zone: _ Outside Flood Zone? Munici al❑ On site dis sal s stem ❑ Public CIPrivate❑ Check if es❑ p po y SECTION2: PROPERTYOWNERSHW': 2.1 Owner'of Record: © jtpejr �J-We -m 1vl/4 557/970 throe(Print) City,Slate,ZIP No.and Stmet Telephone Email AJJnxs SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owne -Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ accessory Bldg.❑ TNumbr er of Units_ Other ❑ Specify: Brief Description of Proposed Work-: /✓6-(,) f-r17z✓4t J ee962'tTC ��,3 7-A l i /tJl^^� -.c9�✓a S /oe.e.iirf- •zu l 3 /( /v c-.� sec, �2 �/ G� G-tt.�/�vG /i✓ .b-/l /fltiti• f //'O.ZF�'E QG��'r.i t�l /w !r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building S /G G� 1• Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ' GGG CI Total Project Cost'(Item 6)x multiplier 3. Plumbing S /GGP �c !�*,gtherFees: S 4.Mechanical (FIVAC) S - List: ` C 5.i\lechanie:l (Fire S Total All Fees:S Suppression) �. <w Check No. Check Amount: Cash Amount: 6.Total Project Cost: S ❑Paid in Full ❑Outstanding Balance Due: c SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL'rype(see below) y 30 ��rv[zff Jf 7 Description No. mud Street ��X96E?y& 4� � G/�� Unrestricted 2 Family s u el ing cu. Il. R Restricted I&2 F:unil Dwelling Cily/fuwn,Stale,ZIP M Masonry _ RC Roolina Coverin WS Window and Siding SF Solid Fuel Burning Appliances 7 f/_6,,1 7 SS 5- I 1 Insulation Telephone Email address U I Demolition 5.2 Registered Home Improvement Contractor(HIC) /6 Ea kBGLS fcw &V HIC Registration Number Expiration Date HINmp:mN v, o iC Registptt :one cJJ cell No. andSueet ��fy� 7��_�7�_7 Email address di * City/Town,State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(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 Isguance building permit. Signed Affidavit Attached? Yes .......... No...........Cl SECTION 7a:OWNER AUTHORIZATION:TO BE COMPLETED.W HEN OWNEWS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorizer t9 act on my behalf,in all matters relative to work authorized by this buildin permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, i hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agee ' Nanw(Elecunic Signature) Date NOTES: I. An Owner who obtains a building permit to Jo his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program),will Lial have access to the arbitration program or guaranty fund under NI.G.L.c. 142A. Other important information on the HIC Program can be found at wwvv.mass. •uL �.!OCa Information on the Construction Supervisor License can be found at w�ov:!dns . 2. When substantial work is planned,provide the information below: 'total floor area(sq. R.) .(including garage, finished basement/attics,decks or porch) Gross living area(sq. 11.) 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 Enclose) Open_ 1. `Total Project Square Footage" may be substituted tor-Total Project Cost" T° CITY OF SALEM. l/'WSACHUSE1TS BUILDING DEP.IRTMEINT 120 IXl.isHLNGTON STREET, 3w FLOOR TEL (978) 745-9595 FAx(978) 740-9844 Kl\(BAY DRISCOLL T1Otk1As ST.PIFRAE i;Nt.%YOR DIRE(-TOR OF PUBLIC PROPERTY/BUILDINfG CO\CUISMONER NVnrkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anolicant lnformatinn s—� Please Print Legibly Name(nusi'mssOrganiralioulnJividual): R9� vlS(GA✓ 73tlm L_i�- Gif197CGY—TiCrtf LLC Address: c>o Jr�Z � (fl Cily/State/Zip:M WCWW 14s6' alfW_ PhoneM -2f-! — G,� [3. c un employer?Check the appropriate box: 'type of project(required): I am a employer with 4• (] i am a general contractor and 1 6. ❑New construction employees(full and/or pan-time).• have hired the subcontractors 1 am a sole proprietor or partner- listed on the attached sheet. t ?• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working'lin me in any capacity. workers'comp. insurance. 9, 0 Building addition INo workers'comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additicl s myself.[,No workers'comp. C. 152, g 1(4),and we have no 12.0 Roof repairs insurance required.) t employees. [No workers' cutup. insurance required.) I3.❑Other -Any applic:un dad checks but sI meal also fill uul the section below showing'hair workers'campenadon policy ini mnallon. 'I lomvowm"wha,uhmit this anlMvil indicating they am doing all work and than hire oulsidocontmaon must auhmit a new anMdavit indicting such. :C.nnrwwn ihul chuck This bug mot alachat an addittunul shot showing lM nano o/the aub4onlrutun anJ their warken'wrap.pullcy information. t one ass einpluyer that Is providing workers'c empensadon Insurance for my employees. Uelov Is doe pollcy and job site htjoritration. Insurance Company ,yore: __... Policy M or Sclf--iiu. Lic. d: Expiralion Date: Job Site Address, City/State/Zip: ,%itacb a copy of the workers'compensation policy declaration page(showing the policy number and expiratlon data). failure to secure coverage as required under Section 25A af\IGL c. 152 can lead to the imposition ofcriminal penalties ofa fine up to S1,500.00 und/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S230.00 a day against the violator. 13e advised that a copy of this statement may Ise furwarded to the O13ice of Investigmionc ol'titc DIA fur insurance envemge verilication. /do hereby certify sander the pubts and renattles u/perjury that the injurnrullon provided above is true and corrrrec•it 11 •' Ills > J �� Daw: Phoned: OJ/iciul use only. no nor write in thiv area, to be cunipleted by city or tawn n/pcial City at Town: - -- --- Form ful.1conse At__ . I.s.suing Aulburily (circle one): L hoard of health 2. Building; Mparfulent J.Cilylfowu Clerk s. F.leetricsl taspcctor 5. Plumbing Inspector b. Other Contact l'crvtu: _ _ Phonc .l: i Marcia Kirkpatrick From: Thomas St. Pierre Sent: Thursday, December 04, 2014 8:28 AM To: Marcia Kirkpatrick Subject: FW: 10-1 Weatherly Drive, Salem MA 01970 FYI From: Cyndy Anselmo [ma ilto:cyndvCdecollc.net] Sent: Wednesday, December 03, 2014 3:05 PM To: Thomas St. Pierre Cc: precisionremodelingmhd@gmail.com; pattyaocCabyahoo.com Subject: 10-1 Weatherly Drive, Salem MA 01970 Dear Tom I am not sure what happened but I believe the email I sent to you regarding the approval of work to be done at the above referenced property was never received by you. The Board of Trustees of the Weatherly Drive Condominium Trust has approved remodeling work to be done on property owned by Patricia O'Connor at 10-1 Weatherly Drive, Salem, which work is being handled by Adam Dixey of Precision Remodeling of Marblehead, Mass. If you need anything further, please do not hesitate to call. Cyndy Cyndy Anselmo East Coast Properties, LLC Real Estate and Property Management 400 Highland Avenue Suite 11 Salem,MA 01970 P: 978-741-2003 F: 978-745-9684 c rnd ?4eeplle.net 1 QTY OF SALEM, MASSACHUSETTS 1K BUILDING DEPARTMENT t, 120 WASITNGTON STREET,3ADFLOOR TtL. (978)745-9595 FAX AX(978)740-9846 MAYOR THomAS ST.PIERRE DIRECTOR OF PUBLICPROPERTY/BUIIAING 00AMSSIONER Construction Debris Disposal Affidavit (required forall 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 c40, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: ��c�SCa� 2 Qi,✓� (name of hauler) The debris will be disposed of in: 1 ow Aj (name of facility) (address of facility) G Signature of applicant Date