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26-36 WEATHERLY DR - BUILDING INSPECTION . I CITY OF SALEM PUBLIC PROPERTY DEPARTMENT - KIMPERLEY DRISCOf..I. MAYOR ' 120 WnstIINGTON$"IREL'T*$ALEM1f,D'LiSSAQiUSE"ITS 01970 /-- TFL978-745-9595 ♦ I",.tir:978-740-9846 a APPLICATION FOR PLAN EXAMINATION AND I BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS IMPORTANT:Applicants must complete all items on this page SITE INFORMATION Location Name Weatherly Drive Condominiums Building 26-36 Weatherly Drive Property Address 26-36 Weatherly Drive, Salem MA Located in: Conservation Area Y/N N Historic district N APPLICATION DATE July 8, 2009 � Use Groups h (check one) .�1 Group Homes R3 R, Residential(3 or more Units) R2 X A Type of improvement Residential(hotel/motel) RI (check one) Assembly(Theaters) Al_ New Building_ Assembly(restaurants&clubs) A2r_A2ne_ Addition Assembly(churches) A] Alteration Business B_ Repair/Replacement X Educational E_ Demolition_ Factory(moderate hazard) Fl_ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building_ Institutional(residential care) 11_ M Institutional(incapacitated) 12_ Institutional(restrained) 13_ Mercantile M_ Storage Sl_Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please type or Print Clearly) ..4, OWNER Name Weatherly Drive Condomium Trust,ICOIAmerican Properties Team t, Address 500 West Cummings Park,Suite 6050,Woburn MA �l Telephone (781) 32-922 > Signature �$ DESCRIPTION OF WORK TO BE PERFORMED I4- �, 3 Replacement of shingle roof ESTIMATED CONSTRUCTION COST $17,791.66 CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIN[BrRJI.Y DRISCOLL MAYOR 120 WASHINGTON STREET♦ SALEM,MA�ACI IUSETrs 01970 TEL:978745-9595♦ FAx:978-740-9846 CONTRACTOR INFORMATION Name Environmental Restorations, Inc. Address 10 Hazel Drive, Hampstead NH 03841 Telephone 603-329-6101 Construction Supervisor's Lie # CS 71077 Home Improvement Contractor# 117430 ARCHITECT/ENGINEER INFORMATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULATION Estimated Cost x $11/$1,000 + $5.00= $195.76 COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge under the penalties of perjury Signed (owner) (agent) APPROVED BY DATE APPROVED: ' CITY OF SALLM ry PUBLIC PROPRERTY DEPART'NIENT Construction Debris Disposal .affidavit (rryuired li)r all demolition :utd renocalion work) In accordance will the sixth edition of the State Building Code, 7SU CNIR section 11 L5 Dcbiis, and the provisions WAIGL c 40, S 54; Building Permil N is issued with the condition that the debris resulling front this work shall he disposed of in a pruperly licensed waste disposal facility as defined by MGL c I1I. S 150A. The debris will be transportcd by: Via Ste Inamc tit hauled I lee dchris will be disposed of in 4al�l�K/ m/�- 1name ul I'uulny) L�JJn;. ..I'I]alilyl n alute ,t(p• 11 itt .11y4inl 2 /3 0 lulr CITY OF S.U.E.`I, �LXSSACHL:SETTS BL'ILDNG DEPARTIEINT 120 WASHNGTON STREET, Seca FLOOR TEL (978) 745-9595 FAX(978) 7449&M lej- 1tIEY DRISCOLl MAYOR THObtAs ST.P�luts DIRECTOR OF PL BLIC PROPERTY/gL IQDNG COSMUSSION ER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers >Pftlicant Information Please Print Legibly Name (Busincuo.Orrgaaniozanotm In/Jtviobsd): El) VI rl IIYfffik pat` &t1/ws � t--w ( - Address- Vz, city/State/Zip: ��7,4E e l Phone N: &00 -0/ 0 1( ire 'on as employer'Cheek the appropriate box: Type of project(required): 1.[71 am a employer with r 4. 0 1 am a general contractor and 1 6. ❑New construction employees(full and/or pan-time).• have hired the sub-contractor 2.0 1 atn a sole proprietor or partner- listed on the attached shteet. : 7. Remodeling ship and have no employees Then sub•contractorx have g. ❑ Demolition workingfor me in an capacity. workers'comp.insurance. Y P ty• 9. 0 Building addition [No workers' comp. insurance S. 0 We are a corporation and its required.) officen have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL I LO Plumbing repairs or additions myself.[No workers'comp. c. 152.01(4),and we have no 12.0 Roof repairs insurance required.) t employed. [No workers' 13.❑Othtr comp. insurancerequired.j .Any applicant this chub Dos o I must aim fin out the section hclow,shoring their worken'c"Vent don policy infurmatlon '1 w.tmemvtwu who submit this atlldrre indicating they am doing all work artd then him ou"join Cw nrnck n ova submit a new amdavil indicting suck :r.mtracten ohm cheek this ban mud artached m 3d6lio ml sheet.hawing the n um of dos su►coman swe and their w.nama'comp,policy information. i am an employer that it providing workers'compormadon insarawer for my employees. Below is the pokey onslim rite information. Insurance Company Name: /,, ' S /� L / �} Policy N ur Self-ins. Lic.�,H: ✓V� �p� ��Q '-f"`�S Expiration Date:_ U Job Site Address: 1V NJ0f/lV bY4t)lQJ City/Stave /Zip: 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 S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the Corm of a STOP WORK ORDER and a floe of up to 5250.00 r day against the violator. Ile advi. d that a copy of this statement maybe furwurdcd to the Otrice of Invcsngatiunn ol'the DIA for insurance covcrago verification. well i do hereby eerti#ardor the pains and penalties of pedury that the informallow provided above is true and carreca Dale: Phone 4: 'mil - (0/O ' iO1riria/use anly. Do nor write in this area, ter bs camp/et[d by riry ter town u/JirtuL City or fuwn: _ __ Permit/I.lccnse N _. lesuing.%uthuril-y (circle une): - --_ 1. Ituard of fleallh I. Ruildinu Department 3. Cityirown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other l: uuact Person: _ _ _ __, __. Phoneii: F CITY OF SALEM �r PUBLIC PROPERTY DEPARTMENT KINIBERI.FY DRISCOLL MAYOR 120 WASHINGTON STRFFT♦SALFM,NIASSAO iusF_Trs 01970 TmI 978-745-9595 0 F xx:978-740-9846 APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS IMPORTANT:Applicants must complete all items on this Page SITE INFORMATION Location Name Weatherly Drive Condominiums Build in 3 Weatherly Drive Property Address 3 Weatherly Drive, Salem MA Located in: Conservation Area Y/N N Historic district N APPLICATION DATE July 8, 2009 Use Groups (check one) Group Homes R3_R4_ Residential(3 or more Units) R2 X Type of improvement Residential(hotel/motel) RI_ (check one) Assembly(Theaters) A]_ New Building_ Assembly(restaurants&clubs) A2r_A2ne_ Addition Assembly(churches) Al Alteration Business B Repair/Replacement ) Educational E_ Demolition_ Factory(moderate hazard) Fl_ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building Institutional(residential care) 11 _ Institutional(incapacitated) 12_ Institutional(restrained) 13_ Mercantile M Storage SI_Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Weatherly Drive Condomium Trust,ICO/American Properties Team Address 500 West Cummings Park,Sufte 6050,Woburn MA q Telephone (781)932-g229 Signature DESCRIPTION OF WORK TO BE PERFORMED Replacement of shingle roof ESTIMATED CONSTRUCTION COST $9,241.70 L CITY OF SALEM PUBLIC PROPERTY DEPARTMENT K WHERL.EY DRISCOL7. MAYOR 120 WASHINGTON$'IREET#$AL.I'iAl,11A-%ACHU51i rIS O79]O TEL 978-745-9595♦ FAX;978-740-9846 CONTRACTOR INFORMATION Name Environmental Restorations, Inc. Address 10 Hazel Drive, Hampstead NH 03841 Telephone 603-329-6101 Construction Supervisor's Lic # CS 71077 Home Improvement Contractor# 117430 ARCHITECT/ENGINEER INFORMATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULATION Estimated Cost x $11/$1,000 +$5.00= $200.07 COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge under the penalties perjury Signed"` (owner) (agent) APPROVED BY: / DATE APPROVED: CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMIERLHY DRISCOIJ, MAYOR 120 WASHINGTON STREET♦SALENt,1`1ASSAa IUSEI I5 01970 TEL 978.745-9595• F.ix:978-740-9846 APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS IMPORTANT:Applicants must tom Plete all items on this paRe SITE INFORMATION 1 Weather) Drive Location Name Weatherly Drive Condominiums Building y Property Address 1 Weatherly Drive, Salem MA Located in: Conservation Area Y/N N Historic district N APPLICATION DATE July 8, 2009 Use Groups (check one) Group Homes R3_R4 Residential(3 or more Units) R2 X Type of improvement Residential(hotel/motel) RI _ (check one) Assembly(Theaters) Al_ New Building_ Assembly(restaurants&clubs) A2r_A2ne_ Addition Assembly(churches) Al Alteration Business B_ Repair/Replacement X Educational E Demolition Factory(moderate hazard) F) _ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building Institutional(residential care) 11 _ Institutional(incapacitated) 12_ Institutional(restrained) 13 Mercantile M Storage Sl_Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Weatherly Drive Condomium Trust,ICOIAmerican Properties Team Address 500 West Cummings Park,Suite 6050,Woburn MA Telephone (781 32-s22g Signature DESCRIPTION OF WORK TO BE PERFORMED 14 Replacement of shingle roof ESTIMATED CONSTRUCTION COST $7,891.66 CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KI NIBERLEY DRISCOU MAYOR 120 WASHINGTON STREET♦ SAL E-AI,NLL6ACIi USF_TTS 01970 TEI_978-745-9595♦ P,ix:978-740-9846 CONTRACTOR INFORMATION Name Environmental Restorations, Inc. Address 10 Hazel Drive, Hampstead NH 03841 Telephone 603-329-6101 Construction Supervisor's Lic # CS 71077 Home Improvement Contractor# 117430 ARCHITECT/ENGINEER INFORMATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULATION Estimated Cost x $11/$1,000+ $5.00= $215.56 COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge under the penalties Of 'ury Signed (owner) (agent) APPROVED BY: APPROVED: DATE / �7 t CITY OF SALEM a PUBLIC PROPERTY DEPARTMENT KIAIBERLEY DRISCOLL MAYOR 120 WASMNGrDN$'IREL•'r*$ALEM,MASSACIiUSE'ITS 019711 'ITI_978-745-9595• FAX:978-740-9846 APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS IMPORTANT:ADDlicants must complete all items on this page SITE INFORMATION Location Name Weatherly Drive Condominiums Building_20 America Way Property Address 20 America Way, Salem MA Located in: Conservation Area Y/N N Historic district N APPLICATION DATE JUIy 8, 2009 Use Groups (check one) Group Homes R3_R4 Residential(3 or more Units) R2 X Type of improvement Residential(hotel/motel) R1_ (check one) Assembly(Theaters) A]_ New Building_ Assembly(restaurants&clubs) A2r_A2nc_ Addition Assembly(churches) Al Alteration Business B_ Repair/Replacement_X_ Educational E_ Demolition Factory(moderate hazard) Fl _ Move/Relocate Factory(low hazard) 172_ Foundation Only High Hazard H_ Accessory Building Institutional(residential care) Il _ Institutional(incapacitated) 12_ Institutional(restrained) 13 Mercantile M_ Storage Sl_Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Weatherly Drive Condomium Trust,]CO/American Properties Team Address 500 West Cummings Park,Suite 6050,Woburn MA Telephone (781)9 -9229 Signature I / r o go, DESCRIPTION OF WORK TO BE PERFORMED /^ •F Replacement of shingle roof ESTIMATED CONSTRUCTION COST $17,341.66 CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMdERLEY DRISC.OLL ALWOR 120 WASHING'1'ON$7RGIiT* $eV.EA(,\L%SSAaIcsr_'rrs 01970 TO-,978-745-9595 ♦ Fkx:978-740-9846 CONTRACTOR INFORMATION Name Environmental Restorations, Inc. Address 10 Hazel Drive Hampstead NIH 03841 Telephone 603-329-6101 Construction Supervisor's Lic # CS 71077 Home Improvement Contractor# 117430 ARCHITECT/ENGINEER INFORMATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULATION Estimated Cost x $1151,000+ $5.00= $91.81 COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge under the penalties of per' Signed (owner) (agent) AP PROVED BY: DATE APPROVED: i CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KINmERI:EY DRISCOU. MAYOR 120 WASHINGTON STREET♦ SALEM,nL1SSACHUSETIS 01970 1Y_t�978-745-9595 ♦ Fax:978-740-9846 APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS IMPORTANT:Applicants must complete all items on this page SITE INFORMATION 1g America Wa Location Name Weatherly Drive Condominiums Building_ y Property Address 18 America Way, Salem MA Located in: Conservation Area Y/N N Historic district N APPLICATION DATE July 8, 2009 Use Groups (check one) Group Homes R3_R4 Residential(3 or more Units) R2 X Type of improvement Residential(hotel/motel) RI_ (check one) Assembly(Theaters) AI New Building_ Assembly(restaurants&clubs) A2r_A2nc_ Addition Assembly(churches) Al _ Alteration Business B_ Repair/Replacement X Educational E_ Demolition_ Factory(moderate hazard) Fl _ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building_ Institutional(residential care) Il _ Institutional(incapacitated) 12_ Institutional (restrained) 13 Mercantile M_ Storage Sl_Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Weatherly Drive Condomium Trust,ICO/American Properties Team Address 500 West Cuinmings Park,Sude 6050,Woburn MA I ^ Telephone (781)s -922s I Signature DESCRIPTION OF WORK TO BE PERFORM D U Replacement of shingle roof ESTIMATED CONSTRUCTION COST $17,341.66 . I CITY OF SALEM ,a PUBLIC PROPERTY DEPARTMENT KINWRLE.Y DRISC.OI I. MAYOR 120 WA.SHING'PON$'IREH'I'*$rV.Eb(,11r\SSr\Cli C5E795 07970 Tri-978-745-9595♦ FAX:978-740-9846 CONTRACTOR INFORMATION Name Environmental Restorations, Inc. Address 10 Hazel Drive, Hampstead NH 03841 Telephone 603-329-6101 Construction Supervisor's Lie # CS 71077 Home Improvement Contractor# 117430 ARCHITECT/ENGINEER INFORMATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULATION Estimated Cost x $11/$1,000+ $5.00= $195.76 COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge under lire penalties of per'ury Signed (owner)(agent) APPROVED BY: mg��, DATE APPROVED: CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMERLEY DRISCOI.I. MAYOR 120 WASHING'fON STREET*S.wsnl,h1.\SSACHCSL'"ITS 01970 'M.c 978-745-9595♦ FeX:978-740-9846 APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS IMPORTANT:Applicants must complete all items on this page SITE INFORMATION 17-27 Weatherly Drive Location Name Weatherly Drive Condominiums Building Property Address 17-27 Weatherly Drive, Salem MA Located in: Conservation Area Y/N N Historic district APPLICATION DATE JUIy 8, 2009 Use Groups (check one) Group Homes R3 R4 Residential(3 or more Units) R2 X Type of improvement Residential(hoteUmotel) RI_ (check one) Assembly(Theaters) Al_ New Building_ Assembly(restaurants&clubs) A2r_A2nc_ Addition Assembly(churches) Al_ Alteration Business R_ Repair/Replacement X Educational E_ Demolition_ Factory(moderate hazard) Fl _ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building Institutional(residential care) II _ Institutional(incapacitated) 12_ Institutional(restrained) 13 Mercantile M_ Storage Sl_Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Weatherly Drive Condomium Trust,ICO/American Properties Team Address 500 West Cummings Park,Suite 6050,Woburn MA Telephone (781)932-9229 Signature DESCRIPTION OF WORK TO BE PERFORMED Replacement of shingle roof ESTIMATED CONSTRUCTION COST $19,141.66 h� CITY OF SALEM PUBLIC PROPERTY DEPARTMENT K1NU3ERLrY DRISCOLL MAYOR 120 Wr1S411NGTON$"fRGE"1'*SAl.tsf,Mt.xSSe\CFIuSEI"15 01970 TrJL 978-745-9595 ♦ F.IX:978-740-9846 CONTRACTOR INFORMATION Name Environmental Restorations, Inc. Address 10 Hazel Drive Hampstead NH 03841 Telephone 603-329-6101 Construction Supervisor's Lic# CS 71077 Home Improvement Contractor# 117430 ARCHITECT/ENGINEER INFORMATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULATION Estimated Cost x $11/$1,000 +$5.00= $106.66 COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge under the penalties perjury Signed (owner)(agent) APPROVED BY: ��� ze2 DATE APPROVED: