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24 WEBB ST - BUILDING INSPECTION `�',�� C� -� I�P'� / � .. �.� ' �� C] � mo 1' ,� The Communwea(tli oF�4�sslchusetts �� �+ �-„ Buard of Building Regulatious �nd Standards CCCY OF n '�' N[assacht�setts State Building Code, 730 C�(R SALEbI . 177 • Rzvised�blar 201! Duilding Permit Application To Construct, Repair, Renovate Or olish a One-or Ttivo-Famrly Dtive(ling Chis SectionForOfficial Use 0nly , Building Permit Number. Date A pfiedS,. ' ;, fo /� � Bmlding OfFicial(Prmt Name) . . �Signat Dnta � SECTION L•S[TE1dFORi�tAT[ON. . 1.1 P�r`p��t� d es :�j.��/ ____ 1.2 Assessors Map 3c Parcel Numbers � �/ �! �,YJ 7 L!a [s this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Informntion: L.4 Praperty Dimensionsc Zoning District Proposed Use Lot Area(sq R) Frontage(ft) 1.5 Duilding Setbacks (ft) - Front Yard Side Yards Reaz Yard Required ProviAed Required Provided Raquired Provided � 1.6 Water Supply; (�1.G.L c.40,§54) 1.7 Elood Zone Informatiou: L8 Sewuge Disposal System: Public❑ Private❑ Zone: _ Outside Flood ZoneT h�unicipal� On site disposal system ❑ Check if es0 i SECTION2:, PROPERTY'OWNERSHIPL '. ` 2.1 n r�of Record: Name y�t� �� , ^ ,— Ciry, te IP� I _ �— �\!/ � �� —��������7 .�1 No. Stre t - e ep one ma Address SECTION 3: DESCRIPTION OF PROPOSED WORK''(check all that apply) New Constructian ❑ Existing Buifding❑ O�vnet-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Dzmolitiun ❑ AccessoryBldg. � NumberofUnits Other ❑ Specify: E3rief Description uf Proposed Work': /T� / . , �'1 a .-, . I 1 , I .. _ . � t� SECTIO�Y a: EST[�L4TED CONSTRUCTION COSTS Estimated Costs: Irem Labor and ,�(ateri�is Official Use Only-, , L Building $ I. Buiiding Perm't[Eee:S indicate tiaw fee is determined: Q Stand�rd.City/'Coivn Application Fet ' 2. E(tctrical $- . .._- � . � . . ❑'Cotal.Pioject Cost�(Item 6)x multiplier x 3. Plwnbin; � 2. pther Fees: $ �� �. �I:chanical (IIV:\C) S List �. �fa�hanical (Pirt S�i� �ressi�,n) _ � ��� l'otal :Ut Fers: :i_ r� 1'atal I'rnicct ('ust: � Chzck No. Citcck�\nmunt: _ C ash \mou.u: � f7 I ii�l in t'ull ❑ Out�Lin<hny I3 illnee Uu� — — _. __._ _ _ _ _ _ � ---- --- -__ —_°. -- ���, � ��� dG;y�e/�_ � _ a -. , . � „ , srcriov s: co�sriiuc rio�v sH;ttvicF.s ' � 5.l Construclion Supervisur License(CSL) oZ �,�1�j� 0 7 6 7 �� — °1 �--- LiansaNumbcr Ge irauun itc N�.ime uf CSL 1 fuldu L i s t C S L i y pu(sez btluw) � "/��(�L� TNJ �ry�� � � Descriptiun Nu. and Strttt n ^� U Unrestricted DuilJin s u to Ji,000 tu. ft. , , �� �T(//��'l� /, d/�V R Rtstricted l&? Famil Dwallin � Ciry/"Po�vn,Smm,Z[P ibl \-lasonr � yNl1/ ��,5 ac a����„ c��«��, NS W indow�md Sidin� g SF Sulid Fuel []uming Appliances `��� �s(J�/Z [ Insulatiun 1'cla huna Email uddress U Uemolition 5.2 RegistereJ Home fmprovementContrnctor(H[C) �6 �}(3 t�l Z� � �y////���j/Z0� CG7�5 �� H[C Rtgistration Number E.rpiratiun Date 111C l'umpany Nnma or(�IIC Registnnt Nann �1r, �T'u D�FL, Ro�rn !o.an�reet D O ?�"� s�s f���Z Email addrcss �.k2�_ln4- /� � Ci /Tuwn,State, ZIP Tzle hone SECT[OY 6: WORKERS' COMPEYSA'C[ON [YSUIL�IYCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance aEfidavit must be completed and submitted with this application. Failure to provide Hiis affidavit will resuft in the denial of the Issuance of the building permit. Signed Affidavit Attached7 Yes .........:❑ No........... ❑ SECTIOiY 7a: OWNER AUTHORIZATION TO DE CObIPLETED WHEN OWYER'S AGENT OR CONTRACTOR e�PPLIES FOR BUILDING PER1V[[T f, as O�vner of the subjzct properry,hereby authorize to act on my behalf, in ull matters relative to work authorized by this b�ilding permit applic�tion. � � ��pGC � 3 Pn i Own� 's N�una(Electronic Signntucc) - n��' SF.CT[ON 7b; OWYER� OR AUTk[QRIZED:\GEN'C DECLr1R:1T[OY E3y entzring my n:une balow, [ hereby attest under the pains and penalties of perjury that all of the infurmntiun cuntaineJ in this application is true and accuratz to the best oFmy knowltdge and underst�ndin�. ' � _ � 3 � ' ��.�a ��r A �� — I'rint �e tr'i or Autiwrited:\;tnt's Nantc(Glcctruma Signature) D,itt NOTES: I. :\n Ownar whu ubtains a buif�ling permit ro ilo his/her uwn work,or en u�vner whu hires an wve�istered cuntractor (nut re;istare� in tha Home Improvamznt CuntracWr(HlC) Program), �vill iint have access to the arbitr;ition progr:un or guaranty tund undcr pLU.L. a Id_>�\. Other important infunnation un the H[C Program can be found at ����w.nriss.��ue oca InForination on tha Cunstruction Suparvisor I.icense can be Fuund at«�e�v.m;us.eo�'�IL 2. 1Vhen substantial wurk is planncd, provida die inform:itinn bzluw: ' Tut:�l Flnur:veu(;y. ft.) ---_ _(including g:uagt, tinishad b;�semanV:�ttics,decks or purch) �lco:; livin.�:vca(;q. ft.l __ __ tl;�bitibl�ruom eount --- ' Number nF tirapl,�ecs_---------- \'umbtr u[bcdru�nns I Viunb�r o!b,�dirnum; __ Numbcr of halG'baths — ------ — --- _----- -- ------ — Cvp�of h..�tiuS sy,t�m _ _-- ------ �umber„t dack�/purchcs -- — -- ----- I)E�e��fco�,lim�, ;yucnt .___ ._.-- Finclo;ed _--- - - (�Pen -------- - � --- -- —' -- -- -------- ---- � 1. `I��>t il I'nyte[ iyu�.u� P��nt i ' indY h� iub;titnt. I I ,r _I��,i.il I'i��jul C��;t" . . . I""�..,,-..�._ • , � . __ . ' . . s�" . . . � . � r � • Y I � � � - '"` - CInoFS , ,�. .,. .��,t, �tiL�sS.�cHt,�sErrs � ''� O�tl.n4vG DeP.1,qr�tF.uT .'��"� �` �� l?0 CV.ISNLVGTON ST7E&T, 3"E�.00IL , :�M1:a,.�,;;�' "I�.t. (97A) 1�3-9593 (<lJCOERL.EY D21SCo[1. F.+-'�()78) 7•W-93�fS ;,UYo,Z T4io5c�Sr.Pt�ens Df:tECTOR UF PCOLlC pROPEATY�8C11DLYG CO.LL\!l55IO.V ER � Construction Debrls Dtspasa! ACttduvit � (required Foc�ll demolitiun ;utd renuv�tion wark) ,�. (n Sccuniance with dta sixdi eJition of the 5tate Building Cada, 7S0 C�LiR section l l LS Dcbris, :uid the provisions uf�(GL c 40, 3 Sd; �uiiding Permit tfi is issued with the cundltion that the debris resulting from �his wur!<shaU be di�puscd of in a proprrly licensed wosta disposal facility as dcfined by�tifGL c l 1 t, S I54A. 1'hc �teb�s will bn trinsportcd by; �� e L � � � (n�mr uChaulur) 'fhe Jebris will b�disposed oFin : I ,p � _�M✓ K/ U �C �/}•/L�� (nama uf 1'dcility) ��t�e�� �� / �o/I/I /�I/r; (,ddresc ur r�.fl��rl t t ' � sign�mrc ufpermit appliamt � . . . � •. .l . . _ . g: J itc , . . . � . �,,. .. �.- - � _..�.� -- - __ __ __ _- - - U � "Massachusetts -Department of Public Safety , � Board of Building Regulations and Standards��',��^ . � Cnnstruction Supen�isor License: CS-070714 �.�:� i. ,� � �. : .. MARK E COLLIPJ�.4 "-� '-. � . 54 NDGE R0.4IY °�y _ . � � LYMV MA 0190� . � . : ;\ � � J,,G,,, �j�.�„ ,"'��• Expiration �� . Commissioner � 11/30/2014�� \ � w� �4 a' � � � 0.8. 15.4' �ed shetl / Sy�b 5'' LOT 1 eOZS. F W AREA = 6905 t S.F. . � l0 0 �^\ "i o r� �'T°'� Z ^� s^rbo� D� o` �O. a �� Oatip d� \ 5.1' � � 12.3' � --��"r�{* . r f; existin � ,` ��" "'�". y, steps �_� ��' �Yn 5t. � to Ce '!y t fir.'e=' ,a 3 1 removed '�+ ''�r`i.i' m 1� ' '�.y ♦-� Y O �24 �,*+�' ApOPOSED-n � �f ' DITION, �a: ro x> �� o �v 12.6' r ��'�u n � ui � � � 6„ ��P y�' � +S; `, � ,, :24 g i y:` 12.3' �n �� 0 15 �ont satback N � �_�s.n• R--4se�se VIOEBB �TREET —PROPOSED LOT COVERAGE = 2g.1%. e;�,.a, , �"'��>''' �� .,P�AN FOR PROPOSED ADDI?lON / y :�, ��'/�:`.4�r,,,.._�....., �''v`\�. ,��'�'' U , �,�y;l;,. 24 WEBB STREET o'r � ��.:.�> SALEM I CERIIFY iHqT THE BU�LDINGS "�+"" ' '�� SHOWN HEREON ARE LOCATED � � '`'°c'`'0�" � ";� PROPERN OF ON THE GROUND AS SHO ' p' �" "' '�`� �.�s,:,;:,..s-fK��;�``; RAYMOND PAGE �� �./ ��� -���-� ;� t�`a��a,,;, , l`;��s;�-'� SCALE 1" = 20� MAY 31, 2013 �./.-����' �� �''���rf . NORTH SHORE SURVEY CORPORATION DATE .PROFESSIONAL LAND SURVEYOR �4 BROWN STREET, SALEM, MA I 978-744-4800 2��$ i From:Nancy FaxID:Vveiros Insurance A Page 2 of 2 Date:6/13/2013 04:55 PM Page2 of 2 I .�'� � ' COLLBRO-01 CANA '`��,R�� 'CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOKYY» 6H 3/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CER7IFICATE OF INSURANCE DOES NOT CONSTTUTE A CONTRACT BETWEEN THE ISSUING INSURER�S�, AUTHORIZED � REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificale ho�tler is an ADDI710NAL INSURED, lhe policy�ies) must be endorsed. If SUBROGATON IS WAIVED, subject to the terms antl conditions oi[he policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement�s�. PRODUCER �SOH)B7B-OSOS NAME:�T Viveims Insurance Agency,Inc. rHONe Fax 375 Airport Road E�qCqNo EH: NC No: Fall River,MA 02720 nooaess: INSURER(5)APFOROINGCOVERAGE NqICtl INSURERA:PBtfOf1S MUYU2I I115Uf2110E CORI an INSl1RED Collins Brothers Construction INSURERB: 54 Jutlge Road INSIIRERC: East Lynn, MA O�SO4- INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUPoIBER: THIS IS TO CERTIFV THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICV PERIOD INDICATED. NOTWITHSTANDING ANY RE�UIREMENT,TERM OR CONDfTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS Sl1BJECT TO ALL THE TERMS, EXCLUSIONS AND CON�ITIONS OF SUCH POLICIES.LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypEOFINSURANCE POLICVEFF POLICYEXP LTR INS NNO POLICVN11M9ER MMIDp MMiDD LIMRS GENEWILLIABILIN EACHOCCURRENGE �% 'I,OOO�OOO A X comMeacw�eeNeRn�unei�m BOP2695918 9/29I2072 9/29I2013 ppEmises eeoccurrence 8 50�000 CLNINS�MhDE �OCCUR MEDEXP�H�ryoneperson7 % $,000 aEasoNn�anoviN�uRv � 7,000,000 eeNean�aeeReen� u 2,000,000 GEN'LAGGREGATELIMRAPPLIESPER PRODUQS�GOMPIOPAG6 $ Z,OOO,OOO PoLICV jEC�T LOG '� GOMBINEUSI L LIMI AUTOMOBILELIABILIN Eeacciclent) 9 ANYAUTO BODILYINJURV(Perpe¢on) $ AI:LONMED ^CHEDULED AUTOS AUTOS BODILYINJl1RY(Peraccident) .6 NON-OWNED AMA - � HIREDAI�TOS AUTUS Peracciden�� R ❑M9RELLALIAB OCNR EACHOCCIJRRENCE $ E%CESSLIAB CLAIMS-MADE AGGRE6AIE E DE� RETEMION f R WORKERSCOMPENSATION WCSTATLL OTH- ANDEMPLOYERS'LIA6ILIN ��N TORVIIMITS ER ANYPROPRIETOWPARTNERIEXEWTIVE ELENCHACCIDEM £ O:RCERIMEMBEREXCLU�ED? � N�A (MandatorylnNH) E.LDISEASE-EAEMPLOYEE $ fyas descAbeunder DESCRIPTIONOFOPERHTIONSbelow ELDISENSE-POLICYLIMIT $ J �ESCRIPTION OF OPERATIONS I LOCATONS I VEHICLES(Attach ACORD 101,Atltlitional RemarNs SCM1etlule,if morc space is required) CERTIFICATE HOLDER CANCELLATION � SXOULD ANY OF THE ABOVE DESCRIBED POIICIES BE CANCELLED BEFORE CI ofSalem THE EXPIRATION DATE TIEREOF, NOTICE WILL BE DELIVERED IN � ACCORDANCE WITH TNE POLICY PROVISIONS. � 120 Washington St Sa�em� MP'- pUTHORQEDREPRESENTqTVE �.�.,_ � �- ��• c `.� OO 1968-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo ara registered marks of ACORD � e^u ..ry.Fanvue✓M� n T "—. .� 3@c`ra�""Wr�'n�wsa �. �v+w� sT�rt�Msmiee�.� `��4ai` f^ IMw 1�i^^� 'h � � Y3'� 9� F �''°.1�1` µ� w4 �L.5 d ,,` . <ir . � . .ef „�( C�>.�d d .�Y "1. . �t CITY OF S.�I.E�I, il�'L'�SS:-1CHL'SETTS � • '� � , BLILI)k\GDEP�R'C�(E.rT 1?O WASHL*IGTON STREET,31D FLOOR � a� T1Ei.. (978}745-95�5 F.tr(978) 7a0-9846 K1\BERLEY DRISCOLL '�obtAS ST.PiERRB �Y�� DIRECTOA OF PL:BLIC PROPERTY/BI:II:DL^3G GOtiL�fISS[O.iER _ . � _ .u .__..--- - Workers' Cumpensation insurauce Affidxvit:DuilderslContractorslElectr[ciansJPium6ers ,q � licant Infi�rmation Please Print'Le ibl :' V�I17C(l3usi�xs%Or izaiioNl dividual): ` � � � � :u ;`` Address: r � � % = ��a � � �: Ciry/State/Zip: Phone 1�:.�� r . Arc you an employer°C6eck the appropdate box: 'Cype of p�ojeet(requtred): 4. � 1 am a general contrrcto[artd} � � 1,0 I em q cmp[oycr with 6. �,New coastntcpon am lo ees fuil and/or patt-eime).• hav¢hinKf tiie sub-contracmrs P Y . � 7. ❑Remodeling 2.� 1 am a sote proprietoi or partner-��. listed on the attachcd eheet� . , . _� � xhip anJ have no employees � 'Chese sub�contractors fiavo � � S. Demolition, , _ . working;for mn in any capaciry. �vorkers',comp.insurnnce. . g, �puiidmg addidon . . (No ivorken'comp.iasurance. 5. � We are a coqmrntion nnJ its. :� .10.0 Electrieal iepairs or addicions � ....�, � ruquimd.] �. otYcers ha4e exercised�the'v� . .. ,.. .. .. . �' . � ;.� 1 am a homeowncr doing all work right of exemptiun per MGL `.���Q P��bing rcpuin or udilitions � . m"yxlf..(ho workcrs'comp. c. 152,ql(4),and,we twve no 12.0 [toof cepaus . � � .insuranae requimd.]t . R � cmployaes. [No workera' �.�. !3.(]Other � . �. , <- -- . comp.intiurance requiicd.J ` : ;: : { ' � r ��nnyappi(c:uttthuch�kabmcNlmustalxufilluu��haucliaabclowsAowingthc'vwakaimmpeneadonpali�ymfamiatton. � � . � �I Limeuurm.++wAo ru6mil this aftidavh indiming thcy ara doiny all�wurk and.thcn Airo aNide�rnntraotora mwt�u6mit�a.rcw aR?Javd indinfing xuch � �Canuac�on�hntch�skthiaboxmuetattuhedm�liuu�ulxl�tyhurinyihenuneofthentbcoMtxtonand�iheU'workrn'-minp.paliqinfomutioq.. , - �,� � � t um an employer that 1s provlding�vorkerr'compensatlon L�turonce jor.my empluyeex Betow Is the po/!ey undJab s!!s ierjonnpriaa • - lnwr�nce Company`lame: - � _ � Policy U ur Self-i�ss.Lic.H: � � �Expimtion Date: . � : Job Site Address: CirylStam/Zipi Attac6 a copy ot the workers'compensatlou po11ry declarattau page.(showing the poliey numbor and explraHqe dnta). Fuiluro to si:curo covcra�e as required unJer Sectioo-23A of MGG c. �52'cut lead.to tfie imposition oforiminal penaltiea of a � fine up ro S I,500.00 und/or one-ywr imprisonmen4�g weii an civil penalfies in the Coem of n STOP WORK ORDEk anJ a fine of up w S?SO.QO a Jay oyroinu�ha violaroc 13e aJvixd thut a copy uf thisstarement may be:forwarded io�the Oflice of : invas�iga�iuns uf thc DIA For insurance covcrogc vcrificalian. ` � . . � - _ . . . � . !do/iesrby cr�r�i/'y,.nnuder thu pulnr und p iuk(rs ojperfury r6af the infarrimutloir proviJeJ u8uv is�iue air coirrck \ ( e'. �r �•X p�/�//',y� � 1�ZlJ � �� Data• � 7 � � . � � s Phnn �• � � OJjrcio/use ouly. Do not iviite in thfr urca,�o be cunrpleted by eity ur�awn nfflcfqt� . City�r;Po�yn: Pcrmlt/[.lecnxc# Issuing Aulhorily(circlo one): - � � � �� I,lTu•rrd uf Ile•rlth 2.13uilding Uep•rrtment 3.CilylfmrqClerk 4. Elec[r1ca1 6�spector S. Piumbing lnspeetor � b.O�her �__.__ . . . Cunlact Person: _ Phonc#: �.. 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