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67 WHARF ST - BUILDING INSPECTION -PL-*NSIAUST-BEfiLf84MiD APPROVED 6Y T44E WpECIM PRIOR TO A.PEMIT MING GRANTED \� CITY OF SALEM No. 7 D Date 6 z vo it is Property Located in Location of tire Historic District? Yak_No_ Building is Properly Located in the Consanratlon Area? Yes No__ BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, R f Install Siding, Construct Deck, Shed, Pool, Repa' epla Other: w,^&,J I PLEASE FILL OUT LEGIBLY r4 COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS. The undersigned hereby applies for a permit to build according to the following specifications: Owners Name C lk 12 L r)) �j(C lR-T Address & Phone U7 Wvikkfl 'Ir (761 q5(�2 3-3ZZ . Architect's Name /10'-' — Address & Phone I Mechanics Name P,J 1N Z©VA 0 9UCO-- Address & Phone «0 f �lRlldl�t r`�� (760 2L 6 5;3P) What is tyre prapoaa of bWidirrp? M"W of txrldirg? V J(Do�s �'m�e u a dw"M,for how many lamwes? WE btAk ing corrtomr to law? S Aebeatos? Estimated coat 52oo.oc� city ucam r N A state Llcenee 41 Rome Improvement Z Lic. i i414�FS X Sigg,44 Togj4plicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE 1 InS�G\� �- �w �.2Plac�ren+ Fyc�d�nJ S' !Q77 \ MAIL PERMIT TO: ✓'H ttUw�oh a S� w�rnAs 0l 9 Z No. -7� APPLICATION FOR PERUTAT TO LOCATION PE M GR TEP b APPROVFD INSPECTOR OF BUILDINGS x the Commonwealth of Massachusetts �w Department of Industrial Accidents Offtce oflnvestigadons 600 Washington Street t , Boston, MA 02111 hFr www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electr[cians/Plunabers Applicant Information Please Print Le 'blv Name (Basiness/Oreggaanization/Individual):--- l,c3 uvtnn t7 cc� , eb'hk(-T Address: City/State/Zip: 01'(07 Phone#: �3 d Are an employer? Check th 'appropriate boa: Type of project(required)_ 1. I am a employer with 4. ❑ I am a.general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6' ❑N construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8_ ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its required] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ 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' 13.❑ Other comp. insurance required.] ;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 conimetors must submit anew affidavit indicating such tConnaetots thatebeck this box must attached an additional sheetshowing the name of the sub_contractors and their worker;'comp,policy information: . I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. j Insurance Company Name: Policy#or Self-ins. L/ric. #/ 'Wip2 ' 20J"1 V (� Expiration Date: Job Site Address: L / W K l City/State/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$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 un r the pains and penalties ofperjury that the information provided above Is truo and correct: Si atuve: Date: ( -. Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/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#• (((ggg Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:, 141448 Expiration:- 4122/2010 Tr# 266042 ji;e: Partnership GIOVANNUCCI BROTHERS BRIAN GIOVANNUCCI:,, 140 HUMPHREY ST. SWAMPSCOTT, MA 01907 �— Administrator B'oa"r"8 oY w mg egu(a"ti�s an an ar s '. Construction Supervisor License License: CS 82463 Expiration:-3812 0 1 0 ' Tr# 19547 1 f /2 Restriction 1G� a .: BRIAN R GIOVANNUCCI 140 HUMPHREY ST SWAMPSCOTT.MA 01907 Commissioner • PICKERING, WHARF CONDONIINIUM ASSOCIATION 23 CONGRESS STREET SALEM, MA 01970 Tel. (978) 745-9540 Fax (978) 740-6728 Trustees July 2, 2008 Richard Rockett Michael Rockett Henry Zbyszynski Joshua Gray David Saia I i Carl Bettencourt Ut. E-3, 67A Wharf St. Salem,MA 01970 Dear Carl: This is notification at the Board of Trustees have approved your request to install new ndom windows in your cointim with the following conditions: 1. You are responsible for paying for this work; 2. All work must be performed in a workmanlike manner by a reputable company licensed to do su h work; 2. You will be held responsible for any damage that occurs as a result of this work. If you have any que tions, please do not hesitate to contact me. Sincerely, Kathy Chapman I i I cc: Residential Trustees i i i I a -d DOZE 13rd3SUI dH wwirs :oi gooe oa unr