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20 WILLOW AVE - BUILDING INSPECTION � ON (\'i AL\� / � � � �� , v_.�TY ��1' � �� f;��l �_ ��'" ,,, ;�� ,�e I�C'RI ,IC: l.'R( )PI� It l l� �..�-.. . _, � , ,<.,��! I7F:1':�R"1'\[1�:�; l ,.,,��,� �.�� , �,�:�,,;,��. �i,��,r. r_u�.� •.�.��.��,.:,��:� � � . ��,;� � . .. . , � � � �� . � i'��:�r::.-is ��s�;; . r�,._ -., � � " �� 9'� v APPLICA'PION FOR PLAN F.KA�I(IVA'I'ION AND 13UILDING PEI2NII"1' l ALL STRUCTURES EYCEPT I AND 2 F.9M/LY DWELI.lNG.S � �� IMYOR'1'ANI'.A licants must com lete ull items on thie a e ' S17'E INFORMAT(ON Location Name ,�i I3uildina . I Property Address�0 W�11�7 � �'�-r�Y"� Map p , r --� . i _ Lucated in: Conxrvetion Area YiN Hiatoric district YiN Use Groups � (check one) Rcsidcntial(3 or mure Units) R2 ✓ Type of improvement Residential(hocel/motel 21 � (check one) Assembly(churches) Al New Building_ . � As.sembly(nightclubs etc) .�2 . .4ddition Assembly(restaurunts, rccrcation). :13_ Altcration Busincss � B Repaid Replacement C� F,ducational E � [hmolition_ Factory(moJemte hazard) FI Muv✓Relocatc Factory Qow hsizard) F2 fbunJation Only__ 1-ligh Hazard li Acc;cSwry Building_ InstiW[ional (residcntial care) It Other(describe) Institutional(incxpacitnted) 12 InstiWtional (restrained) 13 - hfercantile �i � Slorage(moderete hnrard) S 1 Storage Qow hazard) .l'2_ � OW NF:RSIIIN i VFORMA'170N(Please type or Print Clearly) - OWNER Name �Lti� �C,�`A�JJrL �—I.� AdJre�s !�1 lJA$iflNb '�i j 6►tiLEv� Telephone � �� ,.�� u�.�cN�v'r�on oF woRK ro ee reKi��>Rn�r:u � �uS�l�— ✓�'�ZN�NS �"3� 'Q�M^O�� S"� AN9� PP�Yl1U�c�S i� �Jaa 0n1 PLAtJ�_ lNyi�KLL. prFa BA�}F Aa�D �-AuNDer( oN rc LEVEL ! '�Ptl N'EbJ RG1R.Ftcr7� w�n�->> -T46(to,lGlla,r� k�o� tGrua -p.as w�eid�- f 2eAit.E ra+,en,b,.o�, � Rm�F e�'rt.r�,�rrn covs�'Huc'non cosT 95cn� ��"`Q [ 0 . �'( . v� C'ONTILIC'fUR INFV{tMA'CION p � . �� ^��`.� Name � i46t � , (C, Address /9/ i��R3Nrnf3-7n+y s�, �,4�--E�`l Telephone 9�8 93'!- `9Z�' Construction Supervisor's Lic # �Ev � '� ��y3 Home Improvement Convactor# . ARCHITECT/ENGINEER INFORMA"ftON , � N�me Address Telephone Mass. Registration # PEIiMIT FEE CALCULA'PION ,+ � Residential est. cost x $7/$1,000 + $5.00 = V` � ^ Commercial est. cost x $11/$1,000 + $5.00= COMMF.NTS . The undersigned does hereby attest that a[I info ation st ed above is true to tl:e best of my knowledge under the penalties of perjury Signed Date �° tf ot� . „ .. � . . c , �, . ` . sy . . . , ' . ; r � ` , i r ' � - � , , . . . . . , , � _;, �, � . . ' ,, ,; ;;; CITY (�F SALL•'M "��yy� ' Pt1BUC. PRc�PRFRTY � ,+ ' , + ,.. ��; './. =�-% , DEP.�K'I''�iCNT , ' .. �,.I� ��. r. I:� �\ �,irv..��•.�::iif � �.�ii �i. \I�.,v �. .. i . . =l" - I I I ��'�.'J;-�i-:�; � I �\�. ':'.4.'J_ �ri1i� ('onstruction Debris Uisposul .-ltiidavit -� �ftl�Ull'Cl� IUf:III l�CI11UI1I1JI1 an� r�•nuv:uiun �vorl:) � In ac�urdancc ��itl� ih� si�tl� ��ition of thc Statc I3uil�ling Co�e, 7S0 ChIR s�ctiun I I l.� D�bris, un�l thc pro�isiuns ul'1�1GL c 40, S �4; Duilding Permit r� is issucd with the condition that the dcbris resultin� tiom this «�urk sh:�ll he di,posed of in a pruperly licensed �vaste �lisposal lacility as defincd by MCiL c I l l. S I S��A. Thc dchris �+ill bc trunsportcd by: PR�C � �t��-- Inamc uf haultr) � I hc �cbris will be disposed uf'in : � (nsmr uf I��cility) � �addres. ��Yl�cililvl ♦IL'IIJIWI' � 11 .1�)�)�IIdIII t��;1a� ,i�<<• ,� ,� ., . ... �� CITY UF SALEM � , ;`, a,�, �,�; PUBLIC 1'RUPRERTY ' ''' �-�� DEPARTMENT �'.�='!T�D�"� . . . . . .i�u'.:Mf Il"JMIi(.��11 . . \I��K 11C WA��I\t:l�).�S13E1:'I' � SAII`\7.M.\11.\l.11l il'I I�O197,', 1T.i: 978�7�tivi`�i � P.��. 97M�'+C�uBaG 1�brkers' Cumpensation Insurance �ffidavit: t3uilders/Cuntractors/Electricians/Plumbers \ i iliiant Informrlion Plc•rse Print Leeihlv Vamc iii��:��c�v��;;a�u:�n„�vioa�.��m�u: A'l.'E�1 r 1��)s �,��",: l�l (.�A'�P� �1 � — City,St:uc,7ip' .M� t'hune7f: /% o !� / ! !i ' 8 :\rc �uu rn employcr? Check thc appropri�le buc: 'I'Ype uf prnjcc[(r¢quirrd): I �..,/ 4. ❑ I :un �gcncral cowractor and 1 G. Ncw con,tructiun L IJ � •�m a employcr wiih� ❑ cmploqec�(full aneL'ur pur�-tunt).• huvc hircd the suh-contracto�s 7. RemuJeling li;�ad on rhe:�nachcJ shcct. • ?.❑ i ;�m a solc pmprictor or p�rtner- . ,hip anJ h�vc no mnp lu ycc+ Thzx wb-conrcacrors have 8. Demolirion working ti�r mc in any capaciry. ��'orkzrs' comp. insuranca 9. � 6uilding�dJitiun �Kn workers' cump. i�uuranca 5. ❑ We are u m�por•rtion �nd its 10.0 Elec7ical rtpairs ur additions � rcquircJ.] okiecrs havc cxercucd thcir ri�ht of exemptinn per MGL 1 1.0 Plumbing repain or additinnr 3.❑ I ;mi n hnmcuwncr duing all wurk S myselL �Ko �vorkara' cump. c. 152. j ll4). onJ we h;�ve no 12.❑ Ruof npairs in,urancc rcyuircd.J � ��nPl�y��`. l�°��rkus' 13.0 Olher canp. inwreacc reyuircd.J . •�� .�,pLc�m tlmt cl:ccks boa�i OlYll AIpU�1II U1111M1V 4:CIIJII IICIOW illUWlll�(�IICI!N'U(I[1:IY CUIIIPVIO'i1W11�IUIK�'inlircrtwiiun. � I lom.uuncn whu uiUinil�his a17fJavit inAica�ing�hcy�m duing ull�voh aiul tlma Aim uwaiJe cuNrx�un muy�.uMnil a nrw a1f:Aavi1 indiwbng.u.h. �fon�rnwry ihm chcck�hia bos miu�ouxhpl an audiiion�l..h.��..hawiny�ha namc of th�:suD�.onuuwrs md�hnr unrkcn'mmp.puG<y mPormariun. /mn un cu�p(u�•er lhut is pruvidin,e�vurkers'coinpc�n'n�inn insuraure ju�•u�y ru�pl�yres. Brlrnv u rhr pu/ny und�ob.��r i„jonnarinn. Q,,,�.y � Ir,.urancc Cumpany Vame:�:�—!�'A[�1 LL-� . _. _____._------ � Pulicv a ur Sclf-iru. l.ic. n: --_..._ . . __ Expiruuun Date: lobSitc -ldJress: �CO �1�-LObJ e�.1 � Cuy;Siatei"Lip: �`3'�—E7'� �� t— ,�u�ch n cupy of 16e workers' cumpenx�tiva pnlicy declaralion pa�;e (showin� the pulicy nmubcr and ecpiretiun d•rte). I��ilurc w ,ccurc co��er,�ge as required under Scdiun ?5:\oC�IGL a I52 can lead to tlu impusitian of crimin�l penalties of a . tinr up m SIS(lO.OQ an � no-y r impri.omncnt.�s �vcll a,civil �x�wllics in ihc furm ul a STI�P 1VURK URDER and a fine . ,�f up �o �3i0.00 a�a :ig�ins� the v �I;imr. Ile a1cL;cJ �hat a copy uf d�i�,tutcmeni may be WfNJfIICII �O IFIC OIIII'� uI Iin�c,mS�uuiu�I�;hc f A tor in,ura .td c�ncra�u �crilicaUun. , /Jo htrrhy iu�ijv��! , l�r p��.c��nd prn�drics ojperjary/hul r/�t inJunnulian pruvidcJ uGu�•¢is r�ue unJ corrccl. ;�,: �,��„� _ _ -- �,,,�_ '��D l D s3 � i, °S�i( �14� °12�X - O/jiciul i�se wdy. Do�in/ rvri�t in N�i.r urru, tu hc ru�uylr�rJ by city ur lorvn ��J/iri�/. (:iiv or �fao•n: --- — Pcrmi[ll.icensc �.. .. � I I+.uim,�,.\W Imrily (cirdc nnc): I. li�,ard uf Ilcallh ?. ISuildiu� Ucparuncul .i. (:il�;'fo��Clcrk J. L•'Icctricnl lusp.ctor i. Plumbin�; Insycctor G. Qlhcr — CuWa.l Pcnun: ._ . _ I'honc tt: Information and Instructions \I:1�>.ICI1lliClU GCI1Cf]I L'JW5 iI1:1�/Pof I JZ ICyWfCS:III CIII�IIJ)CfS 10 P�OYIIIC IVUfIlCfS� l'JIf1PCf7SJhU0 �Of(FICI!l'i11�IJyCG]. . � Pur.u:mt w �his,iawie, an rmpful�re is Jcfincd:u "_.evary� pccson in tht strviee ot anwher unJer any cunn��ct of hirc, aaprcss or impliaJ. oral or �vri�ttn." � - . . � .\n��nplo��rr is dalined as"an individurl, partnership, associatiou,corpuratiun ur uther Icgal entity, or any ewo or more � ,,r ihc G�rcwing eny�ged in a�omt enterprise, �nd including thr ICb'JI fGPftSCOfJUVCS JI d tI2iCJSrJ empluycr,or the rcceivrr or crusiee ul'.m indiv�dual,pannenhip, associatiun or other legal endry,cmpluying employees. Howevec the . owner uf a dwelling house having not more thnn�hrce apartrnents and who resides therein,or ihe occupant of the � .Iwrlling hou:e of anothtr who empluys persons tu do maincenancr, cunwuction or rop�ir wurk on such dwclling hause � or on rhe erow�ds or builJing appurtrn:uu thercto shall no� because uf such amployment lx deemeJ w be an rmpluyer." �iGL chupetr 152, �'_SG(6) also seacas ch�e"every state or local licensin�a�ency �Aall Ni�bhuld the issuancr or renrwal uf u license or penuit tu uperate n business or to coos[ruct buildings in the cummonweulth [or airy- appli.um �r6o hns not prnduced •rccephrble evidence u(cumplirnce with du insuronce coverage reyuired" .a�di�ion�lly, MGL ch;�pter l i?, a25C(71 srates"Neither the conunonwcalth nor any oF its political subdivisions,hall eneer into any comraa for ihr prrfom��ncr uf puhlic work until accepe�6lr evidonce ui cumpliance wieh the insuranee � requirzmenis uf�his eh�pter have betn presen[eJ w thr contracting auchoriry." . Applicants . � Plaase fill uut �he workers' cumpuuation affidavit complettly, by checking die boxes that apply tu�ywr si�ua�ion and, if neccssary, supply sub-contractor(s) n:tmc(s)� :IIIIIfCS5�C3):1[I(I PF1URtl RWllbtf�S� dl0ilb WI[Il[IICIf l'ifRfIC�IC(S)Ut . insw�ance. Limitcd Liability Companies(LLC)or Limitcd Liabiliry Partnerships(LLP)with no tmployces wher than the members ur partners, are not requireJ to carry worktrs' compznsa[ion i�vuranca If an LCC or LLP does have employees,a policy is roquired. Be advised that chis�ffidavit muy be submitted to the Dep�rtmen[of Industrial Accidenu for contimiation ol'insurance cov�rage. Alxo be sure lu sign unJ Jale Ihe rl'tidavil. The alTidavit shoWd - bc rcwmeJ to die ciry or town thut the application for the pennit or license is being requasced, not the Department of . �flt�ll][CIJ�/�l'OII�COl3. S�I�)U�l� YOU �11VC illly(�LLCS[WRS�2�'�fdlRb' [t1C �8W Uf 1�YUU JIC LCI�W[t(� lJ Ob[LIII il WOf�(CfS� � . � compen,•rtion policy, please call the Dep:rrtment at etie number listed below. Self-insureJ companies should enter their sclf-insurance license number un the appropriatc line. � City or'fown Offlcirb Plcase hc ,urc thuc the affidavit is comptete an1 printed Icgibly. The Depsrhnznt has provided u space at the buuom uf tha affidavit fur you to fill out in the event tha 017icC uf Investigations has to cunlact yuu regarding the applicant.. - Pl:ase be sive to fill in ihe prnniVlicense number which will ba u,ad :�s�referenee �iwnber. In addition,an applicant ih;�t mu�t submit multiple ponnio'licensc applications in any given year, need oniy submit ono aftidavit indicming curten[ policy information lif necrssary) :uid under"Job Site Address" the�pplicane;houW writc"all lucations in (city ur euwnl." A cupy of dic uftiduvit ihat has baen officially�wmpcJ or marked by the city�or town may bc prooiJed w the � :I�1�IIlilfll:15 PfOOY[Il:l[8 V:IIIII :1(FI(IJVII IS OIl �II2 (Of �u[UfC fltl'ITII[.l' Uf IICC175C5. A OCW Jlh(I�VII It1U5I bG hII2d OUI t�Cll year. W here a humo uwner ur citizen is obtaining a licenx or pannit not reLiteJ to uny business or commarcial vanture � . 1 i.a. a dug licanse or permit tu burn leavzs tte.)saiJ person is VOT rcquired to complcte [his atFdavit. I�ho �)fiicc ut Inve,ti�ations ��uuld li;:e w diank puu in aJv:uxe furyour�OOP2f8U01] 8111I\IIUIIItI�'Ull Il'JYC:IIIy (,LLC)U011i, � plca,e d�nw hcsimtt to givc us u call. - � � -fhc U.parnncnt', addresx, tcicphone�nd frx numbtc � � The Commonwealth of Massachusetts . � Department of Industrial Accidents , Otflce of InvesU�allona 600 Washington Street Boston, MA 02l I I Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE ;<:�:.�d 9-zo-us _ Fax q 617-727-7749 www.mass.gov/dia __ __ _ � _ I , � a KITCHEN � LIVING R❑❑M � BATH: O : 00 00 � COMM�N HALL DINING RODM PORCH C❑MM❑N HALL �4 �:FrOVED o -�—_..• Un��:t to apprccal by a . c'�<<.- ae.hor.ty ha•r_z�' - ='L �a BEDR❑OM BEDROOM BEDRD❑M c��f��J'f;=�J;=^ I'�'W. V�:::;�i7i: �_'_�T Pa�a:r,�c.�raee��o�c;�e.c:i c;.�:: - '.:f:AND L'Y?,7"rJN CF fI"" ". � . •' r : .-. . • �',.F{-9g PR07EC7{95 ^N1:=i ' C)_. _^�"i ... i •� 1,�`.TR•_��nJcc' .4�:p� _fi�lf.1 . .....d S'!1 i F;THE F!8E 80_:. BAND�NED iCHIMNEY TO BE REM� VED � � 20 WILLOW AVE, SALEM MA - EXISTIN� CONDITIONS 3-FAMILY DWELLING SALEM RENEWAL LLC TYPICAL FOR E�4CH FLOOR OCTOBER 8, 2008 -A NOTES� ` ALL WIND�WS T❑ BE �``' REPLACED WITH VINYL � � �o � I O O REPLACEMENT WINDOWS I � P�RCH RAILING AND I � DECKING T❑ BE � KITCHF�N REPAIRED / REPLACED LIVING ROOM �� _ _ _ �� AS NEEDED EXISTING PLASTER AND LATHE T❑ REMAIN THR❑UGHOUT � EXISTING KN�B AND O C❑MM�N TUBE WIRING T❑ BE DINING R❑�M HALL REPLACED THR❑UGH�UT C❑MM�N PORCH UNIT SM�KE AND C❑ HALL DETECT❑RS AND C❑MM�N � � AREA SM❑KES T❑ BE OO � INSTALLED ❑N EACH LEVEL AND BASEMENT _ F -• `=�' EXISTING 3-ZONE HEATING SYSTEM T❑ O �' Lr�UNDRYJ REMAIN � WHERE NEEDED, AC❑USTIC TILE CEILINGS T❑ BE COVERED WITH � I � INCH FIRE C❑DE GYPSUM BEDRO�M II- � L BEDR�❑M B❑ARD CTYP 4 R❑❑MS) � r LEGEND BATH � I EXST, WALL � T❑ REMAIN � � EXST. WALL II T❑ BE REM❑VED - - - PROP❑SED � PARTITI�N • 20 WILLOW AVE, SALEM - PROPOSED CONDITIONS 3-FAMILY DWELLING SALEM RENEWAL LLC TYPICAL FOR EACH FLOOR OCTOBER 8, 2008 � - _ ___ ___ _ , � � KITCHEN ' LIVING R❑OM ! BATH O � 00 00 C❑MM❑N HALL DINING R�OM P❑RCH COMM�N I :, HALL , � � �FFP.OVED ` d O.� , Suhject to approva .b ny ct:x' I au�hority.ha•ri�v .::: , ^.•aca, CITI'of SAL•�AR,==1; • , P'LT'� VP.IIi:ui3 +,�-=� BEDRDOM BEDR❑�IM BEDRD❑M r�� - � � FIAi:�R.REAPPRWwDGOLELY ' 3�lrLitTiFlGu;:`:'. : �MD[.'Y.?,�"n7N OF�PI'_r • '�=%LI"' C�' :.�� . � '.F'�.'t PRO7ECTIOy nnn� �.�.__. >""Y . ... � - _ "T1.7._ . °?ES '„1. .CO'tP:..;i � .. . .Thl ,,._ � _ . BANDONEDi CHIMNEY T❑ BE REMI❑VED � 20 WILLOW AVE, SALEM MA - EXISTIN�G CONDITIONS 3-FAMILY DWELLING SALEM RENEWAL LLC `� TYPICAL FOR EACH FLOOR 4CTOBER 8, 2008 1 � -, ... _ _ � NOTES� ALL WINDOWS TD BE REPLACED WITH VINYL ' , o � I O O REPLACEMENT WIND❑WS I � P❑RCH RAILING AND � I DECKING T❑ BE � KITCHE�N REPAIRED / REPLACED AS NEEDED LIVING RO❑M ��-- _ _ = J� EXISTING PLASTER AND LATHE T❑ REMAIN THR❑UGH❑UT � O EXISTING KN❑B AND C❑MMON TUBE WIRING T❑ BE DINING R��M HALL REPLACED THR�UGH❑UT C�MM❑N P�RCH UNIT SMOKE AND C❑ HALL C v DETECT�RS AND C❑MM�N AREA SM❑KES T❑ BE OS O INSTALLED ❑N EACH � LEVEL AND BASEMENT O EXISTING 3-Z❑NE HEATING SYSTEM T❑ O � L�UNDRYJ REMAIN S � WHERE NEEDED, AC❑USTIC TILE CEILINGS T❑ BE C�VERED WITH � � � INCH FIRE C❑DE GYPSUM BEDRD❑M I I— � L BEDR❑�M B❑ARD CTYP 4 R❑�MS) LEGEND BATH � i EXST, WALL T❑ REMAIN � � � EXST, WALL � � T❑ BE REM❑VED — — — PROP❑SED PARTITI�N '` - 20 WILLOW AVE, SALEM - PROPOSED CONDITIONS 3-FAMILY DWELLING SALEM RENEWAL LLC '� TYPICAL FOR EACH FLOOR OCTOBER 8, 2008 ____ �