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23 WINTER ST - BUILDING INSPECTION i CITY OF SMEN4 LASSACHUSETTS &UDMG DEPARTIMNT 120 WAsmiNGToNr FtooR TES..(979)74 95 \ d j FAX(978)740-9846 ICI11$ERI.EY DRISCOLL MAYOR THOSW Si.P[ERRB DiucroR of PI:HUC PROPERTY/BunziNG coJ %awoNER APPLICATION FOR THE CONSTRUCTION,REPAIK RENOVAffON CHANGE IN USE OR OCCUPANCY.OR DEIYOL MN OF ANY BUILDING OR STRUCTURE ThIs Secgon.fcr Of"Use Only 8uu tnapscEors: - " � �.:• ' . I DaOss. Start Ench Corfrrtertis: • 1.0 SITE INFORMATION LocawnNance Budding: jZ P ti Address: 53 vji,vT2 S r Assessors M*Sk.dc uwpafcg 2.Q QWNE 1�lFORNATtON 2.1 Owner of Land Name W F/C fiY c sr Me c Address: 23 !rf 1C1C SF Telephone: 9 ?T— 7 YO- 0 3 2.2 Owner or lessee of buffigng or struchiro Nams: Address: Telephone: 3.0 AGENCY OR AUTHORITY AUTHORIZING CONSTRUCTION Agency Name: e-L E�,,Y Goy •` er1 S Address: / 3 / n/j& o L S I• r3 e ve tz L y Agency Project Number 0 7 - 0 IP ID Project Martager Name: r9/eK bi rLLA . � . w O rw _._ 1 440 PfiOFE3810NAt.DESIGN StcRViCESt; 41 Registered Architect Name: Seal and Signature Address: Tetephor�x >; Fmo 4.2 Roglsterod Professlom#Lnglneerst lam+ad�tarai et esb if necaesey and.atmdi o�appikagon Name: Seal and Ste: Addresac Telephone: Fax Nartte: Seal am sthahui . Address: Telephone: Fax Area of Responsibility: Name: Seal and Signature ` Address: Telephone: Fax Area of responsibility. 5.0 DESIGN AND CONSTRUCTION UTILIZING MGIL C 112 SECTION 81R EXEMPTIONS (See note below) Contractor Name: Of�leiL f f/ 73 �rC�fhS Address: 3 / ��+�, %oGC S1 �3 f ve✓rL� /7�� /y/� fAdddless: of responsibility: ; r r,t L G�irTy o✓L nse Number` C S 0 /09U Date Expi ;mv a a 6 O Sf phone; fractor .. rpm IPrC 2l SPS —/YC j 3 Area of responsibility: Ucense Number. Date of Expiration: Telephone: Fax: fC�rn Conirador Name: PAK L CAA 6-�o""t Address: � y ryJ�i,� ST ®x � p /rl/�. Dl9al Area of responsibility: license Number: Date of ExpimOon: Telephone: Note: For portions of work utilizing sxemptions of MGL c. 112&$1R complete the sft*a above. Use additional sheets if necessary and attach to application. FOFESSIONAL CONSTRUCTION SERVICES:neral Contractors: 3 / I?R�%.,L /3e��Kcam` Al 6`l1 S� Telephone: Fax: Responsible in Charge of Construction: J?op-j�jiv5 , Y0e51 5 SNPa P LL 0)0,<k� .sSOei�-�eJ eft 0 zuodl r` i3ry-v* 7.0 CONSTRUCTION DOCUMENTS -to be prepared by applicant Item d as Applicable 7.1 Plans (Note 1 this page) Submitted inaomolete Not Required x 17.1.1 Architectural 7.1.2 Foundation 7.1.3 Structural 7.1.4 Fire Suppression 7.1.5 Fire Alarm 7.1.6 HVAC 7.1.7 Electrical 7.2 Specifications 7.3 Structural Peer Review 7.4 Structural Tests & inspections Program 7.5 Fire Protection Narrative Report 7.6 Existing Building Survey 7.7 Workers Compensation Insurance T.6 Other Documents (Specify) (Energy Narratives, etc.) Note 1 Areas of Design or Construction for which Plans are not complete at the time of this application must be identified herein. Work so identified must not be commenced until this application has been amended and proposed construction has been approved by the Department of Public Safety District Building Inspector having Jurisdiction. i 8.0 COMPLETE THIS.SECTION FOR NE,�IY CONSTRUCTION ONLY For FJYkd Buildings Proceed to 5ec#On g-0 Number of Stones above Ntirtber of Stories Below Grade Grade: Story Height Floor Area Per Floor Total Building Height Total Bud**Area Above above Grade Grade Total Building depth below, Total Building Area Below Grade. . Grande 8r Description of Proposed Work: 8.2 USE GROUP AND CONSTRUCTION CLASSIFICATION(Newt Conamcdon Only), USE GROUP USE GROUP SUB-CATEtiOR'Y" CONSTRUCTION {J a$applicblek . J as appgp>e ; CLASSIFICATION A . Assembly 1F A-2 A- A=4 1A B Business 18 E Educational 2A F Factory F-1 F-2 2S H High Hazard H-1 H-2 H-3 Hat 2C institutional 1-1 1-2 1-3 3A M Mercantile t 38 R Resklendai.. R-1 R-2 R-3 4 S Storage S-1 S-2 5A U Utility 58 Mx Mixed Use Specify: Sp Spedal Use Specify. 9.0 COMPLETE THIS SECTION FOR WORK IN EXISTING SUILDINGS ONLY For new construction COMDIGtG sect On Addition. Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor(sf) Renovated construction or renovation . of existing building Now Sdef Description of Proposed Wok: 7e —/?Oof { 9.t USE GP;OUP AND C tdNMUCWXCLASSIFICATION(Existfng;9ulldipgs;Q`nty► EXISTINt3 ,. "PROPOSED Change CONStRtlCWff USE Groupts} in CLA$$IFICATt0�1 Use � Hazard Use _ Hazard Herd (note sub-categoryy; Group Index ''croup Index Index• - ' tJ air apWtrabt ). A Assembly S Business 18 E Educational . 2p F Factory 21 H High Hazard 2C� I Institutional. 3A 111 Mercantile 3B R Residential 4 S Storage 5A U Utility 58 Mx Mixed Use Hazard Index Sp Special Use Note: Include Hazard Index Modifier for Construction Type as applicable 9.0 CONSTRUCTION COSTS (See 780 CMR Appendbk L Total Construdlon Cost Building Permit Fee Check Number (1) n(1)x$0.001 a(�r 000 10.0 AUTHORIZATION OF STATE AGENCY FOR AGENT TO APPLY FOR BUILDING PERMIT(when applicable) i, on behalf of the audxvb3k4 Stats Agency or Authority, hereby authorize, to apphl for the building perrrdt for project number, Signature Date 11.0 SIGNATURE OF BUILDING PERPAR APPLICANT l�- Name nature Oate 12. Certificate of Occupancy required uired on completion of projeW �Yes ✓No ..�. inspectors Notes: Application for Permit to: LO Location Permit Granted Ap ved. s Inspector of Buildings 1, V c n Salem Historical Commission 120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 (978)745-9595 EXT.311 FAX (978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: 0 Construction ❑ Moving ❑ Reconstruction Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District:_ WohinWa Square Address of Prope Name of Record Owner: Harry McCo Description of Work Proposed: Gutter & Downspout installation as follows: • Roof of main section of house (A on plan) -Installation of custom formed wood, copper or copper-lined wood gutters with tight miter to match profile of existing gutters; Installation of copper downspouts (one on each end). All painted white • Rear section of house (B on plan) - Installation of new .032 gauge white aluminum 5" residential gutters; Retain wood miter around corners and cap. • Porch/entry (C on plan) - Option to either 1) Eliminate existing downspout or 2) Repair or replace existing downspout in kind(no changes in color, material, design or outward appearance). • 24'section in rear of house (D on plan) - Installation of new.032 gauge white aluminum S" residential gutters • Paint existing copper gutter white • Repair/replace gutters/downspouts on mud room as necessary to replicate existing or with new.032 gauge white aluminum S" residential gutters Dated: October 25 2004 SALEMM HI$TORICAL COMMISSION ✓� � � � By: I / The homeowner has the option not to commence the work (unless it re ates to resolving an outstanding vi anon). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. iww Date: 3/8/2007 Time: 2 :13 PM To: @ 1-978-927-2173 Page: 1 ACOR ,. CERTIFICATE OF LIABILITY INSURANCE DATE03/108/2007 PRODUCER (978)927-2600 FAX (978)927-8938 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leslie S. Ray Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 129 Dodge Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Beverly, MA 01915 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC N INSURED O'Neil Remodeling & Construction Corp. iNSUPERA Firemen's Insurance Co 131 Rantoul Street ur,UPERB Acadia Insurance Co. 31325 Beverly, MA 01915 INSURER Travelers INSURER1 Fax: 978-927-2173 INSURER COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIJSR DD'L TYPE OF INSURANCE POLICY NUMBER POLOYEFFECTIVE POLICYEXPIRATION LIMBS TR NSR ATE MMIDD DATENMOD GENERAL LIABILITY CPA0066499-16 01/21/2007 01/21/2008 LA.CH OCUURRENCE s- 1,000,000 X COAMERCAMOENERALLIABILIT'r DAMkGE TO RENTED '. FMEMVEF1Ee KOuuCX l 250,000 CLAIMS MADE ITIOCCUR MED CXP IAay one peso..) $ 5,000 Q PERsoNu c Anv nudoar ¢ 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCT S-COMPIOP AGE $ 2,000,000 POLICY JC�CT LOC AvromoeaE UAaluTv MAA0108709-13 61/21/2007 01/21/2008 COMBINED SINCLE LIMIT ANYAUTO (EX..,dR, ) 1,000,00 ALL OWNED.W-ROs BODILY IIJJ $ A X SCHEDULED AUTOS IPer l;erso..) INCLUDED X HIRED AUTOS BODILY X NNJ OOWNED AUWS .N) fl INCLUDED PROPERTY DAMAGE IPer acn.rnO F' INCLUDED I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT q. A Y AUTO 0 1LYN EgACC $ AUTO lffO 1I4LY AGG $ EXCESSAIMBRELLA LIABILITY CUA0107656-13 01/21/2007 01/21/2008 EACH OCCURRENCE s 2,000,000 OCCUR ❑CLAMPS MADE AGGREGATE $ 2,000,000 B t DEDUCTIBLE Y RETEM1014 q B WORKERS COMPENSATION AND r XEUB-824K341-3-06 07/03/2006 07/03/2007 X '-')H' EMPLOYERS'LIABILITY l01?1' G� R C ANY PLCTRIETOR/Ra TIJER XECLRNE E L EACHAOOIDEVR 5 SOO,DDD OFECERIMEMBER EXCLUDED' EL a DSEASE-EA EMF 0,000 L DSEASE-POLICYLIMIT SDSPlcIN PROVISIONS Nenw 0,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIOIJS QERIIEICATL HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WETTER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Insureds Copy AUTHORREDREPRESEWATIVE Richard Jones/SHERRI � - ACORD 25(2001108) ©ACORD CORPORATION 1988 \ ✓!Ze 6941/1420Wweam, 0��f�?dld�fLll Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Ma.ssa.clhusetts 02108 Home Improvement Contractor Registration Registration: 138916 Type: Private Corporation Expiration: 5/30/2007 -O'NEIL REMODELING + CONSTRUCTION ,- JAMES O'NEIL III 131 RANTOUL ST. BEVERLY, MA 01915 Update Address and return card. Mark reason for change. DIPS-cA1 Co 50M-04104-G101216 Address ❑ Renewal ❑ Employment Lost Card ✓fie {2�o�unro�.auiea.�./�. n�✓l�.ao9�ucelY � BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR 4 Number: CS 054090 r., I r � Birthdate: 02126/1956 Expres: 02/26/2008 Tr.no: 15789 r ' Restricted: 00 JAMES J ONEIL III 131 RANTOUL ST Q' - BEVERLY, MA 01915 Commissioner i � 1