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5 WOODSIDE ST - BUILDING INSPECTION The (l nunomcealth of MasSaChIlSellS --- r Hoard of Building Regulations and Standards It rlt %it NI( 'it, \1.111 Massachusetts Stile Building ('ode. 73H ('!AIR, 7" edition I '>I. Bt ildin!_ Permit Application To Construct. •pair. Reno\ate Or Delnoli,lra 18,,,,./ /,.nu... 1 Ott - err Ttru- - mill Dtrrl )t,q L ' 'r_•s' \ �\ O Phis S Y m For Officiatpse Only , y I mlJing Perntiu Ntunb _ D to p irJ: �\ Rod Ing Contnu,aundt/ I ,pecior ' wldin Dale )I* SECTION I: SITE INFORMATION 1.1 Prupertr .\ dress: 1.2 .Assessors flap & Parcel Numbers -- f oO rl Sr �C- I.la is this an accepted street yes_—,— t o Map Number Par.cl Numhp`r 1.3 Zoning Inrtirtaation: , 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy 11) Fruntage t it) 1.5 Building Setbacks (fq ! Front Yard Side Yards Rear Yard Required Pr( MRrquoed Provided ReymreJ Prm iJrJ 1.6 Water Supply: (M.G L c 10, §$1) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: ! Zon _ Outside Flood Zone'' Public ❑ Pric!ate❑ Check il'yes❑ Municipal ❑ On site disposal sy,teni ❑ _ SECT' N 2: PROPERTY OWNERSHIP' 1 t Owner'or Record: 1 _ GP/6o �S Nau;r t Print) AJ ress for Sire ice: Stgn:'t tie Tel SECTIO 3: DESCRIP ION OF PROPOSED WORK'(check all that apply) New Consnuctionb Existing Building ❑ Owner-Occupied 'J Repairs(s) ❑ Alteration(s) ❑ r\Jditiun ❑ Demolition❑ Accessory Bldg. ❑ Number of Units_ Other ❑ SpecJy Brief Description of Proposed Work': 6 __— .s —J _ SECTION 4: ESTIMATED C NSTRUCTION COSTS Estimated Cost : Item Official Use Only t Labor and Matrri Isl t� I. Building i, 5 I. Building Permit Fee: S Indicate how fee is Jrternimcd \\, ❑ Standard City/Town :Application Fee a _. Electrical ! ❑Total Project Cost' (Item 6) x multiplier x _ 3. Plumbing S2. Other Fees: $ 3. Mechanical 1HVAC) .S List: __ 1 5. Mechanical (Fire] ----------- Su t rc,stom) Total All Fees: S Check No -('heck Amount: Cash Amount.-_ -- 1 b -rotal Project Cost- ❑ Paid to Full ❑ Outstanding B❑huxr Due:---_--_ ..._- . ' )31 `j i SECTION 5: CONSTRUCTION SERVICES — yl Licensed Construction Supervisor (C l') License N'umher 1`sp1taoun Date Nan,e utl'S1. Iluhler L.,sI C'SL it pc me heluwl \JJrr",�� I n(riot u, lu i5.l N1U Cu I L Reslnrled Ia_' F.umli D„elhne � S,gnaunc gip( G ) N1 NLuonn Onh� ��- Sys a 3/ RC Re,idenual Routine felephom• wS Rc„Jcnoal \\l nJo„ .ud Sidm,-- SF Ite,iJeno.d Solid Fuelw ,u IS nc \�i_mcc D Rc„deno,,l 5.2 Registered Ilome Iniprorement Conl • ctor 0110 HIC Company Name or FSIC Re nstram NameRegI,II'allU❑ Niiiiiher t D Address -- --- Fxp,ra0,m U:LLe Signature SECTION 6: WO KERS' COMPS SATION INSURANCE.AFFIDAVIT (M.G.L.c. 152. § 2506)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to pn„ide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached'? Yes .......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby au[horizr r` to act on my behalf'. in all niatmrs relative to %vo,k authorized by this building permit application. Date Signature Owner ----� SECT►O : OWNE a OR AUTHORIZED AGENT DECLARATION r , as Owner or Authorized Agent hereby declare L that the statements and information on the f gain@ :application are true and accurate. to the best of my knowledge and behalf. i' k Print.Nat Signatu of Owner or thonzed Age Date (Signed under the aim.and enaltie f er to 1 --� NOTES: J I. An Owner who obtains a building perm, to do his/her own work, or:m owner who hires all unieguieied conVo.tor (nut registered in the Home Impruveme t Contractor (HIC) Program), will not have access to in, arbitranwi program or guaranty fund under M.G.L. c. 112A. Other important information on the HIC Prour:mi and Construction Supervisor Licensing (CS )can be found in 780 C NIR Regulations I I0R0 and I I0.R5. respeco,cly. When ,ubstanttal work is planned, pruvt le the information below: j Total ILLLIrS area ISq. Ft.) (including garage. finished ba,enient/attics, decks or porch, I Gross living area (Sy. Ft.) Habitable room count -_- Numberof hreplaces Numberut hedro,nn, Number of hathruunis Number of twit/hash, .--------_.--- _—_.__ I'vpe Number of deck,/ p,uehe, of healing sy,tnm — Upcn I'll,[".Ned ._. —. _.. Type of cooling Ii systcni _ ___--__. -- .__ � 1. "Total Prnject Syuare Footage' maybe ub,tituted for ..ft,tall Pr,ilect C'o,t _..� ACORv CERTIFICATE OF LIABILITY INSURANCE CSR SW DATE(MMMDIYYYY) UNITEDR 1 05 14 08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MF&T Ins. Construction Div. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Construction Division HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 77 Accord Park Drive Unit B-1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Norwell MA 02061 Phone: 781-261-2000 "; j INSURERS AFFORDING COVERAGE NAIC 0 INSURED 'j INSURER A; Northland Insurance y, INSURERS: American International Co. United Roofing Contractors,I LC INSURER c: 5 Brentwood Avenue INSURER D: Salem MA 01970 wsuRERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN'IS$ ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING NTRA ANY REQUIREMENT,TERM OR CONDITION OF ANY COC OR OTHER DOCUMENT WITH RESPECT TO 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 REDUICED BY PAID CLAIMS. Now[ GENERpLYPE OF IN - —i POLICY NUMBER DATE MMID - 'DATE MM/DD --" "- LIMITS" EXPIRATIO LTR.NSR TYPE OF INSU N � I EACH OCCURRENCE $ lOOOOOO A X COMMERCIAL GENERAL LIABILITY CPS54i790 05/08/08 05/08/09 PREMISES Eemcurenm E 100000 CLAIMS MADE ODOQDR MED EXP(AnY one Person) s5000 PERSONAL S ADV INJURY $ 1000000 F - GENERAL AGGREGATE 12000000 P PRODUCTS-COMPIOPAGG s 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: } X POLICY PEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Es amldenl) ANY AUTO ALL OWNED AUTOS - BODILY INJURY s (Per Person) _ SCHEDULED AUTOS HIRED AUTOS - '�; BODILY INJURY - 'S (Per accident) NON-0WTIED AUTOS PROPERTY DAMAGE $ (Per...ident) + - .AUTO ONLY-EA ACCIDENT s GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE s OCCUR CLAIMS MADE _ AGGREGATE $ $ LI DEDUCTIBLE $ �1 RETENTION $ WORKERS COMPENSATION.AND „ II X TOY LIMITS ER B EMPLOYERS'LIABILITY WC 697-01-90 05/08/08 05/08/09 E.L.EACH ACCIDENT $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.DISEASE-EA EMPLOYEE $ 100000 OFFICER/MEMBER EXCLUDED? B yea,desaibe under E.L.DISEASE-POLICY LIMIT s500000 SPECIAL PROVISIONS 1,e]. OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Village at Vinnin, Phase II„S'alem, MA, Stadium Condos; The Meadows in Danvers, ClOistlr Condos in Salem, Highland Condos, Salem, MA i ! ll I ! CANCELLATION CERTIFICATE HOLDER EACOPRO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL .East Coast PIIOP@rt103' IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 400 Highland Ave. 11 REPRESENTATIVES. Salem MA 01970 pU ED REP TATYi.r ©ACORD CORPORATION 1988 ACORD 26(2001/08) l i