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Certificate No: 216-12 Building Permit No.: 216-12
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical Permits
This is to Certify that the RESIDENCE located at
Dwelling Type
44 COLUMBUS AVENUE in the CITY OF SALEM
- -------------------- - ----------- ----- --- - - ----- --------
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
OCCUPANCY PERMIT FOR (44 COLUMBUS AVENUE)
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires unless sooner suspended or revoked.
Expiration Date
j _
Issued On: Tue May 28,2013 --------------------- -------------- - ---
- --------------------
-
GeoTMS02013 Des Lamers Municipal Solutions,Inc. ----------------------------------------------------------------------------
44 COLUMBUS AVENUE 216-12
cr"s# r= 64041jCOMMONWEALTH OF MASSACHUSETTS
Map {, !;' 447,1.,,.:`:u_ r s It .
13iock y „,kaP' CITY OF SALEM
h
Lor 0147.
Category A@f� RENOVATIONS
LL '_
Pe�rllllt#�I� , 21612 .,a.,, ;F ,y u BUILDING PERMIT
Piolect#��:0 �JS 2012-000566,1�;;3t '
Est Cost I� ail.$122,000.00
Fee Charged lK. $854.00-1 t rpI
Balance Due: $oo PERMISSION IS HEREBY GRANTED TO:
onst ;ffn
CClass:'t " m W Contractor: License: Expires:
Use Group ERIC CHASE DBA CHASE CONTRACTCONSTRUCTIO SUPERVISOR- 100531
LotSlze(sq ft) 42501492 ` '
Zomn �`,*"�' Rl "? �. ;�i.� Owner: Lewis Legon
g u4 ;
Units Ganie'd4[tymffl—mifi:Applicant: ERIC CHASE DBA CHASE CONTRACTING
Units tost ;'; AT: 44 COLUMBUS AVENUE
ISSUED ON: 08-Sep-2011 AMENDED ON: EXPIRES ON: 08-Feb-2012
TO PERFORM THE FOLLOWING WORK:
REMOVE EXISTING BACK DECK AND BUILD A NEW ADDITION REMOVE EXISTING ROOF STRUCTURE AND
REPLACEjbh
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
(Underground: Underground: Underground: 11 Excavation: t`-1,
Service: Meter ' ( f Footings:
„Rough: Rough� Rough: ,Z�5 Foundation:
Final: Final:Final: Final Rough Frame:
✓ � r2 S1�.Il f3� �►
Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oil: �t3117
A . O'+" 43 Final:
House N Smoke: }'7 V�
Water: Alarm:
J� Assessor Treasury:
Sewer: Sprinklers: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
Signature: q,
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING REC-2012-000635 08-Sep-I1 925 $854.00
GeoTMS®2013 Des Landers Municipal Solutions,Inc. (/
i
N ' y
V� VSQVE AD
CITY OF SALEM
7 The Commonwealth of Massachusetts
`i Board of Building Regulations and Standards CI'I'1' OF
Massachusetts State Building Code, 780 CMR ti,\Lflht
1
'L„•• Re rived I Lv?0/1
Building Permit Application To Construct, Repair, Renov:f e r Demolish a
1 Our- ur Two-Familt•Divelline
\l This Section For Official Use Onl
Building Permit Number:
g ate Applied:
Building Olticial(Print Name) Signatur a to
SECTION I: SITE INFORA TION
I.I Property Address: 1.2 Assessors Nlap& Parcel Numbers
I.la Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed lJse Lot Area(sq 11) Frontage(R)
1.5 Building Setbacks(R)
Front Yard Side Yards - Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if yesO Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2 1 Owners of Record: �1 '
Lew iS 1-20.0h
N:une(Print)//!�� 1 City,State,ZIP
�q WLVr "
Nu.and Street Telephone Email Addmss
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction QC Existing Buildin�`t6i' Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
BrirfDescriptionofProposed Work': 'S 6t�
tVhJ V AA s>tra...
l�w,r Irxwa.tt •ttlrt4ir,n b� lovv fL��
0
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Ilange
Estimated Costs: Official Use Only
Labor and \Iaterialsl y
I. B $ �' 1. Building Permit Fee: S Indicate how fee is determined:
'. ES �/1 ❑Standard Cny/Town Application Fee
❑Total Project Cosh(Item 6)x multiplier x
i, Pl $ '1 r� �. Other Fees: $ ---
1. .\IIll\':\('1 5 List- -
Firc $ Total :\II Fees: $Chak Nu. __('heck:\mount: C';tsh :\nunnn:Toct Cult S _ ...
�Z—. ❑ Paid in Full ❑Outstanding Bal:mce Due:
r
SECTION 5: CONSTRUcTION SERVICES
5.1 Construction Supervisor License(CSL) '� �t
License Number F.cplratiou I ate
N;une al'C'SI. Holder �------ -
11 c IJSICSL l)M'(Seebelow)_-
.I's.PC Description
No. and Street
1 nresRestricted
l (Buildings Frm li toing cu. It.l
CPCJv� � Restricted I r2 Family Dwellin
C'ityi I'uan..S •.ZIP M M1tasunr
RC Roofing Covering
- W'S Window and Siding
G 'y �•�� I 1 SF Solid Fuel Burning Appliances
60 (owl(. PCiVI( sceo 1N'(•6` I Insulation
Tcle hone Pniail address D Demolition
5.2=egistcredHome Imptrovement Contractor(HIC)
tWt.i I 1IIC Coeany Nm
CR
co
nt Name
itl stration2 NYum=cboer lizpir:oion Dulc
In'.
Nq,iuid Strurtt - a?EIS Email addressr
J'fh H
City/Town.St Me.ZIP 'rele hone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ......... W No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize _
to act on my behalf, in all matters relative to work a is buildil nit a placation.
Le.t.)r �e 25
Print Owner's NunioElectronic Signature) Dale
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Ch $ Z /
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his,her own work•or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program)•will not have access to the arbitration
program or guaranty fund under M.G.L.c. 1 q2A.Other important information on the HIC Program can be found at
wo"t Information on the Construction Supervisor License can be found at 1�n Jp;
2. When substantial work is planned, provide the information below:
Total floor area(sq. R.) (including garage, finished basement'attics,decks or porch)
Gross living area(sq, ft.) - — Habitable room count
Number of lircplaces- `'umber of bedrooms
Number of bathrooms Number of half h:ohs
1')peofheatings)stem Number of decks, porches. -.
l'\pc ofc00li116*ste111 Enclosed Open
7. 'Total Project Square Foolage"may he substituted fi -Folal Project Cost"
CITY OF S.U-&Ni, ,NWSACHUSET rs
BLQMLVG DEPARTMENT
120 W.uHLNGTON STREET, Y°FLOOR
` ILL (978) 745-9595
FAx(978) 740-9846
KiJ(BE3LEY DRLSCOLL
MAYOR THo.+us ST.Pmxa
DIRECTOR OF PLBLIC PROPERTY/KaMLYG CONNISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section l 11.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be dis os cd of in a properly l
icensed waste disposal facility as defined by MGL c
l 11. S 150A.
The debtis will be transported by:
Fes. z
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
Z 6
gnarure of permit applicant
I�r
Jdte
I.M1n ud•bw -
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
.�II16 X:1 y Inlst\•I I
d
12: NVAHILN,;1,a,N,ilxw, a S,,I I•W, M,,»e,.ut a,I INJI97:
1'cI. v7i/lS7ioS • f,x v7N•7tC•'r;fpy
��'orkt ra' Cumpeneallon Insurance :\I'flduviC Builders/CuntractorwEleeirldanyplumbers
� l ilkant In nrinrfion
cp�
V411TQ I Ihlvlk'.yl7raanvJlinlvindlvnlpull: ( rye
WtIres.v:
Cityr.SrarzZipr h
' one
I i4 4'7
.try)too an votployu►'t Chuck the apprnprlute box:
I. I ant a cmpluyur with 4 l')iPe orprnjuet(rugalred):
❑ I :un a general contractor and 1
'•❑ cnlpluycew(toll anll/ur part-time).• bavu hired the.sub•cumrsetors (t' 0 New construction
I am a sale prnprient►or partner. listed on the anachcd sheet r 7�Rcmtrdeling
ship and Nave no empluyeale Thess sub-contractors have
working lbr me in any capacity, workers'comp• insurance. S. Demolition
I Ko workers•cutup. iusurance 1, 0 We are a coo, 9• ❑ Molding addition
required.) pontinn and iu
al)Tcen have esereirad their I0.0 Electrical repairs or additions
).0 1 ant a hunteuwner cluing all work right of a+cmption par bIOL 11.0 Plumbing repairs or idditinne
myself. (t\'o ,rnrkers'cutup• c. I S2,¢1(4),and we huvu no
insurance required.) t employees. (Ko workers' t2.O Rwl'repuirs
crnnp insursnawnyuind.J IJ.DUtbar
•by.yglhaua it'd clwch ltw rl mud:dw 101 uw the wrchul,Wow dwwngt Ihnr.w•wkwa funttwleuelun Iwtliey udiutnwiura
'Il�mw,wrwn whe"donut Ibis affidavit inde ut"s Ih"are opine.11,fXrk and Ib.aa hip"Side pMXlnpftre TWI.YfXni a new JlnJevil i4li,adine ww'h,
�r\rn1r4UX9IhN tha'a'k Ihi1 bar mead Jtgehwl m addfllanyl dhwtt dluwine the naaM 0/fh1 lYk•eenlnelale and IheX 4alkeq'rpXp,ptltc q
m.
/van un avylployrr that It pray/d/nt/workers'rutnprnratlon Lrrarnnra�ur my amp/uprrr, Bdmr/a thepal/ay rrrJ/a1 s
!rt`urntat(tJt4
Insurance Cbmpaay Name: l2wv. ra..rl•�
Policy u ur Sulf•ins. Lic.rs:
�/ EApirallen Dare: 1''
lob $ile�\tilfefs;� T �Q�(Jyy`bV ` � �L�,.a yy'/j,
Cuy'Slate/Zip:"each u coolly of like worker'cunepensatlan poollu) decldrallon page(showing that policy number and e+plr e)
f7m lord to sccuro coserage u required under Suction?SA ul'�IGL c, 152 eau lead to lit*imposition or criminal penalties Ora
fine op m S 0,00 it d Jnd/ur one-year impri.vntunent, Js well Js civil perwlllus in the form of STOP WORK ORDER and a fine
,)(kill rn i'SQ.rM n day.I�ainst the v6rlat'v. Ile advincd Ihut a copy urthis.linemen, may be lurwarded to the Ullice vl'
Igri nII�J11,41f ul llle UTA :or iommirce awc1`43e,crilicJltun,
/du h.•rrhy.,rri/y it , er hit airrc,tnJpandiier ufper/rtry that rhr in urmur(ow/• prvrir/rd u avr/1i7/uur and t'orrerR
�I•::'lee: $ I 1
) Z
rl
II t!%/Iriv/rut av/y. Oo tint Ivrirr in rhlr Orru, lu he rvntp/rtrd by airy of rorvn a//IciuL
( itr ur I'own:
Vcnnif/I.Icv'me 1
I vsuing .l tuhurily (cih•le nnc); ��
I.�i 16rad d llcallh
b. )Iltur 1. Iluddin'j Ucpanlllclll 1 l:i ' ' or i, PhnnDing Insycclor
--------------
I'hunv Y
Inform
arson and Instructions �. .-
cr+o tit the I rvice of another tinter any cuntnct of hire,
>Lu;ochusel sly rotate, an rmplorra is JctiiuJ as,Revery p ors t to provide workers CJlnpeniaUUn lu(their elilp eyee$.
I`unu.utl e
;.press or tinplied. oral or `vrnlen' ' two or snore
�n C,npluprr i+Jctin¢J ss"an individual. partnership.•Iaaeel ItWa,corporation of abet legal entity, or any
.\ the t:,requr14 engaged m a joint enicrpnse.and including he 1¢gal representatives a aOS co,vl,ees.IHow aver the
i ecelver or uusea of.art individual, p
u ril"o . ,ssoewtioa or other lekal entity,amp Y a ' D is ant of the
Woos w do maintenance,curlSouction or repair work on sdch dwelling house
owner of a dwelling house having not more than three apam"ants of wnd hA employment resides
ordeemed tuba Jn dwelling
ho r." .
.Iwellmg house of another who emRle yuith'ereto$hull nol because•
or on the grounds or building app $hall withhold the issuonce or
>lGL chapter 132. 415C(6) also states that"every state or local trust buildings
dings I
0 Of Uaaee wick the Insurance coverage required."
renewal of a Ilcunst or parntlt to operate•huilnsu ar to eoestruet buildingf IN the comttiticsl subdivisions shall
applicant wlto has not produ�ad�SCaD,alaesble r Neither he omlmonwcalth not any of its p
%aditionully, %IGL shaper I s_, i-
ener info Iny:untrac, tor he performance of public work until acceptable evidence ufcunipliarlce with the msuronc
requiremoe of this shaper have been pfestined to he contracting authority."
Applicants to our situation and.if
illation atl7davit con letely,by checking the boxes that apply Y
D wick their c employees
th
Please till out the workers' canoe adth�eulesl and phone number(s)Along with no
employers usher than the
necessary,supply vub-contractors)name(s).
insurance. Limited Liability Companies(LLCworkeirs'tcom pansaed �onaimutonce,(If aa)LLC or LLP dons have
menebars or partners, arc it d to carry
w hie affidavit may be submitted to the Department of industrial
eniployeee,u policy is dorequired. TINartment of
hcation for he permit or liceilae is being requested.not the Dep
\ccidents for confirmation of inatsracico coverage. Also be sure to alga and Jute the ul'tlde io obtain utworkcre'should
that the
be rc tlmaJ to lee city or town You have questions regarding the low or if you an required
InJustriul Accidents. Should y It
the number listed below. Self-instuvd companies should enter their
compensation policy.pica"call the Department
.elf.insurance license number on the a ro riuto lino.
City Gr-rows Officials
uu w rill out in the event the ORlce of investigations has to contact you regarding the applicant
PICaSC he sure that the affidavit is complete and printed legibly. The Department,3 has has provided u space at thebottomts
of the atfidrvit 1'ur y
applications in an given year,heed oil) submit one atiid ion indicating current tar
,'hose bit sure to rill in the pnout in
nwnbelr which will gba use ❑s a reference nce nunibar, In addition,an ap
that must submit mulliple pannio'l nd tinder
policy iut'armatiu'n (if necessary) and under"Job Site Address'the applicant shnuW wri town t"all luay be p o Y
town).",%copy of the utlldavit that has been officially scam ern is e marked censas A ntow aty rilldav t n ux be tiled nut each
applicant as proof that a valid affidavit is un file for tattoo p to any
e`iaa Where
.+e or owner tto burn M islea obtaining
it<eJ R icense
iel uittis YOT required to�ampleetthis erfidavtmnercial wanton
I he hli.e ur lnve$tigatiuns "Quid like to thank y'nu in JJv;lllce for your cooperatioll'JIIJ Shuuld yuu have.arty quastimis,
pleJ,e Jo nut hesitate to give us a call.
the U panment's aJJte++, telephone.and rax number.
The Commonwealth of Ma suchusetu
Department of Industrial Accidents
Olflee of Iavadgadons
600 Washington Street
Boston, MA 02111
'rel. M 617-727-4900 ext 406 or 1.877-MASSAFE
Fast $ 617-727-7749
www.mam.gov/dis