15 CONANT STREET - BUILDING JACKET 15 CONANT STREET
INSPECTION REPORT DATE:
ADDRESS:
OWNER: 457-r- Aoir
r�/ y-�Aw 60 OCA=102O
USE GROUP: 3
NUMBER OF STORIES: r
NUMBER OF ROOMS (BY STORY) : '�'"�9��
HOW HEATED:
GAS: YES "� NO: l
NUMBER OF SANITARIES:
NUMBER OF APPROVED EGRESS DOORWAYS:
REMARKS,,,
FEE RECEIVED: YES ✓ NO:
m To inspect 15 Conant Street, Salem please contact
listing and selling broker, Vernon A. Martin, Inc.
at 777-1090, ask for Mrs. Cherkas or Mr. Beaulieu
Mr. , Building Inspector
:0=/City of Salem
,Ma.
Re: 15 Conant Street
Dear Sir:
In accordance with Section 111.45 and Section 120.3 of the
State Building Code, I, as the owner, hereby request an inspection
of the premises at 15 Conant Street , and the
issuance of a Use and Occupancy Certificate.
Entry to the premises may be obtained by contacting
(or or ) should you determine that an
inspection is necessary or desired.
Will you kindly acknowledge that you have received this letter
by signing and dating the attached copy, and returning it to me
in the enclosed envelope.
Yours very
truly,
r�
a Enclosure: $ fee
On 19 , I received this letter and the fee of $ for
the issuance of_a Use and Occupancy Certificate.
An inspection will be made by our office within three days.
An inspection will not be made by our office.
'4
p,
Mr, , Building Inspector
kPi4/cit.y of sail-M,
,Ma.
Re: 4S Cnnn»ifr .Q+want
Dear Sir:
In accordance with Section 111.45 and Section 120.3 .0f the>
State Building Code, I, as the owner, hereby request an inspection
of the premises at _15 Conant Street , and the'
issuance of a Use and Occupancy Certificate.
Entry.to the premises may be obtained by contacting
(or " or ) should you determine that an >
inspection is necessary or desired.
Will you kindly acknowledge that you -have received this letter
by signing and dating the attached copy, ' and returning it to me
in,,the enclosed envelope.
Yours very truly,'
Enclosure: fee _
On 19' , .1 received this letter and the fee of for
the issuance of a Use and Occupant Certificate.
An inspection will �� ade by our office within three days.
,l An inspection,'will not be made by our office.
4.
1
p�
I
► 's 4 GtG l S Z�6
The Commonwealth of Massachusetts RECEIVED
Board of Building Regulations and StandarOS,SPECT ION PL S'-RVIC1- OF
Massachusetts State Building Code, 780 CMR SALEM
Ry�ro,'bMar 2011
Building Permit Application To Construct,Repair,Renovate g{lp li�a `FF jj
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Rat/Applied:
\, /
�—. Building Official(Print Name) "Signature Date
p. SECTION 1:SITE INFORMATION
�J 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
l.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSW!r s1
2.�Owne� gel—rd:� I Z{3 / lJ N/ �h/t ( /z/1//`l.
Name(Print) City,State,ZIP
/f C641AF-+ J"d y sys� �l3 Ff
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Workz:
(1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee :
2.Electrical $ ❑Total Project Cosls.(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVA $ O ist:
5.Mechanical (Fire $
Su ression Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) !A- ! 7
C d 10 ,p /y/� ,y�uF License Numb Expirati6n Date
Name of CSL Holder
4�� / � M` / List CSL Type(see below) L�
/ /' C
No.and Street r �G G Type Description
n Wiz& d y yi.e /d U Unrestricted(Buildings u [0 35,000 cu.ft.
/!/ (� Ll �/�� �/` R Restricted 1&2 FamilyDwelling
Ci /rown,State,ZIP �/` M Masonry
l'V 0 RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 /Registered Home Improvement Contractor(HIC) /d ( L/, /l/�GLC HIC Registration
`YNumber Expiryfion Date
HIC Company or C Registrant m
'IL bra
No.and Street V/ A Email address
Y� � CXNav �C
Ci /T- ow State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c,152.§ 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 .......... 6-- 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 authorized by this building permit application.
Print Owner's Name(Electronic Signature) f Date
SECTION 76:OWNER' 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.
Cd Nll� /n /i��JN 2-2Ztt
Print Owner's or Authorized A ent s Name(EI ctronic Signature) Date
NOTES:
1. 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. 142A.Other important information on the HIC Program can be found at
www.mass.eov.%oca Information on the Construction Supervisor License can be found at www.massJ,,ov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF SALEM, MASSACHUSE M
BLUDING DEPARTMENP
120 WASHINGTON STREET,380 RLOOR
Ti L.(978)745-9595
Y-B BERLEYDRISODLL PAX(978)740.9846
MAYOR THOMAS STYLERRE
DIRECTOR OFPVBLTCPROPERTY/BUILDING GCMNffSSj0mR
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 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit g is issued with the
condition tha
t the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as
P defined b
tY MGL c 1
Y 11, S 150A.
The debris will be transported b :
P Y
/� l 0 LAL
c �
(name of hauler)
The debris will be disposed of in:
Lyfxl /1I/9 '1�✓ R NE2 �eJ uJ
(name of facility)
Cd wi P-I. ,r--gC"e4 L
(address of facility)
ignature of applicant
/ z l�
Date
Massacnuserrs - Department or Huouc aarety
Board of Building Regulations and Standards
C,,nstructir,n Supcni<or wpm
License: CS-064068
`s_t
Conrad L McKinno '
16 Castle Circle ' • p
Peabody MA 01990
J7� �, . '� "` Expiration
Commissioner 01/21/2017
Office of Consumer�Affairs& Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: 101444 Type: .
` =F Expiration: 6/26/2016 IDEA
HALLMARK HOMES
Ccnrad McKinney
479 BROADWAY
LYNN, MA 01904 tlnderserrelan
vaa�
O
QUALITY - EXPERIENCE t 1
• 1 1 - Insulations
SERVICE Siding
HOXIEIMPROVEMENT ���„�� Hallmark - Roofing
LICENCE#101444 �% Him es L.L.C. - Replacement
CONSTRUCTION SUPER VISOR Windows Specialists
LICENCE#064068 479 BROADWAY,LYNN 01904
LYNN BUILDERS LICENCE#470
Im (781) 592-5900
CONRAD MCKINNEY, President Established 1964
Member Better Business Bureau® www•hallmarkhomes.net
Serving Eastern Massachusetts MEMBER OF THE LYNN&PEABODY AREA CHAMBER OF ONIMERCE
lsaei'rez -6-C/ g C/ 22
01,ner's name z_ L 1 Z Pho r e.� 9 29-a.l D J Gg
7
Job address r Ci ate
/� n- Specifications
l\
{
U �
_$ vA —f 3 t U
620
a o �
dIrshprice of gYods and services: ....... .........................................................................................I...... $aZL. , 4
Down payment or payment at commencement: ........I..................................................I................................ $......................
Paymentwhen 50%complete: ................................................................................................................. $......................
Balanceupon completion: ..................................... .................................................................I.............. $......................
Est. Start Est. Comp. ;- SUBJECT TO.M�aA�CHUsSETTS SALES TAX
Contractor will do all of said work in a good workmanlike manner. The a"ner agrees to notes the contractor in writing,signed by the owner,of any defect in
u orkmanship or material. The contractor shall be liable only if it jails to repair any specified defect, including defective repairs,within thirty days of receipt of
notice, but not otherwise and in no event shall the contractor be liable beyond the cost to it of labor and material requiredfor any repair work.
The contractor shall be paid by the owner(s),all reasonable costs,attorney fees and expenses in addition to the amount due and unpaid, that shall be insured
in enforcing the terms and conditions of this contract and/or and,lien in connection therewith.
Mu mar cancel this agreement(if it has been consummated by a party thereto at a place other than at address of the seller which may be his main office a,-
branch thereof by a written notice directed to the seller at his main or branch office by ordinary mail posted,by telegram sent or by delivery,not later than
midniglu of the third business dar following the signing of this agreement.
No work to be done on this pmperry other than specifies in this contract without additional charges.
This contract contains the whole agreement rrith us. Company will fnnrnish warranty adjusted to the type of work done on above property upon completion of
this conn'act.
Owner agrees this in even of his breach of this contract before work is started. Contractor may demand twenty-five(2501o)per cent of the contract price as its
stipulated damages for the breach.
This connns is subject to strikes,accidents, or oilier delays beyond our control. '
Company furnishes insurance coverage
I/we. the owner(s)of the premises mentioned above, hereby contract with and authorize you as contractor,to furnish all necessary materials,
labor and workmanship,to install,construct and place the improvements accoryling to 4secicatIons,terms and conditions,on premises
above described, which we warrant and represent that we have good local r u'tle s in our own name.
Lt viuness whereof the ponies have hereunm s' their names on this date.... .V....... ...... ......................_......n.................................._.......
C . R4D Ic KINN RESIDENT Signed, i..... � ...........
Owner
OR ................. ..... ....... Signed....,....,.........................................
Repr . ,e Owner
nAgn Lrax L;J-1 5/19/2015 10:59:45 AM PAGE 2/002 Fax Server
A CERTIFICATE OF LIABILITY INSURANCE DATE(MU*DiYYM
05/19/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EMEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN-THE ISSUING INSURER(S), AUTHORIZED
REPRESENrATIVEORPRODUCER AI'IDTHE CERTIFICATE HOLDER.
IMPORTANT: N the cartillostt holder Ism ADDITIONAL INSURED,the policy(lea) must be endorsed.If SUBROGATION IS WAIVED, subject to
the terms and condlaons of the policy,consln Polloles may require an endorsement A statement on this certHlcete does not Pont"lights to the
c'ertakat9 holder In lieu of such endasemen s).
Psaouas � Acr
EASTERN INSURANCE GROUP LLC Ea: see seisms
233 W CENTRAL ST a ' u e68 6YEaD21
NATICK MA 017BO I revtlen. m
(888)661•3938 NBURER(B`.AFFORONG COVERAGE MIC F
INSURER A:TRAVFLERB CASUALTY INSINANCE COMPANY OF AMERCA
Wil-
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NS 1AM L GILBERT DBA II6URERs:
G LBERT HCMEIMPRUVEMENT
E SHERMAN ST IMURERD:
NASHLIA,NH 03080 -----_
INSURER E: _---- -- --
NNMIIRERF
COVERAGES CERTIFICATE UMBER: 8441522313'1931 REVISION NUMBER:
T-IS IS TO CERTIFY THAT THE POLICIES OF WS'JRANCE _ISTED BELOW HAVE BEEN ISSI ED TO THE INSURED NAMED PROVE FOR THE POLICY PERI00
INDICATED. NOTWITHSTANDING ANY REOUAREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED aER E EXCLuSNJVS AND 004DRIONS CF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED 3Y PA!D CLAIMS. IN 15 SUBJECT TO ALL THE TERMS
NS11 ADDI fUAR
TYf4 Of IMBIIRANCF POI.ICYNUYBER POLICY EFF POLCY EXP
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COWEROALGENERLLWBILRY 680.8352)C21 A•T$ 05.r1 B/2015 0&9aN2016 ,LCH DCURgEI CE 7
7.ULlSYADE [Z]O'Y:UR I ri—
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to P' r $5 000
'F RS(kJALeA VINdLRY $1,000,000
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AUrONgILI MASLITY IE�asrNgFOOiSNOL E LIMITS
ANY AJTO EO LY LUURY F*ANtml S
ILL OMM ED aC�[DIILED
All ALTOS BODLYdUURY(PNFzwanll S
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AUTOS ft>ic� ��AOE 5
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(IM E.I.DEEASF-EA FMFIO�EE S
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OESCRiTCN OF OPERATORS,IOCATONa I VENCLLS ACORG IDI,AUUNEraI Rereuea aGIFEYII.Roy W FtleNFe 11 FNIF yF:F Y rpuNW)FOR INFORMATIONAL PURPOSES ONLY
CERTIFICATE HOLDER CANCELLATION
HALLMARK HOMES LLC I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
16 CASTLE CIRCLE THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN
PEASCOY,MA O1960 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Ce'988.2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/0f) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department oflndustrialAccfdents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
rkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information ' ! - Please Print Leeibly
Name(Business/Orrgganimtion/Individual):�/}� t� �t fE, Ll C
Address: �� / of 13a cim City/State/Zip: DC/ hone#: /n
K 0
Are you an employer?Check the appropriate box: Type of project(required):
I El I sm a employer with employees(full and/or part-time).' 7. El New construction
2.Ej I am a.sole proprietor or partnership and have no employees working for me in g. Q Remodeling
any capacity.[No workers'comp.insurance required.]
3.❑r am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9: El Demolition
4.❑I a a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition.m
enure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
S.E3,iarn a general contractor and I have hired the sub-contractors listed on the attached sheet.These 13. Roof repairs
These subcontractors have employees roil have workers'comp.insurmce.r (� I
6.�We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other r [(7 ilk
152,§l(4),and we have no employees.[No workers'comp.insurance requited.]
*Any applicant that checks box Al must also fill out the section below showing their workers'wmpensetion policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box most attached an additional sheet showing the name of the sub-cormacton and state whether or not those entities have
employees. If die sub-contractors have employees,they must provide their-workers'wrap.policy number.
I am an employer that is providing workers'compensation insurancefor my eraployees Below is thepoliky,andjob site
information. j, C) (
Insurance Company Name: r
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: It-c.
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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. y of this statement may be forwarded to the Office of Investigations of the DL4 for insurance
coverage verificati -
I do hereby ce ' u e pen aUfes of er'ury that th 'on provided ab ve is true and correct
Signature, Date: Z ��
Phone#:
Offie4i6se only. Do not lv n 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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or writtep."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the Insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dqg license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017.
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia