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15 CROMBIE STREET - BUILDING JACKET q The Commonwealth of Massachusetts Department of Public Safety f �yU Massachusetts State Building Code(780 CMR) IBuilding Permit Application for any Building other than a One-or w ami.y D lin �J _ (This Section For Official Use Only) - 1 Building Permit Number: Date Applied Building Official: SE/C+TION 1:LOCATION(Please indicate Block#and Lot#for locations for which a s t.address is available) Cfus+y�r 1( .3i �-l1Zyr� No.and Street City/Town Zip Code Narne of Budding(if applicable) + SECTION-2:.PROPOSED WORK pr Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ 1 Repair Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Id Is an Independent Structural Engineering Peer Review required? Yes ❑ No [iT Brief Description of Proposed Work: rtpcAilm sdM SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): I Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA - Existing Proposed) No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable)`` - A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ HIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal:i Trench Permit:Water Supply: Flood Zone Information: Sewage Disposal: Trench Disposal Site❑ ' Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be p required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: I N1r\I hytnnr Comnvysi n Rc. ��,1 r ass: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed ❑ 1 Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY. Edition of Code: Use Group(s): - Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION. .. Name and Address of Property Owner N1ffM�1.He s;l(�— on""Ir .4 t �. :� �sCrw.� c'Sr s�e�,, rA, Name(Print) No.and StYeet City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,One prope1ty owner hereby authorizes Name Street Address City/Town State Zip to act on the 2roperty owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out.Appendix 2).,. If building is less than 35,000 cu.ft.-of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1-Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name �a0, o`� � Nf'a�me�.o{f'PPerson�Reson Res ons traction License NNoo.^and Type if Applicable Street Address City/Town State ZZ q — 1e� ; oft l r� Telephone No. business telephone No. cell m� ail address SECTION 11:IVOt hIR&COMP I:NSAI'tOti tNSURANC I:AHIDAWY M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION.COSTS.AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ 4. Mechanical (HVAC) $ Note:Minimum fee=$. (contact municipality) 5. Mechanical Other $ _ Enclose check payable to 6.Total Cost $ ) (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT:APPLICANT: 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 knowI dge and understanding. Plyd t andign anne Tit ^ Tcle h o. Dale 1 Street Address City/Town State Zip rNlumcpalInspector to fill out this section upon application approval: - Name Date CITY OF S,UzNI, L�rL15&1CHUSETTS BULOLNG❑EP.IATJLEDiT 120 CK1iNL,1rTON STREET 3,* Ftaos TEL (978) 745-9595 KIMOEAL.EY DRISCOLL F•LIt(978) 7.10-9345 ,b UYOR I�laS619 ST.PiF3lit3 1)MECTOROFPUOLICPR0?E.A Y/8j:=LNGCo.wasslO.VER Construction Debris Disposal Aff1davit (required for all demolition :utd renovation work) In accordance with the sixth edition of the State Building Coda, 730 C�, M section 111.5 Debris, and the provisions of tbIGL c 40, S 54; ©ui Iding Permit N is issued with the condition that the debris resulting from this wurk shall be disposed of in a properly'licensed waste disposal l 11, S 150A. facility as defined by,YIGL c The debris will be transported by: -P (Hama ut taulu�) The Hybris will be disposed of in t;Han nt appl' .mt , U . slit• �.__ I CITY OF SmI.M. t1tIAssACHi s=s BL'IL Ou4G DEPART 7%WDiT 120 WASHINGTON STREET,320 FLOOR TFL (978)745=9595. FAX(978) 140-9846 )I3[BEIU FY DRISCOLL MAYOR THObtAS Si.P1ERRH DIRECrGR GF Pt:BUC PROPERIY�BI:IIDI�i IG COSL�IISS[O.iER Workers' Compensation insurance Affidavit: BuJlders/Contractors/Electricians/plumbers Annlicant information Ptcase Print Leeibiy p C� kVatnC(nusitx•ss�Org,tni:atio(Vlndividual): ll � Address: �o �F City/State/Zip: ��/� r of Bane M: Are you an employer?Check the appropriate box: 'type of project(required): I.❑ 1 am a employer with 4. ❑ I am a general contractor and 6, New construction employees(fbll and/or pact-time).* have hired the sub contractor 2. am a sole proprietor or partner- listed on the attached sheet t �• .Remodeling s1hip and have no.employees. These sub-contractor havo S. 0 Demolition working,fur ine in any capacity,. workers'comp instimnce , 9 ❑Duildtng addition No worker, comp.Insurance+ 5. Q we are a oocporation grid t4; rcquired.J of cers have exercised their„ 10 Electrical repairs or additions 3.❑ I am i homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs fir additions myself (Yo workcra'icomp. c. 152 1(4),and we have no j2 0 Roof ispeirs msurance requued j t employee:[No workers':,: 13. OtherQSc(tnw I�p (r( comp,inuuance rcquired.J , Any appliram that chunks bin el muu also rill uut the afeiioo below showing their wwkem,eumpensariun policy inrurmatfo%' 1l,"cowne s who submit this affidavit indicating they am doing all work and that him ou4ida"Mracaom must submit a new aMdayil indicting such 4:umracton Iliac Cheek this box must anached an addiliursa xhmt showing the nano oltha sali-renlnCima and tha4 workers'comp;policy infumialloe:.. fain an employer that&providing leorken'coritpensodon laturnncs jot toy rmpluyeea�Below 14 the po/Icy qqd fob sire Insurance Company Name: Policy Al or Self-ins,Lic.#: _//_ h J�-� �cc (' f5 1� � � Elipiration Date:C Job Site Address: I � l�r[ �`P t> CttylState/Zip: ` i IA, .Attach a copy,of the workers'compensation policy declaratism page(showing Cho policy number and expiration date). Failure to secure coverage as required under Section25A of MGL c. 152 can lead to the imptuuion of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment as well as civil penalties in the foim ate STOP.WORK'ORDER and a fine of up to SM.00.a day against the violator. 13e advised that�a copy of this statement may be rerwarded to.the Orrice of Investigations ofthe DIA for insurance coverage verilica1. - - Ida hereby certify under the pains and penaldes of prrfury lhal ika in/itrinallon provided ub ve is ua and correct.��. arc. s t � OJIcial use ouly, Do not write in rhir area,to be completed by city or to City or Town• Permit/I.Iccn Issuing Authority(circle one): 1. Board of Health 2.Ruliding Department 3.City(rown Clerk 4.E ==inCunlact Person: __. _ Pho A proposal for services required at the residence of Michael Marsille of 15 Crombie Rd in Salem Massachusetts The repair of failing floor framing of porch. The repair required at the connection of the rim joist to the transverse floor beam supporting the third floor, ( under post # 3 counting in from the outside corner ) . A piece of 2x6 pressure treated wood to be sistered alongside the rim joist and bolted into the same with %" galvanized carriage bolts or lag screws. The same to be sistered across the failing connection and the floor beam to be attached to the new surface with a zmax galvanized joist hanger. Additionally, an angle iron(s) to be provided under the repaired connection to support it. The inspection of the base of the post # 2 on the first floor where it is sinking in through the deck surface and a suitable repair to be devised ( contingent upon the discovery of what it is sitting on ) Expected cost inclusive of labor and materials and permit $ 600.00 The repair of failing deck boards and railings at the southeast corner of the porch. The deck boards to be replaced with like kind tongue and groove fir ( an expected seven on the second floor and five on the first ) pre-primed on all edges. And the repair of the railing systems with pressure treated wood, either by components as necessary or in their entirety. All work to be done in accord with epa/rrp regulations Expected cost inclusive of labor, materials, permit & disposal $ 870.00 Thankyou for the inquiry D � �� ) ..�^ Daniel J. O'Leary III Carpentry danielloleary3@gmail.com HIC 159516 CSL 083589 NAT 662191 617-750-1751 > >.lk, of l}arJ N�. t cfr—Pen vow '� ?° fVV The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OFSALEM Massachusetts State Building Code, 780 CMR, 7 h edition Revised January Building Permit Application To Construct, Repair, Renovate Or Demolish a 1, 2008 One-or Two-Family Dwelling This Section Fo Official Use Only Building Permit Number: A Date Applied: /-I U Signature: / '/`� ./ IC) Buil m Commission c uildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers tS erornbl� trcei- Lla 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(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zo ormation: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ 4r Flood Zone? Municipal❑ On site disposal system ❑ if yesO SECTI 2. PERTY OWNERSHIP[ 2.1 Owner`of Record: Mt'ck'-Iej MG sillL 15 CirDrv) ie- Name n Address for Service: - 31"i 32�5 Si gna Telephone SEC N 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ I Number of Units_ Other ❑ Specify: Brief Description of Proposed Work : -rl�ttil ryc� ��o- over 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 CityfFown Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List:_ _ 5.Mechanical (Fire $ Total All Fees: $ Suppression) — Check No. Ched Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 3 -tR- -'j I"L SUyo k / r� License Number Expiration Date Name of CSL-Holder List CSL Type(see below) (ors ArMj Sl_. Shxt Address A T Description 6 U Unrestricted u to 35000 Cu.Ft. Restricted 1&2 FamilyDwellin Signatu - M Masonry Only �1 L' & RC Residential Roofing Covering Telephone Residential Window and Siding F Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) I (,Q-7 IC �aS�h �ryti� HIC Company Name or HIC Registrant Name Registration Number (06 C,Qnlr�l SI-• SI"DVt2-�'G.m NI.G— g-.�G.ZO1O Address Expiration Date Signa� 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 .......... No.....1014,%10 SECTION 7a:OWNER AUTHORIZATION t BE CO Q D WHEN OWNER'S AGENT OR CONTRACTOR APES F DING PERMIT I, M1ChG <� G�Stll� as Owner of the subject property hereby authorize t'1 A-Kb to act on my behalf,in all matters relative Zofe, on d by t ' b 'Iding p t cation. Si a Date SECTION . OWNEW OR AUTHORIZED AGENT DECLARATION I, -v�VV1 6—ba-0— ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of 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 riot have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1IO.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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 SALE:NI, 2UNSSACHUSETFS BuILDIING DEPARTNC&NT • p• 130 WASHLNGTON STREET. 3'o FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KI�tBERj EY DRISCOI L 1VIAYOR TXtOMAS ST.PtERA& DIRECTOR OF PUBLIC PROPERTY/BUILDING CO\L%aSSIONER 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 It 1.5 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 disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: fllrbn� �xteniyS (name of hauler) The debris will be disposed of in �� 2e�UUll� (name of facility) 3�PCi C'oc�r til 1'� . BLW-�rbL&, , h A (address of facility) signadde of permit applicant date debri,air.dm OP ID Dy1 DATE(MMIDOM'YY) CORD CERTIFICATE OF LIABILITY INSURANCE ARONs_ 10 Ol 09. PRoOucPn THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lunt LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Chase & P O Sox Lunt - HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 47 State Street Newburyport NA 01950 NAIC# Phone: 978-462-4434 Fax:978-465-6204 INSURERS AFFORDING COVERAGE UISURFD INSURER A: Liberty Mutual Insurance INSURERS: Norehi.d mear�nee Covmaty.�a Arose Exteriors INSURERC: The Travelers 39357 60 CentraltralSt INSURER D: Stoneham MA 02180 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER 100 INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CE RTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLI ISIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OUCY FAWOMBI�L"IU� YPE OF W BURANCE POLICY NUMBER DATE MMIOD DATE RMIO LIMITS EACH OCCURRENCE $SOOO DDD LIABILITY MERCIALGENERALLIABILITY CP569418 10/10/09 10,(10/10 PREMISES Ea uaurenea $50000 CLAIMS MADE OCCUR MED E%P(Any one pennon) $5000 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2DODDDU CY jEC LOC ILEL"IUI COMBINED SINGLE LIMIT $1000000 AUTO BA0673P265 09/23/09 09/23/10 (Ea aaident) WNEDAUTOS' BODILY INJURY $ (Per person) EDULED AUTOSDAUTOS BODILY INJURY $ (Per aoddent) -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ E%CESSMIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORMERS COMPENSATION AND - TORYLIMITS I ER EMPLOYERS'LIABILITY A ANY PROPRIETOPJPARTNERIEXECUTVE yaC1315369961018 10/31/09 10/31 1D E.L.EACH ACCIDENT $ OFFICERMIEMSER EXCLUDED'! E.1-DISEASE-EA EMPLOYEE $ I daecdbeuhder E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of coverage CERTIFICATE HOLDER CANCELLATION HAVBR01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI.I ED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIF ICATE HOLDER NAMED TO THE LEFT,SLIT FAILURE TO DO SO SHALL. City of Haverhill IMPOSE NO OBLIGATIO N OR LIABILITY OF ANY MIND UPON THE INSURER,RR AGENTS OR City Hall 4 Semler Street Room 210 REPRFSENTAMES. _ Haverhill MA 01830-S876 AUT PREBEF rvE ACORD 25(2001108) ®ACORD CORPORATION 1988 B4 wit rd B if i it il CS SL 100542 Rcstricteri to: RF.W-' JOSEPH ARONE 4 V'i 60 CENTRAL STREET STONEHAM, MA 02180 Ti=: I00542 ivw Regula jotis quid Still ards 3oard of Build vg ClueASKAMOtl PlqGC - Ro ("Tl "W10. Boston. Massa,..husea.s 02 LOS jjomelzaaprir: lte..jrjgjrj(iun 0tiiA Tla V3130 ARONE r-XTERIOPS ...... JOSEPH ARIDNE I'I60 CENTRAL STREET sTONEHAM. t.IA 02180 Sad return aml.Alark L oi-re-imini,2m valid 1hr wd i0rdo I..e a Al hefol'a the expiratium Jlltv'.Xlfvt... r�tum W: HOME WVRr ar Ful hdilw>Itcguhm"I lil Skanda"I. TIV yl3Uii Tyf+.: BOA AnONc rxTc9tQrV, JO$EM ARONE7 qu CENrRA.1 STRFF.T rTrjmFllm'4 aN'Ymb The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers'. Compensation Insurance Affidavit: Builders/Conhractors/Electricians/Plumbers Applicant Information Please Print Le¢ibly Name (Business/organizahor✓Individual): -) Address: (p Q C L YI fYi St"'✓� City/State/Zip: Phone #: U&- ?SS) 5 3 Are you an employer?Check the appropriate box: Type of project(required): 1I am a employer with 4. ❑ I am a general contractor and 1 6. 0 New construction employees ." have hired the sub-contractors 7. Remodelin 2.0 I am a sole proprietor or partner- listed on the attached sheet. t g ees full and/or art-time p y ( P ) ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their exemption of per MGL 11. Plumbing repairs or additions 3.0 I am a homeowner doing all work right p P myself. [No workers' comp. a 152, §1(4), and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeownerswho submit this affidavit indicating they are doing all work and then hive outside contrz.aws must submit anew affidavit indicting such. tContractors that creek this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.polity information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 7 ' ' Insurance Company Name: tf i�' asp e �YZ Gt Policy 9 or Self-ins. Lic. #: W C j iJ S 3(1�9 c 1 I S Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in tha form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofpeijury that the information provided above is true and correct. Si ature: Date: i Phone Official use only. Do not write in this area, to be completed by city or town of i:cial. City or Town: PermittLicense# 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#: 15 CROMBIE STREET r 15 CROMBIE STREET 1002-13 GIS F_ ?61 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Lot '." 0449-803 Category. REPAIR/REPLACE ; BUILDING PERMIT rmit# -�' 1002-13 Pe `; Protect# ° JS 2013 002828 Est Cost. F $1,470.00 Fee Charged: Balance Due: $ 00 "' ae PERMISSION IS HEREBY GRANTED TO: Coast Class. x Contractor: License: Expires: Use Group. , „ _ .fir`- dim: °.Daniel J O'Leary Ill Carpentry CONSTRUCTIO SUPERVISOR-83589 {Lot Size(sq ft.): 1941.9048' g , Zoning' "" s `BS° OWn¢r: MichaelMarcil Units Gained: Applicant: Daniel J O'LearyIII Carpentry Units Lost: ' ,' ' AT: 15 CROMBIE STREET Lig Safe#:!: , . . ISSUED ON: 12-Jun-2013 AMENDED ON: EXPIRES ON: 12-Nov-2013 TO PERFORM THE FOLLOWING WORK: REPAIRS TO PORCH PLEASE SEE PERMIT APPLICATION FOR ADDITIONAL INFORMATION jbh POST THIS•CARD SO IT IS VISIBLE FROM THE STREET 4 lectrtc '.' Gas Plumbing Buildine` (Underground: Underground:YM� Underground - Excavation: Service: Meter: Footings: Rough -- Rough: Rough: r; Foundation:{ ?7 t. q's Final: Final: Final: Rough Frame: Fireplace/Chimuey: D.P.W. Fire Health Insulation: Meter: Oil: Final: —• -- House# Smoke: Treasury: Water. - ... _. Alarm: Assessor !Sewer: Sprinklers: Final: JRIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OFA F ITS skULES AND REGULATIONS. k k_ . . Signature I LZ Fee Type: Receipt No: ,.Date Paid: Check No: — Amount Iii. r..'a. � � BUILDING FP. :1• REC 2013 003074, 12 Jun-13 1467 � �-, , "'$25`00''•--^---- -� Js s.y1j; IMPORTANT:,OWNER OR COr• ^A r-.UST 4.•• ._ .. ' *,° 0-4'1467- + '• "'': a. F.G ,�z. 6�. ARRANGE FOR PERIODIC INS? L it v5 DURING - .�,63 %1 -, ,CONSTRIJCTION-SEE CURREN BUILDING CODE ».,CHAPTER 1 FOR LIST-OF AEOUIRFG.INSPECTIONS' CALL 978-619-5641-T0 SCHEDULE AN INSPECTIONS-- GeoTMS©2013 Des Landers Municipal Solutions,Inc. NDITq� V�w VSQVE AD CITY OF SALEM i t b t. i 3x CK WN Vv Oct �'�-e w�•��r 5�-J ; �, �` -�— w�5 W W_ M Lu L,*r r 1 uhlir VropgrtU -e artment t� Puning Department JPI(lt �. �P�i7PT8 xYxuAk)&bcNk 1 Salem Green 745-11213 March 9, 1976 Mr. Robert H. Roy Jr. 26 Ocean Avenue Salem, , MA 01970 RE: 15 Crombie Street As a result of an inspection on March 5, 1976 at the r^ erenced premises the following recommendations are made before occupancy can be permitted. 1. All fire damaged members must be removed and replaced with new lumber of sufficient size to provide the proper structural support. This applies particulary to the 3rd floor framing, the roof framing and the north wall at thee third floor. . 2 . All doors opening into the stairhall shall be changed to 1 3/4" solid .core or the equivalent . 3. There are signs of ants appearing in the timbers at the third floor ceiling and in some of the studs . There should be an investigation made from the ground floor up, to determine if any extensive structural damage has occured. 4. The gas hot water heaters in the apartments should either , be enclosed or removed. 5. The north corner of the building on Crombie Street shows some signs of dry rot . This should be opened up to determine the extent. 6 . The extent of renovations would require that the structure have an automatic fire warning system. Such system shall be type i[ system i .e . the system shall be installed in conformance with the Mass. Electric Code etc . and shall consist of an approved smoke detector in the stairwell and an approved heat detectors located no more than six feet inside the doorways to the stairhall . Also heat or smoke detectors in the basement and attic . 's. I, Ti#g of o J'�����? �1ti�tllt� �P�,TFIL#3itP21'I �chn �. �3ofnErs ALX XX 1 Salem Green zap-nzi3 Other than the structural items noted above the building appears sound and egress is adequate and satisfactory. We would further suggest the fireplaces and chimneys 'should be examined for soundness . Very truly yours , Daniel Mansur. - Assistant Building-Inspector T1#V ofttlem, HttssttclzsQ##� �A,.:,� �'r? �ublic �ru�ex#g �eiJttr#ment S �rottA4freef 745-11213 November 13, 1975 Mr. Spencer McConnell 31 Circle Street Res 15 Crombie Street Marblehead, MA Salem, MA Dear Sir: At the request of one of your tenants this office conducted an inspection of the rear porches at the above address. The porches and stairs are in poor condition and in as much as they constitute the second means of egress from the dwelling units immediate repairs must be made. A building permit must be obtained before commencing work. Yours truly, Building Inspector