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16 DUNLAP STREET - BUILDING JACKET�� �� � + �1 Certificate No: 191-13 Building Permit No.: 191-13 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at Dwelling Type 16 DUNLAP STREET in the CITY OF SALEM ..._.._. --------- ------------- - - .__....- ------- ------- . . ----------- ------------------- ... ....._.------------.. Address Town/CiName IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 16 DUNLAP STREET UNIT 1 This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ----------- unless sooner suspended or revoked. Expiration Date Issued On: Mon Dec 3,2012 GeoTMS®2012 Des Lauriers Municipal Solutions,Inc. ... Certificate No: 191-13 Building Permit No.: 191-13 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at ----- ------------- Dwelling Type 16 DUNLAP STREETin the CITY OF SALEM - -------------------------------------------------- ---------------------- -------------------------------------------------------------------- Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 16 DUNLAP STREET UNIT 2 This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires - - - unless sooner suspended or revoked. Expiration Date Issued On:Mon Dec 3,2012 ------------ --- GeoTMS®2012 Des Lauriers Municipal Solutions,Inc. --------------- /�A�� 1 i 16 DUNLAP STREET ., _-13 ,GIs# . — 3936 T COMMONWEALTH OF MASSACHUSETTS !Map: 26 CITY OF SALEM WocL !Lot: 0253 Category: _ REPAIR/REPLACE j ;Permit# 11911_3—_---1 BUILDING PERMIT Project# �JS 2013 000926 !Est Cost. _ $38,000.00 ] 'Fee Charged: i$270.00 — _ Balance Due: 1$.00 PERMISSION IS HEREBY GRANTED TO: ,Const. Class: i - Contractor: License: Expires: Use Group: John Karavolas Construction Control-38495 Lot olze(sq_ftBIS :Zoning: �R2 .. ,Owner: Apostol Nakuci Units Gained: T T Applieaut: John Karavolas !Units Lost- —� -- -- IAT: 16DUNLAP STKEE"F Dia Safe#: _J ISSUED ON. 10-Sep-2012 AMENDED ON. EXPIRES ON: 10-Feb-2013 TO PERFORM THE FOLLOWING JIVORK. SIDING, WINDOWS, &DECKjbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: t./L cf/r Set `lL Sevice. Nleter: I Footings: / Rough: Rough: l2migh: Foundation: /r f tZ -. Final: Final: Final: Rough Frau Fireplace/Chiamey: / D.P.W. Fire Health Insulation: /� Meter: oil: /,A 16 9 / Final: D K (f (louse N Smoke: water: Alarm: Ass2ssor r/v/� Sower: Sprinklers: Final: Re g6Iy THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANYF iTS RULES AND REGULATIONS. Signaturu: Fee Type. Receipt No: Date Paid: Check No: AnunnB BUILDING REC-2013-000983 10-Sep-12 cash $270.00 IMPORTANT:OWNER OR CONTRACTOR PI UST ARRANGE FOR PERIODIC INSPECTIONS DWIPIG CONSTRUCTION.SEE CURRENT BUILDING CODE CHAPTER 1 FOR LIST OF REGU RED INSPECTIONS. CALL 978-819-5641 TO SCHEDULE AN INSPECTION GcoTN'ISn 2012 Des Lau'iers iNwiicipal Solulioas,Inc Certificate No: 58-13 Building Permit No.: 58-13 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at Dwelling Type 16 DUNLAP STREET in the CITY OF SALEM —------------------------------------------------------------------------ ------------------------------------------------------------------ Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR(UNIT#1) This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires unless sooner suspended or revoked. Expiration Date ------------------------------------------------------------------------------- Issued On: Toe Jul 24,2012 GeoTMSO 2012 Des Lauriers Municipal Solutions,Inc. ---------------- ------------- ------------------------------------- Certificate No: 58-13 Building Permit No.: 58-13 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at Dwelling Type 16 DUNLAP STREET in the CITY OF SALEM Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR(UNIT #2) This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date Issued On: Tue Jul 24,2012 -- — - - - GeoTMS®2012 Des Lauriers Municipal Solutions,Inc. 16 DUNLAP STREET 58-13 Gis# m 39'6" ` COMMONWEALTH OF MASSACHUSETTS Map 26 >I ! 'Ni Block: CITY OF SALEM Lot iii , rn 0253 Y11 Category ':. REMODEL a BUILDING PERMIT Perrrut# �`�'�. 58 13 9� 7. " �,� .: �Pcolect# n'`i ""JS-2013 000308�, "�: Est Cost `n,'', $8,000.00 x `�e�t Fee Charged, $61.00, Balance PERMISSION IS HEREBY GRANTED TO: Const Class:i 3 ,. ' Contractor: License: Expires: Use Group w" "" ,,,,a� James Cook � ,.�' L'ptStre(sq ft�5185 818 F' F r tI „<Owner: Pamela Sacco �ZOIIIRe w'` i..i Units Gamed: ' ` rl''" `,Applicant: James Cook IUnits Lost:kyr" , -*t:` '"? hM'_' AT. 16 DUNLAP STREET ISSUED ON. 23-Jul-2012 AMENDED ON: EXPIRES ON. 23-Dec-2012 TO PERFORM THE FOLLOWING WORK: REPAIR AND REMODEL(2)FAMILY HOUSE FRONT BACK AND CORNER POST,KITCHEN BATHS DECKS OUT OF HOUSE jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: ' Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: - Rough Frame: Fireplace/Chinmey: D.P.W. Fire Health Insulation: Meter: Oil: Final: House# Smoke: _ Treasury: LC. Water: Alarm: Assessor Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATIONA"NVOF ITS RULES AND REGULATIONS. v Signat�rure: Fee Type: Receipt No: Date Paid: Check No: Amount: 13U"4W 6RT4NT:OWNER OR CONT REC-2013-000319 23-]u1-12 315 $61.00 ARRANGE FOR PER;O IC INSPECTIONS RACTDURING V — ' �o R MUST CONSTRUCTION.SEE CURRENT BUILDING CODE Ci-AFTER 1 FOR LIST OF REQUIRED INSPECTIONS. CALL 978-619-5641 TO SCHEDULE AN INSPECTION � GcoTMS@ 2012 Des Lauriers Municipal Solutions,Inc. q '1r ^ VSQVE AD CITY OF SALEM 16 DUNLAP STREET 977-12 GS# 'z 3936, 1 t COMMONWEALTH OF MASSACHUSETTS Ma 26 P , r sem'at u. spa' fi Block CITY OF SALEM l` ' Lot g 0253 Category a E ` REPAIR L CE 's Pemnt#, ;r ?77,.l r ,. t} BUILDING PERMIT Protect# JS-20,12-002813- Est Cost: + $4 000 00 ,Fee Cbarged. ,' $330 0"" Balance Due: $ 00„1, 4 .r PERMISSION IS HEREBY GRANTED TO: " Const Class Qui rl ti Contractor: License: Expires:. applicant �Lo S e(sq eft) 5185 818§s �"T'! "Owner: Pamela Sacco - - ,]Applicant: Pamela Sacco _ - _ Units Lost`; F t s •i AT: 16 DUNLAP STREET Dig ISSUED ON. 04-Jun-2012 AMENDED ON. EXPIRES ON: 04-Nov-2012 TO PERFORM THE FOLLOWING WORK: REPAIR SIDING, FINISH DECK, SHEET ROCK BATHROOM, CLOSED UP FIRE STOPS AND REPAIR FRONT HALLWAY,REPAIR 1ST. FLOOR KITCHEN jbh POST THIS CARD SO IT 1S VISIBLE-FROM THE-STREET_- Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: _ Footings: - Rough: Rough: Rough: - - - '- Foundation: - - - - - . Final: Final: Final: Rough Frame: k-;.�_�/L {•.1 ``� Fireplace/Chimney: Y �® D.P.W. -Fire,, - Health .. .._ Insulation: Meter: Oil: - - - - Final: House Smdke Water: Alarm: - Assessor Treasury: Sewer: Sprinklers: Finai: - :THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UP S RULES AND REGULATIONS.- - Signature: Fee Type: Receipt No: Date Paid: CheckNo:,, Amount IMPORTJN7:OWNER OR CONTRACTOR W2331 04-Jun-12 cash $33.00 ARRANGE FOR PERIODIC INSPECTIONS DURING CONSTRUCTION.SEE CURRENT.BUILDING CODE ,CHAPTER 1 FOR LIST OF REQUIRED INSPECTIONS. - CALL 978-619-5641 TO SCHEDULE AN INSPECTION _ GeoTMS©2012 Des Lauriers Municipal Solutions,Inc. _ DITR� I . CITY OF SALEM ,5 t t 16 DUNLAP STREET 853-12 3936°a min a COMMONWEALTH T 26 OF MASSACHUSETTS } i MaP a �7a a - ,.<. sl ,Block , , ( ,x CITY OF SALEM I of mk N";0253 # .,5 Category , REPAIR/REPL'ACE tl� 85312r BUILDING PERMIT Project# I` :4 '=7S 2012-002344 jEsi Cost T x$4,000:00 ' ° 'Fee Clmge`&- $33 00 - BalanceDue x$ooe -` �'' PERMISSION IS,HEREBYGRANTED TO: !Const. Class ':' ' Contractor: License: Expires: Use Group:'; Ac¢d �:a. rk�` *+._:_`- John Bafresi CONSTRUCTIO SUPERVISOR-60105 Lot Size(sq"ft) 5185 818 a T Owner: Pamela Sacco^ Units Gained`uAPPiicant: John Bairesi Units Lost:,;,-, ,, SAT: 16 DUNLAP STREET Dig Safe# ISSUED ON: 20-Apr-2012 AMENDED ON. EXPIRES ON: 20-Sep-2012 TO PERFORM THE FOLLOWING WORK: REPAIR SILL FRONT BACK &CORNER POST PUT TOGETHER 2ND FLOOR KITCHEN BOOTH DECK ON SIDE OF HOUSE AND OTHER REPAIRS AS NOTED ON THE BUILDING APPLICATION jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground:-t,- Underground: - — - - Underground: Excavation: _ Service /fir.'//, Meter: Footings: Rough: ought Rough:2y-/f/N 411A Foundation-' Final:OLCX/o�2w` Final: Final: Rough Franc: Firep"lace/Chimney: D.P.W. Fire Health _ - Insulation: Meter. ' I o Final:Smoke: Ir:o!<.:- 77cusup': Water: ASSeSSOr Sewcr: sat dFPs: - Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VI N OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING - REC-2012-002573 20-Apr-12 300 - :, $33.00 IMPORTANT'OWNEP ORrONTRACTOR W'7 ARRANGE FOR PERIODIC INS'?El,i iO iG D'uc,-?,-G CONSTRUCTION.SEE CURRENT BUILDING CODE - -CHAPTER 1 FOR LIST-OF REQUIRED INSPECTIONS. CALL 978-619-5641 TO SCHEDULE AN INSPECTION - - GeoTMS@ 2012 Des Lauriers Municipal Solutions,Inc. 1 L / . N:IZvS dO AZID av anasnWIN A b�y� ow� 9 CITY OF SALEM a PUBLICPROPERTY DEPARTMENT KIMBERLEY DRISOOLL MAYOR 120 WASHINGTON STREET♦ SALEM,MASSACHUSETTS 01970 T'EL:978-745-9595 ♦FAX:978-740-9846 STOP WORK ORDER 16 DUNLAP STREET May 14, 2012 David Sacco Pamela Sacco 17 Jackson Avenue Peabody, Massachusetts, 01960 Dear Property Owner The above listed property has been posted with a Stop Work Order due to being in violation of the following State Codes and/or City Ordinances. 780 CMR Massachusetts State Building Code, Section 115.0, regarding violations of the construction code, states that it is unlawful to add, alter, or construct any structure without the proper permit to do so. No further work may be done until such time as the order is lifted. Any person who shall continue any work in or about the building or structure after having been served with a Stop Work Order, except such work as that person is directed to perform to remove a violation or unsafe condition, shall be liable to a fine of not more than $100 or by imprisonment for not more than one year, or both for each violation; with each day constituting a separate violation. As of May 14, 2012 at 10:45 a.m.your Construction Supervisor has removed his License Number from Building Permit#853-12 associated with your property at 16 Dunlap Street. Thus said permit is in violation of the 780 CMR Massachusetts State Building Code, Section 107.6.3. and all work must Cease and Desist immediately. If you have any questions regarding this letter, please contact the Building Inspectors Office at(978) 619-5648. Sincerely, Michael Lutrzykowski Assistant Building Inspector cc: file :�, I'he C'unununwe;thh of Massachuxus Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 7SO C NIR S,\LI:,\I 'Lai.• Hr roaJ 16u•:fit/ Building Permit Application To Construct, Repair. Renovate Or Denulish a One-ur TuvFurnilr Divellitig This Section For 011icial Use Only Building Permit Number Dale Applied; Uuilding Oliicial)Print N�unc) Signatu Date SECTION I:SITE INF RDIATION I.I Property Address- 1.2,Assessurs,step& Parcel Numbers I.la Is this an accepted st ect?Yes no o Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Uw Let Area(sq 11) Frontage(11) 1.5 Building Setbacks(It) Front Yard Side Yams Rear Yard Required Provided Required Provided Required Provided Ll'�','blic Water ply:IM.G.I.c.40,§») 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Private❑ Iona: _ Outside Flood Lune? Municipal❑ On site dis Check if ycs❑ P posal s)stum ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Ownerto Record: m N;uno(Pool) C V.State,ZIP Nu.unJ StreR -*OF" relephone Email Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) al Alterations) ❑ Addition ❑ Denulitian ❑ Accessory Bldg.(7 1 Number of Units Other ❑ Speciry: Brief Description of Proposed\Vork': d SECTION 4: ESTIMATED CONSTRUCTION COSTS 11em Estimated Costs: (Labur and Materials) MIA Use Only 1. Building 5 4000 1 I. Building Permit Fee: S Indicate how fee is determined: '. lAccirical 5 ❑Standard Citffouen Application Fee ❑Total Project Cost'I Item 6)x multiplier Plumbing 5 , Other Fees: S - J. \Icch.mira1 ill\ 1(') 5 List: \lech.mical iFire - --- --' - I n Total Project Cush i H00 l'hccA \u. -- --('heck Anwunr. Cabh \monun: V ❑Paid in Full ❑Outstanding I1.I1mce Due: l ., '--ry AAIA-X p SECTION 5: CONSTRUCTION SFRII'llit FS 5.1 Construe uirIS, per%isur License((St.) I iwrise Number spiration Dole N"Hile"I.CST'[Folde-r, I Ist CS1. [,.%rw Iscc IwIml) -. —— I•%PC Dcscriplion N". Alid street It 141reslrictcJ illuddill s uO to 31.000"1 — It Iie.,Irictcd 1&2 V-1111il MWIlill L7- - u)i r...11.statc.711 %1 Shl"'ll RC Rixiiiii Onerin %S Window and Sidin SF solid Fucl fluming Appliances I Insulation I&PIlolic Email adtircm 0 Demolition 5.2 Registered Ilome )rovement Contractor 0110 111C Ittegibiration Number F%pirativu Date IIIC Compan) Name or 111C 14egistru4l"vne No. mid Sucid Email address _gijUt/Town,State,ZIP fete hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25CM) 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 ..........0 No...........13 SECTION 7s. OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1.as Owner of the subject property,hereby authorize D'VA —Co-ua to act on my behalf,in all matters relative to work authorized by this building permit application. P ( o' - 'Fruit Owner's Nunio(Electronic signature) Da SECTION 7b: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. � Print owicr'.i or lluthori/vd %gcnri Name(Flectronic Sigmiturv) Dale ,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 Hume Improvement Contractor(HICI Program),will U) have access to the arbitration program or guaranty fund underAI.G.L.c. 142.A. Other important information on the HIC Program can be Illund at o% .,k i Information on the Construction Supervisor License can be round at 2. When substantial o rk is planned, provide-the i t furniat ion below; anal flour area q. (ilcluding gara ge. finished basement attics,decks or porch) Habitable roust count(iois h%ingirea I'd. it.) \unibcr of Iirqllaccs Number ofhedrooms 1')Ilk:oflie.1tilli; S\iwill Number ofdccks, porches I"\Ile ofeoohllg Swill 'inclosed -01'en be u1h%wutvd Ilir -folal Ilrilie"Cost" � J — •�, _ - --- I he C'ununomvcahh ul'Massachusclls - . Board of Iuiding Regulations and Standards Cl I'Y OF Massachusetts State Building Code, 7SO C'MR SALEM Building Permit Application 'ro Construct. Repair. Rcl ate Or De ulish a Ohre-or Two-Famitv Urrellh This Section For Odic( Use Only Building Permit Number: __ Dat ,\pplicJ: !� 11uilJing Oliieial(Print Nmne) Si 1 Dale SECTION I: SITE INFORNIATiON L! Pro rerty AJdffass: 1.3 Assessurs Aiap A Parcel Numbers I.la Is this an accepted street?yes no Map Number Parcel Numhcr 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Fronlage(11) 1.1 Building Setbacks(h) ;runt Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40.§JJ) 1.7 Flood Zone Information: tM, ewage Disposal System: Public❑ Private❑ zone: Outside Flood Zone? cipal❑ On site disposal s)stem ❑ Check if yes❑ 2.1 SECTION]: PROPERTY OWNERSHIP' ..Qwnerro Record-}4Afnc �A 5 rr �(/J6albV IV4-Y-5 0/5'(,/ 6 Mane(Print) City.Slide,ZIP M A CiL YVJ &/i 6/� 82 95K No.and Street rdephone Email Address SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction Cl Existing Building Owner-Occupied O Repairsls) 0✓ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. Number of Units Other ❑ Spco ty: a ir,{-UOesc-pliun of roposed War b,2 T( �— ��� Y� f C CA (C d( C a CG C c�S d✓ 6 ' SECTION 4: ESTIMATED CONSTRUCTION COSTS hrnt Estimated Costs: Official Use Only I labor and.\Imerialsl y I. Building S (}� I. Building Permit Fee: f Indicate how fee is determined: i '. Electrical S ❑Standard CityrTown Application Fee ❑Total Project Cost'(hem 6), multiplier _ __, 1 J. Plumbing S '. Other Fees: S 4, MQ01.1nical III\.\(') S Lisc.- -'_-- j. MQI.l nical Il ire tiu +r.1sion) S Taud .\II Fees: S (�� Check Nu. ('heck:\nunutt uunt: n Tula] Project Cuvt 3 J J 0 p,,id in Full ❑OutSt:wJing liahmcc Due: St.( 110N S: CONS I-RUC ION SF.RVICF.S . 5.1 C'unstructiun Super kor License(CSI.) i Iecnse Nunlher i'\pvalian D;ue Nmnc ul' SI. Holder I isl l'SI. I't Pe(see hcluo 1--_.__-.__ 10, -------'- - ---- - -----...---- 1)pe Description No, mid SI eel A li !/1//[/L/� l� Ihvc,IricrcJ UfuilJin s li 101S,Illltl cu. IL1 RnlricleJ 1&,_+ Famil Dttcllin l'iq%fort n.Sl;ne.LIP \I \lasuu RC Ruulin Coccrin ..._. 'A5 %Vindow.uld.Sidin SF .Solid Fuel Burning Appliances nC— awe, I Insulullun I elt hone V F.mail;IJdre>i D Dculolitiun 5.2 Registered Ilome Improvement Contractor(HIC) 111C itegistratiun Number F.spiruliun Dole I IIC C'ompan) Nante or I IIC R¢gistrunt Name No. wtd Street Email address City/Town,State,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.......... o No...........O 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 Otmcr's Nwne(Electronic Signature) Dote 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. Print Owner's or:\utharired Agent's Name it:Nctrunic Signature) Dute No I-ES: I. .\n O\vmer who obtains a building permit to do his her own work,or an owner who hires an unregistered contraour (not registered in the Hums Improvement Contractor(H ICI Program). will gol have access to the arbitration program or guaranty fund under M.G.L.c. I42A. Other impurt int information on the HIC Program can be found at ttwt m v., ,,t i Information on the Construction Supervisor License can be found at tt ttu lu.t.+ �.n 'Ip' 2. \Then substantial%wrk is planned, provde the inl'urmatiun below: fowl flour area(sq. R.1 - —_.__t including garage, finished basement allies,decks or porch) Gross lit iog area 154 II.) ___.. - habitable roust count _ .. -..-. . .- I \umber of tireplaccs Number ul'hedruums _ .. .. .. \untheral'halhrounts -- ._. ,. _ Numberu(halfhuths I\pe al he.uing s)aem \'anther ol'decks porches I'�pe,4'cool ingsysleln I!nclu,cd Open t 1. I ol,d Proie" Square hoUlagQ-Ilia\ he+llbihluwd tor',I UI;11 Project Cost- � Ct-I'Y OF si�LE,%Itr %Ws.1cHUSE"ITS s BUILDING DEPAKT?LENT 120 WASHNGTON STREET, 1"FLOOR TEL (973) 745-9595 �lye F.VX(975) 1 IMM .<j.\IpF Rf RY DMCOLL ,VLAYO4 T1iOA4\5ST.P1_RM DIRECTOROF PUBLIC PROPERTY/BUIDING CONLUISSIONER 1Vorkers' Compensation Insurance AlVdavit: [3uilders/Contractor.v/Electriefans/Plumbers li t illeant Informatlon Ist ase Print Le?Ihl .V itll"e lnueitws,Ur�,tmratiun lridividilal): " CityrStatc/Zip: �Gi U Phone M: � 5 �S- ll�s Are you os employer!Check the approp a boat llnAlmolloMp prnJect(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1ow,construction 2.0 employees(ILIi and/or part-time).• have hired the subcontractors lama sole proprietor or partner- listed on the allachc' sheet Iemodeling .,hip and have no employees These subcontractors have I. emolition worPing tier me in any capacity, workers'camp. insurance. uilding addition (ho workers',comp.insurance J. ❑ We are a corparnion and its required.) officers have exercised their lectrical repairs or additions ). 1 am a homeowner doing all work right of exemption per M 'L umbing repairs or additions myself.(No workers'Gump. c. 152, 41(4),and we have no of ropairs insurance required.) r employees. [Noworkers, her comp insursncereyuireJ.I •.wy appik,wd thA ahyka bee 41 ar t slue till out the sectiOe below showing their waken'compennlun policy inarmmllon. 'I hvneownero who.uh,ttlt this s@IAnvit indleaing they an doing all work and then him outride contncha a mien ntbmlr a now allldavit indim.Ing,tick:t'1-n1M1QM that chyzk this bull miter Insetted an a Id livrod shut,hewing the nurno of the rub.runlr ium and their wnAeft,sump,policy Inromunoe. l alit tin'HIPloyer that If provldiuX workers'cumprdserlon htrurunee/ar my ernpfuyees Bdow/s Nu pol/ey undJub site infurrrrurlon, Insurance Company Name: Policy 4 or Self-ins. Lic. 4: Expiration Date: i tub Site Address: City/State/Zlp: AlrscIs a copy of the workers'comia"satlos policy deciaratlen page(showing the policy number and expiration date). Failure lu sucuro euvdrege as required under.Section 1JA ofMGL c. 152 can load to the imposition of criminal penalties of s tire up to S 1,J00.U0 and/or one-year imprisnnmcnt,is well as civil penalties in the form of a STOP WORK ORDER and d line of up to S250.(10 s Jay II)r t the viulamr. Ile advi.;ed that d cupy of this statement may W furwurdcd to the Olticu of laerstigutiuns ui die DIA Ib insurance covernge veritieutiun. !Ju/rrrrby erni/' m Jr nr mr rnn/r/rr i/perjury Brut rite iu�unrrudws proviJaJ u6u ve,it,lr Ar ar ad earrrt e I Unto: -- l;40L- a o/; .. U!/iciul nee, ly, Oar our vrire in r!r!r area, robs Completed by u'ry ur rerun nJJh'iui Gry or I'u,rd:_ . _ PcrmiULlcense 4 k,11in„\tit hurily (circle one): I. Iluard ul Ilculth !. Iluildlm2 Ucp:u'hneut 1, fityi fawn Clerk 1. Electric.// htypectnr S. Plnnthinq lutpecnar (. Other Cu,tlncl 1'innn: CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3m FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR TY-IOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER 0 6GlD 5 cam, dc' Y 0 4 N Ln W > o oLLJ Q W �Q WC:l Q �C- U W �+ �- ca Z 16 DUNLAP STREET 853-12 Gis# 3930 COMMONWEALTH OF MASSACHUSETTS Map 26 6 ' Block: —<<: CITY OF SALEM Lot 0253 Category "_ , REPAIR/REPLACE =d Permlt# ., 853.12 BUILDING PERMIT Project# "g" JS-2012 002344 Est Cost: + $4,000.00 1; ,u Fee Charged: -: $33 00 Balance Due: $oo -.:." PERMISSION IS HEREBY GRANTED TO: Const:Class: _ `� . 1 `': `.Contractor: License: Expires: Use Group: ' John Barresi CONSTRUCTIO SUPERVISOR-60105 Lot Sizes+ ft): 5185.818 '1!� °; Zoning art R2Pr Owner: Pamela Sacco Units Gamedj • rl »a°';Applicant: John Barresi Units Lost??, A T. 16 DUNLAP STREET Dig Safe# _ r ' ;ISSUED ON: 20-Apr-2012 AMENDED ON. EXPIRES ON: 20-Sep-2012 TO PERFORM THE FOLLOWING WORK: REPAIR SILL FRONT BACK&CORNER POST PUT TOGETHER 2ND FLOOR KITCHEN BOOTH DECK ON SIDE OF HOUSE AND OTHER REPAIRS AS NOTED ON THE BUILDING APPLICATION jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: ' Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final: House# Smoke: Water: Alarm: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2012-002573 20-Apr-12 300 $33.00 =GcoTMS®2012 Des Lauriers Municipal Solutions,Inc. =� file Commonwealth of Massachusett 1� Department of Public Safety 11d„drhu.r11s ti1.dc 14uilJin+;CuJv(�911 ('1 1uilding Permit Application for any Building other than a . •tt I g . . (I his Section Fur Official (Ice only) liuildiol;Permit Number: .,_. __. ..___ Date.Applicd: __ __._ Building Official: _ SECTION 1: LOCATION (Please indicate Block H and Lut M fur locations for which a street address ', it,ivallabl, lI No.,Ind Slnr't City , Town /it,Code Name uF liuildury;(it apphedblc) _ ... SECTION 2: PROPOSED WORK Edition of .\I:\state Code used _ It New Construction cheek here❑or check all that•Ipl+l) in the two rows Iixistinl; Buil,ling ❑ Repair :\Iter,oioo ❑ Addition.❑ Demolition [3 (Please till"Lit'Ind+ubmit Appendix l) Change of C'so ❑ Change uF Occupanry ❑ Other ❑ Specify:-___-__ :\rcbuilding plans,md/urronstruction if,humentsbcingsuppliedaspartof III ispermitapplicatiun? Yes ---No ❑Nan Independent Structural Engineering I'ver Review required? Yes iNn ❑ Brief Description of Proposed Work:.=_ Lq ,— -Z 0 SECTION 3:COMPLETE IIIIS SECTION IF EXISTING BUILDING UNDERGOING RENOVA'r10N, AUU!'1'ION,OR CHANGE IN USE OR OCCUPANCY Check here it an Existing Building Investigation and Evaluation is enclosed (See 780 C\IR 14) ❑ Existing Use Gruup(s): _41_ _ Pruposcd Use Group(s):______ SECTION 4f BUILDING IIF.IGIITANDAREA Existing Proposed No.of Floors/Stories(include Ia]einent levels)h Area Per Fluor(sq.It) Total Aral Is% ft.)and rota) Height(it.) SECTION is USE GROUP(Check as a liaable) A: Assembly:\-I ❑ A-20 Nightclub ❑ ,\-1 ❑ :\-I ❑ ,\-3❑ B: Business ❑ F: Educational ❑ F: I atto P-I ❑ F_'❑ 11: Ili h Hazard 11.1 ❑ H-2❑ 11-t ❑ 11-4❑ 1.1-3❑ 1: Institutional I-I ❑ 1-2❑ I. ❑ 1-I ❑ \I: Jlercantile❑ IC: Residential R-10 R-2C7/I(-1❑ RA ❑ S: Storage S-I ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Spec tal Use SEC IION 6:CONSII(UCTION I'YPF.(Check as a+ liable) IA ❑ IB ❑ 111\ 0 IIB ❑ IIIA ❑ II111 ❑ IV V:\ ❑ \'I1 ❑ jsl.(:rioN 7: SITE INFOR,\IAI[ON lrefer to 710 C,\IR 11 Lt for details on each item) Water SuFlood Lune Information: Sewage Disposal: french Permih liebrie Removal:I'ublic •rk II outs nle Plrn•.d Cunr❑ Indi+,Ile nnmicip•il .\ Ironih +v.11 sat bc• L'rrnsrd 1)i,pu,ol tiito I'rlc,te indrntill' /nnr' ,ir an.Inc+n.arm ❑ rrquinvlO nr trench nr,prrll+" _ __ hrri it k orir lased❑ I . It,IiIn laJ riglll-nf w'ay: Ilaranls lu .\ir..\tw ig,tiun: . I i \' •t .\lil,hr.ihlr❑ I I,�Ini,Ism a Rhin.ur1e.rt a • ma,h .in•d' . 1 1 I I.their rr,�ir,r ngdrlrJ ' .a'('rnvit L. Mudd ria ln,rd❑ lr, ❑ in\,-❑ r 1r'❑ \,. ❑ ------------------------------------------------------------------ S1( IIO.N 3: 1ON.I L.N I a)F CI It I'IFI(',\Ili t if t)C'C'UI'.\.YCY iWhili"n 'd Ca d,' l ,r l.:nmphl It pool C'• ,,Im,In-n Il•,i. IIwbuddoq�'rw.un .m <I�rw6lrrti„in u' Apr,Ld'�hpulauin. ' r 4 • SE(`I ION 4: I'1(OI'I ItIY MVNtlt ,\U I'll()141L I]ON -----------------------— tuts uul \dtln ss td I ntp, rly Ow nt r till N uoe(Pr int) No mid$trot Cuy/ town 1 I'roperty Owner C otact luftmnatiult: ---- -- ---- _B — Qv�---------- - a mail I�ille 11•Irphune Nu. (business) telephone Nu. (.ell) address II applicable, Ilse property owner howbv outhorii.es _.---- Name ----.._—�— .--- --ytraet Address - -City/Town----- sta to Lip to att on the pro,ern tovncr's behalf, in all matters n•lative it,work authorized by this buildior, ,omit a ,+licaliun. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buildin•IS less 111a11'153M)cu. it.Uf enClowd vace.111,1zor nut under Construction COLItptl then check here Cl 'I'd ski 1 Scctinn 111.1 1(L1 Registered Professional Res unsible for Construction Control Nance tr(;islrant I' e hone p e-mail'I'll css —fl Registration Number /.1 �ry V A '_-t LM�M 1fV� Ewe oc ti Street Address City/rown Stale Zip Discipline Expiration )ate 10.2 General Contractor C,nt ,any N111110 ID (L, �Z• Nance of Persona RR,esponsible for Con. ruction License No. and Type if Applicable 201�- /' tr(1 [mil xvC ��'1 1 `c, A 011f(/•60 Slrcet Address City/jow State Zip role ,hone No. business Tcle,hone No, cell e-mail address SECTION11:tt„t: .1f".• _n ��yu•rv,\lµ+� t�:•tn:.t�tI \I1 �,',. 1I M.G.L.c- 152. 25C6 A Workers'Compensation insurance Affidavit from the MA Deparhnent of Industrial Accidenb must lx Completed g and Submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a si oed Affidavit submitted with this a lication? Yes 17 No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) total Construction Cult(from Item fi) 'S_---_ I. Building 5 ® 0 Building Permit Fee 'Total Construction Cost x _(Insert here '. Electrical S appropriate municipal factor) '$ t. 1'lu nl b inK 5 contact numici ndity Now; \lininnnn fee'S---( L ) 1. \Iccha»ical (I IV:\C) 5 ). \Icchonicol Other) S 1i1,close cln•ek par•thle it, n. Dotal Cast pOo (contact loots ipahiv)and write check number hrre -_ _. -SEC r1ON U:AIGNAIURE OF BUILDING PERMIT APPLICANT 11v ontering my uaule below, I hrrcbv .utest under the pains and pvtmities of perjury that all of the inlonuation 1111"uned ut this •tpplic•tliun is true•old do orate to the best of my Lno,Jrdy;•and uudcnt•mding. ppl l�A� gIr3lep3hune sN�nl.` 9ril(Z Ic9eli� print and 11W ❑.ulle l lite 0 ALv /tp \lunicipal Inspector to fill out this scetian upon application eppruval: N.mw i GARDNER- PARK ASSOCIATES JOB 4 ti I1 Peabody Square SHEETNO. PEABODY, MA 01960 CALCULATE DeY �'' oATe_ (508) 531.4705 -. CHECKED BY _ _ � DATE . SCALE ; .✓ -i � � Cam/ t -t. .._...,....... .._... _.. ....__. __ .. _ .. _. c _ , r ? c,. j < r 'if GARDNER PARK ASSOCIATES JOB 11 Pea¢ody Square SHEET No. OF PtABODY, MA 01960 . (508)'531.4705 CALCULATED SV DATE CHECKED SY DATE SCALE } vo _ - _ V Dom .Rrn w000 J _ AtG7lr 2N"re5rgykxy:KS'iAoan�s`;.�u¢.ra--:ta:e:ztCi:'s•w),Tc«?: . GARDNER PARK ASSOCIATES JOe 11 Peabody Square SHEET NO. OF PEABODY, MA 01960 • ` (508) 531-4705 CALCULATED 8Y DATE CHECKED BY DATE SCALE . ._. ... y ._. ... 2I It A _ b j Act N..Is dA1 1 fJ . _... .A` of W L` 1 P Rs�t) c�-CTE� �.�2..- �� . t lot sec" , . . d__� FSScs tie + ' vd/G c-�S it ...... 2n� 2 f- D6I� _ M ... M_ Poch ��(L. i :1 ,� -.. .c.ct16o MASS �,t>�+ 1G .... P ... .. ........ a-. .. *� 3R.Xd f _ S4 Fi r . n ... ..._ _. V \ ..... MWICIAFI Enge6Nmlmst 1�1®mIm,6ltlOn.Ib54Mdil.io0tlprR�dl6LLfl1E:tEW@SpBp 4 p AeN `n � P s g�K,�xr �1 E � 1r ®P_C SiJD � 1 At - 1 t i r i TI t i JOHN L. t + $ tfpRAV \OEAS IVIF Lo tiL�N i + _ I - 1 7� I 44 I : s 1 _ �z ' r , I t - I f . OPE�J _ I 1 _ tERFRVOL-RS - n `(0 I , I`lic Coin oowcalth of blassachux is is Ihsard o(Building Regulations and Standards CI'1'1' OF J sr Massachusetts Stale Building Cute. 730 C NIR S.\LI:.\I Building Permit Application 'ro Construct. Repair. Renovate Or Demolish a One-ur riru-Piunill•ow"II This Section For 011i6ol Use Onl Building Permit Number: _ Date Applied: lluilJiny Ulliciul(Print N� ��-4 Signature Uurc SECTION I: SITE INFORM ATION L I Property Address: 11 Assessors blap di orcel Numbers I.la Is this an accepted street? a no Map Number Purcel Number IJ Zoning Information: 1.4 Property Dlmenslons: Zoning District Proposed U$e Lot Area Isq III Frontage(Ill 1.5 Building Setbacks(R) Front Vurd Site Yunls Rear Yard Reyuiml Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40.§54) 1.7 Flood Zone Inrormollon: 1.3 Sewage Disposal System: Ihtblie❑ Private❑ Zone: _ Outside Flood"Zone? Check if es❑ Municipal❑ On site disposal$)stem ❑ SECTION1: PROPERTY OWNERSHIP' 2.1 Owners of Record: PAmIV A SAC r.6 �FA6vDv , mA_ Maine(I'nnp city. i 7 I/AC k sn ) MIL 7 7 P 3 i 7- (F(,5 No.and Street relephone III Address SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction O Existing Building❑ Owner•Oceupied ❑ FRepairsfoil ❑ I Alteration(s) ❑ Addition ❑ Den suI Lion ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Speeity: Grief Description of Proposed Work% CI( t Fiio�T Art + atr rr i� klTr eiu c o � Tl �� CSF Iynt1C� SECTION J: ESTIMATED CONSTRUCTION COSTS Item Estintated Costs: ILabur and.Materialsi 01TIcla1 Use Only I. Building S I. Building Permit Fee: S Mdicate how fee is determined: '. Electrical S ❑Standard Citffuwn Application Fee 5 ❑Tural Project Cush((tens 6).x multiplier ___ • .x s I'hunhiny _. Other Fees: S- 4. \leeh.Inwal ill\ 1(') j List: 1ledidnicul il:ve �u , rvssiont 5 roral \11 Fees: S_ r' )'owl Project Cuvt: S k l'hcd No. _...__( 111:1 Amt,uat: . _. ..._. l'•ish \nnnutt: ❑ P.ud in Fall O thnstanding Hal•utce Due: sJ.'C FION S! (,ONSI'R11('TION SF.RN'1('F.S S.1 C'unslructims Supcn'isur l.iceuse IC'SL) Cf 035 0)6 C. I iceu,e Nuu,hcr - - I'ytirution U,Itu N,uncol'l'Sl. it.ldcr ..___—_ IIst0l- 1)pelsecheluwl.__.__.._ _—.._ Micriplion No. .utd weer (I Ih,reslricmJ(IhIilJin'i u' m 11,111ll1 eu. 11.1 p / R Re.IricteJ IR? pwnil Dwellin , L-�jIq Z' ..�2L ----'--.. . ."_— �I \talon rY Cirri Ilan.St,ne.LII' µt Ra,lit C.nerin Window,u,J Sidi" tip .tiulid Ivel Ilurning ApPllances I Iniulutiun 9?ec;-D23 7dld_ hmoiladJres U Demolition relc hn"a 7-ZS`3% 4,1 Registered Ilume Improvement Contractor(HIC) X XmLcS Calk IIIC liegisl I:.vpil Date I IIC Cttnpan) Name or IIIC Itugistrant Name vT L I:mall aJJleia No.w 'Wet 7?A. �-2 Cityrrown, St.to ZIP fell one SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C. 157.1 2SC(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 .......... O No........... Cl SECTION 7 O s: WNER AU THORIZATION TO BE C0111PLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize to act on my behalf.in all matte"relative to work authorized by this building permit application. Datt Print Owner's Nwna(ElecWnic Signature) SECTION 7b:OWNER t 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. Date 1'rinl Ow nuts ar:\uthori/vu Avnt's Noma I pleetrunic Si61 1 VOTES: I. ,\n Owner who obtains a building permit to do his.her own work,ur nn owner who hires access unregistered io nuacwr (nut registered in the Hume Ia,provennent Cuntriour(HIC) Program),will nu have access to the arbitration progrmn of guarutsy fund under M.G.L. c. 141A, Other impunant in1'urnnation on the HIC Progrmn can be round at .% IV,1.. ,•, I Information on the Construction Supervisor License can be found at„!�`� ? \Tlien substantial work is planned.provide the infuriation below: )including gll finished basementanics, decks or purchl total flour area t iy. Il.l . ----"— Habitable rout"count _ .. .. Urossliviogarealsy. lt.l .._.. .... .. \umhero(hedrooms _ \unlheroFlireplaces .. - -- \lunberofh;dl'hmhi ._ . . . . \un,hcrul'hallveulus . . _ . . \umherol'daks. porchcs I\pe of he.tting i)+lam I'ncla,ed )span 11pu, l cooling s)uein 1, oaal I'rojecl Square 1'It�`I,I�e"1181� ha 91b"t111CJ tilt"I'.,t.tl I'nljcct Ca,t" I 72 - 97,P' --- I'he C'onumonweallh of Nlassachusem Board of Building Regulations and Standards SAL OF SAL OF s Massachusetts State Building Code, 790 (AIR Kr.ri.a•i/ I for_'r)ll Building Permit Application Tn Construct, Repair, Renovate Or Demolish a One--ur rtsv-kanillW Dnelfhnq This Section For Official Use Only Building Permit Number: Date Applied: ❑uilding 01176A(Print Mere) Signature Dale SECTION I: SITE INFORMATION L 1 rope Jdre C' LI Asseesyfs ,11ap St Parcel Number — �(\ I.I a Is This an acre ted stre 1? es no J Map Nuinbelro Parcel Nwntwr 1.3 Zonlnj Information; or 1.4 Property Dimensional Luring R37ctf — Vropnaed Use Los Area Isy Is) Frontage(1I) 1.1 Building Setbacks(R) Frunt Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:IM.G.I.c. 40.554) 1.7 Flood Zone Information: 1.3 Sewage Disposal System: Public 0 Prirute❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposals)stein 0 Check if)-esC SECTION I: PROPERTY OWNERSHIP' 2.1 �jwnert of «ord• f o e —MA \ r Gv ivl CC O b d- N,une l Print`)� City.Slate,ZIP 11 URC �S�r< �Y� ct1831 0$6- Nu.and Street rclephune Email Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairsls) ❑ Aiteration(s) 0 Addition O Dentulition O Accessory Bldg.❑ Number of Units_ Other 0 Specily: Grief D ription of Proposed \V k': C? t l?y�.fl CD SECTION a: ESTIMATED CONSTRUCTION COSTS Ilent Estimated Costs: 0111cial Use Only I Labor;u d Materials) I. Building S 1. Building Permit Fee: S Indicate how lee is determined: 0 Standard City,Tuwn Application Fee '. Flalrical V r Total Project C'ust (hem 6)s multiplier l !. 1'Inmhing Other Fees: S_ J. \Icch.utic.tl ill1 \ st:._ ' \u .fesiiuolta) .\11 Fecs: S ccA Vu. Chak :\nnnutl: l'.uh \wuunl: n Tulal Project CnsPaid in Full 0(hrtslanding 11.I1.usce Due: SE( 1*10N t; CONS I-RUCTIQIN .SERVI('F.S 9.1 ('mutructlun Supenisur Liccuse(CS1.1 CS S07 2 c( 25 1Z CSO Z, I ICense Nuolhcr f tpuutunl 1);ItC N.ollc ol'C'.sl 1101de v` OLIJ In -'- --'-- I' Description No. and sweet )1 q �/� U I InrcstricmJ IIIuJJin�s a In ,1)(10 Co IL) _�l I:.un it, Ilssellin C'ityi fall St t- toil). V \I .1lasun e� oi © (c` 6 NC Ntsdin l'usarin q 22,ZZ ttr- '1 SF solid Fuel Ouming Appliances • l J 7J�4�l I Insulation 'I'ek hone fmail;dJress D Danolition 111.2 Registered Home Improvement Contractor(HIC) /// IIIC Hegisu;niun Numher Fq,initiun Vale I IIC Conlput ,un�Il�r\IJ(C Itegistr�t N:ptw 6 a 0 Ve and Street �' �' Emuil address City/Town.State ZIP relc hone SECTION 6t WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 35C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this afidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... O No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h as Owner of the subject property,hereby authorize P Ct WIC X \ , to on my be in all matters relative to work authorized by this building permit application. r 12— l `Z— . Print Uancr's Nunne(Elcctrunic Signature) Data 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 y agtainadrin this,epliCation is true and accurate to the best of my knowledge and understanding. ]^J '/^Vc,� l la� are Trim Danar•e or \uthorircJ,\year's Nana I I.learunle.signature) Data NOTES: I. .\n Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered Contractor (nut registered in the Hume Improvement Cuntmctur(HIC) Program),will rat have access to the arbitration program ur guaranty Lund under M.G.L. c. 14_'A. Other important information on the H I C Program can be laund at Il,,,s I Iitronnatiun on the Construction Supervisor License can be found at ' \\'hen substantial work is planned, proside the information below; Total floor area(ssl. Il.) - ____.._1 including garage. Fnished basement attics, decks or porch Gross lis ing.tea(N. II.I .... .... .... . .. H;Ibitabla room count \un i,vrot'i1rcltlaccs _ _ Numberofhcdruunu . . . \Innharofhathroums .. --- \tnnhcrofllalthalh. I\pc of he'tdrtg s),tent _ \lunhcr ol'JcCks porches I�pc,�l coaling :�gcln I'nclo,cd (teen t •"I', Ld Il/Uleet \1111:Ife t0on.lca 111;1) 1,¢,IIhNII111Cd Illy 1',IL11 Project l'lht'