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32 ENDICOTT STREET - BUILDING JACKET i.. 32 Endicott St. CITY OF SALEM DEPARTMENT OF PUBLIC SERVICES REQUEST FOR CURB CUT DATE OF REQUEST: I d — , — G q q REQUESTED BY: /}n/K PHONE: LOCATION (as specific as possible): J,� Ely Ql(,.,oTT ,S�—�^i noc-orr J Sloe-) rRaM. !7 , ye w'AY rd7'E To w/te2 p�F o ✓r Sim (-o .SE F_K.Ti;N176.p) LENGTH OF CUT: COST PER FOOT: $8.00 INVOICE T0: F A a k FEM i Nd /,�,/ M Irl Sr- ------------------------------------------------------------------------------------------------------------------ t 0 ICE USE ONLY APPROVED BY:-, / �' .r/ BLDG. INSPECTOR DEPT. OF PUBLIC SERVICES NOT APPROVED: DEPT. EXPLANATION: DATE OF INVOICE: PAYMENT RECEIVED: of t3ttlem, lfittssttcl�usett Public Prupertp Department wilding Department (One dalem Qbreen 508-745-9595 Ext. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer December 4 , 1995 Grace & Ali Femino c/o Frank Femino 124 Margin Street Salem, Mass . 01970 RE : 32 Endicott Street Dear Mr. Femino: Thank you very much for your response to the letter dated on August 30, 1995 regarding the above mentioned property. An inspection was conducted and found all violations corrected. This office will notify all the appropriate departments and the Ward Councillor that this situation has been brought to a satisfactory conclusion . Sincerely, J c- �iGGs-Y'Z"LFl Leo E . Tremblay Inspector of Building LET: scm cc: David Shea Tom Kehoe Councillor Donahue, Ward 3 . o (situ of 1�ttlrm, ftts1iac4usEtta Public PrnpertV Department Nuililing Department (One #nlem (rerrtn 500-745-9595 FXt. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer August 30 , 1995 Grace & Ali Femino c/o Frank Femino 124 Margin Street Salem, Mass . 01970 RE : 32 Endicott Street Dear Mr. Femino: On July 6 , 1995 a letter was sent to you with violations concerning the above mentioned property. A follow up inspection was conducted and to this date the violations have not been completed. If this office does not see any progress within the next fifteen ( 15 ) days , court action will be taken against you. Please give this office a call to update this matter or to inform us of reasons why these violations have not been corrected. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E . Tremblay Inspector of Buildings LET: scm cc: Dave Shea Larissa Brown Councillor Donahue, Ward 3 Certified Mail # P 921 991 80a i I ' - ARTICLE + P 921 991 808 0 LINE 1• Grace & Ali Femino - NUMBER c/o Frank Femino 1 124 Margin Street Salem, Mass. 01970 i" Ad " • 0 t W FOLD AT PERFORATION t pAL . INSERT IN STANDARD#10 WINDOW ENVELOPE. , C E R T I F I E D M A I L E R w POSTAGE POSTMARK OR DATE , p RETURN SO- WHOM,DATE AND RESTRICTED W F pP RECEIPT ADDRESS OF DELIVERY DELIVERY O CERTIFIED FEE+gEN NRECEIPT W N SERVICE )y 43 TOTAL POSTAGE AND FEES Z W SENT TO: OINSURANCE COVERAGE PROVIDED W m NOT FOR INTERNATIONAL MAIL Y LL Q RRERRR on �Z Grace & All Femino F� a c/o Frank Famino MI a iZA,Margiu Street u0 A Salem, Niaaa, $1970 yo U� PS FORM 3800 z RECEIPT FOR CERTIFIED MAIL o_ X Pos—ssnncs i STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address of the article,Leaving the receipt attached,and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified-mail number and your name and address on a return receipt card.Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Erdorse front of article RETURN RECEIPT REQUESTED adjacent to the number. t 4. If you want delivery restricted to the addressee,or to an authorized agent of the addresses,endorse RESTRICTED DELIVERY on the front of the article. - 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.if return , receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. SENDER: CI also wish to receive the Complpiete items 1 and/or 2 for additional services. • Complete items 3,and 4a s b. following services(for an extra fee): • Print your name and address.on the reverse of this form so that we can return this card to you. -< 1. ❑ Addressee's Address • Attach this form to the front of the mailpiece,or on the back if space does not permit. • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery • The Return Receipt Fee will provide you the signature of the person delivered to and the date of delivery. Consult postmaster for fee. 3.Article Addressed to: 4a.Article Number 8 a+2t k v'r.J.s-., P 921 991 808 ctr, gSNp171 ntiAz!j . e Type V ERTIFIED 1.D6t'e of DQltvery ign ure—(Addressee) � N F 8.Addresse2' Address (ONLY if"re4uested and fee paid.) GyVfj! ��'� 6 _L.$ignature—(A 6) 6` q�v` ate• 0 �a.G.. � O\ J(ld -PSForm 381 NovgTber 1 h DOMESTIC RETURN RECEIPT \4-. W d United States Postal Service �f r a�. Official Business PENALTY FOR PRIVATE USE,$300 Ill 11all 1IIIll Ill Ill I INSPECTOR OF BUILDINGS ONE SALEM GREEN SALEM MA 01970-3724 of ih1cm, musliar4usEtts Public Prupertg Department iguilbing Department (Pne e:alem Green 508-745-9595 Ext. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer July 10, 1995 Mary Corigliano 33 Sanborn Avenue West Roxbury, Mass. 02132 RE: 32 Endicott Street Dear Ms. Corigliano: Due to a complaint received through the Neighborhood Iinprovement Committee hot line, I conducted an inspection of the above mentioned property and the following violations were found: 1. Facia and soffitt at front porch area needs to be repaired. 2. Install hand rail at front porch. 3. Replace missing down spouts. 4. Rear porches need major work on deck flooring at first and second floor levels, also rails need to be replaced. 5. Repair rail at front porch. Please notify this department upon receipt of this letter as to your course of action to rectify these violations. Failure to do so will result in legal action being taken against you. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Build-, gs LET: scm cc: David Shea Larissa Brown Councillor Donahue, Ward 3 Certified Mail it P 921 991 766 C :> I � � � �. i AIR TICLE + w ; P 921 991 766 `` UNE 1. NUMBER Mary Corigliano 33 Sanborn Ave veaotRoxbury, Mass. 02132 j T FOLD AT PERFORATION T WALZ INSERT IN STANDARD#10 WINDOW ENVELOPE. , f F A T I F I E D - la� M A I I E I w S RETURN POSTMARK OH` ME o SHOW TO WHOM,GATE AND gESTRIOTED W + TAODRESS OF DEWERY "DELIVERY - 6 RECEIPT '6 t CERTIFIED FEE+RETURN REGEIRT OJ n. SERVICE ( q W Vl TOTAL POSTAGE AND FEES 'y""'i� Z W NO INS NCE COVERAGE ROVIDED- W2 SENT TOI NOT FOR INTERNATIONAL MAIL LLa O arq z 0�¢ Mary, Corigliano a� 33 Sanborn Ave xo n Bevat4exbury, Maus. 02132 y= PS FORM 3800 z RECEIPT FOR CERTIFIED MAIL 12 OL UNInDE SE f aw. i STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address of the ' article,leaving the receipt attached,and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified-mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.if return receipt is requested,check the applicable blocks in item 1 of Form 3811. ' 6. Save this receipt and present it if you make inquiry. SENDER: • Complete items t and/or 2 for additional services. I also wish to receive the, • Complete items 3,and 4a&b. following services(for an extra fee): • Print your name and address on the reverse of this form so that we can return this card to yO1' 1. El Addressee's Address • Attach this form to the front of the mailpiece,or on the back if space does not permit. • Write"Return Receipt Requested"on the madpiece below the article number. 2. ❑ Restricted Delivery • The Return Receipt Fee will provide You the signature of the person delivered to and the sets of dishes, ishes Consult postmaster for fee. 3.Article Addressed to: - 4a.Article Number P 921 991 766 "iry COTIF11a110 4b.Service Type 33 uaaborn Ave Ness&C6ioxbary, Naas. CERTIFIED nn � 7.Date of liver � Ei/ 130 'CLA.•~O '7 �ar ;Silt 5.Signature—( dressee) 8.'Addr see's'Address4 Ln (ONLY i1?eque�s(ed�and l e,.fpaid.) "y T 6.Signature—(Agent) 9��0 PS Form 3811,November 1990 D0MESTI „ RECEIPT United States Postal Service Official Business ' PENALTY FOR PRIVATE USE,$300 Ill���u�lll�luln�l�lu�ull�l�ul����l��ul�u��l INSPECTOR OF BUILDINGS ONE SALEM GREEN SALEM MA 01970-3724 ai ��luunlll �nln lllinn�liln ln�i�ilnl��nnnll l�ul Lite of �ttlem. .4flttn5ar4u5ptts Publit 1rnpertu Department I uilaing Department (Put tralrm 6rErn 5OB-745-9595 Ext. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer August ?0 , :995 Grace & Ali Femino c/o Frank Femino 124 Margin Street Salem, Mass . 01970 RE : 32 Endicott Street Dear Mr . Femino : On July 6 , 1995 a letter was sent to you with violations concerning the above mentioned property. A follow up inspection was conducted and to this date the violations have not been completed. If this office does not see any progress within the next fifteen ( 15 ) days , court action will be taken against you. Please give this office a call to update this matter or to inform us of reasons why these violations have not been corrected . Thank you in advance for your anticipated cooperation in this matter . Sincerely, Leo E . Tremblay Inspector of Buildings LET: scm cc: Dave Shea Larissa Brown Councillor Donahue , Ward 3 Certified Mail # P 921 991 80,a ` i < < ��� �� �., �u,� �- � ��� - '��lU -6303 eig 8. Petition of Ronald & Colli width of 'side yard, minimi for the property located 9. Petition of Nancy Harring minimum depth of rear yar located at 36 Juniper Avei 10. Petition of the Estate of requestin a Variance from of rear yard for the prop 11. Petition of AAV Realty Tri conforming one story buil, property located at 68 Lo. 12. Petition of Kennedy Deve parking and a Variance o, located at 224-234 Highl 13. Old\New Business. 14. Approval of minutes as t For t e Board of Appeal . y Sally C. Murtagh CfitU of �ttlrm. .41Httsrjttthusetts `3 1 Publir Propertn Department +iguilbing Department One ealem (5reen 508-7.15-9595 Ext. 780 Leo E. Tremblav Director of Public Property Inspector of Building Zoning Enforcement Officer July 6, 1995 Dolores Mangle 53 Summer Street Salem, Mass. 01910 RE: ?3 Summer Street Dear Ms. Mangle: Due to a complaint received through the Neighborhood Improvement Committee hot Iine„'l Tonductel an inspa^tion of the above mentioned property_,;. °;; _ and the follow-inviolations were found- -1. Replace gutters and downspouts. 2. Repair or remove fence on side of house on High Street. 3. Clean debris from yard. 4. Basement window is broken and must be repaired. 5. Repair siding at right hand side of building. 6. Remove loose wires in front of building. Please notify this department upon receipt of this letter as to your course of action to rectify these violations. Failure to do so will result in legal action being taken against you. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Buildings LET: scm cc: David Shea Larissa Brown Councillor Blair, 'Hard 7 Certified Mail # P 921 991 761 (pity of 3ttajrM. .4fiUjjSar4UjjCttS Public Propertg Department +Nuilbing Department (One fenlem (6reen 500-745-9595 Ext. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer July 6, 1995 Dolores Mangle 53 Summer Street Salem, Mass. 01970 RE: 53 Summer Street Dear Nis. Mangle: Due to a complaint received through the Neighborhood Improvement Committee hot line, I conducted an inspection of the above mentioned property and the following violations were found: 1. Replace gutters and downspouts. 2. Repair or remove fence on side of house on High Street. 3. Clean debris from yard. 4. Basement window is broken and must be repaired. 5. Repair siding at right hand side of building. 6. Remove loose wires in front of building. Please notify this department upon receipt of this letter as to your course of action to rectify these violations. Failure to do so will result in legal action being taken against you. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Buildings LET: scm cc: David Shea Larissa Brown Councillor Blair, Ward 7 Certified Mail li P 921 991 761 CITY OF SALEM NEIGHBORHOOD IMPROVEMENT TASK FORCE jurisdiction Hist. Comm. Yes 13 No 13 REFERRAL FORM Cons. Comm. Yes C3 No SRA Yes 0 No 11 Date: Address: Complaint: a Complainant: - Phone#: Address of Complainant: BUILDING INSPECTOR KEVIN HARVEY FIRE PREVENTION ELECTRICAL DEPARTMENT HEALTH DEPARTMENT CITY SOLICITOR ANIMAL CONTROL SALEM HOUSING AUTHORITY PLANNING DEPARTMENT POLICE DEPARTMENT TREASURER/COLLECTOR ASSESSOR WARD COUNCILLOR DPW SHADE TREE DAN GEARY PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE SHE WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE. ACTION: ARTICLE is 921 991 761 LINE i. - NUMBER Dolores Mangle 53 Summer St. Salem, Mass. 01970 t O INSERT IN STANDARD#10 WINDOW ENVELOPE. C INSERTF I E o M A I I F Rw PosTAGE POSTMARK 00 DATE LRETUJRNAHGWTO NMDELIVEFANO RESTRIQED W ADDRESS OFOM,LATE I RELNERV aCERTIFIED FEE+RETURN RECEIPT TOTAL POSTAGE AND FEES A I J Z NO INSURANC COIERAGE PROMO - 6 W 0' SENT TO: NOT FOR INTERNATIONAL NAIL b.i'. f +LL O M1 0a z Dolores Maugle , ~� aw 53 Summer Se, e , .k `w0 Yp rruuti Salem, Nass. 01970 'F= c N 7 IVB LCL J. o.r PS FORM 3800 r z RECEIPT FOR CERTIFIED MAIL a 0 Pon E - I I SLACK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address of the - article,leaving the receipt attached,and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address ` of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified-mail number and your name and address on a return ' receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space ` permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. > 4. If you want delivery restricted to the addressee,or to an authorized agent of the addresses,endorse RESTRICTED DELIVERY on the front of the article. S Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 8. Save this receipt and present it if you make inquiry. SENDER I also wish to receive the Complete items 1 and/or 2 for additional services. • Complete items 3,and 4a&IT. following services(for an extra fee): • Print your name and address on the reverse of this form so that we can return this card to you. 1. ❑ Addressee's Address • Attach this form to the front of the mailpiece,or on the back if space does not permit. • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery • The Return Receipt Fee will provide you the signature of the person delivered to and the date of delivery. Consult postmaster for fee. 3.Article Addressed to: 4a.Article Number P 921 991 761 il AoYa9 Cnngr,3.e - 4b.Service Type 53 Su-ncteir SG. Sntlem. :'tCts. 11974. CERTIFIED Date of D livery �z 19r 5.Si na e—(Addressee) 8.Addressee's Address (ONLY it requested and lee paid.) 6.Signature—(Agent) PS Form 3811,November 1990 DOMESTIC RETURN RECEIPT United States Postal Service A-ESSt, Official Business �? p M :y ul_ PENALTY FOR PRIVATE USE,$300 INSPECTOR OF BUILDINGS ONE SALEM GREEN SALEM MA 01970-3724 (situ of �ttU em, Mali sar4usetts Public Propertn Bepartment iguilhing Department (Pne 13alem (6reen 5U&745-9595 Lxt. 3BU Leo E.,Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer July 10, 1995 Mary Corigliano 33 Sanborn Avenue West Roxbury, Mass. 02132 RE: 32 Endicott Street Dear Ms. Corigliano: Due to a complaint received through the Neighborhood Improvement Committee hot line, I conducted an inspection of the above mentioned property and the following violations were found: 1. Facia and soffitt at front porch area needs to be repaired. 2. Install hand rail at front porch. 3. Replace missing down spouts. 4. Rear porches need major work on deck flooring at first and second floor levels, also rails need to be replaced. 5. Repair rail at front porch. Please notify this department upon receipt of this letter as to your course of action to rectify these violations. Failure to do so will result in legal action being taken against you. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Buildi gs LET: scm cc: David Shea Larissa Brown Councillor Donahue, Ward 3 Certified Mail # P 921 991 766 -�� �� �- a �� � � �- C�itg of '-*ttlem, mttssar4usetts Public Propertp Department Nuilbing Department (One L+alem Green 500-745-9595 Ext. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer July 6, 1995 Grace & Ali Femino c/o Frank Femino 124 Margin Street Salem, Mass. 01970 RE: 32 Endicott Street Dear Mr. Femino: Due to a complaint received through the Neighborhood Improvement Committee hot line, I conducted an inspection of the above mentioned property and the following violations were found: 1. Facia and soffitt A front porch area needs to be repaired. 2. Install hand rail at front porch. 3. Replace missing down spouts. 4. Rear porches need major work on deck flooring at first and second floor levels, also rails need to be replaced. Repair rail at front porch. Please notify this department upon receipt of this letter as to your course of action to rectify these violations. Failure to do so will result in legal action being taken against you. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Buildings LET: scm cc: David Shea Larissa Brown Councillor Donahue, Ward 3 Certified Mail # P 921 991 760 Cfity of 'qttlem, ,fttsliar4usPtts Public Prnpertg i9epartment qe�,ewe Suilafng Department (One #alem (5reen 500-745-9595 Ext. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer July 6, 1995 Grace & Ali Femino c/o Frank Femino 124 Margin Street Salem, Mass. 01970 RE: 32 Endicott Street Dear Mr. Femino: Due to a complaint received through the Neighborhood Improvement Committee hot line, I conducted an inspection of the above mentioned property and the following violations were found: 1. Facia and soffitt at front porch area needs to be repaired. 2. Install hand rail at front porch. 3. Replace missing down spouts. 4. Rear porches need major work on deck flooring at first and second floor levels, also rails need to be replaced. 5. Grill must be removed from porch (fire code violation) . 6. Repair rail at front porch. Please notify this department upon receipt of this letter as to your course of action to rectify these violations. Failure to do so will result in legal action being taken against you. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Buildings LET: scm cc: David Shea Larissa Brown Councillor Donahue, Ward 3 Certified Mail # P 921 991 760 yid a� Q The Commonwealth of Massachusetts ` '>► Board of Building Regulations and Standards I OR � t4 ,� MUNIi'fP:\LI I 1 �y Massachusetts State Building Code. 780 CMR. 7 edition USE W Building Permit Application To Construct, Repair, Renovate Or Demolish a Rrrised Amum, One-or Tsco-Fancily Dwelling This Section-For Official Use Only Building Permit Number' I/ & D to a Applied: Signature: Building Commissioner/ Inspecwr of Buileting Date ��, p SECTION 1: SITE INFORMATION 1.1 Pro rty Address: p� 1.2 Assessors Map & Parcel Numbers 3 e �ice✓. 1.la Is this an accepted street?yes l� no_ Map Number Parcel Number 1.3 Zoning Information: Ive— S_ 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(1i) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Require) Provided Require) Provided 1.6 Water Supply: (M.G.L c. 40. 3 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone' Municipal ❑ On site disposal system ❑ Public❑ Private❑ Check if es❑ P y SECTION 2: PROPERTY OWNERSHIP[ 2.1Fyne�!,I17l n Name(Print) Address for Service: 2 '} Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check al that apply) III New Construction E3.1 Existing Building ❑ Owner-Occupied ❑ 1 Repairs(s) 01 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': d'� � / CO nr Cie ✓ SL «/ SECTION 4. TIMATED C NSTR CTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) En g $ _ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/rows Application Fee al $ ❑Total Project Cost' (Item 6) x multiplier x ng $ 2. Other Fees: $nical (HVAC) $ List:ical (Fire $ Total All Fees:on) Check No. Check Amount: Cash Am_J ount:Project Cost: $ 0 0 (j ❑Paid m Full ❑ Outstanding Balance Due: fAC41 0Gvh C4,-- SECTION 5: CONSTRUCTION SERVICES 9 5.1 Licensed Construction Supervisor (CSL) C 6 Zr/Ceder �P/�N�f / Lice � nse Number Ex iraon ate I Name of CSL- Holder List CSL Type(see below) Type I Description J (, Address � U Unrestricted(up to 35,000 Cu. Ft.t 9.,„t R Restricted 1&2 Family Dwellin Signature M Masonry Only RC Residential Routing Covering /�✓J Telephone WS Residential Window and Sidra SF Residential Solid Fuel Burning \ lhancc Insi,dlaoon D ResiJenual Demolition 5.2 Registered Home Imp ovement Contractor(HIC) HIC Cumpanfi N• ur HIC Registrant Narne Registration Number AJJ s CU �. Exp atiun D e Sign re elephone ✓ SECTION 6: WO ERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152.5 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 o-the building permit. Signed Affidavit Attached? Yes .......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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. Si nature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 1 as Owner or Authorized Agent hereby declare that the statements and inforgiation on the foregoing application are true and accurate, to the best of my knowledge and behalf. / n/I Print N �/•/ C3 3 Signature of Owner or Authorized Age Dare (Si ned under the Pairs and p e nalti fperjury) 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and I IO.RS, 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 halt/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"