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289 ESSEX STREET - BUILDING JACKET t I Esselte 74520 40%0 P4 Regnante, Sterio & Osborne LLP Attorneys at Law Edgewater Office Park 401 Edgewater Place, Suite 630 Wakefield, Massachusetts 01880-6210 Telephone (781) 246-2525 Paul G. Crochiere Telecopier(781) 246-0202 IReply Refer to File Direct Dial: (781) 486-6222 39297 e-mail: perochiere(a)regnante.com February 4, 2016 CERTIFIED MAIL—RETURN RECEIPT REQUESTED NO. 7015 0640 0007 2543 7832 AND FIRST CLASS MAIL Ms. Derya A. Stafford 10 Highwood Road Manchester, MA 01944 Re: Unit 102, 289 on Essex Condominium, Salem, Massachusetts Dear Ms. Stafford: As you know from prior correspondence, this firm represents the Trustees (the "Trustees") of the 289 on Essex Condominium Trust("Trust")with respect to alleged continuing violations of the Condominium Master Deed (the "Master Deed") and the Declaration of Trust("Declaration") with respect to Unit 102 of the Condominium. The Trustees have been advised that, notwithstanding this firm's letters to you dated June 6, 2011 and September 8, 2014, you may have unofficially created two separate residential subunits within Unit 102. If, in fact Unit 102 has been divided into two (2) separate living units,this action would violate, among other things, Sections 15.e and 20 of the By-Laws contained in the Declaration. Section 15.e provides, among other things,that all alterations or improvements to any unit shall be performed in compliance with all applicable laws. Section 20 provides that no unlawful activity shall be carried on in any unit. You have not requested authority from the Trustees to subdivide Unit 102, and the Trustees have not granted any such authority. The Trustees are unaware of any municipal permits granted for the subdivision of Unit 102. The Trustees demand that you provide them with copies of all municipal permits and other authority documents you have obtained, if any, to create two living units within Unit 102. r February 4, 2016 Page 2 The Board has a duty to investigate the allegations of violations of condominium documents and to enforce the provisions of the Master Deed and the Trust, pursuant to Section 19 of the Trust By-Laws. Section 22 of the Trust By-Laws provides that the Trustees, the Property Manager, and any persons authorized by the Trustees or such Manager shall have a right of access to all units during reasonable times by prior appointment with the unit owner, for the purpose of inspecting the unit. This letter constitutes a demand by the Trustees to inspect Unit 102 for compliance with the Condominium Master Deed and Declaration. Accordingly, the Trustees hereby request that you provide Robert Polansky, President of Gibraltar Management Company, Inc., as Property Manager, by email (robp a gmanaae.com), at least three dates and times within the next two weeks when Unit 102 will be available for inspection by the Trustees, the Property Manager, and municipal officials. If you do not provide such times and dates by February 9, 2016,the Trustees reserve the right to commence appropriate legal proceedings pursuant to Section 19 of the Trust By-Laws to obtain a Court order for access to the Unit and, if the unit is in violation of the provisions of the Condominium documents, to seek an appropriate legal remedy. Very truly yours, 289 ON ESSEX CONDOMINIUM ASSOCIATION, by its authorized attorneys, REGNANTE, STERIO & OSBORNE LLP By PAUL G. CROCHIERE PGC/Igm cc: Mr. Robert M. Polansky, President The Gibraltar Management Company, Inc. a CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3m FLOOR TEL. (978) 745-9595 F HIMBERLEY DRISCOLL FAX(978) 740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER February 11,2016 Ms. Derya A. Stafford 10 Highwood Road Manchester Ma.01944 Re:289 Essex Street—Unit 102 Dear Ms. Stafford, This Department has received a complaint regarding the condo unit owned by you at 289 Essex Street#102 The complaint is that you subdivided the unit into two separate dwelling units.This Department has no records of any permits being granted nor any zoning relief to create another unit. In addition, due to the size of the Building, any construction would have been subject to Construction Control, which in addition to licensed builders, would have required involvement of a licensed Architect. Therefore, under the Authority of the Mass State Building Code 780 CMR section 104.4.1(MGL 143)a required inspection is needed.This has been scheduled for Thursday,February 18th at 1:30.Failure to arrange for this Inspection will result in Municipal Code tickets and further enforcement actions. If you feel you are aggrieved by this order, your Appeal is the Board of Buildings,Regulations an Standards in Boston. If you have any questions,please contact me directly. Thomas St.Pierre cc.Paul Crochiere, Robert Polansky CITY OF SALEM PUBLIC PROPERTY aMr DEPARTMENT KIMBERLEY DRISCOLL MAYOR 720 WAST{INGTON S1'REE1' 4 $ALEM,IMASSACI-NSE9T5 07970 TEL:978-745-9595 ♦ FAx:978-740-9846 March 25, 2010 Mr. Stephen Sharkie By Hand RE: Unit 102 289 Essex Street Dear Mr. Sharkie, The State Sanitary Code, 105 CMR requires that all dwelling units have kitchen facilities. And further, that it is unlawful to rent such a space which does not conform to 105 CMR. See below: I have not yet inspected the unit, but if it is as you describe, it is not a legal dwelling unit. 410.010: Scope (A)No person shall occupy as owner-occupant or let to another for occupancy any dwelling,dwelling unit, mobile dwelling unit,or rooming unit for the purpose of living,sleeping,cooking or eating therein,which does not comply with the requirements of 105 CMR 410.000. 410.100: Kitchen Facilities (A) Every dwelling unit, and every rooming house where common cooking facilities are provided, shall contain suitable space to store,prepare and serve foods in a sanitary manner.The owner shall provide within this space: (1)A kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils;and (2) a stove and oven in good repair(see 105 CMR 410.351) except and to the extent the occupant is required to do so under a written letting agreement;and (3)space and proper facilities for the installation of a refrigerator. (B)The facilities required in 105 CMR 410.100(A)shall have smooth and impervious surfaces and be free from - defects that make them difficult to keep clean,or creates an accident hazard. Sin • ely T as E. McGrath AIA Assistant Building Inspector, Local Inspector COPY cc: Derya A Stafford, Unit owner, Health Dept, Fire Dept. File SHIP U T-9EfiL*G-AN ) APPROVED By T+IE .IUSPZCTD3 PMOR T-O.A.PEENUT B,ENG GRANTED CITY OF SALEM No. V �� '� ��\ Date � Y Is Property Located in Location of �� the Historic District? Yes_No_ Building Is Property Located in the Conservation Area? Yes_No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, air eplac Other: PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name a� 4 mdIq Address & Phone `� [ �55e)( 4A Il(S AC90 Architect's Name Address & Phone ( ) Mechanics Name Address & Phone �Ifn /r What is the purpose of building? �f/� OIL. Material of building? If a dwelling, for how many families?f Will building conform to law? Asbestos? Estimated cost � j City License # N P' State License home Improvement Lice # Signa ut re of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: i r t )A\No. APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED 9/2//o5 2.0 APP OVFD INSPECTOR OF BUILDINGS Cl� 4-- Jof�/o ftMSiMIlST-SEffLf$ 11 AfPROVEO BY T+IE ASpZj;jnR PRIOR TD.A PERIIpIT BEING GRANTED CITY OF_SALEM No. � "�\ \ Data ! l l s: Is Property Located In Location of fhe Historic District? Yak_No r Hailding 0 eti Is Property t ocated in tiw Conservation Area? Yes No_ BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, Repair/Replace, Other: PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS. The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name , Address & Phone Architect's Name Address & Phone I If 1 Mechanics Name �U 1 G JI -((vo Address & Phone What is the purpose ot badt hV? Matedat of bulldit? V rl� r If a dMOV,for how many farnmes? V 3 WE bukbV cordorm to law? Asbestos? Estimated cost • 0p Ctty Licenee e N P' State Ucense r Home improvement Lac. / ZEE: SidKature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE ke-e- �y) Uyi (4- 2 ` - 1 V V11 MAIL PERMIT TO: �' �� /�� aDar� p 6 N0. ` --C6 APPLICATION FOR Q PERWT TO CI�CY V�Ilnroe+. �n•� iil �'I• � LOCATION: ) /d- PER JMIT GRANTTEED 20 APP OV�D 2 INSPECTOR OF BUILDINGS �7 /Wo 5 Citp Df 6atem Almoatb u Ett t PLANS MUST BE FILED AND APPROVED By TSE INSPECTOR PRIOR TO A PERMIT BEING GRANTED Building Permit Application For. L nilm of Building a)4 1 � 5 S 1\- s '(Circle whinccm applies) Roof.Remf. instill Sid' trtrq Deck,shed,Pool Addition, AUeratloq ougdadon Ody,Wtookins Other. ! PLEASE FU L OUT LEGIBLY& COMPLETELY TO AVOID DU AYS IN PROCESSING To the Itupeaor of Buildings; ' Tba rmderaigoad beteby applies for a permit to build acaordiog to the Eoibwiog spadtiwtiaos Owned Nape Dw 1 /I- vd f � ! I Cootrador. � YJ2rSd -e Cov�S�rv�,f�h LLB Street ty sum/O e, e- 6 / city 6,e 1/.e state Phone ( ) 97 L 2 2 ;y,, S state Phone(7�6) ?9(-,) yd 5 5 Arebitect: City of SNeta Lid., Street 6 City State U00 Ev N C 'I 7,� soft Pboaz ( ) — Hoaseowncrtt Ette�pt Foro�es no Stnrdnre:(*m cude) Single Family. Multi Family___Other_ G o n w ENWWAW Cast of job Will bwmwg"arm tolaw! tq Asbata ____yes sa f Douiptia of/Work to be Mae: old fi O Odds— / oc 1I� t5 Drawings Sub iced: o M I Permit to. v 8 5R M� re of Appli ukm4$ GNED UNDER THE PENALTY OF PEIIJURY coTRUCTION TO BrAB60MPLETED WITHIN SIX MONT$S OF PERMIT ISSUED DATE Depanarwt use ody Pettujtr Permit fee CONIWA rS: ,r. o ... . . V _m n r � l .Y?r{ roT1YAi3rA{. / I1iM' 1 r,'4P'itGl i� 'tx�°� 4[. fii(dfAtffl 1ft11, ' �YN+�:�>�:. u••;..^!l�ltN1 !( '; fl;,�It! r�r�ill� �i.Nt11�4hM;�','.i!�trVfe{+fi'1Pilt'•1(ii,>;.' : ;,�sM1a•�.uf'+t!?A.N1JNk'�' �r .�.,�tr :,rv��harp{}. titi ' ;ire, .•nT,.,,.1r't, .a.�.. r F <'tyW », v1 t5d.{1�..k �.. ::c`. ,(r.:•' yM µ. ,r: s%4 ,4"' �• 4X:'i ,' �"k+•J Uf: •, :11't7l,,+r+larAf; ',Ct:yr:rtt�101 ft• gip*,' ..,kJ•:; - :+:: ,aRICO, �. • • � •j � • �.:.:iY1/ -.11'::,. .ia'♦)j:'1' .1«171QNi"• -••f 11 .' : Lr.''Tlf; . ''4iML' •:: ZIUv i.1 (fiG" JjA' .. t:. 7-rati.Y ,M'.:F.+.t'' [•IrrGY' �{AY'• C:y.. 'Y..,•.;.1"t'.• 'yiRllN.l:yy!�ntt'vY!Jttr '. 'j- :i�y�:!j':;:t�.0li'' Y: t;l;�" ..+.�, .f .::it`lSi►��+:(�$Wic:`F4�"4ita.t'.c�.i` .y'; `p . V3 i1:i i;:: xsY r r;x1� rfir}fil!': 't+ N� Ali'. • , t �� , i" (is.; l;+: {SJire�+t?raCJ•�F +e: xl. ); r 15�I t �t 2-2-0 8� The Commonwealth of MaA c usetts L�$ Department ofPublic Safety OV 2b A CF 04 r yQ \1assaehusetts State Buiuilding Cudc(78J¢YU M[# Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) R_ �5 _s-1- #' ()to IT- 50-j No.and Street City/Town Zip Code Name of Budding(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix l) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: ^ } Are building plans and/or construction ducmnents being supplied as part of this permit application? Yes ❑ No B� Is an Independent Structural Engineering Peer Review required? Yes ❑ No g7� Brief Description of P oposed Work• fT c Se i SECTION 3:COMPLETETHIS 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 CNIR 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 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ If: High Hazard H-1 ❑ H-2❑ H-3 ❑ HA❑ H-5❑ 1: Institutional 1-1❑ I-2❑ I-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-I Cl S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IUL ❑ IIB ❑ 111A0 IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public 0 Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ required ❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: hazards to Air Navigation: y1 1 u t .it is n nu},iao If " I....... Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed ❑ Yes❑ or No❑ 1 Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Grnup(s): rype of Construction: _ Occupant Load per Floor:. Does the building iontain an Sprinkler System?: __ Special Stipulations: _ S 6 7 � Li� vJ� 6Z (� L` 1Nt� cctr:tvl �aVT 1211 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and'Address of Property Owner Name(Print) No. and Street City/Town Zip %.)f) -'1 r r 3 Property Owner Contact In /f2fbnna[fon:�j) -_ ,4w �iOX/ Dille Telephone No. (business) Telephone No. (cell) a-mail address If ap licable, the property Owner hereby authorizes ev a.6Wea /-'1,,o&x J,�,6, Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this buil ding 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 13 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Tcic hone e-mail a ILLOstration Numb P, O 3" r 3.�� k ��/��r � 06 £L� Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor - Company Name Name of Person Responsible for Construction L'cense No. and Type if Applicable O iS/Y _�v y' �C w o Fes✓" �LL�a t�S Street Address City/Town -State Zip Telephone No. business Telephone No, cell e-mail address SECTION 11:%VURFERS'C0M11ENSAI'ION INSURANCE AFFIDIvar M.G.L.c.152.3 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents just be completed and submitted withthis application. Failure to provide this affidavit will result in the denial of the ' ance 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) "Tula!Construction Cost(from Item 6)_$ 1. Building $ 06 47 v Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical $ (, . O� appropriate municipal factor)=$ 3. Plumbing .1. Mechanical (HVAC) 5 Note: Minimum fee=5 (contact municipality) 5. Mechanical Other $ Enclose check payable to ® Q©© PY 6. Total Cust S � (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 6y entering my name below, I hereby attest under the pains and penalties of perjury that all of the informationcontained in this application is true and accurate he best of n knowledge and understanding. Pleas print and sign name Title Telephone No. Date Street Address Cil / own Zip c TJ Municipal Inspector to fill out this section upon application approval: I ZS N e Dale The Commonwealth of livfassachusetts i It"`-7 Department of Public Safety ••,� ..\la,+dt hitsolis Shtlr lSuddut};Code(;;Ill 1.\Ilt) Building Permit Application for any Ruil Ili fig other than a Oil e-or-Ilvo-Fantily !)welling (I his Stt titan For(If Iicial Use Only) OuilJinl;Permit Numbrr' ." _ f)ale Applied: _ .__ _ IN iidiog Official: _ SGCI'ION I: LOC'A PION(Please indicate ISluck Y and Lut 1/fur 10c.11lous for which a street address is nut available) Z0'l . k-;5--ex. .'5+, ._ Sale-m. Mt`f _OlGI.7_� :\u. .nt,l Slroct City/fuwtt /ip Code .Name of HudJiol;(if applirabl'9 ✓-.l SECHON 2: PROPOSED WORK PJitiun,�)..\I:\titan•CbItle Ilwd If.Vets Gntstruc lion check hvn•❑or check,dl that apph in the two nncx heh nv _- ! P.nliu}� IfuilJiug " Rc},,tlr❑ :\Iteration Addition0 Ventolitiun ❑ (Pkmse fill out and xlbotit.\ppvndi.x l) Change of Use ❑ 1 Ch,mge of Orcupancv ❑ Other ❑ Arc l+uildirg plans and/on.+nslnrcliun dtrcwucnls being supplied,ts part of this ,emit a +>liiatiun?-- - { 1'c t Is au t "• S > { \t h dt t u dcut_Irurhva t`{ 1 Et},uu'cnng Peer Review nv aired? t'us ❑ No Ilrief Description of Proposed Work:,_ mrwl UT1YG ---+ SECTION 3:COMPLETE IWIS SL'CPION IF EXISTING BUILDING UNDERGOING RENOVATION, AUDI't-ION,OR CHANGE IN USE OR OCCUPANCY Check hen•if an E..istiog lfuilding Investigation and Evaluation is enclosed (See 74U C\IIt.N) (3Existing Use Group(s): _—_._ — Prnpused Use Gruup(s): SECTION d: BUILDING MIGHT AND AREA Existing Proposed No.of Floors/51ories(induJe hasentent Ievela)C Area Per Floor(St(.it.) I'LIMI Artsa(sy.ft.)and rotai I icight(ft.) SECI'IUN is USE GROUP(Check as applicable) A: Assembly:\-1 ❑ A-20 .Vi}Ihichtb ❑ .\.1 ❑ ;\4C3 A-50 U: Business ❑ li: r:Jucatiunal ❑ F: Facto F-1 ❑ F?O H: I I! h Flalwd HA ❑ li-?0 11-1 ❑ I1.4❑ 11.3 0 1: Institutional 1-113 1.20 1-30 1-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R--{❑ .. S: .Stara a 5.1 0 S-_❑ g U: Ctility❑ Special Use O,md ,Irasu dcscnbe l'cloty; �prcial C'a• SECHON 6:CONS I-itUC rION "PF, (('heck as all licable) I.\ 0 .. IH ❑ II.\ 0 IIB ❑ lll:\ ❑ I11B0 IV VA \'If ❑ SIICTit LV SI"IF INFORMA I ION(rcfer to 790(:\lit lllUfurdetAls on each item) _ "Water Supp,y: I Fhmd[one Information: .Sewage Uispusal: french Permit Debris Iteuuiyal: Pubhi Cbct k d„uhmly !Ln•J /nor ' Indit.re nut nu i},a .1 1rrn.lt dl not be I If,rn+rd Dty'.,.tl<nr I'rn.re0 „r mJrn)ily /I nt•. rrgturv, ''V�'nr!rooth „r+ ,ruly ( „r,m site+\+ten ❑ I•vnnd h,•In io„J 0 i ) Raiinr.td right.ntnYv�ty: r I i ar.uds to.f it.Y.n igatiun: - i J i \'.•t \I'!'li,.d),Y,]� h ctru,tort:,itLmt.�ul•,vl.i)• ,......h ......r' , r lSvnr nt U.llmld'.IJ,:.,.11 � i Ir+Q .v \'o 1„ ❑ \,� �7 ( . sl( 11 UN 3:t"ON I I N I FI F it l l hl(_.\IL•'UI't)C( C I'.it Y •� Will, n- l (.•Jr L .r t'w"p") Itl•, .•I t. Tlnn hrn t`,rnp.mll , .id pt-i II, „r 1 IInIadJurl,,. nldm.in ••ImnSlrr-t ' '•pt� �1 i1•ula Urn. ti - d ------ SLCI.ION t I'ROI'rR rY UIVNI[It \Ull i(71iIZ \Ill7N wK in�l \d In+s I�I�'�r gyp, rty(7,c oar - n„Glt iip N,uno (Print) .... _. No. ttjStrvvl Cih'/ . 1'ropvr lY Ocv wr Gnttacl Inlonndtiolc _— ___.—_ .— ----- ------ rnt.ul a,t rase I ills.-_.- ..-_______________. frlrpht ne Vo. (husinvss) rrlopltun¢No. (cell)/It applicable• the propvrty owner hereby.ullhori e.c /L . __`� .. -.—_ GL— •�� EN �7/__,€� tilah Cil lows /.i p OWL Street Address Y/ to,trl an the pro rty , n r' l It of in III matters rs r,I nivv to work authorized by this buildin7; pernit i ++lication. --' SECTION 10:CON51 RUC r1ON CON rItOL(i lease 611 out \ppe dix heck D and All,Srttion ❑L I If btiddin,is Ic.ss tlmn.310 7 cu. ft,el cndused.,ace and or nor under C'onstruttion CVltltl,l then check k h hero 10.117Registered professional Responsible for Construction It /tea (,y_�7AV � � 9» 8`97 3b — -- Re+l+l ation Number Name(Re-istrant) I'cic In' Vo v-mail addr•ss Ol98.� bV/G _..fi5- �_ / 9, Eiiv Discipline E\piration Dote C /town Slate Zip p titrevt Address Y !(1.1 General Contractor Sage Company Name ---- N•mte of person Re.spoosiblu for Construction LicenseNo. and iype if Applicable City/Town State Zip street r\ddmi.4 . rvle ,hullo No. bu rvle+IxnwNa 75C 6 cull e-utailaddress —_---.— s iness SECTION 11: M 1,a.I k,•'I r'ul'I v.to,,\ t>:••li1,' \�y l .\l l ll'•\\'n M.G.L.e. 152 A lVurkers•Compens.ttion Insurance...fidavit from the NIA Depart.......of Industrial ACOLICltt!nuut be completed anal submitted with this opplicatiun. Failure to provide this affidavit will result in the Jenial of the issuance of the building permit.Is a si+ncd Affidavit submitted with [his a lication? Yes❑ No ❑ SECTION 12 CONSTRUCTION COSTS AND PERh11T FEE Estimated Costs: (Labor Item and Aloterials) (oral Construction Cust(from Item b) 'S—__--- I. Oudtlill+ S (000 Building Permit Fee 'Total Com.st ruc lion Cost• _(Insert livre _. l:Icclrical 5 00 appropriate mtuticipal factor) 'S I I'lund'iltt" y 3� Note: \lininuun fee "S_ (inntaet nuwicipalily) \Irch•mir.d (IIVACI i. \Ivchanical (tthrr) `+ I'ncl,Iw chv,k p•q,d,lc to .______.._..-__—_- . . —_ r I, I'nlal CIM > �/ Boo (contact ..tunic Il+ality)and ,.rile,heck number here - SECr1ON 13:SIGN,\PURE OF If UIL DING I'Elt\IIT A1'1'LIC,\Nr Itr entering ntY name hclo,v, I hereby eltvst under the pains.u1" i,�n•thies of pvrlury That all of the wform.tttnu conlaulcJ it Ihis i ,iphliteti,nt is tnn•,uui a„urAv to the bet of"IN kno„ µ•end understanding. .�� 33a°6 Mlle Irlc( lui.-\o I+.Ih• I'Ir.nr pnlit awl .qpu o.unc Ile Vunit ipal lle,Vmor to fill nut this seati„n neon application �tpprucal: ` Ine I+,ur I ! I t' I I I 1 I i 1 ; J 1 a - I I - i _ _ I I � I -- : i I i i I i i 1 i 1 I , �- 1 l _- I : : I - 1 ' 1 I I : I , I I 4 ' I i I I 1 fit! + _ _ t -; �•_ ' ..._� wozi j Vw W-ivs :,Ls ix ash; b , i� 7 . Q 1 i 7i�JTD 'WALt:1I� 1Vj A_t.Y. I I , I i I ! C , I Ir+�RIfJIIIG IFVhGL --- , i , 1 , \ j t O S� �'� 7� (>NIT : zo_jt 2$1 ST, SAL�t, 1 OVEllrt 8�9 q , Zol Z - i C.L-;A �.c-IV ewmw yriAI1S ' 1 : I 1 I _.. ' 1 S yoyJ I i 1 I I O canwrc uM► arc I k I .. 1 dP TD7o :W/!,i'�XLJtJ4 T#,M4PS' 7fyDko yY� !N y11(I�tLjT1EJt7K _ ol sew ss$ I : r : I , ! 1 1 I ' i t � . ^l"✓•••�^� OVAL - : If : 1 2341 FOOT - ; - ccmmoiv eoN _ ' i I � I i LbR NK I I - I syow&wI hR,+- 70. s �r s1[DpFJj Z% 70 ZOP4/N �k- : 7J�f�'i�IEPf' Iy't�Rf.7 I MI/ IN MOV.I-'.T*UoK : I ' • '� � i' 1. i � i sew X TP I ii NVAC Rtte->M I i : .1 MEMO Mill The Commonwealth of MaA c usetts Department of Public Safety�` A Of p4 yu, Massachusetts State Building Code(78jakr#OV 2b Building Permit Application for any Building other than a One-or Two-Family Dwelling _(This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) -aj E-5,5f-x ST 4 ()N1T 50•-1 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used_ If New Construction check here O or check all that apply in the two rows below Existing Building❑ Repair❑ r\Iteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix t) `�- Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: 1^ , Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ed— �� Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work• Jct i c Se .� 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): Proposed Use Grou p(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-I ❑ A-2❑ Nightclub ❑ A-3 ❑ A4 O A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-I ❑ F2❑ II: High Hazard FI-I ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 14❑ NI: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R4❑ S: Storage S-I ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as a licable) IA ❑ 1B ❑ IIA ❑ fill ❑ 7IIA ❑ Hill IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public 0 Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: I lazarls to Air Navigation: �I tit i.�C ui n i ioi�I:, I myr,K Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build aslosed ❑ Yes❑ or No❑ 1 Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: _ Use G'roup(s):_ Type of Construction: _ Occupant Load per Flour: _ Does the building iontain an tiprinkler S}'stem?: __ Special Stipulations: S 7 vJ- 4Lr> L �aVT l2� 1 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner rtiu r f/ h r6Qd�f i FSS'FY da rt /Cat /�itS C y N;une(Print) No.and Street City/Town Zip 'Ill .1 ` , . r._. Property Owner CContact�filfformatiorrid� q-14 Title Telephone No. (business) Telephone No. (cell) a-mail address If ap licable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit application. ' SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) 4Registered building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and ski Section 10.1 10.1 Professional Responsible for Construction Control Nan a(ORe X)y��Ye TelreY ho a-mai �istration Numbe �G Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name Name of Person Responsible for Construction License No. and Type if App tcabl' le ,(s or Street Address ,L City/Town -State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11: INORKER9'COMPF:NSAIION INSURANCE AFFIUAVII M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents lust be completed and submitted with-this application. Failure to provide this affidavit will result in the denial of the ance 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) TotalConstruction Cost(from Item 6)_$ 1. Building S BB OV Building Permit Fee—Total Construction Cost x_(Insert here 2. Electrical appropriate municipal factor)=5 3. Plumbing $ _ pv 4. klechanical (FIVAC) $ Note: Minimum fee=$ (contact municipality) S. Mechanical Other $ Encl Pose check 1y' able to 6.Total Cost S p�® Ie e - (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 informationcontained in this application is lrue,md accurate a best of j Y knowledge and understanding. Pleas print and sign name Title Telephone No. Date ��/C�� Street Address Cil / mwn `4t,u, ZipJ //L Municipal Inspector to fill out this section upon application approval: I z S N e Date The Commonwealth of Massachusetts \'. I Department of Public Safety /.\J1 ,..��✓ .Ma..uhuselt>State Building Code(780 C\IR)Seventh Edition City of Salem Building Permit Application for any Building other than a I. or 2-Family Dwelling (This Section For Official Use Onlv) Building Permit Number: Date Applied: Building Inspector: SECTION 1: LOCATION (Please indicate Block 0 and Lot 0 for locations for which a street address is not available) R9 Essay S7- o�erlNj)as, S11-t-Z j M71 01Z70 2W 0n Zss -x 1-3a x o s, No.and Street Cih• /Town Zip Ckde Name of Building(if applicable) SECTION 2:PROPOSED WORK If New Construction check here❑or check all that apply in the two rows below Existing Building 119 Repair❑ 1 Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of U,r ❑ Change of Occupancy ❑ Other ❑ Specify: Are building glans•rid/oe.rurutruction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? a � ( Yes ❑ Nu ❑ Brief Description of Proposed Work: (:y'FYd-•-f-e 36 N Optn r rY; T7�`r//)P.ah Ilse)t'�'S-'e- Oo"1 — 1/0.3 �'D QGCA.S,S Fo .11T{ h unrt5. rl�xn (r,SPn,rn �1�( -r �efrrtP�I SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed (See 780 CMR 3402.0) ❑ Existing Use Group(s): Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Flours/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•2r ❑ A-2nc❑ A-3 ❑ A-0❑ A-5❑ B: Business ❑ E: Educational ❑ _ F: Facto F-t ❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 Cl 1: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2 Cl R-3❑ R4❑ S:-Storage S1 ❑ S2❑ U- Utility❑ - Special Use❑and please describe below: Special U.se: SECTION 6:CONSTRUCTION TYPE (Check as Applicable) IA IB ❑ IIA ❑ IIll ❑ IIIA ❑ IIIB ❑ IV ❑ 1 VA VB ❑ SECTION 7:SITE INFORMATION (refer to 7W CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public ❑ Check if outside Flood Zone❑ Indicate municipal ❑ A trench will not be Licemed Disposal Sile❑ rc,luired❑or trench ur.pecdc�: I'ncah•❑ or mdenofc' Zone: or on site sc.tem❑ hermit is enclosed ❑ _ Railroad right-of-way: Hazards to Air Navigation: o+„I. I'r, \, 1 :\I•)•hi able❑ I.Structure,nllnn aopurt,tppru,ichcrea' In their review complovd, .r l-„n.cnt to fiudd endo.cd ❑ 1'cs❑ or No❑ 1'es❑ \u ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY I[diu,m d ("'de. _ U•v Gruuplse r%pe ul Comlruclion: Occup.ml Lund per Flour 1),ro• Ilse bu ddu,g opitain an Sprinkler Sr+icm': Special Stipulations: t0 C0"' -' (*Y- SECTION 9: PROPERTY OWNER AUTHORIZATION N V end Address of Property 'N t-h f �D�C o�( ESSEX 5T. Name U'nnt) No. and Street yea y03 City/town Zip 1 uperty 0%%n Como t Information: 1AM 6 -ia� x qj�-1073- 3goo — — Title Telephone No. lbusiness) Telephone No. (cell) a-mall address If a •plicable, the property owner herebv autht razes � I �� 1 �IdJD4K . � e!, 2L- 11 'S 41 U/ 12D G10 A 0 36 Name Street Address City/Town Slate Zip to act on the +ru•erty owner's behalf, in all matters relative to work authorized by this buildin • permil a , tlication. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (It building ix less than 35,th)0 at. It.of endued s ace and/or nut under Comtruction Cuniml then check here D and skip Sectiun MI) 10.1 Re istered Professional Responsible for Construction Control [�A LDd6z_ t, 1`illeF,ass qL-_qQ--7111 to b f9sv eaLT 94N iyam (Registrant) Teleph�ne,,NNu. e-mail addr Rrgi�fr�tton Numbr��T II tldfP �}tLL h GI�JuC� rtY)7 Quin P-< Zd Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor 7� acUI l lOWS( �/� JV Na of Perwpp'� ta)q,,ylr�r r Constructiun License No. and Type if, plicabl � Cf I Iti K O/ 1D �C OIk. 11� W L1 i 136 Street Address City/Town State Zip I t r✓ i121bf9szi �r ftiaGto�_�om - Telephone No.(business) Telephone No. (cell) L mail address SECTION 11: WORKERS'COIvO'ENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) r 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 O No O 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 $ Sid d (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I herebv attest tinder 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. Rf l r�cee6�� Otr�xl 9%fi'yea- 741// y i I'le t,v print and si);n name ritlr relvphone.No. Date // 0/9W titrvet Addres CitviTown Ftate Zip Municipal Inspector to fill out this section upon application approval: Name Date CITY OF S.U.E.`[9 ,LkSSACHUSETTS SUMDING DETARTtENT 120 W.UMINGTON STRFRT. )et FLOOR TEL (978) 145.9S99 F.r x(978) 72498" KIJ®EMXY DRIWOLL THO"ST.Plzuz MAYOR DIRECTOR Of PL PLIC P11OPERTY/Kl1DL%G CO%L%ffSSIO-%ER Workers' Compensation Insurance AMdavit: Builders/ComtractoralEfectrlclsnslPlumbers aunllcant Inrarmatlon Please Print Legibly Vatne laaan.+.ar�,n,tanewln,re seal/:�J/YLIJ/�i L. �Gf��lam] .TIZ Addmss: ll 916VE Lb(-L LL26MJ City/StatrJZip:E,Lm�r,&M� Phone iv: 972f — q Are yos so eapioysT Cheek the appropriate lasts Type of Project(requlreAN 1.Cl 1 arm a employs with t. Q I am a pneral contractor and 1 K ❑Now construction ctespl®yeas(Rdl and/or past-tior).e have hired due sub.eorsraeton 2.® 1 am a gain prepriemr or par mer- listed at the attached a1Kw.% T. ®Retrtodsling :hip and hove no omPloysys Then sub-contractors have V. Q Ikmolition walking ror me in any capacity. evorks e'comp Inn races 9. Q IluiWuy addition 1 No workers'comp insurance S. ❑ We an a corporatism and IS I0.❑Eleeeaid al repairs or additionsrcquita .l okllcaes haw exercised their ).Q I am a homeowner doing all work risks of exanprion per MGL 11.❑Plumbing repairs or additions myself.INe workss•comp c. 1 A 0101 and we haw no 12.Q Reef repoies insurancerequired.Ir . spley"o.INoworhow I).QOlhar comp im%ranee requited.) -Ant appara/nl/draaa ass et meet a4e M uY IM sesrio.aeM 4 radr awbea•ceo prwadrw paler IaeMaYle♦ 't 1 w.iu.nu air"lore sets salarvis irrdiceins they me Joins ra was and on lob onside eostraens mar Same a row allldwir idicriti MA <.enra+ma reel cbea rW best nrud amarh d so aJdirwr.l.hr.#vino tb free er tY w►aerraMe sad tlrM worsted'rarP6 pdky ieMaWML /es ee esplsyer lhor it provilbe;workers'coarpresetbss/nlwwme for my employwa sodded O am po ft auterm e/b infwarodora Insurance Company Name, Policy #or Selr•ins.Lie.M: Expiration Darr lob Sire Addreu City/Stars/Zip: .%tack a Copy or the workers'compensation policy declaration pop(skewing The policy muabs ,and aspiration daft)6 Failure to serum coverap as required under Section 23A of MGL C. 132 can lead to the impoeitan oreriminal penalties are fine up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties is ON roan of a STOP WORK ORDER and a title Of up to 3230.00 A day asainse the violator. Ise advisor/that a copy of this statement may be ruro artied to the Ot71ee of Inec.o#osiuns of the MA far insurance eovcmp vvailkaowm. 1.1e hereby c e ,y under rAe ins and Arne el perloy ther rye informetlon prvvilel ubew is truo and tautest 17�a71)?G> 01fla irl use urrly6 /1e not Write in this nrr .to be'c ump/eMd by wiry of rown nlA." City or ruwn: eermiC4./tense#__. J luuint.%whartly (circle one): I. ❑uard utllvaUb 2. RuddlnY Mparemvnl I. C•lly/fown Clerk t. flectricai It"Peclor S. Plumbing Inspector 6. Other l.ntlace Person: _ _ thane#• lA � i U LEGEND : COMMON AREA A If n "del aI iI f f BR D LIVING ROOM I'�V'+'.�..�� J DR DINING ROOM Kr�Gh o, UiUi i I I BR BEDROOM [� - ' rn BR MASTER BEDROOM B y ; — 6 AT H O IvIB MASA5 TER BATHROOM 402 I K Y.ITC H EIJ / 6265.f. �l- 5 5TU DY � N 5T STORAGE� b i C CORRIDOR 2 71_QII — L LAUNDRY / �i MR MECHANICAL ROOM zcp6vu�tgl.- UNIT MAIN ENTRANCE UNIT 402 _ FO Ul F-1 FLOJR AA - � 5TRUCTURAL COLUMN 51 20' LINE Df51GNATION SCALE: ;" — 0' fG 30, NOTE: 5TRUCTURAL COLUMN ,�{ zF'^1,�°+. '`,:• LINE DE5IGNATION5 DO NOT IJECE55ARILY IIIDICATE UIIIT 5OUNDARIE5 - ' '� �,/ w•:d «,,.....+"'cSY^�� FjRESER`✓ED FOR REGISTRY USE; 341_1 e3t rc 6RR w4�0R3 I 1 LICENSED INS URED 70 s.f. ROPERTY SOLOTjONS terry am GENERAL CONTRACTORS CONSTRUCTION&REMODELING UNIT 403 - FOURTH FLOOR ATO Z HOME IMPROVEMENTS VAL BURGESS 978-420-7411 51 Za VAL61954@YAHOO.COM 5CALE: O'p ICY arY I The Commonwealth of Massachusetts CITY Board of Building Regulations and Standards OF SALEM Massachusetts State Building Code, 780 C•MR, 7'h edition Neviaad J uun+n' K I Building Permit Appliwtion'ro Construct, Repair, Renovate Or Demolish a One- or Tu•o-Furrfil welling This Sectio or Ot cial Use Onl Building Permit Nurn er. Date Applied: Signature: Iluilding Commissioned Inspector Or Boil ings Date SECTION I SI INFORMATION 1.1 Property Address:#qc(o 1.2 Assessors Map& Parcel Numbers 2iact Z—U c S S/}LC Ma Number Parcel Number I.la Is this an accepted street'?yes_ no_ P 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use [,at Area(sq 11) Frontage(11) I.S Building Setbacks(ft) Front Yard Side Yards Rear Yard Require) Provided Required Provided Required Provide) 1.6 Water Supply:(M.G.L c.40,134) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP' \ 2.1 Qwner't fIrd:ti -tf �8a FSs�cSj. �{0(� (Sffl-�!"1T me(Pnnl) Address for Service: 1 (P 1 �1 9" sr'f no �gz Sign ie 'telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: �i"a c e r ore� r Briefl]escription ofProposedWork': / n ir. n 9tn �o % hTro Jns� Sfc C4 CT SECTION d:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials I. Building S / SG6,o G I. Building Permit Fee: S Indicate how tie is determined: ❑Standard Cityrrown Application Fee 2. Electrical S ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 7/4. Mechanical (IIVAC) S List: ''ll / 1 5. Mechanical (Fire S Total All Fees: S Suppression2 Check No. Check Amount: Cash Amount:— 6.Total Project Cost: S �9 3 O G 13 Paid in Full 0 Outstanding Balance Due: , SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 6 J 70 ` �fn,me4�5 U(, License Number Expiration DateDateJAdd ame ul'CList CSL I'1 pe(See below). f� Uescri t.Ft l!nrestricteJ u w JS,000 C'u.Ft.) gnaNr R Restricted 1&2 Famil Uwellin Al Al:uon Only RC' Residential Roolin Co%crin clephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D 1 Residential Demolition 2 Re�,Isfere Home lrr�� ovemer�Contracfor(HIC) 1Z y G C C[nfr�Tianhhiso 'OrP:ia Cumpany,Nam"p o 411C Regi�.mt�lmne Registration Number Tra/ derv,' e a ) Ell ss Expiration Date urn "fclephone 7 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...........O SECTION 7n:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1• �a�i'al Z Sri i e`! as Owner of the subject property hereby authorize ;///G�,f�o .bn f�.,.i� rriAo'rot. to act on my behalf,in all matters relative to work authorized by this building permit application. S, utuuM)o` Owner Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION i• ,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 ofPerjury) 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 I Uo 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 7110 CMR Regulations I I0.R6 and 110.115. respectively. 2. When substantial work is planned,provide the information below: Total flours area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Ilabitable 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 he substituted tor"Total Project Cost" i a , ; ► The Commonwealth of Massachusetts . f Department of Public Safety \la,.tchtawl is Nate Building Code(%80 C\IR)Seventh Editwn City of Salem Building Permit Application for Any Building other than a I- or 2-Family Dwellin (this tiectiun For Official Usv Only) Budding Prrmtt Number: D.atr Applied: Building Inspectur. pd�n ON 1: OCATION (Please indicate Block 0 and Lot 0 for locations for which a street address is not available) eet CRY /Town Zip Code Name of Budding(it applicable) SECTION 2:PROPOSED WORK If New Construction check here❑or check all that apply in the two ruws below ding❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please(ill out and submit Appendix 1) e ❑ Change of Occupancy ❑ Other ❑ Specify: plans and/ur construction documents bring supplied as part of this permit application? Yes ❑ No ❑ dent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Pmpo>xd Work: - SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) O Existing Us*Group(s): Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Fluurs/Stories(include basement levels)k Area Per Floor(sq. It.) -4 Total Area(sq. ft.)and Total Height(it.) SECTION St USE GROUP(Check as applicable) A. Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational O F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-S❑ 1: Institutional I-1 ❑ 1.2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R4❑ S: Stora a S-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe beluw: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ 1118 ❑ 1 IV ❑ 1 VA ❑ VB ❑ SECTION 7: SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: A trench will not be . Ica•n,ra1 Oi,pu.d Site ❑. Public O C heck tf outside 19.s.d Gina•❑ Inaliartr mumupel ❑ . wnd❑or trench or I'm ate❑ or indvntdv Zone: or tin,se c required ,tem O 1 cute` permit :,vrichi al ❑ Railroad right-of-way: Hazards to Air..Navigation: \14Ih,un, t nmu,.i,•n leasers Pn,. \. t \pI•bc.dda•❑ I.�I niuure acithm.nrport epprnach sera.• I,Iha•o revvav enmpleted.• •n l' •mane b.Ilse d.l cncL.�a•al ❑ Yv,❑ or.No❑ lb.❑ \n ❑ SECTION 8:CONTENT OF CERTIFICA rE OF OCCUPANCY I .fitint.d ( • da. ___ Cwl�rnq.l,c ra pv.q l.m,uuaion: lkcupanl Lua.l per liuor I>,a•� iho builJmti aullain.:n ti).nnAlcr�,,Icm'. �pav'ial 7hpulaoany mpro� ��l SECTION 9: PROPERTY OWNER AUTHORIZATION ' Va ran 1 .\.Idr ..al I'nq+a•rivOwner .Name(Print) No.and Street C ily/rown !ap 1'rulwrty 0%%nor Contact Inlurmation: Title Telephone Nu. (business) Telephone No. loll) a-mad aaldre,- If applicable, the property owner hrrrby authoncrs Name Street Address City/Town Slate Zip w act on the properly ,%%ner's behalf, m all m.trtvrs rulativr to work aulhoricrd by IN,building +ermit a + hcation. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (it buddin is lass than 35,tIW cu. It of enclosed s ace and/or not under Con,,tructiun Contnrl than check hen O and slup Smieun 10.0 10.1 Registered Professional Responsible for Construction Contras) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name: Name of Prrwn RrsIxmsiblr her Cunstructiun License No. and Type if Applicable Street Address City/Town State Zip Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WO V (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 O No O SECTION 12.•CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=f V Building S Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical f appropriate municipal factor)=f 3. Plumbing f i. Mechanical (HVAC) f Note:Minimum fee-f (contact unicipalily) 5. Mechanical (Other) f Enchaw check payable to ( J1 / _ 6. Total Cost I f Z4 (contact munici alit )and write check number here SECTION 13-SIGNATURE OF BUILDING PERMIT APPLICANT BY entering my name below, 1 hrrrby.utrst under the pains and penalties of perjury that all of the informauan contained in this application is true anal accurate to Ihr best of my knowlecige and understanding. Please print and .,gn name Title Telephone Xo. Uatr ?Irva•I .\J.In•ss - Cltyi Turcn to Qp O %funiOpal Inspector to fill out this section upon application approval: Xam I it, r _ i UNIT 503 DINING LIVING REMOVE EXISTING NON—BEARING PARTITION. PATCH AND REPAIR CONCRETE DECK AND FINISHED FLOORING, REMAINING PARTITION, AND FINISHED CEILING AS REQUIRED. I, FULL I/2 WALL WALL] NOTE: CLEAR SPAN ABOVE HAS BEEN CONFIRMED BY EXAMINATION OF EXISTING STRUCTURAL CONDITIONS _ i 0 j o KITCHEN 1/2 TH 7L map COMMON CORRIDOR 400 NiM 781, �SYKt3lcccc SALEK �19 S ` I � UNIT 503 UPPER FLOOR PLAN UNIT 503 Partition Alteration NOTES: SCALE 1/4"=V-0" JULY 16, 2010 1. WORK CONSISTS OF THE REMOVAL OF NON—BEARING PARTION AS THE ESSEX HOUSE INDICATED. SALEM, MASSACHUSETTS 2. BUILDING IS AN EXISITNG TYPE IIB FULLY SPRINKLERED BUILDING. USE GROUP — R2 MULTI UNIT RESIDENTIAL. RICHARD W. GRIFFIN, ARCHITECT© Zjv J Z � Z w_. F rza ugfw,• ,'�?R. t . r.v;d�#U r!:•n i 'd 4 �.. lt r�+.$6 }. Y bfi .,i?��r oal �I '� 32 ,.i` 4� " �! '<A, ;;• fM1' a �. y. M 6% It . „{"1 .`�,. � -,,aJe" �, 13t11 S. 1 ,li'%C{ 3ti�.:J 4 '... � •• Am. : . .:: _.... 2iM� "•;:157 k� y'44ii;: i'�" ,�i;'i'1 i,�. • i,:i `i111) '1�i9,:;t n•. 51R.�.� �.� •.i'a3r.ilF�3ty i(,1 ..ir.I pYY pg'!!�" � 1 d .�V7�� .'0��y"}"� i¢,,ti..7"�;�� o- �e.��v�:ll i" 1��4!li��p.1� ,?a��'t!`{Yif'}4•.d'. :f,4S#uW°'1;`. yVq fTPJI B"PiEl�IV t 4Aiild otr,: .i' 1 '�iA ,t7t ct '0"'H i .. N ?IftYa'a l •i1t lJ'.a x;n+q.Yr+r•`• z or n (r F U CL .._ .. ... ..... . o W _ i Citp d �&aY'Em, j.a55arbU5ett5 UA PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BEING GRANTED Location of Building 2 8� �SSez.Sk. Building Permit:Application For: '(Circle whichever applies) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool Addition, Alteration, Repair/Replace, Foundation Only, Wrecking Other. PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: The undersigned \by applies for a permit to build according to the following specifications: ^ Owners Name: 1 a\J I ) I A 4R I ttq Contractor. l h'!O n S Vr✓�i/ten Street 2- j ` Ss$ex S+. 'WCIoty Sc&M StreetL P 5 e ciitty S2- iwn StateA/� Phone (6(7) 9 s7 L//S'7 State /N- Phone o� j ) a7� —,1i'aa-7 Architect: /71/0 City of Salem Lick Street City State Lic# G I O HIP# /y7 Nq State Phone ( ) Homeowners Exempt Form_yes no Structure: (please circle) Single Family, uld Kamily# Other (ptnQLA(h /yGo , o� Estimated Cost of job S1 — 1 Will building confirm to law? yes no � v J o__ Asbestos. es no , Description of work be done: JPr►r Gv le— z°u i,5 . k(Q-e , zAl. l,, /5 GlnJ l e iv�SII Y12w �t7tr,t�3 end �iVh7L( Draw' Submitted, es Y_ no Mail Permit to:g n ature of Application,S GWD UNDER THE PENALTY OF PERJURY 6 „X CONSTRUCTION TO BE'COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE Department use only: Permit:`# Zoning Map/I of T Permit fee$ C0MMMS: 1 'PLO NwreE qu*mD ADPROVEo ey no CITY OF SALEM Do Vftd Is__ � f.Haft OIrAo19h Y�No_ fail�la� at Is P1opwly Loowd In b Cwwwva on Ibw4 Pam1k 10: BUILDM PEM I APPLICATION FM Oft Whioha w ap*) Roof. R$W. IWA Skft C WVW Dank, &W. Pool, Rapak/Ibpi ". Olhar: a nu Uu KUM FU OUT UMMY A COMPLETELY TO AMOID DELAYS M MKXX@Wn TO THE INSPECTOR OF BLIILDING&.The WKW80W '. hotaby apt for a permit to build aooaftto the toNowkp Owners Nam. Te 1�c*)(&Vl Ad*M a Pha» B Cis eX 5} f :7 AMhilaot'a Nanw Addnsa d Phone t M.daMa Nam. D a OS Q pV-g- h Addraaa A Phor» N2 b P�2u�znj �li9nl�o��"v�s ' "W M ar Povo»a WldW// ae� l$/� Mrww d ad&gR_ ari C� We bLdw Gordon awn E.rs.nd cod " 8 00. de a uo.■.. aw.uowr.• C 5 ©0 " some lopmwamt S+anatw. of ApplioarK EIQNEp INOlN THE PENALTY, oEscRIPTION of WM To 0E DONE oP POLRW iv, aSu hs h/m�e�s J�Y)i 11 Sri •n () nI`t5 Ho 3 anj 302- MAIL PENAT TO .t No. APPLWATION FOR PEWW TO &,k-e6 , h 3oa 5.1,( LOCATION xq 5 PERMIT GRANTED BI3e1as- ,s INSPECTOR OF U�� iieparrawea`t OJ wrla��tY,,N.�S��Rt}��/m Acementd 9 600 Was6fegfols Sbad Bosfo4 MA 02111 lvwwau►ssaoWAin Workers'Compensation Insurance Affidavit: Bngden/Contractora/Elecbidam/Plumbers A fit Int Nadu • V (I UC°'rI'Cf 1 Addles: CnyM.. *__ A jVj vUe� M ga y v/b�75rftaoe : 9 Am you an empitger!Chak the appropriate boss employe with 4. 0 I am a pnwai counctor and I Type of project(required). employees(JA and/or part-time' have hied the ftIb4MftCI0II C ❑New comh9ction 2.0 I am a ale proprietor at Parma- listed on We atmebed Beet t 7. D'Iamodding ship and have an employees Then sub-coutracom have S. 0 Demotitiam waking fbt me in any eapecib. workers'Comp•Instance [No workes'a=* iantrance S. ❑ We are a cmpondom add it. 9. 0 Building on FdII onion have exercised d1eir 10.0 Electrical mpsits or addition 3.❑ I am as bomeorvaa doieg all wale rl&ofezenV"Pa MCd. 11.0 Plumbing repass or additions Myself[No werkers'CotrP. Q IA 41(41 and we have no 12.0 Roof repair mtarsoloe n4 ad l f avbyceL(No workers' 13.0 Other CWW'i ] 'An1'OPPHDM net Chub boa ai trot am an out on sedioa below�oek rotes' tHm wwamwhoaduftoteemdewhio ktig&wm�ellw!;edd=biteGaw=' Ceotrwdteminteobaitaenveffldeva. eCa"WOM net ebeok ob but motet NW oo dM000l ebst down lb mine ofoe eobmebesgr end oe:r wmtw• � cock �P�9�o+r+teEfe6 I sae ex eavlmyer dFat It provllLeg wsrAan'COttapaesaslas buwraw efa my ptepAUM Bdow Ar to rpoiL7 and Job ably insurance CampaoyName ._J- b Polity#or SeWimt.Lie. N: l/J C Ezpiradon Date Job site Address:_ $Q�SSe>< 5� 9 City/Sweizip: �`4�t°�! rn k:5., Attach a copy of the workers'Compensation poncy declaration PAP(WkW1108 the Policy number sad explrmuou dale} Fallme to segue coverage as fequiFW under Section 25A of MGL a 152 can lead to the line uP to$1,500.00 and/or one-Ycw imprianmem,as well MI civil in the fbfm of a STOP civil O f 2 STOP ofadmioal Penalties of a of up so WO-00 a day against the violaor. Be advised that a WORK ORDER and a fine luv=tigsaam of the DIA fm Wuramae aoveage vai$pdwL copy of this smtemeat may be forwarded io tba Of&x of I is Aarebyea*waefir and pxd o 000114 y Aw dice bfawaliowMoPlhel S&MV 'our daleNneat SS(S� 7?�f5 ohkid nn Ow{p. Dr am WHO/a Alf area,to he eow,pGfd Ay CI&or ow opkid City or Town: rtrmWLles use t fuming Authority(circle ere): 6. dw-OBoard of HUM 2.Buildfng Department 3.Ckyfrow■Clerk 4.Electrical I=pector 5.numbing inspector contact rersom. Phone 0. �, w 152 requires all emPbyets b provide workee' cusupensmon my wlu» `+ v—f— Massachuseas C.Maal La e� if defied 3{ all C aY P�m the aawce of another under arty contract of im PW=Ot m this stamay+ at snWl� i -' );4 oral of wrius exprea of�P , ;corpotatioa cr othd legal eerie,�my tav'o of»tone An ensplaye is defied s��'��as ko repr�'a of a daceasad�bYQ However of the forte cnOtiAel, assorSatioa or oia legal tmnY+eEW" receive of 1rWlay of eta nj 04 MM 60�ap,mp�mail who toddy ihereiR of the Deeper else � owad of a dwelling _who QoPt�Pam b do mam>raaac+oonstr>ar�or repair wa*on so&dweltios dwenog house ofa bw7diog �D n0tbecrose of each anVbY��d°emed t°be sa emaP » of m the!D� to n shA mmlt`�ty,�pasea or MCI.chaffer Ise, a or pe also " "dam or local Oee ditg agyay resewd Ora or Pdn'�to°��a��or to Isf�» +MGi.chaPsct� •4� mar may of ib Dolidal wbdt s� cow into my contract tiff the pait>msna of Public wolk sad scoop daamP>iseca w>s the id°famos Teqakements of rhos d pter lisvebees pteseoted to the coa"c*g ApplIUMMIS the boxes that apply to yew$bastion mad+if Please fn out the workers+oompematiou affidavit omaiplese�y.by cheelaog wish their oatifasd�)of iwoawY+fib'ems)nmsds},ddreLimb and Phony �)wit to emptoy��r tbm the �ma. Limbed Liability CONVesia P4 or Limbed LiaMWY tt�armoa If m ILC a I.LP doe have members or PI are mat tegaityd to cart)'wotkm 00nsP�a ubmiteed to the Departrnmtof htdustrid employees,s Policy to required. Be advised�this affidavit may employees for o of ioaaawe wveraga Also be aura to MISS ad data the atlldavk. The aiidsvit sboald be tenoned to the 'oity d town = the application inr the petit at license ire being re4amted.ad the Department of MWtiM you bave my gn�0n•�I Indttatriai Accidetto. ou ate ae law or tfy tegabred a obuia s te a+ :R ere mm*b listed below. Self-issued compan sh ies ould suer thdr compeasadospotinY,P>aaw can the fee sex-iasutmee 1iCCUM a on the Lyq or Tom Omldds ,sn at rho bottom please be sae that the affidavit is oompiete and printed te�bly. The Delwumet contact has in conact You regadint>ba'pp of the affdavrt for You m fill out m the eve ffice of InveldSitim w> h w�716e need refaeace mmiba In addiMa,as applicant p be sae to f0 in the pami iiceme en ear.need only submit one affidavit indicating current that mast submit n(itio ne P °u is my given Y Policy infotmsnon(xn ')and image Job Site Address the aPPlicmt ahtwld wrise Of Iowa may be�v�a dw of town}"A copy of aidsvit the has ban ofltaany lumped or tsatked by the cityck applicant as proof that a valid aidsvit s at fle for farce pernuts m Anew affitlavrt mnstbe feed one year.where a bate owed 91 citheen is obuining a HOMO or pamit not related to my busiaea of comtnaeial (it, a dog liceafe of Deo°u to ban lava Cr.)said pason a IVOT regoirod to conipic a We affidavit like>D thank you in advance far yourecooperationand should you ban any potions, The Offee of Imadpoons would please do motbelit o 10 Siva us a can. The Depatme es addrees,teleptou and 6s tatmbaf The ComnMweallh of Massachusetts Department of lndnstrial Accideab Office dInve:tigatlone 600 Washington StW Bostm4 MA 02111 TeL #617-7274900 ext 406 of 1-877-MASSAFE Fax#617-727-7749 Revised 5-26.0 www.mm.gov/dia CITY O/ SAL191149 MASSACMNSICTTS PUBLIC FROMMDVARTM[NT 120 VA MINaf M SMKV, 2e0 VLMn SALSM,MA OI070 TaL(070)710-MM tn. 300 FAR (070)740-0O" STANLCT A U@ Ir.& .ft DL4POSQ DF D»X A"MAVfr Is w modm wilt(ba p WA&M G(MM a 44 SX I aekeewfa*that m a omdi = otfldit Remit r A&Wk maal ft isms the a N&Ndm a dit on A by lbia gwmbs Remit Ass be dlgm d atis a plopuly Noemed aolidmom &Rood bdfiq►e s&&W by mm a IQ Sink The debdo wM be dtepond atat 7L' LaaadaadPadiiq i / 6 c) 5S Sip sbm otParmit ApplcM FLUY Como"the tlsllowb g imhmdk er MJASB PRWr C LUSLY) Nano dRemit Andad Fits N=Nk it my Ad&M city A Stan The abow.saw requires dLd debris Am the damolitio%rgwv&UM mhA or odw aftatatioe otbuildiss or sttuctune be disposed is a pspel.*bcmeed solid-waw diapoeal haft m defined by MM ak Siso.%and tba boil ftpeWti of licenser m m mdko for beatioa ottbr lkality. APPLICATION FOR PERM TO ,Sn,eac,F LOGATION 2?9 orSSC4 PEFO T GRANTED APPPOVfD eLILDO s ,l qPWMlAVWUfAM4AD APMVW sY Re P�m A.P.lEl1E!AE W ORANft CITY OF SALEM No. o r Y S Vftd- 1 ..s LMatlw of 1-"Jo Olydal?N Is Papor Loomd in • ft GWONV NOn Awl? . Yam_No_ MALDMiO PE l APPL=TION FM PsrtnN to: (finds whWhWW apply) �OI1NrSMft � ate' Wwc� PoK PLUME ML OUT L AMY A OOWLEMY TO AV=DELAY:N PROKIp TO THE iNBPEQTM OF NAMNM '. hereby sppNss fora Pam* to build a000nftoo ft imNoGPNNAaftu wkq 0~8 Nana 11�C�6)h to rfl'g r Ad*m d Phone 97� F-!5-:W 6 AndibWs Nana " Addnas A Phone c Msolaldcs Nnn. vid- 9J�e7l� Addraa a Pha Wl iyuntc97� 77 Y r moI.rrpwmilbaw Got MON d ? ILF,� �fG�A N d dwdiq,la how mM Irk? Q vm Odrdrq oailaw a Iwo Arerleao E1s�wMd eod TIS06 . 01 aw ub tom_VA UorM• �� I� � ad L�twoa�wt . I � of AP*W LN TNK PENALTY Op PENURY oEEt�1IPTION OtQ T9 EE DONE y�ere are Cot�fhv . 9- 20,rpo-r �; V4 -Flair , �)/wadi MAIL PERMNT CITY OP 1ALZA% MASSACHuswrTf PUSUC PRO►MW 019PAWNIXT iQ 1 aO 1MaMINafM SMRW,380 PLODS On-M IIA 01070 T0L(8761746- 0 CRT.300 Fm 070174006" STANLev A UO& JII. DL4rOl:AL(!DlOM ARWAVV li aooedaaoa.rill+Iba P"Wmr dMM a 4%SA I ubaiowrla*dw m a awMw of 8Aft>'rsit .of%i Jumft toe Aa soed, wd ft spowd by Ibis Booft Al mh abaft be m pnd aria a pepef►Bodes!aoli&Maw ��r da6lalbyb/Q.s Ot<t111tL� rod"wMb.dlapWataft r�Myfe✓ �r / et��'o facades.arFaoiNgr aAlY Sipmmo of ftz*Applk� FMY ampho 6@ bOmioj m&zWoe a l.1 m paw CLEA>RI.Y) T #v id G JIP-z rar✓l Name of Remit AndoW Fifes Name,ita w ��-F f4e 4;e ;D—* y cw a Sow itfr am"wa raqu m that eabria dos(ba e�oliBoa.rmovarioq,retlab ar ofhar ablWo otbm' ft or suucM be dtipoW a a pmpalr&mod 1olibwaw&VOW bidSlj►ar&& W by 11M A SIM&aW&bWl&gpemita or Scares=r iad(catr�lowfoa of tst!>�►. uepannwm of Jna> 5VM ACeraenrs Oda ofrnvewgatioas 600 Washington Street Boston,MA 02111 wwwMassgodd►i others'Comptenaadoa Inauranae Afi3davit: BnOdenlContnctora/Elecgidam/Pinmbers Ne Int �/1'C� err rnohs Sv 7> 'ate �� you as empb>er?Chtak the appropriate bon Type of proled(required). 1. 1 am a employa with 4. ❑ I am a peoaal contractor and I 6. ❑New construction empbyea(m and/or pa t-tbne).w have hired the aoboonaacim 2.❑ I am a sole proprietor or partner- Umd on the attadied slices.t 7. [3pkcnoddiap ship and bout no employees These sub-contrscba have I. ❑ Demolition wod&g IN me in any eapacigr. waskaa'or�..iasurwce y. Ehuldins addition Rio nour n S. ❑ We in a corporation add its officers have esereised their 10.0 Electricalmpass or additions 3.❑ I amm a bomgurvnea doing all work right of e:aw"per MGL I LO Phmtbiog repsus or additions myself(No woken comp, a 15%JI(41 and we have no 12.Q Roof nepabs insoraooe regn6t) Its wollme 13.❑Otha cramp.immance required.] • Any.ppue4er�dmbrb=aimategoaltatde tv evbmtrbdvwbS4drwgbea'aompm�dm PAW ilkfi m: t Hommwmm vft mtna ado efildevit saedma Say m MM an watund d m tmra attidr coemaetas Umd atxmit a env mfil6vit mdkMeb a sat teonewson the cbwk tada cox mue etwrbad m Wd dund d war d owbig+e.�of do asamh.a ad drat wmt..•cana ter idm+nelae. r tAw laorvt*ft tvorktrs'comPemtdmr buwwow fw my auptoyets ddow b dtt pdk7 arfob aft inaoranceCMFWName: z Policy 0 or SeMim.Lie.N wf -3`J ✓ . a-Z 7 l Expiration Dace: 3 Z� Job Site Addrma L j C , 5 Wi C.'ity/State/ *: '�ql elkv) M017 5 Attach a copy of the workers' compensation policy dedansion page(dmvimg the podgy aomba and expiration date). Failure to secure coverage as required undo Swan 25A of MGL a 152 can lead to the imposition oferi®ai penalties of a Hoe up to S 1,5a0.00 xWor ones-year itnprisonment,a well as civil pamme;in the 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 may be forwarded to the Office of Investigations of the DIA far houraoce coverage verificadoa ZAP Ambycm&mdImrAjj6WsxdpxsAja&OVI ry dyer des bfaasedta prwi/d oboes b aw ad arrret G a � svb Ph=0. �7� 0 15 �7 opkid am od3t Dr nor wrdrt in did orey to fit cowpfertl by cj&«town ejwd City or Town: POUNUCMW 0 lamming Authority(eirde ae)t I.Board of Health 2.Budding Department 3.Ckyfrown Clerk 4.Ehx4teal Inspector S.Plombiug Inspector 6 Otber Contact Person: Phoae f. Maseachuse►u Geaaal I,avus cbapta 152 retpuins ail aoPbYas to peovide wotken' my `�`� "''••••'••• pint t0>bis sutnte■ an Laws chaprs is defined s"••a'aY Person in the aervice of anotha under say contract oflaim, cwass of inP"oral or Whoa dr _OT_ An eapfaya is defined as"an individual,pa� 0. sofost"aa deceased emPby�01 60 of the foreo0iat meted is s joint enterPrue. nsodwn tx other kWt emily.asPloYmt emPlnYeea do . of an iswivi" occop"of So owns of dwcltioLhonsc bx t not MM 60 reteiverartmift *M*w who resides tkeres.a assuch dwe1ft boomdwc int home of another who empkrys Peranna 0 do at repair wofh cr m the poauds orbmldinf &" because of met ernpbymentbe lamed to be as asPloYef•" ako sues that"eva7 Ads car bat tendaa WM da wkhbli the MWMY �� Mfaewd at a license or p�to aP a a bttahuaa car a eontnset bvfiircompossm vAS t V bhe m � • trosspocostw s 10 sst P rodw 4� �� ms any of id POaW subdi mess aAddihdt of n wNe:work umel a0ceptabk evudenrs of eampliana aids the hworaooe wins into any oontoet pafa®sna to to contracting oAm*• Mpifements of this chgpla bat beast prCIONd APP the bona dhnt VPIY to YoOf situation and,it fill out the worfwss' dwsvk oomPleoebr,by cheetmi with their cadfiaoe( ) e and ems)alma s of neeasaty,am �.eontrador(a)name(s),addlesO c Parssersblp g1A with to employee other thm the imamca I dsd LiabMW (uM of Limild LiabDity If an=a LLP doe have members or Partaa>ti to cam workers oompemadm an� cod that this af5davh my be> t0 the DWarm�mt of Industrial p u foesOHV is m of ire v'aa� Ao be sate to dp and date the affidavit. !Lea 'k should ca taws that Dqw=cM Of the awliation for the Pamir of heasei bent n40e�+nt be nmal Should you bave my Qaesd00s nprdiot do hnv car itym era regoQed 1ndmArid tmntba*W below► Self-insured aompame should easel thdr call�e at the, compenwim liom. mart ima seH-iaaataoee Noente nonuba O°ft C7 or Town OOlelak at the bottom rev lore and printed legibly. The Deparunatbas Provided a aWce applicant pkm be mot that the affidavit' oomp tin to coned you nPIdint 69 of the affidavit for you to iM out in the event the Oflsee of bwesti Pions b addudtt4 an�� pkase be Sue m fifi in the pan*&, nw mamba wbkh will be used as a refaace comber. app in any given year,need only submit one affidsvn indicating arrest that y most alk� fylc�unda"job Sine Address"the applicant should wrine"all locations is Wdw (a<Y 0r Utiotown}"A copy of the affidavit that hat bees officially stamped or masked fictusesA new affidavit�MW out such applicant as Pmof that a valid affidavit is m foe fo[future Pamir not related to any barium a ccMMCW vem ofe year.Where a home owmr 9f citiuss is obtaining s liceme a Permit >D tde this affidavit (i.a a dot lid of Pam to bum lava des)said person is NOT required oomP The Office of Investigations would hue sn thank you in advance far your coopaadoa and should you have anY q Mel as' Please do not hesitant 0 give m a call. The DePatment's addrem telephone and&Z ttsmbtr The COMM"wealth of Massachusdb Dgmrbnaot of hubsOW Accidentb Offitx dlnvettttpdO= 600 Washington street Boras,MA 02111 TeL # 617-7274900 ext 406 Of 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia �i3 �• ao�2y�� The Commonwealth of Massachusetts Department of Public Safety 1JV k Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-aa e g (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is n available) !� 9 Ls sue, Sf S,(,, No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other N Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes N No ❑ -Is an Independent Structural Engineering Peer Review required? Yes ❑ No'C Brief escription of Proposed Work: Brief v a jot +y Q R V o o— 4 7X c, t c c Va — Ala— t,2 r(/ t >- A, (•a li r7 S / .2,.- (�Ia S• 4 G2 in-2 5/ f I Fr}1LCr55/ �i�-ct✓ S K.G 'd G aCOMPy� :n 1 /t�l of G' I ti 1✓ t p p M� SECTION 3: L TE 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): 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 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ L Institutional 1-1 El 1-2❑ 1-3❑ I-f❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R=f❑ S: Storage.S-1.-0— 5-2❑ U: Utility❑ Special Use❑and please describe below: Special Use. SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal ❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: \I\ I fklorq_commN'i'm I u 1 "v,sy: 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 On ner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: (f Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building ermit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.it of enclosed space and/or not under Constriction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control J,117,j 6r (�� _ �� 7c( o Name(Registrant) Telephon No e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor / Co any Name T Name of Person Responsible for Construction License No. and Type if Applicable/ Street Address City/Town State Zip 91)SS _r?0)O �2095 `---- Telc hone No. business Telephone No. cell e-mail address SECTION 11: 4VORKP16'COKIPENSA'LION 1N4URANCE:1P-PILIAVCC 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 $ ( 02 OU U 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 $ 61 p0 1 (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, n vledge and understanding. JI t CGetl5a(- 1 ov�. ,P, ��g ') Please print and si n name Title Telephone No. Date � � —(1 , f 5 . S�lo y(� are/) o Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date y 0 •X x y r Y . 9 k 77rnrnpp *�� m o �D .L M z S a --- o aj smz iIGA mp p Z , T , x Oo z x ra W-td' ESSEXSTREETCONDOS MECH. RM RENOVATION RICHARD W. GRIFFIN . PROJECT REGISTERED ARCHITECT 289-293 ESSEX ST. NUMOER12-03 � 37 TURNER STREET SALEM,MA 01970 DATE 2/6/12 SALEM, MA 01970 SCALEAS NOTED TEL:97&74 RIG FAX;976- D 2352 ALL © AICH75 RESERVED 1 'A—Annn —IN MAI 71n1 '07 ')PIN i I I I I I I I I I I I � �1 I I I � I + N� —1 bz ESSEX STREET CONDOS MECH. RM RENOVATION RICHARD W. GRIFFIN PROJECT REGISTERED ARCHITECT 289-293 ESSEX ST. NUMBER12-03 37 TURNER STREET SALEM, MA 01970 DATE: 2/8/12 SALEM, MA 01970 SCALEAS NOTED TEL:978-740 B ALL RIGHTS FAX:878.RESERVED 2352 © l =60b0 'ON WVll Ol_lloz '91 IPN a f" (/1 W Z ; �� D �f�+IO� F m za ----- 4 0 ----_ om z O rN ,X A F _ 2 ° co -n u1 0 ILI o 04 z Id-Id' 0 ESSEX STREET CONDOS MECH. RM RENOVATION RICHARD W. GRIFFIN ' . PROJECT REGISTERED ARCHITECT 289—293 ESSEX ST. NCMBER112 37 TURNER STREET SALEM,MA 01970 �.► z ogre 2/6/12 TEL:978-740-9979 FAX:978-74D-2352 SALEM, MA 01970 $CA)-EAS NOTED © ALL RIGHTS RESERVED I a—rnbA 'am INH77 :hl 71n7 '07 ')PIA Ire„ I I 1 i I I I i I �n I I I 6 I I I N I t II n rmn@@Z VV� Rog bZ g C' ESSEX STREET CONDOS MECH. RM RENOVATION RICHARD W. GRIFFI I PROJECT REGISTERED ARCHITECT z 289-293 ESSEX ST. NUMBER12-03 DATE; Z�9�1Z 37 TURNER STREET SALEM, MA 01870 ,= P S�ILEIVI, MA 01970 scAl EAS NOTED TEL:978-740-9979 FAX:979.740 2352 © ALL RIGHTS RESERVED z .J-690 NVt6 01-zI6- 9z 1pw — - EITOF"AXLE — �' PUBLIC PROPERTY DEPARTMENT KINO RI.EY DRISCOLL MAYOR I M WASHINGLON S17X.Er - ,I\I A i MvcncHt;stres 01970 TPi 978-745-9595♦ FAx:978-740-98" APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: 2SR OCcSex Sk, Building: Property Address: Property is located in a: Conservation Area Y/N N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: AQ 0p Address: 9-%,\ A i�, Duo Telephone: 6\,i q S7 t-11 S 7 3.0 COMPLETE THIS SECTION FOR WORK IN r-wignNa BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (so Renovated construction or renovation 2ovo New of existing building Brief Description of Proposed 1Work: �u� �inc� si nk i qv,o� Foi let ---- Mail Permit to: 2r2,q £Sscx S-V Api s What is the current use of the Building? C04-0 (`n�f.�`>m °Ct c9 c Y1 Q Material of Building? tT�\Ccx If dwelling, how many units? Will the Building Conform to Law? Ze5 Asbestos? Architect's Name ?t`w\te_\U6 ?AO0QA)' tS Address and Phone 2 Tae2 ��v� ( ) 9'lR •Ni5' 2obS Mechanic's Name Address and Phone - 6 X/Yl?C *Construction Supervisors Li ense# HIC Registration#1 y71 y5 C`67 i Jdt Estimated Cost f Project o�oo, .� ertnit Fee Calculation Permit Fee$ 3 0 Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of perjury Date O Zz �v T d v N N � a c ee o 0 V u z "' u � d i CITY OF SALEM rj PUBLIC PROPERTY DEPARTMENT iandWmx-Y Ottscou \tNSACHt:5ETt5 01970 �tAYOt - l�wtilnNGTON$IREET•$��. '(ty 978-74S-959S* FAY:978.740.9W Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accords=with the si11 xth edition of the State Building Code,780 CMR section 111.5 Debris,and the provisions of MGL c 40.8 54; Building Permit q 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: (name of hauler) The debris will be disposed of in : lur S�P C� �t7 � (nW,of fxila�y)/I (address of acility) sipmoue of pomut ap— licant 10 - date ertx;;mraa BOARD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR ar r. k Number:GS 087109 `.w Biytltdate:42/13/1987 -—(pares: 11/13/2L007 Tr.no" 87109 Restricted: 00 j STEPHEN P ANDRADE 6 BROWN AVE . � BURLINGTON, MA 01803 gc6ng C mis Doer I • ,� Board of Bu dmgl�r�,Regursnd tas Z♦e j I `• ' h 41 NgME IMPROVEMENT:CQN,TRACT Registragpn: '124906 I y. Ezpiratlon: 9Y70/2005 f Type: :ORA 3 J � TMO Construction F ,I Antonio Pereira 133 Central Sty, ,;. Somerville,MA 02145 administrator L w - i CITY OF A �lv PUBLIC PROPRERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WAsHNGTON STREET•SALEM,MASSACHUSE TS 01970 TEL-978-745.9595 •FAx-978-740.9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/pinmben Aaolicant Information Please Print Leaib►v Name(Business/Organiration/Individual): 1 I �F�� tmci-r-t x• l�1(1 Address:_ cvshe S� + ems{ City/State/Zip: S�>n e�c\-M r 1�f} U 1110 Phone #: Are you an employer?Check the appropriate box: 1.0 I am a employer with 4. I am a general contractor and IFOR (employees(full and/or part-time).' have hired the subcontractorstruction 2.❑ I am a sole proprietor or partner- listed oa the attached sheet. t ng ship and have no employees These subcontractors have nworking for me in any capacity. workers'comp. insurance.[No workers' comp. insurance 5. We are a corporation and its addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself [No workers comp. c. 152,§1(4),and we have no 12.0 goof repairs required.) employees.(No workers' 13.0 Other comp. tnsulance required.) f*Any appticant slut checks lax NI must also fill out the section below showing their wakes'compeoratl°n policy infonOld= Homeownm who submit thin aHidsvit indicating they are doing all work and dun hire outside cantncton must submit a oew atBdevit indicating 1Contmoan that check this box must attached=additional shad showing the name of the eubSontraatnra aM their aofh WO�s'comp,policy inrarnaum I am an employee that Lt providing workers'coarpensaaan insurance for my employees Below it the policy andJab site information 1 Insurance Company Name:_ t1 iCtln2n� �e.S� o�`�� cjmyN C"\ i Policy#or Se)f-ins. Lic.#: S5 V�—`� (0 �}/} ( �.-5—�� `` Expiration Date: C'I ILO t)`� . Job Site Address: zFfcl �SSC X SY . fit{ Soap f1/l City/State/Zip:-Is," i A{d U 1(7 0 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 c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. f do hereby Ce an er t pains and pe� ' perJary that the information provided above is true and correct Si atur D t Q�o P OJJleial sae only. Do not write in this area,to be completed by city or town o lciaL City or Town: Permit/Liceose ll Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person• Phone# a ion and Instructions aws chapter 152 requires all employers to provide workers' compensation fortheir et plloyOf yeees* te,an employes is defined as"•..every person in the service of another under any plied,oral or written" plover is defined as"an individual,partnership,association,corporation or other legal entity,or any two r t more e foregoing engaged in a joint enterprise.and including the legal representatives of a deceased employer„or the elver or trustee of an individual,partnership,association or other legal entity.a thercinplo g employees However the not more than three apartments and who resides therein,or the occupant of the owner of a dwelling house having construction or repair work on such dwelling house dwelling house of another who employs parsons s al mot because ent be deemed to be an employer." or on the grounds or building appurtenant thereto shall not because of such employment MGL chapter 152,§25C also states that"every state or local licensing agency sha (6)also withhold the Issuance or renewal of a license or Mpermit to°Feral°a hn°Iness or to construct buildings in the commonwealth for any applicant who has not produced25C(7)ablates"Nle ether the commonwealth nor any of its Political ce of compliance with the insurance °subdivisions" shall Additionally,MGL chapter for performance of public work until acceptable evidence of compliance with the insurance enter into any contrail requirements of this chapter have been presented to the contracting authority." Applicant Please fill out the workers' compensation affidavit completely,by checking the boxes that apply your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone numbers)along with their certificate(s)of "m,�"ce. Limited Liability nsurance• If an LLC or LLP does have Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not'required to carry workers' compensation i employees a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance covet-age.cation for the permit or license is beingbe sure to sign and date s requested,not the Departmenaffidsvi should of d be returned to the city or town he affidavit. The t that the application questions regarding the law or if you are required to obtain a workers' Industrial Accidents. Should you have any que es should enter their compensation policy,please can the Department at the number listed below. self-insured cotapani self-insurance license number on the a riate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the boom of the affidavit for you to fill ormntJli in chense numb°e event thewhich will be rence number In additiofice of investigations has to contact you regarding tn an applicant Please be sure to fill in the pe vein year,need onlysubmit one affidavit indicating current that must submit multiple Pe rmidlice»se applications in any given y Brant should write"all locations in (city or policy information(if necessary)and under"Job Site Address"the app town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new aEfdavit must be filled out each year.Where a home owner or cidun is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to barn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dla 4 Prospect Street -Stoneham, Massachusetts 02180 CONSTRUCTION 781-279-2927 Board of BMIding Regulations ylnd Standards lug HOME IMPROVEMENT CONTRACTOR Registration: 124906 Expiration: 9/10/2007 - Type: DBA TMO Construction .:,Antonio Pereira 133 Central St ..,— i,rYu✓ Sornw-ville,M,&02145 Administrator Liability Insurance: National Grange Worker's Compensation: Continental Home Improvement Contractor: Mutual Insurance Company Casualty Company Commonwealth of Massachusetts Policy#: MPS99128 Policy#: 6S5UB-7264A68-5-05 Registration #: 124906 f L�M1B�11N'T�#�M� A�PPIIOViD Alf TiiE •�ID A aPE�>r•�EMKi TiIIANI'�p �1 CITY OF SALEM vita Locatodh N.►adoilo OYYkH Y ✓ Leawam •r 2� f ssF�c S 7. ft ■oNISM Am► P«mk% el<nI.olNca` Pearce APPLICATIDN POI% (Clrola whloh wr apply pouf SWIM Ca NUW Dook, Shed. Pool, PLEAS mL 0Yr LamLY a cowu TlLY TO AvM DR AYE m PIIO q TO THE POPECTiOR OF BIUL,DINOB: The-11 undo.4rd hnft appN.s for a parmk to build a000idh%to tiw_"OWN Owrw. Now g2 j flc j-(J b L2 a,, �W- 5 . Addrm a Phon l qt-,'g, Y!�'F S-7o o Amhhu . Nona Addrem a Phone c MW.ni.. Nona Addraa. a Phone 4r)Z� W-9 w�.r a.r Awe.ar euro� l5 L �0 wrw a a+ow+ N.�a kK new air�., W"ooaon b wrr we..�eo Eaww.aoa° �i� it uor o Ums 0 C 5 o of- 11 Tit PENALTY, oppowm olEt lON OF WOOK To NE v qk, /C) 3 3a'S qo `� , ydS �d2 3o g MAIL PEWT To: No. APPLICATION FOR PENW10 LOCATION Zc& e�ss-6-rc �s✓. PERIA T GRANTED APP OD OF CITY OF SALE11019 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT ' 120 WASHINGTON STREET, 3RD FLOOR SALEM,MA 01970 TEL (978)74E-9593 EXT. 380 Is FAX (978) 740-9846 STANLEY J. USOVICZ. JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40, S34,I acknowledge that as a condition ofBuilding Permit# all debris resulting from the construction activity govemed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility,as defined by MGL c III,S150A. The debris will be disposed of at: Location of Facility �1� Signature of Permit Applicant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) � avf`j 6J�,-c�ah Name of Permit Applicant Firm Name,if any Address,City&State ut 6 y The above statute requires that debris from the demolition,renovation, rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cIII,S I50A, and the building permits or licenses are to indicate the location of the facility. a The Commonwealth of Massachusetts Department of Industrial Accidents a = Otll6B 9/6NBStlgBtlt�OS '= -- 600 Washington Street, 71h Floor Boston,Mass. 01111 Workers'Cont ensation Insurance Affidavit: Bulldin lumbin lectrical Contractors address: city �4 - U'"� ��' state,(Y)`t"/ zin•D l i `f p{� Q C phone# l 1 work site location(full addressY ❑ 1 am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ 1 am a sole proprietor and have no one working_in any capacity. ❑Building Addition am an employer providing,workers' ,,compensation for my employees working on this job. 0' � company name: a.0 1 !h lJ-J] ;,a LLtfA 7- /)�,�r J t P y: yV 'address: NSF ;,, x city '6[f'2'4Z.. r +� ek +'�x� ° .3; N't Dhpfb fi' !s ' Y7� Ia`y m�xef -4 .rr� s ? 3 insurance co. Ida p ❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: - city: nhnned- 'ti J N his franc `"..._ .» w z .J.. .� » F# .r Fez ,� F.h", #'s.'4 +ah+r` company name: - - address: ` a� .ka rr #�Ir:n'��'•�3,y`,ii i-°' `=s d _ city: 4 Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a me up to sl,500.00 and/or one years'imprisonment as well as civil penalties in the form ors STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains a e es of perjury that the information provided above is true and co(rrrrect. Signature _Date Print name Orteuh Phone# O fficialnly do not write in this area to be completed by city or town official : permil/license q ❑Building Department ❑Licensing Board mmediate response is required ❑Selectmen's Omce n: hone#; ❑Health Department P ❑Other n L _ µay Vol, s:.. .. 6640G *Pei 's 3VULMOO1N31Y 'MP eij%8a . :g �SPa•�oop�ln�`��N�3WON� #1 r 3s7'�w!�ieo,b,��Jo Me0g s 'd ti tI t FROr PRINCETON CROSSING PHONE NO. 978 7452065 May. 18 2005 06:42PN P1 I F ; II i Princeton CrOsinR May 18,2005 To Whom it May Concern: This is to confirm that Mr.Zahrieh has permission from the 289 on Essex Condominium Trust to upgrade his kitchen area of his home(Unit 406). This will include cabinetry and flooring. The condomindum association is not responsible for any damage to any common area and Mr. Zahrieh will assume full responsibility for any damage to any common area. Terry Flahive 289 on Essex Condominium Trust I a 0 1 12 Heritage Drive Salem , MA 01970 phone. 97R. 740 . 1700 fax 978 .745 . 2065 w w w. p r i n c e t o n p r o p c r t i c s . c om v The Conl1110mveilth of ltifassachusetts \. 1.`-7 Department of Public S,Ifl:ty .•! S I,I,"1,It itwI19 s6ae Iiaddall,Cti,ie(,80 C\I It) I)Ili ILIing Permit Applic.ition for any Building other than a UnC-or I'wo-ha III ily Dwelling (I his Salim For Official Use Only) fff��J till Wint,PeroitNuml,er I).110Applied: _ __ _ "_.. _ BllddingOfficial: _ ---_SECI'ION I: LOCH ITON(I'lease indicate Block t+and Lut M fur 104:4101's for which a street address is not available) Xu. .nt,l Slmet Clly:Volvo Zip COLIC Manly to Budding(it.Ipplic.lblC) SEC I'ION 2: PROPOSED WORK I', Ilion,tl\I:1 Sr,nr C„ If Nrtr Cunstru,tiun,heck hen•❑ur An•ak all that apl,ly in the hru rates below F.Ist llg lluildiny Repair❑ 1 :Uter.ltiun addilian 0 Ucuudiliun ❑ ((Tease till out and amblmll Al'I'vtnli.x I) Chanl,v of Use ❑ 1 C'hange of OCcup olicy ❑ Other ❑ Specify:---_--- _ _ AN l+uilding plans and/tlr,onslntction documents beingsuppictl as part of this lennita + lication? 1'' o - t u)l ,\t Is an Independent Strudutsd Eul,uu•Cring Peer Review required? Yes ❑ Nu Ilrirt Dscri)+lion of Proposed Work: _ - - SECTION 3:COMPLE'rE I'ul5 SL"CI'ION IF EXtS"rING BUILDING UNUERGOING RENOVATION, r\UUrI'ION,OR CHANCE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enCluied (Sev 780 C\IR.N) ❑ Existing Use Gruup(s)c _— Proposed Use SEC'rION J: BUILDING IIF.IGIIT AND AREA Existing'- Prilpused No.of Floors/Stories(include basement levels)h Area Per Fluor(ml. it.) fatal Artm(sq.ft.)and rota) Height(ft.) SECTION 5: USE C,ROUP(Checkasa Iicable) .it; A\ svnlbly:\-1 ❑ A-70 n _ Nightclub ❑ A.,I O AI❑ A- F: Facto E-1 ❑ I:'' . f : u u: Ili h Flaeard ❑) catiun al InLss ❑ I: Istilutlonal 1-I ❑ I-_❑ i-t❑ I-40 \C Uercantile❑ ? I ❑ II-4 O 11-90 11-10 I(-_'❑ I4-30 R-a ❑ « .S: .Sturage S-I ❑ S-_❑ IU: Utility❑ Special Use❑.nld please describe beluly: tipecial C',o 'ECTION 6:CONS I'I(UC fibN TYPE(('heck ass licably) L\ ❑ Ill ❑ IL\ ❑ UU ❑ tun ❑ lull ❑ 1. Iv ❑ VA ❑ \'ll ❑ su*r1O_s17: S1'rF: INrOit\IA IION(rcfcr fo;911(:\Ili 111.0fordetailsun each item) I Water Suppl I Iloud Lone Info rill ation: .tiewagv Vi.posa,l::/ I'rench Permit: I lebrk It antral- _• - -- !I I'ubh, Chr,k d I-u1,IJc I Lord G•nt ) lnJit,nc•munwt�,tYm, .\ trrnth tc (I nut be 1 I,rn.rd I\LI•,,..d�iA• Pri\. rr Milk llrl?% Ao," C ` or rill . . ,\,Iellll❑� Irallire, of lfCnth i l,pet ll\' 1 l•rnm Is r ,hard ❑ I Il.liln,.nl right-ut-w y: ILvarde lu Air.\".I.ig.ltwo: -1 1 I \'.,t \l'l•h,.d•I,�' J L:Hu,tors:,nhut.url+,•Il all, vr.nh.I m.l' I,th,vr rrt ire „'ulldrlyd ' ( , rt-,hl.rul h,Ilud,i•Al,l,:.r,l � 7 )r,i] •'r \'•� 1„t7 \, I] ' I '• yt( 1IONS: (IN IFNI OF("hlt 1111( .\11:UE(1CC"L I'.\.\'CY I ,LI I,-it . I (", dr L .r l.lrq l•LI I\I•r.,I( it At it,l l,•II k, jI1, it.l•nddny;, iullrr•a.Ism .• t s I Y \.1111V and ddw%%el Pr q,-ill 0%%ntr 2 /-�, - - a/ 11117111IJ - No. •III,I Sircci Cit) Proilt-L tY Osv gar Contok t hitormatioll: Milk 1,-k-phoov Nil.(11ti,1110%.0 rvii-plione No. (all) addre4S fliv propoli.1)kVIlVC ljort-I)y itahowes -ej Sirk is city/ rown State Zip Name S vt Address Ill.1,t ,it tile pro purty owner'i b elmll. Ill 111 imillers rclat v Ili work authorized by 1111.4 -- SEC-l-ION I(): CONS 1 RUL 1 IkJtq CONTROL(Ple-me fill Out APP"no"'4) If bliddil.I,is le.4,4 than 15,111M cu. It ,,endured, under mier Construction Control then check her,13 and ikivjvctloll 10 1) ltegisterqj PrOfLsgional Re4ponsible for construction control 3-Wb V-11 It I litir-.S1% Re it NtjII11lerS1�714J I'vie In - 0 1 Ndille(RL StrAlit) --.— �z Zww --- r\piralion Date Zip Discipline Sheet Address 01, Lny/ toky" State 11).2 General Contractor Company Name N.one of VersOn Responsible for Constru0ion License Na, and Type if Applicable ,;Ifvet Address City/Town St.tte lip r,-lvj+t,oe Nil (bu ephone Nil.(c 11) .41 .1.4 L 'AvI I (M.G.L.C. I SECTION 11: 1,k1! I I IN111 V0 I It 'N I I 1 11' " I 1\1 1 11 Compensation 1114ut-l"ce 1"ff'k1'lv't from the meek uljmrtnlel�i-'; 111,1U.4trial AccloonlMlIct .conipMed allit ,kILjIjjjtte,l %vilh tlli.q application. Failure to provide Illiq Affiti,jklit will result in the denial of the issuance of the building permit. Yes 0 No 13 SECTION 11,CONSTRUCTION CUS-15 AND PERMIT FEE Item EsliIII.Itetl Costs:(Labor rotal Construction Cost(frons Item fl) -5-- "'c'" �L.. ,111d Materials) -rl 1 00 Building Permit rec, -Total Consilnictit (insert11"I COSI X —(insert Hti:lrical 11,i P Apmpriate municipal f,1000 -5 15 -- prIll. r0 Nola: %litiontaill fee \IM1,111it'll jHvAc) 5 jtither) i F,idosv dunk j,o%.ible to I,......... menu 1p"hil,)and V,rite,lwck number here SECHON 13:S1CkNA I LICE OF BUILDING nioirr ttc clitt-Tilli; 111% jjaljjv brluw, I livrcl v .11ttst under the Imills.111d I'vilallivi of l.,,rpjfv tiv,ii all of the mform.thoil wilt-Mv-1 ilk 1111s ,Ippllt.Ihon is true and at'lli-Mv to th'.I'v't A my 1, ILI%% i',L'cud it oder,IJIldl Ile, 11 a lid Ildl�- Pow Ph f"I'll 111d 1�;Il 11.1111k, W d I s51 ;I A , I'.ito \hI llkip'll It jl�dor Ilk I'll mt I t I I ill) I I cAtim �ev�1