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89 FEDERAL STREET - BUILDING JACKET Ra- eFt No. 13�y City of Salem Ward �cN.r.or>or*�tr ' '�cum.c vd APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:I, ll, III, IV, and IX. ZONING I. AT(LOCATION) IaA DISTRICT LOCATION OF BETWEEN �l.c..i/1r/Y P� UI AND BUILDING (CROSS REET) (CRO UI LOT SUBDIVISION LOT BLOCK SIZE 11. TYPE AND COST OF BUILDING -All applicants complete Parts A-D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION'USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ❑ Addition(If residential,enter number of new 12)KOne family 18 ❑ Amusement,recreational housing units added,it any,in part D, 13) 19 ❑ Chruch,other religious 13 ❑ Two or more family-Enter number 3 XAfteretion(See 2 above) of units ................................................. . 20 ❑ Industrial 21 ❑ Parking garage 4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory 22 number of units . 22 ❑ Service station,repair garage - 5 ❑ Wrecking(If multifamily residential,enter number 23 ❑ Hospital,institutional of units in building in Part D,13) 15 ❑ Garage 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 26 ❑ School,library,other educational 7 ❑ Foundation only 17 ❑ Other-Specity 27 ❑ Stores,mercantile B.0 11�IJ�RSHIP 28 ❑ Tanks,towers 8 Pnvate(individual,corporation,nonprofit institutioq etc) 29 ❑ Other-Specify 9 ❑ Public(Federal,State,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,college, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost i L �OQ a. Electrical........................................................................... 'T b. Plumbing.......................................................................... 8000 C. Heating,air conditioning............................................. d. Other(elevator,etc.)._._........_........_.........................._ 11. TOTAL COST OF IMPROVEMENT $ of ODD /��q D III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J& M, all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRICI AL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL Masonry(wall bearing) 35 Gas 40A Public or private company Will there be central air ,311 Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 454 No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 Other-Specify 39 Other-Specify 42 Public or private company ❑ ❑ fy 46 ❑ Yes 47X No - 43 ❑ Private(well,cistern) J.DIMENSIONS 46. Number of stories ............... ................................... � M. DEMOLITION OF STRUCTURES: 49. Total square fastof nNext r area all flours,based o , Has Approval from Historical Commission been received dimensions ............_................. .1 om.._,....... for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.ft. _................................................... Dig Safe Number K.NUMBER OF OFF$TREET PARKING SPACES Pest Control: 51. Enclosed.......(•................................................................... 52. Outdoors ....... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? . Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed............................................................................. - Electric: Gas: 56. Number of wa...... .................................. Sewer: bathrooms f- ............ DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial ......---......"' BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLO ING: Historic District? Yes_ No (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ NOV_ (If yes, please enclose Order of C ditions) Has Fire Prevention approved and stamped plans or applic tions? Yes No_ Is property located in the S.R.A. district? Yes_ N _ Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes,submit documentation/if no,sub 't Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No Is Architectural Access Board approval required? Yes_ No (If yes,submit documentation) Massachusetts State Contractor License # IN2 1A — Salem License# Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX (6) MONTHS OF ISSUANCE OF BUILDING PERMIT M I if an extension is necessary, please submit CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. Owner or d, ( 6 0l�?0 7�1Y-`4 Lessee 2. Contractor Builder's License No. 3. Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Signature.ofapplicatt Address Ap qkAWat r Sa.Zem Ftise DepaAxm r". F.vse P4evenL,Lon HurLeau 48 L4L4aye ete s4ozeet Sateen, Ma 01970 (508) 745-7777 FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In aeeoAdance wdtiz the p ove44on4 06 the Mm"aehu6ett6 State Su td4ng Coda and the Satem Rise Code, appt .4ca ,4on t4 he&eby made 40a apPnovaB o4 ptan6 and ,the 444uance 04 a ce .1,L4.i.cate 04 aPpaavaZ 602 a bu.i Zd ing Permit by the Sa.Zem F44e Department. (Re4. Section 113. 3, 14aa4. State B.Zd.g. Code) lob Location: Ownea./Occupd-mt- no EZec.t� Cont4acto.x: F.vLe Supp,%"44on Cont sacto-L: ne 04 Phone #: 177_ 73Apps-icant: j C(1►d�� ! 71D' Add4Lea4o4 ^ ����(l l . on AppF,icant: Town t� Town: ApprovaZ date: Ca%t.444cate o4 app%ova-e 44 he+Leby 94nitted, on aPPnoved ptano a`s 4ubvm ttta.E o4 pnojeet deta4Z4P by the Sateen FZte Depayatment. A1.e ptan4 axe appxoved .6oeeey 6o4 4.dent444zat4on o4 type and Zvcat40n 04 4-,f-%e P40tect4on dev.ic" and equZpment. Att pean6 a+Le 4ubjeet to approva.Z o4 any othea autho4,Lty hay.cng JuA46di-ct4on. Upon wmpZe,t4on, the aPPZ4c4nX 0n .in6taUen(4) 4haeZ. requ.e.6t an an.epectLon and/ow- te4t o4 the 44,%e Pn.otec 40n dev.ic" and equtpment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) New con4t4uctLon. Property 8oc t4on ha6 no aomptZmae w4th the p-Lov.L4. on6 o4 Chapte,c 148, SectLon 16 C/E, M.G.L. , 4e,eat4ve to the cn ata Za tLon o4 app,soved 44me mt4Am det'40e 6- The awne-s 04 th•i,6 pisope)Lty 14 4.egLZ4,ed to obtain comet-fiance a4 0- p4 4;,j p44;,j - cond4t4gn o4 obtazn.ing a Bu xdl.ng Pe4m44. ® -P4ope4ty--eoc4t4on .14 -Ln c0mpZiance w.i th the p sovZ4.iorw a6 Chapter. 148, SectLon 16 C/E, M.G.L. Exp44zt4on date: SZ9na;wse 04 F.LLe 06iZc-iaZ Fee duz: unde,L 7, 500 Sq. Ft. 7 inn ;n F+ ,.. nn Fnxm ttxI (12P-v. !n /on i M icbael S. Dukakis ✓ '�� �`� ✓ Governor 646 lzizisa.aot. J - Amm /ki Kentaro Tsutsumt ✓ildiam, ✓1�&Mffa:e ea 02108 cham= 16171 ^_^. Charles J. Dingo Adazinv trator MEMORANDUM TO: All Buddme DcpartmentsrzIlate BtuWine Inspectors FROM: Chula J. Dinem Administrator DATE October J1. 178E SUBJECT. MGT. CA S54, Added Rv e594. S9 of the ACVI of 19117 The above-mentioned statute rcuuires that ochres resuitine train the demolition. rcnovattnfl. tChabdltatinfl ,it ninCr alteration nl ] butldlne or struaufe he UIsPOSCtt tit in a praperty Icczascu sultd WU disposal iacinty as dental by MGL 6111. S150A and that huddlne permits or ur ris— arc its Indiate.tbd basion ,I( the lacillly at which Inc said dcnrn is at he dtspmcu. THIS REOUIREmE'VT*DOESNOT ,\PPLY TO NEW ('ONSTRUCTTON. In urdCr tO SIMOttfV the Proras and it) PnMUC unlfofmily. we are 2112CUIne a t:dPlr Ill a lufm y*Ift von ua either rcpmurc anu use as at is since Inc complctea form vnd be attaraca to Inc olliob ceA!et basi"I permits or ham•- or rcl7robuce It an your letterhead. In case of munlanal.commeresal.Industrial.or multi-unit housing construction.the mntraaat MW flet kms the dumpster sul)COM atabt at the time bt the budding Permit application. In suCR—sa.the alteeaeel W" of an Affidavit can be used. The complete law is chniamcd In the Nhvemner issue of CODEWORD which wdl he e1121WIS 10 Vern in the neat two weeks. If you should have anv uucslion. plc= tet us know. CJDAnt AFFIDAVIT As a result of the provisions of MGL c 40, S54, I acknowledge that as a condition of Building Permit Number all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a property licensed solid waste disposal facility, as defined by MGL c III, S 150A. I certify that I will notify the Building Official by /'li ' _ (Two months maximum) of the taction of the solid wa sposal facility where the debris resulting from the said construction activity shall be disposed of, and s 11 submit the appropriate form for attachment to.the Building Permit. y q Date Si ze o ermit Applicant (Print or type the following information) Name of Permit Applicant Firm Name, if any 06i�F,ec� S�� Address In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date Gc COMMONWEALTH OF MASSACHUSETTS n •� G DErAK:MENI'OFINDUSTRIAL ACCIDENTS -. 600 WASHINGTON STREET ,auras Canape}; BOSTON, MASSACHUSETTS 02111 sslone' WORKERS' COMPENSATION INSURANCE AFFIDAVIT I J (hCen3e[]peTtrllR[[/ with a principal place of businessiresidence at: (Ciryistatcizip) do hereby certify, under the pains and penalties of perjury, that: ( ] I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number ( j I am a sole proprietor and have no one working for me. ( ( I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number am a homeowner performing all the work myself. NOTE: Plcase be swue that while homeowners who employ persons to do maintenance.construction or repair work on a dwelling of not more than three units in which the homeowner also resides or an the grounds appurtenant thereto an not geperally considered to be employers under the Workers' Compensation Act(GL G. 152,sea. 1(5)), application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Ikpw=cnt of Industrial Accidents'Of ce of Insurance for coverW �eniieation and that failure to secure coverage as required under 5ccdon 25A of MGL 151 cae lead to the imposition of criminal penalties consisting of a fine of up to $1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S 100.00 a day against me. Signed this L day of� ...... __., 19 Licenseei Permircee UcensorlPcrmittor irk,'kOVED approval by any other having jurisdiction. JALEM, NLASS. ?h,., :--A,1-57PNT1014 BUREAU BY...... PLAiNS A7E APPROVED SOLELY FOR IDENTIFICATM OF TYPE AND LOCAT!G:'. C; FIRE PROTECTION DEVJCd16. ------------------ ALL FIRE PP0TH0Ti:',?I DEVICES ARE SUBJECT TO A Wd"IL MAL TE, El ia3rECttONfOrZ ooF.?pLM CoMp44. ANCE 1T.,I T;j7 FW.CODE APPOINTMENT FOR FINAL INSPECTION MUST BE MADE AT LEAST ONE WEEK AHEAD...---- -- --------------------- ss q, 4zj 6', <-1Y 11 Zr )-10 ......31, DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building ( / _CN FOR DEPARTMENT USE ONLY Permit number 7 Building [/ Use Group Permit issued C 19 9� Fire Grading Building Permit Fee $ 22,r- Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ —1 Plan Review Fee $ TITLE NOTES AND Data• (For department use) 40 nx- Vv PERMIT TO BE MAILED TO: DATE MAILED: — 9 Construction to be started by: Completed by: Y I VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN •For Applicant Use O N rin �.t..w'r.-.. .m •.erc«a.a ....a..•r a. -.wr.vet;!'lMev..-eM¢M.Ri- >.nNaaPxxx?t„ ."BHN!-::xA'�lk w.w«w. v •w _-..rn... -.-.- ..r..»•'•Fy✓r v:.tt.(L'e5an:=.n. ,�"Y`s9 'krEptr CERTIFICATE ISSUED" " ! DATE .Tune 15. 1994 CITY OF SALEM x SALEM, MASSACHUSrTTS 01970 BUILDING. PERMIV�r- �*re me CERTIFICATE--OF OCCUPANCY - OArTE�~FeSrk"y 25 M. 19 . �4 PERMIT NO-. 43-94>' APPLICANT' T..Jane Dwyer ABBRess 89 federal Street Salem, 'ase. tMO.) SSTREET! iCONIA`S LICENSE( PERMIT TO Alterations (__) STORY Dwelling NUMBEDWELLINGUNITSUNITS 1 1,1E OF IMPROVEIAENTI N0.- iPROROSEO USE) AT (LOCATION) 89 Pederal StreetWard 7. ZONINGICcT R2 ' iNR.1 tsTRe ET, } STR BETWEEN summr I.']t . AND Fe.-C1'Ord >t . CROSS STREET) (CROSS STREET( LOT SUNOIVIStON —LOT-BLOCK—SIZE BUILDING IS TO BE FT, WIOE B. FT, LONG BY FT. IN HEIGHT AND SNALLCONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION ITYPG renovate citcnr. on Ist :.loori=aiidicion of Nall :.fairs REMARKS: AREA ORiY@-- E+JEENE�� EMRR�'X VOLUMEE �y�'•Yy^Y�II C DIC-SOVARE FEET( Taarab OWNER e4in 'f Iaue li er bT0 BE POSTED ON PREMISES naTne ADDRESSSEE' EL VEASE S�_EdcP°.CONDITIONS OF CERTIFICATE "9 •�,tt-rat .(,,,t 5;1�,-� ''asp ue_. .,... DEPARTMENTAL APPROVAL FOR CERTIFICATE ee of OCCUPANCY and COMPLIANCE iA"o�tie filled in by each division indicated hereon s '�t4 Jfupori completion lof: its final inspection. ��{BDfNGS II, i Permit No. 43-94 Approved by JOhn J., Jennings Date 6/3'/94 Renmarks i '.• SW PLUMBING i ` Permit No. John L1eClerc 5/27/94 App[oved by i , Date Remarks ELECTRICAL,: I ( Permit No. Approved by ! JohniAai tdi _ Date 3/ 14/94 ; Remari§l OT.HE�t' l Permit Na I `Approved by,� 1 E Date E Re arks , pF�yr j xY ..4 i pproiki by !' i �I r Date ' "- Remarks_ • .:1 . ,...: y ,: `y, , _. „'z"'"'►iC'tle. +¢Nti`f;)M<.`a+mM'aMliifN,J!h=+y�.f .*.:hF�'w.. i�`.>)rCll�°':"h.'iP �9Ys�3�:. a- LLi@*r' .. f, rIT BUILDImame RM ,. jog' 'WEATHER CARD ,.. DATE YlebrBewg 25' lid [y.�� --$ 19 -PERMIT NO. APPLICANT- T•JSA2.__ptb QT _ _ ADDRESSFB_ ®C�t_rB4Rt.481a[DO a4$R♦ y' +R" § -.t._ .._ _ IMO) (STREET) : µye_ (COMTR S LICENSE) ' PERMIT TO ALt�t1 T'Rt SORR t__ ✓ " 1_I liORY^ > �tB I kin& r 'O OWELLRMGOUNITS -ITVFE OF.IMFROVCM[NV ['r MO.. 8r"Qjee�i^C.-_ �„�-(P,ROPOSED UBE)..._ yy�.w.._z R REaa cre*t.:.. .ke s1:. .»w. ,� ., a£� a a L. .y, d - ZONING:,.4# AT IIOCATIONL DISTRICT,-, su BETWEEN •' SuEDBb Yj iY4♦/ °P,1 .�.Y! J".'., w '4' "��AND „ ,�,LCXI,QE St.f " t ..`3.- t ICAOES STRtETI II ig - `ICROSS STREET) .f.l'.i::sA i..it LOT SUBDIVISION -- "'"` - "^ -- LOT' - BLOCK' -' SIZE ��tu , .;�� A _._ *•:�—I -._ .. ..;._.. �';;ta4"4k.,,axh..-wry �� BUILDING IS TO BEFTjyy{WIDE BY FT LONG BY FT IN HEIGHT AND SMALL CONFORM IN CONSTRUCTION TOTYPE. S GROUP �� "'•% BASEMENT WALLS OR FOUNDATION_.- f .4 kit e►n 'loclssrfAd�tfclon at hail atG9rr d RCMARKSi - Jt 2REA OR x,T�!. x s — J -�- •t„�.L.V PERMIT C. .r7 x.�fa, OLUNE ESTIMATED COST @ V FEE tCUSI,FFCpf�.SOIJAR[ FE[TIs- OWNER' I.Eb!)S8 S a�BlT R^R IJ@l`e •m -h .3: - t. d^, a 5� 'F".x. BUIL I G OEaY z eooREss "34' Federal. 0f#gat Sal$11A-Naas.- BY, It ninra AA.r ?'THIS AMENT SC.OENCROACHMENTS RIGHT TO�-OCCLIC ANY ST RE -NOT- PE 09 SIDEW ALN OR ANY PSRT TNER EOF DING'-CO EMPORAR LLT ORS � ! )ERMANEBY TH JUDITIOBEET OR'ALROPEp TT;. S T SPECIFIC ALLY'PE AND LOCATION `BUI SEWERCDOE,.MUST AI AP 't' PROVED BY THE JURISDICTION. STREET S. ALLEY GRADES AS WELL AS DEPTH AND LOC A.TION OF PUBLIC SEA'ERSMAY BE OBTAINED �F FROM TNE�DEPA.R TMENT-OF PUDLi C�W ORKS-TM E;163UANCE�9 MIS PQRMIT DOES NOT RELE 6E-tNE APPLICANT'➢RON:}FHF CONOtTAONS OF ANY APPLICABLE SUBDIVISION`RESTRICTIONS. .pf'-' --i MINIMUM OF .-THREE CALL APPROVED.,.PLANS-MUST.BE.RETAINED ON:JOB AND,TNIS 'A'NERE APPLICABLE SEPARATE° " - INSPECTIONS REQUIRED FOR a ,PERMITS ARE REOUMED, FOR slj �• ALL CONSTRUCTION WORK( CARD KEPT ED UNTILFINAL INSPECTION HAS BEEN ELECTRICAL PLUMBING AND G I.'FOUNDATIONS OR FOOTINGS MADVIWHERE A,CERTIFICATE- OF OCCUPANCY IS AE- MECHANICAL INSTALLATIONS.'V'� x { V2. PRIOR'Tq-COVERING STRUCTURAL UIRED.SUCH BU,ILDING_SMALL:NOT BE.OCCUPIED_U.NTIL �.A , �°� MEMBERS{REAOT TO LATMI O J -, = >q§'_ a 9.`FINAL-INSPECTIONBEFORE FINAL'INSPECTION HAS BEE N MADE „.y<� _^ .rY+ Q •,,:F6 ,K, - y. tn: s ..000VPAMC Y.: ... ..<-ww r e• ..�. - «.<. � 1 .r,x.q.. vYy "a.:'»&`(d, .+de...`as,..w.- - '{"Wi.,3_ a err, I ".+ - : I wk x POSWIHIS CARD 'SO'k-ITS & VISIBLE.1ROM0STREET. � tet, J-_.. BUILDING INSPECTION APPROVAL VA LSH' -" "PLUMBING INSPECTION APPpOVALS -E LECTRICAV I N S P E CT,10N AP P R0VA L5 . - +�� .., "� h -�+a.�.p.r°«w3.« . ' i _......« �..i' .s• tom.. .t ,� .rat :_... 110 z� 4 2 2 �" 4 ""fid;,V y BOA D 0)44fINSEE ON APPROVALS FIRE DEPT.INSPECTING APPROVALS � £ 3sy OTHER CITY ENGINEER 2 2 A WORK�SMALL NOT PI{OCEEO UNTIL THE PERMIT WILL BECOME NULL AND;VOID IF CONSTRUCTION INSPEGTIONS INDICATED ON THIS CARD 1NSdL HAS APPROVED THE VARIOUS WORK ISNOT STARTED WITHIN 54X MONTHS OF'DATE'THE CAN BE ARRANGED-FOR BY'TELERNONE DES. R CONSTRUCTION. OR WRITTEN NOTIFICATION. HERMIT IS ISSUED AS NOTED ABOVE: J -= f Salem Historical Commission CITY HAIL. SALEM. MASS. 01970 t CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed construction [ ] ; reconstruction [ ]; demolition [ ]; moving [ ] ; alteration [x] ; painting [ ]; sign or other appurtenant fixture [ ] work as described below in the . McINTIRE Historic District. (NAME OF HISTORIC DISTRICT) Address of Property: 89 Federal street Name of Record Owner: Kevin & T. Jane Dwyer DESCRIPTION OF WORK PROPOSED: Removal of window and installation of French doors as proposed in drawing. New doors to be M-5915. Framing to match existing windows. Painted to match existing. Fence portion of application to be continued until meeting of 3/16/94. will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (Mass. General Law Ch. 40C) and the Salem Historical Commission. Please be sure to obtain the appropriate permits from the Inspector of Buildings prior to commencing work. Dated: 2/17/94 SALEM HISTORICAL COMMISSION By Chairman Il o -- 1 ly C� vo s u In = � I - Ail +a►i 94 \e /S 4ln - 1 , > June 17, 1963, Gordon Boyd and Company, Inc., 148 State Street, Boston 9, bass. Gentlemen: Attention Mr, Robert J. Reynolds, Adjuster. With reference to your latter of May 15, regarding the case of Jamieson vs Bevins at 89 Federal Street, Salem, Kaes,,, please be informed as followsl I. bsrs. Christine Callahan, the clerk in the office of Inspector of Buildings, received a telephone call regarding the condition of a chimney at 89 Federal Street. It is Woo Callahan's recollec- tion that the call came from a Mrs. Jamieson. No record was kept as to the date of the call, but we feel that it was near the middle of February. 2= Inspection of the Chimney was made the next day after the complaint. The chimney was found to be -leaning out of plumb, but in my opinion in no imeadiate danger. 3* It seems to me that, a letter from this office went out at that time. However, in view of the faet.we can not find a copy in our records, I now am not toob.sure that the letter was mailed. I do: recall there was some delay in trying to find the person in control of the property* The assessors' records show the property. essessed to Wesley R. . Bevins, with Alice Berme and a Wesley S. Bevins, Jr. - also in the picture, ' Very truly yours,. JJORscc spec or s. r //7!F^ 7Z-; ( m -7L e� h -7Z -- - -- - - - y - ----- --- - `/- / _ -C IQ/-g-�--d7rrc e. ._. J /,,c -f Cc - /, -- ,.t11),5 Chi-r r . . �. C9���G�/ot,7� _ �_c --C-IV-11,4 3151 '✓-.tom-,'.�c�. -,. .S . /C/ n -/- � G�_G//Gil/<�.-�S CI4 C: c /l of A ci,, }/. /__/_� o//¢ 74; o �hJ.�.� 746 (2.. - .. _ .:1- et-5- 7ti _E. ct � e . v_-7-'L G, E /k --7Z; - 7`/�. /mo-11 h P Co- / 4</C- 7Z4_..y. C- -,4-, a --l-a,-mac/ fv h 1c /rc-ci--, .%�-c� U c.7' ��� q4 /V.7 /� ?iy Ofd i i-t r O^� / os.. .Q U-=/ .<r,-+✓?r/t• 4 T<^ �/ sem»s X 11-7 F ��� u �� 147 �y;s cF -7/- a -, � n --—� 1 / L --y -1-moi mac. 7 _ -/ G7 c - k."C- G..l7.-�. r- G � .. _ '7 -1-.•-i_C.1 G( -. G'v�J /� Ovr .. �C G .G./L/$ / �-� Gam—+ G7) 7 ,• s, i-� - -�; c/ - �7 !'7 rc Cr.- s o -•`�' _ - C oc, - .-o / a .� _TJ.�,- -.2 C7.�.��. %Li ¢_.. o-s1EJ-50fs - /- rc. cago�s S' h e1 7` 11�. _. - 14-G E---- C—,C 3 G(.-..-u - --- . - -V`1F.5 ./@/_ - - �Cs✓ _._._S-- 4J/5q I Ciondacc S'aryd 8c eaMAaftry, Ism INSURANCE ADJUSTERS GORDON BOYD GORDON D. Baro, JR. 148 STATE STREET RICHARD M. NEGUS ROLF STEVENS PHILIP C. BOYD JAMES M. ROCHE BOSTON 9, M A S S A C H U S E T T S , LEO W. FRASER.JR. JOSEPH T. WHELAN Telephones: Richmond 2.222231.5 JOHN R. MADDEN WENDELL R. WHARFF June 13 , 1963 Mr.John J. O'Rourke , Esq. Supervisor of Public Property & Inspector of Buildings City of Salem City Hall Washington Street Salem, Massachusetts RE : Sydney G. Jamieson vs . Mrs. Alice Bevins (Mrs. Wesley Date of Accident 4/20/63 Bevins) Our file # C-1312 Dear Mr. O'Rourke : We attach a copy of our letter dated May 15 , 1963 . Our records indicate that we have not received a reply. May we here from you concerning this inquiry. Thank you. Very truly yours , GORDON BOYD & COMPANY, INC. —, I - --BY! -Robert J. Reynolds , Adjuster RJR/km Encl. (1) ASIUCHIION of �� NOIN YUI NI INSUAANp H nonisuAs of wssawNxJ E •�, NNssncnA5l ns worsuowr msuUnH¢ a •""`m ousr yxaa• *' May 15;: 1963 Mr. ,john J. O'Rourke, Esq. Supervisor of' Public Property and Inspector of Buildings , City of Salem city Hall : Washington street` Salem, Massachusetts w Rss Sydney G.`. Jam eson Vs. Mrs. Wesley Bevins. (Allce) Date of Accident 4/20/63 Our file C-1312- Dear Mr O'Rourkes F This letter will serve 'to'eonfirm our conversation of May 14, 1963. will you kindly have a check of `your 'records made, in order that we may be in.;- formed n=formed of the .followings ' 1) when and by whom was your office requested to inspect the chimney at' 89 Federal Street, Salem, Mass. 2) When was the inquiry, carried out and what were the findings. 3) Did' your office give notice to the owner of the property at89Federal Street' and if so `by what, means. Thank you for your 'co-operaton. in this ,matter. •, ,,=ti Very truly yours,' a' GORDON BOYO & COMPANY,: INC. Sys Robert J. Reynolds, Adjuster RJR/km INSURANCE ADJUSTERS GORDON BOYO GORDON D. BOYD, JR. 1 4 8 -STATE STREET RICHARD M. NEGUS ROLF STEVENS PHILIP C. BOYD JAMES M. ROCHE BOSTON 9, M A S S A C H U S E T T S LEO W. FRASER,JR. JOSEPH T. WHELAN Telephones: Richmond 2-2222-34-5 JOHN R. MADDEN WENDELL R. WHARFF May 15 , 1963 Mr. John J. O' Rourke , Esq. Supervisor of Public Property and Inspector of Buildings City of Salem City Hall Washington Street Salem, Massachusetts RE: Sydney G. Jamieson vs. Mrs. Wesley Bevins (Alice) Date of Accident 4/20/63 Our file # C-1312 Dear Mr. O'Rourke : This letter will serve to confirm our conversation of May 14, 1963 . Will you kindly have a check of your records made , in order that we may be in- formed of the following: 1) When and by whom was your office requested to inspect the chimney at 89 Federal Street , Salem, Mass . 2) When was the inquiry carried out and what were the findings. 3) Did your office give notice to the owner of the property at 89 Federal Street and if so by what means. Thank you for your co-operation in this matter. P mar truly yours , GORDO B r C�6PANY, INC U Y. ert J. e nolds , A uster RJR/km /r ice...„.._... nswcmnon nl IwIPIrcNAI Nsuennu H f SpJli511 FS of A�yfp„ smsseDlusuls Pmf]FINfNf ,� wsuanH¢ ,Kwµo p1U5if YW�' IC�S� GK31� I The Commonwealth of Massachusetts REED%F Board of Building Regulations and Standards NSP CTIMY RVI ES Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair,Renovate Or DemolishUl5 DEC - I A 11: 2 N One-or Two-Family Dwelling This Section For Official Use Only (J Building Permit Number: ate Applied: cn / / Building Official(Print Name) Signature Date r 1, SECTION 1: SITE INFORMATION U 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers g F_�c�ccA( s F N(((l Lla Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: - -�RII.L 4 (FIrrr- jAIe JW CiNLa, Name(Print) 1 City,State,ZIP !?q F2Jeral S4- g_g37 �9't/7 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) - New Construction[IT—Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. Cl Number of Units Other ❑ Specify: Brief Description of Proposed Work Z: S-Fr i n SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ - ❑Total Project Costa(Item 6)x multiplier - x 3.Plumbing $ 2. Other Fees: $ /� 4.Mechanical (HVAC) $ List: /(JLL(J 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ , I ❑Paid in Full ❑Outstanding Balance Due: I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) + _ ZA 'Zj/RAwe.oExpirationD to Name of CSL Holder List CSL Type(see below) 5�1 No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Telephone /9•� "l V( I Insulation mail address 1/f D Demolition 5.2 Registered Home Improvement Contractor(HIC) 21-,4 --w- / 7G 7G "` / 9 1 7 mber HIC Com any Name or HIC Registrant Name HIC Registration NuExpiration Date D No.and Street/// 7�Z 71 Email address Ci /Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ..........B' No...........Cl SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUIL/DI/NG PERMIT I,as Owner of the subject property,hereby authorize 1 4 6"eAcle to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pequry that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. �/I.._� Jai-& (cam/[�-/K(/iyL -L /l-"5�/.S— Prmt Owner's or Auu onze d !�g�a(Electronic Signature) Date' 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 not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents 4 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ZA 64�1-e"Vee Address: City/State/Zip: &,olreAl /ff r1 p/6 a Phone #: 2P/ Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: gQ /�C✓�vA �f City/State/Zip:__5'4­1eX1 17:1.4 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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: \ XEP-41 111�Q/1�11 Date: Phone 2 Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 1 :. CS4MM9 LAWRENCE HUAREIRAND {� 30 SHMMAN ST WOBURNMA 01801 05174/2016 Office or Consumer Affairs&Business Regula`Nou HOME IMPROVEMENT CONTRACTOR Registration: 176769 Type: Expiration: 812512017 LLC LAWRENCE HILDEBRAND,LLC. LAWRENCE HILDEBRAND 30 SHERIDAN ST WOBURN,MA 01801 Undersecretary r� ® CERTIFICATE OF LIABILITY INSURANCE DATE(o 126YYYYI FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. t THUS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. N SUBROGATION IS WAIVED,subject to e terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to e certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: AL PONTE INS AGCY INC PHONE FAX 819 CAMBRIDGE ST (A1C.H%EXW. (AIC,No): EMAIL SAUGUS,MA 02141 ADDRESS: 28H.A INSURFR(S)AFFORDING COVERAGE NAIC N INSURED INSURER A TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA ITS HOME IMPROVEMENT LLC INSURER B: INSURER C: INSURER D: 11 HAWKINS STREET INSURER E: SOMERVH i.t:,MA 02143 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THBR CERTIFY THAT WE FOUCIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED To INE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBAH.'T TO ALL THE TERMS,EXCLUSIONS AND CONDMONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS, INSR ADD SUa POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICYNUMBER (MM1D01YYYY) (MM MYYYY) LIMITS GENERAL LIABILITY HOCCURRENCE Is COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE a OCCUR. IREMISES(Ea cownence) ED EXP(Any one Person) s ERSONAL&ADV INJURY Is GEN'L AGGREGATE LIMIT APPLIES PER: [BODILY ERAL AGGREGATE $ POLICY PROJECT LOC DUCTS-COMPTOP AGG S AUTOMOBILE LIABILITY BINED SINGLE $ ANYAUTO T(Ea accident) _ ALL OWNED AUTOS INJURY S SCHEDULEAUTOS person) HIREDAUTOS INJURY $ acdtleM) NON-OWNED AUTOS OPERTY DAMAGE $ (Per ecmdent) UMBRELLA LIAB M OCCUR EACH OCCURRENCE Is EXCESS LIAR CLAIMS-MADE FAGGREGATE Is DEDUCTIBLE 11s RETENTION ss A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYERS LIABILITY YM UB4307P186T5 07/132015 07M312016 ITS ANY PROPERITORIPARTNERIEXECUTIVEINA E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCWOED'1 El (Mandatory In NN) E.L.DISEASE-EA EMPLOYEE $ 100,000 Ryee,deam =ler E.L.DISEASE-POLICY LIMIT $ $00,000 DESCRIPrION OF OPERATIONS bel. DESCRIPTION OF OPERATIONSiLOCATX)NSNEHICLESIRESTRIC nONSBPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO TUE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION LAWRENCE=EBRAN LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 30 SHERIDAN STREET IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT ��{ woBITRN,MA olsol ACORD 25(2010/05) The ACORD name and logo are registered marls of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. wvw�� �vrRwlrrnaal Mau?wllrR--PROPf3s7tQ T �Gfi� by LARRY 30 Sheridan Street Woburn, MA 01801 Owners Addrass 781.789.9711 cSIRQ•ii' CS090389 S CiC/ P tT s Home orre Ownors yVlxlc MOM a � g ,�.� Iarryhildebrand{a�verizon.net p�ega PmleGCify - Pined LP Code Project Prawn Ogre Quality Roofing by Lary Hildebrand,hereinafter referred tow"Contractor",hereby proposes to famish to Owner all materials and labor necessary to roof and/or improve the above premises in a good,workmanlike and substantial manner according to the following terms,specifications and provisions: a.Description of the work and the materials to be teed:_... .New Shingle roof as per the attachment"A"project details. A410.t ."New Shingle Roof TOW file, Optional: _ Standard Shingle warranty included 10 yr& v— " e System Plus warranty 20 yr&Lifetime $740 Golden_Piedge warranty?Syr_&..Lrfedmid b Description of arty areas that wnl NOT be worked on . „Jf �.��� Idol_ This list of specifications,maybe continued on Subsequent pages(sae page number below) e.Payment:Contractor proposes to�perfo ttaheBkve work,(subject to any additions and/or deductions pursuant tAmthorized an�o ders),for the Total Sum of I l 1 a&- J 7ti y�l, Down Payment(if any)$ Z>#e)4 r PAYMENT DU $MOUNT PAY - h'ENTS TO BE M46iti rN INSTA�,I tmENTS AS FBLLOWS: G 1 �, '(") de check upon receipt of invoice for draws as al/�— described under "Payment Due When" to the left 2. column. 3. 4. d. Commencement and Completion of Work: Substantial commencement of the job shall mean either the physical delivery of materials onto the premises or the performance of any labor and shalt be subject to any permissible delays as per provision(3)on the reverse side of this ptoPmYcnMMM. - Approximate Start Date: Approximate Completion Date: e.Acceptance: This proposal is approved and accepted.I(we)understand there are no oral agreements or understandings between the parties of this agreement.The written terns,Provisions,plans(if any)and specifications in this proposaUcontract is the entire agreement between the patties.Changes in this agreementsball be done by mitten change order only and with the express approval of both parties.Changes may incur additional charges. Additional Provisions Of This Pwposal/Contraet Are On The Reverse Side And May Be Continued On Subsequent Pages(sae page number below}.Read Notice To Owner on page two(2)before signing.Read"Arbitration of Disputes"provision on page two(2),provision 10 and the NOTICE following this proviston.If you agree to arbitration,sign on the line belowthe NOTICE whane indicated.Also,sign in the same place on EACH COPY of this contract DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES You may cancel this agreement if it has been signed by a party thereto at a place other titan an address of the setter,which may be � r his main office or branch thereof, provided you ynotifyma the seller in venting at his main office or branch by ordinary malt posted, by 5 telegram sent or by delivery, not later than midnight of the third Ved site (ee„er) business day following the signing of the agreement,Sas attached notice of cancellation for an explanation of this right. Garret HUdlow S•2l jJ' NOTE:This proposal may tiewithdrawn after 30 days frond's'a l appwed(cordrador) dere if not approved and signed by both parties. Form RPC-C Copyright®1996-2008 ACT Contractors Forms(800)820-5655 www.calform.com Page one oft Total Pages The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Fnmily Dwelling This Section For Official Use Only Bm`lding P�rntfNumber: Date Ap ied: _ 1 Building Official(Pont Name) — Signature - SECTION 1:SITE INFORMATION I1.1 Property Address: 1.2 Assessors Map&Parcel Numbers N DD 89 FEDERAL ST SALEM. MA 01970 26 n4g9 t D 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number ::„ 1.3 Zoning Information: 1.4 Property Dimensions: i R2 TWO FAM 45 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Requited Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site Check ifyes❑ P disposal system ❑ SECTION 2: PROPERTY OWNERSHW - 2.1 Owner'of Record: JANE DWYER SALEM, MA 01970 Name(Print) City,State,ZIP 89 FEDERAL ST 978-744-4673 No.and Street Telephone Email Address 'SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building 4 1 Owner-Occupied Ef I Repairs(s) 16 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other Specify:Replacement Brief Description of Proposed Worle: REPLACE 1 WINDOW & 1 DOOR - NO STRUCTURAL CHANGE SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official and Materials al Use Only 1.Building S 5,301.00 1. Building Permit Fee!$ Indicate how fee is determined' 2.Electrical $ 13 standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2- Othd Fees; $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. _Check Amount: Cash Amount: 6, Total Project Cost: $ 5,301.00 ❑Paid in Full El Outstanding Balance Due: a CST pFNOMI �.9e SttG i7 � SLG ' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 90125 10-06-16 Jamie Morin License Number E7cpirationDate Name of CSL Holder U 86 Gardiner St List CSL Type(see below) No.and Street Type Description Lynn, MA 01905 U Unrestricted(Buildings u to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-351-2214 I 1 Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-17 Renewal by Andersen HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 30 Forbes Rd No.and Street 508-351-2214 Email address Northborough, MA 01532 Ci /Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes..........9 No...........0 SECTION 7a:OWNERAUTHORTLATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Jamie Morin to act on my behalf,in all matters relative to work authorized by this building permit application. SEE CONTRACT Print Owner's Name(Electronic Signature) Date SECTION 7b:O.WNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is trueac a to the best of my knowledge and understanding. p // JAIME MORIN Print Owner's or Authorized Agent's I ctronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.Wv/oca Information on the Construction Supervisor License can be found at www.mess.eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basemenUattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" r. CITY OF SAMNI, 11fAssAcHmTTS o BunMWG DEPARTMENT 120 W+sH1NowN STREET,3fe FLOOR T zr-(979)745-9595 PAX(978)740-9846 KIIWERL.EY DR15CC)I.1 MAYOR1�to[uAs ST'.PtERRH DmacroR of PuBLIC PROPEATYAUVEDING CO-Haan = Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code,780 CMR section 111.5 Debris,and the provisions of MGL c 40,S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111,S 150A. The debris will be transported by: Renewal by Andersen (name of bawler) The debris will be disposed of in: Renewal by Andersen (name of facility) 30 Forbes Rd, Northborough, MA 01532 (address of facility) s' tore of permit applicant ,?_ C date Jshrisaft:dac R eWal Agreerment Document; and Payment Terms !,And en dbx;kMeaalbrnm&mrKof Botwo - - hme¢kwynr teo k Pbawe-=^xnteaal by An arse I ;,S Federal Si - MC a-170810 Salim.wx1m .�� �.eucveur X"vbus aad7Tknthboraugh,tl'IADII532 r`, G976}7q-0-17877 Ft4wp W3-351-2211 I FaI 154784^x-FQ82{ E+as1unt/ etatiels!±B' er5'epCarpAom 4 ytnuaa�8)Nante_ lane DWyer C,:,Imraa La6c®7�t2G;r1:0 Cmitwoves s).Street Addrtu-89',F2deral St, Sa'learq,IMA 01470 l'ti^:verarl�'I'tlepbuvte'Numb.e_('57W"415-13 S6reaesc36T'Ir'd1epllnme Xw55ber. pr3tt®t 11136ad:oddxis 4'vr+'c4e16 r �l5t➢ fir/ad: l9owurlsPherehVltlntl.yrasrc6'sCrxxUyallrerttstopwcbmeditprnducrsand'dorar6}ry SafR nCv3lby'And-r.CmLLCddb2Renewal 1w eAnd&.,scm of Bk;8Loj"Coi11rM S h in;§I u'n6h tlre:eetlus x319 au}ndceistn a94Yltav'lacd iau this rAgrv-c-tatcttt.Docuuvcat',acrd rayrib-t It Torras,X14 ails of f'anaxliitiram,lPwDixcd Ow&,r ItscCipt,Wknintv,Sslsa Caw Sasisrgr ti A Addendana, Pastae ami Co 6IL�inma�f Ott Levi-Safe Forim.Walwcr,Chore or Budder, lik-ccroudcC umtnt,and any to thislthW6rie.mr Domnxvtir, d6c unnams afvr,K'K a ave all agrmmd:w 6T 6E parrim wA iocaaporaandhacin'h),refmrenrn(smllexamamr}•,3his Buymri'sj hemhy-agrees no segue a moviilncimm= uhcaw aFaer C,matracrmr has curople-mcl.A u rh u:teder Kids aAgc�- $aNat jYilt lAltuolnhP: S7,273 lSy'c4lapM lis agw,-7ngn4,ykgx6owWr t'6r tlhr Max uts9 lul'th.C.gattC41r66' KI 4 162dcW a i uslir lri ja.'�'�tl�" '�5uAmia1 dwk�h elk 4P76'rtt� fect cud ,or exh- l'k{xxie li�Ltivcd: $2;4,2A i BalAMI DM: S4;849 Eatiolmet936att: E,tcuzvrd(�tiiplerlo3: ,tAtoomor'lrirlaenxA: so S-10 1-2 days MtShMd Ed lt'YINWlhl: Credit Card We Fctaefiule'Lr65ea9hworla 1735ed on&c d1Wt of die 55g ed contraor and scmft ladly and PAS 05120 � � 4 A tlanrdate m mVich vw :ornplecc elm 6railsniol mea.4neesmentx_11te ioxvllarloty date thm csrorprvniding at chis time is.ond,*am.ezrima:rc.i'A?'e wiRcuruemunicarean ollicia.1 cuic 113 Staft S2424 acid 6 tat at a hter date- R:du and ate atce tnou eomnuo cau.,Ce fur 1''l3 complatats 52424 a9elsy, Bnytf s)2wtns and undusoads 6169cihis Ap;MMCrhrr,7ast-reutee rhe CotirrnJMkr%UA1Tk_U II)MICCn.the pe6rI III tlwre arelaC.,..Cabal viaattes,til[lditttik eltan0,4me tum,luCyhgt .any of dw mnaas ofthi€rAgrc+rntcatt...No alotraak w to or dexlatsmtta.'r oat this Agwcrawttr hill tae ralyd midtoux rhz sigp d.wriK;co Rn&mT if broth flat'IlurprrGs).atvii C'atntractor. Buycrts)ha*,a krbvv{*dw%hw1�r[s) 'l)16as rend i4+i5 AbtCneaenc,tlodCrswnds 611[6ec6ns of chis t1raCClmaoa,aad 16aE rCCCi+xxl x corcp6f&*4"- , aIf i1 I gocanci5t,in€futiirtg the vu+m attached LN%H sMrca rAiarion,ore c1I dacefim vwsirt. v alxme moa g)s aQly enfnrrmed mFRayet'sve,T to canod this Aqp; nnr. NOTICE V-)47WA:11Z Da rYDt situ this 4xtoetse6 if 66olc 3©u are er euelc l na a cilj y of the cooera a as 61 a 6avmc net sigo. YOU,THE BUYER, MAY-CANCU THIS TD'1 NSACTION AT AuN\Y TIME NOT LATER TH.&N MID iMGHT OF0712-912016Oi14;,:THIETHIRDBU$ l` ESSDrAYAFrE:RTHEDAE.gC'THISTI€A SA�T�QPY, WHWHE:VER DA 1I SEE`1'I-tE ayiTrACHED 1NO'i 10E Ota C INC.EI.La►ON, FORM F'ORAN LUUNATION Of THIS RIGHT. 1�'tiamn klrmemml bs+Ladresma 18:G i�toouQa$ +$�gmcoal neaafB6ma� 5g+tra9tan':uf Salmi Laetson Si7a r:aara7C .Sij;�taeuat Fred!Boucher !d uFe'Dwyer Rick Name of Sakti lvetswtE Priem 6N2ahc Mrit Nwa t& 01126F 16 Parse 2 12ra Renewal Itemized Order Receipt alfa kmc a11Ly_im&mn of6'.umn Exio Dwyer y twalFUM? iFenevalhv?rdminItc .39iPerleral51 HIC&170910 Salam,ria a]_Q70 �vcm>a u awawr 33kxbf'.t-oRl i1 ftliftough-MAP1532 Hfr�i781?'AA11977 n••mrie'5913-3:1-22001 Fac t5GW 9C-rViY rFb�.E[rslun ierahart saAaisenCorpream 101. OUke Patio Door: 2410 Series Pe:rma-Shield, Gliding 2 Panel, Active,+ Stationary, , EXTERWR Wtfige, INTERIOR While,COW:SASh All; Tempered High Per#.SrnarlS-in Glass, 'Hardware.Tr;becaO, White, 4ereen; Glidaa2,Grille Style:Grilles between Glass (GOG). Carillis Patitlrvs;Sacsh All; Colowal 3wr x Sh,M G Custom Casings Interetr Includes casings and sill nose that does NOT require a knife to be made, Custom Casmgs Exterior, Includes casings and so-')nose shat does NOr raquere a knife to be mad 301' A0[ Wi eclow:Casement-Single, Casement, Siatsooary, E9 Frame, EXTERIOR White, IMERIOR While, Glass: Sash At:High Pe+iri mauve Smart5uo frtass, No Patt?rn. Grille 5t1+fe:. No Grilles, Misc Non, 302 Attic kitchen W.1ndow: Double-Hianq. Equal. Full-Frame, Tradbonal Checkrail, EXTERIOR YOrte, INTERIOR White,Gb".5ash All- Kqh Perf.)rmance 5wrt5uri GIaSs, No-P91terrta 89irdwere: While, 'Screen: Fibergilass,.Full kreen, Grille We;Full 19irrded Light fFQL With spacer), C,rill* Pattern:5&0 All: Colonial 3w x 2 h, FAIs€,r4on MNDOWS:2 PA7101000115.1 SPECIALTV 0 MISC.0 TOTAL $7,273 UPDATED: 471UM f Renewal by A.4Amwip is rommirrna 3-o BMr'mromerr'.afetf by ' rnr+�7alyr.Rg wirb dyr r lrr tf eeif d b*.rfw.E,A- ojfz�ot if Page 4 J 20 Renewal Renewal by Andersen Corporation per, X % l 30 Forbm Road-Naifltlm ugly Mamjchimus 0153? IAA"Dow,Ir a�e�iota t ann•acinr b)Anders _ _ ' � Pliume 50R' 351-220n— iLe(50S)98640,72 Atn iur xc ix 17t4 iR?i6xgui W. ixineovr ":CPLAOEMMMT on hakes"Gwt".r , 121L":i/dtl[ZD - k".vleraY V;x ILaa. at.r d tSIaL+ CORrRA=AmumAmNNr . '"lis:lmendmeatl("Amendww"ry'.1.t0 01e CUMkbt 1WilVg?GAV AND lIOQ t rXI M{pMLIT'Cr,ALiR'RNIATF.Yr'Mgmnwrn"D by mnd bel'SWi'en X-new:L3 by e'4ntt:Men GOrlpaenl"k wtd.Jane D p-r("buyers'°). Canirt bLv nyni u yer ct) ktoxcby u�,r�-2 ILM rene+bd and macUfy the jLt nl ne:s6nslict[[�xllrek�u. C1[Ylerihi2n sslt�4[1cLgth lat�Iclliltivu, xl9e¢t teinaYfnul leEstes ±folieAgjWnu2newllE i'iY[at[einila9l fltv,,r 6;+It�eaptdr'B'ecl 'I'Int�t..i,tn udnxr[IJsauhJu:tWr+iWeele9.r�asulTL te�l9dans�Pthellg,L nLcnr. '111W( lylgoddAl,mg, 9t rtiidanv,�e�{:E�liaeia 6o the proluctc and 4ervlLY3 L Myer(a)QML'IW WT bVAIg3 nudes etuttmdduttCttt r,D udg'eL*isten G't"iik•4 idlohcn i5�lttdmLtr,danllD9e h ung r`a 3112 a(P of urvlze:. As.t tt_nill or khese chant.•,iOte fcl wMig i-rrns c(the AgLtiamft"I (IM 11150 chatoe,ltrg (i(Rliew le ito 4:hsrtgp_..an limn w'I1i bL Jell,'blank or buA cd ns'WA",kaaafllk+,UW no chatW apjYlkex: 1Vk`WT®15i job Amkoawk $5,WI.00 puynawet Mrthmd: NcwUegms[t Rtxzl ei:$2,d2A..00 Cmdit Gard t4w ILimimmt 5tumorjab $1,430.00 Credit I"ard New t@115ncc on. ! Credit Qnrct 'SLLLcI`IDaLYI�TL'�RICWI utJ"ob#:pLJl�Y3.� It is aV=d ani undudmmd by and be w=the F,ae(ics that this Amandmont and tho url&ITW Agxccnwm emm dh tc[ha emtlra undentandbM bo Tyson the pmtico.mA these are ao+rattai unda t ndings chug or modkiplreg arty os ft tams d this Atnendmmt BuyaW hereby aa1nt t 'cam thrt a y hm=W Rhin Am=dmcmt and hm rcreivcd x omWIcIrd,Adgncil,rnd dated copy c[rthis Arnemdmemt on th ditc wmim lel uw. QtmwaihpAndarsm CDrpmfin Buyer(s) Or a arsr"ad:dW"2 iss^os..ZSres� T. I,tlauut, �r�"t� ttacth'aulte •e I . lane VI'aheat"0"#-Dwy r Dme adInt"t3:mm PeC+dBOucilCr �i t•f i 8/1/2010 Witt Name cq FpUfl lot AUDI yr Slgnaltm, Gale T/re Commonivealth of Massac%nsefts *57, o Department of Industrial Accidents �. Offfee of Investigations 600 Washington Street Boston, MA 02111 y ;. tvww,trtass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Businessiormnixatiordtndividwi): Renewal by Andersen Address: 30 Forbes Road City/State/Zip: Northboro MA 01532 Phone#: 508-351-2200 _ Amore,/you an employer?Check the appropriate box; Type of project(required): I.p!f i am a employer with_300 _ 4• C] i am a general contractor and I 6. Q New construction employees(full insulter part-time).* have hired the subcontractors 2.❑ 1 um it sole proprietor or partner- listed on the attached sheet. 7.JZ Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity, employees and have workers' 9 E]Building addition [No workers'comp.insurance comp.insurance.; 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 11, 3. i ys a homeowner doing ail work oright ofexemption per MGL ❑Plumbing repairs or additions myself,[No workers comp. 11❑ Roof repairs Insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 1311 Other comp. insurance required.] *Any appliceat that checis bei#r mast also an out the section below showing their workers'compensation policy information. t Homeowners who submit this atlldnvit indicating they are doing all work and then hire outside contmeton must submit a new naldavit indicating such. tContraciors that check this box must attached an additional sheet showing the nanic of die subcontractors and slate whatlrer or net those eadittes have employees. Ir the sub-contractors havectopioyees.they asst pmAde their Mikan'comp.policy number I am an enaptayer that is providing workers'compensation hnsuraace far say employees. below Is the policy and}ob site ht/arnnatJonn' insurance Company Name: Old Republic Ins, Co. Policy#or Self-ins.Lie.#: MWC 303700 . Expiration Date: 10/1/16 Job Site Address: 89 FEDERAL STREET CitytSime/Zip: SALEM, MA 01970 Attach a copy of the workers' cum pensothat policy declaration page(showing the policy aumher and expiration date), Failure to secure coverage as required trader Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form ore 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 Offtce of Investigations of the DiA for insurance coverage verification, I da hereby eer =rut the palms and perrntttes oJper}nry=that the hnforraatton provided above is tare and carter/t.0 care: t Poe#: -2200 OJJPc1al ase oa(y, Do not sprite 1n lhLr area,to be completed by elty or town offlefaL City or Town: Permit/License# Issuing Authority(circle one): 1,Board of Health 2. Building Department 3.Cityrrown Clerk 4, Electrical Inspector 5.Plumbing faspector 6.Other Contact Person: Piton a M 1 CERTIFICATE OF LIABILITY INSURANCE r DAT9p MWW ' ls THIS CENTIFIGATE 15 ISSUED AS A MATTER OF WFOWA70M ONLY AND CONFERS NO RIOHT9 UPON THE CERTIFICATE HOLam TIS C gUITORCATE 0069 NOT AWIRM ATAIELY OR NEGAYNILY ANN% EXTEND OR ALTER THE CLNERAOE AFFORDED BY THE IMCU s4 BELOW. THIS CE MF"TE OF INSURANCE DOES NOT CONSTRUTE A CONTRACT BETWEEN THE IBSUNG UNSURE S)i AUTHOR I) REPRIMENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER INPMANT: N tho oaraUmto bMder ban ADtMRMiAi.I1SUI+BD.9fepoDryp•aymmt4axrdonad. NSUBRODAT(ONI9IADIRlEO,aub)eotb ttW bmR and aomMons of On policy.certain Pnffd m may mqulrn yR andmsamard. A sb*m and on fhb GwOcaB go"no Border Hghb Ed ft aadl9EBa 1WWer m 118{7 alTlUeJS PRoanaaR Willis CorDBcaD)Carder WUBadeB+ nb,Ina, agt�clo 20 Md BT7)_9W77379 i8WI d9T 2979 P.01 tO.99lt ` Ca/NRea na.com sIWREWmmTectiRO 00YBIAQS 7WCx MURNA:Old Ropublic Insurance Cornpany 2414Y m3m3 asulrata: RetMwal by AndArman LLC 90 Farber RAad BINRIma: NoH1lbomivah.Net 0116Hffi - ... .... .. meuaee e: aaemua r: COVERAGES CERTIFICATE NUMBER: REVLON NUMBER; THIS IS TO CERTIFY THAT TFC POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE iNWRED NANEDAIYVE FOR THE POLICY PERIOD INDICATED. NOnAATNSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESIMOT TO WHICH THIS CERTIFICATE MAY BE ISSUEOO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBIBO HERm I8SmMCTTOALLTHETENMS, EXCLIRKWS AND CONDITIONS OF SUCH POLICK&LIMITS SWAN MAYHAVF SEEN REDUCED BY PND CLAIMS, IYFEOF 811nmANCe PaAGYaaaBMl Lamy A CCUMEM 6t GO L WUM ENCH DCmyarms x t, ClAws4mm [K OCCUR SDBxaD 1Y101/M16 101a1/20t9 x Mrs av yN r 14 PER80RnLaA]VIRaIRY x t WnAG aECAT pUR1Wpftr.APPLMPElk 89mRALAGM*MTE x 4,90 X POLICY a JECT ❑LOO r'RDOa058-COMPRIPAOa x +IAM 4 AumNoe:7EUyam x A X ANYADTD 3 x36 trtl6lfAetb 11111111111110,116 aDOEV80lRY0' PwM?d x AL40YtPAT7 pITOg A aOyAY CUURYPW AwhbnV r MRED AVT09 AUTOS x $ VOm�i3AiM9e��, EACHCOMEMNCE I BaW1MLMa CumeMM6 ASSIT-GDE x om ffft N tONy NmRRiRB COaPmYATOmI S A AqaPr ARraewlfCurtaE Tta te76172Di6 ra/atlltMa X 6 1 I alrWreop nrr5 m N N/A EL EACH AOCWSNT MR �al uf�lar ELDiSFASE-EA x 1. a"VemilomstoMw ELDWAM-POUCYLm 8 9.ODQ,pOp oExcrNPnox oropomm mx ruccATkIMA i YNna.Gs Wom,"%Amummm ,,,u smft awe.aaxeh.eaeon AAar mmgmgy 1 CERTIFICATE HOLDER CT1NC6,ULTt01t aHDULaANY OF TM AMM DESCRIBED PQLIcMygSCANCL+LLED THE MUMAYM DATE THEREOF. " CII WILL IN DB.R/If�PnRe BEF IN RIT AANCE WTib POLICY PROMMUMIL AanpaO>m CEP iota ACOtm 00115PON11=16 AS Ngbb ry oimic& ACCIRD 25(M411") 71116 ACORD name and logo Cry mgbAwd mWlO9RACM Dowd oT8u?Wng Peguld m and Stswoods cndmtdw aps.v*ur s m"W Cad atl'. m `a.. ;�Yl7e17�WlDA4F j R: ww+�arR m uT(�wasv A1hM�t saMma�rAe;dafioti mraoWQWffcoNtRACM sty Bx�ragae4'"! f Supplement Grd RMEWALBY At Ltd,,'} } JAIL $AOM f.. 30 FOROM RD �- ....�•�• MORTHBORM*K MA 01632 yy� 1 k i .sIj � i. i ?;.i', ^."vn Pt i i r F";r;R*1"A Q7 LU ed Mo is Ad me n�rr � � •. � off " � gg pp ggR y qq uupp @@ F � ppp p � pp uba LL ui ail CL t ' e ( it •E III �. j I on mtremmi OM law Code Igep OL Ban MLd faffipa 'i Immmqm . � I. byA I mm • N➢qf Yl4J.00R w•YgipOeppop. 4-102 N/ocAND4 OnmPr+alm -� ° G'ae7 . . Aipon Layµ•E� 1 - Pradoot7yµe: CaeerneiR ' . ENMW PERPDFP6AMaE PATW e i . .U-Faomr '&der Hot GZ Coodld nt 0.29' 1.65 0.28 ' AbDMONAL PEMFOM"CF nATIMGa r Vmlbte Tmrornab m 0.4. 8 •. •4tl�tgriMl�vYs+albbb RCM••e�obYVp�1bY'MI• �b4MN IMWr'Pai�bliMvlR.Ma[/aMs�MurM.M<I�+Y, . r gpllbbbbJY•i•Wb'ivy~.I�bv(}�slll�ilib-IMCYAMiR 7n� Milo" ftbv • ♦ IIlSRb'AYYIMaMOh0Y3�MMY OPWOM i • a � rm Mum= - tae9hC19672Le1 "s • nf�b ' 1 • } E The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7 h edition ReOF ALEM nuary Building Permit Application To Construct, Repair, Renovate Or Demolish a I, 2008 One- or Two-Family Dwelling This Section For Official Use Only lBuilding Permit Number: Date Applied: 0 .� Signature: ^ Building Commissioner pector of Buildings Date l\Y J SECTION 1: SITE INFORMATION 1. ,P operty A dress: 1.2 Assessors Map&Parcel Numbers fed"n � t S e2 _ 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ---- ---- — -- — — -- Zoning District 'Proposed Use Lot Area(sq ft) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 0 of Record: Name!P-tint) Address for/Service: (J/, / . ` _ Signature Telephone SECTION 3: DESCRI I OF PROPOSED WORW (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Descriptiop ofSProposed Work 2 1011 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building $ 5 o 60 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑ Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (IfVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 8 50, L10 0 Paid in Full 11 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 0�� PhrlifiahTr License Number Ex iratio Date In r f C - old r List CSL Type(see below) Addre Q Tye DescriptionCu. t U Unrestricted u to 35,000 Cu. R Restricted 1&2 Family Dwelling M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 egis red Home Im rovement C ntrac or(HIC) HI pan ame r IC i ant Name I Registration Number A gxpiratiorilDate Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ..........6 No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, !t/ as Owner of the subject property hereby authorize / to act on my behalf, in all matters relative to work authorized by this building permit applica6A. C 4 b ro Si nature of Owner Date SECTION 7b: OWNER' O UTHORIZED AGENT DE LARATION I, � ��,S hyA p!' I� �-, , as Owner or Authorized Agent hereby declare that the statement and information on the foregoing ap . ation are true and accurate,to the best of my knowledge and behalf. �Z Print m 77- �J_ J U Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury) ' 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.R6 and 1 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 half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts [ Department of Industrial Accidents p> Office of Investigations 600 Washington Street " Boston, MA 02111 �> r„ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p /� ( nn Please Print Lel?ibly Name (Business/Organization/Individual) C V�fF- pu'.I n n l� 11 Il J Address: I I __��y Sdif Q +Q k 7 /� City/State/Zip: I I I b 1 I T Phone #: 9 9 0 I g I - O LI a " Are�u an employer?Check the appropriate box: Type of project(required): 1.[i I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ R of re airs insurance required.]t c. 152, §1(4), and we have no _ employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the time of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. �'n� T,/' 1 p l /� r' C Insurance Company Name: l I (Q f '11y���r�L�P Lf�I l�Policy#or Self-ins. Lic.//#:�� ( 1 I 'U Expiration Date: 13 ,[q Job Site Address: 1 IFed JQ I J ,I Q Q City/State/Zip: l9 m n 070 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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify n er d pains an penalties ofperjury that the information provided above is true and correct. Signature G '7 (_ Date' Phone#: a (�' Io / ` A 1 0 q a q Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 4-24-07 www.mass.gov/dia DISPOSAL OF DEBRIS AFFIDAVIT In accordance With the provisions of M. G. L. c. 40, Sec. 54, a condition of Building Permit Dumber is that the debris resulting from this Work shall be disposed of in a properlylicensed facili as defined b M. G. L. c. e facility y 999, Sec. 15Da. the debris will be disposed at. Salem Transfer Station owned by Norhside Carting Signature o� Prrrs�lit Applicant 9 P P 2/q ` / U Data ChrlstoDhes Zorzy ASame of Pemtit Applicant . A &A PuServices. Inc Firm ma 1-15 North Street. Salem MA 01970 Address, City, State, lip Code iYlassachusetts- Deliartnient of Public Safet}_ •Hoard of HuildiciW Regulations and Staykdards; Cbnstruction Sstpervisor License . ' License: CS 57733 t Restricted to: 00 - CHRISTOPHER ZORZY 115 NORTH ST SALEM, MA 01970 Expiration:.5/26/2011 ('unuuissioncr Tr✓r: 14751 � Office of Consumer Atfair &s B siness Regulation HOM E IMPROVEMENT CONTRACTOR Registration 101609 Type: Expiration -- 6726/2012 Private Corporatio. A&A SERVICES IN� 1, i Christopher Zorzy.1 115 North Street Salem, MA 01970 "- - Undersecretary j Commonwealth of Massachusetts Division of Occupational Safety . Laura M Marlin,Commissioner Deleader-Contractor CHRISTOPHER ZORZY Eff. Date 04/14/10 Date 04/13/11 DC DC000440 ) ►r� Wmberof C.O.N.E.S.T. S �' BO 1111111 Pill 11111111111111111111111111111111111 oil 111 � BOsrON-RENEW 4 it + Above A A 922 A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET,SALEM,MA 01970 • e • Telephone: (978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No. CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers Name Date of Contract T4,V 6- 8 -30 - /O Buyers)Street Address,City,State and Zip Code Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: h.eo978-7YY- W,73 s z5c93g 976-837-S LI 7 l7b'� � Y The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement,and Buyers)have requested that such goods or services be installed or provided at Buyer's address listed above.ARA Services,Inc.("Contractor'),hereby agrees Is install or cause to be installed the products or services listed in this Agreement at the Buyers)address written above. This Agreement represents a cash sale of goods and services. The Buyers)agree to pay in cash the cost of the goods and services Purcludidend as described herein,regardless of timing or approval of any financing Buyers)may seek for their purchase. �l Cifi� �0 �O S Purchase Pric o S Est.Staining Date9-30 fD-/y Down Payment: 2800 Est,Completion Date:10[Y ❑Cash Amount Due on Start of Job: heck ❑Credit Card Amount due on of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion: �YO CVC Code: It is agreed and understood by and between the parties that this Agreement,front and back and any addendum,constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement. Buyers)hereby acknowledge that Buyers)has read the front and the reverse of this Agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms,on the date first written above. Buyers)also (i)acknowledge that they were orally informed of their right to cancel this transaction;and(it)request that they be contacted via their telephone numbers or a-mail, as listed above, In the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. By: Services,Inc.�� ZR i Signature Ls Signature,,s���/a._e Print Name Print Name Signature Print Name You,the Buyers),may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION:The wnirawor and Me homeowner hereby mutually agree In advance that in Poe Senor eMm parry has a dispute wnmrning this contract.either party may submit such distant W a privates catamaran service which has been approved by the Secretary of hie rebound,Carde of Consumer Affairs add Business Regulations and the other party shall be rek iretl to submit to such intended ad,proved in M.G.L.or Acok. G� ./T a Caamses mi 1 dons lMitleln: - -t/ Gas, t u s: --v'I/ onto I O © NOTICE OF f.ANfF eTnN Date of Tranaactinnt�V"' .Yed may Cancel this transaction,without any penalty Or Date of Tmnsa tion���c^/O you maY cancel Chia rransawion,witnnm arty penaltr or obligation,within lM1ree business tlays ham the above Date.Ifyoucence rtrepropeMtredrof obligation,within three buslosss bays from hie above date.Ifuwncol,anypropeMaa min, any payments made beyou under the Commie or Sale,aM any nepe able istument excvled any payments made by you under the Contract or Sale,and any negotiable Instrument ewe rated by you will be remmein wo r 10 days following record by the Seller of your cancellation bide, by yea will be reWmed within 10 days following recalls by the Seller of your cardellafiom notice, and any unfai ry mierest arising out of the transaction will be cancelled. If you cancel,you muss and any secunty interest arising our of the transaction win be canceled. It you cancel,you must make available to the Sailer at year demands,in subsranlaltyaz good mndifon as when received, make availed¢to me Seller at your addencq in woman WI as groin mMirlon as when receFred. any goods delivered to you under this Contract or Sale:or you may,it you eared.comply wim Me any goods delimred to you under this Commar or Sale;or you may,if you ever,simply with the hutruckons of the Seller regarding the return shipment of hie goods at the sellers expense and inurnwbns of the Seller regarding hie realm shipment of the goods ad the Sellers eryense and risk. If you do make the goods available to hie Seller and the Boller devers not pek them up risk. If you do make the game evadable to dur seller and the Seller does nut pick them up within 20 days of hie date or your Notice of Cancellation you may retain or tremor of the goods wiINm 20 days w the auto of your Notice of Cancellation,You may retain or dispose of the goods without any Nissan obligation.Hindu fail tomakethe goods mailabletohie Seller,orlfycuame. wIMandaMfunderabligmlon.ItyaufWlltomeke NegocdaevallabfeWtheeallecorlfyaunmS to return the goods to the Seller add fall to do so,Men You remain[table for performance of all to return the goods to the Seller and fall b do so,than you remain liable for pwMMm ce of Al Obligations under the Contact To cancel Phis trertsedged,mail or deliver a signed antl dated copy D011gehom under Me Contract To cancel Nis transaction.mail or deliver a signed and dated copy of the cancellation entice or any elver wngen trout,or send a telegram,to ABAA Services,�11155 of the cancellation notion or any Sher indent fire,or send a telegram,to A8A 115 Nmm Sea.,Salem,Maessed .01 for,NOT LATER THAN MIDNIGHT OFF Herb Street,Salem,Massanuutk 01970,NOT IATER THAN MIDNIGHT OF 'Z6f4 (Date) (Dots) I HEREBY CANCEL THIS TRANSACTION, Cnsumer5SignaWre Data I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Data .: ��� A & A SERVICES, INC. �AsI:A SERVICES 115 NORTH STREET,SALEM,MA 01970 • Ir Telephone:(978)741-0424 FaX:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 MISCELLANEOUS SPECIFICATION SHEET Buyer(s)Name Date of Contract ®wy A -30 --/0 Buyers)Street Address,City,State and Zip Code Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 978-837-8'/y 7 The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on I this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification f Sheet is a part. SPECIAL INSTRUCTIONS /VbW 1gPY7 &'vI AI-VAIf—vim TX —CJ/xfivn� �L_ r� r, S'rbnl'�'t WGNDcM/:S oyV � S iiJc� � f�U1i+?Lr, � Cr4 U L!C ivl65t-S i'tfY'� Er fFR/�'J g GL L'X i7r2t/�>_ L��j L3S � S'k r7G4(�1/TT I rt rt ° /eo-Lewi,5- r pzs4eos2s e�F b�>orST7ro SK`/L/yA'J OW f3 si0-6 II erF h4s-f /ASS?W-/2 /V' 220 9D 1_t1m6yYZ_ /;72 A/eL4, N ' //V-5 /you 4 ®'D PG L/ kAMW 19iLo1-rvV 6D9-775-A� cry Y;,y�N� . /C& f �_oy N� N'W DPe /�IUS�L� IlHZ✓)c SIC .3o SO`` / �w y �r Vim/-r.� ��pn� x s r � in,Z Nov ageQLIIA.1r r IM51-moe-ff /ate AfbIAJ fi4zrNr+t� �D Ica- t l'i .s1lebn.o . a /1Vs7nzf_ ram' 3o col- /�2dvrvY> /utter s1�y G/C�ff Pv v /ti A/62,0 i r 5l fRo rk:, A&0y,,V0 /.v 7_6-W-e 0Y _ a75:' n«v SicLI Lrr,/f>� /NCL_✓OAS 7AP6_ A-WV /mili/D L3 00771-5 , i NS NSW W 1 e/A/LS /N'ZlYn-myt- 7, a M �12r7YNda No P19,"A/77Ayr is rn�er,°dam , �1 GL s V it is agreed and understood by and between Me parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes the entire understanding between the parties,and Mere are no verbal understandings changing or modifying any of Me terms.This contract may not be changed or its terms modified or varled In any way unless such changes are in writing and signed by both the Buyer(s)and Me Contractor. Buyer(s)hereby acknowledge that Buyer(.) has read this Specification Sheet. 2 p j Contractor Initials: //ra Date: _J a'—/0 Buyer's Initials:�• Date:x C� J! /�