40-42 OSGOOD STREET - BUILDING JACKET yo - yam
UPC 1033
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No. 153L-33
HASTINGS, WN
.�o CITY OF SALEM, MASSACHUSETTS
yc� PUBLIC PROPERTY DEPARTMENT
@ - 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
TEL. (978) 745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR. PETER STROUT, DIRECTOR OF PUBLIC PROPERTY
MAYOR
May 24, 2002
Kenneth Novack
40-42 Osgood Street
Salem, Ma. 01970
Dear Mr. Novack:
This office has received complaints about the commercial vehicle being parked at your
property. This vehicle parking violates City of Salem Traffic Ordinance, Section 42,
which prohibits the parking of commercial vehicles in residential neighborhoods.
Please make other arrangements for parking this vehicle.
Thank you in advance for your anticipated cooperation in this matter.
If you have any questions about this matter, please contact this office.
Sincerely,
Thomas St. Pierre
Acting Building Inspector
cc: Mayors Office
Tom Phillbin, Chief of Staff
Councillor Flynn, Ward 2
TIaJ- L LA - 1 q -'5,70�
The Commonwealth ofMassachusett E�VEO ��CES
Board of Building Regulations and Stan pL $ER CITY OF
Massachusetts State Building Co(m�W1$ SALEM Revised Mar 2011
Building Permit Application To Construct,Repair,Reno ( et�bl a
One-or Two-Family Dwellj4jj 1%
This Section For Official Use Only
Building Permit Number: Date Applied:
1'IWal�1( f l
Building Official(Print Name) Signli a Date
SECTION 1.:SITE INFORMATION
1.1 Pro Z erty Address: \ 1.2 Assessors Map&Parcel Numbers
71O—L4 ®5 q�U S�
L l a Is this an accepted street?yes V 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:
Publicv Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal�On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
K� Ntl✓#�C.k .Sa�lem M
Name(Print) etty,State,ZIP -
y' — �7_ Osp,00� 5� 6/-7-633-33 � '�aih e� a Covh
No.and Stree— Telephone Email Address
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:
BrieefDeesc(riptio7ofProposedWorld: V�•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ El Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ i
4.Mechanical (HVAC) $ List: r/
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 1 o D 0 d ❑Paid in Full ❑Outstanding Balance Due:
i
OLb owl
(`Ilratt_k- CIS
SECTION 5: CONSTRUCTION SERVICES _
5.1 Construction Supervisor License(CSL)
CS-095-Zs9 9-/9 i4/
50 k License Number Expiration Date )
Name of CSL Holderl t /
'7 M„ /AJ^ 1 .,rt, Lis[CSL Type(see below) (/
No./d Street�( 1 Type Description
Ma �d� Unrestricted(Buildings u to 35,000 cu.ft.
11 Restricted 1&2 FamilyDwelling
City/Town,Stat ,ZIP M Masonry
RC RootingCoverin
WS Window and Siding
RC
Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Re istered Nome Improvements Cont{{rlaIctor(HIC) /��
�UGCI oes Y IO
e C- HIC Registration Number Expiration Date
HIC Comp y Nam or HIC Registr t Name
No.and eet _ /i q^A O/9.J� 5'1 Za—&ie Email address
dl�i'1 n O�
City/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 .......... No...........❑
SECTION 7a:-OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNERt 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 applicatioAtruand ate toate to th�my knowledge and understanding. Q
Tt/C C l ZPrint Owner's or Authorized onic 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.eov!oca Information on the Construction Supervisor License can be found at www.ntass.eov/dns
Z. 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"
I
\ CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
\� 120 WASHINGTON STREET,31D FLOOR
TEL. (978) 745-9595
KIMBERLEY DRISOOLL FAX(978) 740-9846
MAYOR THomAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
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 c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
�F'� 1�ns U35P05"-
(name of hauler)
The debris will be disposed of in:
(name of facility)
Ne'�n 0 A 61
(address of facility)
ignature of applicant
Date
CITY OF Si1LEM, NWSACHUSETTS
4 BUILDING DEPARTMEINT
120 CU.iSHCVGTON STREET, 3'o FLOOR
TEL (978) 745-9595
FAx(978) 740-9846
wNjDEp- FY DRISCOLL
`AAYOR THoaus ST.PIEHAS
DIRECTOR OF PUBLIC PROPERTY/BCiLDr\G CO\L\IISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Anoticant Infnrmatinrs Please Print Legibly
t I
Name InusinusOrganirmioro'Individually CC'1 O&D, 14:2 K", f r)
Address: ^ S/
City/State/Zip:y��1� ^ MT� ��1�3 Phane I!:
Are you on employer?Check the appropriate box: 'type of project(required):
1.❑ I am a employer with 4• ❑ 1 am a general contractor and 1 6. ❑New construction
enployees(full and/or part-time).* have hired the sub-contractors
2. lain a sole proprietor or partner• listed on the attached sheet. t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers'camp.insurance. 9• ElBuilding addition
(No workers'comp. insurance 5. ❑ We are a corporation mid its
officers have exercised their 10.❑ Electrical repairs or additions
required.)
3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself.(\o workers'comp, C. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.) t employees.(No workers' 13.0 Other
comp.insurance required.)
•any uppfivastl rue chucks but 91 must Aso GII uul the Section below showing their workers'compensation policy innamatlun.
'I h,mcuwncn who,0n,it this amdnvit indicating they are doing all wort and then hire uulsida contractors mml 30111h a new amdavil indicating such.
elnunwtura that chcvk this box mtwt anachul an additiurusl,hect showing the name of the mbwvmnelon and theft worken'comp.pulley infurmmion.
l ant an eitiployer shut it providiiig Ivorkert'euntpeitsadon iiisurm)ce for my etrrployees. Belury is the pollcy and fob site
lnjannalion.
Insurance Company Name:
Policy 4 or Sclf-iim Lie.4: Expiration Dole:
Job Site Adtkuss: City/state/Zip:
Attach a copy of the workers'compensatloa policy declaration page(showing the policy number and expiration date).
Failure to secure covenlge as required under Section 25A of\IGL 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 line
Of up to S250.00 a day against the violator. De advised that a copy of this statement may be furwardcd to the Office of
Inrrnigatiuns ul'Ate DIA for insurance coverage verification.
l do hereby certify utd the pair J peatuldes of perjury that the hrfurmallmt provide)above
is tru/eLond correct.
4i••❑ I e / - Dar",
Phone,t ZK/� ��/b—�-7/`ter
OJ/irial use only. no oar wrile is this area,to be completed by city ur tolvn of]4- L
CitynrTuwm PermidIAcensclt__..____. ._____,
Issuing• tilhurity (circle one):
1. Board of Ilealth Z. Building Departmcut .3.Cilylfnwa Clerk 4. Electrical Iospcchtr 5. Plumbing Inspector
6. OJrcr
I I
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