23 WALTER STREET - BUILDING INSPECTION 23 WALTER ST. Jam`
Certificate No: 689-09 Building Permit No.: 689-09
Commonwealth ofkassachusetts
City of Salem
Building Electrical Mechanical permits
This is to Certify that the RESIDENCE located at
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Dwelling Type
23 WALTER STREETin the CITY OF SALEM
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Address TowndCily Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
OCCUPANCY PERMIT OF (23 WALTER STREET)
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires unless sooner suspended or revoked.
Expiration Date
Issued On:Fri Jul 2, 2010
GeoTMS®2010 Des Lauriers Municipal Solutions,Inc. -----------------------------------------------------------------------------
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YSQVE AD
CITY OF SALEM
BUILDING PERMIT
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23 WAL 6$9-09
GIs#: _4289 COMMONWEALTH OF MASSACHUSETTS
Map: 2
Block CITY OF SALEM
Lot: 0321 -
Category: ALTERATIONS
Permit# 1659-09 BUILDING PERMIT
olect# JS-2009001318
I. Cost: $38,000.00
k e Charged: $271.00
alance Due: $ 00 PERMISSION IS HEREBY GRANTED TO:
oust. Classf ° Contractor: License: Expires
u' se Group' ul a' PRIDE CONSTRUCTION CONSTRUCTIO SUPERVISOR-CS97788
k of Size(sq.ft) 4000.1148&
onmg' R2 - ]Owner: MUDFORD DAVID &MICHELLE °O'
'nits Gamed. 7JAppiieant: MUDFORD DAVID &MICHELLE �+
nits Lost: 23 WALTER STREET '
t ig Safe
SSUED ON: 09-Apr-2009 AMENDED ON: EXPIRES ON: 09-Oct-2009
O PERFORM THE FOLLOWING WORK:
INTERIOR RENOVATIONS,NEW ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
s
4 Underground: Underground: Underground: Excavation:
i
,..,M Service: Meter. Footings:
'vtT
Rough: RougkRougl �� ` v �Foundation:
01,
�E
Final: _4e e Final: Rough Frame:L1'C •�,ur p�1CI� .� -
t 119
Fireplace/Chimney:
D.P.W. FireQ)e Health "
i' Insulation:
Meter: Oil:
Final: /° AtGV(((
i2 NouseN Smoke: 1'V l/J / �ja •_' y
Treasury:
'. Water: Alarm: As$essOr
Final;
Sewer: Sprinklers:
rry
s THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOL TION OF ANY OF ITS
' RULES AND REGULATIONS. '
Signature:
Fee Type: Receipt No: Date Paid: 'Check No: Amount:
-`'BUILDING 12EC-7009-00149309-Apr-09 1002 $271.00
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APPLICATION FOR PLAN EXAMINATION AND
BUILDING PERMIT
ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS
IMPORTANT: :1 licantc must complete all items on this page
SITE INFORMATION
Localion Name 2.3"('WEST Building $Iil* FAmty
Properly Address 13 t,.Wlih 2 16T, $A6a,t m Ors .
Located in: Conservation Area Y/N D Historic district B "
APPLICATION DATE
Use Groups
(check one)
Group Homes R3_RJ_
.t„ Residential Q or more Units) R2_
Type of improvement .,..i Re'sidential (hotel/motel) R _
(check one) Assembly(Theaters) 'Al —
New
Al _New Building_ - Assembly(restaurants 3c Clubs) A2r_A2nc_
Addition Assembly(churches) Al _
Alteration ,
Repair/Replacement Business ,..; Y
I P y. t1 Efluan,in:d' .
Demolition Factory(moderate hazard) FI
Move/RelocatC •-Il +•'+'
Factory(IoW hLiaid) F2_ j.•,t. ..
Foundation Only High Hazard 11_
Accessory Building Institutional (residential care) 11 _
Institutional (incapacitated) 12_
Institutional (restrained) 13
Mercantile ' ') M_"
Storage ,`�''+ �? - �$I Moderate`I'lafiird
Storaee, S2_Low
OWN&USI llP IN FORNIA'I'[ON(Please type ur I' )
OWNER Name �u{fGIfLLE 4-3=
�Ll(Gt'AQ� 1t LR7>64057nLG PLFIaiIC
Address_ -TP' Aklya�vrt IeGPRe �1A D/
Telephone
Signature ' � � ` 6&1
UI•aCI(IPTwN OF WORK 7'O BF. PF.RFORMF.D
nub JaWF� oFn�g o�n
I•:S'I'INI:1 rl?U CONS'RL'CI'ION COST 39, 000• .r.eq (Vj//
CI Olt IN FORNIA FION
Name P&Alia 6uddekl
Address
"A
Telephone E90=9P&,;1-
Construction Supervisor's Lic # JA
Home Improvement Con tractor#
ARCIII FECT/F
-N(;INI-'I-'R INFORMATION
Name
Address
Telephone
Mass. Registration # ---------
PE'10,1 ITFE'E CALCULATION
Estimated Cost x $1151,000 + $5.00=
CONINIENTS Ve
IN &ICH A ISOABANAA
The undersigned applicant does hereby attest that all information stated above is trite to the best of my knowledge
under the penalties of perjury
Signed (owner) (agent)
APPROVED BY : t
DATE APPROVED:
N1 I CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
,1111 . N1 S.I AM,-11
vl r.,Nt 12: l' 40 SAII.M. In it l IN 3177C
l,1. •)71.,'13-93'13 • P sx 979-.'4G IxuI
loYurkers' Cumpensation Insurance :oifftdavit: Builders/Contracturs/Electricians/Plumbers
tijnycant Information Please Print Leeihly
Name lBu.uwst t)r�anvatinNlnJlciduull:� — (jewu� L C
4A4-MI-?7N .fes
Cilyrstare.%ip. H I'hunc
Are jou at employer?Check the appropriate bus: 'Type of project(required):
:un a employer with 4. El I :on a general contractor and 1 6. ❑ New construction
enq>loyces(full antL'ur part-tune).• have hired the sub-conlracturs 7. (2 Remodeling
2.[] 1 an)a sole prnpricutr ar partner- listed oil rhe attached sheet.
ship and have no employees - These subcontractors have 8. . 1Q'Demolirion
storking for one in any capacity.Ko workers ](corkers' comp. insurance. 9. C] Budding addition
cam
I P insurance' 5. We are a corporation and its yuircJ.] of10. Electrical repair or additions
� rcliccrs have exercise](heir
7.❑ 1 am a hnmcowner doing all work right ofexeniption per MGL 1 I.[f�I'tumbing repair or aJJitinns
myself [Ko workers' Lump. c. 152, ¢1(4),and we have no 12.5rRuof repairs
insuranec required.] r employees. LKo workers' I3.0 011ier VA OHM LOCK
comp. insurance required.]
•tin .•,tpliiant Iliat chucks but nl must:dao till wn the.¢cnmr Iwluw.hawing thou wurkui cumpent,aiwt Iwhcy udiartlutiun
'I Iumuuwnen who udinul this atndavil indicating Ihe)am doing all wort and III=him wl%lde eUOIRM10m must auhmil a new fr,12.4 indiueng.u.h.
{,mo,.Kaav that shock thrs box ental atlwhcd,.n addlliunal nluntl.huwiny the nano of tho sub:ontnctors and Iheu wurton'comp.policy mfurmarion.
/am urr employer that it pruvidine workers'c•unrpenauion in.surancr Jur ury onpluyee.t. Belts is the pu/icy and job.tile
imjunnatiosm
Imirance Company Name:-- - - .-' - -----.----
1'oliev Nur Sclf-ins. Lice K: _sees. . _ __— Expiranon Date:
job Site Address: _-_. City%Stale/Zlp:
Attach it copy of the workers' compensation policy deelarallo i pare(showing the policy number and expiration date).
falluru to secure cuterage as required under SeLliun 25A ul•.%IGL c. 132 can lead to the imposition of criminal penalties of a
tin. up to 51.5110.1)0 and/or une-year iinprisonmcnt, as hell as cis d pcnalncs in the Turin of a STOP WORK ORDER and a fine
Of up to 523(l.00 a day .I galnst the violator. lie advised that a copy of Ihh slolvisicni Inay be IUMarded to the Office car
los ongalnnb u1 :hc DIA :,)rmsurarce Lo%cLl,;e tcrificaCon.
/du herehy c erriw under the pains and pot ev of yerjary that the iufunnuNon provided above is true uod corrrc6
_ _ 1'I, •, e r A,
I)/Jiciul tae mdy. Ou nor n•rire in rhi.r arra, to hr rmuyhvrd by cirycar Conn m//iria/. I
( ilv car fawn: _... _ Pei mit/l.iccnce 0_
Issuing Aulhurily (circle nuc): i
L Ilt.ard of llcaah 2. Itwldiu� Department 1. Cih.'fuao Clerk 4. Electrical Inspector 5. Plumbing lospeclor
6. 011ier
C.utlacl l't nun: .. _- I one it:
FX
Information and Instructions
NI.usoeli scus General Laws chapter I52 tcquires all cinploycrs to provide workers' compensation for their employees.
Pu nuarlt to Inis ,I At ate,an empluree Is dcfi tied-is" e,ery pel.son in the service of another under any contact of hire,
aspress or implied. oral or wniten."
An employer is defined as"an Individual, pumership,association. corporation or tither legal entity, or any two or more
.tl the torcgomg engaged In a joint enierpnse. and including the legal represewatives of a deceased employer, or the
receiver or lru&lee of all Individual,pwlncrJhnp,Association or other legal erlmty,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 011 the,rounds nr,twtljingtappuricnant.;ibereei-Shall Riot because Of etch employment be deemed to be an employer."
>IGL chapter 152. $25C(6)also slates that"every state or local licensing agency shall withhold the issuance or
renewal oto license or permit to operate a business or to construct buildings in the commonwealth for any
applicant "Ito has not produced acceptable evidence of compliance with the insurance coverage required."
Addiuunally. MGL chapter 152, 425C(7)states"Neither the commonwealth nor any of its political subdivisions shall
inter into any.contract for the performance of puhlic work until acceptable evidence of cunipliance with the insurance
requirements of this chapter have been presented to the contracting authority." - -
Applicants `.
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s) name(s), address(es)and phone nunlaer(s)along with their cernffcate(s)of
insurance. Limited Liability,Companhcs(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are nuttrequired to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and dude Ihe al'tidavit. The affidavit should
�hdiiJtnrii`e!I'iaPdic'$iry or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should ynu have any question 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.
Cfly or Town Ofticiala
Please he 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 nut in the event the Office of Investigations has to contact you regarding the applicant.
lll.ase be Sure to till in the pennit/license number which will be. used as a reference number. In addition,an applicant
that must submit multiple pennit 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 rhe 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 nmst be filled out each
year. Where a hums owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. it dug license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
I lu t)l llic of Liv Cvtl�'allUnD would Inn,io think you Ill advance far your cooperation and should you Ila%e dry questions,
please du nut hesitate to give us a call.
fhc DJ p.oancnt's addreS.S, telephone and fax number.
" The Commonwealth of Massachusetts «,:: ,
Department of Industrial Accidents. "t-
Mize
-
Mizeoflnvestigatlons_— — — _- - -- - —_-- --_ ---
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax 0 617-727-7749
www.mass.gov/dia
L.
CITY OF SALEM
<rj, PUBLIC PROPRERTY
�<
�,..\•� DEPARTMENT
I.0 \\ \+I II\ .. ':1;91.1 ! � 1.\I I V, \L\•+11 .. .. I . .I �
Construction Debris Disposal .affidavit
(rctluired fior all demolition and renovation work)
In accordance \%itll the sixth edition of the Slate Building Code, 780 Ch1R section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit i! is issued with the condition that the debris resulting from
this work shall he disposed of in a pruperly licensed waste disposal facility as defined by MGL c
I11. S 150A.
The debris will be transported by:
CAILS- 1900- b8t1- � ����esr 5¢- 1Nr1 fit,, cil �
Iname of hauler)
•
1lie debris will be disposed of in :
(name of facility)
laddresj of lanlity)
+Iplatwc of punt , p I ant
Imr
Plans must be filed and approved by the Inspector before a permit will be granted.
No. J. o -W City of Salem Ward
IS PROPERTY LOCATED IN THE �jv' /
V
HISTORIC DISTRICT? Yes_No� s
IF SIDING, HAS ELECTRICAL
PERMIT BEEN OBTAINED? Yes No Home Phone # 7Y4— A j 7
APPLICATION Bus. Phone # ZZ7—
PERMIT TO ROOF(REROOF R INSTALL SIDING
Salem,Mass.,
TO THE INSPECTOR OF BUILDINGS:
The undersigned herebv
' a_pploa p =build
acding t/ �)Ilgwin specifications:
Owners name and address N® p rb5
y/
Architect's name
Mechanic's name and addressT n( ,��t� E-4m 3o .�3
Location of building,No. v
What is the purpose of building? yes, je gP. _
Material of building? A'a7.1 Asbestos?
If a dwelling,for how many families'_ �'F!wy1 ��/
Will the building conform to the requirements of the 1 w?
Estimaied cost .ontractors Lie.No.
Signature of applicant
SIGNED UNDER THE
��� r re ro0F EMARKS PENALTY OF PERJURY.
No.J�6- i V Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location Z 3
PERMIT GRANTED
19 9V1
Approed
/per %u ding/n