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0002D ARNOLD DRIVE - BPA 16-1113 F The Commonwealth of Massachusetts nraiaF « 'tit 'J� [s " Board of Building Regulations and Standards CITY OOF, Massachusetts State Building Code,780 CMR )1 C R�DrsMdr2011 Building Permit Application To Construct, Repair,Renovate Or Deembolis 2 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:,,. Dat Applied: Building Official(Print Name) Signature 'Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers I 2LJ /�f2n[oLi) 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(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided RequiredProvided 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 2i PROPERTY OWNERSHIP' 2.1 Owner3 of Record: AL�i�r n H tg2y Name(Print) City,State,ZIP 2D /fir Hap Ud y i -/ 9z/-26-3-3 ? No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ I Number of Units Other ❑ Specify: Brief Description of ProposedWork2: 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 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ y, 4.Mechanical (I-IVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Su ression p Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ �5'�D ❑Paid in Full ❑Outstanding Balance Due: 0 t{ M A L t�s'p 'Tp L! . p . . SECTION 5; CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 12I/49 e�aZ� License Number Expifationl6ate Name of CSL Holder' List CSL Type(see below) No./7d jS i2ldn/ �� Type Description anStreet A'// / U Unrestricted(Buildingsu to 35,000 cu.ft. &ggG/e/D I-rI R I Restricted 1&2 Family Dwellin City/Town,State,ZIP M I Masonry RC Roofing Covering WS Window and Siding /! SF Solid Fuel Burning Appliances a a 45T—&ZL)W Na� I Insulation Tele hone Email address -/1 D Demolition 5.2 Registered Home Improvement Contractor(HIC) / ll Z ) 7 Z 7 G)9,C 441 V�✓G'LG- yk'�� HICRegistrationNumber puation Da[e HIC Comm an Nae or HIC Re 'strant Name 17f?Js�n/ J / /7/n/OGAJr,4"1R "-&4N AZ /.e�l) Io 11 9S�S�ZF�C 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 ofthe building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETE])WHEN OWNER'S AGENT OR CONTRACTOR APPLIE�SS FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize 12ZLm��/� �U/'/V`'` to act on my behalf,in all matters relative to work authorized by this building permit application. , moic ? Prit Owner's Narne(Electronic Signature) Date SECTION 7b:OWNER' 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 true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic 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.gov,'oca Information on the Construction Supervisor License can be found at www.niass.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" (214 unread) - dinofasciani - Yahoo Mail https://mg.mail.yahoo.com/neo/launch?.rand=5gi7bif6ke0kd#7674876956 iR Home Mail Search News Sports Finance Celebrity Weather Answers Flickr Mobile More v Q All Dino,search your mailbox S * Home © Dino / Compose Back to Message Arnold 2A-deck approval 09... 1 /1 + X t"b°'(214) American Properties Team, Inc. OR TO: 2A Arnold Drive FROM: Jennifer Pappas,Property Manager RE: Deck Replacement DATE: September 27, 2016 Please be advised that the Board of Trustees for Pickman Park has approved the replacement o the deck at the above referenced unit. This approval is contingent upon it matching the existint deck(composite materials can be used)and following the Engineering Alliance Deck Specifications. The Board will not allow any design alterations. We also require that permits be pulled in advance(regardless of what your contractor may tell you), and then a copy of the final approved permit once completed must be sent to APT for the unit file as well. You will need to bring a copy of this letter to the Salem Building Department in order to receiv your permit. _. Should you have any questions or require additional information,please feel free to call the AP' Service Team at(781)932-9229. cc: Unit File 0 I of 1 9/27/2016 5:36 PM F CnYOFSALEA MASBACF"ETPS BMLDMDaPAaMtr 120W S98 W,3mFio0R 7kL 078 745-9595. BIM9ERLEYDRIS(�IL PAX(978)740-9846 MAYOR 7)KKUSTJUM DmEcrmt crPUUJCFXOFM7Y/BUMW4G00MMONER Construction Debris DisposaiAfdovit (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 coo, S.54; Building Permit 8 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 1501. The debris will be transported by: (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signature of applicant Date k 1 rhe CommonwegM ofMgsswhuseds Depioftent oflxilustrialAecidents I Congress SOM4 Suite In Bosfon,AL4 02114-2019 www.mamgovlaia Workers'Compensation Insurance Affidavit Builders/Contractors/Electriciam/Plombers. TO BE FILED WITH THE PERRurnNG AUTHORITYApplicauthkMation . Plena Mal 14elbly Name(Busineiz)rgamaatiam/Individuel): f9 C/Ah/l r�1i City/State/Zip: �l �� Phone#: �f27420. Are you air empbyeYt deck We spprspalm bo:: jr f e Plama lovervvime6q, ., (full and/or oma e> ) Nengn dp ant>Lavoyaa+workmg formCOMP,mamdce retired.] Demolition3.p1amahmeowmrdomgasworkmywM..(Noworkedcompmamance mgmrod.l i Butldmg'edditiort4.p lam a homeow mdm71 behirMemmactm m condadall wotkon my pmpety. I'comprnufiMiasmancecvMsole ElveWcal repeits or additions I withnoemplayxe. Plumbmgtepausatadditioiis5.Oleaiageaealcoin a wd I hm hind the K"M ed Poe agedabeRood7bmsub w4ac usheveemploymsodhavew�rcomp.m„gaayi. reel6.pWeenacOther15$§l(4),fbot #1 mast alaofill' gig recon itdowahLwhtg�wall ahm. - i Homeowma who sulnmt>biA afftd ; • - . mdmalmg they are doing a0 wmli And thedltire wmde wntaitas nnat'AoLaoa a aewaffidavitmdirJ�g mc6: lCmaacmn that check mii Goa must wmdwd mud"onal sheetahowing annauinfthe'cub woderJuiiand slate ivhePoaarmttireeemiga Lave . employee+.Ift6e aub:e4uvacrwahaya e®pluyas,ffiry,mustpsovide heir-wodms'.eomA lm�Y � .. lam an employer tlratlsproeidfng workefa'compesaogion insurmuefor av �mpd gees 8rlew is thepnliry�a►fob sire lnformadoa. CF)TALi)o �IiIJ. �(/e2� �/�eN ,c�act�(FarFc %/Gd Covtc Instaance Company Name: P. Policy#or Self ins.Lic.# 20o o Expiration Date.- Job ate:lob Site Address• Z O ./f`t'IVCJI4 tO Cih/3tetvyiP: ��/2ry�Z/� Attach a copy of the workers'compensation policy diclaratlon page(showing the policy number and expiration date). Failure to secure coverage as required under MGT.c. 152,§25A is a eirmna]violation punishable by a foe up to E1,500.00 and/or one-year imprisonment,as well u civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy oflois statement rosy be farweided to the Ofice of luvesdggtions of the DIA far insurakce ,covemge veri$cation. I do herehy eelrlfy w4ffr keatinss mg4wWfles ofperjury that the information provided�above it bate and carred Signature: Phone d r6Other cial use only. Do not write h.this area,to be coeydeted by cry or town ofciaL or Town: PermitM&ense# ng Authority(circle nae): ard of Health 2 Bonding Department 3.City/Town Clerk 4.Electrical Inspector 5 Plumbing Inspector act 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 centrad of hire, express or implied,oral or wrinep." 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 die 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 badness or to construct buildings In the eommonweakb 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 diall enter into any contract for the performance of public work until acceptable evidence of compliance with the innmance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by decking the boxes that apply to your situation and,if necessary,supply sub-contractors)narne(s�address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLCM or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to terry 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'compames 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 rust 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 damped 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 trust 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 dqg license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 Tel.#617-7274900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia