7 HERBERT ST - BUILDING INSPECTION 56°= Gi~ 7 8
The Commonwealth of Massachusetts OF
Board of Building Regulations and Standards CITY SALEM
Massachusetts State Building Code,780 CMR Revised Mar 2071
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
Tbi Per 00
FE
g Peainh Numbea: Dale �p/r)ipd: : I`- `i' G4
Priut `ejl:EC770fv 1i SI3iFodIAressiessors Map&Parcel Numberspted street?yes no Map Number Parcel Numbering 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
Regtmed 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? Mumcipal❑ On site disposal system ❑
Check ifyes❑
- SECTION Z 1'ROPEItTY OWAI�RSHIPr
21 0� 1 of Record:
.kg
Name(Print) -- City,State
-* 6 6-:�f 34y_ 1V/
No.and Street Telephone Email Address
SECTION 8:DESCRTPTION;OF PROro'SED WOMO(ehea all that appiy)
New Construction❑ Existing Building❑ Owner-occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.O Number of Units I other ❑ Specify:
Brief Dcscriptian ofProposed World:
't�{reo lat'� rd �6 .•t
SECTTW a:EST14AATED CONSTRUCTION CONS
Estimated costs:
Item Official Use only
(Labor and Materials
1.Building $ 1. Bulkling Permit Fisc:$ Indicate how fee is determined;
2.Electrical $ 0 Standard City/Town Application Tee
D Total Project Cost'(ltctn 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ession Total All Fees:$
6.Total Project Cost: $ OC-00 Check Amount. Lack Amount:
Paid in Fail O Outstanding klalance Due:
5eva TO P.o - (3b Y,
SECTION 5: CONSIRI)CUON SMWM
f5.2Re
struction Supervisor License
l(CSSL) / / ;
/'fCYLi ense Number Expiration Date
CS olderList CSL Type(see below)L3� BYs t trreeet/(eU Umeicted d •din to 35 d00 cu.ftR Restricted 1&2 F Dwe ',State,ZIP ' M MasonryRC RoofinCov 'WS Window and SidingSF Solid Fuel Bmnmg Appliances� Insulation
Email address Demolition
erect Home Improvement Contractor(ffiC) /r5 _ /a/' �Jt? �%J/'�/CL� �Q/6 �(C/Co O—�iratiioonDGate'
HIC Comp6y Name or HIC.SC�Cznt��.**ame
Ve cs
No.and Street Email address
Ci /Town State ZIP Tel hone
SECITON&WORHMS°COMPENSATION UOURANCE AIrMAVIT(NLG.I:c.152.3 25C(b))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
rthis affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... 13
SkCTfbN 7a:OWNER AUTHORIZAMON TO Bi COAVLET?ED WHEN
OWNER'S OR OR JFOR R'INGPERMIT
I,as Owner of the subject property,hereby authorize /Xle/?`�> 1A6c--qv,-a r —>
to act on my behalf,in all matters relative to work authorized by this building permit applicati
Print Owner's Name(Electronic Signature) Date
SECTION 7br OWNEW 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.
13/i 2
Print Owner's or Authorized Agea' e(Electronic Signature) Date
Nt2fi1�S: _
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. og v/oca Information on the Construction Supervisor License can be found at wM.mass.eov/dos
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"may be substituted for"Total Project Cost'
'\ The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
' www mass.govldia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information ,{ Please Print Legibly
Business/Organization Name: AT Cot—
Address:
City/State/Zip: ser � Phone
Are you an employer?Check the propriate box: Business Type(required):
5. Retail
1 'or
I am a employer with_�employees(full and/ ❑
orpart-time).* 6. ❑Restaurant/Bar/EatingEstablishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate, auto,etc.)
employees working for me in any capacity.
[No workers' comp.insurance required] R. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152,§1(4),and we have 10.❑ Manufacturing
no employees. [No workers' comp.insurance required]** 11.❑ Health Care
4.E] We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 12.0 Other
*Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
/am an employer that is providing workers'compensation insurancefor my employees. Below is the policy information.
Insurance Company Name: ey/ Q q
Insurer's Address: yy,�,� `/V/
City/State/Zip: r'( jAll7w
Policy#or Self-ins. Lic.# Expiration Date: ��! 1{o
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 and penalties ofperjury that the information provided above is true and correct.
Sign ure, G� Date: 1 `
Phone#:
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
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 your insurance company's name,address and phone number along with a certificate 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). 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 Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
www.mass.gov/dia
Fonn Revised 02-23-15
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Construction Debris.Disposa/AfffdeW
(required forall demolition andrenovation wwlc)
In aomrdmo wtar ane mbith edlaon of the Stabs e B CQdI,7WCA&%Sedion llLS ibdni
and the provbkm of M161.oW S S4;o mw pem*N is hawed w th are
condW on tort the debris ft from fids worksi*g be dh po;rl of hr a propettl flmned
waste depm*{aims defined by M6t t 221,S MA.
The debris will be transported by:
(name of hduler)
The debris wM be disposed of in:
(narneoffaci ty)
(address of feditiy)
Signature p licant
Date
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6
Qffi��ece of'Griitsumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massaclusetts 02116
Home Improvement Cjb�tor Registration
Registration: 169898
/7) Type: Corporation
Expiration: 8/16/2017 Tr# 269884
MURRAY MASONRY & MORE, CO
BRENDAN MURRAY a $
P.O. BOX 8454
SALEM, MA 01971 r
a�
Update Address and return card.Mark reason for change.
SCAT as 2OM-0591 � Address [] Renewal E] Employment Lost Card
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ce of Consumer Affairs&Business Regulation License or registration valid for individul use only
OMEIMPROV ENT CONTRACTOR. before the expiration date. If found return to:
egistration: !, 96 Type: Office of Consumer Affairs and Business Regulation
piration - Corporation 10 Park Plaz.-Suite 5170
f,J� Boston,MA 02116
MURRAY MASONRY' - - [iORATION
a
BRENDAN MURRAYO
10 REAR JEFFERSON - ti r, . ,.� �'
�9L�M,MA 01970 ~Undersecretary Not valid witho e
li
• cfT,4e�ommeontoeo/!�c o�'Ca/lloaaaalucseda .
of ConsomerACaus Busium Repletion I3cease or registration valid for individual we only
E IMPRO ENT CONTRACTOR before the e4*stion date. If bond ram to.
OR6oe of Consumer A&=and Busmess Regulation
Type: 10 Park Plaaa-Suite$170
Supplement Card Bow,MA 02116
MURRAY MASON. ORATION
BRYAN BORRELU
10 REAR JEFFERSON'S
KEW,MA 01970 Undusecretary Not valid withoutsignatnre .
� �J�Office of Consumer���nd B�u�es�g�ula
10 Park Plaza - Suite 5170
Boston,=ntractor
husetts 02116
Home Improve Registration
Registration: 169668
Type: SupptememCard
�? r1 Expiration: 8/16/2017
MURRAY MASONRY &MORE, t�
BRYAN BORRELLI a�
P.O: BOX 8454
SALEM, MA 01871
/a
° M }'O Update Address and return cartyt�.�M....a��rkkrnass�on'forchaoge.
SCAT 0 2DMZSMt ❑ ' ❑ Rmewal ❑ Empl ymeent- ❑ Lod Card
Structures North 00 ®®® 60 Washington St, A01 401
97
Salem,MA 01970
www.structunes-north.com
CONSULTING ENGINEERS, INC. T 978.745.68171 F 978.745.6067
ProjectMemoranctum 9
To: Dorothy Raczkowski
From: Greg Nowak
Re: 7 Herbert Street
Salem,Massachusetts
Date: 27.July.2016 Pages: 1 (including cover)
Dear Dorothy,
We recently received photos from Murray Masonry&More Corp.,who performed the structural repairs at
your residence at 7 Herbert Street in Salem,Massachusetts. The repairs included: placing new cast-in-place
concrete footings, re-building the lower portion of the chimney(including steel angles with adhesive-set
threaded rods to restore support to adjacent floor joists), replacing an under-sized beam and replacing deficient
columns(vertical supports). The scope of this work outlined on our sketch SKS-1 was limited to the southeast
corner of the house,below the kitchen; this was later expanded to include an additional column replacement
below the living room.
Based on the photos and discussions with Brendan the work has been completed in general conformance to the
design drawings we provided dated 3/11/2016.
Please call or email me if you have any questions on this information.
Thank you,
Greg Nowak