Loading...
5 LARCH AVE - BUILDING INSPECTION The Commonwealth of Massachusetts i Board of Building Regulations and Standards CITY OF A / Massachusetts State Building Code, 780 CMR SALEM 5' Revised,C/ar 1011 ^ ll Building Permit Application To Construct,Repair, Renovate Ot Demolish a \V One-or Two-Family DiveUing . .., This Section ForAflicial Use Only.: I BuilJingPemiitNumber. Date Ap led. -Building Official Print Name). - —�-"`—" g ( St tore .. - Dale f DI SECTION t SITi;INFOILNATION 1.1 Property Address: r 1.2 Assessors Map&Parcel Numbers 'rJ man G to 09t rC, ! I.1 a is this an accepted street? es no Mop Number j i ;p e 1.3 Zoning Information. 1.4 Property,Dimensigunrrf#a�l;g; jt) Zoning District : Proposed Use - LorArea(syR) "F(+britnge(R) ,. IS Bull dingSetbacks(R) . Front Yard - ` Site Yaeb - Rear Yard Required Provided Required -Provided. .Rcgeiled- " - Provided 1.6 Water Supply:(M.C.L c.40,§54) 1.7 Flood Zone InferronNow 1.8 Sewage Disposal System: Public O Private O. Zone: _ Outside Flood Zone? Municipal O On site d�sposaisystem O Q0401Tf esO Y"OIVIYERSHIPr SECTIONS: PROPER 2.1 Owners of Record r y / �S.. Y ..Nt me(Print) - S9�y-�� -Vor No.and Street - Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check n1I tbaE apply) New Construction O EXhling Building0 Ot"Or•Occup(ed D Repairs(s) O Iterrtion(s) 0 Addition O Demolition O Accessory Bldg.O . Number ofUnits / Other Specify Brief Description of Proposed Work-: S SECTION 4:ESTIMATED CONSTRUCTION COSTS. : . Itcm - Estimated Costs: -- Labor and:Materials Offleinl Use Only 1. Building $ 1. Building Permit Fee:4 Indicate how fee is determined: �.Elecuical $ O Standard Cityagvrn Application Fee- ❑Total Project Lose((tem 6).%multiplier x 3.Plumbing S ! Qther Fees: S 4.Mechanical (FIVAC) S List: 5.:Mechanical (Fire Su ressiun) $ Total All Fees:S G.Total Project Cost: 6t) Check No. Check Amount: - Cash Amount: _-o l7 Paid in Full ❑Outstanding Balance Due: (Inr--A-t asp IJ Sf�vL <�i SET ?�"?SECTION 5: CONSFRUCI IONSERVICES / S.i Construction Supervisor License(CSL) q(Z 3 Ll9- License Number Expiration Date Name of CSL HolderELlt: W.FalrB ListCSL'rype(see below) I HIM "acct IT. Description . No.and Street UnstrictSBie � din u 'to 33,000 eu.R. Restricted IB2 F unit Dwellin Cityfrown,State,ZIP :M Meso RC Rooting Covering NS Viadow and Sid' SF Solid Fuel Burning Appliances q'-7 - 7(, Y- 9'l 14 5 1 lasula ion Teleone Email address D Demolition 5.2 Registered.ttome Improvement Contras or jHIC) t1 Z�/s(, /Z / . w(asitheirization,LLl• HIC Registration Number Expiration Date t11C Company Name � �0llle Email address No.acid Street _ Ci /Town State ZIP Tel hone S,CT.[()N 6:WORKERW..COMPFANSATION:INSURANCE A#FIDAkVI I (NLG.C:.c sa :I52.§25C(6)y.. Workers Compention Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance ofAtiflitulding permit. Signed Affidavit Attached? Yes.......•.• No••^••• "'O SECTION 7a:OWNERAUTHORIZATION.-TO BE.COMPLETED-WHEN,'. OWNER'S AGENT OR CONTRACTOR APPGIE3FOR DUl/LDING.PERMIT 1,as Owner of the subject properly,here y authorize �V t G PQ L f vl t9 act on my behalf,in all m//otters relay a to work authorized by this building permit application. P/ r Dote Print Owner's Nante(Electrons Si one _ SECTI N 7b:OWNERu ORAUTHORUED AGENT DECLARATION By entering my name below,l 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 Owr er s or r uthorizcJ rt� c Icctronic Signature) Dote NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires art unregistered contractor _ ontractor(HIC)Program};will ne have access to the arbitration (not registered in the Home.Improvement C . m �inf— n theH — rmes uWar programorguaranty Lund under M.O.L.c. 42AOt ortelnorononProgacano www mass eov'oca Information on the Construction Supervisor License can be.found at AAA, ass.govhlus . 2. \Vhen substantial work is planned,provide the it*0 rot c dingl�g�finished basementiattics,Dxcks or porch) 'rota)floor area(sq.ft.) Habitable room count Gross living area(sq. ft.) lumber of bedrooms Number of fireplaces Number ofhall7baths Number of bathrooms Number of decks!porches 'type of heating system 'type orcooling system Enclosed Open ). '*Total Project square Footage"may be substituted t'ur"Total Project Cost" Mass baa basic tegauemc�fsoffiestaR'sH®e3m(ryvffi®t _ 0lboeof YY � � OTmPtat�eaP'be£ataa em P�nm �1O9�eolssyoAdS�Ktdttam COPYof�'A dB°�esRogdaum§Coostm¢3nf'otm�ioaFntlme�617 -5787 1-ES&28?- n wP9ltYUM1115the FfOe�aarrrner]�r87nE3aD 3757 arm aa:urb� kli xame Q:oatracFordllformaFion &trsethddrea(dv wtuseaPost aoeau L ) Coatmtod nil c9 .illic Ciry/I'm:n $tate '6!`' 'Jet4er�pn AWmpe 8miae.4Add�s(rm�-• DaytimePhmc„ - . . 'evenmyPunae" '� City?arm size, zip Cade Mailirg hdaca¢(ndiiierentEom ohm-e} 8®e>r Paw, Frderd rPapte7¢IDe$S.Nma57 L�A� �i•"s'fJ de t>:2fCFlariengr;nt$ftRfha$ma�.:Der. _ (D3cnbe in deal Wea'mkme®Pteub•ep y�sNC4'p;.Incnd.md ice ego' Henaired?'<Shcnjth ds3wY he :4Fnouhcflta1cm—idthme8h'P¢n uTsaetuy ;ad CaIDpld ac"rd tha handhdtana WemsaAgE ..... = eDQnn,2n n SaSadnte-15CfOIIopipgschE�7ewta ®dthecmttacfolswntrdarisr A tr'eii.ha©SerMU—) - 'Fend[sravesiflns os" Ilatevdren emmngoryral brgo wnNtetW aadc Tota}Cont aC P:3L and Pa . Dates�dtpa timtracted twdcen7l6emn .."..... Ymzat$rheaele �oamplmat. ?hc ContramH:gRes to F+'rimatLn..mlti fvrvfs3 dtemateaal aodlahnr {��� P43MMIS1v311bamadenooe sP�Bedabtmcisthemm}srm o£ _..dX/C/ Q� 'fW o� .. tdmStn NefaBnnimgschedote: (% upon s3givgwnhaC(amte atased 3r afthero:al ronhact s °Y capon Pdceg the cattnfsasvl atderitem;Wa3ehevaisg�t¢) s wmvledm a[ by wopen camoteden of ri7 _e ir/)v ---F"�upon wmnletian oFthewntprt. 'Befaxen;ng.�,ea:.t Sp'��® Wnit2C i5 al bmb - ardaad�efamdmcmrr a m s b .d f _ ,Pedro PaityJs�tis6Uion) .H me eampl:7a,_efi�yya{^j S h- fm pIc?T5:()inGeding.ll fiazncr'QrEaP%L-:•r" tent ra:cesdt'v°6x°aeroE(a)ai>th{al of aiirimw.4��J ard¢,d m- •PtYmcar gadr�6y�wnn`i ea eYamnaII fill as�, .dvunoro�We�r�pte5anxehNde��m:tafmrysp�al�IviPmrnt aruvtammademzlend Grn:�ay5rcr--n _ta: �n.-�srnmnntva'n Sobun!ramor;-Tneeoatmv^rx ^':am tnthcmatrarnn - pmlgfsabaHntyyn:a813z:d n�°smto�ietYtcnoaable;atwmol ,se�vr;t°n °fm°a°.mn.�ttra mm:ntne erinnt m-tariaJs adlv6 ru d�-h �e Cjp� inemn(r�ttorfan've efioa o:thea.ma-desajnedryip�aFdreac(ansaPwyWild Cvnesct Ree. is `"� a3rres to hesddyrpp�yefnr P�wfstoaa sabaeahaotmsRc wnhactr P � .3aoe siptln_this deo.��6�esabindm . -hall aotlmPl3'diat�ytiea a:otlt¢�nyH�-t5z;6eense�Gactnnd¢law 3)at careFidly before signipg this caanact P3awdm the asathetvn�trotedtmEtm Wisdnenmens the +mdcnee Reviecrr7ielo8mtsngwnpp��nnGees ° Don'[C-e[nn�med(ata ai�3pBdtecapayi^t ° ivaf_sw-eehawn � rtea:av,33dY a�tio5meto zad and fidl� Ask et5mmen _ . _ahacntractas tohe. ertCantraztorP..j, -a 4n-etiansuaom g�smdeer. . reys+ladan 6Yuii[ia at tsito iheD GroP$jop'iome3mptnpomwt Conazetar nelmrregm:es seoa cny}o�'�m oiy�jw?TvrWeC®7w,to%io:hu59sm>mw cam o211�6oryyglhSG�X87 or8E8-3E33757. and ° l;nor:}•Harr,'.- s'n�'dvcumaat paeybran- ee so tktyan cam coni mfs�du-y�,cuyybH3Gcs.Zead r = °a°aa84 orzs.§to Guide to theXorae ictpcnyemertCoaanUar3,az�Poaagfj°f°tmm an mczrase - sdeoflh�imm aedgmacapyot'theCoes®er \ frau may mew, ism'a-m®tifith�he�sigaedaaP3azeafL¢ I tW'rd busbissd°yneUmgatlde/h¢maie v6mp¢-p,mmett1>s Wemaaaetm`san,.,.,t me of \\ 1tG':^esigdngafthisa8teameat s� edtpoll iavwafraHm:s� wyy Malm�Prott1:15yyonn raftha u�Q.' eDhtu=y n-EadonFom mr�ecpu�npnn wthEsrigut Taoid_r�cm�°rL:.c-_cr6> CT3-, �:a��e°as:'aa Atm 'i. z�T•£ai�Q:TM�uYsr n ldmm�vcaer'e$f Caataetar'o3Y Daz Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitmati,acfion(as an alternative to court action)if they have a dispute with a coutrecmr The same right is Out automatically afforded to a } contractor.however. The contractor would bave to resolve my disputebe/she has with ahomeowaur in court unless both parties agree to the optional clause provided below. This clause would give the coahactor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the coctor� i the SecrettayofthaEliq9litz.371gghe dispute to a private arbitration firm which has been approved by firm which has been approved by dasumer Affairs and Business Regulation and the consumer shall be required to submit to sucfi aihdrati asc f#$llt4�chusetts General Laws,chapter 142A. 7 �!! Homeowneses Signature Cm ct a ro s�`ianature tr- 1V®TICS:The signatures of the parties above apply only,to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(Le.MGL cbapier93A)may-not be waivedin anyway,even by agreement. However,homeowners may be excluded from certain rights ifthe contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manger Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty forwodonansbip ormateriaLs. In addition to guarantees or wairmties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration.of tNhermatters on which the homeownerand contractor lawfully agree maybe added to the terms of the contract as long as they do not restrict a homemvnees basic consumer rights. Ifyou have questions about your coasumer/homeownerrighis,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties am also advised not to sign the document until all blank sections have been - ailed in or marked as void,deleted,or not applicable. One original signed copy ofthe contact with attachments is to be given to the owner and the otherkept by the contractor Any modification to the original contract most be in writing and agreed to by both parties Contracted workmay not begin until both parties have received a fiilly executed copy of the contract,and the three day rescission period has expired; Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems hinaerself to be financially insecure,the contactor may require that the balance offends not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Vriihdrawal of fimds from said account would require the signatures of both parties. Additional Information If you have general questions orneed additional information about ffie Home Improvement Contractor Law or other consumer rights,or ifyou wish to obtain a flee copy of"A Massachusetts Consumer Guide to Home Improvement" contact Consumer Information Hotline Office of Consumer Affair.and Business Regulation 10 Park Plato Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR ivebsitc at htto:/Av%w mas"ov/ocabr/ If you want to verify the registration of a contractor m if you have questions or need additional information specifically about the contractorregistra5m component of the Home Improvement Contractor Law,contact Director of Home Improvement CmtractorRegisuation Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,988-283-3757 or visit the BIC vrebsite at htto:fAracw.massxoc/acabr/ Go online to view the status of a Home Improvement Contractor's Registration: htm://db.statem&usthomeinmrovement(licenseelisLasD For assistance with informal mediation of disputes or to register formal complaints against a business,call: ` Consge6Complaint Section offfdbft�bAttorney General 617-727-8400 kIMIOR Better Business Bureau 508-6524900.508-755-2548 or 413-734-3114 v�.i.zi-urmmto The Commonwealth of Massachusetts Department of Industrial Accidents 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 LeyAly Name (Business/Organization/Individual): A&0a5tt610 �/ ttictttlattult,LLC: 61 R e crmw Avenue Address: Saiefn \n n 1)1970 City/State/Zip: Phone Are yo n employer? Check the appropriate box: Type of project(required): 1. I am a employer with Z _ 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. r-1Weare a corporation and its 10.❑ Electrical repairs or additions 3 ❑ I am a homeowner doing all work officers have exercised their l I.E] Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12.❑ Roof r pairs insurance required.]t c. 152, §1(4),and we have no 13. !her employees. [No workers' ^L/✓S cf� dv comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing theirworkers'compensation policy information- "Homeowners who submit this affidavit indicating they are doing all work and then Etre outside contractors must submit a new affidavit indicating such. FContractors drat 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: O u?-I G 4 Policy# or Self-ins.Lic.#: 1�6 a 7 D /2- Expiration Date: 3/ZULI Job Site Address: . LEC /;I-0'eCity/State/Zip.5 " f 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 abre is tr a and correct. Signature: 60" Date• Phone 9: 9. 7W Citi 3 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 1. Other Contact Person: Phone#: gF- , Massachusetts Department of Public Safety Construction Supervisor - n Board of Building Regulations and Standards Restricted to:. License: CS-087977Unrestricted-Buildings of any use group which cor#ain Construction Supervisor Yf lelosed han35,000 cubic feet(991 cubic meters)Of R ERIC W PALM 3HILTON ST SALEM MA 01970 Falum to Possess a'current edition ofthe Massachusetts (' �•^K -CX— Expiration: State Building Code is cause for revocation ofthis license. Commissioner 04123/2018 - OPS Licensing information visit W W W-MASS-GOU/DPS or rr oxr,rrr/f6.3/7 fr rr net! License or registration valid for mdlvidul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to:. - -.1 Q ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation - a - egistrabon: 147089 Type: 10 Park Piazze-Suite 5170 _ iration: 31121.2018 Ltd Liablri Co or 02116 OP P _ N R Boston, ATLANTIC iNEAT HERIZATIOT&L.C. ERIC PALM 61RJEFFERSONAVE - -SALEM,MA 01970 Undersecremry Not valid without signature i