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11 OAK ST - BPA-16-952 'Z- The LThe Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code,780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a / One-or Two-Family Dwelling N This Section Far ficial°Use Only Building PomtiF Ahnrtber: . Date Applied: I Bandag OfEPW(Print Name) Signature s 9 SECTION 1:$ITE INTORMATION j 1.1 PFor!r dress: �� 1.2 Assessors Map&Parcel Numbers l.la Is `this an accepted street?yes no MapNumber Parcel Number I® 13 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public Private Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2�Owver�of Re�co`rd: . . LJT+ \\N/ c`L Name'(Print) City,State,ZIP 9`la lo6y °7 No.and Street Telephone Email Address SECTION 3:DESCIUPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building.. Owner-Occupied ❑ Repays(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 AccessoryBldg.❑ I Number of Units-ZZ I Other ❑ Specify. Brief Description ofProposed Work': UgAwylg ©R5� 100 —i- v L o oaL 1 k SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only . Item abor and Materials - - - 1.Building $ IV,IDOo 1• Building permit Fee:$ Indicate how fee is determined- ❑Standard City/town Application Fee 2.Electrical $ 3 �b0 p Total Project Cost?(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: 4.Mechanical (HVAC) $ List: 5.Mechanical (Five $ Total All Fees:$ Suppression) Check No. Cheek Amount. Cash Amount. 6.Total Project Cost: $ 3 FaCO ❑per]is Full ❑Outstanding Balance DW.' SECTION 5: CONSTRUCTION SE2VICES 5.1 Construction Supervisor License(CSL) n j 1 L LI Awt& w,Al--)AA License Number Expiration D���dddtttttteeeeee Name of CSL Holder �. List CSL Type(see below) � S '1-4 L��/lcCb.NS l N No.and Street V Unrestricted l JSFSolid cted1&2F(Buildings n,teoniu 000cu.R City/Town,State,ZIP m Coverin ow and Siding (�-� 2(� ` j ` Fuel Burning Appliances C 1 ; J� J-t .` b i 9Lt t'd'�I�PW'e��{ tion Telephone EmM Em ' address D I Demolition's 5.2 Registered Home Improvement Contractor(HIC) 3 'Expiration! Date ill An.� stAL's}(t'Al2 PE.I MZ" HIC Registration Number Expiration ate HICmpany Name or HIC Registrant N e r LAV �.�41Jcs Of z�Street b t s( TtANA w��ana t c No. ddreA `C tom- 5 W(CF 1 AAA, �als60 .�l 14 Email a Ci /Town State ZIP Telephone SECTION tk WORKERS,COMPEPISATION MURANCE AFFIDAVIT(NLG.-c.152.4 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 ..........,BL, No...........❑ SECTION is:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT Qjt CONTRACTOR APPIJM$.IaQR DUMPING rMM I,as Owner of the subject property,hereby authorize W l LL) acv, �Y-AL 4 to act on my behalf,in all matters relative to work authorized by this building permit application. ie> Print Owner's Name(Electronic Signature) Date T— SECTION 7b: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 conitained in this application iis�true and accurate to the best of my knowledge and understanding. 7r M Print Owner's or Auth i.Zed Agent's am� eE1 cfiDnic-Si�ature) � '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 mvw.mass.gov'oca Information on the Construction Supervisor License can be found at wwwmtass 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 ofMassachusefLs Deparbnent oflndushWAccrdents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia WWorkers'Compensation Insurance Affidavit:Builders/ContractordElectricians/Plumbers. TO BE FILED YAM TBE PERNaT MG AUTHOR1Ty. Applicant Information PleasePrmt Legibly Name(Basineas/Orgamration/fndividaal): W t I I1 AAA W4L,!5� Address: IS ir t-A l; MA ks:S 113 City/State/Zip: ` Ps\,\t uC4 Phone#:_ � 7Joo t Are you an enspbyerr Check the appropriate boar l.Q 1 ern a employer with employees(fill]and/orv Type of project(required): � d Z.�I am a sok propaiesor or parthership and have oo employeer.oddng forme in 7. ❑New construction any capacity [No workers'comp.:ousnance required) 8. Remodeling 3.❑I are a homeowner doing all work myself(No workers'eomp.insurance require&)1 9. ❑Demolition 4.0 1 am a homeowner and will he hiring cuum n rs to conduct all work m my properly. I will 10❑Building addition ensure that all contractors eitkvhave workers'compensation resonance or are sole I1. Electrical prgmetm with W employees. ❑ repairs or additions 5. l am a 12.❑Plumbing repays or additions ❑Th��g atom IhavehkW the workers'co p,inamtheatlached sheet bm employees and have workers'comp.msnuanee-f 13.E]Roofrepairs 6.0 Weare a corporation and it officers have uereised their right of eremption per MGL,. 14.❑Other 15Z,§1(4),and we have no employees.[No workers'comp.imurante required) 'Any applicant that checks baa al must also fill am the secdou below showing their workers'wmpeassom policy,m(armeuon. Homeowners who submit this affidavit indicating they=doing all work sod than hue ounide contractors go suhntit a new atiidavit iodicatiog such. tConiracmrs than check this bpm muss etloched an additioml sheet showing the mneme of the sub-cantr .and sante whether a not those entities have employees. Ifthe aubemntractors have employees,they must provide thea vrorkua'comp,pohry number. I am an employer that is providing workers'compeer tunion insurance for cry information employees Below is lhepolfry andjob site Insurance Company Name: Polity#or Self-ins.Lic.#: 13xpuatioa Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation poBry declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage veification. 'do hereby certify ander tie pains and peaakres ofperlury that the mformadon provided above Lr tree and correct .. Sutra• (A" lJ. Date'-! Z� Phone M G7 360 F )we only. Do not write in lhir area,to be completed by city or town oj)iciaL Town• Permit/Ucense# Authority(circle one): d of Health 2.Building Department 3.City/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector r 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 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 buildmg 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 commomreakh 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 sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(11C)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 thea o ste 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 pemnit/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 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 our 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 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.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia al YOF SALEM,MASSAaRSET ' BUIDMDsrAMAW 12o WA9MV710NS7aser,5m7 MIL 7454595 g ynurcrr�r FAX PM 740-9846 MAYOR 7�iar�sSTP Daux3cacippLaucanwt7y/Bmnmcmaamcmm Construction Debris DisposaiAffrdWit (required for all demolition and-renovation work) in acwr&nw with the sbrth edition of the State Building Code, 780CMit, Section iii.s Debris, and the provisions of MGL coo,S 54; Building Permit B is issued with the condition that the debris resulting from this work shall be disposed of in a properly ikensed waste deposit facility as defined by MGL c iii,S 150A. The debris will be transported by. � w��� 5 o ►� wA�� (name of hauler) The debris will be disposed of in: Mfi`!_tom (name of facility) �fl7Z.0 o (address of facility) Signature o pplicant Date r Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-058383 Construction Supervisor F - WILLIAM MICHAEL WALSH�4 c LAKEMANS 1 - IPSWICH MA 01938 IP . - r�J"'CK . Expiration: Commissioner 12/19/2017o1'C�/ aaorzT.LuaeCta'1 :Oitfce ofCoasumer A�'fa�rs&Business Regulation.. OME IMPROVEMENT CONTRACTOR a . egystrat�on ' 3 aR '. Fypo, ExPiWtj-on Y: a .. DBA- `.. . WILL W - f .WILLIAM WALSH 15.LAKEMANS LN -� IPSWICH, MA 01938 Undersecretary .. `°N° 4 Commonwealth of Massachusetts 60n R Citv of Salem 120 Washington St,3rd Floor Salem,MA 01970 978 745-9595 x5641 9 ( ) Return card to Building Division for Certificate of Occupancy Permit No. B-18-541 FEE PAID: $25.00 PERMIT TO BUILD DATE ISSUED: 6/12/2018 This certifies that WALSH CASEY J WALSH COLBY M has permission to erect, alter, or demolish a building 11 OAK STREET Map/Lot: 260020-0 as follows: Other Building Permit REMOVE & RE[;ACE EXOSTOMG 2'-8"X 6'-8" ENTRY DOOR Contractor Name: WILLIAM M.WALSH DBA: WILLIAM WALSH CARPENTRY Contractor License No: CS-058383 6/12/2018 Building Official Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. H I C#: 127323 "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641; Return card to Building Division for Certificate of Occupan Structure CITY OF SALEM BUILDING PERMIT PERMIT TO BE POSTED IN THE WINDOW Excavation Footing INSPECTION RECORD Foundation Framing Mechanical i Insulation INSPECTION:! BY DATE Chimney/Smoke Chamber i Final�_� I� Plumbing/Gas Rough:Plumbing J Rough:Gas J Final 0 Electrical Service Rough Final Fire Department Preliminary I I Final Health Department Preliminary Final "Ith of Massachusett O l � � "Salem n St,Bi�I Fedor Salem,AAA 01970(978)745-9595 x56111 ° ? DlWslon for Certificate of Occupancy (Permit No. B-16-2§2 FEE PAID: $161.00 >- TO BUIL DATE ISSUED: 9/2/2016 w � This certifies that HOMER � J r„ has permission to erect, alter, or demon " 'Id t as follows: Repair/Replace 1 SLUEBOARD &PLAS F £ A 1 WILLIibM M.WAILSH Contt©r-Name: : DBA: Contractor License No: C$,058383G< �« 6E. I This permit shall be deemed abandoned and invalid u may grant one or more extensions not to exceed six d All work authorized by this permit shall conf rrn to the . nand the approved constructltNt' " All construction,alterations and changes of Use of any $ Ititcures shall be in compliance with the This permit shall be displayed in a location¢leanly visibl t or road and shall be maintained ope „ work until the completion of the same. y The Certificate of Occupancy will not be issued until a + attires by the Building and Fire Officials H I C#: 113433 $T t wlitr 1 teoo"" actors daoot have" Restrictions: Building plans are to be availabkrerr-site. All Permit Cards are the property of the PROPERTY ,f. �e ;rz st CvmmonweaIt c RV 120 Washington St,3rd Floor Salem,AAA 010 Retum card to Building vision for Cert u M OF SkL riE�I BUILPL N , a 'PERMIT To BE POSTED 1 -PECTIQiV, x r � ing Acw k k', p MM ae + i< P ri Wal as mbi �k LGas. 4 C. tw z, 1 4 N t^ ` "'le rctelc`dt� x 71 i H6a1th Dep �tmi�� � t r � * { w � kiinonwealth of C`Fitv#v of Salem 11 120 Washington St,3rd Floor Salem,MA 01970(978p 745-95' x641 Return card to Building Division for Certificate of O�„,�pancy Permit No. B-17-209 FISIT TO B ILD t FEE PAID. $161.00 DATE ISSUED: 3/29/201.7 1 TNs certifies that FRAZIER ROBERT J has permission to erect, alter, or demolish at�Nlld�n � ( $ j Map/Lot: 260020-0 as follows: Repair/Replace SE ry REMOVE & REPLACE E REPLACE EXISTING WINDOWS Contractor Name: WILLIAM M.WALSH sR a DBA: "� � 0 Contractor License No: CS-05 4 y '` 3/29/2017 Date YM _ This permit shall be deemed abandoned.and invalid u after Issuance.The Building Official may grant one or more extensions not to exceed six All work authorized by this permit shall conform to the and the approved construction permit has been granted. a a• i All construction,alterations and changes of use of any res shall be in compliance with the d codes. This permit shall be displayed in a location clearly vial t or road aifd` be^aintained o n for the entire duration of the work until the completion of the same. The Certificate of Occupancy will notl,*issued until al b Bui an permlt. 'a" 4 # #: 127323 'P rrty fund (as set forth in MGL c.142A). Restrictions: r ri are to be Ot1 840. }, All Permit G O roper df'the PROPS OWNER. u, < w CdMMd Wg61th of Massachusetts � q; . • . Cid Of Sal 1201Nashingtot�St > or Sateen,MA01974 ac5641 iiuth card to SundlWon for Cerdillcats of0cc pancy Structure CITY OF SALEM BU'ILO },G PERMIT PERMIT TO BE POSTED. IN HE WINDOW Excavation . Footing 4 INSPECTION REC RD Foundation. Framing x.. : . echanical " Insulation ,, ;.> INSPECT DATE Chimney/Smoke Chamber Final 4✓ �� "^� � � Plumbing/Gas `��� ` Rough:Plumbing .R Rough:Gas Final g ZLfa Electrical .Se.service Rough irr Fire D artment Preliminary . Fitaat Health Department p s Iminary filial ,/`u