18 SAUNDERS STREET - BPA 11-540 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
i I Massachusetts State Building Code,780 CMR,7"edition OF SALEM
Revised January
Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008
or Two-Family Dwelling
his Section For Official Use Only
Building Permit 14um r: a Applied:
Signature: 1 q q ¢
Buildiomnis n Ins ctor of Buildings Dale
SECTION 1:SITE INFORMATION
1.1 Pro ddress: fi G4*AN191.2 r� rsors Map&Parcel Numbers_ O
L l a Is this an accepted street?yes no Map Number �� Parcel Number
13 Zoning Information: 1.4 Prope Dimensions:
Zoning District Proposed Use Lot Areli(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
5` A I 1T l o'
L6 Wa er Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood one?
Public Private❑ Check if Yess Municipal �On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
NTf &LK*
Name(Print) }• Address for Service: J'� J
1111. 17y l�uS
Signature Q Telephone
S CTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction& Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Workz:
w a ►nt , ��� F�ti�l���
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ I,S p�4 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
Ooo ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ oaa 2. Other Fees: $
4.Mechanical (HVAC) $ ow List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
I Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ I bu 0�0 ❑paid in Full ❑Outstanding Balance Due:
L (
y SECTION 5: CONSTRUCTION SERVICES ,
5.1 Licensed Construction Supervisor(CSL) Ian 1 21 1 C
--MO License Number Expiration Date
Name of CSL-Holder 1' n V1 d
16ASAb1 List CSL Type(see below)
Address Type Description
U Unrestricted(up to 35,000 Cu.Ft.)
R Restricted 1&2 Family Dwelling
Signature M Masonry Only
IN- RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature 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 of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�12tLkA, rwj as Owner of the subject property hereby
authorize4iel to act on my behalf,in all matters
relative to work authorized by this buir,
pe 't application.
Signature of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1, as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
7
Signature ofO er Authori gent Date
Signed and the ' s and penalties of
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) I Ay l F�, (including garage,finished basement/attics,decks or porch)
Gross living area(Sq.Ft.) 141,M
u )Itl V WOW Habitable room count S
Number of fireplaces Number of bedrooms 3
Number of bathrooms Number of half/baths
Type of heating system W A0A Number of decks/porches Z
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
' FROM (WED>OEC 1 2010 14:01ZST. 14:O0/N-.aSOS4e4S6B P 2
OP ID:KQ
CERTIFICATE OF LIABILITY INSURANCE °"'11"x°°""""'
12roU10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. ,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N the Cariifieata holder is an ADDITIONAL INSURED,the pol"Ies)must he endorsed. N SUBROGATION IS WAIVED,subject to
the terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not Confer rights to the
certificate holder in lieu of such endorser s.
PRODUCER 978-465-Mi CONTACT
HAZE:
Arthur S Page Insurance Agency 97852-0890 PHONEHp.
57 State SL L
gxtk Newburyport,MA 01950 p =
None REDCO.1
WMJRMS)AFFORDING COVERAGE NAIL e
INSURED Redco Construction,Inc. INSURERA:Scottsdale Ins Co
Erica Reddy INSURERS:
8 Pheasant Run Drive
Newburyport,MA 01950 INSURERC:
INSURER D:
INSUNER E:
I RF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED- NOTWITHSTANDING ANY REOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAJN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR AM 3
LTR TYPEOFINSURANCE INVOPOLICY NUMBER POLICYEA MYRS
GENERAL UABanY EACH OCCURRENCE 3 1,000,000
A X COMM ERCIALGENERALLIABILITY PS1185773 06/08/10 0510/11111 PREMISES Eeace:C w i 50,000
CLAIMS-MADE FXI OCCUR MED EXP(My..pe0 S 5,
PERSONAL"ADVINJURY 3 1,000,
GENERAL AGGREGATE E 2,000,00
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-CONIMP AGS $ 1,000,00
POLICY 7
PRO- LOC $
AUTOMOeILELIABILRY COMBINED SINGLE LIMIT S
(Ee ardent)
ANY AUTO BODILY INJURY(PW pNNm) S
ALL OWNED ATOS BODILY INJURY(Px amd" 5
SCHEDULEDAUTO
PROPERTY DAMAGE 3
HIRED AUTOS (Per aWdwit)tlMlt)
NON-OWNEDAUTOS S
i
UMBRELLA LMB OCCUR EACH OCCURRENCE S
EXCESS UAB CLAIMS-MADE AGGREGATE S
1 DEDUCTIBLE 3
RETENTION 3 3
WORN ERSCOMPENSIITNIN WC5TATU- 0714
AND EMPLOYERS LIABILITYYrN
ANY PROPRIETOR)PARTNERIEXECUTNE ER
OFFICERMEMBER EXCLUDED? 17 NIA El EACH ACCIDENT S
(MandMaryln NN) EL.DISEASE-FA EMPLOYEE S
If yes,dasalba Ueda
DESCRIPTION OF OPERATIONS DMwi EL.DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Aft AACORD101,AddMmal Re SMIaOui%ff o Wnelea Wmd)
CERTIFICATE HOLDER CANCELLATION
HALLORA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
JEFFERY HALLORAN ACCORDANCE WITH THE POLICY PROVISIONS.
CI +C2 SAUNDERS ST
SALEM,MA 01970 AUTHORIZED ATNF
None
;=z
®1968-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009!09) The ACORD name and logo are registered marks of ACORD
FROM (WED)DEC 1 2010 14:09/8T. 14:08/Mo.9303484988 V 2
MASSACHUSETTS ASSIGNED RISK POOL
REQUEST FOR CERTIFICATE OF INSURANCE
Use this form to request a Certificate of Insurance from an Assigned Risk Pool Carrier.
Please provide all of the requested information, including the facsimile numbers) of the person or persons to whom the
Certificate of Insurance should be issued. If this forth is fully and accurately completed, the Certificate of Insurance will be
issued and distributed by facsimile to each fax number provided below,within two(2)business days of the carriers receipt,
This Form may be mailed or faxed to the Assigned Risk Pool Cartier. To obtain each carrier's contact information refer to the
Certificates of Insurance section located in the Producer Community section of the Bureau's website, (www.wwibma.oarl.
1. Name,address, telephone number and facsimile number of the INSURED:
Name: Redco Construction Inc.
Mailing Address: 8 Pheasant Run Dr. NewburyoortMA 01950
Physical Address: Same
Phone: 97B-270-8740 Fax: 978-255-2489
2. Name,address, telephone number and facsimile number of the CERTIFICATE HOLDER.-
Name:
OLDER.Name: Jeffrey Halloran
Mailing Address: C1+C2 Saunders St. Salem MA 01970
Physical Address: Same
Phone: Fax: 866-648-8251
3. Name, address, contact pennon, telephone number and facsimile number of the PRODUCER.-
Name:
RODUCER:Name: Arthur S. Page Insurance
Mailing Address: P.O. Box 391 Newburvoort MA 01950
Contact Person: Kate E. Quill
Phone: 978-465-5301 Fax: 978-462-0890
4. Policy Number,Policy Effective Date and Policy Expiration Date
If a Certificate of Insurance is needed for more than one policy term, provide the Policy Number,
Effective Date and Expiration Date for each policy term.
If the policy has not yet been issued,you must attach a copy of the Notice of Assignment.
Policy Number: WC002011897
Effective Date: 03/05/2010 Expiration Date: 03/05/2011
S. List any special requests for optional coverages/endorsements(see Page 2 for listing of coverages available
in the pool and the conditions of avaffabflity)or additional Information(including changes In exposure not yet
reported to the carrier)that will assist the carrier In the issuance of the Certificate of Insurance.
NOTE: An additional lnsured(s) shall not be listed on any Certificate of Insurance unless such additional
Insured(s)is a named insured on the policy.
H18 CERTIFICATE 18 ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
ERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
Y THE POLICIES BELOW.THI8 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN
HE ISSUING INSURER 8 AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
MPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION
8 WAIVED, subject to the terms and conditions of the policy,certain policies may require and endorsement A statement
n this certificate does not confer rights to the certificate holder in lieu of such endorsement
PRODUCER
Arthur$Pagelnsuranas Agency Inc
57 Stats Street
Newburyport, MA 1050
COMPANIES AFFORDING INSURANCE
COMPANY A GRANITE STATE INSURANCE COMPANY
INSURED
Redco Canstruc Ilan, Inc
B Phessent Run Dr
Newburypart, MA 01050-0000
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR
THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER
DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE
POLICIES DESCRIBED HEREIN 18 SUBJECT TOALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF BUCK POLICIES.LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
DD
Lin TYPE OF INSURANCE POLICY NUMBER POUCYEFFBORSE DATE FOICY LVIRATION DATE
A RNERSCOMPENSATEN
DEMPLOYERS'LCIBILnY
LIMITS
E PROPRIETOR/
PARTNER&EU�CUTNE
OFFICERSARE:
INCL❑EXCL❑ 2011807 3/05/2010 3/05/2011 FrATUTORYLINITIS
OTHER
Caerapa Applla I o MA OpareTm�Ori.
EACH ACCIDENT $ 100,00
ISMS POLICY LIMIT $ 500,00
ISEASEF.ACH EMPLOYEE 111 100 OO
DESCRIFMN OF OPERAT10NWEHICLESISPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
JEFFREY HALLORAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE
C1 &C2SAUNDERSST WRITE THE POLICY PROVISIONS.
SALEM. MA 01070
AUTHORIZED REPRESENTATIVE
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Q- 4 .�; ... f� ✓/M T000/WXOftU/E[E�r�� O�✓�Zf!'J�[k�l/!dB(IL
Office of Consumer Affairs&Business Regulation License or registration valid for individul use a
ur - HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
S m Registration:- 764875 Office of Consurner Affairs and Business Regal
Expiration: 10127/2011
m TKI 290056
;; 10 Pork Plaza-Suite 5170
n
1Z,, Type; Pdvate Corporation
Boston,MA 02116
w O ° p f8 q REDCO CONSTRUCTION INC.
u ttii Z PATRICK REDDY ~�
co wr O �" 8 PHEABAhiT RUN DRIVE �.s..
$ -� p� NEWBURYPORT MA 01950 — ��
e d_ .? Undersecretary g
CD
Not vva�id without i nature
o m J $ Fw
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b CITY OF S�ULE.NI, NL-kSSACHUSETTS
BLU DIING DEPART.N NT
120 WASHLNGTON STREET, 3"FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
xlaIBERLEY DRISCOu
MAYOR THo.�L►s ST.PtERRs
DIRECTOR OF PUBLIC PROPERTY/BVILIONG COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition.of the State Building Code, 780 CMR section 1 l 1.5
Debris,and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111,S 150A.
The debris will be transported by:
r � (✓ 2 t—`S B S
(name of hauler)
The debris will be disposed of in :
r
(name of facility)
(address of facility)
signator oC ermit applicant
IZ Alp
date
IcAnvlf JAR
CITY OF SALEM
ROUTING SLIP
New Construction_
Certificate of S Occupancy_
f
LOCATION t6 Sc_uv%cll!✓5 S+z_ DATE
ASSESSOR DATE Ld- 2 )o 0
93 Washington St.
CITY CLERK DATE
93 Washington St. ,�(
PUBLIC SERVICES '" -"DATE
120 Washington St.
WATER DATE /7/ G�l4)
120 Washington St. 1/
CROSSCONNECTION N ikVDATE
5 Jefferson Ave
PLANNING Dt«� DATE 0
120 Washington St.
V CONSERVATION DATE CJ �12/ F6�—Sod a
120 Washington St
V ELECTRICAL -DATE 2 d
48 Lafayette S V
-� FIRE PREVENTIONDATE
29 Fort Avenue
HEALTH C il DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.
L