15 SAUNDERS ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 CMR,7t'edition OF SALEM
Revised January
Building Permit Application To Construct,Repair,Renovate Or Demolish a 1,2008
e-or Two-Family Dwelling
his Section For Official Use Only
Building Permit Number: Date Applied:
Signature: Aw
Building Comaflssionedlnspecings Date
T16N 1.:SITE INFORMATION
1.1 Pro yV Address:�o ` �� V .2 A,s ssors Map&Parcel Numbers O^ �/_�0461
1.1 a Is this an accepted street?yes no ' Map Number Parcel Number Y/
13 Zon�1 is ng Information: 1.4 Prop Dimensions:
lL 10M 41
Zoning District Proposed Use Lot Area sq ft) Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided 11``
W %, L 1 % 2J` to V
1.6 Water 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 yes Municipal On site disposal system ❑
SECTION 2: PROPERTY O uNERSHIy/P'h t p
2.1 Owner'ofRecord: 1 LD r, Il
Name
Nae(Print) t+ Address for Service:
r- III'. 1`i`1 1�oS
Signature a V Telephone
CTI 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction tExisting Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work:
WN !�4M W1111
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ , O'Jv 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $
13 Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 041 2. Other Fees: $
4.Mechanical (HVAC) $ ,SI000 List:
5.Mechanical (Fire $ O
Suppression) Total All Fees:$
1I Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
CITY OF SALEM
ROUTING SLIP
New Construction
Certificate of Occupancy
LOCATION Is S�M�++ S DATE
ASSESSOR / DATE
93 Washington SLD 6.wR ,A,. Z Lr"
CITY CLERK DATE
93 Washington St.
PUBLIC SERVICES ATE LV (J
120 Washington St. v
WATER (/� DATE 2 2
`120 Washington St. / I yl
CROSS CONNECTION MkOIDATE I14Zq (y
5 Jefferson Ave
PLANNING
- - JD. A,1 DATE 12 L��
120 Washington St.
.-,/CONSERVATION DATE
120 Washington St.
ELECTRICAL DATE 2
48 Lafayette S .
/ FIRE PREVENTION DATE
29 Fort Ave ue
/ HEALT ' DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) h 11I 11.1I
��` y` APw License Number Expiration Date
Name o I Holder{ , List CSL Type(see below) O�
T Description
Address U Unrestricted(up to 35,000 Cu.Ft.
Signature R Restricted 1&2 Family Dwelling
%1i, 11tr ��I M Masonry Only
Ll 1 X111 Q 0 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
i
1, 0 f AA r as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this bui mg pe it apIdicilion.
Signature of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
I, 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.
e r
Not Name
D
Signaturq&0wne Authorized Aged Date
(Signeunder th 'ns and penalties of
NOTES:
1. An Owner who obtains a building p it to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Impr ement 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 110.86 and 110.115,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) 0{1 g1l,11 11' (including garage,finished basement/attics,decks or porch)
Gross living area(Sq.Ft.) Habitable room count 5
Number of fireplaces Number of bedrooms ;
Number of bathrooms Number of half/baths 0
Type of heating system Number of decks/porches 1
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
Dec 01 10 03:10p Erica Maki 978-255-2489 p.2
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AC RO C7 OP ID:KC1
ti.--- CERTIFICATE OF LIABILITY INSURANCE CIATEM Awf"
7H18 CERTIFICATE 18 1SSUE0 ASA MATTER OF INFIDIOIIATION ONLY AND 12101 NO
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOA CONFERS NO MGM UPON THE CERTIFICATE HOLDER.THIS
BELOW. THIS CERTIFICATE OF INSURANCE DOER NOT CONSTITUTE A CO OR ALTER THE NTRACT BETWEEN THE 188U GRAGE �NSUI$R�8), AORDED By�UTF�Ipg12ED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: H the ions o th holds b an At Poll AL INSURED,111e pw ICy p)must be erAMB& If SUBROOATNIN IS YEARNED,subject b
the brine and conditions of Me policy.prtebl Po1klcE m ft require an mdO=M"L A statstenn on this tsrtlBCeb does nog CONTar rights to the
eoHifilab heltlerb tleu a/aueh endo a
PROpucm 97B�f65S701
Arthur SPage lnsuranceAgency iTl8iH2-0890 wlorm
57 State SL u
Newburyport MA 01950
None
eREOCO-1
IN$UREG Radeo Cono&uction.Inc. INallg APPOaa1NG COVPAIIac RAGS
Erica Reddy nOURMA-SOOMBdak Ins Co
8 PheaBant Run Drive m me-
Newbu7port,ATA 01950 WIRER C:
IRSIINER a.
RBORm E:
COVERAGESr:
CERTIFICATENUM13EP-
THIS LS TO CFJtTIFY THAT TFff POLICIES OF INSIIRANOE LISTED BELOW I i1 ii BEEN ISSIED TO THE e61RtED NAMED ABOVE FOR THE POLCY pplp00
CER71FICA NOT BEREVISION NUMBER:
ISSUED O ANY REOOIREMENT,TERM OR COMORbN OF ANY CONTRACT OR OTHER DOCUAENf WITH RESPECT?D WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIBEO HERRN IS SUBJECT TO ALL THE TQTHIS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.La SHOWN MAY NAVE BE EN RE
INR Ol10ED BY PNO CLAIgAH.
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OB6RIIL LMmATT I.RIIre
A X COMM I*WALGENEMLUABlnY PS11t36773EACH OCCURRERCE t 1,DOp,
OBIOMIO OBIONf 1 pR t 50,CIAIMSrMOE I CCCul
M®EKP A,M mrpval t
PEIISOWLLR ADY Ut0.lRY ! 1.000
I GEN-LAGGRE ArELMrrGE EMAGGREOATE S 2,000
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ELOPRODUC $-COMIOPAOO t 1.00
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CER77FICATE HOLDER LANCE TKIN
HALLORA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE Will be DELIVERED IN
JEFFERY HAL
C1 ACCORDANCE WITH THE PrXUCY PROV INDIA
C1 s C2 SAUNDERS ST
SALEM,MA 01970 AUTM MED ATNF
None
ACORO 28(2009/OB) 01M-MOS AO D CORPORATION. AN rlghb nmlmed.
The ACORD nameand 1090 ere registered made 0 ACORD
Dec 01 10 03:10p Erica Makrys 978-255-2489 p.3
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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 rermber(s) of the person or persons to whom the
Certificate of Insurance should be issued. If this form is fully and accurately completed,the Certificate of Insurance will be
issued and distributed by facsimile to each fax number provided below,vvifhin two(2) business days of the carrier's receipt.
This Form may be mailed or taxed to the Assigned Risk Pool Carrier. To obtain each corms contact information refer to the
Certificates of Insurance section located in the Ro&cerCommunty section of the Bureau's website,(www wodbrrra aro~.
1. Name,address, telephone number and facsimile number ofthe INSURED.
Name: Redco Construction Inc.
Mailing Address: 8 Pheasant Run Dr. Newburvoort urs 01950
Physical Address: Same
Phone: 978-270-8740 Fax: _ 978-255 2489
2. New, address,telephone numberand facsimile numberof the CERTIFICATE HOLDER
Name: Jeffrey Halloran
Mailing Address: Ct+(2 Saunders St Salem MA 01970
Physical Address: Same
Phone: Fax: SM-648 8251
3. Name,address,marledperson,telephone number and facsfm►Ta number of the PRODUCER:
Name: Arthur S.Pace Insurance
Mailing Address: P.O. Box 391 NewburvnortMA 01950
Contact Person: Kate E Quit
Phone. _978-465-5301 Fax: 978-012-0890
4. Polley Number,Polley Effective Dab and Policy Expiration Date
If a Certificate of Insurance is needed for more than one policy tam, provide the Policy Number,
Effective Date and Expiration Date for each policy term.
'f 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: 03/052011
5. List any special raquesta for optional coverages/endmsenrents(sae Page 2 for Rating of coverages available
in the pool and the conditions of evaHability)oraddidonat Imbrmation(fnc/uding charges in exposure not yet
reported to the carrier)that will assist the carrier in tyre issuance of an Car iffkate of insuranca.
NOTE., An addWonal insureds) $01811 not be listed on any Certificate of insurance unless such additional
insured(s)is a named insured on the pokey.
HIB CERTIFICATE 18 ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
ERTIFICATE HOLDER.THI8 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(S).AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
MPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(iss) must be endorsed. If 8UBROGATION
S WAIVED, subject to the tensa 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
Arthi Page Insurance Agency Inc
57 State Street
Newburyport. MA 1950
COMPANIES AFFORDING INSURANCE
COMPANY A GRANITE STATE INSURANCE COMPANY
INSURED
Redco Construction, Inc
8 Pheasant Run Dr
Newburyport, MA 01950-0000
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 8UBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co
LTR TYPE OF NGURANCE POLICYNUMBER POLMOPPEOMOATE PMJWWRATIONDATE
A RRERSCOMPENSATION
D EMPLOYERS'LIABILIiY LIMITS
E PROPRIETOR/
PARTNERSIE]�GITM
OFFICERSARE:
NCL o EXCL❑ 2011897 3/05/2010 3/05/2011 STATUTORY LIMITS
OTHER
CawapcAppllwto MA OpwetlmoO*.
rH ACCIDENT $ 100,00
ISEASE POLICY LIMIT $ 500,00
ISEASE�EACH EMPLOYEE a 100.000
DESCRIPTION OF OPERATIONSNEHICLEWSPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
JEFFREY HALLORAN SHOULD ANY OF THE ABOVE DESCR IBED POLIC ES BE CANCELLED BEFORE THE
W RATION DATE THEREOF,NOTICE WILL BE DEL VERED IN ACCORDANCE
C18C2SAUNDERSST WHITE THE POL ICY PROVISION&
SALEM,MA 01970
AUTHORIZED REPRESENTATIVE
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OMCe Of Consumer Affairs&Business Regulation License or registration valid for individul use 0
HOME IMPROVEMENTCONTRAOTOR before the expiration date. If found return to:
ig
Registration:- 164075 Offiee of Consumer Affairs and Business Regal
0 10 Park Plaza-Suite 5170
ra Explration:.1..1O@7/2011 TrA' 290056
Type; � Private Corporation
Boston,MA 02116
w` t Pq REDCO CONSTRUCTION INC.
j } z yy' PATRICK REODY ^�1
a s P7 ' $ C �\ = 8 PHEASANT RUN DRIVE �...s..-�Z. �
o ' c�7 $ 8 W i- .e NEWBURYPORT,MA pi No undersecretary s=
Not valldL.- witboutIgnature�
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b CITY OF S.1L.E.N1, ,L-kSSACHUSETTS
BI:ILmG DEPART?tENT
' 120 WASHNGTON STREET, 3 °FLOOR
TEL (979) 745-9595
FAx(978) 740-9946
KIJt$FjUEY DRISCOLL
MAYOR T'HoarAs ST.P1ERRa
DIRECTOR OF PUBLIC PROPERTY/BCII.DNG 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 111.5
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:
J ) L , ��S����
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
signator f permit applicant
IL lip
date
Icbna.,t(�.R