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20 SOUTH ST - BUILDING INSPECTION The Commonwealth of Massachusetts Town of Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR, 7ih edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Tiro-Fmnily Divelling, This Section For Official Use Only Building Permit Nu`mbe/r�:� /yQ Dale Applied: Signature: ✓ '�""" i(.O l""'Pir^^• fO/�! Building commissioner Inspector of Buildings Date SECTION 1: SITE INFORMATION 1.1 Property Address• 1.2 Assessors Map& Parcel Numbers �� ��L1t1-� Parcel Number I.I a Is this an accepted street?yes�Z no. Map Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water upply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal In site disposal system ❑ Public Private 13 Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner)(1 4 yl f Record,:I Q0 SA U , a t-_ 16 M N riot) Address for Service: 975 -ZW! R, ;;z Sure Telephone ig SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building C3 Owner-Occupied O Repairs(s) ❑ Alteration(s) ❑ Addition ❑ . Demolition ❑ 1 AccessoryBldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': ' SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials I. Building S I. Building Permit Fee: S Indicate how fee is determined: O Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S / /2� 4. Mechanical (HVAC) S List: l�fY 5. Mechanical (Fire S Total All Fees: S Suppression) 00 Check No. _Check Amount: Cash Amount:_ 6. Total Project Cost: S �QQQ ❑ Paid in Full ❑Outstanding Balance Due: � SII SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supen'isor(CSL) �6 Uh(o ",, � �`0 +��' Ascr� �y (��rj _� License Number Ex Name of CSL`IVIder 7� List CSL Type(we below) U'� /\ Address /J T e Descri tion U Unrestricted u to)S,OIb Cu. FtJ SignatureR Restricted I&2 Family Dwelling St Masonry Only RC Residential Raofin Coverm Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Regist red Home Improvement Contractor(HIC) �,a-�r���in�� i� lyhi HIC Company Name or HIC Re list ant Name Registration Number / Address p 179,S-621 7f / 9.pirtioh Date Signature C, Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.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 .......... ❑ No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, U D Q1 1 D1 P� + fO IAf 1 A, as Owner of the subject property hereby authorize U4A-.Iej� to act on my behalf,in all matters relative to work authorized by this building permit application. Si ture 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 Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury NOTES: I. 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 I I O.R6 and I 10.115, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/anics,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' - 978. Sol• 7011 . �o 15 (ou T �- SdrL�Ie.. yX 1r 'L- 2xt0't. � iGONGfLET� '�Ofl�t1"✓ � Lota�otiI-rJ5�-- WALK bU'►'"-31+y. ,CONT 00 7"jy�/ 10 �' �xrsT,t�4 t�viEu.rnr� pr�x�a 1�G��. kGNatcE-1�'to � grnty� Fvwvvstr►ary roorPQ'IMT-o X,ihriAt4, KN*5oWRY ,tom©"n.GH (R Fav X w -7�* �, A" t{1C / {�( 'L- 2X 10' ''Z iCOIVGflETE .�OAtR-1'✓$� x7"Iq /— o� ' N grEv 4 pr�xio L�G�r�: hU-la�.r�'i'a L,TDl4�i ..'F(JUN'p6tTtlJN C ,{ � X i I's CITY OF SU1. Edi, �L1SSACHt;SETTS BUILDING DEPARTMENT \ 120 WASHINGTON STREET, 3w FLOOR ISI.. (978) 745-9595 FAX(9713) 740-9846 [INtBERT EY DRISCOLL (MAYOR Tvimw ST.PtEm DIRECTOR OF PL13LIC PROPERTY/HCILDING CONMaSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anplicant Information Please Print Leeibiv Nalne (Busitx�sOrganizatiovindividual): (�K f�I1l/L� Address: /zl City/State/Zip:-2&1l bf�- 7��►A� Phone #:_9 Z&,8'67, 7oi7 Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am a employer with 4. 0 I am a general contractor and 1 6. 0 New construction i;mployecs(full and/or part-time).' have hired the sub-contractors2. 1 am a sole proprietor or partner- listed on the attached sheet t 7. 0 Remodeling ship and have no employees These subcontractors have g. 0 Demolition working for me in any capacity, workers'comp.insurance. g, Building addition [No workers' comp. insurance S. 0 We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 1 1.0 Plumbing repairs or additions myself. ]No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs 'N t employees. o workers insurance required.] i 13.0 Other �D�/I/ comp. insurance required.] Any applicant lira chceks hon[el must also fill out the section below showing their workca compenmim,policy information. 'I hwneownces who submit this affidavit indicating they ate doing all work and then him outside contracrors most submit a new affidavit indicating such. =funtrmnon,that check this box most attached an a,Witiwol sleet showing the acme of the subtonttactors and their workers-romp.polity infentution. I am an employer that it providing workers'c ompensation blsurance information for my employees Below Is the policy and]"site Insurance Company Narne:_ At w4 JJ Policy 0 or Self-itis. Lic. a: (V((f lOD7�I"K �0 Expiration Date: d 20/ice Job Site Address: :Zo 7 JOL - l '�/ ]�i'P�� /��Q� City/State/Zip: 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 e fine up to S 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$250.00,A day against the violator. He advised that a copy of this statement may be forwarded to the Office of Investigations ol'the DIA for insurance coverage verification. I do hereby certify t r the pains and pnnaldes of perjury that the int/ormutionprovided ab ve is true and corrCCL �i,•r t ue Date: Phone 4: efO 7 7,0!7 DVIc•ial use only. Do not write in this area,to be completed by city or town offlciai City or Town: Permit/I.icense q _ Issuing Authority (circle one): 1. hoard of Health 2. Building Department 3.Cilyfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone p: 04%13/2009 16:54 9789219162 LAIRANZANO ROUGIER PAGE 01/01 LOCO CERTIFICATE OF LIABILITY INSURANCE 03 13(N 2 PCOM 00 PRODUCER (978) 927-9420 THIS GMTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON T41E CERTIFICATE taursnama insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 107 Dodga Street ALTM THE COVERAGE AFFORDED BY THE 9041 •S BELOW, swillcly MA 01918- INSURERS AFFOR0076 COVERAGE MAIC Y INBORED IN ARE A.A.-Z-M. Mntoel Mark R. Eldridge - IN$U We9tern Mari o 20 ?age Street WBURER C: 1NEUR 0 Danvers MA 01923- E: COVERAGES . THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY =REOUIRMAENT,TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE IS8IM- D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID OIAMA 'OR ADMhm rMORRRWRANCE FOLICYNUM IM DA TR LIMTTB H Gm W4 UABOITY 1R'C19B2 02/03/2009 02/03/2010 EACH OCC a 1,000,000 R OMGENERAL LIABILITY aE° ° eI a 100,000 CIAINS IPOE a OCCUR / / / / MEO P s T 5,000 PERSONALAADVINJURY a 1,000,000 2,000,000 ENY AGOREWTEpLRIAR APPLIEG PER' 0 1,000,000 X C JE LO AUTOMOBKE UADDAN / I I I COMBINEDSNGLELWR 0 ANYAUTO IMawform ALL OVMED AUTOS / / / / BODLY NJURY e SCHEDLLBDAUTOS - (Pm PN m NMWAUTOS / / / / BOOLY INJURY NON-0VRIED AUTOS (pw 0 PROPFHTY DANAOB. 0 - (Pn eoCdwlO OARAOE UASSJTY JAUTOO Y•EAACCOENT e li ANY AVO / / / / OTHERTNAN EAACC AUTO ONLY: O 0 ESCEswMBReuA UABLITT / / / / O 0 OCCUR FICLAMNIADE II AOGREGAW e DEOUOTIBLE RETENTION ! A IYORNBRB COMPENBAnOM AND TINL 600790801 03/09/2009 03/09/2010 X ANYPROPFU LWLOTY ANY PROPTUBTORNARiNERAI%BCUTAT; E.L.FAOM&OCIDENT 0 100,000 OFFICERAIEMSER EXCLUDED? / / / / C 100,000 lfyftsm k pi mi T s De v LIMIT a 500,000 o"MR DESCMPTMIN OF OPERATKWRACATN)NINEMN:LBBXDW 090Ns IAOED BY EIIpONSg1ENTgPECUL PRD10e0NS CERTIFICATE HOLDER CANCELLATION ( ) — (978) 777-1044 INIULD ANY OF 70E ABOVE PEBCRBED POLICIES BB CANDID IW SEFORE THE EXPIRATION DATE TNFIROR. TNM MRRRNG MMMMX MRL. BNOEAVOR TO MAL DAYS NRITTEM NOTICE TO THE CERTfTCATE NOLDf3T T M TO THE LRFT,OW TNLURE 7000 308NAll NO OWOATTON OR OP ANY 19NO UPON THE INSUM"SAPPRIF AUTIWRUM RIMI LIVE ACORD 25(2001/08) a ACORO COMPORATION 1B1M �TM-INSDEB(0101M.05 ELECTRONq LASER FORKS,INC.•N0OW17-ma �s CITY OF SALEM l 1.^ PUBLIC PROPRERTY DEPAR'T'MENT •,� ., .n L': �1 rdu\i.., ii r . ,.,ii m. ,%t,.. Construction Debris Disposal Affidavit (rciluired lirr all demolition and renovation work) In accurdance %%ith the sixth edition of the State Building Code, 780 CM1IR section 111.5 Dcbris, and the provisions of MGL c 40, S 54; Building Permit K is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name ul'hauler) - I he debris will be disposed ofin : (name of facility) iaddres< uf facility) /, NLIIa IU c of pinto apphcanl 'late Card 1 of I Location 20 SOUTH STREET JE Property Account Number Parcel ID 15-0523-0 Old Parcel ID 42 - Current Pro ort Mailin Address Owner NOT AVAILABLE City State F[ Address Zip Zoning R1 Current Property Sales Information Sale Date 1/1/1936 Legal Reference 9818-119 Sale Price 0 Grantor Seller FOURNIER A 0& M K Current Property Assessment Year 2006 Building Value 195,500 Xtra Features Value 2,400 Land Area 0.101 acres Land Value 123,100 Total Value 321,000 Narrative Description his property contains 0.101 acres of land mainly classified as Two Family with a(n) Multi-Conver style building, built about 1890 , having Vinyl exterior and Asphalt Shgl roof cover,with 2 unit(s),8 total room s 4 total bedrooms 2 total baths 0 total half baths 0 total 314 bath (s). Legal Description _- Images to Enlarge r a'. 0001 •tea l.0 M 6 http://salem.patriotproperties.com/summary-bottom.asp 5/16/2006 Massachusetts- Department of Public Sefetc. Board of Buildim, Regulations and Standards Construction Supervisor License License: CS 85056 Restricted to: 00 " MARK R ELDRIDGE 20 PAGE ST DANVERS, MA 01923 �-�- -�• Expiration: 8/12/2010 (bunnis`iimer Tr#: 1260 Bar o ui m�la�ons` /5 an� One Ashburton Place - Room 1301 lug Boston. Massachusetts 02108 Home ImprovementContractor Registration Registration: 113142 ..___. . Type: Individual Expiration: 5/20/2011 Tr# 284549 MARK ELDRIDGE MARK ELDRIDGE 20 PAGE ST - - ------ ------ DANVERS, MA 01923 ----- -- - Update Address and return card.Mark reason for change. Address Renewal E] Employment Lost Card DPS-CA1 0 40M-08/08-DBSLIFORMCA108212008