BUILDING JACKET J
I
oa
PUBLIC PROPERTY
/ DEPARTMENT
KINIHOl.EYDR15l:OLL�O// /D
MAYOR Y
120 WASHINGfON StxFEr 4 Jw��„u AkS•UCHLSL-1'rs 01970
1Fi 978-745-9595♦F,%X 97&740-99"
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
fyl(�
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: (00 - 17OS- 5L19q
3.0 COMPLETE THIS SECTION FOR WORK IN EXICnKG BUILDINGS ONLY
Addition
Renovation I% NumbeLfStorielt
Change in Use Demolition
Approximate year of Area per floor (;f) Renovated
construction or renovation
of existing building a oc�P New
Brief Description of Proposed Work:
\r\el.j WinaowS, Cer��rwl hC.l new )6% -hev\l Y) ew
Mail Permit to: — y
What is the current use of the Building?
\e
Material of Building? V k If dwelling, how many units? ,
r
will the Building Conform to Law? 4 e.S Asbestos? v, �----
Architect's Name
Address and Phone
Mechanic's Name o
Address and Phone
/5 rm�� ti �d uyl�ii vl8�l
Construction Supervisors License#r 5 0`�� 15 HIC Registration#
Estimated Cost of Project$ 1 0Q O Permit Fee Calculation
Permit Fee$ 5 00 Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to uild to the above stated
specifications. Signed under penalty of perjury
Date i� a o
S
(, O
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4
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CTTY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
wau6u,ar oaaao�s
N.roa 13o wwo,wZo„s7sasr•sum,ar�a�os,sars otl70
Tn.M74S-"U•FNt W&74&no
Construction Debris Disposal Affidavit
(required far ell demolition sod m ovatim wools)
In aceordsom with the sixth edW=of the State Building Cads.7S0 CMi;section 111.5
Dam*ns,and dw Pro visions of MGL a 40.S 54
Building Permit 0 is ismW with d w condition that the debsb testaldog fivm
this work shall be disposed of in a properly!icon d waste disposal&duty as defined by MCIL a
1 11.s 150A.
The debris will be b=Vorted by:
(rims albsslf)
The debris wiq be disposed of in:
'a�A-V-t C
(nuw of Pxility)
(addnu of 14eilhy)
s�saasw of parnut app4aol
dus
.tehri.a7J�s / .
Ir.
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
KAtaERLEY DRISCOLL
MAYOR
120 WASHINGTON STREET♦SAI EM,MASSACHUS T S 01970
TEL 978-745.9595 a FAX:978-740.9846
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name(Business/Organiution/Individuat):
Address: i
City/State/Zip: UJQbuc-r\ (`l--A 0\e)o l Phone#: to l
Are ou an employer?Check the appropriate box:
1.01002
am a employer with 4. 0 I am a general contractor and IF[0:JRcm0d01in
t(required);
employees(full and/or part-time).• have hired the subcontractors shuction
2.0 I am a sole proprietor or partner- listed on the attached sheet, t ingship and have no employees These subcontractors have onworking for me in any capacity. workers'comp, insurance.[No workers' comp. insurance 5. ❑ We are a co addition
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 I LEI Plumbing repairs or additions
myself. [No workers'comp. c. 152. §1(4),and we have no 12.❑Roof repairs
insurance required.)t employees. [No workers'
comp.insurance required•) 13.0 Other
fAny applicant that checks boa at must also fill out the section below showing their workers'compensation Policy information,
Homeowners who submit thin afHdevit indicating they an doing all work and then him outside cm
[Contractors that cheek this boa must attached an addttiond sheet showingtine �e'a must submit•new an it
mdiu4ng suck.
tam an employer that it providing workers'co
name of the sub-conuaetora and their workers'comp•policy information.
aspensadon Insurance for my employees. Below Is the policy and fob sire
information, _
Insurance Company Name:
cl
Policy#or Self-im.Lic.#:_ (-5 t�i1l).5 A L1 A1+530(>
Expiration Date-_[C3�a S)b-+
Job Site Address: i -S kf— C Y_3r-�_ City/State/Zip: SpAern r [^ zk__
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 fine u to S 1 5 Po criminal 0, 00.00 and/ ties of
P and/or sae-year imprisonment,as well as civil Penalties m the form of a STOP WORK ORD�R and a fine
of up to S250.00 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
!do hereby certify r the pains and penalties of per/ary that the information provided above is due and correct
Si atu K
D t a
P oIS-,5 y
Ofjlcial use only]Donol writein this area,to be completed by city or town oJJIclaL
City or Town• Permit/LicenseIssuing Authorione):
1. Board of Healding Department 3.CitY/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their contract pllooy=
Pursuant to this statute,an employee is defined as"...every person in the service of another under any
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
partnership,association or other legal entity,employing employees. However the
receiver or trustee of an individual,
and who resides therein,or the occupant of the
owner of a dwelling house having not more than three apartment co or repair work on such dwelling house
dwelling house of another who employs persons to do maintenance,
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer..
MGL chapter 152,§25C(6)also sous 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 commonwealth 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 "m�*""co
requirement of this chapter have been presented to the contracting authority."
Applicant
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
addresa(cs)and phone number(s)along with their certificate(s)of
accessary,supply sttlscoattactor(s)name(s),
e. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
required to carry workers' compensation insurance. If an LLC or LLP does have
members or partners,are not advised that this affidavit may be submitted to the Department of Industrial
employees,a pokey is required. shod
Accidents for confirmation of insurance coverage.
for�the permit or o be sure lsl icense gn and is being t e vquested ut the Department of
be returned to the city or town that the application
Industrial Accidents. Should you have any questions regarding the law or if you are required to o eater
compensation policy,please call the Department at the number listed below. Self-issued companies
their
self-insurance license number on the a line.
City or Town Officials
it is complete and printed legibly. The Department has provided a space at the bottom
Please be sure that the affidav
Office of Investigations has to contact you regarding the applicant.
of the affidavit for you to fill out in the event the t Please be sure to fill in the permittlicense number which will be used as a reference number. In addition an applicant
that must submit multiple permit/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 mayloca b provided to s in the or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be p
. applicant as proof that a valid aff[davit.is on file for future permits or licenses. A new at idavir must be filled out each
year.Where a home owner or citizen is obtaining a license or permit related to any business or commercial venturc
yea a dog licensee permit to bum leaves ell.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
O®ee of Investigadons
600 Washington street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05 www.mass.gov/dia
1 .,
BOARD OF BUILDING REGULATIONS
License:. CONSTRUCTION SUPERVISOR
k Numberi-,
:-�t� 078615
Si ribdateItl244�661�948
H kxpire 1v11I2006- Tr.not 55250 a'
R4e�atrte6eda
i JOSEPH M DASI 018L
V — x
J 1�5 MURRAY RO
WOBURN, MA� 07801
- Commissioner
14°<
� q �LL ✓�ie TOm21sto9e��� o�./I0O0daC�JB�d ?`"
Board o(BUOdieg Reguisdons sed$tenderds'
HOME IMPROVEMENT CONTRACTOR
Ragisti ti n-'-139820
i 8/?7/2007,
DASILVA CONS7;.R.yt1CTION
JOSEPH DASILVAt �
15 MURRAY
WOBURN,MA 01801 Administrator
a;
k-
xk.
X•
y
DaSifva Construction
Home Improvement SyedaCist
Phone: 781-281-2203 CeCG 617-908-5494
NAMENINFEN PROPOSAL
ADDRESS: 7-9 CEDAR COURT DATE 7-12-06
SALEM, MA
DESCRIPTION AMOUNT
EXTERIOR
POWER WASH HOUSE
REMOVE PAINT FROM FRONT PORCH & REPAINT
REPLACE ALL WINDOWS WITH NEW WINDOWS & ALUMINUM TRIM
FIX ALUMINUM TRIM AROUND THE HOUSE
INSTALL DOUBLE GLASS FRONT DOORS ONLY ONE WILL BE ABLE TO OPEN
INSTALL 2 EXTERIOR DOORS
INSTALL 1 NEW TRIPLE PANE WINDOW
REMOVE AND PATCH 2 CHIMNEYS
INSTALL NEW 3 TON HVAC & FLASHING ON ROOF
INSTALL GALVANIZED SHEETMETAL WITH 1 IN. INSULATION & VINYL FOIL WRAP
AROUND DUCTS' MAIN TRUNK
INSTALL 1 CENTRAL RETURN IN 1ST FLOOR HALLWAY
INSTALL 1 SUPPLY IN EVERY ROOM
HEATING SYSTEM WILL BE 60,000 BTU'S
INSTALL DIGITAL THERMOSTAT
INSTALL NEW DOOR BELLS
INSTALL OUTSIDE LIGHTS & NEW OUTLETS ON EACH SIDE OF THE HOUSE
REMOVE & REPLACE NEW CURUIT BREAKERS & ADD 200 AMPS
INSTALL A PUBLIC METER TO THE EXISTING METER SOCKETS
INTERIOR
FIRST FLOOR KITCHEN
DEMO KITCHEN & 1 KITCHEN WALL
INSTALL NEW WIRING & PLUMBING -
INSTALL WASHER & DRYER
REMOVE & INSTALL NEW TILE IN KITCHEN
INSTALL HANDICAP RAMP EXITING THE KITCHEN & PAINT
REMOVE OLD BASEBOARD HEATERS
MAKE NEW KITCHEN & INSTALL APPLIANCES
WIRE KITCHEN WITH GFI PLUGS AROUND COUNTER FOR APPLIANCES
INSTALL 6 RECESSED LIGHTS WITH SWITCHES
HALLWAY & BATHROOM
INSTALL NEW HADICAPPED BATHROOM WITH GLASS SHOWER DOORS
INSTALL NEW PLUMBING & ELECTRICAL
INSTALL NEW HARDWOOD FLOORS
DaSifva Construction
Home Improvement Syeciaftst
Phone: 781-281-22o3 Celf 617-9o8-5494
NAME:VINFEN PROPOSAL
ADDRESS: 7-9 CEDAR COURT DATE 7-12-06
SALEM, MA
DESCRIPTION
AMOUNT
WIRING FOR GFI PLUGS,SWITCHES FOR BATHROOM LIGHTS & LIGHT/FAN
INSTALL NEW HVAC UNIT IN FIRST FLOOR WITH A 60,000 BTUS EFFECENCY
SYSTEM
REMOVE FURNACE AND DUCTWORK
RUN SUCTION LINE TO BLOWER
INSTALL PUMP & OPEN DRAIN
INSTALL MAIN TRUNK
INSTALL 1 CENTRAL RETURN IN 1ST FLOOR HALLWAY
INSTALL 1 SUPPLY IN EVERY ROOM
HEATING SYSTEM WILL BE 60,000 BTU'S
INSTALL DIGITAL THERMOSTAT
INSTALL 6 FT SLIDING DOOR IN LIVING ROOM PAINT ENTIRE FLOOR
SECOND FLOOR KITCHEN
DEMO KITCHEN & AND REMODEL INTOA BEDROOM
INSTALL NEW WIRING & PLUMBING
INSTALL 3 DOORS & CAP OFF OLD KITCHEN TO FINISH BEDROOM
REMOVE OLD BASEBOARD HEATERS
INSTALL NEW HADICAPPED BATHROOM WITH GLASS SHOWER DOORS
INSTALL NEW PLUMBING & ELECTRICAL
INSTALL NEW HARDWOOD FLOORS
PAINT & BUILD SOFFITS FOR NEW HVAC UNIT
BASEMENT
INSTALL NEW DOOR & 3 WINDOWS
INSTALL 10 LIGHTS WITH SWITCH ABOVE TOP OF STAIRS
RUN WIRING & INSTALL EMERGENCY LIGHTS UNIT
REMOVE WATER HEATERS & REMOVE OLD HEATING UNIT
INSTALL 2 WATER HEATERS & ADD NEW PLUGS
INSTALL 6 CARBON MONOXIDE ALARMS & WIRING
INSTALL 10 SMOKE ALARMS & WIRING
ESTIMATED
TOTAL
$99,100.00
The Commonwealth of Massachuse(��PECTIOtd/�L SER ICE�ITY OF
1 Board of Building Regulations and Standards SALEM
I Massachusetts State Building Code, 780 CNIR e p (, p ed,Nor 2011
Building Permit Application To Construct, Repair, Renovaa a OPPClemblisR 3
One-or Tivo-Family Dwelling
_ l This Section For Official Use Only
I Building Permit Number: Date Applied:
Building OlTicial(Print Name). Signalure� at�
SECTION 1:SITE INFORMATION`
Li P7-i �o� t ddre s: 1.2 Assessors Map&Parcel Numbers
C�Lv.wi
e
I.I a Is this an accepted street9 yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Aq 11) Frontage(It)
rca(s •-
1.5 Building Setbacks(R)
Front Yard TInformation:
RearYard
ReyuircJ Provided RequiredvidedIRequired Provided
1.6 Wnter Supply:(h1.G.L c.40,§Sd) 1.7 Flood Z8 Sewage Disposal System:
Zone: _ Zone? anici al❑ On site disposal system ❑
Public 0 Private❑ p p0
SECTION2: PROPERTY OWNERSHIP!:
2.1 Owner'of Record: 4ao-A
I��hme�(Print) City,State,
, Y
V f �/'� 7 /2 5'�-•
No.and Strect Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ 1 Alteration(s) Cl Addition ❑
Demolition ❑ Accessory Bldg.0 Number of Units I Other 0 Specify:
Brief Description of Proposed Work':
r SECTION q: ESTIMATED CONJOUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costs(item 6)x multiplier x
3. Plumbing $ P 9ther Fees: $
q.Mcchmtical (FIVAC) S List:
5.Mechanic it (Fire j total All Fees:S
Su resxiun)
Check No._Check Amount: Cash Amount:_
6.Tutai Project Cost: $ ❑ Paid in Full ❑Outstanding Balance Due:
A/CN
\44E LONLI— VIU Zo�
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) V~d,-Jp/
/�I�r/i'.- 'Li���� License Number Expiration Date
Name ofCSL Holder
,{ List CSL'Type(see below)
01 JyX3l�G Awe Typo - , - Description .
No.and Street
U Unrestricted(Buildings up to 35,000 cu. tl.
�'r✓th'N�!</ M"941 (o� R Restricted 1&2 RunilyDwelling
City/Pusm,State, at Masonry
RC Roofing Coverin
WS Window and Siding
SF Solid Fuel Burning Appliances
91 �! 331 I Insulation
Telephone F-� Email address D Demolition
5.2 Registered`Home Improvement Contractor(HIC)
HIC Registration Number Er iru non Date
f IICc�m any Na a oc HIC Registrant Name
14
No. � tre J,2t�t! 91 ' 3 3 Email address
_C.i /_T_own State�Z1_P_ Telephone _
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.15L§2SC(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...........0
SECTION 7a:OWNER AUTHORIZATION,TO BE COMPLETED WHEN: '
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING:PERMIT
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relati to work authorized by this building permit application./ y
Print Owner's Name(Electronic Signature) rDate
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
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) 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. 1 J2A.Other important information on the HIC Program can be found at
wwvv.mass.euv:'oca Information on the Construction Supervisor License can be found at www.mass.govldns
2. When substantial work is planned,provide the information below:
Total fluor area(sq. ft.) (including garage,finished basementlatlics,decks or porch)
Gross living area(sq. ttJ Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
type of heating system Number of decks/porches
'rypeofcoangsystem Enclosed' Open
3. "Total Project Square Footage'may be substituted for"Total Project Cost"
7
7-9 CEDAR STREET COURT
SALEM, MAT� �e
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11 3 MAP 34, LOT 87
6.0
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?27' o
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cli
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5.00' 16.3 i
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MAP 34f N
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7.7 a W
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N 82-30100" w
MAP 34, LOT 84
O
PROPSED DECK PLAN
PREPARED FOR: VINFEN CORP.
LOCATION. 7-9 CEDAR STREET COURT, SALEM, MA
SCALE. 1' = 20'
DATE: JANUARY 7, 2015
COUNTY LAND SURVEYS, INC.
Professional land Surveyors'PO Box 5<Gloucester,MA 0 1931-054 3'(978)282-0443
, �� � �
/�� ------
/�.� 7. I'he Cununoinve:dth pf Massnrhusclts -_ _ .. _
� ��, �� 13oarJ u([3uilding Regul:uions anJ Standards C'I'il'OF
� �;, � M;isspdiusctts Statc Duilding Code, 730 CMR S�1LE�I i
'L"•� � . llrri.srd.V��r_'!Ill
, I3uilding Perinit Application To Conslruct. R�pair. Rriwvate Or Dcmulish a
l)nr-ur Turo-Fuwilc Din�!(rn,��
This Sectiun For 0(ficial Us nl
f3uilding Perniit Nwnber: Date:1p icd:
, � //�/l
Duilding Otticiul(Prinl N�un�) Siyiaturc , � Uutc
SECTION 1;SITE INFORDIATIOIV
I.I Property AdJress: 7 ^q C P C,[� �,Z q��san blap& Parcel Numben �
�5 t
I.I a Is this an accepted itreet?yes_ no M1lnp Nuinher Purcel Numbmr ��
1.3 Zoning Infonnatio I.i Property Dimensianr.
���,a�w,w� c�,i c�i �a.�
Zuniitg Districl Prnpnsed U,c � Loi Arca Isy Itl I�mm�gc(Il)
I.5 Building Setbacks(h)
' Franl Ywd Si�c Yanls Rcar Yard
.Reyuircd � Pruvided Reyuircd � Providnd Reyuimd ProvideJ .
�`�� � ISr. /e�'� �9 /1; ¢ a2lo.3
1.6\Vx�t/er Supply;�M.G.I.c.JU,§5�) 1.7 Flood Zone Infarmatlon: 1.8 Sewage Dis osal System:
Public[3 Private❑ Zane: _ Ouuido Plood"Ly�e?
. Check if �csfrd� Municipal On si�e Jispusul s�stem ❑
SECTION 2: PROPERTY OWNERSHIP�
1•� p^per�of ljqcord: 1 � � 1
V �'an C.O�ar-a.�i �wlY��i ,� V�lf� C3al�( �
NumolPnnq . Uq•.Siotc�l.IP �
F
9�o Ca� r��a�e S�- I'�-y�l/- 1775 �"�2(Xel r-a.)� ►J�n-�h
Nu.;viJ S�rcet ' . "felephune Fmuil Addrcss
SECTIOIV 3: DESCRIPTION OF PROPOSED WORK°(check all thrt apply)
New Construction❑ Esisting Building❑ Owner•Occupied ❑ Repairs�s) ❑� Alteration(s) ❑ Additiun
Demulition ❑ Accessory 8(dg. ❑ Numbarof Units Other ❑ Specil'y: �
�r'ef�DescriptionofProposed Work': h � I � - ry�, , N
��+ d roo f(rx w� �v�
SECTION �: ESTI��IATED CONSTRUCTION COSTS ���
� Itcin � . Estimated Costs: '�j
ILabur and \Imerials) Offtciul Use Only
I. Duilding � S �-S Otlp I. BuilJing pertnit Fee: T � Indicate how fee is determined:
'. Filectrical g ❑Standard Ciry.�To�rn Application Fee
B�O ❑Tutil Project Cost'�Item 6)x miJtiplier ___r
j ?. Pluinbing S- 0(� I. O�hcr Fres: S � /{� �
� . � J, \Izih;mical III\':1('1 S a, v LisC—_-- -- ��{� /x� ,
5. .\Icehaniral pFin
�«��f� �
I tiu�uissipnl 5 � �'I'ot;d :\II FCtS: $ -- —�------ ------.. .
, � �,. Turrl Projcct C��st: 5 /�/ `l ('hcck vu __c�hcck:�muunt: - --- C;uh :�niuunc _ . _ . .
V(J (�//v �Puid in Full ❑Outslanding f)ul:mce Dur:
�i 9���/ _ -���
l
sr:c•rion s: c onsrancno� seHvu•F:s
5.1 Cunstructiun Supen�isor License�CSI.) � /'� --7��� —�Z— �
l_ � y- 2-- -� 3
�OS�pN ���C�f_rG�._._-----�--- LiccnscNwuhcr P�pir;uionl):uc '
\'amc ol l'.til. I IulJcr � �
/� _ � cy � I.i9t C5L�I)�x I.+«hclo��1 �.l� __
� ��S�t^'��_—JL—__ �------ -���� . Ucscriptian � .
Na. :niJ tiircct �
. . U 1 inrc�iricicd I Iiuiidin�s ii tn}5,000 cu. �l.l
�'� 1.3 . 6303$__.... a RcstricicJ I�� Pan7il ' D�wllin� .
Citci fu��n.S ,nc.ZIP M1I Alasun
- � RC Rnolin�Cuccrin
� _ - K'S - R'inJu�c:mJSiJin �
SF tiuliJ I'ucl Ilurning Applianccy � . . .
��--235-7/53 f'�iX2r('�� �n�w.omj, i i�,s��i�u„n
'fcic hnnc I'mm iJdrcss D Dcmolitiun
5,2 Re istcredllumelmpr+orementCuntr;icror(f11C) �a�5� � �
��ii\�Qt'� Cqr�oru,�{-tpl/� IIIC Rcgisvatiun Numhcr licpv;itmu I)utc �
I I�5i�pai N,m r I I ILt�ISlf�lll N�IIfO .
---� ��r��•�,p 5f -�eMe�ro�����h�er.or�
N :mdSv•cl Gmm :IJlIR1�—r
t'' ��r�cQue }^�� o2/y( bl�-y5���i775
Cit /I'own,State, IP Tcic hune
,. SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. IS2. ¢ 25C(6))
Workers Compensation Insurance affidevit musl be completed and submitted with this appiication. Failure to provide
this atTdavit will result in the deniel of the Issuance of the building permit.
Signed Aflidavit Attachedl Yes .......... No..:........ ❑
SECTION 70: OWNER AUTHORIZaT10N TO BE COMPLETED W HEIV
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of lhe subject property,heraby aulhorize �
to act o ny beh¢If,in all matters relntive to work authorized by this building permit applica�ion.
� � /lL� . /�
Prin �vne 's �me(Electrunic Signature) � . . �te
SECTION 7b: OWNER� OR AUTt10RIZED AGENT DECLAFWTION
By encering my name balow,I hereby attest wider the pains and penalties of perjury that all uf the infornmtiun
containrd in this application is true and accuram ro the best of my knowledge and understanding.
'�' �` �S ��
�oS E � 1P'l \e caL� �Y�,
I'rint O�wcr's nr:\uthuriicd�\gan�'s N;mm 11(ccvunicFigna�uru) mc
�o res:
' I. ,\n O�vner�vhu ubt�ins a building permit to do his.her u�vn �vurk,or an o�vner who hires an unregistrred cuntractor
- �nut registered in tha Hume Improvemrnt CuntracWr�HICI Programl,�vill no have access ta Ihe arbitratiun � �
I program ur guar;mry 1'und under\I.G.L c. I�'_A.Other impurt�nt inFormation on the HIC Program ran be IiiwiJ ai
- � ������ m.�.. :•,�� ,��.i Infonnatiun on the Cunstruction Supervisor License cnn be faund at ������.m:�.< ���� ��I^.
� \1'hen substantiol��urk is planned, pro�ide tha infurmatiun belo�r,
Total fluur arca Isy. fl.l 1 including garage, tinishad b�srmcnC�ttia,dcc�:s ur porch 1
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BOUNDARY RETRACEMENT EXH/B/T
PREPARED FOR: VINFEN CORP.
LOCArION: 7-9 CEDAR STREEr COURT, SALEM, MA
SCALf: 1 " = 2tl' �
DATE: MAY 25, 2011
� COUNTY LAND SURVEYS, INC.
ProfessionalLandSurveyors'POBox593Glourester,MA0193/-0543"(9781282-0443 . � . �
' �� �i:is.a:ichusctts - Dcp:u;tmcn� nl' Pu61ic SaFct� ' �.
� 6u;u•d of Quil�lim� Rc,idations :ind St:ind:u•ds I
Construction Supervisor License
License: CS 78674 � -. ��
ar
JOSEPH M TEIXEIRA +�,'�� �{
� 27 CENTRAL ST � ^� I
DERRY, NH 03038 1�
�-!=- �y�jj-� �, � Expiration: 2/22/2013 I
C'nmmL.niuneY' ' Titi: 13017
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� OfliccoPConsumc�:\Tfairs.� U�uessRegulatiun�
i� = HOMEtMPROVEMENTCONTRACTOR '' , �
RegistraUon p142586 TYpe;�
� Expiratlon 4f1212012 � Private Coraorati'n�
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� 950:CAMBRIDGE9T� ��"� �/� g�r�, �Q �,_
CAMBRIDGE�,MA 0�141 7�i , --� �
� � � Gndersecretar�`�'' ��
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� Client#: Z2500 . . � VINFENCORP . � � .
ACORDn, CERTIFICATE OF LIA�ILITY INSURANCE °ATE`M�°o`"�,
7n srzo��
THIS CERTIFICATE IS ISSUE�AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGH75 UPON THE CERTIFICATE HOLDER�THIS .
" �CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR�ALTER THE COVERAGE AFFOR�ED BY THE POLICIES -
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZE�
� REPRESENTATIVE OR�PRODUCER,AND THE�CERTIFICATE HOL�ER. � . � - .
IMPORTANT:If the certlficate holder Is an AD�ITIONAL INSURED,the policy(ies)must be endorsed.If SUOROGATION IS WAIVEO,subject to
�the terms and conditlons of the policy,certain pollcles may requlre an endorsement.A statement on thls certlficate does not confer rights to the
. certiflcate holder In Ileu of�such endorsement(s). � � � � �
I . . PROOOCER� ' C�NTACT
NAME:
HUB.Intemational New England � . P"o"E g7g 657-5100 9769860038 � �
. . ac No ex�: ac No;
299�8allardvaleSt . . � E�MA�� - � ' �
� ' ' AooREss; �
wilmington, MA O�BB] � INSURERS AFFOH�MGCOVERAGE NAICR
978 657-5100. � � � � - wsurseaa:New Hampshlre Insurance Compani �
INSUREO � . - � �. _ - �NSORERB; � ' '
- Vinfen Corporetion � . � . �
� INSURERC: �
I . 950 Cambrldge�Street _ . . -
- . iNsuaen o-: � -
Cambridge,MA 02141 � � . � . - . . I
� INSUflERE:
� . " INSIIFERF; . ' . .
COVERAGES ' CERTIFICATE NUMBER: � � � � � REVISION NUMBER: � ' I
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW-HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NONYITHSTANDING ANY REQl11REMEN7, TERM OR CONDITIONOF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT'TO WHICH THIS ,
CERTIFICATE MAY BE ISS,UEO OR MAY PERTAIN, THE WSURANCE AFFORDED BY THE POLICIES DESCRI9E� HEREIN IS SU6JECT TO ALL THE TERMS, �
EXCLUSIONS AND CONDITIONS OF�SUCH.POLICIES. LIMITS SHOWN MAY HAVE BEEN RE�UCED BY PAID C1.41MS.
LTR TYPEOFINSURANCE . ADULSII6R - , POUCVEFF POLICVEXP ��MIT9
INSR � POLICY NlIM9ER MMIDU MM/�D/VVYY
GENERAL LIA0ILITY � � - � EApC�Hq OECCTIIRRENCE S '
COMMERCIALGENERALlIAB14TY 'PREMISES Eeoocurzence S . '
ClAIM5�MA0E ❑OCCIIR ' MEO EXP(My one pereon ' S
� PERSONAL6AOVINJURY S ' '
. GENERALAGGREGATE S '
- GEN'LAGGREGATELIMITAPPLIESPER: ' . PRO�UCTS-COMP/OPAGG S
POLICY PE� LOC � � � s ' .
AUTOMo91LE LIABILITY . - COM9INED SINGLE LIMIT � � �
� Ee eccldenl
ANYAUTO
. ' ' 60�ILV INJURV(Perperaon� . S � '
ALLOWNED SCHEOULEO . � BOOILYINJIIRY(Peracdtlanl) 5
AUTOS ' AUTOS
NDN-OWNE� � PROPERiY�AMAGE S
� HIREOAUTOS AUTOS , . - Peraccldanl
S
� lIM6RELLA LIAB OCCUR ' EACH OCCURRENCE J
EXCESSLIAB � CLAIMS-MAOE AGGREOATE S �
�ED RETENTIONS '- S
A� WORKERSCOMPENSATION � Ws]]�ZQ�4 �/O'I/ZO'I'I O�I/O'I/YO'I X WCSTATO� x OTH- -
ANO EMPLOYERS'LIA6ILITY
ANYPROPRIETOR/PARTNER/EXECUTNEv�N 'ELEACHACCIOENT S� OOOOOO '
� �FFICER/MEMBERE%CW�EDi � N/A � . � . �
fMvntletorylnNH� . . E.L.OISEASE-EAEMPLOYEE S� OOOOOO
11 yes,tlesvibe untle� ' � .
. DESCRIPTIONOFOPERATIONSbalow � ' - E.L:�ISEASE-POLICYLIMIT S��OOO�OOO �
DESCRIPTIDNOFDPEMTION9ILOCATIONS/VEHICLESIAIIachAGORO701,Atld10onelRemarksSchedule,Ilmomspacelcrequlretl) � � . II
CERTfFICATE HOLDER � - CANCELLATION
- ' , SHOULO ANY OF THE A90VE DESCRIBEO POLICIES BE CANCELLEO BEFORE
� � . � . , . �THE EXPIRATION OATE THEREOF, NOTICE WILL 6E DELIVERE� IN -. +
� ' � ' - ACCOROANCE WITH THE POLICY PROVISIDNS. � . .
. - - AUTHOWZEUREPRESENTATNE I
. . . . . . //G�taa[ /P' Ci�T"„' _ .
� � � . OO 1968•2010 ACORD CORPOR4TION.All rlghts resefved,
ACOR�25(2010/OS) ' 1 of 1 The ACORO name and logo are registered marks of ACOR� � � - . � .
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4'POURED GONGRETE SL.AB .
f 0'X 20'POtJRED GONGRETE FOOTING
SECTION �
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