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91 BAY VIEW AVENUE - BUILDING JACKET tuperTab. W%cnre* III I 3 M EAD0 KEEPING YOU ORGANIZED No. 10301 rAWNSI W � • . POMMMM Nm WORGMMEDATS -COM ..�,, � 0. , _. _>_�.... _.,_�.. _•4 800E ' _ � ._ _ ._ _� _ 2LL0 Ofi60 fi000 OfiTT 800L 40) CITY OF SALEM, MASSACHUSETTS ' BUILDING INSPECTOR120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 N LTt� ON pg n 2 f 2GL0 0fi60 .fi000 WITT 900Lom om� 9t �aciFsm 3M OL JQ m oNin 0 V���A11V►�® �1!' l r �,: �7 "a « � � i _.--�-v-. ,-._.e._.� i i' x UNITED STATES POR-� IPE- A Fee%Ral&. ug ..... 19 X" • Sender: Please print your name, address, and ZIP+4 in this box SECTIONSENDER: COMPLETE THIS SECTION i COMPLETE THIS . ■ Complete Items 1,2,and 3.Also complete A. Signature > Item 4 I Restricted Delivery is desired. / t Agent ■ Print your name and address on the reverse X a ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of I' ■ Attach this card to the back of the mallpiece, or on the front if space permits. D. Is delivery address different from Item 1? es 1. Article Addressed to: n tt YES,enter delivery address below: ❑ No 3. Service Type ❑Certified Mall O urn Mail 13RetReturn❑Registered Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number „, •' (transfer from service laben a— PS Form 3811,February 2004 Domestic Return Receipt te259502-WI540 ° CITY OF SALEM, MASSACHUSETTS + ef� BUILDING DEPARTMENT a I t 120 WASHINGTON STREET,3" FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 HIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRF_ DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER February 19,2009 Edward Richards 91 Bayview Ave Salem Ma.01970 R.E #4 Allen Street Mr. Richards, Several weeks ago, you came into my office to discuss the problems with the property you are renting at 4 Allen Street. Part of that conversation was the agreement that the third boat ,not owned by you, needed to be removed as soon as weather permitted. You also agreed to tell us where the boat was headed if in Salem.The weather has removed the snow banks and it is time to move the boat. You are directed to remove the boat within 7 days of receipt of this letter. Failure to comply will result in additional tickets being issued. Thomas St.Pierre C-4'. 4ZOZ-114 Building Commissioner/Zoning Officer ccJason Silva, Joan Lovely, Robert McCarthy " LAW OFFICES OF WILLIAM J. LUNDREGAN JANE T. LUNDREGAN ONE DERBY SQUARE SALEM,MASSACHUSETTS 01970 TELEPHONE(508)741-3888 FAX(508)745.3607 l7 � V1 Gid T rn Cl (m Co June 27 , 1990 «1 u; Vf �, Rebecca A. Backman, Esq. Ardiff 6 Morse , P. C. 10 Elm Street P. O. Box 59 Danvers , Massachusetts 01923 Dear Ms . Backman : Please be advised that I represent Mr . and Mrs . Edward J. Wolfe , 95 Bay View Avenue , Salem, Massachusetts . Mr . and Mrs . Wolfe have turned over to me a copy of your correspondence to them dated June 19 , 1990 with reference to thei_r,alleged encroachment on property of Victor Rita at ;91 JB y iew Avenu;, Salem, Massachusetts . I enclose for your information a copy of a plot plan of land at 95 Bay View Avenue , Salem, Massachusetts , Scale 1" to 10" , August 4 , 1986 , Otte and Dwyer , Inc. , Surveyors , 196 Central Street , Saugus , Massachusetts , commissioned by my clients and the Shawmut Bank which shows that the alleged encroachments are clearly within my clients ' property lines. Any attempt by Mr. Rita to place a fence on our property will be met with a prompt removal of that fence by my clients and commencement of litigation against your clients for any damages sustained by my clients as a result of his errection of a fence on our property. In addition if Mr . Rita places that fence on our property blocking the egress from the front of the house , we will , of course , hold him liable for any damages or injuries sustained by my clients due to a lack of egress from their property. It has been my advice to Mr . and Mrs . Wolfe that any attempt to construct a fence subsequent to your correspondence to Mr. and Mrs . Wolfe it would be a very strong presumption that the fence being built was a spite fence. In addition, I have advised Mr. and Mrs. Wolfe that in the event that their plot plan is inaccurate and Mr. Rita ' s plot plan is accurate then Mr. and Mrs . Wolfe have clearly established adverse possession. I would also like to point out to you that at the time your surveyor was drawing his plot plan he admitted to my clients that he was probably incorrect in his lines . I would appreciate it if you could call me upon receipt of this letter so that we may discuss this matter in detail . Very truly yours , WILLIAM J. LUNDREGAN WJL/amp Enclosure cc : Mr. David Harris Assistant Building Inspector City of Salem Mr. and Mrs . Edward J. Wolfe The Commonwealth of Massachusetts CITY OF e 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 r * This SgCUOn For Official Use , Building Permit Number Date;A d Buildtng official(print Name) SECTION SITE I, ORMA._ ON 1.1 ! rt ddress: 1.2 Assessors Map& Parcel Numbers Ma Number Parcel Number I.la Is this an ac epted street?yes_ no p 1.3 Zoning Information: 1.4 Property Dimensions: Lot Area Frontage(ft) Zoning District Proposed Use (sq ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard q Required Provided Re uired 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 yes[] SECTION 2-,PROPERTY OWNERSHIP':.'';`. 2.1 rtof,Recorr L � L City,State,ZIP Name rmt) ^>� j �Vlt/W "U v Email Address No. and Street Telephone `� SECTION 3: N DESCRIPTIO OF PROPOSED WORK?(check all that apply} New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Aireration(s), Addition ❑ Demolition ❑ Accessory Bldg. ❑ N mber of Units_ Other Specify: tt. / B ief Description of Propose Work': t t w I l.� L03V "IS `S(/ Gt SECTION 4 ESTi VIATED:CONSTRUCTION COSTS Estimated Costs: OffietalUse Only. Item Labor and Materials ` 1. Building $ 1 Buildug Permtf F.ee $ Indicate how fee is:determmed: ❑ Standard City/Town Application Fec 2. Electrical $ ❑Total Eiodect COW,(Item 6)xinultipher x 3. Plumbing $ 2 Other Fees $ 4. Mechanical (1IVAC) $ List> 5. Mechanical (Fire $ Total All Fees $ Suppression) Check No Check Amount :�Cash Amount 6. Total Project Cos QQ ❑ Paid is Full ❑ O t: $ utstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ' 5.l�nLHolder isor License(CSL) �" k'✓ Licensse Number E. irati Date Name of � Lis[CSL Type(see below) !/✓ No and Street Type. Description : U Unrestricted B i - s u to 35,000 cu. ft. C27�✓ `_. ! R Restricted 18c2 Fnml Dwell;—n Cny/'Down,State,ZIP Nf Masonr RC Rootin Coverin WS Window and Sidin � SF Solid Fuel Burning Appliances O I Insulation "Cole hone Email address D Demolition //ll 5. egistered ome Imp rove en Contra or(HIC) III Registra Numbe xp'r.tion Date HI N?m r HIC�R e at Name o. a d re t �l D / Em it ad r s City/Town, Z State, P Telenhone. 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 ISS11909e of the building permit. Signed Affidavit Attached? Yes .......... No........... ❑ SECTION 7a: OWNEIYAUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNERS 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. u-fAl In �-+ ��X 1 2, Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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 fiord under NLG.L. c. I42A. Other important information on the HIC Program can be found at www.nnrss.,,ovioca Information on the Construction Supervisor License can be found at www.mass.eo�:.dM 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 Pype of cooling system _ Enclosed Open J. `'f otal Project Square Footage may be substituted for"Total Project Cost" i CITY OF SAME, TNLksSACHLSETTS • BLu.DNG DEP.�RTnt&NT p 130 WASHIINGTON STREET, 3" FLOOR TEL (978) 745-9595 FA.X(978) 740-9846 KINtBFRT FY DRISCOLL T MAYOR HO\tAS ST.F�IERRs DIRECTOR OF PLBLIC PROPERTY/BuimNG COS12,1155I0NER 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: " /f-VC,Y-",-p (numc of hauler) The debris will be disposed of in )LLA-t (name of facility) ddrass of facility) Y1gnamre f ermit applicant 2 date tend„rc,i;x • ' •4 i CITY OF Samoa .EM, NLAiSSACHUSETTS BUILDING DEPART%1EDiT tr a 120 WASHINGTON STREET, 3'a FLOOR TEL. (978)745-9595 F.Ax(978) 7.10-9846 K,,fBERT EY DRISCOl.I Tl MAYOR -iOR(ASST.FIERRS t . DIRECTOR OF PUBLIC PROPERTY/BUILDING CONL\IISSIONEI@ ` Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aprilicant Information tease Print Legibly NOI1lC ter(BusincssOrgani:ation,'InJivi sal); �.S ' Address: �Z q City/State/Zip: tool/ Phone It: y 60 ! / Arempi an employer?Check the appropriate box: Type of project(required): Im a emplo with 4. 0 1 am a general contractor and 1 6. ❑New conswetion oyees ull, d/or pan-time).' have hired the sub-c:ontractocs 2.0 1 am a sole pnetor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition workingfor me in an capacity. workers'comp.insurance, Y9. [:] Building addition [No workers'comp.insurance 5. We are a corporation and its required.] officers have exercised their i0.❑Electrical repairs of additions 3.0 I am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself.(No workers'comp. c. 152, 41(4),and we have no 12.[� Roof re airs / insurance required.)t .; employees. i workers' `—�/ uSV „ comp. insurance requiro 13. O or_ U •Any appliesm our chunks box#1 mustaiw fill out the action below showing thoir workets'compenntion policy info a o I Lvneuwu:who,ubntil this arR6ivit indicating they ate doing all work and thm hire outside contractors must submit a new arlfdavit indicting x :Conuxton that chc<k this box must atlachod an addiiiomasheet showing the more of the sub contnctors and their workm'comp.policy infomution. /am an employer that fs providfuLvor kers' mpensailon insurance for my employees Below G the policy and fob site information. G/ Insurance Company Name: Policy N or Self-ins. Lie. d: Expiration Date: lI/ 0 f2r, /. Job Site AdJress: V�CW City/State/Zip: D 17V Attach a copy of the workers'co pensation 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 a tine up to S1,500.00 and/or one-year'n ri. ent,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$2-0.00 a J. agains i I advised that a copy of this statement may be forwarded to the Office of Investigations of l in ra •ov age verification. /do hereby cer ffy i e th a mnaldes ofperjury that the inforinuthin provided abut, is tr and correct, 1. 1Ire Date• 7/ phone#: OJJiciul use only. Do not write in this area,to be completed by city at town official City or Town: _._ Permit/t.lcense Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.Cilylfown Clerk J. Electrical Inspector 5. Plumbing Inspector 6.Other .___...-- Contact Person: ....................__.._ Phone#: 09/04/2012 09: 00 19785212751 ANTHONY&MALCOLM INS PAGE 01/02 ACORA - CERTIFICATE OF LIABILITY INSURANCE DATE(MMmo/YY Y) 09/04/ZO12 PRGDucER (978)373-5623 FAX (978)521-2751 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ANTHONY & MALCOLM INSURANCE A6CY., INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3 50. CENTRAL ST. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR BRADFORO, MA 01835 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC# INSURED Allan Veilleux, 7r. a INSURER A, Phenix Insurance Co. Heat Quest Insulation Company LLC INSURER9' Safety Insurance S Shawsheen Rd. INSURERC: The Hartford Lawrence, MA 01843 INSURER O: INSURER E: COVEBAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR oD' TYPE OF INSURANCE POLICY NUMBER PIf OLICY EFFECTNE POLICY EXPIRATION LIMBS GENERAL LIABILITY CPP0713253 12/27/2011 1Z/27/2012 EACH OCCURRENCE $ 1 Q00 G COMMERCIAL GENERA_LIABILITY DAMAGE TO RENTED PRI'MIRFAINUAAta) $ 5D OOO CLAIMS MADE C] OCCUR MED EXP(Any one Pme") S 5.000 A PERSONAL&ADV INJURY $ 1,000,000. GENERALAGGREGATE $ 2 OOO 0DO GEN'L AGGREGATE LIMITAPPLIES PER, PRODUCTS-COMPIOP AGO S 2 000 OOO POLICY JEC F7 LOG AUTOMOBILE LIABILITY 5021421COMO5 12/26/2011 12/26/2012 COMBINED SINGLE LIMIT ANY AUTO (Ee Acadenq $ 1,000,000 ALL OWNED AUTOS BD INJURY $ B X SCHEDULED AUTOS (POI pdr person) X HIRED AUTOS BODILY INJURY X NON-DINNED AUTOS IPer BoOdenq S PROPERTY DAMAGE S (POr accldenp GARAGE LIABILITY AUTO ONLY-EA ACCIDENT g ANY AUTO OTHER THAN EA ACC S AUTOONLY AGG S EXCEgSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND 6560UB9609L39011 11/08/2011 11/09/2012 WC STATU- OTIh EMPLOYERS'LABILITY E.L.EACH ACCIDENT $ 1,000.00 0 C ANY PRORRIEWRIPARTNERIF•XECUTNE OFFICERNEMHER EXCLUDED➢ E.L.DISEASE-FA EMPLOYEE $ 1,000,000 R yyee,dewibA under SPECIALPROVISIONSbemw E.1-DISEASE•POLICY LIMn S 1 OOO 00 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES I EXOLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS insulation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Salem 10 DAYS WRITTEN NOTICE TD THE CERTIFICATE HOLDER NAMED TO THE LEFT, Inspectional Services BUT FAILURE TO MAIL SUCH NOTICE MALL IMPOSE NO OBLIGATION OR LIABILITY 120 Washington St. 3rd Floor OF ANY KIND UPON TH E INSURER,ITS AOENT9 OR REPRESENTATIVES. Salem, MA 01970 AUTHORIZED REPRESENTATIVE n , Frederick Malcolm 7r. JA Y r�T•X/TaH'� ACORD25(2DOVD8) FAX: (978)740-9846 ®ACORD CORPORATION i989 09/04/2012 09:00 19785212751 ANTHONY&MALCOLM INS PAGE 02/02 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endarsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditlons of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certlfcate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the Certificate holder, nor does it affirmatively or negatively amend,extend or alter the Coverage afforded by the policies listed thereon. ACORN 25(2001/08) ✓fie�umc [ r g 8 sin ss Regil non 4 j! ' OCCne of Cun CTOR -r e — HOME IMPROVEMENT CONTRA Type:. t " Registration �153660 _ g{ DBA , t 't on 1212112012 Expirati , - I � HEAT QUEST INSULATION ' AL LAN-VEILLEUX 5 SHA`NSHEEN RDf J, 4 �— Lp, RENCE,MA 07843 , a% Undersecretary r 11 t++:ichuutt+- LDep a Mient bt Public Satct+ r Board d Buddtm� Re ul ttitiits utd St ind trtls - - License- Construction StipFrvisor Specialty. License: CS SL 99215 -n,- Restricted to:.WS,IC ALLAN VEILLEUX JR 5 SHAWSHEEN ROAD LAWRENCE, MA 01843. Expiration: 8119120Q. - (.ounuis5i,lner.• Tr1i 9k15 WAP Work Order North Shore Community Action Programs,Inc. Job Number:28804 98 Main Street Work Order Date: 7/17/2012 Peabody,MA 01960 Ownership: Owner Phone: 978-531-8810 Heat Quest Insulation Auditor: Doug Cranford 5 Shawsheen Road Email: dcranford@nscap.org _ Lawrence MA 01843 Cell: 978-335-7154 Email: heatquest@aol.com Phone: 978-531-0767 x135 Phone: 978-691-1166 Cheryl Richards DOE WAP 2012 $3,366.80 91 Bayview Ave NGRID Gas $4,488.75 Salem MA 01970 Total $7,855.55 978-740-0339 DOE WAP 2012 Repair/Health& Safety $554.40 Safety Issue(s): Knob&Tube Wiring/Lead Paint Possible Tit, , ;� An[horized> ':( Actual' 1 ; ". "I , ,it !it ' 1 I 1 h I r Measure,Description , - I : _ , Comments fi ? TPnce� I ,Total �,Qty , Total 1 cl 10 Attic Insnlation Il I , n u t i i f:., h - r§o ! I ',u r. _ ♦: 'r.=r r. r. 5 a rr : . . R-30 restricted-slopes/floored fill 255 $1.48 $377.40 w/cellulose R-38 unrestricted-settled cellulose 255 $1.47 $374.85 Fixed Sweep 2 $15.75 $31.50 . Weatherstrips/Q-Ion or equal 2 $45.50 $91.00 Health &Safety CIO Ex a Vent kit/ba fan _ NoT !;>oI Misc Insulation Blow/Plug/Seal.Rigid Foam Board 520 $1.82 $946.40 Blow Domestic water pipe wrap 6 $2.63 $15.78 Foam Board 1 0 $3.30 $1716.00 - basement window to Instal I)l 0 1 y%f Date: 7/17/2012 Page WAP Work Order: Job Number: 28804 Hydronic pipe insulation to 1 in. 165 $3.41 $562.65 copper pipe R-5 Misc Measures i i Attic sealing with two-part foam 1 $75.00 $75.00 Basement sealing with two-part 2 $75.00 $150.00 foam Blower door set-up with pre&post 1 $45.00 $45.00 tests 87 Downspout 60 $4. p Seamless Gutters - 33 0 . 0 IF FI Permit , IF un Building Permit 1 $100.00 $100.00 Wa1lInsulattop Drill finish patch plaster(dense 57 $1.90 $108.30 pack) Wood clapboard/shakes/shings or 1413 $1.79 $2,529.27 vinyl(dense pack) Total Contractor Instructions: �� ✓l SeD oT 3 Z 2 ,g Before Starting_the Job: Darine the Job: 1.Please notify us 24 hours before starting or scheduling a job. 1. This residence was built be ore ea sa a practices are 2.Obtain required building permit. required. 2. Total for Heath& Safety and Repairs cannot exceed$2500.00. 3.Davis Bacon time sheets required for ARRA work on US- Department of Labor Certified Payroll Report Form WH-347. 7UtnOlotC �SStI�' Date: 7/17/2012 Page 2 WAP Work Order: Job Number: 28804 Additional Contractor Instructions: Certificate of Insulation posted? Yes No (Circle One) Attic Inspection form attached? Yes N/A (Circle One) Where Posted: - Contractor: Date: WAP Auditor: Date: Energy Director: Date: Fiscal Officer: Date: FOR AGENCY USE ONLY Pre Post Language Other than English needed? Yes No (Circle One) Dryer CO 0.000 If Yes, indicate language: Stove CO 0.000 - Occupany change in last 18 months? Yes No (Circle One) H2O Tank CO 0.000 Comments: Heating System CO 0.000 Number of windows Ambient CO 0.000 Number of rooms Blower Door 0.00 Date: 7/17/2012 Page 3 -ft�IMtST-BE f4LE-13 fl APPROVED By T*IE p,XTD-R ,PF1Ofl TD.A.PEFINTBEING GRANTED CITY O-F SALEM No. —� Oc��l 2� Z ,yctt .,�, r��\ Date NE Is Property Located in Location of the Historic District? Yes_No Building Is Property Located in the Conservation Area? Yes_No t/ BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding Construct Deck, Shed, Pool, Repair/Replace, Other: PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name C'Jh�ra\ oU PV-ET ID ' I Address & Phone �A�� lE vJ p�re� fl�r6) 7 u�, OS39 Architect's Name Address & Phone \ ( ) Mechanics Name Y� I 4 Address & Phone � �- VAW a6uJ �U-U �o ) �6-- to7 :9 1 What is the purpose of building? Material of building? IN Cr0 If a dwelling, for how many families? Will building conform to law? Asbestos? Estimated cost y f o�m City License# N P' State License # Home Improvement V LK Loa �� Signat of Appli t SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE i' k MAIL PERMIT TO: / �0/0 5 No. Z✓L) -20-b(--( APPLICATION FOR PERMIT TO LOCATION. �y PERMIT GRANTED AP nbVfD 4 ?n' /%' lNsPEcToA OF BUILDINGS OF 5ALEM. lllAbbHa.nv�r_ . PUBLIC PROPERTY DEPARTMENT • ° 120 WASHINGTON STREET, 3RD FLOOR SAL'EM,MFx 01970 ` TEL. (978)745-9595 EXT.360 FAX (978) 740-9846 . STAMLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition of Building Permit# all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility,as defined by MGL c III,S150A. r The debris will be disposed of at: s�\t.,r^ '� V �Q Location of Facility `Moa aN A �t>a Signs Of Permit phcant Date FULLY complete the following information. (PLEASE PRINT CLEARLY) Name of P t Applicant Firm Name,if any Address, City & State The above statute requires that debris from the demolition,renovation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cM, S 150A, and the building permits or licenses are to indicate the location of the facility. CITY OF SALEM BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please Prins DATE JOB LOCATION A HOMEOWNER C\" S� ADDRESS HOMEOWNER 42— 033 S TELEPHONE PRESENT MAILING ADDRESS (T\� A U y lbvz) The current exemption of"homeowners"was extended to include owner-occupied dwellings of TWO Units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner act as supervisor. DEFINITION OF HOMEOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which them is,or is intended to be,a one to two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she be responsible to all such work performed under the building permit. B g �Po The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable goes by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that h/she will comply with said procedures and requirements. HOIv¢OWNER'S SIGNATURE APPROVAL OF BUILDING INSPECTOR "1 See other side for state code HOMEOWNERS E XEWTION The code states that: "any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1.1—Uceusiug of Construction Supervisors); Provided that is a homeowner engages a person(s)for hire to do such work,that such homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors,Section 2.15). This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with licensed Supervisor. The homeowner acting as supervisor is ultimately responsible To ensure that the homeowner is fully aware of hill=responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a supervisor. You may care to amend and adopt such a form/certification for use in your community.