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3 BERRYWOOD LANE - BUILDING JACKET f3 Berrywood Lane .COMM(•_ 5 ! CERTIFICATE ISSUED CITY OF SALEM DATE June 16. 1995 s SALEM. MASSACHUSETTS 01970 BUILDING PERMIT - ,A40p� CERTIFICATE OF OCCUPANCY Q 12/27/94 616-94 DATE 19 PERMIT NO: APPLICANT County Humes Inc. AOOREsS . Hart3t Beverly, iiA 1302 IRO,) (STREET) (CONIA`S LICENSE- PERMIT TO guild (_I STORY dwelling OWEOF BLNUMOE RNG UNITS 1 (TYPE OF IMPROVEMENT( x0, IPPOPOSED USE) AT (LOCATION( ' 3 Berrywood Ln. Ward 3 '0"'4ST,cT A-1 IR0.1 _ (STREESI. _BETWEEN - AND 'CROSS STREET) - (CROSS STREET)., ..LOT' �... SYBOIV IS ION"' ._ - LOT - BLOCK.' ' - ' -SIZE BUILDING IS TO 9E cn FT. wi OE. FT-. LONG BY FT,ANi HCAGNT AND SNALL>CONFORM`IN CONSTRUCTION TO.TYPE - USE.GROVo ' BASEMENT WALLS OR FOUNDATION Insta3i foundation &''build sin le Ea»il dw 119T E REMARKS y ,g IRI R AREA - = Mis VOLUME " NEW C;SjCr SDIUAFFEETI 1 OWNER. -1 l.Onnty HOMeinC'•... . - - ...'..>Y+-v.nvrwr.wvewseTroen.ue.�-b�i-vervew se.Nse�nsensrnvewv - T BE POSTEB:TIM-PREMESES r eV@r yT SEE ,REkE0 NOIT IONS OF CERTIFICATE ADDRESS 114 - ., r _ _ _ _ DEPARTMENTAL APPROVAL FOR CERTIFICATE of OCCUPANCY and COMPLIANCE t _ " To be filled in by each division indicated hereon upon completion of its final;inspection. BUILDINGS Permit No. "- -61,6-94, Approved by John J. Jennings Date 6/16/95 Remarks PLUMBING Permit No. Approved by Dennis. Ross . Date 6/14/95 Remarks 9 ELECTRICAL Permit No. Approved by Al Fawski Date 6/16/95 Remarks OTHER Fire Permit No. Approved by_ Capt. Hudson Date 6/16/95 Remarks OTHER Permit No. Approved by Date Remarks BUILDING PERMIT JOB WEATHER CARD DATE . . IB PERMIT NO. APPLICANT ADDRESS - (MO.) (STPEEiI ICONTR'S LICEXSEI PERMIT TO I_) STORY c .".:,'.. NUMBER OF (TYPE OF IMPROV[Mf XTI XO, (PROPOSED USE) DWELLING UNITS AT ILOC>ilONl ' _ ZONING 1X0.1 (STREET) DISTRICT BETWEEN ICRO55 STREf i) AND (CROSS STREET) SUBDIVISION LOT BLOCK LOT SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY _ FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: - ,.... _ -�eS:.::.:;L .. �, - - a.'Cli n / �i ,:, ;Ilii v ut.�u}t'j AREA OR VOLUME a PERMIT Sp _ :CUBIC;SQUARE FEETI ESTIMATED COST $ FEE � -� OWNER .. _'. '9t ....... ADDRESS - - - "" BUILDING CEPT;.' BY pTHIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR . PERMANENTLY, ENCROACHMENTS ON PUBLIC PROPER , MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEYTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS ET AA LH INISPECMT IONS REOUIREDFOR APPROVED PLANS MUST BE RETAINED ON JOB AND THI$FWEHLL PPLICPPABUULE SEP4RATEALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INS" ONION HAS BEENARE REQUIRED FORAH YE I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY i5 RE• AL INSTAL LATIONS.D 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL 3. FNAB EI NSS PEC TDION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELEC TRICSL INSPECTION APPROVALS I 1 ~ \ 2 1 ,0 2 -�� 2 F7- ;r BOAR OF HEAL �� GAS INSPECTION APPROVALS FIRE DEPT. INSPECTING APPROVALS I � I Clk L/!/6 4� OTHER CITY ENGINEER 2 2 WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME III VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WIINIF;N SI%MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTES ABOVE. OR WRITTEN NOTIFICATION. No. (01 l _q q City of Salem - ' Ward a APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:1, ll, 111, IV, and/X. 1. AT(LOCATION) -3 ZONING LOCATION wp.l ) OF BETWEEN AND (CROSS STREET) (CROSS STREET( BUILDING LOT SUBDMSION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A-D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1New buildingRe&�enntW Nonresidential 2 ❑ Addmon(it residential,enter number of new 12 CHAT'/One family 18 ❑ Amusement,recreational (rousing units added,it any,in part D,13) 19 ❑ Chruch,other religious 13 ❑ Two or more family-Enter number 3 ❑ Aaeration(Sea 2 above) of units ..................._._................. ......... 20 ❑ Industrial 21 E] Parking garage Enter nu 4 ❑ Repair replacement 14 ❑ hotel,motel,or dormitory- Enter number of units ........................... zz E] Service station,repair garage 5 ❑ Wrecking pt musifamiiy residental,enter number 23 ❑ Hospital,institutional of units in building in Pail D.13) 15 ❑ Garage 24 ❑ Oflice,bank professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 26 E] School,library,other educational 7 ❑ Foundation only 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP 28 ❑ Tanks,towers 8 mate(individual,corporation,nonprofit institution,etc.) 29 ❑ Other-SpecAy 9 ❑ Public(Federal,Sate,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing pant, machine shop,laundry building at hospital,elementary school,secondary school,college, parochial school,parking garage for department store,renal office building,office building 10. Cost of improvement .......................................--------_ $ 7 (gyp.O at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost aElectrical................................................._...._.........."" b. Plumbing................................................_..._._...._.___ c. Heating.air conditioning................................-___ - d. Other(elevator,etc.)..........................._......_.__.__._. . 11. TOTAL COST OF IMPROVEMENT is 1300 -O III. SELECTED CHARACTERISTICS OF BU LDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J&M, all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 ❑ Masonry(wall bearing) 35 ❑ Gas W Public or private company Will them be central air 31 ©'Wood fame 36 Oil 41 ❑ Private(septic tank etc.) conditioning? / 32 F1 Structural steel 37 ❑ Electricity 44 [-] Yes 45 ❑PMo 33 ❑ Reinforced concrete 38 ❑ H. TYPE OF WATER SUPPLY Coal Will there by an elevator? 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ublic or private company 46 ❑ Yes 47 43 ❑ Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 48. Number of stones ........................................................... as. Total square feel of floor area, Has Approval from Historical Commission been received all floors,based on exterior dimensions ...................................«.......................... for any structure over fifty(50)years? Yes_ . No_ 50. Total land area,sq.n.a.�f�.... 6. f.... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed................6A.................................................. 52. Outdoors HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? ......... Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed............................................................................. Electric: Gas: 54. Number of Pull.._...._(�...................... Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial...................................... BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No flf yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes_ No -/ a S a 0""'F4 Aref5 C 5 Is property located in the S.R.A. district? Yes_ No� Comply with Zoning? .Yes��No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No�If yes,submit documentatioNlf no, submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No—c_-- Is oC_--Is Architectural Access Board approval required? Yes_ NOf yes, submit documentation) Massachusetts State Contractor License # d��1 7 zf b Salem License # i 3 C)aZ Home Improvement Contractor # Homeowners Exempt form (if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX (6)MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: – �� If an extension is necessary, please submit in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. Owner or Lessee 2. Contractor Builder's License No. 3. Architect or Engineer ��1� ' C� (rot `—I" /«✓�!' /i'r /�F• 0� 1 hereby certifyat a proposed wo is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorizeda nt and we agree to conform to all applicable laws of this jurisdiction. Sig ture of In Addr7/ � � 6 Application date � / f DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building ' /„ FOR DEPARTMENT USE ONLY Permit number lY v Building Use Group Permit issued 19 Fire Grading Building 0-6 Permit Fee $ .���` Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ Plan Review Fee $ TITLE NOTES AND Data-(For department use) i `o/Z D !9 s e se G �ql �Ce u�J PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN •For Applicant Use ON „ r i COMMONWEALTH OF MASSACHUSETTS 5 DEPAIC'MENT OF INDUSTRIAL ACCIDENTS '' 600 WASHINGTON STREET aures a acoer BOSTON, MASSACHUSETTS 02111 ss,one WORKERS' COMPENSATION INSURANCE AFFIDAVIT — (licensceipermined. with a principal place of business/residence at: iii ' f S74-- 65-e-,-� 1y IOW 0/ 2 g_ (City/&260p) do hereby certify, under the pains and penalties of perjury, that: [ ] I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Co pany Policy Number [ ] 1 am a sole proprietor and have no one working for me. [ ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number [] I am a homeowner performing all the work myself. NOTE: Picric be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in whicb the homeowner also reside or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)), application by a homeowner for a license or permit may evidence the legal scams of am employer under the Workers' Compensation Act. i understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to $1500.00 andior imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a Fine or S 100.00 a day against me. Signed this day of 19 �L Licensee/Permiaet: sor/Permiaor a p / ' .A4 Aoaoa o1�r� .3.e�ata4oiiar atom f�i. Michaele Dukaltt: .. &;&m.ma .>0laL e-fmm�;�rr 4,60_ Covettior &,no WUW0W ✓Taco — Aaosw -/3C! Kentaro Tsu-umi Ag&m, ,,tz Waaie's " 02108 Chaumn tem :. Charles J. Dingo Administrator MEMORANDUM TO. A11 Building DcpartmenwSute 9uiidine Inspectors FROM: Charles J. Dinezto. Admintsimtor DATE October JI. 1988 SUBJECT. MGT. cJn, 154, Added Rv r594. S9 M the Aetf of 1987 The above-mentioned statute requires that ucbris resulting from the demolition. lcndvatlnn.YCIsbllifitWe of nlhcr alteration of a buddine ar structure he dtsposcu of in a property htcnseu solid-wane disposal taaluv as defined by MGL c111. S150A anu that nuiidine permits or licenses are to in(iu=.the. ocuum- id the Iactiuv at which Inc saw dchns is tit ne utspaseu. THIS REOUIRE14ENT-DOES':-NOT ,\PPLY TO NEW CONSTRUMON. In order to simetifv the process and tit prtmde uniformity, we are attaching a copy of a lufm-whieb rou - can either rcproducc and use as it is since the cnmplcicd form will be attached to Inc tillice copy of beakfing- permiu or hccas= or rcpmdum it on your lcticracau. In Case of muntopaL commercmL Industrial.or multt•unit housing construction, the contractor mar Not 1111110R the dumpster subcontractor at the time at the budding permit application. In such iasis.the attaebed CW* of an Affidavit can be used. The complete law is contained in Inc Nnvemner Issue of CODEWnRO which will he mailed to Wm in the nen two weeks. If you should have any question. plcasc tet us know. CJDAM AFFIDAVIT As a result of the provisions of MGL c 40, 554, I acknowledge that as a condition of Building Permit Number 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 111, S 150A. I certify that I will notify the Building Official by (Two months maumum) of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment to the Building Permit. 12-�1�9 Date Signature of Permit Applicant (Print or type the following information) Name of Permit Applicant irm Name, if any Address /4�/ In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of Facility) �ignature of Permit Applicant -/ ,� gate 95 AIU IJ IIIf y �xlEm, � a �Lhu��tt� ASSESSOR CITY OF SALEM 00 " TING SLIP /REVIEW AND PASS ON AS INDICATED LOCATION.( DATE APPLICANT: ('JOIL IN ERT DATE WHEN PASSING ON 1np AgTMFNT. Assessor Date CONTACT PERS Peter Caron ox M—c id cr S 2nFPARTMFNTi Fire Department / = .r Insp. LaPointe 4113A S Department of Public Services 3 � 3 � Director 9c 4 DEPARTMENT : Water Department CONTACT PERSON: Maroaret Haoerty/HelenJiadosz S S 5 F Planning Dept. RSONi Beth Debski 6 DEPARTMENT: City Clerk ( if involving new streets ) CONTACT PERSON: 7 DEPARTMENT: ELECTRIC DEPT. CONTACT PERSON- PAUL TrY= 8 DEPARTMENT: CONTACT PERSON: RETURN TO `� --�3�-�--�:2 ��-� � �a � � ����� — ��'�'